Hi, i’ve been using rogaine foam for about 7 1/2 months, and started using nioxin system 1 shampoo and coditioner. i’m starting to get a lot of head aches i think from the foam (since i think i’m using too much) and i’m not sure i’m getting much results, so i was thinking of starting using propecia, except it’s costly and i’m afraid of the side effects, seeing as i’m only 22, male. i heard the younger you are though, the less likely you are to have side effects from propecia, is that true?

i’ve been reading around and would like to only use .5mg, by cutting themin half. is it safe to just take a knife and cut them in half though? and i’ve heard using nizoral shampoo along with the foam is considered the “big 3” and has shown a good amount of results for people, do you recommend using all three products?

Headaches may be from the hypotensive impact of minoxidil (Rogaine), which does drop blood pressure in some people. You may be using too much of it, or may just be too sensitive to it.

If costs on Propecia is too much, you can get a prescription for the genetic finasteride 5mg tablet and cut it into quarters. At our local Costco, the cost runs about $5/month for the 5mg generic. With regard to halving the dose, the financial solution to your problem is discussed already with the generic finasteride… and why take half when a full 1mg dose is better? Side effects are rare in men of all ages, but I don’t recall seeing statistics about side effects relating to age.

You can use Nizoral, but aside from being a good shampoo, I’m not sure it’s going to regrow your hair. If you’ve got the financial means to do so, you can continue to use all three products.

An earlier question brought up an article about a topical DHT inhibitor at HairLossTalk:

The doctor interviewed in the article made some pretty impressive claims. Paraphrasing:

1. His topical DHT blocker is as effective as Propecia as long as you could apply it to the affected area
2. Downside of topical: It’s more of a pain to apply. It would be really difficult to apply to entire scalp, whereas Propecia blocks DHT everywhere.
3. Upside of topical: it only blocks DHT near the scalp, having less of an affect on serum DHT levels. This decreases the chances of side-effects.

The claims seem to make sense to me, but this kind of stuff can sometimes be counterintuitive.

1. Do you agree with his general evaluation of topical vs. serum DHT blockers?
2. Do you have an opinion on the specific topical solution he is talking about?

We have written about topical DHT blockers before here. The doctor in the article you referenced is a web-based provider of compounded, off-label medicaments for hair loss. The use of spironolactone has been a mainstay as a treatment for female hair loss when taken orally, but there is no real evidence that it works and many studies show the controversy, saying either it works or does not work. It is tied to the belief of the doctor, but you must keep in mind that doctors who recommend it profit from its use. When you take such medications and convert it to skin (topical) use, there is no guarantee that it works, if it is absorbed through the skin and just where the medication works (if it does work at all). It is easy to make such compounds and when a doctor puts his concoction into a cream or topical, there is an implication that it is safe and effective. Spironolactones are known antiandrogens and as such should work in men, but if taken orally, men will have significant secondary sexual side effects, such as loss of libido and problems with sustaining erections (when and if they get them). The question one should ask is whether this medication has sexual side effects. Without proper scientific studies, we really can not tell.

I never understood why men chase this stuff when the rare sexual side effects from Propecia (finasteride) have been measured. I would guess that if spironolactone was taken orally, they would dwarf the side effects of Propecia in men, yet men somehow want to experiment and may find themselves swamped with side effects or ineffective treatment losing valuable time on fixing hair loss with what is known to work. Topical spironolactone has a bad smell associated with it which is claimed to have been successfully addressed by this doctor, so I don’t know if this medication stinks from the aroma or its success and without good science behind it, it becomes a real gamble with the belief of one doctor who makes his living putting topical medications together.