Category: Drugs

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Treating Female Androgenetic Alopecia with Proscar and Avodart? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

Thank you for your ongoing commitment to hair loss! You are a Godsend, my friend.

I have female androgenetic alopecia (first uncoverd after using Accutane) diagnosed at age 27 by scalp biopsy. I began using regular Rogaine, only available at that time. I am now 41 and use an advance regimen of Xandrox 5% BID topically, Proscar 5 mg QD, Spironolactone 100 mg BID, Avodart 2.5 mg (just started two weeks ago) as well as Saw Palmetto, Stinging Nettle, Pygeum, Soy Isoflavones, as well as a few other things like Viviscal and use the Laser Comb every other day. I try to keep up with the latest advanced and spend a lot of time and resources keeping my hair on my head.

My question is there is conflicting information in the literature about the best birth control pill to take to help with adrogenetic alopecia. I currently take Desogen but have tried Ortho Cyclen, Ortho Tri-Cyclen and Yasmin. I use the American Hair Loss Associations guidelines now. Can you weigh in?

Also, any idea when there will be a topical growth modultor that keeps the follicles in anagen? I’ve seen Dr. Kevin J. McElwee of the University of Vancouver’s work with mice and it is facinating.

Your thoughts on these issues as well as any other advice is much appreciated. Take care and thanks in advance for your kind reply.

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You are scaring me!

Finasteride currently does not have a FDA approval for use in women. Even if it did, Proscar (5mg finasteride) is a very high dose for androgenic alopecia and in the studies on men, it was shown that the 1mg dose was just as effective as the 5mg dose. That is why the recommended dose is 1mg for androgenic alopecia.

Avodart (dutasteride) is not FDA approved for the treatment of androgenic alopecia. There are many patients who still use Avodart for hair loss, but they typically do not use it in combination with Propecia or Proscar and I do not understand the logic for this therapy. Avodart has a very long half life (the time it take half of the drug to be cleared from the blood stream) measured in weeks or months (compared to a few hours for Propecia) and this makes its dosing a controversial issue because nobody really knows what the best dosage to use is. The most important factor for women taking these medication is its potential implication of cervical, uterine, ovarian, and breast cancer because of its hormonal interactions and its potential for birth defects (well proven in pregnancy).

General disclaimer that needs repeating — BaldingBlog is not meant to diagnose medical condition or give medical treatment plans or advise. It is meant to educate the general public on hair loss issues. Before taking or stopping any medication, please see your doctor and discuss any issues, but I can state categorically that you are on a plan that has little benefit in sight and great harm as a possible clinical outcome.

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Doctor Won’t Transplant Me Until I’ve Taken Propecia for a Year – Hair Loss Information by Dr. William Rassman

I met with a doctor in Madison Wisconsin, Dr. Gencheff.

I am 21 years old, soon to be 22. He advised me to start taking Propecia first to “stabilize” because he said young men can have an “shock loss” if transplantation is performed without it. This was in December 2005. It’s been 6 months roughtly since I started the drug. I actually take “Finpecia” which is a generic finasteride. I think it is working to slow down the process, but I can’t tell the full results yet. I will continue to take it as long as i need. He mentioned that transplanting in the crown area is not a good idea. I am not exactly sure why, i think he said its because you don’t know how far its going to progress. All in all, he said I had good hair to transplant with, but he said he wouldnt operate on me until I had taken Finasteride for at least a year. Is it possible to transplant in the crown area? By the way, i think he diagnosed me as a future 5a. The mid scalp is thicker as well as the front hairline. Thank you for your help, I may be seeing you soon.

From your brief description, I agree with your doctor that you should be on Propecia for a reasonable amount of time before resorting to a hair transplant surgery — especially at the age of 21. Your doctor seems to be looking out more for your interest than his own bank account, which is definitely a good thing. I often write on BaldingBlog about the “Master Plan” of a life long goal of maintaining a desirable head of hair, rather than just achieving a quick fix. If you are indeed a future Norwood 5A (assuming you are a Norwood 3A now) then it would be wise to see how much Propecia can slow, stop, or even reverse the hair loss process. Maybe you will be lucky and reverse some of the process you are now experiencing. I look forward to seeing you in San Jose and would be happy to map out your scalp for miniaturization, trying to outline where you may be going with the balding process.

