Category: Drugs

I hope this is not a stupid question. I know in a perfect world no man would ever go bald and we would all have perfect hair. But, since its not the case and I know most men have some degree of hair loss as they age.

My question is regarding men who started balding when they were 18, but with the aide of finasteride it has been a really really slow balding process. Do you usually notice that these men, once they are in their 30’s, they are a norwood 2-2a and then when they are in theirs 40’s they are a norwood 3-3a and then in their 50’s they are a 5-5a and then 60’s either a 6 or 7?

It’s not a stupid question, but I think you’re confused about what the Norwood classifications are for. The Norwood chart (see below) classifies the final patterns of balding. By final, it generally means that there is no going back. Of interest, the patients with the most advanced pattern of balding (class 7) usually get there in their 20s and rarely show up becoming a Class 7 at the age of 60. Norwood classes are not a guideline for balding by age or decade.

Finasteride can slow the balding process and in very young men without advanced balding, it may reverse crown loss and occasionally even frontal loss (as it did in my son). The projections you did in your question is the work of a dreamer.

Hello Doc,
This is great blog you have here.

Ive used Rogaine for over 10 years (since I was 22) to treat my balding hair. I’m mostly losing my hair at the crown. I really don’t know if its done any good but since most of the men in my family are really really bald, I think my hair isnt that bad.

Anyways in the last year I began using Rogaine Foam. I started to notice a slight shortness of breath and dizziness. I discontinued use and felt fine again. Ive been thinking of going back to the liquid rogaine. Any reason why the foam would have this effect but not the liquid? Or after 10 years why I would suddenly have this reaction to minoxidil?

You should go get a physical exam by your primary care doctor. It may not be as simple as a reaction to minoxidil. After all the other medical issues have been explored, it may be that your absorption of the Rogaine Foam is higher than with the liquid. One of the side effects of Rogaine is a drop in blood pressure and that can cause dizziness.

Dear Mr. Rassman,

Thank you for all the help you are providing the public. I am 23 years old and suffering from thinning hair. Unfortunately, we have limited options in Dubai. We have only one product of minoxidil 5% which is regaine, however, I develop scalp irritation from using it. A dermatologist asked me to try ordering rogaine foam from the US. He believes that the irritation was caused because regaine 5% is an alcoholic solution.

1) Do you think rogaine foam does not have alcohol? If yes, can you recommend any other product that contains minoxidil 5% but is not an alcoholic solution. Minoxidil is my only option and it is very important for me to find a way to avoid irritation.

2) I used the total daily dosage of regaine 5% at once a day, not twice as recommended. Do you think that is the reason for irritation?

3) I want to study whether regaine is effective with a microscope and taking pictures. How can I be sure that I am comparing the same spot with the same amount of zoom. For example, I zoomed a little and found 10 hairs in area A in the first month. I am worried that I might zoom less and find 12 hair counts after six months. Moreover, I might take a snap of another spot (beside the original one) in area A.

Thank you very much in advance.

1. Rogaine Foam does contain alcohol, but it is the propylene glycol that is generally what causes skin irritation in some people. Rogaine Foam doesn’t contain propylene glycol. If it is the alcohol that’s causing your irritation, unfortunately I’m not aware of any particular minoxidil currently sold with zero alcohol content. I have no way to know exactly what is causing your skin irritation, though.

2. Using it only once a day might just not be as effective as the recommended twice daily application, but I doubt the lesser dosage is what is causing your irritation. The irritation is probably from the propylene glycol in the Rogaine liquid, or perhaps an allergy to one of the other ingredients.

3. I suppose you could have a permanent dot the size of a pen mark tattooed on your scalp to be sure you have the exact spot monitored each time, but I think that’s a little overkill. The better way to go about this is to have a professional check the overall hair bulk using the HairCheck instrument, then recheck it again in a year to see if the numbers changed (increased bulk means you’re having more hair growth).

