Propecia and Rogaine

Thanks for the wonderful blog. Can you please post your opinion on the combination treatment of Propecia and Rogaine ?

Applying rogain twice a day is cumbersome for me. But I have started on Propecia since past 2 weeks. My derm tells me combo is a the best. I dont think I will be able to continue on Rogaine for longer than 3 months. Can I leave it after 3 months since I am already on propecia? how do you think it will impact my hair? Also How bout the option of 5% minoxidil once a day combine with propecia? My hair thinning/ some loss is 8 months old. Thank you!

Block Quote

The two medications have different mechanisms of action. Rogaine (Minoxidil) gets great results about 15% of the time, but does require twice daily use and has side effects of dryness and flaking. Some people get dizzy from the antihypertensive effects of this drug. Propecia (Finasteride) works in a much higher number of young men, so I tend to recommend it with little side effects. I’ve found that increased sex drive occurs in about 10% of men (it happened to me), a decreased sex drive in less than 2% of men, and a decrease in the occurance of prostate cancer in about 25% of men by a recent report.

I prefer starting on one first, usually Propecia, and then after a year if the goals are not met, I may start the patient on Minoxidil.

Hair Loss from Climate?

ok, so far very few people have been able to answer my question. i have been living in dubai for 3 years and after a summer in london i’ve been experiencing hair loss every year. i am using bottled water as there is chlorine in tap water here. have been told that the hair loss is possibly due to the climate and air conditioning in the buildings. if so, then what can i do to stop this hair loss? my diet is the same and i use only good shampoos, etc and plus i take vitamins. in fact i do mostly everything i know to keep my hair in good condition. it is naturally dry. please help!!!!! many thanks

Block Quote

Hair loss is not caused by climate. If you use a head dress, then you could be producing traction from it and this would/could cause traction alopecia. Chlorine without toxicity, will not produce hair loss nor will any reasonable shampoo that is commercial. You need to be evaluated for male patterned hair loss (assuming you are a man and not a woman — sorry, you didn’t specify) and this would take a good microscopic assessment from various areas of your scalp to determine the degree of miniaturization of the hairs in those areas. If you have genetic balding there will be patterned hair loss (in men) and Propecia and much of the material on that drug reflected in this blog and on our website is appropriate for you to review.


Are you familiar with Viviscal tablets & are they effective???

Block Quote

Ah yes, another fancy name of yet another “miracle” solution for hair loss. In looking up this product on the internet, I found the following comment on the site of a Viviscal reseller: “Although he was thrilled that I was growing out my hair, my boyfriend was skeptical about this ‘miracle pill’ I was taking, and was worried that I was taking something with a ‘secret’ ingredient. To calm his concerns, I showed him the box and he read over the ingredients, then agreed that the cartilaginous seafood extract, acerola extract, silica compounds, microcrystalline cellulose, magnesium stearate, and natural black currant flavor were more than likely safe. When I convinced him I wasn’t experiencing any negative side effects, he seemed much more at ease with Viviscal and began to realize that I would have longer hair sooner than he and I had previously estimated.”

Ok, where is the science in this? Is this the best testimonial that the reseller could come up with — “my boyfriend thinks it’s safe“??

Some months ago, NBC News’ Dateline show had a story on the results of five balding treatments. One of these treatments was Viviscal. Dateline had a physician evaluate each of the five candidates prior to beginning their treatments, and then again in six months. The person taking Viviscal was the one with no growth. So while this may not have been a perfect double blind scientific testing process, the Dateline show made a reasonable effort to compare the five methods of hair treatment. While Viviscal may not have harmful ingredients, why spend the money (about $600 per year) on an unproven food supplement?

On a side note, as I looked over their site, what initially caught my attention was that the male model shown in their site design is bald. That may have nothing to do with anything, other than the tastes and aesthetics of the web designer, but I thought it was a little strange to promote a hair product and showcasing someone with shaved head. The company seems to reflect more of an entire hair product line, rather than a treatment for hair loss. So when you ask if it is effective, I can only say that it may be effective as a good shampoo (I do not have any first hand knowledge) and the other products in the family line may be ones of personal choice. With the included ingredients (Water, Sodium Laureth Sulfate, Lauryl Glucoside, Cocamidopropyl Betaine, Pisces, Panthenol, Betaine, Lauryldimonium Hydgroxypropyl, Hydrolyzed Wheat, Protein, Sodium Chloride, Citric Acid, Propylene Glycol, Disodium Edta, Diazolidinyl Urea, Methylparaben, and Propylparaben), I do not believe that these components individually or in combination should accelerate hair growth or prevent hair loss.

Lexapro and Hair Loss

Do any anti-depressants such as lexapro cause hair loss?

Block Quote

Antidepressants do cause hair loss (see Lexapro information on Stress is also a cause of hair loss on those who are impacted with the genetic balding defect. There is a chicken and egg scenario here; which comes first? Speak with your doctor about switching medications or in helping you deal with the stress of life that may be accelerating your hair loss if you are genetically prone.

