Category: Drugs

Dear dr. Rassman,

I hope you answer my question.I am at a very desperate stage in my hairloss. The daily appplication of minoxidil is making me look horribly bald. Can I drink the minoxildil solution twice per day rather than put it in my scalp? will it give the same results? I do not care about the heart side effects as looking into the mirror is enough to give me chest pains and anxiety attacks. Please answer my desperate plea.

The stomach will probably destroy the minoxidil when taken orally unless it was put into some compounds for oral ingestion. Minoxidil was originally on the market for blood pressure control many years ago, sold as a pill called Loniten… but for the best results as a hair loss treatment, topical is the way to go.

I wouldn’t expect the topical form to be safe to ingest, considering it contains propylene glycol (which may cause gastrointestinal irritation with nausea, vomiting and diarrhea). Plus I doubt it would be effective. I think that you need to meet with a doctor and get your problem surrounded.

To sum it all up though, do not drink the minoxidil.

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Dear Dr. Rassman,

I’ve got some puffy nipples since I was 15 (now I’m 22) and after 4 months using Propecia it seems that they are a little larger. (anyway not a big change). I’ve read about this gel “andractim” and seems it’s a good treatment for those who have slight gyno. I don’t want to stop using propecia, cause it works really well for me. The thing is andractim is a topical DHT… which should be applied on your nipple area, so maybe will stop propecia from working. Do you know any way to keep taking propecia and not making my slight gyno/hair fall worse?!

Best regards!

I can not tell you what using Andractim (topical DHT gel) will do for your gynecomastia. This condition is common in boys of your age as the hormones your testicles produce along with other hormones are all over the place while you are maturing. I doubt that the topical medication will hurt you or make Propecia stop working, but I would not go along using it for too long without having your doctor examine you and determine just what is going on.

Hi doctor how are you?

This is my question regarding propecia.

Most people think only DHT destroys hair but the follicles are sensitive to testosterone as well. Its interesting to note the first thing that goes on most guys is the hairline mostly the juvenile hairline which is often made up of small vellus like hairs. This is because they are sensitive to testosterone more so than DHT. And we all know finasteride lowers DHT and raises testosterone.

Can that make a persons hairline even worse by trying propecia or can propecia help maintain it? Basically is propecia good for one thing on the scalp and bad for other areas such as the hairline.

I would really appreciate if you could answer my question, because I have searched in your blog and haven’t found a clear answer when regarding testosterone and hairline balding and not DHT.

Propecia has the same impact on the frontal hair and the crown hair, but it appears that it is less effective on the frontal hair, which is often caught later after the hair loss is detectable. The crown seems to have a slower loss rate and that is probably why Propecia (finasteride) works so well in the crown. Finasteride is not bad for frontal hair and I have even seen people reverse frontal hair loss with it in the very young man, although it is rarer in the front than the crown.

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Hi Dr. Rassman,

Quick question: What happens if you miss a day(or two) of your finasteride dosage? Can the benefits quickly be reversed? If you miss a week, do you start from scratch when you start taking it again? Thanks a lot.

A day should not make a difference, but skipping many days may make a difference and many weeks will make a difference that may not be reversed by taking proper doses of finasteride.

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hey doc(s) There have been a lot of questions about if propecia will lose it’s effectiveness, but I haven’t seen any on if rogaine will too. Can you shed (pardon the pun) some light on that?

Thanks lots

I am not sure about the loss of effectiveness for Rogaine or Propecia. It is my opinion that these medications continue to work. In other words, they do not stop working as long as you use as directed. The reason I say this is because I have seen patients who have been on Rogaine and/or Propecia for many years and decide to stop the medication for their personal reasons (as they may believe it is not worth it or has lost effectiveness). These patients often come to me expressing regret for their decision to stop the medication, as they notice an increase in their hair loss within a few weeks. The main issue here is that hair loss is a continuing process that can accelerate at times, but the dose of these medications is constant.

There is no single medication that STOPS hair loss forever. At this point there is no cure, however, the medication does slow it down or minimize the loss. It is just that medications do a better job for certain patients and at certain times in their hair loss process.

