Hair Restoration Blog

Hello, Dr. Mohebi.

I used the Propecia prescription you gave me.  It cost me over 80$ to get 30 1mg pills, since it’s not covered under my insurance.  I looked online to see if I could find it cheaper and found a number of sites selling it for much less.

Do you think it’s not a good idea to buy Propecia online?  The site I found doesn’t require a prescription or anything and I can actually get 270 pills for almost the same price I just got the 30 pill refill for at the pharmacy.

Could you check out this link out and tell me if it’s not a good idea to buy it? It seems to me that the pharmacies can charge whatever they want for it, but 80 dollars for 30 pills just seems outrageous to me…  I wonder if $90 for 270 1mg pills is for generic finasteride, and not actual propecia.

I just want to know what your opinion on buying propecia online is.  Sincere thanks.
See you soon.

A:
I have heard bizarre stories about online medications that are sold to patients. There are many stories about affordable hair loss treatments as there are for affordable hair transplants.  I generally don’t approve buying Propecia or any other medications online.

Think about it, the current medical system closely supervises all stages of production, distribution and sales of the medications. Everything is highly regulated and controlled to minimize the chance of mistakes.

Online medications for hair loss or any other conditions, do not have this regulations and if something goes wrong or you get a product that does not contain the medication at all, you have no control on it and no one will be responsive. The fact that prescription medication is sold online without the doctor’s script is risky too.
You can shop around to find the best price for Propecia or finasteride, but I cannot support online shopping for medication from non-supervised resources.

Q:
I am 30 year old man with male pattern baldness. I have been on Propecia for two years. I have been feeling hot flashes in the last month to the point that I cannot tolerate them at night. My doctor thinks that I have to stop Propecia, but I am hesitant to do so because I have seen good results from Propecia in last 2 years. What do you think I should do?

A:
Hot flashes are seen in some hormonal imbalances. More commonly it is seen in pre menopausal women and in men following castration or using anti-androgen medications. Hormones such as FSH, LH and lactogene are responsible for hot flashes. None of the Propecia studies did prove association between those hormonal levels and Propecia use.

Since you have been on Propecia for about 2 years, but only experiences hot flashes in the last month it may not be related to Propeica. There are many other medical problems that can produce hot flashes such as other hormonal disorder like thyroid diseases.

You need to be seen by an endocrinologist and be evaluated for other medication problems, which can mimic hot flashes. Many of those conditions could be easily diagnosed by a simple lab work. Some medications can also be responsible for hot flashes and need to be considered.

One simple solution is to stop taking Propecia for a short period of time and see if your hot flashes get better. If that is the case then you have the option of switching to other medications that can help your hair loss but don’t give you hot flashes.

Q:

I have heard that one of the side effects of finasteride could be breast enlargement. Is it possible to develop more breast tissue because of blocking effect of finasteride on testosterone?

A:

One of the released researches from finasteride clinical studies indicates that breast enlargement (gynecomastia) rate was not higher in patients who took Propecia (finasteride) in comparison to the ones who were on placebo. One out of every 100 patients may experience breast tenderness and some degrees of enlargement, which is about the same in placebo and medication group. The similar rate of breast complications indicates that this side effect may be simply a placebo effect. Think about it, you are giving a medication to male patients, which they know has to do with their testosterone or testosterone related factors. What do you expect?

Q:

I have read an article on the active half life of finasteride, which is a few hours, but you mentioned in one of the posts that its side effects may last up to 5 days after discountinuing the drug. How do you explain that?

A:

Finasteride (Propecia) functions through blocking the enzyme, 5 alpha reductase. The enzyme five-alpha reductase is responsible for conversion of the male hormone, testosterone to dihydroxytestosterone (DHT), which is the form of the hormone affecting hair follicles and causing hair loss. That is true that finasteride gets eliminated from our body in a few hours, but its blocking effects on the enzyme 5 alpha reductase continues for a long time. If you ever experience side effects of finasteride, you can stop the medication and its effect will be gone in 5 to 6 days.

Q:

I am a 40 year old man with class IV hair loss. I started taking Propecia recently with great result on the crown area only after a few months. However, it seems like I need more time to get an erection. The other problem is that I cannot maintain an erection as before. I know there is a lot of psychogenic side effect associated with this drug so I am not sure I am really experiencing a side effect or it is just in my head?

Thank you,

A:

You have been taking Propecia (finasteride) recently and have had great result from it, but you are recently experiencing erectile dysfunction. Erectile dysfunction has been reported in men who used Propecia. The comparison of its occurrence between the Propecia and placebo group showed a slight difference (1.3% in Propecia group vs. 0.7% in placebo group).

