Dr. Roger Responds

Earlier this month, we invited readers to submit medical inquiries to Dr. Roger Kapoor, a resident at Harvard Medical School. In this follow-up post, Dr. Roger answers your questions.

Is [Dr. Roger] legally allowed to give medical advice?

Dr. Roger: All post and information provided within these responses is for informational and educational purposes only, and is not to be construed as medical advice or instruction. No action should be taken solely on the content of this website. Please consult your physician on any matters regarding your health and well-being or on any opinions expressed on this website. You, as the reader, are responsible for consulting with your own health professional on health matters.  No responsibility can be accepted by the author for any damages resulting from the misuse of this information.

I had a very stressful month at work and also noticed that I lost clumps of hair. Is there a connection?

Dr. Roger: Sorry to hear this has happened. Your intuition is spot on; there is a connection. The condition is called telogen effluvium and is a temporary increase in the rate of hair shedding. This is actually the second most common cause of hair loss (after genetic hair loss) and has a variety of causes, including stress. The good news is that this is temporary—you will experience complete regrowth of your hair—but the bad news is that it will take some time after the stress for it to come back (a few months to one year). For telogen effluvium, no treatment is necessary.

Would [Dr. Roger] recommend Propecia (finasteride)? Is it safe? Are there any side effects? Is it okay to drink heavily and do other drugs while you're on it?

Dr. Roger: Deciding whether or not to take finasteride should ultimately take place during an office visit with a physician after reviewing your medical history and ensuring that you are an appropriate candidate. The medication is not a panacea for hair loss but has been shown to benefit some men as long as they stay on it. That is to say, once you stop the medication, the hair that you may have gained or maintained will be completely lost within six to 12 months.

Finasteride typically takes about three months to see an effect. The side effects are rare and reversible but should be carefully considered in your decision. The most common side effects include abnormal ejaculation, breast tenderness, and reduced libido. For women, finasteride is pregnancy category X, meaning that it is known to cause birth defects and should not be taken if you are considering getting pregnant. Finasteride does not interact with many medications, though one medication, St. John's wort, has been shown to reduce the effectiveness of finasteride.

Drinking does not mean that you cannot take finasteride, but both finasteride and alcohol are broken down in the liver. If you are drinking enough alcohol to extensively damage your liver, then you should take precaution when considering taking finasteride. A number of people opt to begin treatment with topical minoxidil (Rogaine) and test its effectiveness before starting finasteride. Topical minoxidil can be bought over the counter and has minimal side effects.