Propecia for hair loss, side effects and benefit for hair growth, safety, danger, by Ray Sahelian, M.D.
Feb 15 2014

Propecia, an orally administered drug approved for male-patterned baldness. It helps regrow hair in many men, that is a fact. The generic name is finasteride.

Propecia side effects, safety, danger
Although the maker of prescription medication Propecia denies serious side effects from the drug, there are some Propecia side effects that have been reported. These include decrease in libido, and a decrease in general vitality or wellbeing. These Propecia side effects occur gradually and in a subtle manner, and many men do not realize it is occurring and forget how they felt before they started Propecia treatment for hair loss. Another Propecia side effect may be an increase in abdominal fat (increase in size of the belly).
   To reverse the sexual dysfunction, one can consider natural aphrodisiac plants and supplements.

Propecia and women
When given in combination with oral contraceptives, Propecia can improve female-pattern hair loss in most women. At present, the main treatment for female-pattern hair loss is topical minoxidil, which is somewhat effective. Whether treatment with agents such as Propecia, which show activity against male hormones, might promote hair growth in women has been unclear. However a research group reports in Archives of Dermatology, March 2006, that women with female-pattern hair loss who were treated with Propecia in combination with an oral contraceptive did report benefits. Propecia has been linked to birth defects and that was the reason the women were given birth control pills. After 12 months of Propecia therapy, and out of 37 women treated, hair growth improvements were rated as "great" in three patients, "moderate" in eight and "slight" in twelve women. Thirteen women had no improvement and one patient experienced a worsening of her female-pattern hair loss.

Hydradenitis suppurativa
JAMA Dermatol. 2013. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. Propecia is a therapeutic option that provides benefit for pediatric patients with HS.

Losing effectiveness
I am 34 years old and I have been on Propecia now for about 6 years. The medication appears to be losing it effects over the past 6 months with a deterioration at the hairline and at the crown of the head. I am concerned that it has lost its effectiveness.

Questions
Q. I am currently taking Propecia, do I need to reduce my dose if I am taking Prostate Power Rx?
   A. Perhaps you will need less of a dose but your doctor is the person who makes the final decision since he or she prescribed the Propecia and knows your condition best.

Q. Can a person stop this medication cold turkey after several years of use, are there withdrawal symptoms?
   A. As far as I know, I do not think there are withdrawal symptoms.

Q. I was reading something on your website about Propecia and how it caused one of the people to gain belly fat. I've been taking Propecia for 4 months and I've now started to notice that my belly is just like always inflated for some reason. I haven't gained a single pound but my belly is bigger than it used to be and so are my breasts. I read on the Propecia website that breast enlargement was one of the side effects, but can you give me some more information about the belly increase. Do you think it's because of the Propecia and how exactly did the Propecia work to make my belly bigger? Also I was wondering, when people stop taking Propecia, do their belly go back to the size it was before starting taking Propecia or not? And if not what can I do to return to what I used to be because it doesn't feel like extra fat, it just feels like something is like extremely inflated in my stomach.
   A. I don't know the exact reason why Propecia may increase abdominal fat, but perhaps blocking dht and maybe shifting to the estrogen pathway may lead to more belly fat? It's quite likely that symptoms would reverse a few weeks after stopping the Propecia.

Q. I am a 26 year old male and have been taking Propecia treatment for 7 months. I understand women are not to be exposed to Propecia concerning possible birth defects in born children. Is there any risk to the female through intercourse with a male who is currently using Propecia ie detectable amounts through the semen? I'm simply concerned that my Propecia useage will hinder any hopes of having healthy children.
  A. We don't have any good information on the role of Propecia ingestion in a male and subsequent childbirth. Our first thought would be to be on the safe side and to discontinue Propecia usage several months before insemination.

Q. I thought I would give Propecia a try as I seem to be losing hair more than ever (I am 52). As you must know, "Propecia prevents the conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is involved in the development of benign prostatic hyperplasia (BPH) and hair loss." I've heard that Propecia works, but once you stop taking it, then over a short time, I would lose all the hair that that I would of lost had I not taken
Propecia. I will try your advice on taking a portion of Proscar 5 mg, as I found out that there is no generic and that my drug plan does not cover Propecia and can't afford the $1000/year. I know from your readings that you are against messing with hormones like testosterone, but is this
one OK, I didn't see any cautions against it and I am already taking Prostate Power Rx.
   A. Side effects of Propecia that some people notice include a reduced sex drive, perhaps slight loss of vitality or the 'magic of life,' perhaps increased abdominal girth, and unknown long term side effects. Hair loss could return full force once the Propecia is stopped. It is a difficult decision, and each person needs to determine the benefits versus risks for themselves.

