Author: Dr. William Rassman

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Avodart – An Update

I would like to know what you found out in regards to Avodart at the hairloss convention. Please get back to me when you get a chance.

There is a strong suggestion that Avodart will work better than Propecia from what I heard at the meeting. There are, however, many questions not answered such as:

  1. What is the appropriate dose considering that there is a half life of 6 weeks for the medication in your body? Nobody seems to have a good answer to this question.
  2. Some think that Avodart may stay in the tissues for over 6 months, so what effect could this have on your system?
  3. What is the long term safety of Avodart taken by young man? All of the documented studies are on men over 50 (old-‘farts’ like me)

These are the reasons that most doctors do not want to prescribe Avodart ‘off label’ (not FDA approved for hair loss treatment). From a medical-legal point of view, as well as a licensing issue, I can not really prescribe it. Also, my expertise is in surgery, not medications (although I try to use medications I command and know forward and backward). There are some dermatologists, internists, urologists and family doctors that would prescribe this medication, and if you want to go that route, you should try to find one of them to prescribe it for you. With an off-label use, the issues of safety are risks that you must take.

The preliminary studies that were presented indicate that it works to grow hair when Propecia fails to do so. Still, Propecia should be the first line for the medical treatment of hair loss. What does concern many doctors, however, is that there may be a Vioxx type of hidden side effect in the young man that is not known. Will it produce cancers or heart disease or some other problem that is not yet identified? This is the reason we look to the FDA, to define safety and effectiveness for us. So far, the safety is not clear and the effectiveness appears to be coming into view through unofficial channels.

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Avodart and Androgenic Alopecia in Women

What information did you learn about Avodart’s effectiveness in treating androgenic alopecia at the Sept. ’05 conference in Sydney, Aust.? Any hope for female pattern hair loss?

Avodart (dutasteride) may have value in those men where Propecia (finasteride) fails to work, but as it is not FDA approved for treating hair loss I can not in good conscience wholeheartedly endorse it. It does not show value in women.

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Average Age of Developing MPB?

What would you say the average age is for men to develop MPB? I know there is a wide window, but what is considered to be the norm? (Any pattern of MPB)

Most people lose (or start to lose) their hair in their 20s. A few people have started it as early as 14, but that is unusual. I have seen others start losing their hair into their 50s or 60s.

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Aveda Invati Shampoo

I was wondering if you have any thoughts on the new Invati Treatment for Thinning Hair (shampoo, conditioner, and scalp revitalizer) from Aveda. Supposedly it won’t regrow hair, but it will stop hair loss (at least that’s what they said in the store.) Sounds too good to be true. It also seems to be mainly targeted towards women, though they claimed it would work just as well for men.

Thanks!

I found the product’s page and have seen the commercials on TV. The site says it stops hair loss from breakage, meaning it does nothing for actual genetic hair loss, but rather, it may strengthen hair. I think you answered your own question about it sounding too good to be true. Having said that, if you want to try it, it is your prerogative.

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Autoimmune Disease causes thinning

This patient has thinning in the front and top of their head. The leading edge of the frontal hairline shows loss of vellus hairs suggestive of an autoimmune disease such as LLP, FFA or CCA. This patient should NOT get a hair transplant because it will fail. This is why you need a skilled doctor who knows how to make a diagnosis that tells that this is not a hair transplant case


2021-03-20 08:21:07Autoimmune Disease causes thinning

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Australian Doctor Recommends Buying Generic Propecia Online

Dear Dr Rassman,
I am a hair restoration surgical trainee(I am thankful to say that my mentor is a very well respected Australian ISHRS member).

I would like to respond to one of your recent patient questions regarding the availability of generic Propecia.

It appears that generic Propecia IS currently available from some online pharmacies under the brand names Finpecia and Finax(as an example visit this link- https://www.unitedpharmacies.com/Hair_page_3_c_3.html).

It appears that there are legitimate ways that some countries can get around the relevant patent laws.

With kind Regards

I am presenting this as it was sent to me. The consumers must determine if this approach works for them. I would not recommend it for US-based people (due to it not being quite legal), but my opinion isn’t shared by everyone.

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Azor, Toprol-XL, and Hair Loss

Hi,

I am currently taking Azore for high blood pressure and occassionally toprol xl for heart palpatations. Can these medicines cause hair loss of a significant nature?

