Category: Drugs

Dr. Rassman –

On March 13, you wrote:

“Men in the process of losing their hair in a Norwood class 6 pattern may not be thinning uniformly. They may be losing more of the frontal hair faster, yet have the overall pattern of a class 6 that may or may not become complete. Some men who take finasteride will arrest much of the class 6 pattern thinning, especially in the top and crown of the head, but their frontal balding could actually be advanced.”

Could you explain this in more detail? Are you suggesting that finasteride might accelerate frontal balding, beyond what would have occurred without medication? Or are you just saying that finasteride might have relatively minor efficacy in the front?

I’m a 26-year-old caucasian male, and most male relatives on my mom’s side have Norwood 6 or 7 patterns. Like the guy who wrote on March 13, I appear to be in the early stages of thinning towards a Norwood 6 pattern. My own loss is heaviest in in the vertex, with some loss also in the middle and front (although I have a strong forelock). About three months ago, I started taking 1.25mg of finasteride daily. At my checkup a week ago, my dermatologist noted new growth in the vertex (hooray!) and agreed that my corners were a little worse.

I’m interested to hear your thoughts on how finasteride might impact my ultimate balding pattern, both in the front and back. And I’m interested in a clarification and elaboration of those comments from March 13! Thanks for all your work. Your blog is a great read.

Sorry if I wasn’t clear in my prior post.

A simple way to think about this is that Propecia does not stop hair loss completely, and it works best at the top / crown area. So if you are balding in a Norwood 6 or 7 pattern, Propecia will slow down the hair loss on the top / crown area while the front area will have faster hair loss than the top / crown.

Eventually, you may reach the Norwood 6 or 7 pattern, but if Propecia thwarts the hair loss process, you may be able to delay this for 10+ years if the drug works that way for you.

I am a 31 year old male who started Propecia 4 1/2 months ago after noticing very slight corner recession. I have very thick hair and have always seemed to shed a fair amount. After starting Propecia the shedding immediately stopped. However, 4 1/2 months later, my hair has definitely thinned at the corners and my frontal hairline is eroding. While my hair loss is not yet noticeable, I feel my time is short.

Should I still hold out hope for Propecia at this point? Could I still retain those minaturized hairs? Or are they now beyond the drugs grasp? This is having a profound affect on my self-esteem. Any insights you could provide would be greatly appreciated. Thank you for your time.

Let’s start from the beginning with education and facts:

1. There is no drug that permanently stops hair loss.
2. Propecia takes about 8-12 months to see its maximum benefit. Sometimes it takes a little time beyond that.
3. Propecia seems to work mainly on the top and crown area. It does not work well for the front and front corner areas. If it does, it is in a minority of people.

I understand you are trying to address the hair loss issue but you need to discuss these issues with a physician who can give you a realistic expectation and long term goals. We often refer to this as the Master Plan, which we are a big advocates of.

OK, here is my take on the latest happenings in the hair-loss debate…the recently reported topical inhibition of PGD2 and hair loss / re-growth.

OK, prostaglandins are both a GOOD and a BAD thing. You need some prostaglandins, but not others. Some prostaglandins are required for the inflammation associated with healing, while some are responsible for the negative effects of inflammation – mainly pain and the link in the chain that results in disease.

If prostaglandin D2 is indeed partially responsible for hair loss, then why not simply use a product that reduces or inhibits prostaglandin formation? These products do indeed exist. They are called COX-2 inhibitors, namely NSAIDS. However; all NSAIDS are not created equal.

One of the most potent, and selective COX-2 inhibitors is called Meloxicam, otherwise known as Mobic. It is an extremely effective pain reliever and anti-inflammatory. It’s anti-inflammatory properties are due to its inhibition of the cyclooxygenase-2 enzyme (COX-2). Since Meloxicam is soluble in methanol (think EverClear), why not simply put a few Mobic pills in ethanol for a few days, then simply apply it to the balding areas?

I do not claim to be a doctor, I do not even play one on TV. That right is reserved solely for Dr. Rassman, so I may be completely ignorant of the chemistry involved here.

Dr. Rassman, do you think this may be a viable approach to inhibit prostaglandin D2 topically? While I am pretty certain it could not cause harm, since it would not be absorbed systemically, would it be of any value as a topical PGD2 inhibitor?

As always, my deepest respect and thanks to you, Dr. Rassman.

While your insight is interesting, I do not think think the solution is that simple.

For argument’s sake, let’s say you dissolve Mobic in methanol and apply it to your sore back. Do you think it will relieve pain? It does not. Drugs don’t work this way. And I haven’t found any study that shows people who are on chronic pain medication like Mobic (that inhibit prostaglandins) have more hair growth or less hair loss.