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Should I Be Using 2% or 5% Minoxidil with Propecia? – Balding Blog

Hi Doc, what a wealth of information this blog is so many thanks. I have recently started propecia for vertex thinning and am thinking that i should also probably use minox in conjunction with it. Do you have any thoughts on wether it should be the 2% or 5% dosage or if i should use it at all. Im 7 months into my propecia regime. thanks

In my practice, I generally recommend one change at a time. Wait out the full 8-12 months on Propecia before you add minoxidil. You should be using a good metric on this treatment (mapping out your hair for miniaturization) so that you know what is really happening and what you really need.

Higher concentrations of minoxidil have a greater risk of potential side effects such as dizziness and fainting from low blood pressure. Minoxidil and Propecia have different mechanisms of action and do not have any significant interactions.




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Any Products That Work Around the Temples? – Hair Loss Information by Dr. William Rassman

Hi,

I have recently been placed on a treatment of Propecia for a receding hairline and first stages of thinning of the crown. After reading information on this drug I have noticed that it apparently has no proven effect on hair loss around the temples. What products would be useful to use along with Propecia to increase my chance of actual hair growth and/or thickening? Thickening shampoo’s? Serums? Vitamins?

Thanks.

Propecia, I am certain, will slow down or stop the hair loss in many areas where genetic balding from the effects of DHT is occuring — that includes frontal and temple hair. As I have said before, many patients report that the frontal and temple hair loss has stopped with Propecia. I have seen two patients with full reversal of frontal hairloss, although this is unusual. Merck (manufacturer of Propecia) can not promote it for something that is not documented for in the FDA studies. The other cosmetics/shampoos/conditioners that thicken hair shafts by making them absorb water or vitamins will not impact the hair loss process.

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Restarting Minoxidil Months After Transplant – Hair Loss Information by Dr. William Rassman

I had a transplant procedure (approximately 1600 grafts) 4 1/2 months ago mainly to the thinning crown of my head but some to reinforce the frontal hairline. The frontal grafts are beginning to show evidence of growth. The crown graft areas are causing some problems with redness and some sore spots that have been addressed elsewhere in this blog. The itchy red patches have made it impossible for me to continue using Minoxidil. As the patches eventually resolve am I likely to experience benefit from restarting Minoxidil even 5+ months post surgery? I am female and had one transplant 10+ years ago which was very effective at the time and from which I did not experience the same degree of problems with an itchy red scalp. It should be noted that I am 56 years old, with very fair skin and have had fine texture hair throughout my life. I was carefully evaluated prior to this procedure and determined to be a viable candidate for the procedure again. I did find a reputable transplant surgeon.

Thanks for your help.

If you have confidence in your tranplant surgeon, these are issues that the surgeon should address. You need to be examined to make sure there is no chronic infection (folliculitis) or other problems. It is always important to achieve a good patient to doctor relationship and these problems and concerns should be mentioned during your meeting.

With regard to restarting minoxidil, that is not a problem as long as the itching and active inflammation are gone.

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Taking Propecia for Telogen Effluvium – Hair Loss Information by Dr. William Rassman

If a male is suffering from a bout of Telogen Effluvium rather than MPB, would taking Propecia be either harmful or is it just totally benign, outside of the possible latent benefits for his prostate.

I doubt that taking Propecia (for men) would be harmful. However, I have many questions that were raised by your question, such as — How did you make the diagnosis of TE?

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Norwood Classes vs Mature Hairline – Balding Blog

I am a 28 yo male who’s hairline has been receding at the temples since I was around 16 years old. It is now at around a Norwood 2/3 although there is very little recession at the front. I realise it is either slow mpb or a mature hairline from reading your very informative answers to other guy’s questions but I wanted to ask you whether its possible to recede to a Norwood 3 and remain there? I noticed miniturisation in the areas which have now receded but there doesn’t seem to be any further miniturisation. Also there is no hair loss at the crown area (yet!!)

