Category: Uncategorized

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How Many Pumps of Minoxidil 5% Spray?

I just started using Minoxidil 5% spray, but I’m not sure how many pumps I should use on the affected area (front). The directions just say apply it to affected area and my dermatologist didn’t say anything either, just to use it twice a day. I’ve been using 5 pumps in the front and one in the back for good measure. Is this fine, too much, or not enough?

If 5 pumps is enough to put over the affected area, I would think 5 is your magic number. There is no absolute number. Obviously, don’t drench your scalp with it as a light covering should be adequate.

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Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

Dr. Rassman,

I’m a 32-year-old with a Norwood 2-3 pattern in the front and some very mild but immistakable loss in the Crown. I very recently started taking propecia and am strongly considering trying that in conjunction with Rogaine Foam. Your esteemed colleague, Dr. Bernstein recommends the use of both of these products simultaneously, right off the bat. You suggest that one hold off on Rogaine until propecia has been shown to be ineffective, as it causes “dependencies”…

Not to create friction, but what is the source of your disagreement on this? What do you mean by “dependencies”? I don’t understand because doesn’t propecia create a dependency as well? (i.e. if you stop taking it, you lose all of the benefit)…

There is no disagreement. I would also recommend Propecia and Rogaine. But, think ahead for a second:

  1. Once you start both Propecia and Rogaine, you need to take both for life.
  2. You will never really know which medication is working more or less if you start both at the same time.
  3. Rogaine can be difficult for many men to follow the twice a day application (a pill like Propecia is easier to deal with and faster to take).

If you can accept the above, I agree you should take both Rogaine (minoxidil) and Propecia (finasteride 1mg). Both create the same dependencies and I’ve never tried to downplay that. If you stop either medication, the benefits received (maintaining or regrowing hair) will be lost, therefore you will depend on both to keep your hair loss in check. The medications work differently, so finasteride can’t retain hair grown by minoxidil and vice versa.


2008-01-25 10:57:42Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

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How Rare Are Permanent Side Effects from Propecia/Finasteride?

The science papers suggest that the sexual side effect (the focus of most men on this site) are less than 2% and are reversible if stopped early. The nocebo effect is much higher as young men bring on their sexual side effects by obsessing over taking the drug, and reading forums that suggest that this is a common occurrence. The greatest concern of most young men is the condition called Post Finasteride Syndrome which if real, may reflect a 1% risk at most. There is controversy over the existence of this condition within the medical community, but it is nevertheless important for any man considering this drug


2020-03-23 15:54:06How Rare Are Permanent Side Effects from Propecia/Finasteride?

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Why Don’t Studies Discuss Type I or Type II DHT?

In all of the studies trying to determine whether natural supplements like saw palmetto or green tea block DHT, they never refer to Type I DHT or Type II DHT — just DHT. Why is this? Good question, huh?

Good question. Propecia (finasteride 1mg) blocks mainly DHT type II, and Avodart (dutasteride) blocks both DHT type I & II. You would think if you block ALL the DHT it would be better against androgenic alopecia. Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. There are clinical observations that suggest that dutasteride is better than finasteride, but it is not approved for hair loss by the FDA and the long term safety on human reproduction for dutasteride (reports of sterility is a complication) have been suggested in some rare patients. We have received many reports by varying doctors who switch people from finasteride to dutasteride and get a better response. The next logical question should be: If we increase the finasteride dose to 5 mg or so, will it be better to treat hair loss? I don’t know if anyone really knows that answer for sure. Some of the original studies on finasteride suggested that the 1mg dose is the most universal dose, but it may be that a high dose in those who are refractory to finasteride may help. Some doctors are using a higher dose of finasteride on long term users. It’s a prescription drug, so I’m not suggesting you should take a higher dosage. The problems for either finasteride and dutasteride is that side effects rise when increasing dosages.

To get back to your question though — it’s been proven that type II is linked to male pattern baldness, but type I hasn’t been linked yet (though it’s possibly just not been proven yet). I couldn’t tell you why the studies out there don’t provide a breakdown by type, but I have not found scientific evidence that saw palmetto or even green tea actually block DHT anyway. And even if it did block some DHT, there is nothing in the literature that shows saw palmetto or green tea being effective for treating androgenic alopecia. I don’t mean to be a pessimist, but even Propecia does not completely stop androgenic alopecia.

The real quest should be finding other (non- DHT related) mechanism for androgenic alopecia. DHT is not the only solution out there… we just haven’t discovered the other yet.

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How to Measure a Mature Hairline?

this may be a strange question, but when one talks about measuring how much a hairline has receded, and says that a normal (“Mature”) hairline recedes a half inch in the front, and an inch and a half at the corners, how do you measure that? vertically, as if straight down the face to a point parallel to where the hairline initially was??

thanks!

The measurement of the mature hairline is essentially done with a drop string (gravity), from the leading edge of the hairline and to the highest wrinkle of the furrowed brow. Here’s a list of past posts that may help:

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Why is the temple corner of many transplant not look right?

I’ve noticed a lot of hair transplants even relatively good/expensive ones the thing they seem to not ever really get completely “right” is the upper sides/temple corner area but like on the side still where hair goes vertical up side of head. I think it has to do with the angle at which the hairs are inserted which is it because naturally those hairs are at such a steep angle that they can’t replicate the same? Always seem like hairs there in transplants end up sticking out weird and randomly slightly. Was curious if there are any doctors or techniques that remedy this? Thanks!

