Reader’s Minoxidil Theories About Side Effects

I just wanted to see what your thoughts were about my “theories” in regards to Minoxidil 5%.

Firstly, I have read online about how it has caused erectile dysfunction, anxiety, heart palpitations, etc.

Are there any studies that show that these are legitimate side effects, or are they just symptoms listed by individuals? I think it is highly possible that these individuals could be effected by the listed side effects due to psychological issues due to their hair loss, and assuming the minoxidil is causing these physiological symptoms.. What do you think?

Secondly, do you think that the failure rates of minoxidil are due to people who stop using the solution too early on, rather than the minoxidil not “working”?

What you read on the web isn’t always true.

The official reported side effects are listed on the minoxidil insert and the drug profile (see here). Minoxidil taken orally in pill form is a blood pressure lowering mediation, so it is conceivable you can get lightheartedness and heart palpitations if your body absorbs too much of the topical. Chest pain and fainting are also possible if you’re sensitive to the medication. Erectile dysfunction is more likely to be due to a psychological issue or an underlying medical issue, rather than minoxidil.

With respect to the failure rates of minoxidil, I believe it is partly because of compliance issues. Many men and women have a hard time adhering to a twice a day schedule, and therefore do not get the full benefit of the treatment.

Reader Tells Others to Calm Down Over ACell Inquiries

Hey Dr Rassman i hope your day is treating you well.

Being a hairloss sufferer myself i can relate to the extraordinary anticipation and hype surrounding the new buzz word in the field of hair restoration ”Acell”. However i also realize that this is far from establishing itself as a practical solution to genetic alopecia(if it even makes it that far). As a hair restoration physician i imagine you grow tired of those ”cure” type perennial questions. In my opinion readers need to recognize that when the hairloss community is equip with innovators like yourself Dr Rassman it provides us with the best chance possible of making the most out of these types (Acell) situations.

Being a daily reader of this blog i have nothing but good things to say about it. There is not a doubt in my mind that Dr Rassman and the other physicians that contribute to the blog will be efficient at posting occasional updates. So for a lack of a better term just ”chill out” time will tell…..

Thank you for your support! I don’t mind the large amount of emails I’ve received with ACell questions, as I kind of expected that… but I don’t want to give anyone the wrong idea about what it can do (we’re still trying to figure it all out).

We will most definitely update the readers of this site on our progress as we can.


2010-12-07 11:03:21Reader Tells Others to Calm Down Over ACell Inquiries

Reader Shares His Daily Hair Routine

Dear sir,

I first of all thank you for taking your time out to answer this question. I’m sure you’re quite busy…I’ve seen more balding heads on the streets than ever.

I’ve been losing my hair since I was 17. I just turned 21.

I went through all the usual stages. Denial, loss of confidence, etc. I still have as much left as many men RECIEVE in their procedures, but it will only get worse. I had a solution in Spring 2006, while I still had enough that no one knew – Propecia. My (completely bald) doctor recommended it for me.

But I was an idiot.

In December 2006, I stopped taking it. I felt it hadn’t made any difference. No further thickening, no regrowth. Everything seemed fine until summer 2007, when it started becoming frighteningly apparent that it HAD kept some hairs in (I washed many long, luxurious strands of Marc Bolan-style hair down the shower drain). I didn’t know why this was happening all of the sudden – I did not know that stopping Propecia not only stopped the positive effects of Finaesteride on DHT, but also allowed the MPB held back to return with a vengeance.

Within six months, my hair loss had become worse and more apparent than it had since it began. It happened quite quickly.

I went to the barber’s in October 2007 and cut my long hair off. I could tell where the hair loss was hitting hard; the hair cut from the sides and back was thick and Roman, while the hair cut from the top and front was lighter and frizzy. Not enough hair was growing to create curls or waves, so it looked like it was damaged.

Immediately I began a plan of action. This time, I wasn’t going to hit MPB with just one drug. I was going to have an armory full.

