Category: Drugs

Dear Dr. Rassman,
How long does it take for minoxidil dependence to occur ( once use has been started)

I do not know the definite answer to this, as there are no studies published about it (to my knowledge). First, the hair must be responsive to minoxidil for it to become dependent upon it and that means that the hair is thin and not normal. This generally takes many months, to a point where the drug is making a difference.

If you put a non-balding person on minoxidil, I believe that the hair would not develop a dependence upon it.

Is it possible to not have any side effects while taking Propoecia, but then expriencing them after quitting?

Propecia (finasteride 1mg) stays in your blood stream only for one day, which is why you need to take it daily. You weren’t clear as to what side effects you are experiencing after stopping Propecia. I would need more information from you to know where you are taking me.

What is the difference between Regaine and Rogaine where I can see that these two products have the same ingredients (Minoxidil 50 mg; propylene glycol; alcohol and purified water) are there any difference between this two products and which one do your recommend thanks for your time.

No difference that I know of. Regaine is the name in the UK and Australian markets. Rogaine is the name in the US market (and possibly other markets). They even share a similar logo and packaging.

• Rogaine (US)
• Regaine (UK)
• Regaine (AU)

Dear Doctor:

Let me first state that I have had an obsession with my hair loss for some time. I have been on Propecia, Avodart, Revivogen and may others in the hopes of saving or regrowing my hair. However, I am an extremely thin male (40 years old) with very little muscle mass. I am now getting quite flabby around the gut with pretty severe love handles. I am a gym rat, going to the gym at least 4 days a week doing both cardio and resistance training. My diet is extremely clean. I am attempting to increase muscle mass and decrease my abdominal fat, but have had zero results over the past 2 years. I have discovered a product by the name of Novedex XT, which is an estrogen inhibitor. From the research I have done and the people I have spoken to who use it, they say it is the best product they have ever tried to gain lean muscle mass. There is a pub med article on it as well.I wish I could provide the link, but it doesn’t point to the page. The bottom line is that Novedex XT increases Testosterone, free testosterone and DHT levels significantly. My question is this, would continuing to use Avodart reduce the chances of DHT related hair loss? I assume the DHT increases because estrogen is inhibited and both total and free testosterone is increased. This is not an anabolic steroid that uses some “unknown pathway” to convert to DHT. So, if I were to continue using Dutasteride, would this offset the DHT related hair loss? Here is the article from pubmed:

Willoughby DS, Wilborn C, Taylor L, Campbell W.
Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX 76798-7313, USA.

This study examined the effects of an aromatase-inhibiting nutritional supplement on serum steroid hormones, body composition, and clinical safety markers. Sixteen eugonadal young men ingested either Novedex XT or a placebo daily for 8 wk, followed by a 3-wk washout period. Body composition was assessed and blood and urine samples obtained at weeks 0, 4, 8, and 11. Data were analyzed by 2-way repeated-measures ANOVA. Novedex XT resulted in average increases of 283%, 625%, 566%, and 438% for total testosterone (P=0.001), free testosterone (P=0.001), dihydrotestosterone (P=0.001), and the testosterone:estrogen ratio (P=0.001), respectively, whereas fat mass decreased 3.5% (P=0.026) during supplementation. No significant differences were observed in blood and urinary clinical safety markers or for any of the other serum hormones (P>0.05). This study indicates that Novedex XT significantly increases serum androgen levels and decreases fat mass.

PMID: 17460335 [PubMed – indexed for MEDLINE

Thanks!

I get questions like this all of the time. Playing with your hormones could very possibly do damage, as these are off label uses of these medications. You can not stop the negative effects of the hormone blockers with dutasteride or finasteride, but you trying to do it anyway. Maybe one day you will learn what you are doing to your body and realize that it can’t be good with estrogen blockers and pushing your testosterone high to get in shape and impact the blubber that you have around the middle. I don’t mean to sound rude, but why not do it the right way, which is a good exercise program with a professional trainer working with you on your routine and your diet?

I also gleam another question: Whether the estrogen inhibitor will increase DHT to the point that dutasteride is rendered ineffective. I don’t believe that is the way it works, as this is a competitive inhibition process between the drug and 5 alpha reductase. It will still compete effectively for the receptor.

