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My Doctor Suggested I Use Minoxidil for 1 Year, Then Gradually Stop Using It

Dear Dr. Rassman.

I wrote you before about my hair condition. I am male, 22, caucasian. I went to the trichologist last week and was prescribed to apply topical Minoxidil 5% +mpg 0.0125% together with some vitamin-enriched solution called “Biostim” (ingredients include: Aqua, Sabal Serrulata extract (biogen), mono propylene glycol, ceramide, panthenol, calcium pantothenate (vitamin b3), vitamin E, vitamin A, Vitamin H (biotin), vitamin H (P.A.B.A.), Inositol (vitamin B8).

The doctor I went to also told me the weirdest thing about the long-term treatment plan. he suggested that I follow the usual minoxidil regime for 12 to 14 months, then switch to less concentrated solution with less frequency of application until I’m in my late 30s. What he added to that,that it is possible to take me out the medication at that age, because (quote) my “hormone levels will settle up”… I don’t know what to think of it? It sounds like some sci-fi scenario for me…

another thing I want to ask you is that I’m currently quite happy with my hair – I have slight recessions at the temple area and that is my only problem. I always had quite high hairline, so recessions are quite visible (if I for some reason will go for shorter haircut). I have no history of baldness in my family (my father is 60 and he is on NW3, so are/were most of my family). So as far as I understand the idea of the treatment is not to let my hair loss progress…

I’m very confused abouth this whole situation. Should I trust my trichologist, or does he sound ridiculous? Should I consider undergoing Minoxidil treatment at this stage or not?

I look forward to your reply.

kindest regards

Hair loss is a progressive process and if you think about it, you can logically figure out if the Master Plan made by your trichologist makes common sense. Certainly, I approach the problem with a solution (Propecia and/or minoxidil) and continue treatments that are successful. The idea of starting minoxidil and withdrawing it if it is working, guarantees hair loss from that withdrawal. Propecia always works at least by slowing down the hair loss (to what degree though, is different per person), possibly stopping it altogether, or maybe reversing it.

As for the Biostim product, the only place I can find that references this is one trichologist in London, leading me to believe he is the exclusive marketer of this product. Perhaps it is a private label item and he is just looking to make some money? I don’t know. The ingredients you listed do not look like they’ll do much for your hair. It is your call, of course.

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My Doctor Suggested I Take Generic Propecia

Hi Dr, many thanks for the excellent blog. I just had a question regarding generic propecia. My doctor in the UK approved me as a good candidate for propecia and advised me I could now buy generic 1mg propecia online to save money. I’m currently on merck’s product and haven’t experienced any serious side effects.

The generic manufacturers on the site he suggested are Sunrise and Cipla. I can’t find much info on these companies and was wondering if you were familiar with them and if they are reputable, or furthermore if you think buying generic 1mg is a good idea in the first place, even if I have been examined by a Dr?

Any advise would be much appreciated. best

The generic should be the same as the name brand. The 1mg generic finasteride isn’t legally available due to patent restrictions in the US, but the 5mg generic is off patent and available. Things could be different in the UK. I suppose that if you get the generic from a reputable source it would be fine, but many online pharmacies are suspect since they don’t require a prescription in the first place. I’m not a fan of that.

As for the companies you asked about, I think Sunrise is US based, but I’m not too familiar with them. All I could really find was their website and an FDA warning letter from last year about the use of excessive active ingredients in some medications they made. I am more familiar with Cipla since I’ve been asked about them a few times before. Cipla is a very large pharmaceutical maker out of India and their biggest claim to fame is that they’re the world’s largest producer of HIV/AIDS fighting medications.

For more info on Cipla:

For more info on Sunrise:


2011-08-04 09:46:17My Doctor Suggested I Take Generic Propecia

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My Doctor Says There’s No Way My Female Hair Loss Is Thyroid Related!

I am deeply troubled with my recent hair loss. I am a 62 year old female and have been on synthroid for 2 1/2 years at 88mg.I have just had a blood test that came back at a level of .087 and told by my doctor that I am in the normal range. He said theres no way my hair loss is thyroid related and has set me up to see a dermatologist. I cant get in there for 3 more months and I’m experiencing a very high level of anxiety over the amount of hair I’m losing. I’ve started with thioxin and am taking a hair supplement purchased on the internet called hair genisis that I;ve been taking for a month but hasnt improved. I started reading everything I could re: hairloss and am now wondering if its my adrenal glands. I have gotten beyond obbsessive about all this feel like I have no where to go for help. I dont know if I’m taking too high a dose or too low a dose of synthroid or if is the synthroid itself causing the hair loss. How do I know if the t4 is converting into t3 properly. I’m afraid I’ll go completely bald before anyone listens to me. Can you give me some advice???

I would trust your doctor to treat your thyroid issues with the dose of medication that he prescribed, but Synthroid (levothyroxine) does list “mild hair loss” as a possible side effect (see Drugs.com). While hair loss from a thyroid issue is possible, it is unlikely to continue as you are being treated for your thyroid issues. Without the benefit of knowing your medical history or being your doctor, I’m guessing that the Synthroid is not the cause, as you’ve been taking it for over 2 years and your hair loss started just recently. An interesting post with more links can be found at WomensHairLossProject.com.

