Category: Drugs

Hi,

Thank you for your great blog. I’m a head shaver, and currently I’m using Rogaine foam. I will shave, then shower, then use the foam. I was wondering if it’s ok to put moisturizer on my head before the Rogaine foam? Would that change the effectiveness? Thanks!

Probably not, but more chemicals on the scalp could potentially block the Rogaine Foam absorption. The application instructions for Rogaine say to apply it to a clean and dry scalp.

Dear Dr. Rassman,

recently you wrote on this blog about having advised several of your patients seeing a certain loss in efficacy of finasteride treatment to higher the dosage from the regular 1 mg per day to 2.5 mg (half a proscar). In older entries, however, you are strongly advising against that therapeutic “move”. Could you please explain why you seem to have changed your mind on this and what conditions you´d like to see fufilled before making such an increase in dosage!

Thank you so much!

There have been more and more complaints by some patients that over the long term, Propecia seems not to prevent the advancing balding patterns that they are experiencing. Because of the high interest in Avodart in some individuals who are not getting control of an advancing balding pattern (without its FDA clearance), there seems to be a consensus by some of the prominent doctors in the field that 2mg of Propecia (or 2.5 mg of generic finasteride — which is a half of a Proscar/generic finasteride pill) may be better in some of these individuals and worthy of a try. Please note that I’m not suggesting that people increase their dosage on their own without talking to their prescribing doctor.

As long as there are no negative side effects, I believe it is a better option than Avodart, which I am reluctant at prescribing until I get more comfortable with the FDA clinical trial that just completed. I will try to understand this better at the ISHRS meeting next month in Amsterdam, where the Avodart study will be discussed. Once I know more, I’ll post it here.

Dear Dr Rassman
You wrote an answer to someone yesterday saying this:

“The issues of safety and effectiveness have not been fully explored in the youth like you with Avodart. Without that information in a research controlled, FDA approved study, there is no way to tell the answer to your question. Unfortunately, the manufacturer has not elected to sell into the hair market, despite the good blocking effect that Avodart has on the targeted enzyme. The FDA has certified this drug for prostate disease and I suspect based upon this, the drug should have no impact on the egg fertilized by the sperm of a man taking the drug, or when having unprotected sex during pregnancy”

Does that mean that they do not want to put Avodart on the market for hair loss after all? Please Advise!!! Thanks

The answer you’re referencing is something I wrote way, way back in February 2006, before official trials for using Avodart as a hair loss treatment took place. I’ll know much more about Avodart after the International Society of Hair Restoration Surgeons (ISHRS) meeting next month in Amsterdam and will post what I find on the blog.

Hi Doc,

I have been on propecia for over 4 months and had to stop due to side effects (started developing gyno). Couple of months passed and I started seeing massive shed which is probably the catch up hair loss. Since I cannot go back to propecia/fin, is there any topical treatment (other than rogaine) that can help slow down this process? I am not looking for any regrowth at this point, but just want to make sure the catch up hair loss can be controlled at all? Thanks for your valuable suggestions.

I just had a patient who reported gynecomastia along with some sexual side effects from Propecia, and after he reduced his dose to 1/4 of a pill (0.25mg) he was able to continue taking the drug without side effects. It is only a report by one patient though. Most of the patients who have had gynecomastia usually do not tolerate the drug even at lower doses and when there is gynecomastia, there is often other libido and erectile dysfunction side effects as well. A quarter of a pill is better than none, so I would recommend trying a lower dose of Propecia before completely quitting on this medication. Minoxidil (Rogaine) is the only other FDA approved hair loss medication, so your choices are limited.

Hi, you will probably think this is a dumb question, but I’ve been using Rogaine Foam for about a month now and I can never tell if I applied the foam to all the proper areas of the vertex. I’ve started putting the rogaine foam can in the refridgerator. After it has cooled down, it applies (without dissolving in my hand) onto my head quite well and the coolness is a good indicator of where it has been applied. MY question is, will the lower temperature effect the potency of rogaine foam? Thanks.

I had a patient tell me about his trick with Rogaine Foam — if you keep your hands cold (put them under running cold water for a moment) when applying the foam it doesn’t melt as easily… but I’ve not heard about using the cold as an indicator. I think it is a clever idea, but I do not know the answer.

I doubt a colder temperature would affect the potency of the minoxidil, but I’m unsure if the packaging is made to withstand the very cold. Proper storage of Rogaine Foam is at room temperature, between 68 and 77 degrees Fahrenheit. You can try getting better info from the source by writing or calling the maker of Rogaine via their website.

How long do you have to be taking Propecia to then quit and see “catch-up” loss? I only took it for 3 months and quit due to sides. My hair loss never really stopped, and I heard it took a year for a real effect. Is that enough time to cause accelerated shedding/loss thru the catch up process as opposed to the regular speed of the balding process? I mean, my “real” pattern three months on should not be that much worse.

I believe you are probably safe, as you have not taken the drug long enough to get the benefit you would lose by stopping it.

Paid advertisements (not an endorsement):

Dear Dr. Rassman:
I have a question about finasteride as a topical solution. There is much speculation that topical usage of finasteride is as effective as oral administration. I even heard that some chemists are grinding finasteride and dutasteride into some vehicle like alcohol and apply it topically. There is also a company (www.hairgrowthmd.com) selling combined minoxidil and finasteride as a spray product and claiming the success with no side effects. Considering the fact that finasteride has large molecule size ( C23H36N2O2 with a molecular weight of 372.549), it is hard to predict that the topical form is to have any effect on the hair follicles (they have to penetrate the epidermis and enter the capillaries in the dermis and subcutaneous layer). As far as I know, FDA has approved only oral administration for 1mg a day for male patterned hair loss.

Do you have any opinion or suggestion regarding to use finasteride in a topical form?

P.S. There is also one publication on this: “Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol 2009;75:47-51″

thanks

I would like to believe that the problem is solved with topical finasteride, but I need a good solid peer reviewed article to make these claims credible. The study you mentioned does conclude with, “Finally, we suggest replication study of more samples, with longer period and assessment of patients’ satisfaction after treatment.” — and I agree that it needs more work done before one could reasonably conclude that a topical finasteride is as good as the oral treatment. The problem I see is that if it is not effective and you take the topical preparation instead of the oral proven medication, you will lose hair irreversibly the longer you delay treatment.

Paid advertisements (not an endorsement):