Author: Dr. William Rassman

Dear Dr.,

Thanks always for devoting your time to the public with this forum. I notice you’ve been getting swamped with questions about a cloning cure (i.e. a class 7 bald person having a teen-age head of hair again), and people don’t seem to want to accept such a thing is so many years away. I was wondering if it’s more realistic to speculate: for those of us in our early 30’s who’ve preserved most of our hair and reversed some thinning with Propecia, is it reasonable to think a better pharmaceutical for holding on to what we’ve got will come out at some point this decade?

Thank you

There are drugs in the pipeline for hair loss, but the real question is which, if any, will make it through the investigative and FDA process. It must be proven to be safe and effective at doing what the manufacturer will claim. So I suppose it is reasonable to assume (or at least hope) something will come out eventually, but I couldn’t begin to guess at how much better it will be than what is available now. Keep your fingers crossed.

Hi…Thanks a lot for this perfect blog that answered many questions that concerns hair loss and balding. I had a HairDX test for Finasteride response and my score of CAG was 24. The dermatologist who did the test told me that I have a negative result regarding finasteride response.

1- What do you think of Hairdx test regarding F.R.?
2- Do you think I should take finasteride though I got CAG of 24 ?

Thanks

I do think the HairDX for Finasteride Response test is a good idea, but it can open people up to the idea of taking medication when it is not necessary. Just because the test tells you that your response to finasteride would be good, it doesn’t mean you should automatically get on the drug if you’re not experiencing hair loss. In your case, I don’t even know if you have any degree of balding. Do you have a full head of hair and afraid of going bald or are you already seeing hair loss? If you are bald or have definite signs of balding, then what do you have to lose by taking finasteride regardless of the CAG score? Were you prepared to not take finasteride (Propecia) if the test was negative?

In any case, it is something that needs to be discussed with your doctor who knows you better than I do, as our communication has been limited to an email. If your dermatologist told you the result was negative, perhaps he/she meant you aren’t likely to have great success from the medication. It is worth noting though that you may still see some beneficial response from finasteride with a CAG score of 24. According to HairDX, “Scientists discovered that among men that had the best response to Finasteride approximately 70% had a CAG score below 22 while among men that had a subtle response to Finasteride approximately 70% had a CAG score above 22.”

Dr R

Do you have any opinion on Azelaic acid as a dht inhibitor when used topically by itself or in minoxidil tandem?

Thanks

I do not think there is real evidence that azelaic acid inhibits DHT or works for genetic balding. I am aware that there was a study which was published in 1988 (22 years ago) titled, “Inhibition of 5α-reductase activity in human skin by zinc and azelaic acid“. The testing was not carried out in humans, but in a test tube, and the information is floating around on the Internet (our everyday source of good solid medical information *note sarcasm*).

Aside from this study, I do not know of any other information with regards to azelaic acid and its “theoretical” treatment for balding, yet the legend of one decades-old study will propagate down the immortal path of the internet. For further reading and other physician opinions on this, take a look at this post from a few years back.

Dear Dr Rassman,
In your last post you wrote the following in regards propecia.. “It does not work for frontal hair loss in most instances other than possibly slowing the process down, but is it the only real medication to address what you are going through”. However in December 2005 you wrote that “Propecia slows or stops hair loss throughout the head”.

I was just wondering if in the intervening years you have become more pessimistic about the effectiveness of Propecia on frontal hair loss?

Regards

I’ve not become pessimistic about Propecia. I have seen a few cases where the drug has reversed frontal hair loss to some degree (regrew hair), but it is not common. What is common is that this drug can slow or stop frontal hair loss, and stabilization of hair loss is a real benefit for those who are actively losing hair.

Hello Doctor,

I want to thank you for a great blog that I visit nearly daily. I visited your offices around 5 months ago and had a consultation with Dr. Pak, who was very informative and understanding. Since then, I’ve been on a daily regimen of Finasteride 1.25 mg/day but am going to wait until the follow up appointment before I make any judgments (superstition does that to you).

I have two questions. I already know that Finasteride does not completely stop hair loss. It just provides its patients an outlet for growing old gracefully (under my impression). Have you seen or heard of any patients who took Finasteride while also including Minoxidil in their regimen to maintain for longer than 10 years with good results?

My second question is how big a part does diet factor into the MPB process? I’m already exercising 6 days out of the week even before MPB hit me but diet (what kind of foods to eat) has always escaped me. I would like to know if there is any information a professional such as yourself can provide pertaining to what kind of diets would promote hair growth and what kind of diets work best in conjunction with Finasteride and Minoxidil to maintain hair.

I apologize for the long message and sincerely appreciate all the help you have given.

Best regards!

I believe that for some people, the use of both Propecia and minoxidil has value when used in combination, but that may depend upon a variety of factors including age, appropriate use of the medication, where the minoxidil is applied, and where on the head the balding is that you are treating. The crown generally does better with combined treatment compared to the frontal hairline. I have seen patients using both medications with good results after a decade of use.

I do not believe that any particular diet works better than another, provided that the diet is well balanced.