In November, I began a treatment which gathered supplements, drugs, and shampoos over the course of those following months. It has come to finally include the following daily routine:

Propecia (1X)
Rogaine Foam (2X applications)
Saw Palmetto (supplement, 400 mg each; 2X)
Nioxin 3-part System (no.2; in the shower)
Neutrogena T-Gel (1X; shower)
Nizoral (1x; shower)

The anti-MPB effects of Propecia and Rogaine are known to you. Saw Palmetto is reputed to have anti-androgen effects, as is coal tar (1% found in the T-Gel) and ketoconazole (1% in the Nizoral). Nioxin is proven only to thicken the APPEARANCE of the hair, but claims to clean away “environmental residues like DHT” on the box. Reviews and hearsay seem to back this up, so I’ve been trying it.

Why go through all the bother, you ask? Simple.

I am a musician. A player, a writer, a performer. Not just a musician, either. A damn good one, with artistic vision and a damn good shot at making it.

But this is the one thing holding me back.

1: Toupee/Wig – Will not. Don’t want to be playing a windy outdoor show or find myself in the throes of lust with someone I fancy when the proverbial “rug” falls off.

2: Shave – The aesthetics of being a performer on stage in the rock/pop medium require a youthful, attractive appearance. This I know firsthand; people who knew me when I had a large rockabilly pompadour or a healthy tangle of curls suddenly looked at me with sad shock when my receding hairline and thinning temples were revealed. I have an odd-shaped head, and that doesn’t help either. So nix the Telly Savalas look for me.

3: Hair Transplant – This is the most promising option. I have read all sorts of “breaking news” regarding WNT proteins and new solutions for this age-old bastard curse, and they may eventually pan out. But not in the next five years, and certainly not soon enough to take advantage of my youth and hit the big time. But I do not have tens of thousands of dollars to spare (especially in the midst of the economic recession), and I know that (sparing a new cure) my situation is only going to get worse.

I have read on many forums that Propecia (or finaesteride at all) loses it’s effectiveness on most men after 5 years of use. This rumor is widespread and greatly troubling; if true, the backbone of my (and many other men’s) MPB treatments will be null and void in 5 years or less, leaving us to lose all the remaining hair in a fast, depressing way (as I did much of my hair last summer).

I am at ends. While one’s self-worth should not be based on looks alone, appearance is crucial to the formation of identity. And when that tool, that weapon of good looks is taken away from a hopeful star, what is there to do?

Again, your time is most sincerely appreciated and I truly thank you for reading this.

You are incorrect with regard to Propecia (finasteride). It continues to work for years and does not simply stop at the end of the 5th year. What usually happens is that hair loss continues to progress and eventually (around the 5th year), you may go back to your baseline hair loss pattern — but if you stop the Propecia altogether, you will be far worse.

You need to get a good doctor to build a Master Plan for you. It is said that the person who treats himself may have a fool for a doctor. You’re throwing everything at your hair loss, and while it may not be a bad thing (unless you count the expense of money and time involved), it might be excessive and unnecessary. Please, discuss this with a doctor — the physician that prescribed your Propecia is probably a good place to start. Thinning hair can be devastating to one’s self esteem, and many people will do whatever it takes to not let that happen.

I wish you good luck and thank you for sharing your story with us.


2008-03-18 10:01:57Reader Shares His Daily Hair Routine

Reader Says — Patents Stop Innovation

This is a comment left by a reader in response to Propecia being under patent protection…

And that is exactly why we need to see the end of Patent laws as we know them today, companies are given way too much time to bleed us. Its evil. Especially when medication has been Government funded or approved.

