Using Minoxidil Once Every Other Day

/by William Rassman, M.D./1 /

Hi,
I am a 24 year old male and have begun the early stages of MPB. My doctor has prescribed Minoxidil 5% and I know your suppose to apply it twice a day but that doesn’t really fit into my schedule, so I have only been applying it about once every other day. My question is, is there any harm that can be done applying 5% Minoxidil once every other day or is it simpy not as effective as using it twice everyday? Thanks.

RogaineYou shouldn’t need a prescription for minoxidil 5% topical for use in treating hair loss, as it is available over the counter (at least in the U.S., though I can’t say for sure in other countries).

The recommended dose as you know is applying it twice a day. There is no harm is using it once every other day, but you will not be using it the way it is recommended and you may not get any benefit from infrequent use. I suspect poor compliance and/or not following the recommended directions are the main reasons why patients give up using minoxidil, because they don’t see a benefit.

Tags: minoxidil, rogaine, regaine, hairloss, hair loss

I’ve Seen Improvement from Propecia, But Can I Cut the Dose in Half?

/by William Rassman, M.D./0 /

Hi Docs,

My question is about propecia. I’ve been taking the med for about a year and a half and have seen some nice improvement in the crown and im sure it’s doing the rest of my hair some good.

I’ve been off of the pill for a week. I’m planning to go back on asap but i was wondering if i would maintain these great results if i were to only take half of the dose each day?

Thank you!

The recommended dose for treating hair loss is 1mg finasteride per day, which is what you were taking. If 1mg (Propecia) is working for you, why would you want to change the dose? I would expect that if you cut the dose in half to 0.5mg you may see some continued benefit, but you will run the risk of losing the crown improvement you currently enjoy.

If cost is the reason you’re considering a lesser dose, then you can ask your physician for a prescription of the 5mg finasteride (available in generic form, which works out to about $70 for a year supply) and cut it up into 4 pieces, taking one piece each day. Ideally you should cut it is in 5 pieces, but cutting a small round pill into 5 equal pieces is very difficult. Cut only one pill at a time and store it where moisture won’t get to it (and out of the reach of children, pregnant women, and women that could become pregnant).

There is no generic 1mg finasteride legally sold in the US due to U.S. Patent protection until 2013. There should be no difference in the 5mg generic and 1mg brand name medication other than the cost and having to cut the pill.

Tags: propecia, finasteride, proscar, hairloss, hair loss, generic, medication

Family History Shows Men Losing Hair Later, So Why Am I Losing Hair at 19?

/by William Rassman, M.D./0 /, ,

My father start to lose his hair at 45 and my uncle at 35-40, and no grandfather have hairloss problem. I have 21 now and for 2 years i’m fighting to keep my hair with avodart, kirkland and some vitamins named forcapil, but this seems that not work very well for me. Why i begin to lose my hair at 19 if my father start to lose at 45. I can make something else for my hair?

ForcapilFamily patterns do not necessarily follow either by the degree of balding or the onset of balding. Sometimes they can be used as a guideline, but it’s not a guarantee. So why did you start losing hair at 19 years old? I guess you can attribute it to bad luck.

You’re young with early hair loss and you’re using multiple treatments. Let’s break down your regimen:

Avodart (dutasteride) — I assume you don’t have a prescription, as I’d expect most doctors would not prescribe this strong prostate medication to a 19 year old with early hair loss. Avodart is not approved to treat hair loss at this time. Although there is evidence it works to treat genetic hair loss, most doctors would not be comfortable prescribing this until at least dosing and safety data is available. If you do have a prescription, you should be talking to your doctor about this.

Minoxidil (I believe this is what you meant by Kirkland) — This is fine, but I don’t know if you’re following the dosing instructions. Apply it twice a day to the area that you’re losing hair. If you’re losing hair in the frontal hairline, it probably won’t be much help there.

Forcapil (vitamin supplement) — Their site describes it as a “special formula combining vitamin B complex, sulfurated amino acids, zinc and vitamin D3“… which means if you’re taking it with hopes of regrowing your hair this is probably a waste of time and money. I hadn’t heard of Forcapil before, but it appears to be made by a French pharmaceutical company and not sold in the US. I found the dosing instructions are to take 6 pills a day for the first 2 weeks, then 2 pills a day for the next 6 weeks… so I hope you enjoy taking pills.