The research on PGD2 is interesting, but it is only part of the big picture. I am sure that there will be research carried out.

Dear Sir .. I am suffering from severe hair loss since last one year.

Recently my doctor prescribe me the Dutasteride (Avodart) Medication for hair loss prevention. I continued the medication for 10 days and then I started to get severe Abdominal Muscle Cramps. After I stopped taking this medication the pain subsided slowly. I have recently read the article about Prostaglandin D2 protein and baldness on some website. Wanted to know that the Dutasteride is the cure for Prostaglandin D2.

Now I am confused that should I continue the Avodart medication or should I discontinue it permanently. I want my hair so I wanted to have your help, If you can prescribe me a good medication for hair loss prevention and regrowth .. So that I can discuss your prescription with my doctor.

Will be thankful for your reply and suggestions.

Regards

First things first — Avodart (dutasteride) is not approved for treating androgenic alopecia, and I don’t know what dose you’re even taking. I’ve read internet reports of abdominal cramping for some users upon starting Avodart, but I don’t really have much info beyond that. With respect to taking a prescription medication, you need to discuss these issues with the doctor that prescribed you the medication, especially if you feel you are having side effects!

As far as I am aware, dutasteride has no correlation with prostaglandin D2.

Hi there. Once again thanks for maintaining this excellent resource for info on hair loss. I’m a regular visitor to the blog and I’ve been following the news and updates about prostate cancer risk and finasteride usage with interest. I’m 28 and have been taking 1/4 proscar tablet to treat MPB for nearly 4 years now. The drug has worked well to stabilise my hair loss.

I just wondered if I could summarise what we actually do and don’t know about the risk factor of taking the 1mg (or 1.25mg) finasteride dosage for treatment of hair loss (at this moment in time).

As far as I can make out, after reading all the relevant entries in the blog, there doesn’t actually appear to be any specific evidence yet which states that taking the lower dose poses a prostate cancer risk. Do please correct me if I am wrong, but is there really any need to get concerned when all the studies are relating to the 5mg dosage?

What we could do with is an actual study focusing just on the use of propecia or 1/4 proscar tablet usage over a pro-longed period…

That said, I believe that as a patient who has elected to take a form of medication, it is sensible to keep updated about the possible developments (both positive and negative) – the news entries in this blog are most welcome.

I tend to agree with your assessment. There are no studies on Propecia or finasteride 1mg or 1.25mg that relates to prostate cancer risk that I’ve found. Even the studies on Proscar or finasteride 5mg is equivocal on the risk of prostate cancer. Moreover, there is evidence of LOWERING cancer risk for prostate as well.

Hi!

I am 25 and have been using rogaine since i was 20…the foam worked great having used it twice a day however it seemed to be ” lacking” recently and with instructions from Dr.Bernstein in NYC switched to the liquid only at night time. Few questions:

1. Can i use foam in the AM and liquid at night?

2. Does PG help with hair growth? I just went through a new shedding stage and am assuming that was weak hair falling out.

3. Any vitamins to help with hair loss? I take the standard multi but wonder if there is anything more or shampoos to block DHT? Ketoconazole?

Thank you

Yes, you can use the foam and liquid on the same day.

As for “PG”, I assume you mean propylene glycol. It is included in minoxidil to help the medication penetrate the scalp (see here).

Some people use ketoconazole with hopes of treatment help in the battle against hair loss, but I’ve got mixed feelings about it (see here).

Hey Dr.Rassman,

What do you think of the placebo effect in regards to side effects associated with taking Propecia? This snippet from Wikipedia on the placebo effect got me thinking about alot of individuals that have expectations/concerns on getting potential side effects from the medication.

Snippet:
Expectancy and conditioning

“In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. Both conditioning and expectations play a role in placebo effect, and make different kinds of contribution. Conditioning has a longer-lasting effect, and can affect earlier stages of information processing. The expectancy effect can be enhanced through factors such as the enthusiasm of the doctor, differences in size and color of placebo pills, or the use of other interventions such as injections. In one study, the response to a placebo increased from 44% to 62% when the doctor treated them with “warmth, attention, and confidence”. Expectancy effects have been found to occur with a range of substances. Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture.”

Sometimes I feel like alot of us convince ourselves we have these side effects when in reality they are non existent.

I have no doubt that many of the problems with sexual side effects reported while taking finasteride, are impacted by the power of suggestion. Also, some men have erectile dysfunction prior to ever starting the drug finasteride, so it is easy to blame the drug for that problem if they exercised denial. Thanks for sharing this with us.