If you do not believe you are being adequately treated you should express these concerns to your doctor. Also, I don’t know that you should wait 3 months to get medical attention. I either would call your doctor’s office to find out what he can recommend to speed up the evaluation process, or perhaps get a referral to a different dermatologist.


2008-06-13 11:59:32My Doctor Says There’s No Way My Female Hair Loss Is Thyroid Related!

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My Doctor Said to Use Propecia Daily for a Month, Then Every Other Day Afterwards

I’m a 22 year old suffering from hair loss. I was using 5% Minoxidil at the advice of my local physician for the past 2 years with limited sucess as it managed to slow my hair loss but not reverse it. After seeing a dermatologist recently, he advised me to use propecia once a day for a month and then take it every other day afterwards.

He said that after a month Propecia will lower DHT levels in my system and will be effective for 72 hrs which is why he said I only need it every other day as this will save me money. Do you believe that by taking propecia this way it will have the same effect as using it once a day?

The recommended dose of Propecia is one pill a day for treating hair loss. I do not understand you doctor’s logic, but I will defer the treatment to your doctor as you are under his care… not mine.

I do know that Propecia’s half life in your blood stream is 4 to 6 hours, which means most of the drug will be gone from your blood stream in one day.

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My Doctor Said SMP Alone Would be a Mistake For My Norwood 6 Pattern

Hey Dr Rassman. I hope your doing well.

I had a consultation with my hair doctor. At which i brought up the proposition of a combined SMP and hair transplant procedure. His response was the 2 would compliment each other well but just SMP alone would be a mistake. What are your thoughts does SMP look more natural when done in conjunction with hair transplantation?

And lastly i recall reading about a young man who won the American Dream contest a few years back. You performed surgery on him as my balding pattern would be close to his (ill prolly wind up developing into a class 6)and our ages are close or were im 23 now(i have been on finasreide since 20) i am interested to see his results. Thank you.

Each person is a separate case. I can not tell you that Scalp MicroPigmentation (SMP) plus hair transplants is better than either alone. I make each judgment when I understand the patient, when I see how fast the hair loss process is, and when I can then build a Master Plan. Generally, the hair transplant is the way I start, adding SMP on only a minority of patients.

As for the winner of the American Dream Vote television show (see here if you don’t remember the single episode that aired before it was canceled), the last update photos we had to publish were from 2009 and can be found here.


2011-07-09 07:49:06My Doctor Said SMP Alone Would be a Mistake For My Norwood 6 Pattern

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My Doctor Said My Hair is Fine, But I Want You to Judge It

Hey Doc,

I’ve been concerned about my hair for nearly two years now. I’m 21, nearly 22.

I went to my GP who said there wasn’t a problem with my hair, and that I didn’t need to go to a dermatologist. However, I’m still a bit iffy about it. I (think) I have a natural parting down the middle of my head. You be the judge. But either way, am concerned about miniaturisation and recession.

Based on those pictures (taken a couple of months ago), can you see if there is anything I should be concerned about with my hair? Hairline and crown/top of hair.

Feel free to post pics if this gets posted. Thanks.

 

I just chose a few photos to post out of the 35 or so you sent in the link, but I appreciate you allowing us to publish them.

I think you should listen to your doctor. Based on photos alone, your hair seems fine. I’m not seeing any cause for concern, and your hair looks great. We can let all the readers judge as well. Click the photos to enlarge.

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My Doctor Said I Wasn’t Programmed to Have Crown Loss, So Propecia Wasn’t Necessary

First, I can’t thank you enough for maintaining this resource–it’s alleviated a lot of my anxiety about hair loss simply by giving my a place to find answers to my questions.

I recently had a consultation with a surgeon about reshaping my temples. I’m 29, and probably a NW2-3. (I’ve had relatively high temples since high school, though the spaces have expanded slowly since though then.) He ultimately recommended 1100 grafts to fill in my temples and create a relatively straight hairline.

I have two questions:

1. He told me that diet has a significant impact on hair loss, second to genetics. He advised a vitamin regimen of L-Lysine, Vitamin E, Saw Palmetto, MSM, Glucosamine, Chondroitin Sulfate, and Ester-C. In addition, he recommended that I stop consuming creatine, and eat a sulphite/nitrite-free diet that’s rich in antioxidants and low in refined sugar and bleached flour. I realize that much of this might be good health advice generally, but does it have any non-negligible connection to hair loss? I appreciate interest in my general welfare, but this had me a tad skeptical.

2. After examining the entirety of my hair, he told me that I’m “programmed” for hair loss not beyond a NW3. He did not conduct a miniaturization study; this was a “naked eyeball” examination. Because he didn’t think I’m “programmed” for any crown-area loss, he said Propecia wouldn’t be necessary. Should I take this pronouncement with a grain of salt, or could he accurately reach that conclusion via the type of examination he made?

Many thanks, and all the best. If it’s at all relevant, he did not recommend any type of hairline lowering, but simply filling in the temples and leaving the forelock as is.