Tags: hairloss, hair loss, dutasteride, avodart, forcapil, vitamins, supplement, minoxidil, age

Anastrozole and Propecia

/by William Rassman, M.D./0 /

Hi doc! Thank you for your excellent and informative blog! I’ve been hearing things recently about using the very potent aromatase inhibitor anastrozole to prevent the ‘estrogenic’ side effects of finasteride. Anastrozole drastically reduces estrogen levels in men and, unsurprisingly, raises free testosterone as well. Would you be comfortable with one of your patients adding anastrozole (‘Arimidex’) to his propecia regimen, or would you see this is opening up a whole other ‘can of worms’, and potentially serious side effects?

ArimidexArimidex (anastrozole) is a anti-breast cancer medication for post menopausal women. There are no clinical trials in men. You would basically be experimenting with your body without any knowledge of the consequences. I would recommend against this. Especially since I’ve seen the complaints/worries people have about side effects from Propecia, you would be just adding fuel to the fire.

According to the Arimidex website, some of the most common side effects seen with the drug include, “hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache”. Also, a less common side effect of Arimidex is hair loss.

Tags: anastrozole, arimidex, propecia, finasteride, hairloss, hair loss

I’m Worried About Initial Shedding from Finasteride

/by William Rassman, M.D./1 /,

Hi there,

Thanks for this blog it really is so helpful to many of us! I am 24 and definitely going bald, all the men in my family on both sides have MPB. Although I am going bald, at the moment I am hiding it pretty well with what I have but it’s getting to the point where I can’t hide it any longer, so I plan on going on Finasteride in the hope I can conserve what I have.

My only concern is that I have heard some awful stories about Finasteride actually causing an initial shed, or at least worsening the hair loss before it makes it better. In your experience have you encountered this with patients? Although I am determined to put a stop to it I would be devastated if taking Finasteride made my problem rapidly worse even if it would help in the long run.

Thanks for your time.

I have not seen patients in my practice who shed hair after starting Propecia (finasteride), though I have seen patients who shed initially after starting Rogaine (minoxidil). I’ve also seen patients who continue to lose hair while on Propecia, but it may just be regular genetic balding that is outpacing the medication itself. I really haven’t seen a case where someone has accelerated hair loss after starting Propecia. Either way, both medications do help most men in treating their hair loss.

If you are worried about these issues, please discuss them to your prescribing doctor. When you take ANY medication or partake in ANY medical treatment, you need to consider the risks and benefits and understand why and what you are treating. Just being scared will not solve any problem without a good solid assessment of what you are trying to do.

Here are some recent past replies about finasteride shedding, if you’re curious:

Tags: propecia, finasteride, minoxidil, rogaine, hairloss, hair loss, shedding

Finasteride Prevents a Quarter of Prostate Cancers from Developing?

/by William Rassman, M.D./0 /,

Greetings Dr. Rassman,

I am a very happy patient of yours. (Background: I’ve had two procedures and am taking Propecia.)

I wanted to pass along the information below. Perhaps it would be useful for your blog. I was flying the other day, and in the airline magazine, there was an article on preventing cancer that mentioned finasteride: “Dr. Peter Greenwald, director of the Division of Cancer Prevention at the National Cancer Institute in Bethesda, Md., notes that the drug finasteride could prevent about a quarter of prostate cancers from ever developing.”

Full Article: Pursuing Prevention

Best regards

Thanks for sending this. The information about finasteride reducing the incidence of certain prostate cancers is correct, but that study is based on taking 5mg of finasteride daily (Proscar, a prostate treatment). I’ve actually been writing about this for years. Propecia is 1mg finasteride and you cannot establish an exact parallel, but the inference is there.

Many experts, however, feel that the 1mg dose may have the same impact as the 5mg dose, but without proof, one can not state this as a fact. The reference to Dr. Peter Greenwald is correctly stated, but the dose was not in the quote offered.

