Author: Dr. William Rassman

Dear Dr.

I have been taking Minoxidil 4% plus progesterone for 16 years and stopped 3 months ago because I was worried about the possible long term effects and I wanted to look at a more natural approach. Since then the shedding had increased dramatically (over 150 hairs during shampooing), my scalp can now be seen through my hair for the first time ever and the hairs that are falling out are thinner and in some cases shorter than before I stopped.

It was suggested by a trichologist that I am seeing that when you stop using Minoxidil the capillaries shrink to smaller than their original size, reducing the blood flow to the hair and causing them to fall out. He also suggested that they dont return to their normal size for up to 9 months and in some cases never as the damage is permanent.

However another trichologist told me that the hair loss could not be so sudden and it would take 6-12 months before I would notice any hair loss and even then it would only be the hair that was “saved” by the Minoxidil in the first place that would fall out. Can you tell me:

1. Do you know of any research to support either of these claims?
2. Is there anything I can do to stem the shedding if the cause is the fact I have stopped using Minoxidil?
3. Could blocked follicles (as the first trichologist suggests) also be a contributing factor?

Thank you for your time.

You are asking me to comment on what your trichologist told you and I don’t know what to say about blood vessels, shrinking capillaries, etc. What I do know is that for 16 years you used minoxidil and that you most likely have minoxidil-dependent hair that will not grow back unless you go back on the minoxidil and are not too late in doing so. So to answer your questions:

1. I’m not aware of any research, but I can’t say that it doesn’t exist.
2. Stopping minoxidil will result in losing benefits of the minoxidil — which would be any hair retained or regrown by the medication. You’ve been on the medication for 16 years, so you’ll have a difficult time guessing which hairs were saved by the minoxidil (meaning, the hairs that will be lost).
3. Isn’t this the same as question 1? I don’t have an answer for you, unfortunately.

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Hello Dr. Rasman,

First I would like to thank you for such a wonderful site. I have been an avid reader of this blog for some time now and find your dedication to this field quite remarkable. I have a question that I would like clarification on regarding finasteride dosage. It seems you that you frequently state dosages higher then 1mg have no increased effectiveness in treating MPB. Most recently quoted here: What If I Take 5mg of Finasteride to Treat Hair Loss?

“Taking finasteride 5mg (Proscar) daily will not have any benefit over the finasteride 1mg (Propecia) in the treatment of androgenic alopecia (AGA).”

But I have come across some blogs in the past were you seem to state that there “may” be an increased effectiveness in higher doses. I have quickly searched your site and here are two examples:

1: Propecia and Dosage
The dosage of Propecia was arrived at because when Merck went through the FDA the 1mg dose was found to be lowest effective dose to get the desired result based on the clinical trial program that was done.

“That may suggest that a higher than 1 mg dose may be more effective, but that was not studied for treating hair loss.”

We do know that higher doses of finasteride will increase the known side effects. A decreased ejaculate is one of those side effects. With regard to brain fog, there is nothing that I know of that will support this as a known side effect of finasteride. Be careful that you are not setting yourself up for this and obsessing too much.

“If you want to play around with the dosage, wait a few weeks between changes as it takes that long to change the tissue levels of the drug.”

2: 1mg vs 5mg Finasteride for Hair Growth
I am not familiar with any study that directly compares the 5mg dose to the 1mg dose, but I would suspect that like any bell curve, the 1mg recommendation applies to those individuals in the center of the bell curve and that “some people most certainly would be better with a higher dose,” possibly worth trying if the 1mg dose is not adequate to meet the needs of the patient’s problem.

Even your colleague Dr. Bernstein makes refrence to this on his own site, which is linked here: BernsteinMedical.com

So then is their truth to the statement, that though unproven, a higher dose of finasteride may be more effective in treating MPB?

I thank you again for your time and this wonderful site.

Best Regards

When I discuss finasteride dosing, I’m referring to the dose that the studies show is effective and safe. There is never one dose for every person, because we all have different body weights, different metabolisms, different hair loss (possibly from sensitivity to DHT that may vary by time, where you are on your hair loss cycle, your genetics, etc.). You can pick and choose and interpret all that has been said about the dosages of finasteride, but in the end 1mg finasteride works and in a large population it is the dose that worked most effectively.

Looking at the big picture, a higher dose is probably not going to make a huge difference. All drugs have limitations and a higher dose is not going to give you dramatic gains. Case in point: think of all the bald men who are taking 5mg finasteride for their prostate issues. I believe that the men on 5mg finasteride are not much better off than men taking 1mg finasteride when it comes to their hair loss.

I am afraid we are beating this issue to death, but I appreciate the time you took to find out about my consistency and respect you for it.

This is a follow-up question I received from Should I Be Applying Rogaine with a Rubber Glove?

once you apply Rogaine foam can’t you simply wash your hands with anti-bacterial liquid soap instead of wearing a glove?

The minoxidil absorption is probably fast, but I do not know how fast. If you are absorbing it with more hand hair, then a glove is the only guarantee to stop it getting through the skin and into your hands and body.

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Doctor, I have a question to make you, I’m wondering if a comment from one user of Scalp Med it’s true, I doubt it honestly, the commentary says, ‘I have using Scalp Med since 3 months and im started to lose a little vision in my eyes since this three months’. I honestly don’t believe that, but I wanna be sure that Scalp Med doesn’t have these side effects.

So I would really like if you know from this side effects of Scalp Med, cause I’m thinking seriously in use this product.

Thanks in Advance.

ScalpMed contains minoxidil, which is known to cause blurred vision as a rare side effect in some people. For more info, see:

• BaldingBlog – Blurred Vision from Minoxidil
• Drugs.com – Minoxidil info
• Health A to Z – Minoxidil

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