Update: This link was brought to my attention —

Patchy Hair Loss and Alopecia Areata

I have patches of hair coming out on my head. It looks like someone hit me with a shot gun and every place the buckshot went, I lost a patch of hair around it. It started a couple of years ago and then stopped, but did not get better. What should I do? Will a hair transplant fix this?

Block Quote

It sounds like you have Alopecia Areata. This is an autoimmune disease that has genetic origins. You need to see a dermatologist. Hair transplants usually fail to grow in the patches of hair loss if the disease is active. Visit the National Alopecia Areata Foundation website for more information.

Changing Hair Characteristics

hello i am 19 and i noticed that me hair was thining last year while i was a freshman in college. i also started to notice that the hair on the side of my head and in the back some wouldnt grow as fast and became very curly and dark.i was wondering if this would have somthing to do with the thinning. it was just kinda weird to have 2 differnt kinds of hair on my head. i started taking propecia about 4 months ago and started to notice results within the first 2 weeks, no more hair falling out. i was wondering since the hair loss was so sudden as was the curly black hairs if this could have something to do with a chemical inbalence of somekind. i was thinking maybe thyroid or somthing. if u have ne advise i would be happy to hear it. thanks

Block Quote

It sounds like you are experiencing male patterned genetic hair loss and the Propecia has started to reverse it. Wait for a full 8-12 months and you may find that the hair will return to your normal thickness. Get a working diagnosis from a doctor with a good microscopic assessment, so that you are not blind to the things that are going on. You will want some ‘metrics’ (numbers) on the amount of hair miniaturization you have before the Propecia takes full effect, so that you can gauge the changes over time. You should have a Master Plan for the many years you have in front of you, so that as you age and your hair loss problems progress, you will have a better idea of what your options are. For more information on a Master Plan, see the NHI Master Plan page.

Family History of Hair Loss

Hello doctor. Thanks for your time. I have medium length wavy hair. I have notice recently a lot of hairs coming out in the shower and sometimes on my pillow. My fringe feels thinner and i feel a little bit thinner on top, but my hairline does not appear to be very receding. I’ve also had an itchy scalp of late. My brother suffered hair loss aged only 21 and my uncle also lost most of his hair before he reached 30. This would make me believe it is hereditary hairloss but my hair doesn’t appear to follow the pattern that i’ve read about. Could there be another reason? Thanks.

Block Quote

You need to be examined by a good doctor and the diagnosis of genetic hair loss needs to be made with objective criteria. A close microscopic examination of the scalp (all over) will show indications of patterned hair loss common in the genetic cause of hair loss in men. Please, before you jump in and start taking drugs, let’s make a diagnosis and map out the full impact of the genetic balding now. Then, knowing what you have in store for you, Propecia would be a good drug to combat your hair loss (assuming you are a young man) and a repeat microscopic examination of the hair in different areas of your scalp will show the areas that are most improved with Propecia.


What can you tell me about a company called Current Technology and a procedure called CosmeticTrichoGenesis(CTG) that they have the patent. You sit under a chair with a hood for approx. 12 minutes 1x per week and it emits small amounts of electric energy to both stop hair loss and enhance hair growth. Although not FDA approved, I am seriously considering taking advantage of the treatment. I think I’m a good candidate and not ready to go the transplant route. My wife’s hair salon just got a chair and I know several clients who are very pleased. Please let me know what you’ve heard about the procedure and its efficacy and or results. Thank you.

Block Quote

The new names never cease to amaze me. As I have been reviewing questions people have written to me for this blog, fancy new names of “magical” cures continue to come in from various individuals surfing the net. This one is all in the name. Cosmetic implies elective fixes to improve looks, Tricho means hair, and by linking the two words together you get the loose meaning of “hair improvement therapies”. Genesis means growth, and implies that there is something that stimulates the hair to improve the cosmetic appearance of a person. There is nothing new here, other than the combination of colorful words.

Thinning of Transplanted Hair

How big of a problem is the gradual thinning of transplanted hair — have you seen cases where a transplant looks decent but then some years later looks crummy because it thinned out too much?

Block Quote

In about 30% of the male population, men will lose some of the hair we call permanent hair from the sides and back of the head. If that would have been you, then you might lose hair in the transplanted area. There are other causes of hair loss, so seeing a good doctor should help you with the diagnosis. I would want to look at your donor hair and see if there is significant miniaturization in that area. With loss of donor hair, we should see some miniaturization in the donor area.

Hair Coloring and Hair Loss

i sm 20yrs of age. i use to have very thin hairs. i not use any hair oil or any hair ointment, but use to shampoo twice a week. Also i have habit of applying my hand on my hair regularly, but now the problem is that my hair starts falling & shine is also lost. Please tell me if applying hair color is safe or not. so please send me the related information.i shall be highly thankful to you.

Block Quote

Daily washing of the hair is a good idea, but being gentle is important. Fine hair is more fragile then coarse hair, so damaging it is a real consideration with a strong massage or heavy handed brushing. Ask a good hair dresser for advice. Careful coloring should not be a problem provided that high quality materials are used by a professional skilled in the art.