Hello Dr. Rassman,

So I have several questions. Firstly, I read somewhere that if the scalp is wet upon application of Minoxidil, that the Minoxidil would be absorbed better achieving better/faster results. I’m a little skeptical of this. Is this true?

Secondly, if I apply the Minoxidil before I blow dry my hair, how long should I wait to blow dry it to achieve maximum effectiveness? I’m kind of in a rush in the morning and so waiting more than a half an hour would kind of be impossible. If this were the case, I might abandon application of Minoxidil in the morning. How less effective would only one application of Minoxidil per day be?

This is perhaps a stupid question that I should have asked my physician a long, long time ago, but, how is 1 mL of Minoxidil supposed to cover my entire scalp!?!? A lot of it tends to run down my forehead as it is, thereby wasting it, but even if it were all put to good use, 1 mL only seems to cover several square inches before I no longer feel any left on my fingertips during the massaging. Is it there even though I don’t feel it or something? What am I doing wrong?

I don’t know if this is relevant or not, but after 4 months of using 5% Minoxidil and noticing no results, I decided to switch to 15% Minoxidil w/ 5% Azelaic acid.

Azelaic acid is an irritant and in using it is supposed to increase the blood supply to the scalp and therefore increase the absorption of minoxidil. Your point about coverage is well taken. It takes a lot of minoxidil to cover the entire scalp, so I generally advise patients to apply it only to the areas that are thinning. Minoxidil is best applied after a hot shower, as the circulation of the scalp is higher at that time. Waiting 5-10 minutes should suffice, but using the Rogaine Foam rather than the liquid could solve your styling timing issues and it may be more effective.

Many of your additional minoxidil questions have already been answered at Rogaine.com.

Hi Dr Rassman,

Will Propecia show up on my Insurance or my company’s medical report, namely the urine sample test? I’ve been on Propecia 1 mg for 2 months now, and I’m 24 years old. I am taking Propecia without a prescription, my local pharmacist sold it to me

Should I tell the insurance people about the Propecia, or is it nothing to worry about?…Personally, I’d like to keep it to myself..

Thanks a bunch doc :)

I am not sure what you are worrying about. Is it illegal to take Propecia in your country? Propecia is not a controlled or illegal substance. In any case it is ALWAYS a good idea to tell your health care professional what medical issues you have and what medication you are taking. Always tell the truth! I doubt that any insurance company or government agency will react to your taking finasteride, unless you’re competing in sports where finasteride is still banned (though most bans should’ve been lifted).

There’s info about Propecia’s detectability in urine tests at Google Answers. The author of that post concludes that it is around 90 hours, and provides links and the math to back up his calculation.

Hi Dr.,

I have a question concerning Nizoral shampoo. I take Propecia once a day, and have been using Nizoral every few days for the past month since there seems to be a great deal of praise for it as a supplemental item when using a treatment like finasteride (no decent clinical studies to back that up, I know). My question is, have you come across any recent evidence that suggests it has negative consequences/interactions as part of being on a regimen like Propecia.

Thanks

The use of both Nizoral (ketoconazole) and Propecia (finasteride) together seems to have great popularity to many of this site’s visitors. I have not seen negative reports from using both of these products together, so that’s good. There was a small study published in Journal of Dermatology in August, 2002 about using a ketoconazole and finasteride combination. From the study:

“One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups.

Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year.

At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. "

There are possibly more recent studies on using ketoconazole as a hair loss treatment (there’s one from 2007 with no abstract available), but this one from 2002 includes combining the medications and was the first such study I could find. If anyone using both treatments together has a story to share, feel free to send it or leave it in the comments section.

Hi Im sorry if you’ve answered this before but what in your opinion would be the best way to tackle hairloss? Would you reccomend using Propecia, Regaine and Nizoral all at the same time or just Propecia or Regaine and Nizoral? I did try using Regaine and was fine with it for a year or so but then for some reason the itching got unbearable! Any tips for that? Thanks

Itching while using minoxidil may reflect an allergy to the drug, though it is interesting that it developed after using it for a year. Which strength were you using? Perhaps you could try a lesser strength.

As for the best way to tackle hair loss — well, I’ve already written a book on it (Hair Loss and Replacement for Dummies), so I’m not going to rewrite that here. I can tell you that Propecia (finasteride) and minoxidil (commonly sold as Rogaine or Regaine) are the only FDA approved hair loss treatments currently available, and as I’m a US-based physician, I look to the FDA. Another way to tackle hair loss would be hair transplant surgery, but I would not suggest rushing into that. Your question doesn’t really have a cut and dry answer that works perfectly for everyone. You can learn more by searching this blog (search box in the top right) or reading up on hair loss at NewHair.com.

Snippet from the article:

The Web site of Allergan Inc.’s Latisse is misleading because it suggests the company’s eyelash thickener is more safe than proven, federal regulators said.

In a letter to Allergan dated Sept. 10, the Food and Drug Administration said the company’s Web site omits information about how people using Latisse are at risk for contracting bacterial keratitis, which can be blinding. The letter was posted on the FDA’s Web site Wednesday.

Read the full text at Wall Street Journal.

This problem shows the value of the FDA in protecting our interests. You would not want to go blind and without proper informed consent on drugs, you may not know what you are getting yourself into. Cheers to the FDA.

I have been using Propecia for five years with great results. I have been reading about the significant side effects. I have started to use Rogaine and plan to come off of Propecia. As an aside, I would like to start a family with my wife, which is the catalyst in my decision.

Will I keep all the good results from Propecia

I am a little confused. You’ve taken Propecia for 5 years without side effects, and you are now stopping the medication because you’ve recently read about potential side effects (that you don’t have)? If you stop taking Propecia, you will lose all of the results and the hair that has remained with the help of the medication. Rogaine will not keep the hair grown that you saved while you were taking Propecia (and Propecia won’t keep any grown by Rogaine).

As for starting a family, I’m not sure what you’ve been reading, but I’ve written about this many times before. Here’s one from Merck, the drug maker, about this very issue.