Everybody is different! You may recede to a Norwood Class 3 and stay that way for the rest of your life. Your hair loss should stablize by your late 30’s. If you are still concerned about hair loss, you may benefit from seeing a doctor who can quantitatively record the miniaturization of your scalp hair and give you more information on its extent. If the miniaturized hair is only found in the frontal area, then you may be more confident that the hair loss will probably not progress significantly beyond what you have already experienced. On the other hand, if there is miniaturization in the crown or further back in the front (even it there is no balding at this time) then the prognosis may not be as good. In this later situation, the drug Propecia (finasteride 1mg) is the best way to arrest the process.




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Propecia and Frontal Hair Loss Over Time – Hair Loss Information by Dr. William Rassman

Hi, I am 24 years old and am experiencing some frontal hair loss. Nothing major, but my hairline has receded a few centimeters beyond what I would consider a mature hairline. On my mother’s side, my grandfather still has his hair as do most of my uncles. My father also still has his hair, but his father went bald in front.

I just started taking Propecia this week to prevent further loss. In your experience, have men in situations like mine managed to keep their frontal hair after taking Propecia for a long period of time? Or should I simply consider Propecia a stop-gap measure?

As a side note, I noticed on your blog that you suggested Propecia can only slow down frontal hair loss in most cases-that is, it will continue eventually. But I recently looked over a study on Propecia’s effects on frontal hair loss and the results seems more promising than you suggest (you are probably already familiar with it). Here’s the link: http://www.hairlosstalk.com/download/finfront.pdf

According to this study, investigators and a global assessment found that almost all the people on Propecia halted frontal hair loss (about 94 and 99 percent) over a one year period-and the study suggests that the effects even improved after a 24 month period.

Has this also been your experience?

In my experience with patients taking Propecia, I find that Propecia generally has better observable effects on the crown than the frontal hairline. I have little doubt that Propecia slows down frontal hair loss if it is clinically indicated and I have seen good results from it in the frontal area, therefore agreeing with your reference. I have seen a very small number of young men actually reverse frontal hair loss.

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Starting With Propecia and Minoxidil 12% with Azelaic Acid – Hair Loss Information by Dr. William Rassman

Hi,

I am based in London, UK and I just had a first evaluation session with a center specializing in hair loss.

The trichologist has evaluated that I was genetically pre-disposed to hair loss. I am now 37 and vertex 3, so nothing dramatic; I just want to stop the balding process.

Now, I have been prescribed Propecia 1mg + Minoxidyl 12% with Azelaic Acid. I am a little bit surprised to immediately start with the highest level of Minoxidil as I’ve read that you after time you need to increase the dosage. If in a couple of years, Minodixil 12% has decreased effect what stronger will I have to take? Also, are there some studies which show the dosage of Minoxidil has to be increase.

Thank you for your help.

You should talk with your doctor to address these concerns. When topical minoxidil is used for male pattern hair loss, some doctors may prescribe a higher concentration formulation. I like to start one medication at a time. I do not like what your doctor has given you with the ‘nothing dramatic’ view of your problem that you hold. You should be aware and informed about the potential side effects of any medications that you are prescribed. Once started on the minoxidil and the Propecia, you may be ‘hooked’ on both, for life. That is, you may be inclined to take both since you won’t know which medication is contributing more to the benefits you may see.

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Is There a Pill to Prevent Shock Loss? – Hair Loss Information – Balding Blog

What is fallout/Shockloss? Is there a pill or something I can take after surgery to prevent it, or is it temporary and nothing to worry about?

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I just made a post related to this yesterday (see How Long Should I Take Propecia Before Transplant to Prevent Shock Loss?).

Shock loss occurs when the follicle becomes ‘insulted’ by swelling and inflammation, causing the hair to shed from the follicle. The follicle then enters a resting state and may never go back to an active state (if there is genetic balding in that particular follicle) or after a period of time it may go back to an active state and grow normally again. We suggest taking Propecia before the surgery to help minimize shock loss after hair transplantation because the hairs that are genetically impacted have the greatest risk of permanent loss from the shock of the hair transplant process. Propecia minimizes this risk.