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I am a medical student and was wondering how finasteride works to give people a fuller appearance of hair.

In the Journal of the American Academy of Dermatology July 2006, Volume 55, Dr. Vera Price summarized the action of finasteride as follows:

“Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

This is important, because what she implies is that the miniaturized hairs reverse. That is why it is so important to map out the scalp for miniaturization and to perform bulk measurements with the HAIRCHECK instrument. These two approaches used prior to starting finasteride (Propecia) gives us a baseline metric to determine the value of the treatment. I have seen people with miniaturization in the 80% range, reduce substantially to almost normal levels (under 20%). This is why everyone taking finasteride should be evaluated prior to starting the treatment by a doctor who understands this process clearly.

Too many finasteride (Propecia) users do not get evaluated prior to starting the treatment. They depend upon their memory of what they looked like after being on the drug, the appearance of hairs falling out and found in the drain, and even photography. Considering the investment of emotion (and money) in treating hair loss, every person should be a HAIRCHECK done for bulk measurement. After a year on the drug, you will know if you are gaining, losing or just staying put. This is the critical first phase of a Master Plan for hair loss that everyone using it should undertake. These measurements along with the first visit check-up, is free at the New Hair Institute. For women, the HAIRCHECK measurement is also important for knowing where the hair loss is going.

I am a medical student and was wondering how finasteride works to give people a fuller appearance of hair.

In the Journal of the American Academy of Dermatology July 2006, Volume 55, Dr. Vera Price summarized the action of finasteride as follows:

“Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

This is important, because what she implies is that the miniaturized hairs reverse. That is why it is so important to map out the scalp for miniaturization and to perform bulk measurements with the HAIRCHECK instrument. These two approaches used prior to starting finasteride (Propecia) gives us a baseline metric to determine the value of the treatment. I have seen people with miniaturization in the 80% range, reduce substantially to almost normal levels (under 20%). This is why everyone taking finasteride should be evaluated prior to starting the treatment by a doctor who understands this process clearly.

1. Is initial shedding experienced with minoxidil the same as loss due to trauma? That is, does the initial shedding often experienced from a topical solution represent permanent loss (like loss from surgery or medications), or is it simply the start of a new hair cycle, with potentially thicker hairs growing back. Or is this the same as traumatized hair that, once it falls out, regrows weaker and smaller? I ask because I began adding liquid Rogaine on weekends in addition to the foam during the week (it is just too greasy otherwise), and I am hoping that maybe some of the most recent loss might have been caused by the liquid formulation.

Minoxidil is known to cause shedding in the initial use. It is not comparable to trauma. The hair should come back and start reversing from the short term loss within 2 or so months.

2. We discussed formula 82M. So, in addition to 5% minoxidil, it contains retinoic acid, tretinoin, 0.01% topical steroid fluocinolone, and oleanolic acid. I am just curious if you would expect to see any real difference in response to treatment between 82M as opposed to Rogaine. I have not felt any irritation from the 82M upon application, but my scalp has become extremely dry with a tremendous amount of skin flaking (when I wake up in the morning, my pillow looks like it has been sprinkled with confectioner’s sugar). I never had a problem with scalp irritation from either liquid or foam Rogaine. If there is no reason to expect different results from 82M versus regular minoxidil, I do not know that it will be worth using in the long run.

The various acids in the 82M or other similar medications generally cause the scalp irritation, dryness and flaking. The basic theory behind the extra ingredients is to irritate the skin to absorb the minoxidil better.

3. Many doctors promote PRP treatment, and I know you remain fairly skeptical without good clinical evidence, but have you actually seen positive results in any patients anywhere? Is it a hit-or-miss type of treatment, where some people respond and some do not, or is it purely nonsense?

PRP has not shown any value. This came up at the recent international meeting for hair restoration surgeons and after review, it was my conclusion from that meeting (as well as many of the respected doctors who where there) that PRP has little value, if any in the various balding or hair transplant scenarios.

I have not seen positive results or met anyone who claimed positive results.

4. There are no solid studies regarding the effectiveness of LLLT on hair growth. Despite the question of efficacy of LLLT, I wonder if it is still possible to determine which device may be the best choice for the end user. I was considering trying a new laser, if only for better coverage and convenience of use, but is there any reason to think that the hair cap, for example, is any better than other laser products?

I have tried LLLT on patients over the years and I never saw any value and that is my belief. One doctor I respect, told the meeting that of the various devices, the Laser Hair Comb might be the best. I ask the best of what?

When I was in my teens and twenties, my hair was long, lush, wavy and full bodied and made me look sexy. Now at 48, my hair is thin, the opposite of lush, limp and impossible to deal with. Is this a health problem that my doctor can help me with or is there someone else I can see to get my hair back to the way it was when I was younger.

I am going to use this question as a way of addressing a variety of subject reflecting hair questions that rise from our readership from time to time.

Hair changes with age and often becomes finer. The lushness and full bodied hair you are talking about is the result of the texture of your hair and its thickness. Over the years, our hair changes its character, not only turning gray, but also becoming finer. If you have long hair and you use a hair blower to dry your hair, curlers to add body to it, curling irons to add more body to it, you will damage the hair that you have more with each use. You may have gotten away with it when you were young and your hair was more coarse and your sebum glands were more active in producing the wax that protected your hair; however, at your present age your hair will tolerate less and less of these treatments. Curling iron and hot irons or all kinds, kill hair.