Azor (amlodipine and olmesartan) does list hair loss as a possible side effect. Taking Toprol-XL (metoprolol succinate) can also lead to hair loss in rare cases, as we’ve mentioned before. With the combination of these two drugs, you do have a higher likelihood of seeing thinning hair.

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Avodart and Mixing Shampoos

Hello Dr. Rassman.
Thank you for taking the time to respond. I also wanted to ask you about going on Avodart (Dutasteride) or it’s Generic Dutagen. I have been on Propecia since 1999, and I think it is no longer working. I read Merck’s official report on Propecia’s 5 year efficacy, and it looks like after 5 years Propecia stops growing any hair at all, and it’s ability to keep hair is weakened. Dutasteride appears to block 93% of DHT production, where Propecia can only block 38-45% DHT. Can I get a prescription form you or Dr. McClellan? I am noticing that my “own” non-transplanted hair is thinning, and hopefully the Dutasteride or it’s generic version can stop any more loss.

Also, I am using Nizoral shampoo (Ketoconazole) 2 times a week, and Head and Shoulders shampoo (Pyrithione Zinc) on the other days. Is it safe to mix the Ketoconazole and P. Zinc? A friend told me that the P. Zinc can cause miniaturization of the hair follicle, and mixing the 2 shampoos can have disastrous results. Then on the the other hand, many people on online hair loss forums are saying it is fine to mix the two shampoos. Only using Nizoral 2x a week does not stop my newly acquired incessant itching. It would be great if I knew it was safe to use Ketoconazole and P.Zinc.

Thank you so much for you time, I’m sure you hear all these worries all of the time. Now that I see my new hair sprouting, I want to keep it growing, and keep or grow more of my own.

Here is a link to some of my other posts with my comments on Avodart. I will make a decision with regards to prescribing Avodart in early September, after I return from the International Society of Hair Restoration Surgery meetings in Sydney, Australia.

With regard to the various questions you had concerning the shampoos you mentioned, I really do not know the answer, as many people respond differently to each. Experiment with each and when you find something working, then stick to it. Mixing shampoos should not be a problem.

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Avodart (Dutasteride) vs Propecia

Hi.DR.RASSMAN, I would like to know if type 1 DHT causes hairloss?? or is it just type 2..?? Please let me know when you get a chance… and do you think they will becoming out with anything better then propecia in the near future???

Propecia is a type 2 competitive inhibitor of DHT and Avodart is a competitive inhibitor of both Type 1 and Type 2 receptors. I think that is what you are asking. There is no clear evidence that blocking both Type 1 and type 2 receptors is better. What we do know is the Avodart does drop the DHT level in the blood stream more effectively than Finasteride (90% vs 75%). What this means is suggestive that it might work better in some people. But I must state clearly that safety and effectiveness is the mainstay of the FDA and until we have a handle on these two issues, I believe it is better to stick to Finasteride.

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Avodart Info

A BaldingBlog reader named Greg originally posted this as a comment to a blog entry, but I’ve formatted it to make it easier to read and have reposted it here.

The FDA has found Avodart to be safe (for BHP). The side effects were very simliar if not a tad less then Proscar 5mg, which also was cleared by the FDA many years ago. I think Avodart should be indicated as a off label prescription in some instances.

  1. non-responders to Propecia
  2. When the loss of efficacy of Propecia becomes bothersome to a indivdual

One other interesting point is that the age group the FDA studied on Propecia (18-42) was quite younger than what Proscar/Avodart (50+ median age 66 approx) so the chances of sexual side effects will inherently be larger in this age demographic as opposed to Propecia… meaning the side effects are probably even closer then one thinks/ Propecia versus Avodart. The one draw back with Avodart is that there is no “human model” with type 1 suppression so there is a question on “long term” safety as with many drugs. As long as you dont have any side effects with Avodart, the long half life can only be beneficial with Androgentic Alopecia and the phase 2 studies show this. People held onto the hair they gained (even grew more) 12 weeks “after” the the medication was discontinued (0.5 mg/ 2.5 mg only). Proscar users saw a sharp decline in this time frame. I hope these facts are helpful in some way.

Thank you for your insight. I believe that what you said makes good sense. I would hope that I could adopt a similar view in an ethical/legal framework.