Concerns about starting propecia

[litcII]

Hi everyone, this is my first post here, so I guess I’ll kinda use this to introduce myself.
I am 23 years old, and I have diffuse thinning, with some areas thinner than others. I still have most of my hair, but I am worried about losing it, as there is a history of hair loss in my family. The lady who cuts my hair noticed this thinning a little while back, and I’ve noticed it too, but those in my family who I’ve asked said that it’s “not really noticeableâ€. Anyways, I am thinking about starting propecia to prevent further hair loss, but there are a couple of things that I am worried about, mainly relating to getting side effects and long term propecia use:
- Should I start with just half a pill a day? I’ve read that this is enough for it to be effective. I am thinking of doing this because I am worried about side effects, and also the cost. Would taking half a pill a day reduce the likelihood of getting side effects?

- I’ve also read that if you do get side effects near the beginning, you should try to “power throughâ€, because they will stop after a while. Is this true, and at what point should I just stop taking Propecia?

- The shedding that happens after starting Propecia- is this a onetime thing, or does it happen more than once? And how bad does it get? Does shedding happen to everyone?

- Has anyone here taken Propecia for a long period of time? And by a long period of time, I mean like for around 10 years. If so, any comments? Does it still work? Any side effects?

- If I stop using propecia (and assuming it works for me), does the rate of hair loss just continue at the same rate as when I started using it? Or does it speed up, or slow down?

- I am also trying to weigh my options of taking propecia, or just waiting and getting a hair transplant. If I do get a hair transplant, would I still need to take propecia? What would you guys recommend?

Apologies for the long post, but this has been on my mind for some time now, and I would really, really appreciate any help that you guys can offer to clarify this matter. Thanks!

p.s. I realize that many similar questions have been asked and answered already, however I’ve noticed that each case always seems to be a little different for each person, which is why I decided to start my own thread.

 

[Flavio]

Welcome to the forum. I've been using finasteride for 10 years with good results and no side effects (no impotence, no shedding), so it worked for me.

Some advice:

-I suggest you take the recommended dose - 1mg everyday.

-If buy Proscar and cut it into 4ths you will save a small fortune

-Results are not spectacular, so don't set your expectations too high

-You may be lucky, finasteride works better with diffuse thinners

-Finasteride is a life sentence, if you stop using it, you'll rapidly lose what you've gained

-It is a safe drug, only 2-3% of users suffer from side effects

-And it is the most effective baldness drug there is today

 

[Flavio]

[...] - I am also trying to weigh my options of taking propecia, or just waiting and getting a hair transplant. If I do get a hair transplant, would I still need to take propecia? What would you guys recommend?[...]

I don't want to be rude, but if Propecia works for you, you'd be a fool to even consider doing a hair transplant. That's not even an option.

 

[souljaboytellem]

-Finasteride is a life sentence, if you stop using it, you'll rapidly lose what you've gained

does this mean you will lose what you have grown quickly? or even what you have maintained?
as in would you look like you had never taken finasteride in your life, if you went off the drug for say a year?

 

[Quantum Cat]

-Finasteride is a life sentence, if you stop using it, you'll rapidly lose what you've gained

does this mean you will lose what you have grown quickly? or even what you have maintained?
as in would you look like you had never taken finasteride in your life, if you went off the drug for say a year?

basically, if Finasteride works for you, you have to keep taking it forever otherwise you may lose the gains you've made.

 

[helpmyhair]

-Finasteride is a life sentence, if you stop using it, you'll rapidly lose what you've gained

does this mean you will lose what you have grown quickly? or even what you have maintained?
as in would you look like you had never taken finasteride in your life, if you went off the drug for say a year?

basically, if Finasteride works for you, you have to keep taking it forever otherwise you may lose the gains you've made.

I think he means in terms of maintenance. Lets say you get no regrowth from finasteride, but halt further hairloss.. and go off finasteride, are you going to quickly loose the hair that you have maintained?

 

[Nevis]

I'm not sure you want to use the adjective "quickly" when referring to quitting propecia. Not sure we have data on that (Bryan? similar to the Vera 1999 minoxidil quitting study you just showed me?). Propecia will have been shielding your hairs from the effects of male pattern baldness for the treatment time. But I'm not sure there's a mechanism that would cause you to "quickly" or rapidly catch up to your sans-Propecia baldness trajectory once you discontinue.

