Author: Dr. William Rassman

Dr. Rassman,

Thanks again for maintaining this blog. I have asked a number of questions before and appreciate your prompt responses. I have a few questions about minoxidil and propecia. Here they are:

1. I have been using minoxidil (liquid solution) for almost a year. A couple of months back it really started to irritate my scalp. I am almost convinced that it is a reaction to an ingredient i even here) that people have reported increased shedding after switching from the solution to the foam. Is there any explanation for this? Do you think it can hapn the solution that is not in rogaine foam because I have tried using the foam and it doesn’t irritate my scalp at all. I want to switch to the foam completely, but have read elsewhere (maybepen?
2. If I do have an allergic reaction to an ingredient in the solution, will that inhibit its ability to work? In other words, does the irritation prevent the minoxidil from re-growing hair or preventing further loss? I do note that sometimes after I brush my hair when the solution has dried (8-6 hours later), large flakes and hairs fall off my head (though not an alarming amount of hair).
3. Can I use Rogaine Foam in the morning and the solution at night? I figure if I use the solution only once a day and wash it off in the morning it may not irritate my scalp as much.
4. I take propecia in the morning, first thing when I wake up. I also go running in the morning, right after I wake up. I know that exercising will not prevent propecia from working, but my concern is related to the timing. If I take propecia, then immediately begin to exercise, will I somehow decrease its ability to work? For example, will I sweat some of the medication out before it begins working?

1. You are probably right that your irritation is from the non-active ingredient in the minoxidil. There is your explanation! Many people have said this as well. So try using Rogaine Foam. You’ve tried it and it doesn’t irritate your scalp, so there’s the solution!
2. If you get irritation from minoxidil, you should stop taking it, switch to a lower dose, or change the formulations (to a foam for example). What you are reporting is not a good finding, but for the flaking, maybe the foam will solve that problem or the amount of minoxidil you apply should be at a reduced volume. If you have an allergic reaction to something then you should not use it anymore. You shouldn’t be thinking about if the irritation is preventing minoxidil from working! You should NOT be using it.
3. Use Rogaine Foam as directed on the bottle, which is twice a day. Most people use it once in the morning and once at night… unless you want to use it once in the afternoon and once when you wake up in the middle of the night.
4. If you are worried about “sweating out” the Propecia when you exercise, then take it after you exercise. I do not, however, believe that this is a problem.

I’m a 52 year old and I’ve been using Propecia for almost ten years. I really believe it stopped the progression of my hair loss but did little to grow back hair. In the past couple of years I’ve been irregular with my usage and haven’t noticed additional hair loss. Is it possible with lower male hormone levels that result as you age that I may be wasting my money in purchasing Propecia.

Since you have not been using it regularly (stopping it and starting it over the years) I’m not surprised to hear that there was not more hair loss, as what you were doing probably had very low value. We generally progress until our genetic pattern is reached. If I had to guess, I’d say that your balding pattern reached your “end” genetic pattern about when you started Propecia. It’s difficult to say for sure, but I wouldn’t want to give you the OK to completely cease the medication and risk the hair loss progressing again.

Hello good doctor I messaged you before and I understand you are busy. I am 22 years old and I have begun to notice a little bit of hair loss. The hair seems to be thinning out. I have started taking 0.5mg of Propecia today, I experienced some side effects with the 1 mg dont know if they were psychological or physiological in nature. My doctor recommended it but didn’t do any tests like the miniaturization one you mentioned.

I respect your experience and was hoping to send you some pictures so you could give me your expertise in this manner.

I couldn’t say whether what you experienced is from the power of suggestion or if the Propecia had a physiological impact. That being said, the psychological aspect can be powerful (see Are Propecia Side Effects Just In My Head?). Half a dose is better than no dose at all. Half a dose works about 80% as well as a full dose. Hopefully that will help with the side effects you experienced.

I have written extensively about the value of establishing a metric for the degree of miniaturization for both diagnosis and follow-up treatment. Unfortunately, some doctors are lazy and do not establish this baseline.

If you’d like to send photos, please email them to the address on the Contact page (and reference this post when sending).

Hi Dr.Rassman,
I currently have been on finasteride, 1mg, for 8 months with good results, although I do have a problem with gynecomastia(glandular) as I have gotten it excised twice before and unfortunatly It’s flaring up again. I did have this before I was on propecia. Im just afraid that the doctor will stop the propecia If I tell him its flaring up again and I dont want to stop using It. What should I do? Thank you in advance for your respected opinion

You can talk to your doctor about reducing the dose to 1/2 or 1/4 of a Propecia pill, but since you had gynecomastia twice before taking it, I’d wonder if this round of gynecomastia is even related to the medication. Be open and honest with your doctor, and if he decides to take you off Propecia, explain your case.

Do you have a hormonal imbalance or something that might be causing this? I’d also discuss the other causes of gynecomastia with your doctor.

Hi Dr,

I tried Propecia about 2 months ago and got sides (could not maintain full erection during sex after a week). I stopped for a month and have now take .5 propecia for the past 2 weeks with no problems. I am 25 and have a bald spot in the back forming with diffuse thinning down the middle of my scalp.

What do you advise as my plan of action for re-growth, would you recommend me to up the full dose soon? Rogaine? Have you seen good results with adults my age range?

thanks for you help

If half the dose of Propecia works, you will get about 80% of the value of the drug, on average. That may be enough to accomplish your goals. You can try increasing the dosage up over time, but I really don’t want to give dosing recommendations for someone that isn’t my patient. This is a prescription medication, so you should go over your options with your physician.

You can try adding Rogaine to your routine, which is sold over-the-counter.