Hello Dr,

Im 25 and have recently suffered hair loss on my crown. I have been using Minoxidil 5% to try and control it and it has worked quite well but my scalp gets quite itchy and spotty. Also people are commenting on my eyes, the lids appear thicker and there are lines appearing around my lower eyelid. I have mild acne scaring around my temples but this seems to have flared up and the skin pores enlarged. Do you think this is something that will go away in time or should I stop using this medication? thanks

Some people do develop facial changes with minoxidil. For example, women have reported increased facial hair growth when they use minoxidil somewhat frequently. As for lines under your eyes, some might be quick to point out that we’ve posted messages from readers in the past that suggested they had premature wrinkles caused by using minoxidil. There was a study on rats from years back that showed minoxidil use was inhibiting collagen production, but I don’t know of any study that shows that is the case in humans. For what it’s worth, I’ve never heard complaints about wrinkles being caused by minoxidil from any of my own patients.

It’s possible that what you’re experiencing is simply an allergic reaction to one of the ingredients in the medication, causing your puffy eyes. You could try stopping the minoxidil for a week and see what happens to the changes in your eyes. There is very little risk in stopping it for up to 2 weeks.

I am on finasteride for 4 months. I think I suffer side effects. I would like to know how ‘real’ these side effects are, so actually ‘test’ the side effects.

Therefore, what if I stop for 2 weeks?
– would side effects go away in 2 weeks, so can I feel a difference in that time?
– would a stop of 2 weeks hurt my hair?

Reason for this: I just want to know what if side effects are psychologically or if they are ‘real’.

I suppose you could try it. To be thorough, I’d talk to your prescribing doctor before you make any changes to your medication.

In two weeks, I doubt that you will lose the benefit of taking the finasteride over the past 4 months. The side effects should be gone by then (I’m not sure which side effects your experienced or how quickly you saw them), unless there is some psychological reason for them to persist.

Hi doctor, I used oral finasteride for many years but never stop my MPB progress and give me hard side effects. So after stopping the drug, i started with topical finasteride and after 3 months it appears to me that there is regrowth and including the temples (a tough place to get results).

I believe that topical finasteride reduced much more topical DHT than oral, so that neither produces more sebum on the scalp. Why even prescribe oral finasteride giving serious side effects, if topical is much better?

In the United States, I am not aware of an FDA approved form of topical finasteride. If there was a topical form of this drug sold commercially, the FDA would have to review it for safety and effectiveness, which would likely take years before coming to market. Unless you’re buying a compounded topical lotion or shampoo from a licensed pharmacist, anyone today who is claiming to supply a topical finasteride is violating the FDA regulations and would be open to FDA sanctions or prosecution.

I don’t know what you’re using (brand or dosage), nor do I know of its safety or effectiveness. That said, the reason I prescribe oral finasteride as opposed to a topical is that the oral is a prescription drug that is available for sale in any pharmacy. I don’t know of any topical finasteride sold here. If you’re outside the US, the rules may be different… but I’m a US-based physician.

Hi Dr,

I have been taking 1.25mg of finasteride daily for about 5 years. My wife and I will be trying for a baby in the next year or so and I don’t want any chance of her coming into contact with finasteride powder while pregnant. For that reason I wish to switch from splitting a 5 mg pill to taking the 1 mg propecia tablet instead.

I have two questions:
1)Should I stop taking finasteride while trying to conceive?

2)Will reducing my daily finasteride dosage to 1 mg per day affect the management of my hair loss?

Many Thanks for your great blog.

Your first question is often asked of me (examples: here, here, here). There is no evidence that a man taking finasteride will produce an abnormal child as a result of taking the medication. I only know what I read and what the FDA publishes, so I can not advise you beyond that.

Your second question is an easier answer. There is essentially no difference between the 1mg Propecia pill and the 1/4 of a cut 5mg pill (1.25mg). The switch should be easy and seamless.

I’ve been taking Propecia for over a year now and had a blood test recently done. It shows that my serum creatinine is in the slightly above normal zone which is an indication of possible kidney dysfunction.

Can propecia cause kidney damage? If not, can I still continue taking it?

As I’ve written before, there is no documented adverse effect of Propecia on the kidneys.

Elevated creatinine is something that you should understand. I’ve written about that before as well, here. What I generally do is first repeat the test in the case that the lab test is in error. Then your doctor will dive into it more deeply. Ask your prescribing doctor if you should continue taking the medication, as I cannot give personal medical recommendations.