Dear Dr

I currently have a norwood 2.5 shape hairline with moderate recession at both sides. I have been using minoxidil for over a year and while there hasn’t been any regrowth, there has been a definite slowing down of recession. My hair is very thick at the forelock and all over the rest of my head so my question is:

Is it worth committing to propecia when less than ten percent see a benefit at the front hair line? From the studies i have read, minoxidil has as much chance if not more than propecia of making a difference at the hairline. I don’t want to commit to a drug with until i have to, and would prefer to wait and see whether my hair loss will extend to the crown or won’t, but would appreciate your advice.

Many thanks

Without actually seeing you and examining you, I can not tell you what to do. Your assumptions about minoxidil and where it works best, are not standard thinking… but if it works to slow down your frontal loss, that seems to be what you want.

Many Norwood class 3 balding patterns will evolve into a class 3V (which includes the crown). Finasteride is good at stopping or slowing crown loss if there is miniaturization present. You should see knowledgeable doctor who can do a bulk analysis on your scalp hair, because that measurement will determine if the process has started in the crown.

If you really care about the future of your hair, why not get a professional involved in helping you make intelligent decisions? Propecia could make a difference in at least preventing further loss, but taking that medication is going to be something a doctor will have to recommend after an examination.

Hello Dr. Rassman. First, a huge thank you for this great site. It is an island of real medical information amidst the sea of misinformation of hais loss.

I have a question I believe has not been asked before. Can the switch from finasteride to dutasteride cause catch up loss?

After 4 years on 1.25mg of finasteride, 3 months ago I added 2.5g of avodart daily for two months, lowering the dosage to 0,5g daily after that. I mantained finasteride for the first month of avodart and stopped taking it since about two months ago.

As of now I am experiencing massive shedding all over the scalp (including the sides and donor area), with the characteristic white bulb of a telogen effluvium. Could this shedding be catch up loss from not taking finasteride, causing permanent damage, or does avodart “picks up” that protection and is just normal shedding from switching medication? Is it reasonable to expect my hair to grow back? I discussed this with my doctor, but he simply does not have your knowledge. I returned with my daily 1,25 of finasteride a few days ago, just in case, and will maintain a low dose of avodart for extra dht suppression.

Thanks for your time!

Changing many factors makes an analysis extremely difficult. I haven’t heard of a switch between medications causing catch-up loss, but I’m not sure why you were taking both medications and changing doses so much. Did your doctor prescribe this method?

Since you’re going back to your finasteride routine that worked for you before, I’d give it some time to see what happens. I’m not sure why you experienced a massive shed, and it’s particularly troubling that it occurred in the back and sides of your scalp. If your doctor isn’t knowledgeable about treating hair loss, you should try to find one that does. You should have your scalp examined and baselines measured so that you can know for sure what any treatment is doing (good or bad).

I said this many times, and it may not be something you want to hear, but in the end your genetic predisposition will win out. It is really not about total DHT suppression.

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.

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.

Can you tell me if this could prevent minoxidil from working? Liquify the foam so you can apply it with a dropper. Fill the cap with foam. Hold the cap in a glass that’s filled with hot water. The foam will melt. Then apply with a dropper.

I do this because I get irritated by liquid Rogaine and I find that the foam doesn’t reach properly the scalp.

I haven’t heard of this being done before, but I’d think that this is a reasonable solution to your problem.