New (legit) question for Dr. Feller

[eastend]

Dr. Feller,

 

Way back in November 2002 there was a thread called "HT's to thicken exisiting thinning hair", and in that thread you stated that you were not a proponent of finasteride (which is NOT to say you were you anti-finasteride either). Your comment was that you believed that DHT may be needed for other biochemical processes and that causing hair loss was just one part of it. Fast forward to today, where you just stated in that other thread that you have never taken any hair loss drugs (though your support of minoxidil for post-HT recovery is clear).

 

So the question is, do you still have the same opinion now about finasteride as you did then, with 20 or so months of additional data?

 

Thanks for your time.

[eastend]

Dr. Feller,

 

Way back in November 2002 there was a thread called "HT's to thicken exisiting thinning hair", and in that thread you stated that you were not a proponent of finasteride (which is NOT to say you were you anti-finasteride either). Your comment was that you believed that DHT may be needed for other biochemical processes and that causing hair loss was just one part of it. Fast forward to today, where you just stated in that other thread that you have never taken any hair loss drugs (though your support of minoxidil for post-HT recovery is clear).

 

So the question is, do you still have the same opinion now about finasteride as you did then, with 20 or so months of additional data?

 

Thanks for your time.

[metro]

Be careful some doctors and h/t reps will post comments in here and then tell you something totally different in person or over the phone!!

[Dr. Alan Feller]

I have had mixed feelings about propecia. At first I didn't really believe it gave cosmetically significant results. That alone was reason enough for me not to recommend it. Then I saw a patient who started it about 4 months before a visit to me who showed near miraculous growth. He was proof that it could work very very well. I felt obliged from that moment on to at least mention it to all my patients.

My biggest problem is that it IS a HORMONAL ACTIVE drug. That is, it isn't a Flintstone's vitiman, and shouldn't be treated as such.

 

Nobody really knows what the cumulative effect over the years may be. It was always this that prevented me from offering it to patients. I wouldn't take it myself for these very reasons, and still don't. But that is MY opinion. So far, the data from Merck has been postitive with no significant long term side-effects. Good. This is enough for me to offer it to patients ( I never charge for these scripts and actually give away all the free samples the rep gives me), but I still don't want to take it myself. To me, the benefit to risk ratio is just not there. There is just SO MUCH we don't know about the body, so I have a hard time messing with the works unless I absolutely have to. If it ain't broke, why fix it? Hair loss isn't a pathological (sick) state, after all.

 

Remember, the body is very efficient. It doesn't produce DHT just to make men bald and upset. There is no physiological advantage in doing this. The complexity and energy necessary for the body to continuously produce DHT must be surving some higher purpose, even if we don't know what that is. Personally, I believe hairloss is a side effect. In the hormone system, everything is in balance (or it should be)when you add or remove a hormone from the body, the body responds to counter balance the new state. It's call homeostasis (remember this from highschool?). So if you block DHT, what is actually happening? Nobody really knows yet.

 

Dr. Feller

FUE and Strip HT

Great Neck, NY

516-487-3797

[arfy]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>There is just SO MUCH we don't know about the body, so I have a hard time messing with the works unless I absolutely have to. If it ain't broke, why fix it? Hair loss isn't a pathological (sick) state, after all.

 

The obvious response would then be "Why the heck do you intervene with surgery, if you think "it aint broke"?

 

Also, I have to say that I am surprised that several statements in your post are what I would call "less than scientific".

[Dr. Alan Feller]

Arfy,

I understand where you are coming from, and perhaps cosmetic surgery isn't objectively justifiable (although I obviously believe it is), but you misinterpret my position. The altering of physical appearence through minor cosmetic surgery is one thing; messing around with the body's well balanced hormonal system is quite another.

 

Should the skin be cut, it will heal fairly easily and predictably without side effects (long term or short term); block a natural biochemical pathway and you may experience detrimental effects in both the short and the long term that may affect both quality and quantity of life.

 

Look at the body as the intricate workings of a complex swiss watch (the old type with lots of gears and springs). When cosmetic surgery is performed it is analogous to changing the length of the arms or the style of the numbers, not very invasive; when biochemical blockage is performed, it's like randomly poking at the finely tuned workings. I'll even grant that the tinkerer succeeds in effecting a postive change like a softer tick or more accurarcy; but what are the chances that the watch will continue to run properly AND as designed?

 

Now, try to understand that the human body is millions of times more complex than the swiss watch. Get the point?

 

As a lab rat and clinician for years I can assure you that we know very very precious little about the physiology and biochemistry of a single cell, much less the human body. While I believe we some day can and WILL, it isn't today.

 

How is your healing and growth since you trip downunder?