It's possible (maybe probable) that you'd just start balding at your regular, genetically pre-determined rate once you quit. For example, let's say you achieve complete cessation of balding while on propecia, and maintain for 10 years or so like Flavio, myself, and some others. Once you stop propecia you would not immediately drop all the hair you "saved" in the 10 years. (or like the rapid loss you can see when quitting Minoxidil). You were protecting the hairs in your scalp that would otherwise be sensitive to the DHT-induced minituraization process. When the propecia is gone, they would then be exposed, and start the process just as if you had a later-in-life onset of male pattern baldness. This process can be slow or rapid, depending on your genes, but the years of finasteride usage should not change that rate...right?

Anyone have a graph to back me up?

So yes, it is a "life sentence." But in a very different sense than minoxidil is a life sentence. We should be clear so we don't scare anyone into thinking that if they forget their propecia for a day, a month, or even several their hair will fly off like a dandelion in the breeze. (aka "massive shed")

 

[Nevis]

@ litcII. On a side note, be aware of the selection bias of the posts you read here too. You'll naturally see lots of discussion of side effects of propecia, as people come here to ask advice on them, or change their regime because of side effects. As a young guy, you're less likely to have side effects, and more likely to have good results from propecia for a significant amount of time. And especially since you have 'all' of you hair still and would, by the sound of it, be fine just keeping all of what you have now, you're a prime candidate for a successful long run with propecia.

with that in mind, taking half dosage may reduce your chance of getting sides without changing your results much. but there is less data on that. The dosage response curves that show that the lower dosages still have a solid effect on DHT levels would also imply that it would have a similarly stimulating effect on whatever DHT-dependant pathways lead to side effects. Others though have found cutting the dosage worked well in reducing sides.

And just talk to your doctor. He or she has written more scripts for propecia than anyone on this board has! ;-) I'm sure they'd be willing to discuss their experiences with it. You'll get a broader opinion than trying to read through and summarize all the various opinions and experiences here! Although we're always happy to chime in. Best of luck!

 

[litcII]

I'm not sure you want to use the adjective "quickly" when referring to quitting propecia. Not sure we have data on that (Bryan? similar to the Vera 1999 minoxidil quitting study you just showed me?). Propecia will have been shielding your hairs from the effects of male pattern baldness for the treatment time. But I'm not sure there's a mechanism that would cause you to "quickly" or rapidly catch up to your sans-Propecia baldness trajectory once you discontinue.

It's possible (maybe probable) that you'd just start balding at your regular, genetically pre-determined rate once you quit. For example, let's say you achieve complete cessation of balding while on propecia, and maintain for 10 years or so like Flavio, myself, and some others. Once you stop propecia you would not immediately drop all the hair you "saved" in the 10 years. (or like the rapid loss you can see when quitting Minoxidil). You were protecting the hairs in your scalp that would otherwise be sensitive to the DHT-induced minituraization process. When the propecia is gone, they would then be exposed, and start the process just as if you had a later-in-life onset of male pattern baldness. This process can be slow or rapid, depending on your genes, but the years of finasteride usage should not change that rate...right?

Anyone have a graph to back me up?

So yes, it is a "life sentence." But in a very different sense than minoxidil is a life sentence. We should be clear so we don't scare anyone into thinking that if they forget their propecia for a day, a month, or even several their hair will fly off like a dandelion in the breeze. (aka "massive shed")

Yes! This is exactly what I was wondering- whether the hairloss process would continue at the same rate as before taking Propecia (or whatever genetically predetermined rate I have). My hairloss isn't progressing too aggressively at the moment, but its been happening slowly for about three years now, and it is only now that its visibly noticeable.
I am wondering what would happen if I had to stop (due to side effects, lack of money, etc). And also to consider the option of stopping once I reach the age where hairloss is normal. If it all just falls out in like a week, then thats...not good.

 

[litcII]

[...] - I am also trying to weigh my options of taking propecia, or just waiting and getting a hair transplant. If I do get a hair transplant, would I still need to take propecia? What would you guys recommend?[...]

I don't want to be rude, but if Propecia works for you, you'd be a fool to even consider doing a hair transplant. That's not even an option.

No worries. I was actually wondering about this the other way around- like once I get to the point where I've lost enough hair to want to get a transplant, and then after getting a hair transplant, would I have to take Propecia to try to prevent the non-transplanted hair from falling out?