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What are the side effects (Other than the ones easily available through literature) of taking something like propecia, rogaine, or saw palmetto when there isn’t any hair loss evident? What I mean is there any extra harm one can do to themselves if they choose to take one as a preventative measure?

As a matter of point, the side effects of taking nothing are less than taking something. Why take a medication that has no proven value for you as a young man? One can make an argument that Propecia can reduce the risks of prostate cancer, although it is not the reason used today to take it in a normal young man. It will not prevent hair loss if you do not have the gene for hair loss.

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According to wikipedia: DHT is “formed primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase”.

Notice how it says testes. Surely this has to affect the sperms in some way! So what would it mean to take finastiride for the sperms? I want 100% healthy children in the future!

This has been studied and shown that it does not affect the sperm or your future children. I understand your deductive reasoning, but if you are concerned about finasteride and its impact on your unborn child, you can stop using finasteride for about 1 week prior to conceiving a child as the medication should be cleared from your body. Many men have taken finasteride without problems getting a lady pregnant, resulting in a healthy child. Look at it from another angle — the drug has been on the market for more than a dozen years, and it would’ve been huge news had this been an issue.

Read this to help put your mind at ease — Official Word from Merck Regarding Propecia’s Effect on Sperm and Pregnancy.

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I have been on Propecia for 2 years; I am 45 years old and have seen no improvement in my hair. I am somewhere between a NW 2 and a NW 3. The fontal forlock has thinned significantly while on Propecia. In your practice have you seen any patients quit Propecia and not get any worse or do most people experience increased hair loss once they go off the medication?

Also, I would do a hair transplant immediately if I was confident that I could go back to work undetected after 2 weeks. It would be a big help to get your thoughts on this as I think this is probably the biggest reason people do not get transplants. Perhaps post some pictures of patients at 14 days. Your blog is great and NHI would be my choice once I decide to take the plunge

Assuming that you have the balding gene and a HairDX finasteride response test indicates that you have an average sensitivity to Propecia, then I would expect that you, like many other men, had their hair loss stabilized on the drug. If that is the case, then you can assume that you may very well lose hair by stopping the Propecia. The series of steps and events are important in the building of a good Master Plan so that whatever happens, it will be planned for. I am sure you can see a series of potential scenarios here, so a good working relationship with your doctor is all important.

Here are some previously posted examples of patients just days after surgery:

• Female Hair Transplant (2 Weeks Post)
• Norwood 6 Patient (10 Days Post)
• Scabs After a Hair Transplant (11 Days Post)
• Norwood 3v Patient (10 Days Post)
• Norwood 5 Patient (12 Days Post)
• 2 Different Patients (1 Day and 10 Days Post)
• Hair Transplant (10 Days Post)
• Hair Transplant (2 Weeks and 5 Months Post)

Dr Rassman
If i take 1/4 proscar with breakfast will it get absorbed in my blood streem or is the tablet just too small after it is mixed with food? Do you think it is better to take it on a empty stomach? Thanks

I’ve often said that in my opinion, it is best to take it before breakfast. I generally think that it is best taken on an empty stomach although it probably makes no difference on the absorption issue.

Can Regaine cause hair growth all over even if i don’t put it on that part of the skin? I think I read something about this happening, but i can’t find the source. thanx

A patient reported last week that when he used minoxidil regularly (also known as Rogaine/Regaine) some years ago, he eventually saw hair grow over the entire face and forehead, giving him a Wolf-Man type look. I wish I had photos, but it was just a story he told me. After stopping the medication, he said the abnormal facial hair disappeared. This might sound ridiculous to some people, but I believed him. There have been similar reports posted before.

I asked some other prominent hair doctors (part of an email group of physicians I am in) about this, and some reported seeing this rare phenomenon in patients as well. We do see facial hair growth in some people that can be substantial, and it’s a particularly rare problem for some women on this medication as well. And when I do have photos, I’ll do my best to get permission to publish them…