Should I Continue Using Rogaine After 10 Years? – Hair Loss Information – Balding Blog

Dr Rassman, I have been using both rogaine and propecia for the past ten years. I think they have worked fairly well but I have read that rogaine becomes less effective over time. My question is it still worth using, does it have any negative effect if you continue to use it even if it does not seem to be growing as much hair as when it was first started. I don’t have any shedding due to its use and have always read that using them together is a good approach to fighting hair loss.

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If it is working now and you’ve had success for a decade, I’d keep up with your daily routine. Why take chances? Do what you know best. If you discontinue its use now, you’ll lose any benefits you’ve had for all this time. Remember, new hair that has grown from minoxidil is dependent upon the drug and if it is withdrawn, it is highly likely that these dependent hairs will fall out.

Clarification – Propecia and the Hairline – Hair Loss Information – Balding Blog

I’m pretty confused about the whole “propecia working on the frontal area/hairline” debate. It seems your various posts about the topic vary greatly in opinion of its efficacy. Let’s say I’m a 21 year-old male, Norwood 1.5 moving toward a 2 and my hair loss is undetectable to outsiders at this point. Would propecia be good to stop the hair loss at my hairline/front or could it reverse the thinner hairs? Or would I just absolutely be wasting my time with the drug? I also heard that frontal hair loss is caused by testosterone and propecia will have absolutely zero effect on it?

I’m quite confused and am getting tired of all the conflicts of interests/information. I’d say the miniaturization at my hairline is pretty mild at this point; the hairs almost look the same as the rest of the hairs on my head but I can just tell they are getting thinner. You say that if caught early enough, propecia works equally all over the head, but then you’ll say that it isn’t known to work on the hairline. For instance:

Why Is the Hairline Immune to Medication?
Could Propecia Shedding Be Cosmetically Significant?

What’s the deal??

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I don’t know what conflict of interest you see, but I do see why you’re confused. In one post I said, “Propecia is not known to work on the hairline or reverse hair loss on the hairline (it happens in extremely rare cases).” In an older post I said, “Medication does work in the hairline, but I believe the hair loss has to be treated earlier.” It seems consistent to me, although perhaps a little ambiguous. Allow me to explain. Propecia (finasteride 1mg) isn’t reported in the literature to work at the juvenile hairline, which is the part that begins at the highest crease in the wrinkled brow and extends 2/3rds of an inch toward the back of the head. But I have seen rare cases of reversal of the leading edge of the mature hairline, which starts about 2/3rds of an inch above the highest crease in the wrinkled brow. One problem is that by the time the hair loss is noticed, it is too late for Propecia to do much good in the hairline. This is why I recommend mapping your scalp for miniaturization to be able to watch for this early loss. Hair loss has to be treated with finasteride just as it starts miniaturizing at the mature hairline if you want to try to halt the hairline from moving further back.

So what is the deal? This is the deal! I believe a Norwood Class 2 frontal loss reflects in most men, the loss of a juvenile hairline. I do not consider losing the juvenile hairline as balding. It is unknown if Propecia can impact the migration from a juvenile hairline to a mature hairline.

Norwood 7If you have miniaturization behind the juvenile hairline location, I would think that a DHT blocker like Propecia could reverse that balding, but I’d be more confident that it would slow down or halt the loss in most cases for a 21 year old. I say “most cases”, because I haven’t examined your scalp and I just don’t know if you are heading to a Class 7 pattern (see diagram at right), where taking Propecia when you’ve got massive miniaturization may not help much. I wouldn’t think you’re wasting your time with the drug, but it could end up being the case.

Hair Loss InformationThe FDA Has Been Wrong in the Past – Hair Loss Information – Balding Blog

I hear you say any Propecia side effects are gone within a few days or weeks at most. But what about other drugs that the FDA has recalled because of permanent side effects? Those drugs presumably had half lives, and the literature indicated that side effects would go away soon after stopping those drugs. Maybe the same scenario goes for Propecia.

