Since You Suggested Minoxidil and Propecia Are Better Together…

I received 2 emails from 2 different readers about my recent post discussing using minoxidil and Propecia together —

EMAIL 1:

I was interested in your recent suggestion that minoxidil and propecia used together may be better than only one at a time. My question is concerning minoxidil. I tried it a while ago but got very bad itching of the scalp. Is there a form of minoxidil that won’t give me this side effect? (e.g. rogaine foam or some other variation). I would really love to use it in the hope that it will slow down the hair loss process. I know others have previously stated that they couldn’t use it due to the itching, so it would be great if there was something out there to fix that problem.

Thanks doc. I read your site almost every day and love it.

EMAIL 2:

In response to your new theory on the combination of Rogaine and Propecia. Would you then advise immediate combination of the two, or would you still prescribe a one year period of just Propecia? Could it depend on the results that one are looking for? i.e. regrowth vs. maintaining/slight regrowth. Thanks. Very helpful website.

I combined the answer of these two questions.

Although the combination of minoxidil and finasteride is reported to have a superior effect on hair growth over taking them separately, I generally do not start my patients on both of these medications at the same time. I may add minoxidil to the treatment regimen of a patient who has been on finasteride for a while and now feels that finasteride is not holding anymore. This usually happens after the first year of taking propecia when patients are done with the initial hair growth and stabilized in a new and better status. At this point patients’ rapid hair loss either stops or significantly slows down and the patient does not see hair grow as they initially saw within the first year, so they get disappointed and seek further help.

I like to leave at least 6 months to a year before starting a patient on the second medication and I also perform a miniaturization study before starting the second medication. This may give me some idea of the rate of growth with each of them. By starting one medication at a time, I know what medication is responsible for the good or bad changes. Also, if patient develops an allergy to one of these medications, it would be easier to find the culprit when you start them one at a time.

If you develop a contact allergy to minoxidil, it might be the result of the other chemicals in the solution and not the medication itself. You can switch between different versions of the same medication (i.e. minoxidil lotion vs. foam) to see whether you experience the same reaction or not with that particular product.