Category: Drugs

Hi Dr.Rassman,
I am 27 years old suffering from male pattern baldness for over two years. I want to know whether spironolactone lotion (used on the scalp) really works as some of such brands said:

(1). Spironolactone significantly reduces the amount of DHT in the scalp by inhibiting the conversion of precursor steroids to DHT.
(2). Spironolactone reduces DHT in the scalp by converting localized testosterone into estrogen, which is thought to be protective of the
hair follicles.
(3). Spironolactone blocks the follicular androgen receptor sites, thereby rendering any residual or circulating DHT harmless to the hair follicles, and it doesn’t have such side effects as Propecia; and whether it is widely used in treating with male patten baldness.

Thanks for the your answer!

Spironolactone is generally used for treating high blood pressure. While I realize there is a theoretical anti-androgen property associated with spironolactone, there is no conclusive evidence that it really works to re-grow hair. I also realize that many doctors may prescribe spironolactone for hair loss as an “off-label” use, but I personally do not see (or have seen) any benefits from it.

In conclusion, it is still a “buyer beware” mantra that I maintain. It’s also worth noting that Spironolactone has its own list of side effects.

I know that with regard to cut up 5 mg finasteride pills, you recommend that pills are only cut up one at a time, to avoid excess hydration of the pill fragments with vapour in the air.

I have a question about the storage of the three pill fragments each time a pill is cut (assuming it is cut into quarters). Right now, I just leave the pill fragments inside the pill cutter, but would it be more effective to store them in an airtight container for three days? Or does it not make a considerable difference, given the short timeframe of storage?

Thanks.

It might not make that much of a difference if you’re cutting one pill at a time (which is what you should do), but I would err on the side of caution and store the fragments in an airtight pill bottle.

Hello Doctor,

I’ve always enjoyed reading your blog. Thanks for sharing your knowledge.

I’ve been getting my Propecia delivered in the mail via Walgreens for quite some time. I’ve always taken the Merck brand, but was surprised to see my refill was something called “Dr. Reddy’s Finasteride” made by an Indian company. The cost for 90 tablets was $183, which seems a bit high for generic.

Walgreen’s never notified me that they were changing my prescription from Merck to Dr. Reddy. Also, I’m concerned with the shipping of this product overseas and the possible very hot climate in transit. If the temperature in transit were to get into the 90’s or higher, it could be problematic for the medication.

I’d love to hear your opinion on this new generic brand that seems to be out on the market and what we should expect as a cost for a generic version. Thank you!

We previously wrote about the generic Propecia finally being sold in the US in a couple of posts —

• Generic Propecia (1mg Finasteride) Now Available in the US?
• More Info on Generic Propecia in the US

The cost will remain on the higher side for at least 6 months, because Dr. Reddy’s has an exclusive window to sell the generic 1mg finasteride. Once other manufacturers are able to sell their generics, I would expect the price to come down.

Dr. Reddy’s is an Indian pharmaceutical company, but they do have manufacturing facilities in the US (I’m not sure which facility their finasteride is made in, though). I would think safeguards are in place during shipping of medication to maintain proper temperatures in transit, and everything that they do is over-viewed by the FDA.

Dear doctor, I am 30 years old and development of my secondary sex characteristics was always far behind persons of same age. My beard is still not fully developed, I have hairs around my chin and under nose, but almost nothing on cheeks and around ears. I have first noticed starting hairloss about the age of 28 and I started with finasteride treatment. Could this drug affect my beard developing and slow down this process yet more?

Finasteride does not affect beard hair. I wouldn’t expect you to finally start growing a beard at 30 years old (with or without finasteride). Some men just have patchy facial hair, and that is your genetics.

You can consider doing a hair transplant to your face where the beard is not present if it’s bothering you that much.

Hello Doc,

I’m 27 year old male on finasteride (aprx 1 mg) for the past 3 years. I have thinning in the Frontal and Crown area. Before starting finasteride I use to lose approximately 100 hairs per day (aprx 30 hairs /day now). I don’t see great results with finasteride however I have retained most of my hair. I’m in the same stage as I was 3 years ago which is a good thing.

A year ago I also started using Rogaine liquid and I haven’t seen any results as well. I’m very consistent with my medication and haven’t missed my dose(99% of time). With respect to side effects I can say may be mild to moderate decrease in Libido, lost some hair in my legs but nothing major.

