Category: Drugs

In a report in the Australasian Journal of Dermatology published last week, a case was presented of a 47 year old man who did not see the same hair density after 4 years on finasteride. The doctors added 0.5mg/week dutasteride to the treatment plan and there was a dramatic increase in hair growth.

There is a problem for what is called “poor responders” to finasteride, and the focus of this article was to add a low dose of dutasteride weekly. There was no significant sexual side effects with this particular patient, but of course, the issue remains that sexual side effects could be significant in other patients. Dosage is a problem, as some doctors have prescribed 5 times the dose of dutasteride at 2.5mg/week, or even daily use. The dose increases the costs for the patient and no one really knows the recommended period that a patient should take this increased dose nor the time to obtain the therapeutic response. Worst case, we do not know if dutasteride acts as a carcinogen that can cause a high grade prostate cancer, as the story is not in yet on the full extent of the safety of this drug over time.

In no way am I recommending you add dutasteride, but you can talk to your prescribing doctor about your case. The above is just a single case study presented, but it was worth posting here to get your always fascinating feedback.

I have been reading a lot about the drug Latisse as a possible use for MPB. My doctor prescribed me a generic version to try.

Do you think I could mix it in a bottle of minoxidil and use it or do you think it might need a different carrier agent or a stronger version to work.
I know you are not involved in this kind of research but I would appreciate your opinion

While I am not directly involved with this type of research, I have seen patients who have tried Latisse (bimatoprost) on their own scalps without success. I also have been told by a scientist (a patient) who is familiar with Latisse that just applying it to the scalp does not work. If only it was that simple.

As Latisse is packaged in very small quantities for use on the eyelashes, the costs for applying it to the scalp are out of reach for most people. I’m not aware that a generic version is available for sale in the US. The last I remember reading, a generic drug manufacturer was seeking FDA approval to market a generic bimatoprost, but it was being challenged by Allergan (makers of Latisse). If there’s anything more recent about this, I’m not aware of it.

As for your question about mixing Latisse and minoxidil — this isn’t something I’ve heard done before, and I don’t know what kind of results could be attained by going this approach. Have you talked to your prescribing doctor about it?

Hi Doc, Id like to ask you if you have any pictures of the best results of propecia on any of your patients that you could show us. Thanks a lot. I love your blog.

I just searched for “propecia results photos” using the box in the top corner of the site and found these —

1. 1 Year Propecia Results in a 45 Year Old Man
2. Patient Result — 1 Year After Rogaine Foam and 0.25mg Finasteride
3. Reversing Frontal Hair Loss with Propecia
4. After a Year on Propecia
5. Response from Propecia in 49 Year Old Man

There’s more on the site, but these are the first ones I found. There’s a lot more great results I’ve seen in my practice, but I can only publish the photos when I’ve been given permission. Hope this helps!

Hi,

Am going for FUE at the end of this month. Doc says its better to stop smoking one week before and two weeks after surgery so that maximum oxygen is carried in capillaries. is this true?

Also, anything else I need to check on or ask before going?

Doc told me no need to take finpecia for shock loss, but would it help if i took it 2 weeks before and 2 weeks after surgery?

I am 39 (40 in a few months). If I have my HT in 2 weeks, when should I start and stop propecia to minimize shock loss?

Also, at my age, is propecia helpful?

Smoking may be deleterious to graft growth and your health, so I would always advise against it.

Finasteride (Propecia) is a lifelong medication and generally people start taking it before the surgery as recommended by their doctors. The need for Propecia reflects your risk for accelerated balding. This is a judgment call based upon the doctor’s experience with your level of balding and miniaturization. The more miniaturization, the higher the risk. In other words, I don’t know about your hair loss, so I don’t know if Propecia will be helpful.

I want to know if it is normal to experience more hair loss during the 6th month of Rogaine use just as I experienced during the first 4 weeks of use which was considerably.

I have been experiencing hair loss since I was 18 (I am 29 now). 3 years ago I starting using products with Minoxidil 5% prescribed by physicians. However it became to expensive. After 5 months of quitting I decided to start using Rogaine due that I was losing more hair as I stopped using those products.

Results after 3 to 4 months of using were really tangible. However, as I said I am on the 6th month and I am experiencing more hair loss from about a couple of weeks ago. I am assuming is part of the hair loss cycle, however I am not sure if Rogaine is no longer working for me. Or what should I expect in the following weeks?