Tags: prostate cancer, propecia, finasteride, proscar, cancer, hairloss, hair loss

I Upped My Finasteride Dosage and My Hair Loss Stopped Drastically

/by William Rassman, M.D./0 /

Dear Dr. Rassman,

I understand the debate regarding the appropriate dosage of finasteride to be taken seems to have no end. I am currently taking 2.5mg (half proscar since 3 years ago where Propecia stopped working as well), so far so good. I would not say propecia stopped responding, but more of my genetics are catching up. Anyway, by upping to 2.5mg , hairloss has stopped drastically but still very gradually.

My conclusion is that, any amount of finasteride is better than none when it comes to fighting hair loss. And according to scientific results, 1mg vs 5mg has similar effects on hair loss prevention. Therefore 2.5mg should be a safe and worth-trying dosage provided no major side-effects are present. Hence, I think its ok to recommend to people who has stopped responding well to propecia to try 2.5mg (half proscar), even though there is no guarantee that it might work better – ultimately, any finasteride is better than none?

Thank you for your thoughts. In general, more does not necessarily mean better and the recommended dose of finasteride for the treatment of male pattern balding is 1mg a day. As always, please discuss your treatment options with your prescribing physician.

Tags: finasteride, propecia, proscar, hairloss, hair loss

Shouldn’t Finasteride Have Made a Dramatic Difference in 6 Months?

/by William Rassman, M.D./0 /

Hi Dr. Rassman,

I first noticed a thinning of my frontal hair around April of last year. I am 26 years old Asian male. Hair growth slowed down and the front half of my scalp started to feel thinner than the rear.

In January this year, my dermatologist confirmed presence of early MBP and prescribed me finasteride (Proscar quartered daily). At that time I also started to use Minoxidil 5% nightly. It is now mid-June and I feel like I am still thinning rapidly. The frontal thinning is becoming visible now and I feel all the hairs on the top of my head have gotten much softer than the sides and back, which I suspect is because of miniaturization and the hairs growing thinner.

Its been almost six months. Shouldn’t finasteride have made a dramatic difference by now? Is there no hope? At this rate, I will be bald before I’m 30 and it’s a very, very, very saddening and scary prospect.

How long does finasteride take to show its effects visibly in the hair? I would be happy just to see this hair thinning halt and stabilize.

Here’s a graphic I grabbed directly from Propecia.com that might help —

Propecia timeline

 

So really, the value of finasteride takes at least a year to see, and I’d say the full benefits may take 2 years to see. Some people might see less hair loss around the 6 month mark, but hair grows out at 1/2 inch per month… so after 6 months the hair that is 3 inches long will have just started to be exposed to the drug when it was formed.

Please understand these facts:

  1. There is no cure for genetic male pattern hair loss. Medications such as Propecia (finasteride) and Rogaine (minoxidil) help, but neither will stop hair loss completely or forever. For some men the medications can dramatically slow the progress, but eventually your genetic predispositions will win out.
  2. The front hairline is very difficult to treat with medication alone, as Propecia and Rogaine are not officially recommended for that area since it really doesn’t seem to help in clinical studies. Many patients still use these medications in hopes they’ll help that area a bit, and in some patients it may actually help to some degree.
Tags: finasteride, propecia, hairloss, hair loss, minoxidil, medication

I’ve Taken Propecia for Years, But Now I’m Afraid

/by William Rassman, M.D./1 /,

I have been on propecia for 4 years prior to a procedure. The medication was working very well and I was holding on to most of my miniaturized hair until the procedure shocked all of it out and basically voided any benefit and progress that the medication provided me.

Since my terrible experience with this surgery, I have been doing so much research and have come across horrible side effects of propecia that I previously was not aware of…ED, breast enlargement, etc…. This has scared me so bad and is adding to my stress level which I am trying to control. I have not experienced ED up to this point, but not sure about the other…..have you seen these side effects in others and how often?

My question is that do you think (in your general experience) since most of my hair has been lost because of surgery that the propecia is not really necessary now? I just want to get off it and not take any more risks….

PropeciaSo you took Propecia for years (including follow-up visits and prescription renewals) and somehow were never informed of any side effect potential, nor did you even read the insert that comes with the medication? If you have not had any side effects after 4 years, it would be unlikely that you will experience them now or at any time. I believe erectile dysfunction risks are about 1%, libido decrease 1%, breast enlargement much less than 1%. You should be in discussion with your prescribing doctor, not me over the internet.

