This patient came to our office a year ago showing a Norwood Class 3 pattern of hair loss. Dr Pak prescribed Propecia to this young man and after a year of taking it every day, the patient returned to our office to show off his results. He had no hair transplant surgery. The results shown (in the photo on the right) are strictly from a daily Propecia pill.
Before on the left, after on the right. Click the photos below to enlarge.
I have been experiencing male pattern baldness for some years now. Initially used Rogaine, it worked at first but now no longer respond to it. Next used Propecia, but had to stop due to side effects.Lasercomb failed too. I am currently saving up and considering getting a hair transplant maybe in 4 years time.I’ll have enough money by then.
There’s one thing I’m really curious about. Would you happen to know anything about Revivogen from www.revivogen.com. It’s a topical lotion combined with shampoo/conditioner that was invented by Doctor Alex Khadavi, MD, a US Board-certified dermatologist. I have a question below which I hope you can answer and shed light on.
All I just want to know before trying the product and applying the lotion to my scalp is for my “safety” concerns.If this product was developed by a dermatologist (i.e.Dr Alex Khadavi,MD) is it okay to allow myself to test it out even if it may not grow/and or stop hair loss but at least I can be rest assured it won’t cause allergic reactions on the localized surface of my scalp. Although I don’t have sensitive scalp skin, some of the things I’m scared of are like more hair loss(worse than pre-treatment) or cause unknown severe harm like scalp dermatitis/acne/burn/swolleness, stain my scalp permanently orange etc.(I’ve probably just exaggerated every side effect.May or may not true!). This is what I mean by safety. What’s the worse a topical solution like Revivogen could do to my scalp anyway? Any potential risks? Are the ingredients mentioned on the website even safe on humans?
Finally, do you believe it is safe enough and whether its worth a try for me to test out what appears to be a very safe and sound consumer product and hopefully not a scam? There’s nothing else on the market and I’m really desperate too to give it a go(whether it works or not its a small price to pay).
Please do feel free to take your time and answer me whenever you can.Your comments and recommendations would be very appreciated. Thanks.
You can experiment with almost anything that is not prescription, including Revivogen. It is not true that medications that are developed by a doctor will not cause allergic reactions as they happen, but if someone is telling you this, then I would run from the recommendation. You can still get an allergic reaction if you’re allergic to an ingredient in the product. Being made by a dermatologist doesn’t make any difference in that regard. The ingredients are safe for humans, but I am not an expert on this product so I can not offer you advice on its efficacy. It contains saw palmetto extract, and that appears to be the active ingredient… but I’ve written about saw palmetto before (see here).
What you should be doing is what I’ve discussed over and over again on this blog: the use of one or both of the proven drug approaches to genetic balding, finasteride and minoxidil. If you had side effects from the Propecia, you should consider cutting the dosage in half (some finasteride is better than none). If you stopped responding to Rogaine, perhaps you could try a greater strength. As you have seen, the LaserComb does not really add any value, so I can not put more advice that you already do not know yourself.
Hi,
I’m currently on propecia which I started 6 months ago. I experienced a shed in the 2nd month lasting for 2 months which stopped and my hair started growing in the temple region. Its good for a month or so and I’m experiencing a shed again, this time mainly on the top of my head. Is this normal – to have shedding twice? or have my body gotten immune to the pills? Pls advice if I should carry on the medication. I’m 26 by the way.
You must have had a doctor prescribe you the Propecia and you should be going to that doctor for this type of advice. I would need to see you, map out your hair for miniaturization and it would have been best to do this before you started the Propecia so we could understand what is happening to you. Better late than never, so get back to your doctor for the advice you seek. I can’t tell you whether to stop or start a prescription drug that I didn’t prescribe to you. I don’t think you’re immune to the medication, though.
Dr. Rassman,
Have you received reports from any of your patients claiming that they are allergic to Rogaine Foam? The Rogaine Foam apparently has a fragrance in the formula, which I suspect is responsible for the irritation it causes in some individuals.
On various message boards, there are reports of this allergy or irritation from Foam. I have tried contacting McNEIL-PPC, Inc. about the “non-scented version” that they have apparently received label approval for from the FDA, but this “non-scented version” of the Foam has yet to hit the market. It makes no sense to me that the Company would only offer the “scented version” of the Foam while the Regular Rogaine (liquid formula) comes in both “non-scented” and “scented” versions. Additionally, most dermatologists claim that fragrance-free is the way to go!
Can you contact the makers of the Foam and see when they plan to market the “non-scented version”? Perhaps you will have better luck getting a response back from them! Thanks in advance for your time and attention to this matter.