The real issue is that patents stop other companies from innovating. In fact while I’m thinking about, we should all be lobbying against the company that tried to sue Histogen. Because that company only cares about your money not your hair. There is nothing more criminal then these companies slowing down the discovery process – its anti human and we want our hair back

USPTOMaybe you are right, but we live in a capitalist society. I’m not going to make excuses for it. These are for-profit companies and they spend millions (if not billions) of dollars on research and tests to develop new products and new drugs. Some drugs fail, some succeed. When one succeeds, it makes up for all the R&D and failures that still had to be paid for.

Do you think they should just give that away for essentially nothing? Patents form the backbone of what built our country into an industrial giant. In time though, the patents on these drugs will expire and generic versions will be legally available in the US… so there’s no stranglehold forever.

We all have the right to our own opinions, but hair loss is seen as a cosmetic issue. I have a hard time believing that the government would fund hair loss issues when its hard enough to have HIV or diabetes or heart medicines funded. But hey, maybe you can lobby the government and try!

Reader Says He Discovered the Hair Transplant Miracle-Gro!

Hello! I’m a 55-yr-old guy who’s had several HT procedures over the past 20 years. My last two were performed by different surgeons (both well-respected in this field), and both times I was surprised and delighted to note astounding growth of newly-grafted hair which I believe resulted from my coincidental use of a unique nutritional supplement. At six weeks following surgeries, I already had a solid half-inch crop of thick, colored new hairs which continued to grow like crazy. My current HT doc is starting a small trial with this supplement next week. Would you be interested in hearing about this? I think I accidentally discovered HT Miracle-Grow!

Sure, please keep me in the loop. I try to keep an open mind.

Update:
The person that sent me this email has told me that he’ll send me updates when he can, so I’ll post more information as it becomes available. In the meantime, take the above for what you will. Anyone want to wager a guess as to what this supplement could be?


2008-04-10 08:46:47Reader Says He Discovered the Hair Transplant Miracle-Gro!

Reader Response to Using Rogaine Foam

A reader wrote in with a quick review of his experience using the Rogaine Foam, and I thought it was worthwhile to post for those that are still looking into trying this newly released product…

It’s easily available now without a prescription and the foam does have some advantages. It doesn’t run, so it’s easier to apply. And it contains no propylene glycol as does the Rogaine XS solution. However, I have some reservations about its use. The beneficial actions of topical minoxidil are dose related and the Rogaine foam is only a 5% compound. The foam by its sheer volume deposits a large amount of each application on the hair shafts, where it cannot be absorbed and remains ineffectual.

Out of curiosity, I recently bought a bottle of Rogaine foam ($29.99). It seems to be more inconvenient to use than the Rogaine XS solution. Unless your hands are cold, the foam will immediately liquefy. You should also be aware of the fact that the foam contains both butane, isobutane and propane, so it is highly flammable. But, if the Rogaine Foam fits your needs, this might be a good alternative product for topical minoxidil use.

These are the inactive ingredients listed for the Rogaine Foam: butane, butylated hydroxytoluene, cetyl alcohol, citric acid, fragrance, glycerin, isobutane, lactic acid, polysorbate 60, propane, purified water, SD alcohol 40­B, stearyl alcohol. See product warnings.


2006-11-16 15:36:51Reader Response to Using Rogaine Foam

Reader is Not Convinced That Bulk Analysis is Worthwhile

I’ve seen you mention many times that bulk analysis is a good way to determine if someone is balding and that density should be the same everywhere for a non balding patient.

But I’m not convinced by this – I recently saw a well known hair transplant surgeon and he said that people typically have less density around the crown and temple areas anyway. He didn’t believe in bulk analysis for analysing hair loss.

Today I saw a male child who must have been around 8 years old. His hair was shaved short and sure enough, his temple/corner areas were noticeably less dense than the rest of his hair and this went quite a way back (I suppose to the point where someone might have suggested he was between a NW2 and NW3 on a balding scale if he was an adult).

HaircheckYou may not be convinced of the value in measuring hair bulk, but I am not going to try to convince you.