I’m considering hair transplant to the frontal and crown region to add thickness to my existing hair. I hope there wont be any shock loss as I have been on finasteride for a long time and will continue to do.

I was wondering what else I can do to retain all my hair and maybe grow some in frontal/crown/sides/back area as sometimes I feel my side and back region are also thinning.

Thank you very much.

I think you are doing pretty much all the right things. Propecia (finasteride) and Rogaine (minoxidil) are the only medications approved by the FDA for the treatment of androgenic alopecia. The next step may (or may not be) a hair transplant, but that would be decided on by a consultation with a doctor.

If the sides and back of your head are also thinning, this isn’t typical of male pattern baldness, so your doctor will have to determine whether you’re even a surgical candidate. Good luck!

Hi Doc,

I am already on Finasteride 1 mg. I had bought Minoxidil for application on temple region. Since i am not able to maintain the medication schedule (twice a day forever till one wants to maintain hair), i discontinued after applying for 5 – 7 days. I plan to apply it whenever my busy schedule permits me (maybe once / twice a week during weekends).

Do you think there would be any benefits in doing so OR would i be doing more harm than good (like accelerated hair-loss for the first few days while applying Minoxidil)? Thanks.

A couple things that should be pointed out —
1. Minoxidil is indicated for top/crown hair loss. It really does not work all that well for frontal hairline or temple areas.
2. Minoxidil is recommended for use twice a day everyday for several months before you see some improvement.

If you know the two facts above, you can make an educated and informed decision about whether random applications to an area that the medication isn’t intended to regrow hair in will be beneficial for you or not.

Doc.. does minoxidil have to be rubbed into the scalp to be effective. I feel like my hair is soaking it up when I do that.

Also my hair looks much worse with it. Even if I use it just at night and wash it out. It seems to effect the texture. If i go a few days without it my hair returns to normal looking much better. I guess that’s the trade off. Wish I never started it.

Thanks.

Minoxidil is for use on the scalp, not the hair. Unfortunately, much of it is wasted on the hair because of the applicators and their limitations. There almost seems to be a conspiracy to design the applicators to be wasteful and more profitable for the suppliers selling the products. Maybe one day, a better applicator will come along.

Minoxidil is also known as Rogaine, and there is a video on Rogaine.com, showing you how to apply the foam. The same application instructions apply to the liquid version, though the foam likely involves less of a mess.

I’m 33 years old and have been using Propecia for about 5-6 years with great results. my hair on top of the head regrew almost completely. three months ago in order to save costs, instead of using Propecia, I started dividing a generic Finasteride 5mg into 4 pieces and take a quarter daily. Ever since then ive started noticing that im losing hair again. this may or may not be related to Finasteride and could be down to the fact that the drug itself may have stopped working for me.

Ive introduced Minoxidil Foam Extra Strength twice daily and will use Nizoral 2% 3 times a week but I’m a little anxious about this and wanted you opinion. do you think i should go back to Propecia or perhaps take 2.5mg daily of Finasteride, or alternatively start taking Avodart?

Many thanks for your help

As you know, the medication in Propecia and the 5mg generic are the same, just different dosages. Cutting the 5mg pill shouldn’t produce anything different from the 1mg name brand pill. I guess you could go back to trying the name brand Propecia to see if that makes any difference, but I would be surprised if it did.

Many men use minoxidil and finasteride at the same time, and I suppose you can add Nizoral to your regimen. One thing that I should point out about using a bunch of daily treatments is the financial commitment you’ll need to make to continue these for life.

As for whether you should take Avodart (dutasteride) or increase your finasteride dosage, that is something you’ll need to talk to your prescribing doctor about.

I’m 24 years old male and have hair loss both at the front of my head and the crown. I’m starting to use rogaine foam in combination with propecia. I’ve heard that using minoxidil in higher concentrations (10%) makes you see better results faster. Is this true?

Perhaps it’s possible that high concentrations of minoxidil will bring about faster results (I’m not sure), but nothing occurs overnight in this business as the timeline often goes into months. In other words, don’t expect a miracle. I don’t recall seeing any studies comparing the speed of regrowth for the 10% vs 5%.

Higher concentrations of minoxidil will produce more side effects, so read the instructions carefully.