Q: I heard that Propecia stops working after five years. Is this true and why in five years? — B.P., Stamford, CT
A: That is not correct. Although the effects of Propecia (finasteride 1mg) will diminish over time, it does continue to work. Using finasteride long-term will still be better than stopping it at some arbitrary interval. In clinical practice, I often increase the dose of finasteride, after someone had been on the medication 3 to 5 years, to help maintain its effectiveness.
Posted byQ: I am 22 yrs old and I started shedding hair in a very limited form since I was 20. I have now been on Propecia for nearly 8 months. To date I have not experienced any benefit. In fact, I have seen my hair continue to thin. Is it possible that this thinning is a result of Propecia? — M.M., Boston, Massachussetts
A: Usually the shedding associated with finasteride will subside by 6 months.
If you are still losing hair at 8 months, most likely the medication is not working. Unfortunately, it is not effective in about 15% of patients.
Posted byQ: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon
A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.
I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.
For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).
If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.
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