Category: Hair Loss Causes

Dr Rassman,

My question is: does finasteride play any role in maintaining minoxidil dose-dependent hair?

I got started on 5% minoxidil topical in early Feb, 2009. My derm prescribed Finasteride oral 1mg/day too, but I did not pursue that medication due to the usual side-effects related concerns. There was an initial minox-induced shed: not a massive one, but scalp showed. Things started looking up 4 months later but then again in July/August a bout of minor shedding ensued. Survived that too. In November yet another shed started and this one was bad; short fine hairs all over the pillow in the morning. Scalp showed yet again, as bad as after the first shed in March. In December, I panicked, decided that Minox wasn’t working for me, and got started on Finstaride 1mg.

By mid-Feb this year, there was a sort of minor miracle on the top of my head. My hair is looking its best in maybe two years. I hope you agree with me that it’s unlikely that Finasteride started growing hair within 10 weeks of beginning its use. My (semi-literate) guess is that Minox first grew “peach fuzz”, which gave way to intermediate hair, which then was replaced by terminal hair. I suffered synchronized sheds, the last one being the shedding of intermediate hair. Maybe more sheddings are in store for me, maybe not.

To get to the point, I am so pleased with the result that I’ve gotten greedy: I want Finasteride growth too. No sexual side-effects so far. I’d like to press on with Fin, and reserve the option of discontinuing it in future if side-effects show up. I understand that that would result in catch-up loss, but then probably I’d be content with the hair that Minox grew for me.

Hence the question: do minox and Fin have a cumulative beneficial effect on the same hair follicle? Will minox-dependent hair too be lost in catch-up loss if Fin is stopped? If the answer is in the affirmative, I’d probably be better off stopping Fin right away, since I’ve been using it only for 3 months.

Thank you for a patient reading, and thank you for your time.

You would have to poll each hair follicle and ask them what they liked better. If you can not communicate with them, then you are like me who frankly does not know the answer to your question. My best guess though (keep in mind I could be mistaken) is that because the medications work in different ways and finasteride will not keep hair grown from minoxidil and vice versa, that the benefits are independent of each other. Many men do use both medications concurrently, and as long as you can afford both (and maintain the regimen) I say go for it! It’s ok to be greedy and want your hair to look as great as possible. If the meds work well for you, that’s great news!

While it is unlikely that any major hair growth you’ve seen in just 10 weeks occurred from finasteride, you could’ve seen benefits from the medication that have helped your hair look better overall. The two drugs work differently. Minoxidil will grow new hair but the quality of the new hair varies in individuals from thin and poor, to strong and good (less than 15% of people). Finasteride probably does not grow new hair, but most likely works on the miniaturized hairs that we see in male pattern balding as it progresses. This is why finasteride (Propecia) will have no effect on the new minoxidil produced hairs. Minoxidil has not been shown to work on miniaturized hairs, at least that is what is presently understood.

Doctor Rassman I have a question. once every 2 months I eat Veal Liver that is milk raised. I just want to know can that cause genetic hair loss because liver has high cholesterol and stuff. and its always a very small piece that it every 2 months.

I’m not sure how you made that correlation, but there is no connection with a veal liver or higher cholesterol diet with hair loss.

Dr. Rassman:

Prior to reading this, thank you for your time. Your insight and knowledge is of great appreciation.

My situation is as follows:

I started propecia, was on it for a month, then underwent a HT of 1,900 grafts mainly in the front hairline. I continued to use propecia for 2 more months and began to experience some serious sexual side effects. I stuck it out for another 3 weeks however the side effects continued so I stopped the propecia. The sad part is that the propecia began to halt my hairloss however I could not deal with the sexual side effects.

Sadly my hair is shedding. After another apt with my hair restoration doctor, he suggested I take Avodart 0.5mg twice/week. He had mentioned that some of his patients who were having side effects from Propecia took the Avodart bi-weekly, (due to the drugs long half life) and were able to halt hairloss but did not experience the side effects which I was experiencing from my daily 1mg Propecia regiment. I have read all of your posts in regards to Avodart and I understand that it is not FDA approved nor do you prescribe it to your patients.

My main question to you and issue at hand:

I know that when people start taking Avodart they experience a shedding phase which generally kicks in after the first month or two of starting the drug and can last a few months there after. My first question – If I am only taking the drug twice a week and have only been off of propecia for 4 weeks will I also experience a shedding phase? I am confident that the shedding phase is the transition to a greater good…as the weaker hairs fall out months later they are replaced by stronger, new hairs. My problem is that I am in the entertainment industry and will be starting a one month taping of a TV series from June 30th-July 30th of next year. I would like to have as much hair as possible by that time so would I be better off waiting to take the Avodart after the taping is complete, or should I start now and hope that the avodart will not cause a drastic shedding phase and help me stabilize the hair that I currently have? I guess this really comes down to a game of timing.

It will be 14 months since my HT when the taping starts in June so I am hoping that the transplanted hair will already be full by then. Also, most of the hair that I am losing is from the front hairline and temples. The crown seems to be doing ok.

Thanks again for your time and I would also be interested in undergoing a transplant with your team following the taping.

I really do not have a clear answer to your situation. In general, Propecia or Avodart will not be as effective on your front and temple areas. They each work best on the top/crown areas of your scalp. I do not know if you will have more or less shedding as everyone has different results, different side effects, etc. Shedding isn’t seen by all men that start the medication. Really, only time will tell and there is no clear way to predict this.