You can stop Propecia for 2 weeks to test it. If you don’t feel any improvements in 2 weeks, Propecia cannot be the cause of your problem. If your erectile dysfunction improves by stopping Propecia, then you can reduce the dose of Propecia to half and you may not experience the problem with the new dose. This method is effective in most patients who experience erectile dysfunction with Propecia.

You have to understand that erectile dysfunction may be the sign of some other medical problems and you need to discuss it with your primary physician to rule out more serious causes.

Q:

Do you recommend Finepecia for treatment of hair loss?

A:

Finepecia is another name for finasteride or Proscar. Finepecia or finasteride is a medication that blocks the production of Dihydroxytestosterone (DHT) and can stop or slow down the process of baldness. The medication is also prescribed for treatment of enlargement of prostate by physicians. You need to be evaluated by your hair doctor preferably with a miniaturization study before starting on Finepecia. For more on Finepecia or generally medical treatment of hair loss you can visit the website of US Hair Restoration.

Q:

Next week will be the second month I have used proscar, and to be honest, the shedding has only lessened a little. I would say it is better than before. Do you think I will see more observable results by the end of summer perhaps?

By the way, after looking at numerous propecia experiments, I think that some of the results could be misleading. Now, I mean this in a good way. It is possible that the success rate could be higher if the experimentation would be more controlled. The reason why I am saying this is because there are not many parameters that are being analyzed within the experiments. It is also important to see people’s “daily actions” to see the possible reasons why proscar/propecia might not work for them. Even though the mechanism mostly occurs internally, there are external factors that could play a pivotal role.

Thank you! Hope you have a good week.

A:

Hair shedding is not always a sign of hair loss. In fact the real bad hair loss that leads to balding in male pattern hair loss is losing miniaturized hair that you really cannot see. People who take finasteride may have increased levels of hair shedding due to the increased hair cycling within the first few weeks to months. The initial hair shedding should get resolved within a month or two from the time it starts. The final effect of finasteride should be assessed and judged at least after 6 months from the time you start the medication, but it may be also seen as late of 12 months from when you start the medication.

Remember that with Propecia, we are not only after re-growing hair and stopping or slowing down the process of baldness is the goal of treatment for most people.

I understand your points on the research done on Propecia (finasteride). Most Propecia studies are done on a large number of patients like many other double blinded prospective clinical trials; so the individual differences are diluted and negligible.

Q:

I am 34, male with recession of hairline slightly. There are many bald men in both side of my family. I have been trying Rogaine for about 10 years until I thought it is not working anymore and my hair loss strated to speed up. I recently started taking Propecia. I am originally Mexican. Is Propecia as effective for Mexican as white Caucasians?

Thank you

A:

Propecia (finasteride) has been studied extensively within the last few decades in terms of its effectiveness on different age groups, balding classes and even ethnic groups. Below you can see that the effectiveness of Propecia in comparison with the Placebo on the vertex baldness has been compared in different ethnic groups:

Combined analysis of the two studies on vertex baldness, mean hair count changes from baseline among Caucasians, Blacks, Asians, Hispanics and other ethnic groups. Patient self-assessment showed improvement across racial groups with PROPECIA treatment, except for satisfaction of the frontal hairline and vertex in Black men, who were satisfied overall.

Q:

Hope you had a great weekend, Just a quick question.

After how long usually I would see the result of those pills (finasteride)? Will it grow like baby thin hair and it thickens over time or should I like shave my head to help it? J just wonderin‚
Regards,

A:

Be patient,

It is unlikely that you grow new hair from the areas that you lost hair follicles. The medication finasteride can help increase the thickness of your miniaturized hairs that normally do not give you any significant cosmetic effects. You should not see the effect of medication before 3-6 months from the time you started it.

Remember, the purpose of medical treatment is not to grow your hair back as it was when you were 17. The goal of medical hair restoration treatment with either minoxidil or finasteride would be to stop or at minimum slow down the progression of hair loss. Shaving your head should not change the progress of hair loss or gain either. When you manipulate your hair whatever you do, you are dealing with external part of the hair, which is not alive. The follicle does not sense what is going on outside at hair shaft level. To restore it more permanently in front and top of your scalp, you would need a hair transplant.

Best,
Dr. Mohebi

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you don’t recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you guessed I cannot recommend dutasteride solely for prevention of hair loss not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.