Month: April 2012

Dr. Rassman –

On March 13, you wrote:

“Men in the process of losing their hair in a Norwood class 6 pattern may not be thinning uniformly. They may be losing more of the frontal hair faster, yet have the overall pattern of a class 6 that may or may not become complete. Some men who take finasteride will arrest much of the class 6 pattern thinning, especially in the top and crown of the head, but their frontal balding could actually be advanced.”

Could you explain this in more detail? Are you suggesting that finasteride might accelerate frontal balding, beyond what would have occurred without medication? Or are you just saying that finasteride might have relatively minor efficacy in the front?

I’m a 26-year-old caucasian male, and most male relatives on my mom’s side have Norwood 6 or 7 patterns. Like the guy who wrote on March 13, I appear to be in the early stages of thinning towards a Norwood 6 pattern. My own loss is heaviest in in the vertex, with some loss also in the middle and front (although I have a strong forelock). About three months ago, I started taking 1.25mg of finasteride daily. At my checkup a week ago, my dermatologist noted new growth in the vertex (hooray!) and agreed that my corners were a little worse.

I’m interested to hear your thoughts on how finasteride might impact my ultimate balding pattern, both in the front and back. And I’m interested in a clarification and elaboration of those comments from March 13! Thanks for all your work. Your blog is a great read.

Sorry if I wasn’t clear in my prior post.

A simple way to think about this is that Propecia does not stop hair loss completely, and it works best at the top / crown area. So if you are balding in a Norwood 6 or 7 pattern, Propecia will slow down the hair loss on the top / crown area while the front area will have faster hair loss than the top / crown.

Eventually, you may reach the Norwood 6 or 7 pattern, but if Propecia thwarts the hair loss process, you may be able to delay this for 10+ years if the drug works that way for you.

I am a 31 year old male who started Propecia 4 1/2 months ago after noticing very slight corner recession. I have very thick hair and have always seemed to shed a fair amount. After starting Propecia the shedding immediately stopped. However, 4 1/2 months later, my hair has definitely thinned at the corners and my frontal hairline is eroding. While my hair loss is not yet noticeable, I feel my time is short.

Should I still hold out hope for Propecia at this point? Could I still retain those minaturized hairs? Or are they now beyond the drugs grasp? This is having a profound affect on my self-esteem. Any insights you could provide would be greatly appreciated. Thank you for your time.

Let’s start from the beginning with education and facts:

1. There is no drug that permanently stops hair loss.
2. Propecia takes about 8-12 months to see its maximum benefit. Sometimes it takes a little time beyond that.
3. Propecia seems to work mainly on the top and crown area. It does not work well for the front and front corner areas. If it does, it is in a minority of people.

I understand you are trying to address the hair loss issue but you need to discuss these issues with a physician who can give you a realistic expectation and long term goals. We often refer to this as the Master Plan, which we are a big advocates of.

OK, here is my take on the latest happenings in the hair-loss debate…the recently reported topical inhibition of PGD2 and hair loss / re-growth.

OK, prostaglandins are both a GOOD and a BAD thing. You need some prostaglandins, but not others. Some prostaglandins are required for the inflammation associated with healing, while some are responsible for the negative effects of inflammation – mainly pain and the link in the chain that results in disease.

If prostaglandin D2 is indeed partially responsible for hair loss, then why not simply use a product that reduces or inhibits prostaglandin formation? These products do indeed exist. They are called COX-2 inhibitors, namely NSAIDS. However; all NSAIDS are not created equal.

One of the most potent, and selective COX-2 inhibitors is called Meloxicam, otherwise known as Mobic. It is an extremely effective pain reliever and anti-inflammatory. It’s anti-inflammatory properties are due to its inhibition of the cyclooxygenase-2 enzyme (COX-2). Since Meloxicam is soluble in methanol (think EverClear), why not simply put a few Mobic pills in ethanol for a few days, then simply apply it to the balding areas?

I do not claim to be a doctor, I do not even play one on TV. That right is reserved solely for Dr. Rassman, so I may be completely ignorant of the chemistry involved here.

Dr. Rassman, do you think this may be a viable approach to inhibit prostaglandin D2 topically? While I am pretty certain it could not cause harm, since it would not be absorbed systemically, would it be of any value as a topical PGD2 inhibitor?

As always, my deepest respect and thanks to you, Dr. Rassman.

While your insight is interesting, I do not think think the solution is that simple.

For argument’s sake, let’s say you dissolve Mobic in methanol and apply it to your sore back. Do you think it will relieve pain? It does not. Drugs don’t work this way. And I haven’t found any study that shows people who are on chronic pain medication like Mobic (that inhibit prostaglandins) have more hair growth or less hair loss.

The research on PGD2 is interesting, but it is only part of the big picture. I am sure that there will be research carried out.