Hair Restoration Blog

Q:

I have read online that Propecia can cause depression as a side effect. Some articles I read say it is a very rare side effect and others say it can occur in 75-80% of the time. Which is correct?  Thanks.

A:

The primary clinical trials on finasteride (Propecia) were conducted with a large number of patients over a period of 5 years. These initial trials did not reveal any evidence of depression in the participants. However, subsequently a few more recent reports indicate the possibility of depression occurring after taking finasteride.

A prospective study on 174 young men in 2004 suggested a higher chance of depression in men who used finasteride. The authors of the study concluded that finasteride might induce depressive symptoms. The recommendation from this study was that finasteride should be prescribed cautiously in patients who have higher risk of depression. This could be further underscored by the studies on psychology of hair loss and hair transplant in patients which notes alteration in self image and esteem and possibility of improvement of depression. The 2004 study emphasized that further clinical research is necessary to evaluate the behavioral effects of finasteride in higher doses in patients who are more susceptible to depression.

Based on the results of this study, we cannot suggest a percentage for depression in patients taking finasteride. Obviously, if you are experiencing mood disorders or any other symptoms while taking finasteride, you need to discuss it with your doctor for further diagnosis and treatment.

Q:

I started the hair medication finasteride. Will this help stop me losing more hair? I was concerned that if you restored my hairline would I need to do another surgery in years to come if my hair continues to thin and fade behind where the restoration was done? There are many stories on the internet of people that have had multiple surgeries (other doctors) and they are still not satisfied so I just wanted to take the opportunity to gather as much information and ask the appropriate corresponding questions so I can make the most educated decision.

A:

While reviewing your miniaturization study (the microscopic evaluation you had in our office), it indicated that you have some hair loss activity on the top areas of your scalp as well, but it is very minimal. If you continue using medication, your hair loss will range from none to very minimal in the next few years. One hair transplant procedure in combination with medical treatment with Propecia (finasteride) can maintain your look for many years to come.

Q:

Hi Dr. Mohebi,

Trust you are well. It was a pleasure meeting you in Los Angeles back in June. I had a few concerns about taking Finasteride and wanted to have your opinion before taking the medication.

I read few articles that side effects of finasteride include impotence, abnormal ejaculation, decreased ejaculatory volume, abnormal sexual function, gynecomastia, erectile dysfunction, ejaculation disorder and testicular pain of which I experienced some of them when using the medication back in 2010. It was also stated that patients have reported persisting erectile dysfunction despite discontinuing the drug. I do feel this is also the case for me at times. Do I need to consult with a Urologists?  Would taking 1/4 of the pill every other day have any impact on slowing down/ prevent the hair loss and at the same time not damage sperm quality?

I am still looking at a few dates to come back and get my hair transplant as I don’t want to depend on medications for long. I am aiming for either this Nov. or April at the latest.

 Regards,

A:

The initial double blind study of Propecia (finasteride) did not reveal any evidence of permanent side effects from it.  This research was done on over 1000 patients and around the same number of people who were enrolled in placebo arm of the study. In fact it showed that the adverse effects of Propecia in people who initially experienced sexual side effects and decided to continue the medication improved over one year from the time they started experiencing the side effects. Recent reports from smaller studies that focus on possible long term or permanent side effects of Propecia, listed side effects including erectile dysfunction, lack of sex drive or even mood changes.  After reviewing the cited articles and their methodology, I was not convinced that the data was collected and documented properly.  The International Society of Hair Restoration Surgery (ISHRS) also assembled a group of hair restoration doctors to evaluate the validity of some of these reports regarding the side effects of Propecia.  The group’s evaluation did not support the claims of the new reports on irreversible side effects of Propecia.

It should be noted that, Merk & Co. Inc, pharmaceuticals now include an insert in Propecia packaging. This insert discusses the possibility of long term side effects. We also review this with our patients.   My thought is that a more significant study on a large group of people who took finasteride for a long period of time is needed to confirm the new claims.

If you have any sexual side effects such as changes in sex desire, erection or sperm count, you need to be evaluated by your primary doctor or a urologist instead of assuming that it is only a side effect of finasteride.

All the Best,

Dr. Parsa Mohebi

Medical hair restoration: Hair transplants are the most successful form of hair restoration.

The advanced modern techniques used today in hair transplant surgery are a proven, natural  and preventative method to slow down and/or stop further hair loss. It could be used with or without hair transplant surgery. When you talk to friends and family about hair loss treatments, you will find a lot of do-it-yourself hair loss methods or products such as creams, ointments, lotions, nutrition supplements, scalp products and other herbal, all promising to stop hair loss and re-grow hair.