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You have an agenda in your question. God does not reside at the FDA, which means that their activities are less than perfect, and yes, they’ve made mistakes in the past. We can only tell you what we believe we know. Finasteride has been on the market for over a dozen years now. If you can’t find the research and proof to be credible by now, I don’t know what more I can do to help.

Shedding from Hair Loss Treatment Medication – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I appreciate you answering the last few questions I’ve sent over. But to follow up, when I see hair shedding as a result of minoxidil and/or finasteride, can I read anything into the quality of the hair that is shedding? Does it mean one thing if the hairs are long and dark as opposed to miniaturized and light?

I believe that you are reading too much into the shedding, but I have not examined shed hair so I really do not know what is happening. The shedding appears to be a shifting into another hair cycle, nothing more.

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Hair Loss InformationDid Surgeries from My Fibrous Dysplasia Cause Hair Loss? – Hair Loss Information – Balding Blog

Dear Dr Rassman:

I’m a 27 year old who has long suffered from Fibrous Dysplasia (I’m not sure if you are familiar with this disease). Due to my ailment, I have incurred over 30 medical surgeries over my lifetime. My hair was thick up untl high school, and then it really began to thin. The only ancestors of mine that have been bald were only two of my great-grandfathers. I was wondering if all of the major surgery I have had would have caused my hair loss. Also, I have been on propecia since November of last year and am having some back surgery next week. Would the shock of surgery or the medications used cause my hair loss to increase? Also, because I may be missing a couple of days of propecia doses would this affect the progress of the drug in combating my hair loss?

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Fibrous dysplasiaI’m familiar with fibrous dysplasia (it is a very rare bone disease), but I do not know what surgery you have had or what medications you take. Your question is very general and it is not something I can give you an answer to in this format. You need to see a physician and have a complete history and examination.

In most cases, hair loss in men is caused by genetics. If you have an autoimmune disease like a form of a scarring alopecia, surgery done in these conditions can be dangerous and produce failures of the grafts and further scarring of the scalp. Any medical illness or surgery that is a stress to your body can cause hair loss (sometimes permanent). But to distinguish that from genetic causes is something that only a thorough examination with a physician can provide. You are looking for a cause and effect type of relationship and I really cannot help you with the limited information I have.

What’s a Typical Result After a Year on Propecia? – Hair Loss Information by Dr. William Rassman

Hey doc, just finsihing my 10th month on propecia, pretty sure hair isnt any better maybe alittle worse in front. However I think propecia is working to at least slow down my loss. So my question is, after 1 year of treatment what is the state of the typical propecia users hair. Also what is their own opinion of their hair, before you look at it, do they think that their hair is better, worse, or the same? Finally I have heard that best results (thickening of hair) do not happen until 24 months, how true is that for most of your patients? Thanks!

It takes about 2 years to maximize the benefits of Propecia (finasteride 1mg), but in one year you will kind-of know what you are going to get. Reversal of frontal hair loss is not common, but stopping or slowing the hair loss is common. Response to this drug is often age dependent with the younger men getting more benefits, provided that they are not heading to a Norwood Class 7 (extreme case) by the age of 23.

The hair that reverses in the crown is just like it was before it went away, but you really can not tell one hair from the other. The degree of miniaturization is a better indicator for benefits if you want a metric on this process.

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Anti-Itch Medication to Use with Minoxidil? – Balding Blog

Hi doctor,
Twice you have answered my question. Thanks a lot for that.Now I would like to know Whether provillus is effective for thinning hair. The topical contains minoxidil 5% but the supplement contains 1500 mg of saw palmetto plus some vitamins and minerals. Since there is know proven results for saw palmetto’s efficiency on hair growth, Is it an effective way of combining it with minoxidil? as with provillus or what alternate supplement you suggest that can be taken with minoxidil which faster the hair regrowth process other than finasteride?

And I have tremendous amount of itching on my scalp if I apply minoxidil (even 2%) now what shall I do? Do I take some anti-allergic pills and continue application of minoxidil?

