I just wanted to see what your thoughts were about my “theories” in regards to Minoxidil 5%.

Firstly, I have read online about how it has caused erectile dysfunction, anxiety, heart palpitations, etc.

Are there any studies that show that these are legitimate side effects, or are they just symptoms listed by individuals? I think it is highly possible that these individuals could be effected by the listed side effects due to psychological issues due to their hair loss, and assuming the minoxidil is causing these physiological symptoms.. What do you think?

Secondly, do you think that the failure rates of minoxidil are due to people who stop using the solution too early on, rather than the minoxidil not “working”?

What you read on the web isn’t always true.

The official reported side effects are listed on the minoxidil insert and the drug profile (see here). Minoxidil taken orally in pill form is a blood pressure lowering mediation, so it is conceivable you can get lightheartedness and heart palpitations if your body absorbs too much of the topical. Chest pain and fainting are also possible if you’re sensitive to the medication. Erectile dysfunction is more likely to be due to a psychological issue or an underlying medical issue, rather than minoxidil.

With respect to the failure rates of minoxidil, I believe it is partly because of compliance issues. Many men and women have a hard time adhering to a twice a day schedule, and therefore do not get the full benefit of the treatment.

Hi doctor, I’ve been using finasteride 5 mg for MPB, but in the third month I had total impotence and shrinkage, i stopped, sexual organs returned to normal size hear some gain libido,but erectile Dysfunction persists even after 6 months ( no morning erections, or nocturnal) and and I also have pain in the prostate, what should I do? ( I used previously for 2 years finasteride of 1mg without side effects.

We never recommend taking the 5mg dose of finasteride for the treatment of hair loss. Did you increase the dosage on your own to 5 times the normal amount for treating hair loss, or did your doctor prescribe this to you? And if you took the recommended 1mg dose for years without side effects, why was your dosage even increased?

In any case, you should see a urologist. These are prescription medications, and I don’t know enough about you (medical history, age) to really have an idea of what is going on.

“Let the buyer beware” has been placed at the end of many of our posts. Researching your doctor is your responsibility. You must do the necessary research to protect yourself from doctors who claim expertise in the hair transplant surgery field and then can not deliver what they promote.

A gynecologist in Puerto Rico moved to California and set up shop doing hair transplants. Unfortunately, the reviews this woman found online for this doctor lead her to have surgery with him, resulting in horrible complications. I don’t know how much research was done beyond reviews (did she meet patients to see real results in person?), but I feel for this woman and her story should be a cautionary tale for everyone.

I found this video from NBC News in the Bay Area (Northern California), which I’ve embedded below. Warning – The photos shown in the video require a tough stomach.

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First of all, I’m a huge fan of your blog, it helped me a lot.

I visited a surgeon a year ago and he said he would do the surgery for me, but finally i did not have it done. I’m 24 and I haven’t noticed any hair loss for a year or so. I’m only balding in the front and it’s not too bad either.

I’m thinking of doing it now. But I read here that it’s usually not suggested to have it done at this age. Does usually mean that there are exceptions and occasionally you have patients at this age? How do I know my surgeon has my best interest? I actually do trust him. He is a member of ISHRS and seems very trustworthy. He said he usually doesn’t do it for young people, but that I have a lot of hair in the donor area and that since my hair is bright and curly, it’s easy to hide the balding.

We put together this post to help people like you to select a doctor: Selecting a Hair Transplant Doctor. You have to apply judgment in filtering out the variables discussed in this reference.

At 24 years old, you are at the marginal edge for doing hair transplants. Ask yourself — what is the rush? Is it bothering you enough to do something about it now or would waiting another year help you make the decision?

I recently suffered from an OCD scalp-picking condition (dermatillomania) from high levels of stress, for about a year. Now, there are no scales on my scalp and it is really sensitive. All the hair is still there, it just sits really strangely on my head (without direction). I wanted to take steps to returning it to its original condition, but I’m not sure where to start. Thank you!

I’m not sure how you would be able to correct the direction of the hairs. You might try topical conditioners and test many of them. You may have caused permanent damage to the skin and thus seeing the directional issues with the hair.