Q. I had a question about a hair loss issue thatís been bothering for the last year. I began losing hair when I was about 18 years old and I wanted to do something about it. I began taking Propecia immediately and everything was working fine. I had regained the little bit of thinning that had started to occur. After about 4 or 5 months of taking Propecia, I stopped taking it because I thought it was causing me stomach problems. After about 3 or 4 months, I realized that it wasnít Propecia that was causing my stomach problems and therefore started taking Propecia again. The medication began working again, until about 4 months after when I had a very large hair shed. I didnít know it was a sign that the medication was working and therefore due to my panic stopped taking Propecia for about 2 or 3 weeks. After I did some research and realized that this was a good sign, I began taking Propecia again, but then I also found out about Avodart and began taking that in conjunction with Propecia. Itís been almost three months of taking both Propecia and Avodart and although my hair doesnít nearly as much it first began, I still have some hair falling out. For example when I shower, I find 10-20 hairs in my hands. The problem that Iím having lately though is that I feel all these effects on my skin. My skin has always been very sensitive and Iíve been noticing skin darkening in some areas, dry skin and sort of like rough spots like a mini rash. Also on my face Iíve been developing, not acne, but my skin is getting rougher with a very light degree of acne. Iíve read that some of Avodartís side effects include rash, and side effects to the skin, which concerns me. Iíve also read of people who took Avodart and they said that it caused a lot of shedding and it
ruined their hairline in the first few months, but after 8 or 10 months they said it worked so well they called it a miracle drug. I want these results but Iím concerned about the side effects. My 3 months supply of Propecia is almost over and I was thinking of just sticking with Avodart for the next few months. Will this have negative results on my hair loss? Also should I stick with Avodart or is there a chance that the shedding was just a sign of not working? Iím just wondering if the shedding lasts this long. Ultimately I want to stop taking Avodart and use Propecia but now Iím afraid that if I do, all the hair that Iíve lost wonít come back because Propecia is not as strong as Avodart. Am I correct in assuming this? Or should I stick with Avodart until I see the great results that people have experienced and then switch to Propecia because its side effects arenít as potent. Or are there any other alternatives for me? Iím very sorry to write such a long e-mail and ask so many questions, but hair loss has been such a big problem for me that itís caused me depression at times.
   A. We understand your frustration but we can't give individual advice. It is a long term concern to use both Avodart and Propecia since we don't know the powerful blockage of DHT will do in the long term for overall health. We prefer people use one medication at a time or perhaps alternating them. Your doctor and you have to make the final decision.

Q. Can you tell me if Propecia can work for women who have had hysterectomies.. I have had hair loss from cancer treatment (I assume its from that as there has been no other reason drs can find).. i am getting on Propecia as my dr said it wouldn't interfere with Arimidex and i've had a hysterectomy so no worries there.. pls advise// i am about at the end of my rope.
   A. We don't know.

Q. I am 28 years old, last year I took Propecia for about 15 days, and during those 15 days, something really weird happened. my testicles were shrunk as if I was sitting in cold water, and it was even hard to pee, and I felt really depressed. Then I realized it might have been Propecia that was causing it, so I stopped. The doctor who had prescribed it to me had also prescribed several vitamins for hair growth, and several anti-biotics to kill some germs or so. I stopped those also. The situation went back to normal. But for some reason, now I am thinking about it, it seems like I am not where I was sexually before I took Propecia. Since then, I feel that I am not having as strong morning erections, and also I also had some problems with my girl friends. I used to get an erection just by kissing or just by the thought of being with my girl friends, and now I need to concentrate and work at it. I randomly discovered that 2 things help me: Yohimbe and DHEA hormone pills. Sometimes, when I take these pills, in the morning or during the day, I have the same kind of erections I used to have before I took Propecia. And I think the best one is when I take DHEA and yohimbe together. This makes me think that the situation probably is not psychological or because I am getting old or anything but must be due to Propecia. I am still losing my hair, which seems to me that I still have the same levels of testosterone.
   A. It is possible that Propecia decreased the testosterone conversion to DHT and lowered sex drive and sensation, along with inhibiting erectile function.

Q. Q. I was thinking of taking tongkat ali because of decreased libido from taking Propecia for a long time. Since you do research on herbs, i was curious to know if there are herbs or anything natural other than Propecia and Minoxidil to stop hair loss and regrow hair.
   A. See the link for hair at the top of the page.

Q. I am a woman and my doctor prescribed Propecia as i have had a hysterectomy but I didn't see any improvement so i stopped it, yet i worry what I've read that if you stop Propecia, the hair loss make get worse.
   A. This is a good question. We don't know for sure if hair loss becomes worse after stopping Propecia but it is likely that certain hairs that were just hanging on due to the effect of Propecia may now fall out easier and shedding may continue at a faster rate initially.