While it is possible that you won’t advance beyond a Norwood class 3 hairline, I don’t trust doctors who give eyeball opinions for predicting hair loss. There are some good tests (miniaturization mapping and better yet, bulk analysis) that will tell you with some certainty if you are balding.

The decision to take drugs like finasteride should be based upon clinical evidence of balding. You might want to consider getting a second opinion, hopefully from a doctor that can give you a more thorough analysis of your hair. If you aren’t balding, Propecia isn’t necessary (though you should consider it to prevent shock loss from any hair transplant you may have). If you do have early balding, now would be the best time to start the medication.

As for the recommended vitamins, I am not a nutritionist, so your doctor’s suggestions may be good ones for your overall health. I wouldn’t expect to see lush hair growth upon taking them, though. None of those have satisfactory evidence linking them to treating genetic hair loss.

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My doctor said I shouldn’t transplant the crown

I am naturally a Norwood 3-temple recession and minor crown recession as well.

Had a 1200 graft hair transplant last year on my temples, and slightly slowered the hairline. The doc did not put enough grafts in, so I am getting a 2nd HT Nov 20 for an additional 300-500 grafts to fill it in, free of charge (there was sooo much drama surrounding this, see my post history for more info).

My crown was not operated on during my last HT, but since I am already going under the knife, I would really like my crown filled in as well. I’m not sure how to rate my crown loss-I guess a Norwood 2- in that my crown clearly has loss, but it is not unbearable. Sort of like how Norwood 2 on the hairline is noticeable, but a lot of people can still get away with it.

Both my doc and another doc in the office looked at my crown. They both advised against getting grafts on my crown. One of the docs said he never operates on the crown on people under 40 (I am 30) because of potential future loss. They also said I do have significant hair on the crown still (albeit miniaturized) and putting new grafts in could shock loss out these already fragile hairs. Essentially, they are saying that while I clearly have crown loss, it is not bad enough to merit a hair transplant for it.

I was very disappointed these docs advised against operating on the crown. My arguments for getting a crown are, if they do grafts on it and I do have future loss, I am prepared to get a 3rd HT. I am currently taking Dut and using Rogaine on this area, so not sure if I would even have more loss.

The docs recommended SMP as an option for the crown. I actually visited an SMP guy Thursday. It just seems like so much maintenance. The tattoo only lasts 4-6 years, have to put sunscreen on it everyday. Nervous it would look unnatural. So don’t want to do SMP.

Toppik works VERY WELL on the area, but again, it is still a lot of maintenance. And I would rather have the permanent option of a HT. I’m kind of confused as well. I’m sure if I consulted other doctors, or went to Turkey, I could find a reasonable # of doctors who would work on the crown. Not sure why both these docs are advising against it.

My questions are:

-Should I insist my doc operate on my crown?

-Has anyone here had any experience with doctors advising not to get grafts on the crown?

-Would you side with the doctors or me in this situation?

-Any advice on how to deal with crown loss? Toppik works very well, but Id rather have the permanence of a HT.

Transplanting the crown is something that I have been doing for 29 years with no problems. Clearly the issue is skill of the doctor, experience, and proper indications for doing it (never too early if it responds to minoxidil for example). I have had my crown transplanted and it looks great!


2020-02-20 17:47:42My doctor said I shouldn’t transplant the crown

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My Doctor Said I Should Take Oral Minoxidil for Treating Hair Loss

hello, i recently started propecia and minoxidil tablets one each daily. here in japan doctor said minoxidil tablet is ok, but i read on internet it is only for heart problem. is it ok to take it for my hair loss? thank you very much

Without seeing the patient in person for my own assessment and examination, I do not usually like to override another doctor’s opinion since they may have their own reasoning for giving a particular recommendation.

But in this case, I disagree with taking oral minoxidil tablets (also known as Loniten) for treating hair loss.

Perhaps you misheard your doctor or were confused by the instructions. Oral minoxidil is a blood pressure lowering medication. Topical minoxidil is a hair loss treatment. Propecia is an oral hair loss treatment you can take (with a doctor’s prescription).


2014-01-08 11:51:51My Doctor Said I Should Take Oral Minoxidil for Treating Hair Loss

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My Doctor Said I Only Need to Take Propecia Every Other Day

Hi I have been using Propecia for just over 6 months with no visible benefits so far. I understand that it can take anwhere up to 18 months for you to see results.

The trichologist that I have been seeing and who prescibed the Propecia has told me that the half life is such that I only need to take it every other day. Which is what I’ve been doing for the last 6 months. Is this correct?

Thanks for your site its a great help.

Half life of Propecia is around 4 hours. The half life is the time it takes half of the drug to be out of your blood stream. Let’s do the math…

6am – take Propecia (assume 100% got into your blood stream…)
10am – 50% of Propecia is in your blood stream
2pm – 25% of Propecia is in your blood stream
6pm – 12.5% of Propecia is in your blood stream
10pm -6.25% of Propecia is in your blood stream
2am – 3.125% of Propecia is in your blood stream
6am – (a day later) only 1.5625% of Propecia is in your blood stream

Realistically, all the Propecia is out of your blood stream after 24 hrs. That is why you take Propecia once a day.