I noticed your recent post about protein powders and how they have no effect on DHT and hair loss. I’ve seen some posts on your site, but I feel that exercise and supplements (other than steroids which obviously impact hair loss) have not been adequately addressed.

For example, many studies indicate that creatine increases testosterone and DHT. Also, generally speaking, exercising increases testosterone levels. Therefore, wouldn’t exercise and working out increase DHT and therefore hair loss? Also, maybe we can get a more straight forward answer on certain common supplements such as Creatine and Glucosamine. Thanks

I do not believe that working out will increase hair loss, but the straight forward answer is that we don’t know for sure. If you search the web, many talk about creatine and how it may relate to increased DHT, and ultimately hair loss. I do not know of any well constructed, reliable, or definitive studies about it, though.

In the world of genetic male pattern hair loss, the keyword is genetic. I suppose there are extraneous things you can do or take (anabolic steroids – a drug/hormone – not a supplement) to make the genetic trait worse or accelerate it. But in the end, even if you don’t do anything, but you have the genes for it, you will lose hair.

If taking creatine or glucosamine or other supplements worries you, then consider not taking them. Prioritize your goals. If you are taking these supplements to enhance your workout and gain muscle etc, nothing beats actually working out (an extra day per week or an extra 10 minutes in the gym is better than any supplements in my personal opinion).

I am 41 years old and a female. When i was 4yrs of age, i lost all my hair, including eyebrows, eyelashes, scalp and the nails on my fingers and toes. With homeopathy over a period of time, i regained my eyelashes, eyebrows, nails. With puberty, i grew hair in the correct places, normally. Just my scalp, arms and legs remain without hair till today.

I was diagnosed with Alopecia Totalis. I am happily married with a son also now. Do you have any hope for me,whatsoever? If not clinical, then
anything cosmetic that you can recommend for me which would be available in India?

Unfortunately, there is little anyone can offer for treating alopecia totalis. There are people with this disease where the gene runs in the family and the hair loss goes complete at the age of about 4. These conditions do not reverse.

You can visit the National Alopecia Areata Foundation site for support and the latest research.

When applying rogaine, does it matter where you apply it on the scalp for it to work? Doesnt it get absorbed in the blood vessels and spreads out throught out your scalp?

For example if you apply it on the top wouldnt it work for the front as well, or does it have to be applied on the exact area of hairloss? Thanks

I would follow the instructions including in the packaging. The basic idea is that you apply Rogaine (minoxidil) where you want hair to grow, twice daily. If you apply it on the top, it wouldn’t really do much for the front.

Hi there doctor rassman
here is a study on minoxidil injected to the scalp vs topical treatment – Egyptian Dermatology Online Journal

The injected minoxidil was done 2 times and then one time a week and yielded greater results than topical treatment.

This is clearly not an approved study; however, I would not doubt the results reported by the Egyptian doctor. Minoxidil was originally an oral medication for the treatment of high blood pressure, and it worked, though not well.

At an ISHRS meeting a couple of years ago, it was reported that minoxidil by mouth or intramuscularly could reverse hair loss and was a common practice in India. We know from the old studies on the oral minoxidl that systemic administration produced excess hair production in different parts of the body.

I will not be offering it in my practice until the FDA comes out in favor of it, but it is interesting research.

Snippet from the article:

Going by the recent study on Alopecia by Chandigarh-based Plastic Surgeon Dr Tejinder Bhatti, it’s not just the “G” factor but the “A” factor that plays a major role in baldness. Dr. Bhatti has explained that the “G” factor – genes – do play an important role, but the “A” factor – A+ blood group, especially in males – makes one more prone to baldness. Dr Bhatti initiated the study in 2007 and completed it in December 2012.

Dr Bhatti opined that although patients blame water content or quality of their shampoo for baldness, but blood groups play an equally important role. A+ blood group people are unable to optimally absorb B vitamins, including Biotin, in their blood and therefore the thickness of the hair is quite low.

Read the rest — ‘A’ factor leading to baldness?

I’m not sure that I agree with this. It would be interesting to read it on a medical journal.

They kind of lost me once I read, “Dr Bhatti says that In male pattern baldness (MPB), in 80% cases the gene causing baldness comes from the mother’s side. So if your nana or mama are bald, there are 80% chances you too will be bald.” That actually just a myth and has never been proven.