I would doubt that I would have any influence on the makers of Rogaine Foam. They will release it when they are ready and that may include FDA testing, manufacturing problems that are worked out, and many other such parts of the process. Many times, the filler ingredients are responsible for the allergies we see, so your claim is not unreasonable.
When is the right time to start using Propecia? I’m 29 and have visited three doctors to get different opinions about my slowly thinning hair that I’ve started to notice in the past year. Two doctors told me my thinning is not significant enough for Propecia and instead suggested I try Rogain. The third doctor told me to start Propecia, Rogain and laser comb therapy as soon as possible.
If you are balding, then you should start it ASAP. Mapping the scalp for miniaturization will give you a metric for a starting point so that in a year you can compare not only the value of returned hair, but the change in the degree of miniaturization. You can even map your own scalp, as outlined in part 1 and part 2 of Mapping Your Own Scalp for Miniaturization.
Propecia is available by prescription only, so your doctor has to be involved with that — Rogaine is available over the counter, and I seriously doubt the laser therapy will provide any help. The right time to start treatment is when you start seeing early hair loss, and you don’t have to wait until you’re significantly balding.
Dear Doctor:
I saw this online about the cancer risk and PSA results of people on propecia. What do you think about this article?
Thanks for sending that link. It has been known for some time that finasteride will reduce the PSA levels so a pre-PSA level is critical to get, particularly if you are over 50 years old when you start the drug. Prostate cancer is highly unusual in men under the age of 50, so I routinely get a PSA test on all men over 50 who I start on Propecia/finasteride. The interesting studies indicate that this drug will reduce the risk of prostate cancer, and that is great news.
I am 57 and had a hair transplant three weeks ago. I had a full head of hair until I was 40, and then very gradual thinning. The transplant was done to provide more thickness in the front and in the crown. The surgeon who performed the transplant said that in addition to taking finasteride (which I have done for several years), he advised using Rogaine (Regaine outside of the US) for three months on the new grafts.
However, the Rogaine website specifically says that the product should be used on the top of the head only. When I checked with their help line, they said that research had not been completed about success using rogaine at the front of the head. My guess is that this is because the success rate (both to promote new growth or even to arrest hair loss ) in the front of the head has not been good. I am looking for a second opinion and want to know whether it is best to ignore the front and just put it on the crown. If so, I wonder why one would apply six pumps to the area rather than one or two, the recommended dose, regardless of the area being covered.
The Rogaine representatives are clearly pleased that the product is being recommended by tricologists for hair transplant patients in the post operative stage but they will not endorse the use of the product on the front although they believe one should follow the advice of one s doctor. With your knowledge of transplanted follicles, what would you say about it? Many thanks
I did a study some years ago where I used minoxidil on 1/3d of the transplants and on the other 2/3rds I did not. I maintained the treatment for the entire growth period for the hair transplants (6-8 months) and noted:
I never published the study because the doctor who was doing this with me was a bit sloppy in his record keeping and I was not surprised at the outcome. I was able to conclude, however, that minoxidil has no effect on transplanted hair.
I take propecia. It works. I’ve taken it for about 6 months. How long can I miss a dose? If I miss a day, I know it says just take one the next day. But will my hair fall out, and then the program just restart? Is there a site describing the way the drug works in your body, that would help me get this idea down? How much time can you miss?
Thanks.
Well, I wouldn’t suggest that you try to miss a dose. If you should miss a day, I doubt that it would produce measurable hair loss. Same goes for two skipped days… but 1 week starts to creep up on you and one month certainly will not be good. I have only seen 3 months of stopping Propecia where significant hair loss occurred. Don’t make it a regular habit of skipping days, though.
I thank you for your time and for effort in keeping up this blog. I have been taking propecia for a month now and since starting I have developed very oily scalp as well as acne all through my hair and forehead. I know that there can be an initial increase in testosterone and was wondering why this would only be temporary? How long does this usually last and what will happen to the excess testosterone over time ?
The body has feedback loops, which means it senses what is happening to it and tries to correct any imbalances that are created either from disease or from drugs. The increased testosterone can take up to 3 months to correct. As for the acne from Propecia, see here.
I recently received topical generic minoxidil solution and it says that it is only to be used on the vertex and is not for frontal hair loss. Is this true, will applying it to the front hairline be useless, if so, why?
Also, i would like to use a non-finasteride supplement in addition to the minoxidil, can you recommend one, or which ones are most popular??
The FDA only approved claims for crown benefits for minoxidil so the manufacturer complies with the FDA ruling. I don’t think it’ll be completely useless in the front, but the success rates are likely higher in the vertex than in the hairline.
There is no good substitute for finasteride in my opinion, but a popular natural supplement is saw palmetto. Popularity and reliability are too different things, however.