Just because you had the surgery doesn’t mean Propecia is unnecessary. I don’t know where your surgery was on your scalp, but let’s assume it was done in the hairline and Propecia has kept the crown. Stopping the Propecia would just create a need for further procedures, as the hair that Propecia kept would soon be gone. Obviously this is just an example as I have no idea about your case or history, but if you stop the medication all the benefits disappear within a year.

With regard to the shock loss you experienced following your procedure, this is highly unusual in patients that are taking Propecia. I would have to know more about you, examine you, and understand just what happened and when.

Tags: propecia, finasteride, shock loss, hairloss, hair loss, hair transplant

Using Mesotherapy in Treating Hair Loss?

/by William Rassman, M.D./0 /,

Hi Dr. Rassman,

First of all I want to congratulate for the beautiful book you have written (Hair Loss & Replacement for Dummies). I am a practicing dermatologist and am also working with a well known hair transplant surgeon in Hyderabad, India. I have a query regarding the benefits of mesotherapy. Where in the drugs include minoxidil, biotin, dexpanthenol and bilobine, since the drug is injected into the mesoderm where as the follicle is in mid dermis, are we justified in giving this treatment to the needy in the hope of achieving results? Since you are a pioneer in hair restoration i would be greatful to have you throw some light in this regard and clear my doubt.

Thanking you in anticipation.

I’ve speculated about mesotherapy before, and I still don’t know much about possible benefits, if any, to give you an opinion. On random occasions, I have seen patients who have had these treatments, and Dr. Jae Pak has also visited the NHI office in Korea where it seems to be popular adjunct (as a culture).

That being said, there are no definitive or enthusiastic findings about mesotherapy as a hair loss treatment that I am aware of.

Tags: mesotherapy, hairloss, hair loss

Why So Adamant About 1mg Finasteride Daily?

/by William Rassman, M.D./2 /

Hi Dr. Rassman,

Dr. Jerry Cooley in North Carolina has said that taking Propecia three times a week is a practical dosage, and that most of his patients are on that dosage with good results. I’ve read a lot of your responses about reducing Propecia dosage and you are very adamant about the 1 mg/1 pill a day dosage and not any less.

I don’t want to put you in a tough position but in all fairness, it seems quite reasonable to think that Dr. Cooley is making a valid point. Why not jump on the wagon and start advocating the same thing? The more and more I think about it, the more and more it seems like Merck has got you secretly locked in to a deal with them. Frankly, Dr Cooley has made a believer out of me. Even my doctor in Korea has me on Propecia four times a week and he told me that three times a week is also good. I have some minor side effects, not of the sexual nature but for me it’s the dark circles. I’m curious to see if going on 3mg a week EOD will help get rid of my problem. And if so, would you care to know about it?

Here is the link to what I read: Regrowhair.com

Thank you kindly

Tin foil hatDear conspiracy theorists all over the internet:

I advise and treat my patients based on standard medical practices and recommendations. I have no loyalties to Merck, other drug companies, or bandwagons. In fact, Merck probably does not like me so much, because I have no problem telling patients and readers of this site about the generic finasteride that ends up costing about $70 a year, instead of $90 a month for the name brand.

Our goal here on BaldingBlog, as well as in our private practice, is to empower patients with education. If you search enough through this site, you can see that we have been pretty consistent with this over the years.

Last time I checked, the standard recommended dose of finasteride for treating androgenic alopecia is 1mg a day. I realize some doctors prescribe different doses to their patients and rightfully so (because they have a medical license to treat their patients). I also realize there have been studies that support taking less than 1mg finasteride a day. In fact, some of my patients do take less than 1mg of finasteride a day… and *gasp* some of my patients take more than 1mg of finasteride a day. Each patient is unique and with different circumstances.

In general for most of my patients, I prescribe 1mg finasteride a day because as I said, that is the general recommended dose for androgenic alopecia supported by research.

Anyone interested in treating their hair loss needs to see their doctor, discuss treatment options and dosing of medications, and go by what their doctor recommends. I am only here on this site to give general information, not medical advice. You have every right to agree or disagree with my views, but this is my site and these are my views.

Tags: hairloss, hair loss, finasteride, propecia, proscar, merck

Does Dr Rassman Use Styling Gel?

