Spironolactones and Minoxidil – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I read your comment on Spironolactones.

However, some doctors argue that combined application of Spironolactones with minoxidil significantly enhances the regenerative effect of minoxidil. Would you please make a comment on this? Thank you

I am always concerned that some doctors speak because they have to differentiate themselves from the crowd of doctors trying to sell you something. If I believed that these two medications added value, I would be at the head of the crowd recommending and using them.

Balding Forum - Hair Loss Discussion

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Hair Loss InformationGenetic Code Catching Up – Hair Loss Information – Balding Blog

In a previous post you said “Remember, hair loss is progressive and either with Propecia or Avodart, sooner or later your genetic code will catch up with you.”

What do you mean about genetic code catching up with you even if you take Propecia or Avodart?

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Thank you for drawing attention to my cryptic medical speak. This is best explained by using an example.

First, it is important to show the Norwood Classification chart, so that the readers here can see what I am referring to.

Norwood Classification

Now, let us assume that your genetics will eventually take you to become a Class 6 patterned hair loss, but now you show only a Class 4 pattern because you are still losing hair and have not arrived at the final hair loss pattern you may have inherited from your family. In some people, their hair loss is so slow that they progress from the Class 3, to a Class 4, to a Class 5 and so on. The change can take years and be very slow to occur. In other unfortunate people, the loss may first show as thinning in the Class 6 pattern and then advance to a complete Class 6 pattern within a couple of years. If you are that Class 4 pattern person and take Propecia, the size of the bald spot in the back of your head may become smaller and the hair in the top may fill in a bit. You may go backward on this chart from a Class 4 to a Class 3 Vertex pattern, or you may regrow your thinning Class 6 pattern to a full head of hair with Propecia alone. If you stay on Propecia for life, maybe you will stay at a Class 3 Vertex, or you may slowly progress to a Class 4 or 5 or possibly 6 pattern over your lifetime (it could take 20-30 years or so to get there). If you got back the thinning hair in the 8 months that it takes for Propecia to act, you could lose it again, finding yourself back to ‘square one’ as the progressive nature of the hair loss continues to take its toll on you. We do not know if drugs like Propecia will stop the Class 6 pattern that you were destined ‘genetically’ to become, but it is not unreasonable, with what we know of today’s medications and what we know about Propecia, to actually see the value of this medication decrease with time. That means that the drug may eventually become less effective in preventing the progressive nature of the hair loss.

Avodart is a stronger medication for blocking DHT, and maybe by the time Propecia stops working for you, the FDA will clear Avodart for use in preventing hair loss. More likely, however, some new medication that is more effective than either of these drugs may come to market. It is my hope that medical research will continue to improve the effectiveness of medications for hair loss prevention or regrowth. What we must do now is to be patient, use what is there and what is safe, keep our fingers crossed and use the transplant ‘card’ when you are not satisfied with what you can achieve with drugs.

For people who have a Class 6 pattern and do not like it (or a lesser pattern hair loss which can be seen in over two hundred patient pictures at newhair.com), for example, they can become more hairy and reduce their balding appearance to a Class 3 or possibly even a Class 2 pattern if they have the donor hair to do it. That is what I mean by the hair transplant ‘card.’ We live at a wonderful time, where a simple outpatient surgery can transform a patient from a Class 6 to a Class 3 pattern in just a single surgery (under the right conditions). That means, between modern medications or hair transplantation, you can take charge of your life and your ‘hairy’ appearance. Remember, you are in the driver’s seat, so drive carefully.

Hair Loss InformationFrontal Hair Loss and Propecia – Hair Loss Information – Balding Blog

Hello Doctor
Does Propecia help with the Frontal Hair loss. My Hair loss is more in the fronal top part of the forehead. My right and left side has no hair loss.

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Propecia slows or stops hair loss throughout the head. In some cases, it will reverse the hair loss. These select cases are often younger men, but on occasion we see return of hair in older men, mostly in the crown.

In answer to your question about frontal hair loss, Propecia slows or stops hair loss everywhere you are impacted by the genetic balding process. The reversal is less frequent in the frontal areas, however. On occasion, I have seen complete reversal of hair loss in the front, top, and crown area in some young men.