It would be interesting to know if Avodart did indeed change your sexual side effect issues, as I would expect that it would not make it better. There’s not enough reported about Avodart dosing in the treatment of hair loss for me to suggest that bi-weekly pills are the way to go.

We called around the Los Angeles area.
Only Costco appears to have lowered their prices to an affordable rate.
Costco and Target still offer a year supply of 5mg pills for $27 (90 pills, or $9 for #30) This works out to 360 day supply or less than $3 a month.
Finasteride 5mg is still the least expensive option for those who are willing to cut the pill in equivalent dosing.

All prices below reflect generic 1mg finasteride as of October 2014

Costco:
#30: $16.37
#90: $36.89

Target:
#30: $83.00
#90: $249.00

Ralphs:
#30: $59.29
#90: $177.79

Walgreens:
#30: $81.99
#90: $233.89

Rite-Aid:
#30: $72.00
#90: $186.00

CVS:
#30: $69.99
#90: $209.99

Includes snippets from Wall Street Journal Article: Crucial to the hair-growth and balding process, scientists have found, vitamin D and the microscopic receptors that bind to it in skin as essential to good hair growth. These elements have become the focus for several research teams. (Supplements might offer health benefits for people lacking enough vitamin D, but they won’t bring back lost hair, researchers say.)

Some researchers, including those from the San Francisco Veterans Affairs Medical Center and Harvard Medical School, have identified molecules besides vitamin D that appear to activate the receptor and hold potential for future hair loss treatments. Japanese researchers demonstrated in animals that adding vitamin D helped the process of using stem cells to generate new follicles. Found in the Wall Street Journal — The Search for a Baldness Cure

My friend Dr. Richard Shiell commented:

“Plenty of sunlight and Vit D here in Australia (world’s highest rate of skin cancer). From my observation, our baldness rate and pattern-type is pretty much the same as elsewhere.

We are seeing Vit D deficiency in some Muslim women and children who cover-op and do not take advantage of our sunlight. I have not heard of any increase in hair loss. Kids at the beach these days are covered from head to knee as in the Victorian era so, if the author is correct, we should see more baldness in the future. I don’t believe it.”

It’s important to highlight the sentence from the article that states: “Supplements might offer health benefits for people lacking enough vitamin D, but they won’t bring back lost hair“.

In response to this news, some hair restoration doctors stated that they often recommend vitamin D as part of the treatment for women with balding or thinning hair. There does not seem to be a downside to this use, but I wouldn’t get too excited just yet about calling this a “cure”.

Tags: vitamin d, hairloss, hair loss, wsj

A recent article in the International Journal of Cardiology showed that baldness is tied to Heart Disease (coronary artery disease, the metabolic syndrome,hyperinsulinemia,insulin resistance. higher cholesterol, higher triglycerides, and higher systolic and diastolic blood pressures (high blood pressure). The article summarized 31 studies involving 29,254 subjects with alopecia and found these relationships. They pointed out that such measures such as weight loss, smoking cessation, and other modified risk factors should be the way patients fight for their health.

Hi I had a hair transplant in Mid July of 13, and I have had no growth in the frontal and the crown where the transplants were done. I have been keeping track of the transplant with pictures and it has gotten a little better in the front, still not the kinda of results I was hoping, but in the crown area there has been absolutely no growth. In fact the small hairs that were inserted never fell off nor did they grow, they are still there I can actually feel them when I run my fingers through. Is this normal that the hair sometimes doesn’t grow?

What you described should not be normal. There are autoimmune diseases that appear in some patients that can kill the hair transplants. These diseases are more often recognized in the frontal area, but you did report some growth there suggesting that the skin and scalp is probably normal. This may reflect a technical failure in the surgical process. A hair transplant failure is something you need to discuss with your hair transplant surgeon.

I have FUT surgery scheduled in late late December. I am planning on taking propecia in Mid-November..so is this long enough to prevent shock loss. I do not want to go through this shock loss that others have reported.

The longer the better, but 4-6 weeks should cover you. Even a shorter period will work, but taking it is critical particularly if this is your first hair transplant and you are under 30 years old. Shock loss is most common in young men and after the first hair transplant. Stay on the medications until all of the results are achieved and then consider staying on the drug for life. Talk with your doctor about this.

I had lung cancer and my last chemo treatment was in July of 2012. I finished radiation in October December 2012. I had some balding prior to the Chemotherapy that you might classify as a Norwood Class 6 pattern, but there was still hair throughout the head. It was just thinning. It has been almost two years and now my hair loss pattern is very clear and all of the thinning hair has not come back. I have a few sparse hairs all over my head, but they are very sparse. I am off my medications at this time. Will my hair come back and what can I do to help it. I have used Nioxin for two years and just recently started uses minoxidil. Are there vitamins to help? Just what can I do?

I do not know how to help you. You clearly had male pattern balding that was not complete and the chemotherapy stressed your fine, miniaturized hairs and finished the balding process in them. One of our patients had used the ‘Cold Cap’ when the took Chemotherapy and lost less than half of the hair. Few doctors are aware of this treatment. At this stage, I believe that you can expect that hair regrowth will not occur. We have a treatment that may be worth looking at, called Scalp Micropigmentation (scalpmicropigment.com). Many patients convert from a Class 6 or 7 pattern to a full looking head of hair by taking on a shaved look. Just like the star of Breaking Bad, many men look great with the shaved look and your case does parallel the main character’s appearance. This is something to consider. Many times I ask myself if SMP was available when I started to treat my hair loss, would I have chosen this option. The answer is yes, but at my age, this is not something that I would do considering that my hair loss is gone and my hair transplants were 100% successful in addressing by large crown loss.