Hi Dr. Rassman,
I am 19 years old with no signs of hair loss but I have a family history of mild MPB (Dad has thinning in crown + vertex, no recession). I was just wondering if there was anyway starting Propecia now could worsen my hair. I understand that it doesn’t make sense to take a drug if there is no hair loss, but I’d rather not play catch up. Also, have you had patients where there is no recession but thinning on the top near the mid scalp + crown? Thanks!

Propecia (finasteride) is not something you take to prevent balding when you don’t have a diagnosis of androgenic alopecia. You don’t use an antibiotic when you are healthy to prevent getting an infection. You don’t take blood pressure lowering medication to prevent high blood pressure that you don’t have.

This is one of the many reasons that you need to see a doctor before starting medication. You should begin by finding a doctor who can examine your hair for possible miniaturization and/or bulk changes, and ONLY if you are diagnosed with androgenic alopecia can you consider taking Propecia.

This is not about catching up or waiting for hair loss to occur. It is about a medical process that is logical and safe for you.

Hi Dr. Rassman,

Firstly, thank you for your awesome blog, it’s a brilliant resource for hair loss sufferers.

About 2 months ago I started using liquid rogaine in the evening instead of foam (I still use foam in the mornings). I did this because my hair is relatively long and I felt that the foam was just going on my hair rather than my scalp. My hair has been shedding like crazy recently and I’m wondering if this could be due to the switch to liquid in the evenings?

I’m hoping that now more minoxidil is reaching my scalp it’s causing miniaturized hairs to fall out rather than the balding process accelerating. What do you think, could my theory have any credibility?

PS. I have been on proscar split in 1/4s for over a year.

Many thanks in advance.

I suppose it’s possible that you could have an allergy to something in the liquid that isn’t in the foam, but the active ingredient in both versions of Rogaine is 5% minoxidil. Some people notice increased shedding in the first couple of months, so continue using it and see what happens over time.

You should be managed by a competent, experienced hair doctor who uses the HairCheck device to accurately measure your hair bulk to see if you are losing hair. Once baseline measurements are made with this instrument, you can repeat it in a year to see what, if anything, changed.

I am a 22 year old male who has had thinning hair for almost 5 years and have got to a point where my quality of life has deteriorated, due to this I decided to take the plunge with propecia.I took my first dose of propecia yesterday at 0.25 mg and plan to take this twice a week, every Tuesday and Saturday, having read about success with this regime.

I know propecia only has a half life of 8-12 hours but it takes the body around a week to start creating the enzyme that creates DHT in the body and studies show that 0.25-0.5 mg has up to 80% success of 1.0 – 5.0mg. This is because I’m terrified of sides on propecia and also I would not be comfortable taking any medication every day of my life. I just wondered what you think of this regime?

When the Propecia (finasteride) studies were performed that eventually led to the medication’s FDA approval, various doses were tried. The 1mg dose gave the most consistent results for treating hair loss. Above the 1mg daily dose, the results were no better than the 1mg daily dose; however, below the 1mg dose, it was found to be less effective. In your case with taking a 1/4 dose only twice a week, the medication will be out of your system for days at a time, so the benefits might be fairly limited.

The side effects you are concerned about may happen, but statistically it is a small risk; however, I have found that the risk of sexual side effects increases in those young men who obsess over the possibility of having side effects, somewhat talking themselves into it. It is your call, of course.

Hi Dr. Rassman,
I have read about Propecia and you said to take it once daily no matter what time. I have been taking it for about 4 months now but I just realized I need to be taking it around the same time every day. I have been taking it at various times, 8 am all the way to 3 pm. Will this cause Propecia to have less of an effect?

As long as you take it daily, the time of the day will not matter.

I hope this is not a stupid question. I know in a perfect world no man would ever go bald and we would all have perfect hair. But, since its not the case and I know most men have some degree of hair loss as they age.

My question is regarding men who started balding when they were 18, but with the aide of finasteride it has been a really really slow balding process. Do you usually notice that these men, once they are in their 30’s, they are a norwood 2-2a and then when they are in theirs 40’s they are a norwood 3-3a and then in their 50’s they are a 5-5a and then 60’s either a 6 or 7?

It’s not a stupid question, but I think you’re confused about what the Norwood classifications are for. The Norwood chart (see below) classifies the final patterns of balding. By final, it generally means that there is no going back. Of interest, the patients with the most advanced pattern of balding (class 7) usually get there in their 20s and rarely show up becoming a Class 7 at the age of 60. Norwood classes are not a guideline for balding by age or decade.

Finasteride can slow the balding process and in very young men without advanced balding, it may reverse crown loss and occasionally even frontal loss (as it did in my son). The projections you did in your question is the work of a dreamer.

Dear Mr. Rassman,

Thank you for all the help you are providing the public. I am 23 years old and suffering from thinning hair. Unfortunately, we have limited options in Dubai. We have only one product of minoxidil 5% which is regaine, however, I develop scalp irritation from using it. A dermatologist asked me to try ordering rogaine foam from the US. He believes that the irritation was caused because regaine 5% is an alcoholic solution.

1) Do you think rogaine foam does not have alcohol? If yes, can you recommend any other product that contains minoxidil 5% but is not an alcoholic solution. Minoxidil is my only option and it is very important for me to find a way to avoid irritation.

2) I used the total daily dosage of regaine 5% at once a day, not twice as recommended. Do you think that is the reason for irritation?

3) I want to study whether regaine is effective with a microscope and taking pictures. How can I be sure that I am comparing the same spot with the same amount of zoom. For example, I zoomed a little and found 10 hairs in area A in the first month. I am worried that I might zoom less and find 12 hair counts after six months. Moreover, I might take a snap of another spot (beside the original one) in area A.

Thank you very much in advance.

1. Rogaine Foam does contain alcohol, but it is the propylene glycol that is generally what causes skin irritation in some people. Rogaine Foam doesn’t contain propylene glycol. If it is the alcohol that’s causing your irritation, unfortunately I’m not aware of any particular minoxidil currently sold with zero alcohol content. I have no way to know exactly what is causing your skin irritation, though.

2. Using it only once a day might just not be as effective as the recommended twice daily application, but I doubt the lesser dosage is what is causing your irritation. The irritation is probably from the propylene glycol in the Rogaine liquid, or perhaps an allergy to one of the other ingredients.

3. I suppose you could have a permanent dot the size of a pen mark tattooed on your scalp to be sure you have the exact spot monitored each time, but I think that’s a little overkill. The better way to go about this is to have a professional check the overall hair bulk using the HairCheck instrument, then recheck it again in a year to see if the numbers changed (increased bulk means you’re having more hair growth).