Hey doc, been using Propecia for 2 1/2 years its slowed things down a lot, just added Rogaine Foam last week. Just wondering if I can get a straight answer on the effectiveness of Rogaine Foam. The commercial says 85% of men see regrowth, ive heard other people say it only works for 50% of men and then I saw a post from you in your archive where you say it only works well for 15% of men. Well which one is it?

We are prisoners of our words, so I will stick to what I said.

If you are in the 15% of good responders, then it moves you into the 100% category (playing with numbers, or course). Some people feel that the Rogaine Foam works better than standard liquid Rogaine drops, because it is easier to use and thus better for those who find the drops difficult to titrate. If there are 85% of men that see some growth, I’d estimate that maybe 15% of men see it work very well.

I’ve received a few emails directing me to the a publication in the New England Journal of Medicine from last month regarding finasteride, dutasteride, and prostate cancer reduction. We’ve written about this issue here and specifically, albeit briefly, about this NEJM piece here. So I’ll take the opportunity to highlight it again, since people are still finding their way to the article.

The authors’ take on the relationship between the use of these drugs (finasteride and dutasteride) and the risk/benefit relationship on prostate cancer concluded that the original reports of a cancer reduction in the studied men (about 10,000 men who received finasteride 5mg dose) showed that the lower risk was found only in men with low grade cancers. If men had a high grade cancer, they felt that there would be no benefit to taking these drugs and suggested a possible harmful risk that is clearly ill-defined at this time. On the basis of this conclusion, the use of finasteride or dutasteride as a preventative medication for prostate cancer is claimed not to be justified.

The FDA came out echoing this sentiment. It appears that “the labels of approved 5α-reductase inhibitors, which are currently indicated for the treatment of symptomatic benign prostatic hyperplasia and male-pattern hair loss, have been modified to include the observation of high-grade prostate cancers” found in the relevant trials.

I am sure that one result of this formal, official FDA change in position is that some men will consider abandoning the use of these drugs. I will be attending the annual ISHRS physician meeting in September, where this subject will be discussed amongst many doctors who are concerned about this announcement. I’ll be curious to learn about patient reactions to the FDA’s position.

I am in my early twenties and am in Type II of my hair loss. I started losing here about 2-3 years ago and in the past year it is becoming quite noticeable, i am losing hair at a faster rate then ever and am concerned that I will end up like my father (type 6). I have been staying away from Propecia and Rogaine due to their irreversible side effects concerning sexual dysfunction. Is there no viable alternative other than hair transplant for me?

Nope.

Side effects are not proven irreversible from Rogaine and Propecia, but if you don’t want to try either of the two FDA approved hair loss medications, that is your choice. Unfortunately, hair transplantation is the only permanent solution at this point if you do not want to manage your balding problem with medication.

Does finasteride thicken up hair shafts DURING the growth phase, or (with good results of course) does it thicken up only when a new cycle begins?

I do not have a definite answer to your question, but I can venture a guess. As the usual hair cycle is over 2 years in most men and we see benefits from Propecia in 8-12 months, I would guess that as the hair shaft emerges from its source, the shaft thickens. Of course, as the hair growth above the skin grows at about 1/2 inch per month, I would expect that the thickening of the hair shaft starts quickly and increases over time.

All miniaturized hairs are not equal. Let’s say that the shafts that have lost 90% of their bulk will be slower to benefit (if they benefit at all) than those miniaturized hairs which have lost 20% of their bulk. The impact on new hair should be better if these new hairs are healthy ‘terminal’ hairs that have considerable life left in them. When I see patients for follow-up examinations and comparison studies, I see that there are less miniaturized hairs and more of thicker shaft hairs, and as we use the bulk analysis instrument on more patients, the answer to your questions will be much more clear.

I think you have a great question from a scientific perspective. I wish there was a time lapse photo of a hair shaft under the influence of Propecia (or even Rogaine).