In a non-balding man, the bulk analysis shows that the hair in the 4 areas we measure (down the midline: front, top, crown and donor area) are all within 10% of the measurement of each other. I do not measure the hair at the sides of the head, because that is not where the balding will be. I would therefore possibly agree with you that the side densities are not as high as the midline densities.

Out of curiosity, I will measure a non-balding man’s sides and see if we are both correct.

Reader Doesn’t Think ACell Will Work

I don’t believe that A-Cell will work. Is there actually any proper evidence of this technology working anywhere? It seems to be just that guy with the finger which I am unsure whether has been exagerrated/fabricated. Other than this it feels like all hype.

Also, it seems like when you pluck these hairs, you have to take out so much of the hair that logically thinking I’m not even sure if they will grow back the same thickness (if at all). Now I know people will come back with how they wax their legs, chest, arms or even their head regularly and they always grow back, but I seriously doubt that when a normal person plucks/waxes, they are extracting the amount of tissue required to perform the A-Cell procedure.

In addition, Jerry Cooley states in his presentation on one slide: “you can see the thicker FUE grafts vs the thinner plucked hairs” – so this really isn’t what it is being hyped up to be?

This unfortunately to me feels like just another method of doing a standard hair transplant. Maybe it will infact become the common way as it appears to allow it to be done without any scaring at all, but right now it looks like you would actually be worse off using A-Cell method over current methods, as the hairs at the donor and recipient region will grow back thinner, that is if they grow back at all.

I don’t know of Dr Cooley’s reputation, but from watching his presentation this just doesn’t seem that impressive. The only way it might work is using beard hair that thinned out during the process and ended up like scalp hair, but even then if this worked perfectly is it really a cure? You can’t do whole units and can you control the direction?

Perhaps you are right, but in the spirit of scientific research we have to try. That is one reason why we are trying to conduct formal IRB approved clinical research. It will either prove or disprove the concept.

The hope is that the plucking approach will yield more hair than moving the hairs around with traditional transplantation. The fact is that not only us (NHI), but the entire hair transplant surgeon community needs to be able to replicate this technique to stand up to the test.


2010-12-10 09:08:40Reader Doesn’t Think ACell Will Work

Reader Concerns — Advertisers Are Recommended Doctors on Hair Loss Forums

I have a hair transplant procedure scheduled with a ABHRS surgeon yet I’m starting to have some concerns due the HLH/HTN websites.

Concern 1) On the HTN/HLH website there are a handful of doctors mentioned often in the forums – shaprio, wong, hasson, fellar and ironically these are the same docs that do most of the advertising – any other doctors basically sounds inferior. I find it hard to believe so many doctors are being excluded and if you mention their name on the forums the immediate majority response is see one the “HLH/HTN” inner-circle of doctors… Are these sites more of a gimmick then a legit source of information and where do you recommend finding a valid source of information regarding a hair transplant surgeon?

Concern 2) How much weight to put on the ABHRS certification. One of the boards member I believe is closely tied to MHR/Bosley – and that company just gets flamed on the HLH/HTN forums?

Thanks In Advance For The Time!

The advertising websites like Hair Transplant Network (HTN) and Hair Loss Help (HLH) provide a forum for their doctors to “pitch” the public with a storyline about themselves. These sites do restrict doctors to those who they believe perform only follicular unit transplantation and those who are willing to pay a fee to get the endorsements of the HTN/HLH websites. Some physicians do not like the politics of these websites, and certainly the HTN/HLH forums can be harsh on doctors (particularly if they are not paying members). Members are not necessarily spared from harsh criticism just because they pay their monthly fee, though. I have seen firsthand that these forums will try to implement controls on its user audience, but if freedom of speech is what is claimed, clamping down on vocal forum users can be difficult. Some forum users have too much time on their hands, are malicious jerks, or just lonely people who use the forums to obtain an audience. Others like the comradery of the group and provide interesting feedback on a variety of disparate subjects, so their input can be illuminating. If I were to have one criticism of those sites, it would be that many forum participants are out of their league with regard to the medical jargon and what it means, or when the issues of complications of surgery come up, there is a naivety in forum participants that everything is black or white. You need to do your own research — view photos, meet patients — and use these forums as a starting point, but don’t just accept 100% of what is written. As for why some doctors seem to be in the inner circle, I think it has to do with participation. The more these doctors participate, the more fans they gather, and the more vocal those fans become about those doctors. As for me, I tend to devote most of my available time to this site.

