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I am writing this post from the ISHRS annual meeting in Chicago. I have just heard a wonderful and informative discussion on the use of of the drug finasteride. As we know, the hormone DHT is 40 times as powerful an androgen as testosterone. The treatment of genetic hair loss is to address blocking the DHT hormone. One of the worlds experts, Dr. Mohit Khera from the Baylor College of Medicine, told me privately that when DHT levels are in the low normal range, the use of DHT blockers such as finasteride will have little value and may not be effective in the treatment of genetic hair loss. With this as a suggestion, we will now optionaly offer DHT blood tests for any person who wishes to have this test prior to going on finasteride (Propecia). If the blood levels are low, we may not advise the use of this drug as the goal of using this drug is to drop DHT levels, which may already be low. This lecture is based on considerable research both in animals and human studies but it is not absolutely definitive as there was much controversy at the meeting that the doctor may have had a conflict of interest in the opinions he drew.



I have a question regarding exclamation point hair. Or more specifically thinned proximal shafts (Picture linked at the end). Age:18,Gender:Male

Online sources say that exclamation point happens when you lose hair in patches or in non traditional MPB ways but I am suffering diffuse style MPB (pattern) and the hair that falls off is really thin at the root with a white bulb thick at the top. I also have seborrheic dermatitis. I was prescribed 2% nizoral which then caused me to lose almost 50% of my hair in the span of one year (or maybe it was meant to happen?). Could nizoral cause scalp inflammation that leads to MPB?

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The online source of “exclamation point” hair shaft from Am Fam Physician. 2009 Aug 15;80(4):356-362 is describing Alopecia Areata which is a disease process where your body’s immune system “attacks” your own hair causing hair loss.
Male Pattern Balding is a genetically inherited condition where men lose hair in a typical “pattern”.
Seborrheic dermatitis is an inflammatory condition which causes scaly patches on the scalp/skin which may cause hair loss from the inflammatory process.
Nizoral is a shampoo with antifungal properties that is used to TREAT Seborrheic Dermatitis. Some people may have an allergic reaction to this and a rare side effect is hair loss.

All of the above are separate and unrelated causes for hair loss and it is understandable you are searching for a unifying answer.

The simple answer is that Male Pattern Balding is genetic and unrelated to Nizoral, Seborrheic Dermatitis, or Alopecia Areata.

For a more complete answer you need to follow up with your doctor to find out the cause of your hair loss especially if you are having side effects with the medication you were prescribed.


Doctor Rassman, one last thing if you don’t mind, for someone like me who has been on finasteride for like 4 years with good results, im thinking of adding dutasteride 0.5mg to my regimen every other day, not because I want more hair because im happy with what I have its because I want to destroy dht even more, and who know I might get more benefits who knows. I know eliminating all of dht is not the answer but I just want to. there was a study where a man added dutasteride 0.5mg once a week to a finasteride regimen and got better benefits. is it redundant to take both? to be honest side affects are the least of my worries, as with finasteride I have experienced non at all. even if I dot get sexual side affects I don’t mind as my hair is more important LOL. that’s just me lol. When I asked my doctor he said if I want to get hair greedy to add rogaine, but I don’t like topicals at all and I rather add duatseride, he said no, to only take either finasteride or dutasteride. but he is a regular GP, not a hairloss expert like yourself. I read a lot of forums where people take both as well, not sure. can one medication offset the other if taken together. thank you so much, your awesome.

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If every thing is working on finasteride, why risk new side effects by adding dutasteride?


I’ve been taking Propecia for many years (generic over the last year), and my hairline has remained stable ever since. I just noticed a nickel-sized bald spot on my crown. I thought Propecia worked better on the crown than on the hairline, so what gives?

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Propecia is a medication for the treatment of genetic male pattern balding also known as androgenic alopecia. It works best for treating the thinning / balding on the top and crown areas of your scalp. It does not work as well for the front hair line. Propecia is not a cure and its response is different in each individual. You may still have thinning or continue to lose hair. The point is that it should slow down the hair loss. There is no cure for genetic balding.

You should see your doctor. A bald spot the size of a nickel could be the result of other causes like alopecia areata. A clearly defined bald spot is not a presentation of genetic male pattern balding so you must be assessed by your doctor.