Q. I have a quick question about something i recently read on your website regarding the drug propecia and its sexual side effects. You said (These Propecia side effects occur gradually and in a subtle manner, and many men do not realize it is occurring and forget how they felt before they started Propecia treatment for hair loss. Another Propecia side effect may be an increase in abdominal fat (increase in size of the belly).) I Was wondering where you got this information and if you have had any patients that have reported this from the use of propecia. I have read nowhere else online about this happening. From what I understand the sexual side effects are extremely RARE , not much different from the placebo group , they happen within the first month of use in those who do get them , and generally resolve with continued treatment. This is the opposite of what you said. I have never read or heard of anyone gradually getting these side effects over time. I am greatly concerned now and I was just curious where you came across this information. Also I have never heard of an increase in belly fat from propecia either. If this does occur because of an increase in estrogen , how effective is zinc at blocking the extra estrogen to avoid this as well as gynecomastia?
   A. These Propecia side effects are based on my clinical experience with patients.

Q. I want to report an interesting Propecia side effect. I came across your web page while researching side effects of Propecia use. I've been on Propecia drug for 7 weeks exactly, and I do not notice any sexual or physical side effects at all. However, I do notice one mental side effect -- tripping over words. Normally, when I spoke before taking Propecia medication, it was usually pretty fast, witty, and it came across very smoothly. I never thought about speaking. Now, I seem to be thinking much more and I'm tripping over words. Also, I don't seem to come up with dry humor as quickly. Interesting, I also started drinking a lot of soymilk since starting Propecia as well as using saw palmetto / pygeum, and soy protein powder. I also stopped regular milk intake. I'm at a crossroads here. It seems I have to choose between hair loss and speech. 
   If I stop Propecia, (I've been taking it for 7 weeks), will the side effects go ahead completely? Also theoretically, if I was taking Propecia for 15 years, would the side effects go away completely if stopped then?
   A. It is possible that a propecia side effect could include memory or cognitive impairment due to disruption of optimal testosterone / DHT function in brain tissue. I suspect Propecia side effects would reverse completely if stopped after only a few weeks of use, but my best guess is that some Propecia side effects would persist if this product is taken for more than a decade or two.

Q. I take Proscar ( propecia ) 1.25 mg. Are there any problems combining Proscar with Passion Rx?
   A. There are many factors that have to be considered when combining medications and herbal products. We have not come across any obvious interactions or side effects when Proscar propecia is combined with Passion Rx, but the final decision rests with your doctor.

Q. Can I take both Propecia and tongkat ali at the same time? I have been taking Propecia now for about 4 years and I just received my order of tongkat ali. Will tongkat ali affect Propecia to where it doesnít work? Also should I just not take the tongkat ali? I would really like to be able to take it and see if it works, but not if it reduces the effect of Propecia.
   A. We have not seen any studies regarding the combination of Propecia and tongkat ali or other herbs used for sexual improvement. Tongkat ali, as a general rule, is not taken every day. Most people take this herb two days on, and two or more days off. It is up to your health care provider to determine whether tongkat ali or any other supplement is appropriate for you.

Q. How long will it take for any side effects of propecia to show up? I've read side effects of Propecia can occur anywhere from 30 days to two years.
   A. Each person is different, for some it could be as quick as a month, for others much longer, and still others may not notice any Propecia side effects since they may occur in such a subtle manner over time that one could overlook them.

Q. I read that Passion Rx may reverse the sexual or libido loss from the use of Propecia. Are there single herbs that can also help?
   A. Passion Rx, along with certain individual sex herbs as found in Passion Rx can help. It's difficult to predict which individual herbs ones will work in any one person. Some to try include mucuna pruriens, tongkat ali, horny goat weed, tribulus, muira puama, and catuaba.

Can you tell me if the affects of Propecia on testosterone are the same in each man? I have not had any problems with erections etcÖ. and I was wondering if my testosterone level could still be fairly high. Is it different for different men? I am 53 and have no problem, but I do not want a problem in the future.
    Yes, different men will react differently to the effects of this medication. It is possible that the impotence effects could become more noticeable over time, especially since there is a natural decrease in testosterone levels in men with aging.

I was hoping you can help me with this question that I have been stuck with. I currently take Propecia and just recently bought an herbal product called Active Herb Vive. The main ingredient in the herb is He Shou Wu. My concern is, I hear herbs may interfere the effectiveness of prescription drugs. As you're very knowledgeable in this arena, would it be ok to take these 2 products together?
   I am not aware of any studies that have combined the medication and the herb, but I don't suspect any major negative interactions. Each person is unique in their response.

I have just discovered this week, that I have been overdosing on DHEA (50mg applied topically daily with bio-identical hormones estrogen and testosterone) (the pharmacy misread or misunderstood the doctorís dose of 25mg per day (as if this wasnít enough) and doubled the amount. I have been having hair thinning for a year (thank goodness, I have a lot of hair). I suspended the Dhea and was thinking taking Propecia for a couple of months to perhaps help restore my hair. Does the DHT linger or remain in scalp after it was created by the body because of the excess testosterone due to excess DHEA that was consumed?