Allergy to minoxidil is a common side effect and other than stopping the medication completely, lowering the dosage is reasonable to try. I don’t think an over-the-counter anti-itch cream (with benzocaine or something similar) would be of much help. When you develop an allergy to minoxidil, topical steroids may be the only thing that will help, but it could do more harm than good and I don’t advise that.

Combining the saw palmetto with minoxidil in a topical medication as Provillus does suggests that the company is tossing everything but the kitchen sink into their product line. I’m not convinced of saw palmetto’s use as a hair loss treatment (especially as a topical), and the only suggestions I feel comfortable giving for hair growth are the FDA approved ones that are proven to actually do what they claim: minoxidil and finasteride.




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Can I Let My 15 Year Old Son Use Minoxidil Until He’s Old Enough for Propecia? – Balding Blog

My question is for Dr Rassman: I have a 15 year old son who seems to be losing his hair (from the crown only – mpb in the family). I understand that Propecia is not suitable until he is 18. Is it worth using Rogaine until then and at what strength? Based on your experience how successful do you think it would be in retaining the hair he has until he is old enough to try the Propecia?

I know you have to deal with many questions but I would be so very grateful for your reply.

A worried mum.

I am reluctant to recommend Propecia (finasteride) for someone that young, but I and many other doctors have done this provided that your family doctor goes along with it. I have allowed my young patients to use Rogaine (minoxidil), starting off with 2% and moving up to 5% in the crown, if his family doctor does not want to use Propecia.

One thing to keep in mind — benefits from minoxidil are not kept by finasteride and vice versa. In other words, if he sees positive results from Rogaine and then decides years later that he wants to take just Propecia, it won’t maintain what Rogaine has kept.




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Any Minoxidil-Based Treatments That Just Require 1 Daily Application? – Hair Loss Information by Dr. William Rassman

Dr. Rassman
I have started using scalpmed. It requires daily twice application. I cannot go to office with greasy head. I either have to take bath after applying or have another minoxidil based solution that needs daily once only application. So

  1. What should be the minimum time between application of minoxidil and shower?
  2. Is there any minoxidil based treatment that requires once nightly application?

The minoxidil will have been absorbed by the skin within an hour or so, so that should be the time in between applying and showering.

Using Rogaine Foam might solve the greasy head problem for you. Since both the foam and ScalpMed are minoxidil based, you wouldn’t lose benefits by switching between the two. Most minoxidil products recommend twice daily use, but some people do apply just once a day.

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If My Libido is Higher on Propecia and Avodart, Does that Mean DHT is Increasing? – Hair Loss Information by Dr. William Rassman

I started taking propecia when i began noticing my hairline receding and hair becoming thin in the crown. About 1 year later i decided to give dutasteride ago. Throughout both medications my testosterone increased quite alot, causing increased libido to such a degree that i was getting an erection almost 3 times a day compared to almost never (unless needed) when i wasnt on the medication. i have been taking these medications now for 3 years and my testosterone shows no sign of of decreasing back to normal.

My question is, if i am taking medications to reduce as much DHT as i can and my medications are actually increasing my testosterone which inturn is creating more DHT as its a by product isnt it a paradox and useless. I have however heard that this increased testosterone isnt almost a momentary thing that may last a while because my bodys thinking ‘we need to make more testosterone’ due to the decrease caused by the medication.

Thanks NHI Team

Few men will complain of an increased libido or an increase in the frequency of erections. As you noted that the increase in erection function has been now two years since you started it, I would imagine that it will continue. How do you know your testosterone levels increased? Did you have them measured before and after you are taking Propecia and/or dutasteride? These blood levels need to be compared to the normal values established by the lab testing you.

The connection with your sex drive and the DHT block from the drugs you are taking, and possible increased levels of testosterone are unclear. Without knowing testosterone levels before and after you started taking the DHT, I can not tell you much. I personally think that you are going overboard with analysis here, and should just enjoy the moments as long as everything is working well.

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