Among all the many so called remedies for hair loss  for nonsurgical treatment of hair loss for men and women (pattern baldness), you will find that only two that have been approved by the U.S. Food and Drug Administration, and are recommended by physician hair restoration specialists. Hair loss products not approved by the FDA are often enriching the manufacturer but too little to help the man or woman suffering with hair loss. Some actually even harm the individuals who experiment with these unproven methods.

The FDA approved finasteride (Propecia) and minoxidil (Rogaine) are the only two medications presently that directly address hair loss. The other products that are considered effective as hair loss treatment usually contain either of these medications or similar chemicals as ingredients.

There are many other options that are touted out in the marketplace. These products do not have enough evidence based information.  It is best to consult with your doctor about all options before committing to any of these types of treatments.

US Hair restoration combines medical treatment of hair loss with surgical options or hair transplant to create a master plan for obtaining the best final results.

Q:

Hi Dr. Mohebi,

I had been taking 1.25 mg finasteride pills M/W/F and I started experiencing sexual side effects a couple weeks ago.  I’ve since stopped taking the pills and the side effects have decreased.  The side effects have not completely gone away yet.  Previously, I had quit for similar reasons and started up again going from 1.25 every day to 1.25 mg only M/W/F.

What do you recommend I do

Thanks,

A:

You need further evaluations besides stopping finasteride to make sure there is no other reasons for the sex drive changes you are experiencing.

Since you have had your hair transplant only a few months ago and have significant miniaturization (a sign of active hair loss), you need to use Rogaine 5% solution or foam twice a day to minimize the shock loss on the entire area of the scalp that is prone to balding.

Shock loss after a hair transplant surgery could be seen in the few months.  Studies have shown that shock loss could be prevented or minimized significantly when patients are taking finasteride after hair transplant procedures. We recommend Rogaine for women or men who cannot use finasteride for any reason for at least 6 months following their hair transplant to minimize the risk of hair transplant surgery.

Q:

Dear  Dr.Mohebi,

Salam; I would like to introduce myself as a man, 43, engineer with master degree, single and currently living in Iran. As far as I remember my hair has started to shed when I was young, I would say around 18 years old. On that time I visited several dermatologists in Iran they prescribed me with Betametazone to put it on the scalp and I already got shot Vitamin E.

The top of my head became thin and the skin is seen easily. About 10 years ago Finastride and Minoxidil were introduced to the market of Iran. I first used Minoxidil but after 6 months continue using of this over counter drug I didn’t see any significant improvement so I stopped this method. I made a decision and started to take Finastride 1 mg every day, hopefully it was effective and the thin and tiny hair of the crown of my head started to grow hair and got thicker. The problem was about testicles pain, erectile dysfunction and libido decrease. I was scared and stopped taking Propecia.

And add salt to the injury I recently proposed to a woman for marriage and she rejected me for my semi-bald head. I became heartbroken and decided to transplant hair. My friends had such surgery and unanimously tolled me don’t do it; that this method has yet to be successful in Iran. They said that it would not satisfy my expectation.  I’ve studied a lot and have found out the main problem is DHT and there are some elements can be used as a DHT blocker. I would like to restart my hair re-growth regimen as follows:

1. Taking Magnesium + Zinc Sulphate + Vitamin B6 as natural DHT
   blockers each day.
2. Messaging scalp with Sesame oil before shower for moisturizing and
   natural anti dandruff.
3. Washing hair with Nizoral (ketocenazol %2 ).

My hair situation is exactly like Zidane and Agassi as per attached photo. I would be obliged if you would advise me if this method can be effective for regrowth of my hair or tot just drop it. In addition I would be grateful if you would inform me if there’s any new method without surgery for hair restore and growth. Your expertise and opinion is highly appreciated. In advance thank you very much for your understanding and help.

Best regards,
Babak

A:

I understand that you have tried everything available to you for your hair restoration. I am sorry that you experienced some adverse effects with the medication you were taking.  As you mentioned in your email, hair loss can affect on many aspects of men’s lives and many people like you try many options to find out what is the best one for them.