With regard to the American Board of Hair Restoration Surgery (ABHRS) certification, what this shows is whether these doctors passed the oral and written examination, and gained a standard of knowledge. The problem with the ABHRS is that the training of a hair restoration doctor is a willy nilly process that does not prove if the doctor is capable of performing the surgery with knowledge or wisdom under any reasonable situations that reflect the reality of the field.

When I took (and passed) the American Board of Surgery examination, it was two years after a five year intensive period of practical training with mentors (expert surgeons) watching me every step of the way. I was judged competent by these professors because they watched me as I made decisions and they followed the outcomes of my patients by direct observations of my results. The ABHRS can not replicate that type of control, so that means to me that their certification may have limited value to book testing alone. There are no great systems out there for quality certification of skill and knowledge as they integrate with each other in the field of hair restoration surgery. As I have said over and over again here on BaldingBlog — let the buyer beware!


2009-02-13 15:58:56Reader Concerns — Advertisers Are Recommended Doctors on Hair Loss Forums

Reader comments on Finasteride, DHT and skin levels, clinical activity and results

“Drake, Lynn, et al. “The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia.” Journal of the American Academy of Dermatology 41.4 (1999): 550-554.”.

Can’t post a link because it’s behind a paywall my university has a subscription for. That study is published in a well respected journal and sees to be cited many times

“Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56.5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declinied significantly (P<.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1 and 5 mg finasteride treatment groups, respectively.”

The values are without error margins but I’m willing to bet that they might not even differ significantly.

I’m not sure why you claim that my post contains mis-information and then proceed to say the exact same thing.

It’s a competitive inhibitor, sure. But that just means that the affinity for finasteride to the enzyme is much larger than the affinity of testosterone to the enzyme. If it was reversible you wouldn’t see such a flat response and it also wouldn’t take 2 weeks for DHT to go back to baseline.

Finasteride does irreversibly inhibit any 5alpha-reductase it comes into contact with (see e.g. the Merck patent which is even called “Irreversible inhibition of human 5?-reductase ” https://www.google.com/patents/US5962442 ” In practice, the halflife of the enzyme-inhibitor complex is so long that the inhibition is for all intents irreversible, and release of the inhibitor probably occurs by death of the enzyme rather than turnover to regenerate catalytically competent enzyme.”) .

That’s as good as destroying the enzyme because it forms a strong bond with it that has a longer half-life than the enzyme itself. In other words, the enzyme will die long before it’s able to release finasteride.

The body replenishes 5AR constantly and that’s exactly why it takes >2 weeks for the DHT to go back to baseline.

Nice citations; however, the effectiveness of finasteride may be due to other factors such as the sensitivity of the receptors and the rate at which the enzyme is turned over in response to the blockade, etc.. Enzymes are always consumed in a chemical reaction and the human body just produces more of it. Skin levels may not be reflective of the type of response seen clinically. This is the practical side, because we see patient who do not respond to the drug regardless of the dose and then we see great responders. I can’t address your mechanistic point very well and correlate the DHT levels, enzyme levels and clinical responses. You have clearly spent more time on this than I have; however, what I focus upon is clinical responses and side effects to the drug. With my focus, the pharmacology you reference does not produce a one-to-one clinical response with the values of DHT in the skin as you are referencing.

I like it when the consumer does research on what is happening to them and the treatment options. Sometimes what is read needs to be filtered by an expert so that is my role here in this reader’s posting which I am publishing at his request.