I have been on Propecia for over a year. I think it stopped my hair loss and overall my hair appears thicker. I used to have to shave my knuckles and feet before I started the propecia as well as I always had hair coming out of my ears. I recently looked at my feet then my hands and all over my body and noticed that all the hair has vanished. I was just wondering if that was normal. I am relieved that I am not as hairy as I used to be but should I be concerned?

The finding you report is uncommon, though I have had quite a few emails about this phenomenon over the past month and others have periodically reported this side effect over time as well. It did not impact my ear, nose, or body hair, so that is a personal disappointment for me. I don’t see it as any cause for concern.

The writer of the piece below researched the value of Propecia for our review. If you choose not to go to the source, at least read what is written here.

Dr Rassman

Brilliant site. In response to a post dated April 16 (Propecia Success Rates), you asked your readers for a link related to the success rate of Propecia use. While the clinical studies supporting drug approval (links below) involved many endpoints and durations of observation (from 12 months to 5 years), the most dramatic evidence is at the 5-year assessment for men with vertex baldness:

“ An independent analysis of photographs (of the entire head)….. showed that at 5 years, 48% of men using Propecia had increased hair growth, 42% of men had no change (from pre-Propecia baseline photos), and 10% were rated as having lost hair. For placebo, 6% of men had increased hair growth, 19% of men had no change (from baseline photos), and 75% were rated as having lost hair.”

For your readers, the best link to summarize the clinical studies supporting regulatory approval in the US for any drug is at the FDA’s web site and will contain both the “Product Label” or “Summary Basis of Approval”. The Product Label is a brief summary similar to what is found in the package insert that comes with the medication, and the “Summary Basis of Approval” (also termed “Review”) is a detailed submission often involving thousands of pages. However, the “Medical Review” in the Summary Basis of Approval is a document that is well indexed and usually contains the clinical studies supporting safety and efficacy.

This information can be accessed without charge. For any drug, the link is Drugs@FDA. One can then choose the drug as listings are by alphabetical order and trade (brand) name. Once the drug is chosen, then choose the link with “Label Information.” For Propecia, therefore, the link that takes the reader to the “Review” from 1997 Drug Approval Package #020788.

For Propecia, three double-blind, placebo-controlled randomized studies of 12 months duration were conducted with 1879 men. The two main endpoints were hair count by photography of selected areas and patient self-assessment. Secondary endpoints were investigator ratings and ratings of photographs (by independent counters). Main results were as follows:

Combined data from Study 1 and 2 in men with vertex baldness (number of men = 1533): At 12 months, there was a 107-hair difference within a 1-inch diameter circle compared with those in the placebo group. An extension study showed that the hair count was maintained for up to 2 years in men taking Propecia, compared with the placebo group (38-hair placebo-adjusted difference at 2 years). Related to the figures your poster of April 17 noted, at 12 months, the investigators rated 65% of men treated with Propecia as having increase growth compared with 37% in the placebo group. At 2 years, the same investigators rated 80% of men using Propecia (compared with 47% of men using placebo) as having increased growth. These figures were 77% (Propecia) and 15% (placebo) at 5 years.

An independent analysis of photographs of the entire head (without reader knowledge of treatment assignment of person is photo) showed that at 12 months approximately 50% of men treated with Propecia (compared with 7% using placebo) had increased growth. At 5 years, 48% of men using Propecia had increased hair growth, 42% of men had no change (from pre-Propecia baseline photos), and 10% were rated as having lost hair. For placebo, 6% of men had increased hair growth, 19% of men had no change (from baseline photos), and 75% were rated as having lost hair.

Additional data including info on Study 3 (hair loss in anterior mid-scalp with or without vertex baldness) can also be evaluated.

This is a scholar’s view of the long term studies on Propecia, as published. This writer’s review from a practical view shows that the drug Propecia works for hair retention. I have never understood the focus on unproven alternatives by much of the balding male population who read this blog and write to me. Rather than get predictable hair retention, men seem to be willing to take ‘things’ that have not been shown to have hair retention value and during the period that they take these compounds, they are losing hair that will never grow back.

So where Propecia seems to hold the ‘status quo’ for years, too many men seem to be willing to accept progressive balding when psychologically, they obsess over their hair loss. And far too many men believe what they see on television or the Internet and don’t think that pictures of hair growth they’re shown may be fraudulent.