What you need to do is to lubricate your hair, restore hydrophobicity, neutrilize the charges on the negatively charged hair and add lipids (fats to your hair). Think about your fingernails. When the tip breaks, the break propagates further into the fingernail. Hair is like the fingernail and you can not prevent the propagation of the break in the fingernail by putting a gel on it to fix it. Good quality shampoos and rinses, possibly with silicone, will help maintain ‘hair health’. I put quotes around the term ‘hair health’ because you all should know that the hair in our head is keratin which is not alive to the concept of ‘health’ here reflects the preservation of hair qualities and our abilities to make the hair look and feel better to us.

Silicone will smooth the feel of your hair and reduce friction thereby making it easier to comb your hair. When you pull your comb through your hair with any resistance, you break the hair fibers. The silicone in many of the hair products help, but all silicone is not the same. Silicone in our hair products come in different size particles. If smaller particles of silicone are used, they coat the hair better but because they are small but they wash out more easily. Higher quality silicones can be very expensive products, so be careful when you buy them as many are over priced products. When buying a quality product, if you like it, stick with it.

Hair conditioners work to make the electrical charge on the hair more positive. The use of surfactants also has value. Hair is covered with a naturally produced hydrophobic oil (repels water) and the poils are easily damaged bu UV light. As the hydrophobic oils leave the hair, the hair develops a negative electrical charge. The use a surfactants reduces the electrical charge, but may not make the hair as hydrophobic as you may want (repelling water)

I know how important hair is for many people as the focus on your hair grooming takes a considerable amount of time daily. But you must recognize that your hair changes as you age (men and women) and many of the things we do to help our hair, actually damages it. Use a good commercial shampoo made by a reputable suppliers and a good conditioner to ‘top off’ your daily cleaning routine. Once you find the shampoo you like, stick with it. Sulfate free shampoos probably makes no difference in the products you buy. The use of spray-on solutions for UV protection may not work well (long hair as the overall length of the hair, end on end, can be many, many meters long). When you use good hair products, its is about deposition and evenness in its application and putting things on and into long hair is not easy.

Organic shampoos make no difference on your hair health. The use of hyaluronic acid can add moisture so it can be used for moisturization when found in products, but its use is still in a research mode. As hair is normally resistant to water, getting products into the hair can be very difficult but in the research mode, Hyaluronic acid seems to work well for moisturization.

Water conditions in the area you live in vary and may significantly impact the shampoos and conditioners you use. Check with the labels on the products you use and see if it discuss their use in hard water. Some companies put kelators into the products to normalize the water. Copper is the worst thing found in water and kelants can neutralize the impact of copper. Frequent washing of your hair with hard water is bad, so using a conditioner is important. Make sure that the water you use in washing and with conditioners is cooler water, as hot water can damage hair.

There are products that thicken the hair shafts by making it absorb water or by coating the hair shafts to make it look fuller. There are products that produce thicker and fuller hair but this is a difficult area to make recommendations for as many of the product offerings are not really effective. If one thickens the hair shaft by just a little, the overall effect on hair bulk can be very significant considering that the thickening impact reflects the length of the hair measured end-on-end from a bulk point of view. Such products can act as if you have added 5000+ hairs to your head. In some countries, oils are added (e.g. olive oil) which may thicken the hair as it coats each hair shaft.

For hair regrowth, minoxidil is the only game in town that has been proven to grow new hair follicles from balding areas. For frequency recommendations for washing: the less the better. skin has a microbial community and the sebum and flakes cause micro-organizes to eat that fat. These bacteria eat sebum and the unsaturated fatty acids these bugs produce are irritants. Wash 2-3 times a week may be ideal for addressing these ‘bugs’. People with lower hair density and lower hair bulk need less washing because less sebum is produced and the hair shafts have more air movement around them causing more drying. Asians, with their lower densities, might take note here.

Minoxidil is the only game in town for new hair growth. Propecia may work mostly on reversing the miniaturized hairs that are already beginning the genetic slide with androgenic alopecia.

Like it or not, this has been the benchmark approach to learning about new treatments for disease; but it doesn’t always relate to the human diseases it mimics.

https://theconversation.com/of-mice-and-men-why-animal-trial-results-dont-always-translate-to-humans-73354

I went to my dermatologist because I’ve also been dealing with diffuse thinning on my scalp. Very aggressively lately. He told me about finasteride and gave me 300 tablets. I’ve been on them for 3 weeks now. In the first week, my libido went up a lot. From zero to feeling horny almost every single day. Kinda like my old self.

Now, I did some research… and I know this is common for people starting fin. However… I read that this is because fin gives a slight boost to testosterone… resulting in extra sex drive. What I don’t understand is that my testosterone was already pretty high. Almost at the ceiling of the normal range. And yet my sex drive was very bad. Yet this slight testosterone increase from finasteride gives me an enormous libido boost.

Is there an explanation for this? I’m obviously happy about the change, but I’m also not expecting it to last and I’m kinda interested in the science behind it.

I have heard about this many times, but I can’t explain it. Consider it a blessing.