Author: Dr. William Rassman

Hey doc, I just saw this article that talks about a Consumer Reports poll about hair loss treatments. Kinda interesting that minoxidil doesn’t seem to work all that well for most men but Propecia did have a good response rate.

‘Consumer Reports,’ stylists say hair loss remedy results mixed

Here’s the part of the article that you’re referring to: “Twenty-seven percent of men who used finasteride (marketed as Propecia) said the pill was ‘very effective’ at treating hair loss and 41 percent said it was ’somewhat effective.’ Only 4 percent of men who used minoxidil (marketed as Rogaine) called it very effective.”

It’s an internet survey of just over 8000 Consumer Reports readers so it isn’t scientific at all, but this sounds about right to me. Minoxidil works for many men, but “very” effective it is not.

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Hi Doc

After spending hours on your site I have decided to take the brave step of seeking help from my local GP, Doctor, about my hair loss. I still have a good head of thick, black hair but I am shedding some hair. Uaing Nitozrol seems to have helped, less loss and thicker heir.

My GP stated that he is willing to prescribe me Finasteride in the 5mg ‘as we have seen best results at this dosage from our patients’.

Doc is that perfectly normal to take 5mg I thought it was 1mg per day not 5? Have you seen better results with 5 then 1 with your patients?

Thanks

Reports originally sent to the FDA by the pharmaceutical company Merck show that the 1mg dose of finasteride is as good as the 5mg dose of finasteride for treating hair loss. There may be an occasional patient who does better on a slightly higher dose (2mg), but as the dosage goes up the side effect risks become higher. Even in those cases, I have a difficult time delineating that a higher dose provides more benefit. I have suggested to some patients that have seen a cessation of visible benefits after some time on Propecia to increase their dosage, but so far the results have not been clear… and I’ve not recommended those few patients increase to the full 5mg.

On the flip side, there are some doctors out there who believe 0.25mg finasteride is just as good and there is some evidence that this tiny dose is 50% as effective as the 1mg dose! In my practice, I recommend the standard dose for treating genetic hair loss: finasteride 1mg. As most people likely know, the reason a 5mg pill is available is because it is a prostate treatment (marketed as Proscar). 1mg for hair loss, 5mg for prostate.

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Is there a danger to taking Finasteride if I don’t have androgenic alopecia? I have a lot of hair loss, but it’s possible that it could be from an Iron or a B12 deficiency from a poor vegan diet the last 3 years. If I start taking Finasteride, but it turns out my hair loss is not due to androgenic alopecia, will Finasteride cause me to lose more hair somehow?

Finasteride 1mg (Propecia) is meant for treating genetic androgenic alopecia (hair loss) in men. If you do not have this genetic hair loss, you should not be taking Propecia. You shouldn’t be taking any medication if it is not meant for you. Hair loss from iron or vitamin deficiency is not androgenic alopecia and hair loss patterns are completely different. They are two completely different things and easy to distinguish.

It sounds like you are trying to play a guessing game and experiment on yourself so rather than continue doing that, I suggest you see your physician.

Dr Rassman
I have read about avodart injected into the scalp with good results. Can you tell me how it would work without getting into the blood stream first. Here is the link:

Mesotherapy using Dutasteride-Containing Solution in Male Pattern Hair Loss
(PDF file)

The results are interesting, but the sample size was very small and the length of the study was only a few months. This might be worth exploring with further research, though. The paper is almost 2 years old, so if there’s a follow-up study I’d love to see it.

This paper says there were 28 patients that completed the study, with 14 having received an injection of “0.05% dutasteride containing solution” and 14 receiving a saline placebo. Hair growth was noted in most of the 14 dutasteride-treated patients, and all of the placebo patients did lose hair. This is promising, but since the study only went on for 12 weeks (I realize it was just a pilot study), a longer study should be established in the future to address safety concerns. Growing hair is great, but if you end up risking your health it negates the cosmetic benefit of your hair. Also important to note — this doesn’t appear to have been published in a peer-reviewed medical journal, which means it wasn’t subjected to any scrutiny by those experienced with this medication and method of application.

I appreciate you bringing this to my attention as it is quite interesting, but I wouldn’t suggest anyone rushing to have this done though. Besides, taking a pill sounds a whole lot easier and less painful than injections in the scalp — not to mention that dutasteride still isn’t even FDA approved for use in treating hair loss and anything injected into the scalp (which is very vascular) will see fast absorption into the body 100% of the time. The paper itself concludes, “As is often the case with previously untested new techniques, this study raises more questions than it answers.” Indeed.