 

Dr. Feller

[trspl]

Dr. Feller,

 

Your position is cautious but legitimate and defensable. However there is another side to the issue. We tamper with the hormonal equilibrium to a much larger degree when dht blockers are used to treat benign prostatic hypertrophy. Perhaps in this case the benefits outweigh the risks, whereas the benefits of incremental hair growth does not outweigh the risk. This is a judgement call for sure. I am not aware of any current evidence of risk beyond the adverse effects mentioned in the drug insert (significant as they are). The FDA has looked at the evidence and finds the drug safe and effective for its intended use. Of course, new evidence could surface over the years and that opinion could change. Also, in contrast, the hormonal manipulation that women endure for birth control, menstrual pain, fertility, menopause, etc. is on a totally different scale than dht blocking- synthetic hormone analogs, horse estrogen, etc. The calculus is different because it is used for vastly different reasons, but we do have a decades long medical legacy of hormonal manipulation- for better or worse.

 

Tom Spruill, M.D.

[Dr. Alan Feller]

Tom,

Remember that dht blockers for BPH are usually used in older men (usually 50 and up). I don't find this to be a fair comparasion to say a 20 year old who takes it for 40 years. Also, let's not forget that propecia shouldn't even be HANDLED by pregnant women due to its ability to cause developmental disruption of the fetus' genetils. How do we really know how much of this stuff is absorbed by various tissues and ensure that the fetus won't get exposed. Again, the prime market for propecia are young men in their child producing years. Would you take the chance? Would you let your patient's take a chance?

Manipulation of the female hormonal system is not done out of vanity, so I have no problem with taking some risk to set some hormonal imbalance straight. In contrast, hairloss is not a good enough reason, in my opinion, to offer the risk without also speaking of the dangers.

[Big1]

Tom Spruill, M.D. said,

"we do have a decades long medical legacy of hormonal manipulation- for better or worse."

 

 

The "decades-long legacy of hormone therapy" that you speak of was never a study of hair loss treatment; obviously, it was implemented and used to treat prostate cancer. Its long term effect on men that suffer only from hair loss has yet to be established.

[Guest]

Dr. Feller,

 

Thank you for posting this information. I have had these concerns myself and did not even consider using Propecia since so much was unknown. After a consultation with one of the docs from this forum, he recommended I try it and he did not feel there was anything to worry about.

 

I specifically asked him what effect Propecia would have when it came time to have a child with my wife. He said there was nothing to worry about and impregnating a woman while on Propecia is safe.

 

What do you think of having children while on Propecia? Are there any studies that have been performed on this specific issue?

 

Thank you for standing apart from the crowd and educating others about the possible dangers of Propecia.

[trspl]

Biff, I hope you don't mind me submitting a bit of information. This is the data submitted to FDA re: safety. Not the most comprehensive info in the world, but a start. I'm certain Dr. Feller has an opinion on this.

 

Tom Spruill, M.D.

 

"Semen levels have been measured in 35 men taking finasteride 1 mg daily for 6 weeks. In 60% (21 of 35) of the samples, finasteride levels were undetectable. The mean finasteride level was 0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using this highest semen level measured and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal absorption would be up to 7.6 ng per day, which is 750 times lower than the exposure from the no-effect dose for developmental abnormalities in Rhesus monkeys"

[Guest]

Thank you Dr. Spruill. When you say this is the data submitted to the FDA, I am assuming this is what Merck, the manufacturer of Propecia, has submitted to the FDA?

 

I'm not trying to put Propecia or Merck down, I simply want to understand where any inherent biases may exist.

[arfy]

Dr. Feller asked<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>How is your healing and growth since you trip downunder?

I'm doing fine, I see the beginnings of growth and that is positive. half of my grafts are body hair, and they were placed in a scarred recipient area, so I expect a slower response than a virgin patient.

 

I think your comments about a pregnant woman not even touching Propecia may be a little overblown. Handling tablets and ingesting tablets are 2 differnt things. Sure, why have a pregnant woman touch Propecia unnecessarily. But your comments might suggest that Propecia shouldn't even be in the same house where a pregnant woman lives.

[EastCoast]

I am almost 8 months post op from 1k fue from Dr. Jones. My areas was scarred from some type of lighting bldae. I am just starting to sprout a hairline. It does take much longer in scarred area's. Thank god it's growing.

[trspl]

Biff

Merck submits the research data to the FDA. All pharmaceutical company research works this way. The drug companies are the only ones with the incentive to do the research because they are the only ones who will profit from it. Thats why an independent FDA review process is so important. These days a new drug has to be able to sell at a bare minimum $500 million during the patent life, or the pharmaceutical co. won't even start the approval process with the FDA because of the expense of getting a drug to market.

 

Arfy,

Beleive it or not, the FDA gives a stern warning to pregnant women not to touch the (broken or crushed) pills. Refer to the PDR. I think it is a theoretical risk to the fetus. I am not aware of any human cases of fetal genital malformation directly traced to finesteride, although there may be. That would be an interesting question to ask Merck.

 

Tom Spruill, M.D.

[Dr. Alan Feller]

Arfy,

Tom is correct, it is Merck that announced the handling precautions for pregnant women, not I.

Also, if my wife were pregnant I WOULDN'T have it in the house.

I'm not anti-propecia. I believe in certain patients it is a miracle drug, but there are downsides and potential downsides to everything. If I wouldn't let my wife handle drug, I don't want your's or any other patient's wife handeling it either.

