Question: I had a bad reaction to Propecia, including severe shedding (especially in the front) that commenced within a few days of starting Propecia, and stopped within a few days of stopping Propecia. I'm assuming this is Reflex Hyperandrogenicity (let's call it R.H.).
Could it be that I have a particularly low tolerance to the effects of Propecia, and that if I take less (say perhaps 1/4 of a pill per day, or every couple of days) that I'll avoid the R.H.
I suppose to word it another way, is the R.H. caused by the inhibition of just too much 5ar, making it so if I inhibit less, I may avoid it while still getting the benefits of Propecia ?
Dr Proctor answers: Shedding that occurs before about 2-4 months after starting a treatment was of hair that was already in the loss phase when you started. That is, such hair shedding is just coincidental or due to early fallout of loss-phase hair as follicles come out of dormancy under the influence of a hair-growth-stimulator. This hair was about to fall out anyway.
Not that hair loss due to reflex hyperandrogenicity doesn't occasionally happen with Finasteride. However, Finasteride (Propecia) differentially "protects" hair follicles. Thus, enough reflex hyproandrogenicity to exacerbate balding is very likely to be associated with other hyperandrogenic symptoms such as increased libido, skin oiliness, etc. In the absence of these, I consider it unlikely. So you can rest reasonably easily. I hope....
Peter H Proctor, PhD, MD