/by William Rassman, M.D./0 /,

Hello Dr Rassman,
Just some curious questions about yourself… what brand name shampoo do you use and how often do you wash your hair? Do you take propecia? Gel for styling? Have you ever had a hair transplant? Just wanted to know how the “Master of Hair” keeps its hair.

Thanks

Lightning handsI think “Master of Hair” sounds more like someone that can make hair grow by shooting lightning from his hands, but I appreciate the compliment nonetheless. As for my hair history:

Shampoo: I use a series of shampoos, but I don’t focus on any brand in particular.

Propecia: I don’t take it anymore, but I explain that in this post.

Gel: Recently, when I had my hair cut a little shorter than normal I found it was more difficult to manage, so I occasionally used styling gels.

Hair transplant: My entire crown was bald and I received 1600 grafts to fill it in (see this post for a photo and more complete description).

Tags: propecia, rassman, gel, styling, hairloss, hair loss, shampoo

Did Propecia Make Me Irritable?

/by William Rassman, M.D./0 /

Doc..I am a pharmacist..37 y/o male..I was started on propecia approx 2 weeks ago and noticed that I have become moody and irritable. do your patients complain of similar sx? is this common? does it resolve or should i consider stopping? thanks

PharmacistYou are a pharmacist, so your post-graduate training has been the study of drugs. You do not need me to tell you about side effects and how Propecia works. In fact, you are one of the rare few that can read the entire drug profile insert that came with the medication and actually understand it!

If you are asking me if I have personally seen anyone with your complaints at my private practice, I would say yes, on rare occasions people have discussed personality changes with me and mood swings. This is not a common complaint, and I don’t have information about whether it goes away or not. If you do enough research on the Internet to see if people have complained about your possible symptoms, I am sure you will find it.

I have come across a Neuroendocrine Physician, Dr. Alan Jacobs, and he wrote an interesting blog post on his site that you may wish to read.

Tags: propecia, finasteride, irritable, mood swing, hairloss hair loss

Is the FDA Not Investigating Male Breast Cancer and Finasteride Links?

/by William Rassman, M.D./0 /,

Dear Drs,

What’s the incidence been of people using finasrteride to treat hair loss getting male breast cancer? I heard it’s high and that the FDA is not investigating it.

For people not wanting to take oral medication for hair loss, is there any other “gold standard” approach? Like minoxidil with alzeic acid or the like…

Finally, what’s your take on caffeine and soy protein (said to create a substance that stops DHT from being made).

Instead of focusing on lowering DHT levels, hasn’t there been research into stopping the hair follicle from reacting to DHT? I’m assuming the DHT was always there and then the hair follicle got programmed to be ruined by it, or does the DHT increase as a sign of aging.

Many thanks

Huh? I don’t know where you heard the incidence of breast cancer from finasteride is high, but I’ll assume it’s F.U.D. as I’ve never seen any published medical studies showing that. I am not aware of any existing studies designed to connect breast cancer and finasteride. The FDA just announced they’re investigating finasteride and dutasteride (5-alpha reductase medications) in relation to breast cancer risks, but the probe just began .

Unfortunately, there is no “gold standard” medication for treating hair loss other than DHT blocking with finasteride. Minoxidil works, but the results are mixed.

There is no scientific proof of a connection between caffeine and soy protein and hair loss.

Finasteride is a competitive inhibitor for 5-alpha reductase and as such will compete with DHT at the hair follicle level.

Tags: finasteride, propecia, avodart, dutasteride, hairloss, hair loss, fda, cancer, breast cancer

Best Way to Store Finasteride in a Humid Climate?

/by William Rassman, M.D./0 /

Doc,

It’s hot and humid outside! what’s the best way to store your generic finasteride in these hot months? I keep it in a drawer away from light and try to keep my non AC room as cool as possible. Thanks a lot!

I would say store it in the bottle it comes in, and only cut one 5mg pill at a time. The situation you describe sounds reasonable for many people. It sounds like you’re doing the right thing in terms of medication storage. I doubt there would be any problem with the finasteride effectiveness if it is kept in a drawer with limited light and kept as cool in the room as possible.

Here’s some more tips on storing medication.

Tags: finasteride, propecia, storage, temperature, humidity