Tags: generic propecia, propecia androgenic alopecia, propecia alopecia



I’ve been reading your blogs for a while now but have finally got the nerve to send you an email to ask a question. I’m 28 yr old male. I have been taking Propecia since I was 24 yrs old. Actually I first started taking Propecia, I was told by my dermatologist to take it just three times a week because he felt that my hair loss was very minor. I did that for about 3 months or so then I went on one pill a day from the time I turned 25 and took a pill a day for about 1 year and a half. By the time I was 26 and half, I was reading that Propecia could affect my ability to have children so I stopped taking the pill. I started to see heavy amounts of shedding of my hair but I thought it might be due to the amount of stress I go through. However, after a six month stint off Propecia, I met with a doctor and decided to go back on it until now. Since the time I started back on it last February (2007) I’ve noticed my hair is substanitally thinner than it was last year even though I’ve been taking Propoecia. Its thin to the point where I can see my scalp in most angles of light. Does this mean that Propecia is not working for me? I’m actually going through a stressful time in my life right now, does that have anything to do with it or cause Propecia not to work? I lose about 30 hairs everytime I shampoo my hair and there is basically hair everywhere over my pillow case. Are there any suggestions you may have for me?


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You cannot expect results when you take a medication inconsistently. The recommended regimen for Propecia is to take the medication daily. You need to stick with a knowledgeable doctor and maintain taking the drug daily if you want a chance at some results. Taking Propecia is also a lifetime commitment so you need to understand this before embarking on taking the medication. Anything less will eventually push you into what I have discussed many times on this blog — “catch-up hair loss”. There is also no comparable “catch up hair growth” that equals the value when you first started to take the drug and during the first full year of treatment. Today, doctors have an instrument which measures your hair bulk and hair miniaturization so you can see, over time, if you are winning or loosing the hair loss battle. My best advice has always been to go see your doctor in person to address your concerns.

Regarding whether Propecia is working for you, you should be able to ask your prescribing physician, who I hope has measurements of your hair loss at the time you restarted the drug over a year ago to be able to compare them to now.

Tags: finasteride, hair loss finasteride, propecia switch


just to share something and also post an enquiry. January this year, after seeking advice from a dermatologist, I decided to take the plunge and switch from propecia to avodart. It has got to be the worst mistake I ever committed. since the time I stopped propecia, hair shedding started about close to a month after switching. In a matter of 5 months, my hairloss progressed drmatically and I have now a very noticeable receded hairline. I should have stayed on propecia, although it didnt regrow a lot of hair I have expected, but It did regrow decent amount and most importantly, maintained what I had. Looking back, I could only blame myself for all reports that supported Dutasteride were either small scale, or short-term. I have since switched back to propecia a week ago after seeking a 2nd medical opinion.

My question would be that, is my shedded hair all lost and not returning? Notice I am not like the typical propercia user who quit due to side effects, I switched to a more powerful anti-dht and am not switching back propecia. Bearing in thought that all the while I had decreased DHT in my body, and during that 5 months, decrease up to 90%.


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Thank you for sharing your experience with Propecia (finasteride) and Avodart (dutasteride).

To answer your question in perspective, there is no magic pill or drug to cure or reverse hair loss. If you are genetically predisposed to hair loss, Propecia will only postpone it as long as possible. For some men this may be many years. For other unlucky men this may be a few months or a few years. This does not matter how much DHT you block. Most men who do this also get a drop in their sex drive as Avodart has a higher sex drive suppression than Propecia.

Tags: avodart, finasteride, switch back to propecia, hair shedding, decreased dht


The drug Ouabain, used to treat heart diseases, appear to be able to prevent prevent virus replication. Julian Hiscox from the University of Liverpool, reported in the Journal of Proteome Research.

I am sure we will hear more about this drug very shortly.


I am taking Red Bull along with my work out program. I keep losing hair and I saw from your blog site that working out will not cause hair loss. With that in mind, I want to know if using energy drinks can help my body grow hair. I drink a great deal of Red Bull, but I have not seen value for my hair regrowth.

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What in the world would make you thing Red Bull may help your body grow hair? I am missing the logic!
Red Bull contains: caffeine, niacin, pantothenic acid, vitamins B6 and B12. There is nothing special about it from a hair follicle point of view.

