Author: Dr. William Rassman

Dear Doctor,

I have been on minoxidil 5% for about 6 years. It has been alright this while holding on to the hair i have without much regrowth. Recently, i feel that my scalp starts to get immune to minoxidil and i can see patches of baldness. Do you know if the effectiveness of minoxidil actually decreases over the years? How long can the effectiveness sustain?

So far, this is the only treatment i have received. Could you kindly advise me on what i can/should do?

For you advice and opinion please. thank you

People who have benefited from minoxidil will continue to sustain some benefit over time, but if your hair loss is progressive, the benefits vary with the status of your hair loss. I don’t know anything about you, so I can not advise you on what you should or should not take.

My hairline had receded slightly over the years and more so on the corners but was in pretty good shape as of my 45th birthday. But over the past 10 months I’ve noticed a lot of thinning on the hairline and in the area behind it, which I know now is called the mid-anterior scalp. I went to see a local dermatologist/hair transplant specialist who told me that propecia wouldn’t work in that area as it was only effective on the crown. However, he did offer to restore my hairline with 900 grafs for $5,000.

Luckily, I found your site and later read Merck’s report on propecia’s effectiveness for frontal hair loss. After crunching the numbers it seems to me that it works just as well in this region as it does in the back, although it may not be as apparent. Here’s how I got there. At the start of Merck’s vertex study, the average patient’s hair count in a 1 inch circle was 876. After one year of use the average propecia user gained 86 hairs. If we assume that the pre-baldness count per square inch was 1,400 than the average guy restored 16% (86/(1,400-876)) of his lost hair. In the frontal study the average starting hair count per inch was more dense at 1,096. One year later there was a mean gain of 49 hairs so the percentage restored was 16% (49/(1,400-1,096), the same as in the vertex study. Doctor, am I overlooking something? If not, why do so many dermatologists continue to believe that propecia won’t work for frontal hair loss?

If you are thinning in the front (and have some hair there), Propecia is worth a try, but it is not as simple as crunching numbers, as you will still have thinning in the corners. I think you are on the right path of doing research on the matter. Just remember that even a hair transplant procedure will not completely give you back what you lost.

I always tell patients that going to a hair transplant surgeon requires a buyer beware caution. I’m glad that you’re taking charge and believe that Propecia is worth a try for the area you are focusing on before looking for a hair transplant. As to why many doctors believe Propecia will not work at all in the hairline, I’ve addressed this before in Why Is It Difficult to Regrow the Hairline?.

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Hey Doc

You run a super little website on the gamet of hair topics. If I could pick your brain or seek your opinion.

Merck wont be too forthcoming. Obviously there is some info floating out there that there is no real toxicological risk if man conceives with a woman. However are there now reports out there stating that the “quality of the sperm” is affected by taking finasteride. Meaning number of sperm, motility and I even wonder if you have a higher ratio of having a female birth over a male

What are your honest thoughts on this topic? Mighty thanks

From what I am aware of, finasteride 1mg does not affect sperm quality or have a propensity to increase the chances for conceiving a female child. There is no scientific basis behind this.

As I am not adding much information for you, I will write to Merck for a response to your question and appropriate references and then post the answers that they send me.

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