The corner hairline has a transitional hair direction as it goes from the frontal part where the hairs run parallel to each other and perpendicular to the ground, to the side hairline where the hairs point laterally (look at your hairline and you will see this transitional zone that is about 1 cm wide where the hair changes direction. The surgeon must replicate this transition zone for correctly placing the hairline. See a good example here: https://baldingblog.com/repair-of-hairline-transplants-photos/


2020-12-04 11:34:44Why is the temple corner of many transplant not look right?

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Human Growth Hormone Reversed my Post Finasteride Syndrome

good afternoon Dr. Wrassman, I would like your opinion on the use of HCG to reverse the effects of PFS. This user reports reversal in 6 months after HCG administration: https://raypeatforum.com/community/threads/finally-cured-from-post-finasteride-syndrome.33215/ “…After nearly 4 years of suffering, I have finally & fully recovered from Post Finasteride Syndrome

All my symptoms have subsided and improved with this method which takes a while but I am fully functional It’s H.C.G (HCG) dosed at 250IU Monday, Wednesday and Friday only. I did this for 6 months straight but at the 10th week or so, the improvements were weekly. That is 250IU, not a typo… so you’ll mix your 5000iu HCG with 5CC water and take 1/4 CC intramuscular three times a week using an insulin needle…”

Have you heard about it?

I am not aware of the use of Human Growth Hormone in the treatment for Post Finasteride Syndrome. I did a limited search and did not find other such claims. Worth exploring possibly for those people who have not found a cure.

 


2020-11-01 09:51:29Human Growth Hormone Reversed my Post Finasteride Syndrome

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Why So Pessimistic About Ketoconazole?

Dr. Rassman,

I enjoy reading your blog, and nearly always agree with you, but I do feel you are a bit to pessimistic about ketoconazole. In another response to another member you dismissed of a Japanese, justifiably I suppose, because of the small sample size. (Have you seen the pictures of the impressive regrowth seen in three of the six patients? They shows an obvious reversal of AGA.)

What about this controlled study: “Comparative efficacy of various treatment regimens for androgenetic alopecia in men”

In this study men were divided into four groups: “Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.”

I don’t believe this has been mentioned on your blog before, and the results are exactly as most men would expect them to be:

Finasteride + Minoxidil > Finasteride + Ketoconazole > Finasteride Alone > Minoxidil Alone after one year.

I’m sure, like every study, this one also has it’s flaws, but together with all the other research — from Piérard-Franchimont C (1998) to Rajput RJ. (2010) — I’d say that the evidence for the efficacy of ketoconazole in AGA is highly suggestive. It’s certainly much stronger than for the majority of the things men try outside of finasteride/dutasteride and minoxidil.

And we know that all anazoles are somewhat antiandrogenic, but only ketoconazole will compete for the AR, and is used in androgen modulated prostate cancer.

How can you be so pessimistic about it in light of the totality of the evidence? Do you believe it to be dangerous?

I am not pessimistic about ketoconazole. Our job on this site is to educate you, the reader, on the realities of such claims and treatments and warn you if there is danger in using such “stuff”. While I don’t see ketoconazole (better known as Nizoral) as dangerous, it has yet to be proven to my satisfaction that it’s a treatment for hair loss. I’ve always maintained that Nizoral is a good shampoo for treating dandruff and fungal infections.

What I have always maintained is that nothing stops a genetic trait. There are drugs that slow it down and there may be other remedies that also work, but my mantra has always been “buyer beware”. The small study you referenced is indeed suggestive of positive benefits, and if the readers out there want to try it, I think that is their choice to make. But keep in mind that while the 1% ketoconazole is available as an over-the-counter shampoo, 2% ketoconazole (as used in that small study) is a prescription medication and as such, you need a physician to oversee the treatment. Side effects include burning and itching sensations.

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I Am 20 and Need Transplant Advice

So I am 20, soon turning 21 and I have recently been more and more adamant that a transplant would be the best thing for me. I never did have a perfect hairline since a kid and having a Dad who went bald probably about 30 it was going to happen. But I probably started noticing around 16/17. Then about a year and a bit ago it got really bad. Now I am a constant hat wearer. So my hairs receeded a fair bit at the temples as well as my hairline.

I have looked into transplants and come across various reviews of Turkey. Being a student the cheaper price there sells it immediately. I was wondering if anyone had any advice etc on it and could maybe point me in the direction of well reviewed trust worthy clinics. I have come across this https://www.medaway.co.uk/hair-transplant-turkey/ but just seems bit fishy even with over 3000+ successful transplants???Any advice or guidance would be much appreciated

Yes, don’t do it, not at 20 and not in Turkey. See this blog post here: https://baldingblog.com/22-year-old-received-a-hair-transplant-of-2800-grafts-from-reddit/ This explains the many reasons why you shouldn’t do it now. Get a good doctor who can work with you on a Personalized Master Plan that will insure that you will keep your hair, one way or another, through your entire life. I have had many patients who I worked with (see here for a couple of examples with photos:https://baldingblog.com/difference-between-norwood-class-7-patients-with-photos/ ). Be smart about your hair, please don’t dive into hair transplants now for your own sake.


2020-06-24 08:30:42I Am 20 and Need Transplant Advice

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Will my body hair transplants fall out as I get older?

Body hair transplants don’t have the staying power as you get older and drop your DHT levels as body hair is dependent upon DHT for growth. This also applies to beard hair as well. That is why some men who take DHT blockers like finasteride or dustasteride lose their body hair over time and some of them find that their beards are thinner as well.