I speak with the merck rep all the time and he has told me that studies were performed that showed practically negligable levels of propecia in the ejaculate and NO human birth defects reported thus far. However, many test results and conclusions are based on statistics, and even if something is 99% safe, that means 1% of the patients may be "stung". What if that 1% were your unborn child? Get my point? If propecia were a necessary drug for health reasons then I would feel and act differently, but it isn't. It's a vanity pill that works sometimes. Period.

[noreaster]

arfy, dr. f, and other medical professionals, as a drug rep myself i feel i must chime in. Dr. F's concerns w/ hormone levels are very insightful. The fact that the drug should not be handled by women who are pregnant, and if i remember correctly, those who intend on being pregnant, should be a red flag. A problem i have as a rep is that a drug originally studied for bph, turns out to grow hair on mpb individuals. And because merck had the resources to do the studies to market propecia as a hairloss drug, the fda has not linked the relationship between bph and hairloss. In my opinion, any drug for bph should contain the same warning for pregnant women, or those who intend to become pregnant

[Dr. Alan Feller]

Noreaster,

You make a very good point. Perhaps a pregnant daughter of a man taking proscar should be informed so as to not handle her father's BPH medication. After all, proscar is typically 5 times the strength of propecia. Excellent point Noreaster.

 

Dr Feller

[baldcasanova]

Dr Feller,

 

Would you recommend Proscar? I am using propecia and i dont think its working...

 

 

Also are you saying that a pregrnant woman merely TOUCHING a Propecia pill can develop some sort of problem? Will the drug seep through the skin ?

 

Cas

[Robert_]

Baldcasanova,

 

Propecia and Proscar contain the exact active and inactive ingredients in two different dosages: 1mg (Propecia) and 5 mg (Proscar). The reason for Proscar's popularity is for its price. Proscar is cheaper to buy than Propecia when you take dosage into account. The idea is to split the pill into fourths and take 1.25 mg per day.

 

As far as pregnant women touching the medication (Proscar OR Propecia): It is my understanding that exposure to these drugs by a pregnant woman can potentially cause trauma to the genitals of a male child. Of course a doctor can go into more detail, but I believe this to be the "gist."

 

Long story short, take whatever advice the good Dr. Feller gives you, but personally, I would not take the risk of any woman touching the medications. I have two female roommates and so I do not even keep my Proscar in the bathroom medicine cabinet. It is stored safely away in a desk drawer. Better safe than sorry is my policy and they aren't even expecting children!

 

-Robert

[bverotti]

Great thread.

I share Dr. Fellers thoughts all the way.

BV

[M-J]

What worries me is what happens after taking propecia/proscar for many years and then stopping. It would be quite shocking to go from a nw3 to a nw7 in a couple of months.

 

That's an interesting point. Why is that the case? Any opinions?

 

I experienced the same while on Proscar. I quit for about 2 month and I was losing so much hair that my hair loss became noticable to almost everyone in a matter of weeks. THAT was horrifying! Wish I had never started it.

 

Anyways, I've been on Propecia/Proscar now for 5.5 years and it helped stopping/lessening my hair loss. But I'm quite concerned about side effects and I'm planning on consulting an urologist in the near future just to make sure everything's in order.

[Robert_]

Great thoughts, beerman.

 

I think that a lot of what forum visitors are hearing is "Take Finasteride! Take Minoxidil!" right away with not enough emphasis on the medications' inevitable implications or that they are even medicine at all. Finasteride in the form of Propecia OR Proscar (obviously, the same drug, different dosage) is NOT a Flintstone's Vitamin. These are medications that should be taken ONLY under the supervision of a physician. That is why the prescription exists: to ensure that persons are not diagnosing and self-medicating freely without some sort of medical advise.

 

I have also known the disaster that can happen in stopping the regimen of Finasteride AND Minoxidil. The effects are not fun and quite disturbing. Personally, I feel that the benefits outweigh the side effects FOR ME. I also feel that some of the side effects are largely blown a bit out of proportion, though this is completely understandable due to their potential severity.

 

In conclusion, I believe that a high level of research, personal planning, and common sense are to be utilized in starting on Finasteride, Minoxidil, or anything that can have long-term implications. I wish everyone the best in whatever decision they do make.

 

For anyone that is not very familiar with Finasteride (the active ingredient in Propecia and Proscar) look here.

This will certainly shed some light on the subject and may help you decide what is best for you.

 

-Robert

[metro]

I don't take any kind of drug if I don't have to. Propecia is a hormonially active drug, it is not on the level of vitamins or supplements, it is a serious drug that the body must adjust to.

Dr Feller

 

Dr Feller,Thanks to this response from another thread. My question is what are the vitamins and supplements you recommend to take to help prevent hairloss?

[Guest]

natural supplement-multi,msm,saw palmetto,Chinese herbs.

 

MJ~Interesting point and keep us aware of you condition after your series of tests.

 

Beerman~good point.They certainly of rather don't often tell you this at Merk or some HT clinics now do they?!

 

Furthermore,why would the large pharmaceutical tell the general public the truth about the negative side effects of their drug when it stands to hurt their marginal and net profits.

 

Merk(oligoloply)+greedy ceos(retirements,golden parachates)+HMOS=$$billion dollar industry!