For photos of Propecia’s regrowth results, see past blog entries:

Hair Loss InformationAfter 7 Years of Propecia, Should I Take Avodart? – Hair Loss Information – Balding Blog

Dr. Rassman,
I have been on Propecia for about 7 years now. For a good part of that time it seemed to halt much of the hair loss and at times it appeared to grow some hair. Over the past year though, the hair loss has accelerated at an alarming pace. I do not use any minox as it iritates my skin almost immediately and causes uncontrollable itching. Is it time to get off the propecia and start Avodart in its place? Or is there a minox formula I can add that doesn’t cause irritation? I still have coverage all over with the usual magic and mirrors but I’m reaching panic stages regarding my next move. Your insight is greatly appreciated.

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First be assured that if you do have genetic hair loss, Propecia is the right choice. You should review all of the material on this blog with regard to Avodart. With these risks understood, a good doctor working with you, and a logical unemotional head, you can make the assessment of Avodart (which has been reported to pick up where and when Propecia becomes less effective). Remember, hair loss is progressive and either with Propecia or Avodart, sooner or later your genetic code will catch up with you.

Hair Loss InformationPhone Consults for Prescriptions? – Hair Loss Information – Balding Blog

Do you offer phone consultations for prescribing propecia? If so…what is the cost? I have been on it in the past but my script ran out some time ago. I really do not want to go to my family doctor for this again.

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Before starting more medications, you should get a metric (measurement) by having your scalp mapped out for miniaturization to determine if you have premature genetic balding. I prefer that you visit in person for a Propecia renewal so that I can evaluate your hair better. However, if you can not come by, then I don’t mind doing phone consult with proper photographs. My charge for this assessment is $85.

Hair Loss InformationItch and Dandruff from Propecia? – Hair Loss Information – Balding Blog

Hi Doc,
I recently came in for an open house at NHI and it was very helpful. Unfortunately, I forgot to ask one question. I’ve been on propecia for about a month, hoping that it reverses some of my miniaturization (you said about 50% in the crown and 40% in the mid scalp from what I remember). Almost immediately after starting propecia a month ago, my scalp started itching and I’ve noticed slight dandruff. I’ve seen other posts on propecia as a cause for this annoyance, but never any scientific evidence (I believe there is evidence that Rogaine causes thes same effects).

I’m not sure if this is expected or can cause further loss due to irritation of the scalp; any inputs? I’ve starting using Novarel 1% dandruff shampoo to hopefully manage the itching/slight dandruff.
Thanks!

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Treat your dandruff as you are doing, as there is no evidence that Propecia causes dandruff. Wait out the 8 months. Hopefully with good dandruff treatment and shampoos, the problem will abate. Glad to hear that you came to an NHI Open House and I hope that others reading this blog will do the same. Our next open house is on Thursday, January 12, from 4-7pm.

Hair Getting Thinner with Rogaine Use – Hair Loss Information – Balding Blog

I am nearly 23, and my hair has begun to thin out quite a bit (in my opinion). There doesn’t appear to be a pattern at all, so I believe this may be diffuse thinning. About six months I felt that the front of my scalp felt thinner, but the rest didn’t. When I got my hair cut two months after, I became alarmed at the thinness of my hair behind my hairline and decided to go on Rogaine in September. I spoke with a dermatologist, and he described it as “minor thinning” and after a blood test (nothing abnormal although I initially tested positive with the lupus test), he prescribed Propecia for me which I went on in the beginning of November. Since I initially have gone on Rogaine (about 3 months), I have noticed that the thinning has seemed to spread throughout my hair – in fact my hairline has thinned (not receded) significantly in my opinion. I know without a miniaturization test (I’m going to go back to my dermatologist in a month to do this), it is difficult to diagnose, I would like your opinion on my prognosis. Although the thinning only is noticable to me (my parents can’t tell in pictures and no one has commented on it to me) when I apply the Rogaine in the morning and at night, it looks quite thin in parts, particularly behind the hairline. I don’t know if I’m responding to the Rogaine yet (it has only been three months on it, and since its diffuse thinning, it would probably be difficult to see results at this point), although on my hairline, I do feel small hairs (which could either be new hair or old hairs being miniaturized).