Thanks for the support

I wouldn’t say it’s common to see increased shedding after 6 months of Rogaine use. I’ve heard about shedding after starting the medication, but that shedding shouldn’t reoccur after half a year. The loss could be coincidental to something else going on.

You might want to go back to your prescribing doctor for a follow-up. Since the Rogaine doesn’t actually block DHT (the cause of genetic hair loss in men), you could be experiencing the normal loss you’re genetically determined to have. I really have no way to know. Or you can just ride it out and hope for the best.

Hi
To be begin with I want to say how wonderful your blog is, thank you very much.

After reading your blog I decided to get propecia over three year ago with great success. About two years ago I added 5% minoxidil foam to my routine twice a day. Then however about 9 months ago I wanted to achieve more hair growth and added 15% minoxidil with 5%AA and caffeine and retinol to my routine. So apply the 5%foam in the morning and 15% at night. I have no side effects from the higher dose but it seems like I have lost more hair with a higher concentration. Is this possible? Because there is a successful hair loss centre in London that sells 12%Mioxidil with AA so I thought that if I buy 15% minoxidil from ebay I will have more success.

My question is will are they able to get better results with a higher concentration and when I try it, it fails?

Thank you

There is a suggestion that higher doses of minoxidil is more effective than lower doses, but so are the side effects.

Hair regrowth from this drug was originally identified when it was used as a hypertensive agent in the 1960s. As a high blood pressure treatment, this drug is commonly sold in India in pill form, because it is cheap and easily available. At the last ISHRS physicians meeting, a doctor from India discussed the widespread use of the minoxidil pill for the treatment of hair loss, instead of the topical treatment approved by the FDA in the US and Europe. This doctor reported that when minoxidil was taken orally, it is more effective than when applied to the scalp. We know that this drug can be and is often absorbed through the scalp, and that is why dizziness and lightheadedness is seen as a side effect of the drug. Another side effect of the oral form of minoxidil is the appearance of hair in different parts of the body (that is what led to the connection between minoxidil and hair growth when used topically).

I am absolutely not recommending oral minoxidil, as side effects can be significant, but if he keep increasing your dose, you will run the risk of absorbing enough of this medication through the skin that you may be overdosing yourself. If you continue to treat yourself, you are clearly not prepared for what might happen. I would stick to what is known and what is safe.

I used Propecia for years but developed serious and persistent sexual side effects. I have had to see various urologists. My testosterone and other medical work up was normal and I am fit and of ideal body weight. I do not have any health problems (no cardiovascular disease, no diabetes, and so on). I also developed brain fog and a sort of amotivational syndrome on Propecia which I had misattributed to other things.

It wasn’t until I stopped the drug that my motivation, aggression, and cognitive performance returned to normal. After four months, my ejaculate volume remains miniscule. The problem I having now is that my hair loss is alarming rapid and I am distressed by it. I have just experienced a serious shedding. Feels as if I lost 50% density and the hairline has shot up seemingly a half inch in the temporal areas.

Despite the side effects, I am considering going back on to slow the loss hoping something else will come out. I am scared that I will be impotent and infertile back on. I feel I am between a rock and hard place. What do you recommend patients do? Would a low dose be wise? 0.25 mg? 0.5 mg?

I generally suggest that my patients reduce the finasteride dose from 1mg to 0.5mg or 0.25mg and see if these lower doses work. Some earlier estimates I have reviewed suggest that the 0.25mg dose still works at about 50% efficiency on stopping hair loss.

Now that I told you this, you need a good doctor to manage your problems. This is a prescription medication, so all I can provide is general advice. You need to talk with your own doctor about what is the right step for you. Lower dosage has shown some effectiveness in my patients that were worried about side effects, but it isn’t a guarantee to work the same for you. Get a bulk measurement of your hair so that you will know if the dose adjustment still works.

Is is safe to assume that vellus hairs turn into normal hairs on finasteride?

Vellus hairs stay as vellus hairs. In every follicular unit, there are one or two vellus hairs (short like stunted hairs). Miniaturized hairs, on the other hand, are terminal hairs (normal hairs) that lost their bulk and these are the hairs that get positively impacted from finasteride by increasing their shaft thickness when they are miniaturized.