Unfortunately, many of the products or methods that are stated in various online sources are not scientifically or medically substantiated. These promised solutions are not real remedies for hair loss and should not be considered as viable treatments for hair restoration.  These items you propose for your regimen: taking Magnesium, Zinc Sulphate and Vitamin B6 have no direct proven effect to stimulate hair growth in men who lose hair as a male patterned baldness. If they did the store shelves worldwide would be bare. Likewise, massaging scalp and anti dandruff products are not among the known treatments for male patterned hair loss.

Washing hair with Nizoral (ketoconazole %2) is one of the few among what you described that is proven for hair loss prevention.  Minoxidil is the other medication that has similar effect on prevention of hair loss in its female or male patterned type.  I think you need to discuss the finasteride and the side effects you have had from using it with a good hair specialist.  In many cases the side effects may be psychogenic and not real.  A good doctor can discover if that is the cause in many cases.

Hair transplantation is still the only permanent, proven and natural looking solution that can restore your hair and eliminate baldness in many people. I know you have heard some controversies about hair transplantation.  However, our experience in US Hair Restoration is different.  I have to say it is a pleasure of mine that we see many life changing results in our hair restoration clinics in California on a day to day basis.  I think you should try to find a good hair transplant surgeon and be assessed before you rule out this solid option in favor of these various remedies that have no known effect on hair loss.

I appreciate your sharing your experience and trust you will find benefit in my response.

Regards,

Dr. Mohebi

Q:

Hello Dr. Mohebi,

Please, allow me to ask the following question on behalf of my son ‘J’ your patient — he would greatly appreciate your feedback:

He is taking the small dose of finasteride each day, potentially have the side effect of minimizing or adversely affecting his muscle gains that he might otherwise achieve as a result of daily work-outs at the gym?

Thank you in advance for your support, time and consideration. All our best regards,

A:

Finasteride works through blocking the conversion of testosterone to Dihydroxytestostrone (DHT). Testosterone is the main hormone affecting the muscle growth in men. DHT is the hormone that adversely effects hair follicles leading to thinning hair and baldness. By taking finasteride the patient benefits from reduced conversion of testosterone to DHT. However, the medication does not have any effect on testosterone itself and its effects on muscles mass.

In short, losing muscle volume is not one of the documented side effects of finasteride.

Have a great day,

Dr. Mohebi

More recommended reading:

• What is DHT?
• DHT and hair growth inhibition

Q:

Hi Dr. Mohebi,

Trust you are well.

It was a pleasure meeting you in Los Angeles back in June. I had a few concerns about taking Finasteride and wanted to have your opinion before taking the medication.

I read few articles that side effects of finasteride include impotence, abnormal ejaculation, decreased ejaculatory volume, abnormal sexual function, gynecomastia, erectile dysfunction, ejaculation disorder and testicular pain of which I experienced some of them when using the medication back in 2010. It was also stated that patients have reported persisting erectile dysfunction despite discontinuing the drug. I do feel this is also the case for me at times. Do I need to consult with a Urologists?  Would taking 1/4 of the pill every other day have any impact on slowing down/ prevent the hair loss and at the same time not damage sperm quality?

I am still looking at a few dates to come back and get my hair transplant as I don’t want to depend on medications for long. I am aiming for either this Nov. or April at the latest.

Regards,

A:

The initial double blind study of Propecia (finasteride) did not reveal any evidence of permanent side effects from it.  This research was done on over 1000 patients and around the same number of people who were enrolled in placebo arm of the study. In fact it showed that the adverse effects of Propecia in people who initially experienced sexual side effects and decided to continue the medication improved over one year from the time they started experiencing the side effects.

There have been recent reports from smaller studies that focus on possible long term or permanent side effects of Propecia, The reported side effects included erectile dysfunction, lack of sex drive or even mood changes.  After reviewing the cited articles and their methodology, I was not convinced that the data was collected and documented properly.  The International Society of Hair Restoration Surgery (ISHRS) also assembled a group of hair restoration doctors to evaluate the validity of some of these reports regarding the side effects of Propecia.  The group’s evaluation did not support the claims of the new reports on irreversible side effects of Propecia.

It should be noted that, Merk & Co. Inc, pharmaceuticals now include an insert in Propecia packaging. This insert discusses the possibility of long term side effects. We also review this with our patients.   My thought is that a more significant study on a large group of people who took finasteride for a long period of time is needed to confirm the new claims.

If you have any sexual side effects such as changes in sex desire, erection or sperm count, you need to be evaluated by your primary doctor or a urologist instead of assuming that it is only a side effect of finasteride.

