Author: Dr. William Rassman

Dear Dr. Rassman,

My question is regarding the non-approved use of minoxidil for frontal balding. In your response here your thoughts were that it might work to some degree. My question is whether there is a physiological difference between balding at the hairline and on the crown? If not, is there some other reason why minoxidil might be less effective at the hairline, or is it simply the case that Pfizer didn’t test it there, and if not, why not as it would surely increase sales.

The drug PI in fact specifically says not to use it for receding hairline, do you believe that it’s possible that it may have negative effects? Further, is there a likelihood that minoxidil use by a man who in fact wasn’t balding but only having a maturing hairline would have negative effects (other that normal drug side effects)?

Many thanks

You raise an interesting question, but no one really knows why minoxidil or finasteride work better on the crown area. There may be a physiologic difference of hair follicles in the frontal area versus the hair follicles in the crown area, or it could be that hair loss in the frontal area is more rapid and medication works better when the hair loss is earlier with more miniaturized hairs. I do not think there is a danger or negative consequence of using the medication for the frontal area, though. In fact, many of my patients do use these drugs for the frontal area with some success.

I really do not know why the drug companies did not study the effect of the medication on the frontal area of the scalp. My cynicism would tell me that their initial results were very weak and they’d rather not publish poor results, but I actually believe that it was too complex for a good science study to show the type of results seen in the crown.

Here is a quote I just found on a health & fitness website:

“Over-masturbation or over-ejaculation converts too much testosterone into dihydrotestosterone(DHT). High levels of DHT overload the body causing baldness and possible prostate enlargement. Reducing the frequency of masturbation or ejaculation will help maintain low levels of DHT and avoid hair loss.”

So should I really believe this stuff and, well, ‘keep it in my pants’? I’ve never heard of ejaculation elevating DHT before, so any comment would be appreciated.

Older studies show masturbation cuts prostate problem risks, but a more recent study shows that it could possibly increase prostate troubles for younger men. Yet the study suggests that older men should have frequent sex or masturbate more frequently. Some male health experts believe that men should either have sex once a day or masturbate once a day, but the evidence is really not scientific.

Every man has DHT, yet not every man loses hair. For those that are susceptible, DHT is a cause of hair loss. But even if ejaculating caused a DHT increase, you’d have to be genetically inclined to lose hair for it to actually cause hair loss. Why does this not make sense to people? Masturbating doesn’t cause hair loss. Genetics does. If you never masturbated or had sex in your entire life, you could still lose hair.