I’m 61 years old and have been using Rogaine for about 3 years. I have had positive results, but they recently have been leveling off as I still have some bare spots where my hair simply won’t grow. Could this be because the hair follicles have miniturized to the point where they have simply vanished?
I would need to map out your scalp for miniaturization to determine an answer to your question, but it is not unusual for minoxidil to level off on its value over time.
Hi. I just came home from seeing a new dermatologist. She said if I tested positive for AGA then she would prescribe Propecia as a hair loss treatment. Is this the right solution for a 33 year old female? I heard that it isn’t use in women. I thought the better course of action would be the combination of Yasmin and Spiro.
Also, I would like to know how safe is Rogaine for the long run (decades). I am very hesitant about taking anything orally that would play around with my hormones (Yasmine, Spiro., or Propecia). Thanks for your time. Much appreciated!
There is no really great, proven treatment for a typical female hair loss. Rogaine (minoxidil) is FDA approved to treat hair loss in women, but it doesn’t get to the root of the problem (no pun intended). Even if your hair loss is found to be androgenic alopecia, there are no studies to validate that any treatment really works for women. In other words, there really isn’t a better course of action.
In theory Yasmin (drospirenone and ethinyl estradiol) and spironolactone should work for treating hair loss in women, but that is not always the case. Yasmin and spironolactone are not FDA approved treatments for androgenic alopecia, and I would be particularly cautious about starting Propecia (finasteride), as it is not FDA approved for women due to a risk of pregnancy complications (birth defects) and other unknown hormonal issues. While many doctors do use these medications for certain women with some benefit, they are not for everyone. The best advice is to be closely followed by a physician or get a second opinion (this does not count as a second opinion — I am not your doctor).
It is safe to use Rogaine for a long period of time, but follow the instructions. It is a topical medication and many patients have been using it for decades.
Dear Dr. Rassman,
I’m a 55 year old male in good health with the exception of being a type 1 diabetic. I have been using propecia and rogaine for 10 years with very good results and have maintained almost all of what I started with.Here’s my question. My hair is thin at the nape of my neck. I can pull on it and 5 or 10 hairs will come out each time. I don’t think I have DUPA because I cannot see any change in my crown,vertex or hairline. I have read on your site that this type of loss is genetic. I know you prefer not to diagnose online but could the diabetes have anything to do with it? my A1c is 7.5 to 8.0 which I know is an the high side – Thanks
I doubt that the diabetes is causing your neck hair loss. I have seen men over the years (in airports, on the streets, in shopping centers, etc) who have lost just their neck hair and not their scalp hair, so I believe that this is a genetic trait in these men. I suspect that the number of hair cycles your neck hair has is limited and those hairs develop apoptosis (meaning that they have reached the end of their lifetime); if this is the case, there’s not much you can do. Perhaps applying minoxidil to the area will cause new hair growth? Also, I agree with you — it doesn’t sound like it is DUPA if it is limited to the nape.
New study showing heavy alcohol usage blocked effects of finasteride (half way down page): Prostate cancer and alcohol
The link has quick paragraphs about a variety of topics, but here’s the relevant info from the page (the bold emphasis added was mine) —
This is interesting, but it doesn’t necessarily prove that heavy drinking blocks finasteride effectiveness. Heavy drinking (4+ drinks a day) in itself can cause higher grade cancer. It should go without saying, but heavy drinking is not good in any case. If there is indeed an association with finasteride not working when you drink heavily, I would say it is a good idea to limit your alcohol intake!
Hi,
Can someone have shedding after increasing the dose of propecia? I’m 22 years old started losing hair 2.5 years ago, a year ago I started taking proscar pills cut in quarters, hair loss continued but it may have slowed down a little bit, about 3 months ago I started taking proscar pills cut in half, and since then my hair loss increased a lot and I lost hair much faster than before, so could it be shedding from increasing propecia dose?thank you
When finasteride is taken and is effective, it can accelerate the hair cycle and can give you temporary hair loss. We have seen this rarely in people who start the drug and it often disappears in 2-3 months. I would guess (although I have not seen it) that the same phenomenon can be observed if the increased dose was working on you. It should abate in 2-3 months.
Doctor,
I’m a 29 male in good health who has been taking avodart daily for ~5 years and took propecia for four years before that. I recently had a sperm analysis done along with my physical as I was concerned about potential risks associated with avodart. The results that came back were positive in the sense that my sperm count was in a normal range. My question is can you recommend any other tests that I could take to monitor my fertility while on avodart?
I do not specialize in male fertility, but if the sperm have a normal count and a normal motility, I would expect that there is no problem with it. I would pose this question to your primary doctor or better yet, a fertility specialist. This is beyond my scope of knowledge.
I was stupid and took steroids for a little while to improve the results in the gym. I realised I was being very stupid and doing harm to my body and have stopped. I have been taking Proscar (finasteride) before, during and after taking steroids to try and slow down going bald but with just ok results. While I was taking the steroids I was getting spots on my head. Since I stopped these spots did not go away and I went to my doctor and got Tetralysa l (Lymecycline) to take to help with the spots. This has helped somewhat but I am losing more hair now than I have done in a long time. Do you think the Tetralysal is affecting the Proscar or is it possible that I have some infection in my scalp that may be affecting the Proscar from working?
I would really appreciate any help you can give me. Thanking You
You said you’re already taking Proscar, but is it the full 5mg pill or did you cut the pill to take a smaller dosage? 1mg is recommended for treating genetic hair loss, but I have no idea how much you’re taking or how long you’ve been on it. Keep in mind genetic balding is lifelong and it will progress to a certain pattern. Finasteride is not necessarily a cure, though it does slow down the loss dramatically in many men. I doubt lymecycline has anything to do with finasteride.
Lymecycline is an antibiotic used to treat infections and sometimes acne. I am not sure why lymecycline was prescribed for you. You need to ask your doctor what your diagnosis is and what you are being treated for. Until then, you are approaching your problem backwards! Find out what you have first! Perhaps you’re seeing a temporary stress loss unrelated to any medication you took. Perhaps you do have an infection and that is why you were prescribed lymecycline. Perhaps, perhaps, perhaps. There’s much I do now know about your situation that would make it impossible for me to provide much more help without typing up a page of random guesses.
Hi,
I understand that Rogaine may cause initial shedding, but I’m concerned that mine is going on longer than it should– 2.5 months. At first I had some minor thinning on the crown and minor receding at the temples (my friends think I’m crazy, but I saw a dermatologist who noticed thinning), but not really anywhere else. After following her advice to take Rogaine, my hairline (not just the temples) has receded some, and all of the hair on top of my head is thinner, to the point that I can see scalp, which I never could before. At this point, should I discontinue Rogaine, or try to stick it out for a few more months?
Thanks
I can’t tell you what you should do with medication, but I can tell you that shedding from Rogaine (minoxidil) may last up to 3 months. You have a dermatologist and I would ask her that question, as she has the advantage of being able to examine you.
I am recently diagnosed with ckd (kidney disease) stage 2 (mild one). i was on topical minoxidil for almost 4 years but i stopped after my knowing about my ckd. is it possible that minoxidil cause ckd within this 4 years? And can i use minoxidil 5% again or it is dangerous for progression of my kidney problem ?? does minoxidil worsen kidney problems?? I also take propecia for almost 2 years.
A precaution in the literature for minoxidil states, “Tell your doctor your medical history, especially of: heart problems, kidney problems, liver problems, other scalp conditions, allergies (especially drug allergies).” This is a question you need to discuss with the doctor treating your kidney disease.
Minoxidil is an antihypertensive medication, which means it can reduce your blood pressure when given orally or when absorbed through your skin in substantial doses. Generally, lowering high blood pressure helps to prevent kidney problems, but that connection between blood pressure and kidney function is what you need to discuss with your doctor.
Hello Doctor Rassman!
Huge Balding Blog fan here! Have you considered selling official ‘Balding Blog’ T-shirts? Regardless, my wife thinks it’s nuts I have this site bookmarked, but it’s an invaluable resource!
My question is this:
I’ve switched from Merck Propecia (1mg) to generic Teva Finasteride (5mg). When I cut the pill into 1/4 (1.25mg), I get a fair amount of powder that comes out of the pill. Undoubtedly, when I put the pill into my mouth, my saliva would break down some finasteride. I guess my worry is that by splitting the pill, exposing the white powder, and swallowing is resulting in poor absorption.
A picture of the pill is here: photo
What are your thoughts?
Thanks!
Thank you for following the site. We played with the idea of selling BaldingBlog shirts, but the idea never took off simply because we really didn’t think anyone would buy them.
Splitting the 5mg finasteride pill in quarters should not have any clinical significance on absorption or effectiveness. My Propecia drug representative from Merck has raised this question before, but there are conflict of interests there as you may guess.
Hi. I am a 32 year old female who has been experiencing hair loss every six months for the last two years. Every time my dermatologist or GP would prescribe Fluocinonide Topical Solution (.05%). The shedding would stop about 2 months later. However, 5 months later the shedding would start up again. I had some blood work done, but they came back normal. Can you tell me what is going on?
Also, can you recommend a hair loss expert/dermatologist in Orange County? I would like some answers.
Thank you so much for taking the time out of your busy day to answer my questions.
This may be a jaded perspective and opinion, so be forewarned…
Hair loss for women can be a very frustrating condition to treat and diagnose for physicians. Miniaturization studies will show the status of the hair, thinning possibly in some areas. The doctors are under pressure to be proactive and to provide some form of treatment to the distraught patient even if they are not losing hair. If a doctor prescribes a harmless treatment that does not really have any clinical basis or proven results, is the doctor being honest? Treating hair loss with a corticosteroid (anti-inflammatory drug) such as fluocinonide would mean that there may be some inflammatory process going on behind the hair loss, but even without the use of such drug it is more likely the shedding would have stopped in a few months time. Hair loss can be cyclical in women. Oh… and don’t discount the power of the placebo effect.
I would think that if you have some sort of an inflammatory cause of hair loss (that is responding to fluocinonide) you would need a scalp biopsy to make the diagnosis. Any GP or dermatologist would be able to do that. Be forewarned that a biopsy would leave you with a small bald spot.
hi dr,
just had a few questions about propecia and why its peek results are reached at 2 years. is it possible that it could continue the de-miniaturization process beyond that point for a young man such as myself at 21? i began taking it at an early 20. thank you for this informative blog and your response in advance.
We don’t know why results from Propecia (finasteride 1mg) peaks at the first 1 to 2 years, but it is an observation many doctors and patients have made. With that said, it does not mean the medication stops working or is less effective after that time frame.
For the few who see more balding after years on Propecia, I have been advising that they consider increasing the dose to 2mg daily provided that there are no sexual side effects. Of those whom I’ve given this recommendation, none have reported sexual side effects. Please remember, I’m not your doctor and I’m not recommending this to anyone here.
Hello. I noticed that I started thinning at the top of my head when I was about 23-24 years old. I lost quite a bit of hair but still had a reasonably decent amount of hair left. I am now almost 28 and have not really lost any more hair but haven’t really regrown it either. I have started Propecia to prevent any further loss but I was wondering if I have waited too long for any regrowth to happen. If my hair stays like this it’s ok but I do feel a little bitter at myself for not starting propecia earlier.
I would follow up with the doctor you are receiving Propecia from and get a good documentation of your current state of hair. This may be in the form of a photograph… or better yet, a miniaturization study to get an estimate of the percentage of miniaturization on certain areas of your scalp. Then you can judge if Propecia is worthwhile or at the least keep track of the hair loss progression. Lets try to take a scientific approach! Regrowth isn’t guaranteed for anyone taking the medication (some will just see the hair loss halt), so I wouldn’t beat yourself up about it.
Hi Doc,
Thank you for this site, it is a source of valuable info for a lot of people including me. Keep up the good work.My question is, can tongkat ali affect the effectiveness of finasteride (Proscar) in stopping hair loss? I read that tongkat ali is a natural testosterone enhancer and can benefit the person using it with stronger libido, sexual performance enhancer, and can promote good physical well being. Will it make the finasteride less effective? According to some research it has not found any baldness side effect for people using tongkat ali. Thank you and more power to your work.
I’ve got no experience with this herbal, also known as eurycoma longifolia, so I turned to the internet for some info. According to this page, tongkat ali requires DHT to boost the libido, and finasteride blocks DHT. Therefore, you should not take both at the same time if you want the tongkat ali to work and if what I read on that site is actually true.
I don’t know if it’ll make finasteride less effective, but it seems that the finasteride would make the tongkat ali ineffective.
Dear Doctor. Thank you for this blog. It has helped me so many times!
I was wondering…Im only 21 and I’m already beginning to loose my hair. Actually my hair loss already began in the age of 19. But I was looking at some old pictures of dad when he was about 33-35 years old, and his baldness first kicked in around the age of 36. I really dont understand why I’m already beginning to loose my hair? Is it just bad luck, because you can’t look at your dad and foreseen when your hair loss will start? I was just thinking that 15 years is a lot before my dad’s hair loss started! Can there be another reason to my hair loss besides genes? I’m in good shape and I’m eating healty. I can litterly “pull” oyt my hair when strokeing my fingers trough it. Or when I’m washing it my hands are full hair. Thank you for your time!
Best regards
The most common cause of hair loss in young men is genetic. There could be other causes, but it is much more likely that it is your genes. The fact that there is hair loss in the family tree helps, but you won’t necessarily follow the exact same timeline of loss as your father.
A direct examination of your scalp with mapping for miniaturization will tell you the diagnosis. Then if you are positive for genetic hair loss, Propecia is a great (prescription-only) drug taken daily to address the loss problem as it will slow down the loss, possibly stop it, and if you really lost hair it might even reverse it at your age. See a good doctor.