Energy drinks like Red Bull will not grow your hair back as you have already noticed. When taken in excess amounts, this particular brand can be dangerous, especially if you are a diabetic. There was been one report in the medical literature that presented a patient who drank about 100 ounces of Red Bull per day (5 20 ounce servings). In this particular patient, he developed renal failure (kidney failure) which fortunately did reverse when the Red Bull was stopped. Red Bull contain caffeine as well as other ingredients such as vitamins, sugar, amino acids, and herbs and when taken in moderate doses, it is probably safe, but 100 ounces a day for 3 consecutive weeks, did seem to bring on the kidney problem, a condition that could be life threatening. Just one report may not really do this side effect justice. Using energy drinks in moderation like anything you consume, makes sense.

Tags: energy drinks, renal failure, kidney failure, Red Bull, hair growth, losing hair


I had been experiencing hair loss the last year and now my hairline has started receding.

I am now 24 and i was in denial but now that it’s visible i started propecia although i didn’t want to because of the horror stories i read. After i started i had testicular pain and i felt a lot of anxiety and stress so i decided to stop. It’s been a week since i stopped the 1 mg per day. How long do the effects of it need until they are gone?

From a study i read the byproduct ([3H]dihydrofinasteride) has a half life of 1 month and the intermediate adduct of it (NADP-dihydrofinasteride) still effects DHT production. Will i need that long to be sure that it doesn’t creates me the stress i feel? The fact that finasteride is an irreversible 5AR2 inhibitor means that i will have to wait for new 5AR2 enzyme to be reproduced, and can this be downregulated in any way? Is my anxiety caused by the the inhibition of allopregnanolone maybe?

Thanks for your time, your input and knowledge based on your experience will be very helpful.

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For all practical purposes, the half life of Propecia (finasteride 1mg) in your blood stream is about 4-6 hours. This means the drug should be out of your blood stream in one day. This is why you need to take the medication everyday. Some believe there is a component of tissue fixation where some residual drug linger on for about one week. This is why we often write that if you experience a side effect you should see it reverse in about one week.

It is quite a remarkable coincidence that as someone who was apprehensive about taking Propecia from reading the “horror” stories of on the Internet also happen to get the rare side effects. Testicular pain and anxiety as a side effect in it of itself individually is probably less than one percent but having BOTH would be even rare. Also note that these symptoms are not even reported in the actual drug insert. Please note that I am not trying to ignore what you are experiencing but rather you should also speak to your doctor as testicular pain is a very serious medical issue that may not be related to the medication itself.

With respect to all the biochemistry questions of the breakdown of Propecia, I do not believe it has anything to do with your issues. I am also not a biochemistry expert to state all the importance and functions of the enzymes or hormones you are trying to correlate with your issues. I have said many times before, our body and its function/dysfunction is not so simple to define with single biochemistry pathways.

With all due respect your “anxiety” may just be more of a psychological issue rather than these enzymes and by products of Propecia. Because if you really want to really get in to all the biochemical process behind your “anxiety”, you must think of all the other medications you may be taking (for example: anti-depressant drugs can cause sexual dysfunction, anxiety, suicidal feelings, etc), recreational drugs you may be using or have used (for example: effects of marijuana, cocaine etc can cause long lasting mood related side effects), your social life (for example: dating in your 20’s while losing hair in it of it self can be filled with anxiety), the sun exposure you have (for example: not having enough sun light can cause psychological effects), your childhood experiences (for example: you can fill in the blank and blame x y z from your childhood), the friends you have, etc etc etc. This list is endless and Bladingblog and a short paragraph cannot begin to understand the big picture nor solve your issues. I will say again, biochemistry alone does not explain your mood.

My final point: TALK WITH YOUR DOCTOR for your anxiety issues and your testicular pain.


I am a 23 Female, I have been losing hair for 2 years now. My dermatologist prescribed minoxidil 2%, but after 4 months i didn’t see any results. Is it safe to use both 2% and 5% (2% in the morning and 5% at night) to make it more effective?


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In general we advise our female patients to use minoxidil 5% twice a day, although the official recommended dose is 2%. We take the blood pressure of the patient prior to prescribing this medication. Although this medication can be purchased directly from any pharmacy or grocery store, there are side effects that you must read about prior to starting the medication.

Tags: minoxidil, dose


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