Category: Drugs

Hello Dr. Rassman,
My question is not related to hair loss, but i figured you might know sth about it…What exactly is Retin A and how does it work? Does it come only as a facial cream or it can be taken orally as well? Does it cause vascularization when applied topically and why…as far as i know it stimulates collagen production, so capillaries should become less visible as skin fat increases…and one last question, my boyfriend is balding due to stress, what should we do? I would very much appreciate your answer/s. Thank you for your time

Retin-A (tretinoin) is the acid derivative of retinol, vitamin A. For much more on this, please see SFSU: Student Health Services.

As Retin-A is applied to the skin and can produce burns to the skin. It is believed that a light burn will make the skin more able to absorb other medications (like minoxidil for hair loss), because increased vasculatiry is induced by the burn. Because it creates an injury to the skin, the entire injury process induces the body to repair it. The skin irritation could be a problem and is a problem for many users. The formation of new collagen is part of the process of repair and replacement as the body regenerates the damage caused by the acid.

With regard to your boyfriend, stress does accelerate hair loss. I hope you love him enough to reduce his stress so that he remains young looking and hairy longer.

Dr. R,

First off i want to say what a great site you have created. With all the nonsense out there on the internet, your site differentiates itself as being very informative and a trusted source for MPB.

A recent post said you were aware of two new drugs that are in the works to combat MPB. I understand there is a confidentiality issue, but is there any insight you can give as to how the product works and a possible viable timeline? I am aware of the length of drug approval from the FDA (5-10 years is your estimation) but a new product has not been released since 1997. Nearly a decade later and there doesn’t seem to be any progress which concerns me greatly. I am sure these drug manufacturers are aware of the multi billion dollar market there is yearly in the fight against MPB. If for nothing more than to make money, shouldn’t these companies be attacking the market as aggressively as possible? Those are just a few thoughts. Please get back.

Regards

The answers to your questions are almost impossible for me to relate them to you. On one of the drugs, the effect was found as a side effect of its use for treating another disease. Once they found that the same medication grew hair, they move it into a topical and speculated on mechanisms of action (looking for the science). One of the drugs is already in a clinical trial in another country and early indications have shown great results. The researchers told me that there were a few hundred people put into a double blind study and although they did not know who was on the topical medication and who was on the placebo, they did note that half of the people who were coming back for hair counts had good hair growth while others had none. They assumed (probably correctly) that what they were looking at was a remarkably strong hair growing medication. Until the study is complete, we will not know for sure, but the entire science will have to be understood and toxicology studies will have to be in hand in thousands of patients before the United States FDA will allow the drug come to market. Sorry, that is all I can say. Coming to market: A few years at the least, I would suspect.

It is interesting that minoxidil was first used as a medication for high blood pressure. It worked poorly and without consistency for blood pressure control but did grow hair on many men and women who took it systemically. As the drug already had some safety and other toxicology data, the move to a topical for hair loss was a bit easier. Propecia was originally used for men who had urination problems, but when taken for the prostate, some men grew hair. Again, another discovery by serendipity. Could you imagine what we would get if we found out about drugs by intent rather than serendipity?

Dear Dr Rassman,

Thank you for this informative blog and your dedication to answering our balding questions.

My question is regarding rogaine or minoxidil and its effects after you have a break after several years of treatment. I for one am 25 and have used minoxidil 5% since I was around 22. My barber here in New York told me that for Minoxidil not to lose its long term effect it is good to have a break after a few years and then go back on it again so to keep its effectiveness. Is this true?

I for one listened to his advice and stopped using minoxidil 5% for three months and I could see an increase in hair fall out after two months specially in the templar areas where I had gained a lot of new growth. Now my second and more important question is will I once again benefit from using the minoxidil again? I went on minoxidil about 6 weeks ago again but havent seen any results yet.

so two questions:
1) Is it good to have breaks in minoxidil treatment?
2) Will the effects of the minoxidil come back after restarting the treatment?

Breaks in the use of minoxidil are disasterous, as you have already seen. So the answer to your first question is unequivocally, “no”. The hair may come back if your ‘rest’ period is under 2-3 months. Read elsewhere on this blog about Propecia and its appropriateness in young men losing their hair. Get a diagnosis and proper treatment.

Paid advertisements (not an endorsement):

My Primary care physician recently sent me this statement
“propecia has side effects and so we try to avoid it. rogaine actually works better.”

I am a 21 year old male that has started balding in the last few months. In your experience have you found that Rogaine works better than Propecia? I did research on the internet that Rogaine does not have very good long term success because the hair follicle eventually dies, and Rogaine is thus rendered ineffective. Also, There is no bald men on my mothers side of the family, but there is on my fathers. But nobody on his side of the family went bald until around till their late 20’s or early 30’s 30’s. He said he started to bald at the earliest in his family. He was 29. Do you think it is unusual that I would start balding now when nobody else in my family did not. I am starting to thin in the vertex a little bit. I am interested in starting Propecia. Am I a good canidate for starting Propecia.Do you think I should consult another doctor about my hair loss.

Genetic balding can come from either side of the family. It could be that you are following someone else in your family line, as not all of the genes are expressed in your father’s or mother’s evident ancestors. You need a diagnosis and your scalp mapped out for miniaturization to find out if what you are seeing is actual balding. If you have genetic hair loss, then Propecia will address the cause and will be far more effective and appropriate than Rogaine, which is a hit or miss product that works better in women and it may work in men who are past the point where Propecia may help. I would not use Rogaine first and I strongly disagree with your doctor.

Late last year, a reader of this blog alerted me to Curis, the potential development of a topical Hedgehog agonist for hair growth. At that time I was excited and remain so. More has been brought to the public, so please look at this press release for an update.

Curis Reaches First Preclinical Milestone in Hair Growth Program with Procter & Gamble

I was wondering how common it really is for someone to have substantial sexual side effects from Propecia. I am a young (22 year old) man who recently had erectile dysfunction and pain probems for a month or so which seemed to begin shortly AFTER I stopped taking propecia (I ran out). My urologist said to stop taking propecia because that might’ve caused them, even though I thought there might have been other causes, and even though they started once I was already done with or just ending propecia. And sure enough, the problems slowly went away. I would like to know if you think it was the propecia that caused the problem because I’ve heard the chances of sexual side effects are slim, like 2%. But I was considering taking propecia again because I know it helped me, and I now know that any problems would be reversible if I discontinued use. But my gut feeling is that it was the propecia and I shouldn’t even bother with it again, which is unfortunate. What do you think?

I tell patients that 1 in 100 men will experience a decrease in sex drive. However, I often find men are very prone to the power of suggestion, especially when it involves their manhood. For example, if there is a mention of decrease in sex drive, they may have a decrease in sex drive because they will be too worried and too obsessed about it. That being said, it is my opinion that pre-exisitng sexual dysfuction may sometimes unmask itself with a drug like Propecia. Some sexual dysfunction is present in 20% of men in their 20s, 30% in their 30s, 40% in their 40s, and so on.

Your story is unclear and it raises a red flag for me. Why is a 22 year old seeing a urologist? Did you see the urologist before or after you started taking Propecia? Do you have an underlying urological problem? Your erectile dysfuction may or may not be related to Propecia and its manifistation may have just been conincidental. There is really no way to tell. You should follow-up with your doctor to explore other possible medical causes of erectile dysfuction.