 

[Nevis]

And also to consider the option of stopping once I reach the age where hairloss is normal. If it all just falls out in like a week, then thats...not good.

Nope, as far as I know it's not gonna explode out of your head. it may proceed slightly faster than it is now (untreated at 23) as there could be---check that, will be---other changes in your body chemistry over the next 10 years. But not because of propecia usage. Just the way your body produces and plays with testosterone, dht, etc. as you age. Not sure what that sum effect will be on your hair personally if you quit propecia in say, 5, or 10 year, but from what I understand and have read (and someone could correct me here if I'm speaking out of turn, and have missed a report!, i'm only a mid-level functionary here) your post-cessation rate of balding will not be accelerated by your years on finasteride.

Now, if you add something like minoxidil, different story. Then, your hair apparently jumps right back to where it would have been when you quit, taking the express route rather than the untreated rate of progression. FYI.

 

[H/B]

"your post-cessation rate of balding will not be accelerated by your years on finasteride. "
Oh, yes it will. :whistle:

 

[Nevis]

"your post-cessation rate of balding will not be accelerated by your years on finasteride. "
Oh, yes it will.

As I noted in my post, I was not 100% positive on this. What information do we have on this topic? Is there a mechanism by which it will speed up?

 

[Bryan]

I'm not sure you want to use the adjective "quickly" when referring to quitting propecia. Not sure we have data on that (Bryan? similar to the Vera 1999 minoxidil quitting study you just showed me?). Propecia will have been shielding your hairs from the effects of male pattern baldness for the treatment time. But I'm not sure there's a mechanism that would cause you to "quickly" or rapidly catch up to your sans-Propecia baldness trajectory once you discontinue.

Vera Price _did_ do a study in 2002 which was very very similar to the one she did in 1999 with topical minoxidil, only it was with finasteride (1 mg/day). She measured haircounts and hairweights in exactly the same way over 96 weeks just like she did with the minoxidil, but in my opinion she blundered by NOT doing one very important thing: she didn't STOP the drug at 96 weeks, while continuing the haircount and hairweight measurements. Therefore, there's no way to tell from her study how rapidly your hair goes downhill when you stop taking finasteride.

However, we _do_ have an important clue about that, and it comes from the original large Phase III trial by Merck: "Finasteride in the treatment of men with androgenetic alopecia", Kaufman et al, J Am Acad Derm, V. 39 No. 4, 1998. In the main haircount graph near the end, we see what happened in the group of test-subjects that got the placebo for the entire two-year period, and also the ones that got finasteride for the first year, but were then switched-over to placebo for the second year. That second group had a very noticeably sharper decline in haircounts than the first group, during that second year. That strongly suggests that you _do_ lose hair significantly faster if you've been on finasteride for a period of time, and then stop using it.

The exact reasons for that phenomenon remain unclear, but I'm guessing that at least part of it may have to do with that notorious increase in androgen receptors with finasteride usage that people like to talk about, and possibly other related issues having to do with increased follicular sensitivity to androgens. That's why I've always suggested that if you decide to quit using finasteride, do it sloooowly over a period of time by gradually decreasing the dose and frequency. I wouldn't stop using it cold-turkey.

 

[Nevis]

ah ha! that was the info I was missing. thanks for the clarification! won't make that mistake again.

 

[Nevis]

bryan when you say "that people like to talk about", is that regarding the comment from Sawaya that we're missing evidence for (hence people talk about it but we don't have studies on it)? Or am I mixing things up here?

 

[Bryan]

bryan when you say "that people like to talk about", is that regarding the comment from Sawaya that we're missing evidence for (hence people talk about it but we don't have studies on it)?

Yes. The notorious "intense upregulation in androgen receptors" in finasteride users that Sawaya claimed to find. As far as I know, that information still hasn't been published anywhere.

I believe I was the first one to mention it on these hairloss sites a few years ago, and I was amazed at all the interest and discussion it generated!

 

[Nevis]

hmmm, I don't suppose we have any info on "down-regulation" potential after quitting propecia? would we have evidence to indicate the up-regulation is permanent or rather dependent on the endocrine changes that finasteride causes and maintains?

 

[Bryan]

Sawaya hasn't said anything about it, but I have no particular reason not to assume that the numbers of androgen receptors probably DOWNregulate after stopping finasteride at about the same rate that they UPregulate, when you start it.

 

[Nevis]

Did Sawaya find/give a rate for that upregulation?
Thanks as always.