Q:

I am to have a hair transplant surgery with you this early July. I’ve noticed increased shedding lately and thus have been researching additional pharmacological adjuncts to add to my daily regimen. I am currently taking 1.25 mg Finasteride and shampooing with Nizoral 2% a few times a week. I’ve read online that topical Spironolactone has been used by some with some results, and wanted to know your thoughts. I’ve also found other topical medications ( especially Monoxidil) that I cannot use due to my daily use of concealer. Are there any other medications, topical, shampoos etc. that you can recommend?

Thanks ,

A:

Minoxidil and finasteride are the only two FDA approved medications for hair loss treatment.  Nizoral (ketoconazole 5%) is an antifungal and anti dandruff medication that can also affect hair loss in male patterned baldness.  Nizoral is not one of the FDA approved medications for hair loss treatment.  Spironolactone or Aldactone is primarily a medication for treatment of hypertension, but it has some anti-androgenic effects.  Systemic administration of spironolactone has been shown effective in some forms of female hair loss. Spironolactone in its systemic form is not recommended in men due to its side effects such as sexual dysfunction.  There have been limited studies on the topical spironolactone for treatment of acne and hair loss so we don’t recommend topical spironolactone for treatment of hair loss for androgenetic alopecia in men.

If you want to do everything possible to minimize the hair loss, you can add minoxidil to your daily regimen of finasteride.  Minoxidil is recommended to be used twice a day, but once a day could be used as well.  You can use it in the morning before you put on the concealer or at night after you wash them off.  Minoxidil does not double up the effect of finasteride but can add to it as an adjunct treatment.

 Also See:

Finansteride, Minoxidil Or Both and  Ketoconazole for Male Patterned Hair Loss

Here at US Hair Restoration, we are constantly hearing about the concerns of our many patients who have been prescribed the popular hair loss preventative medication known as Propecia (finasteride). Most patients with concerns have seen recent news reports, commercials, or magazine ads talking about the dangers of taking Finasteride. Since this is an effective medication proven to aid in the sustainment of receding or thinning hair, it is important to explain the facts in comparison with the rumors.

Early side effects (1 year)

The reported side effects based off of precise medical research for Finasteride at the 1-mg dose are uncommon and reversible. The one- year drug related side effects were over 1% greater than in the control group. The data showed that 3.8% of men taking Finasteride 1mg experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo.

Most reported rumors center around sexual dysfunction occurring after beginning use of the medication, but there have been reports of sexual dysfunction that have occurred at later points in time. When studies were performed based through proper research methods, the sexual side effects were reversed by all the men who discontinued therapy, and in 58% of those who continued treatment. Once the medication was stopped, side effects generally disappeared within only a few weeks.

The initial studies done on finasteride for 12 months show that 1.4% of patients taking Propecia (945 patients) were discontinued due to adverse experiences which may have been drug related.

Here is the break down on the sexual side effect of finasteride in the patients who used it for one year only.

The men who continued using finasteride resolved some of the side effects in many cases. The resolution of the side effects was compared in the drug and placebo group. The incidence of each of the above adverse experiences decreased to ≤0.3% by the fifth year of treatment with Propecia.  This shows improvement of the side effects in the patients who took it over time.

In a study of finasteride 1 mg every day in men showed some decrease in volume to ejaculate of 0.3 mL (-11%) compared with 0.2 mL (–8%) for placebo in 48 weeks after beginning the treatment. Decrease in ejaculate was shown more significantly in higher doses (5mg) of finasteride which is approximately 0.5 mL (-25%) compared to placebo in ejaculate volume.  However, the decrease in ejaculate has been seen to be reversible after the treatment has been stopped.

In the clinical studies with Propecia, the incidences for breast tenderness and enlargement, hypersensitivity reactions, and testicular pain in finasteride-treated patients were not different from those in patients treated with placebo.

Long term side effects (up to 4 years)

Long term side effects of Finasteride were extensively studied in the Finasteride 5mg (Proscar) Long-Term Efficacy and Safety Study for 4 years in 3040 patients (1524 on Finasteride 5 mg/day and 1516 on placebo). 3.7% (57 patients) treated with finasteride 5 mg and 2.1% (32 patients) treated with placebo discontinued therapy as a result of adverse reactions related to sexual function, which are the most frequently reported adverse reactions.

Although the initial side effects of Finasteride has been higher than placebo over time the difference decreases to the point that in years 2-4 of this research, no significant difference between the two groups (treatment groups and placebo) was reported in terms of the incidences of impotence, decreased libido and ejaculation disorder.