My maternal uncle and grandfather both had receding hairlines and went bald at young ages, but my father still has an extremely thick head of hair. I have always had thick and coarse hair like him, but in the last six months I feel that I have lost half the density of my hair. The dermatologist described it as “minor thinning” and said usually when he sees hair loss in someone my age, it is usually stress (I moved to New York to begin a job in finance six months ago), but I don’t believe it’s TE as I don’t shed (either on my pillow or in the shower to the best of my knowledge), nor have I. I would appreciate your advice/opinion.

Thank you.

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Nothing replaces a good exam, but it sounds as if you are experiencing (possibly accelerated) genetic hair loss, regardless of your Dad’s currently thick hair. Rogaine typically takes at least nine months for maximum results and the Propecia needs about that long to show a change as well. It will be difficult for anyone in your position to make an objective assessment because of the emotions involved with losing one’s hair. Before starting more medications, you will want your scalp mapped out for miniaturization to determine if you have premature genetic balding. I suggest the following:

  1. Stay on the Rogaine/Propecia for at least a year. Neither of these drugs are associated with hair loss unless you stop them. Be patient and 9/10 times you will see results.
  2. Each month, have a good friend take a photo of your head where you are concerned about the loss. I will warn you that hair loss often looks worse in photos (especially if you use the flash), but the benefit is that if you standardize the lighting and the pose in the photo, you will be able to compare them over time and make an objective assessment.
  3. Do follow up with your dermatologist or a good hair surgeon (since you are in New York, I recommend Dr. Bernstein) to both document any miniaturization and classify your hair loss according to the Norwood-Hamilton Scale. These people can take photos for long term documentation as well.

Female Thinning Hair and Kevis – Hair Loss Information – Balding Blog

I am a 41 year woman and for the past two years I have noticed my hair beginning to thin. My Mother (67) and Aunt (58) both have thinning hair which did not begin until their fifties. I am hypothyroid but it has been well undercontrol for 8+ years now. The texture of my hair has changed significantly over the past 3 years or so, much less thickness etc. I do not want to see my hair thin anymore if I can avoid it, would I see a dermatologist or an endocrinologist for this issue? Also there is a “natural” hair loss product called Kevis on the market that is suppose to stimulate new hair growth – do you have any experiecnce or knowledge of this product? Thank you

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There is no scientific data to support Kevis is any different than minixodil, which is actually the active ingredient in Kevis (but many times more expensive). Minoxidil comes in generic form or Rogaine (brand name). Use the minoxidil made for women, which has alcohol and is easier to style your hair with, rather than the variety made for men.

If the thinning is already in two members of your family who turned through menopause, then it is likely that this will also be your fate. I would like to see that you have an accurate diagnosis, which can be obtained by mapping out our scalp for miniaturization. In addition to pointing to the diagnosis, it should clearly show the degree of hair loss and give you a good baseline for future comparisons. Please be sure that you are medically OK; read through the Female Hair Loss category for more info.

Hair Loss InformationAdvised To Not Take Propecia? – Hair Loss Information – Balding Blog

HI Doc,

Im a 20yr old male and have just noticed that my hair is thinning out and im losing it. My hairline has been reduced and in the middle and back ive lost a significant amount of hair too. I can see through my scalp now in many parts. Also, in the front you can see through my scalp and actually count the hairs that are in front! I look at my pictures from last year and even this summer and im seeing a huge difference! im really getting scared.

Im using rogaine now, started a week ago. I want to take propecia but been advised not to. i ve also looked in getting FUE or FUT! Please let me know what you think? And also do the hairs extacted from the donor area grwo back or not?

Thank you very much for this amaizng service!

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Propecia is only for male patients treating male pattern baldness and it is the ideal drug to prevent or possibly reverse your hair loss.

I would say that you are too young to consider any type of hair transplant. At the very least, you should try the medications and then develop a Master Plan for your future with a good doctor. You need to be evaluated for miniaturization. I am the physician who helped shape the Follicular Unit Extraction (FUE) procedure, which extracts 1 follicular unit at a time using special instruments leaving very minimal scarring. The hairs are moved from the donor area — so no, they can not grow back into the donor area.

More information can be found at the links below: