Hair Restoration Blog

Q:

My doctor put me on propecia at 21 when I told him about the hair loss and I took it for about six months but it had no effect on my hair loss. I also started to use rogaine around age 23/24 for a couple of months but stopped because it made my hair loss worse (before rogaine the majority of my hair loss was in the front area of my head and after using rogaine I started to lose hair on my crown as well). My hair loss has been pretty stable over the past 2-3 years and I have continued to lose some hair but nowhere near the amount I lost initially.

I wash my hair every 2-3 days and only notice about 20-30 hairs lost compared to the hundreds I lost early on. My hairline has not really been effected at all and my hair loss doesn’t seem to match any on the norwood scale, it is just diffused loss throughout and matches the description of many accutane users who have lost hair. I have also been using the ProThik concealer spray for the past 3 years which works great because my hair loss is diffuse and makes it unnoticeable, but the process of applying it in and combing through it causes my hair to get tangled and pulled out so I think over time that has also contributed to my hair loss. I lose far more hair putting in the concealer than I do washing it and combing through it naturally.

For the first 2 years of using it I would wash my hair and re-apply it daily, although over the past 6-8 months I have gone 2-3 days between washing and reapplying it and only lose 10-20 hairs when I comb through it in the morning. I am not sure how much of my hair loss in recent years has been caused by this but I suspect that is has had some effect, especially during the time I was applying the concealer every day.

A:

Many young hair loss patients may start taking finasteride or minoxidil when they see the signs of active hair loss in their early 20s.  That is the time most people lose hair at its maximum speed.  Medications such as finasteride or minoxidil are only to prevent hair loss or even in some cases slow down the process.  They are not to bring your hair back to where it was before you started the process of hair loss.

I recommend you visit a hair specialist who can perform microscopic evaluation of your scalp (miniaturization study).  That can give you more information about the type of your hair loss and the treatment methods. Having regular follow up visit with your hair doctor helps you to know whether or not your hair loss medication works.  You may also need a hair transplant when the time come and the time and type of the restoration surgery could be discussed with your hair transplant surgeon.

Minoxidil (Rogaine) is one of the two proven treatments for hair loss along with hair transplant. Although minoxidil mechanism of action for hair growth is not fully understood, there have been several suggested mechanisms such as:

• Nitric oxide chemical agonist effect impactig scalp blood vessels
• Potassium channel opener causing hyperpolarization of follicles cell membrane
• Vasodilation possibly due to its nitric oxide effect

This new study is done in Department of Immunology of Kyungpook National University in Korea. The result of the study was published in The Journal of Dermatological Science shows a new mechanism for minoxidil as activator of β-catenin pathway in human dermal papilla cells, one of the two stem cells involved in development and growth of hair. The investigators announced that this mechanism could be an explanation for anagen prolongation effect of minoxidil.

The length of the actively growing hair in anagen phase (growth phase) is responsible for hair length. The investigators indicated that maintenance of β-catenin activity in the dermal papilla cells (DPCs) enables hair follicles to keep growing actively. Minoxidil or Rogain promotes hair growth in male patterned baldness suggesting that minoxidil can prolong the growth phase in hair life cycle.

The study is done in mouse model with application of 3% minoxidil for ten days. DPCs were transfected with β-catenin responsive TCF reporter plasmid. They showed that extension of anagen phase was significantly promoted after minoxidil application. The researchers concluded that minoxidil extends the anagen phase by activating β-catenin activity in the DPCs and that can be one of the main pathways in its hair growth or hair loss prevention mechanism.

Studies like this increase our understanding of hair loss and hair growth and over time can help hair restoration field to have more options to fight hair loss in a more efficient way.

Q:

Hey Doctor, 

Hope all is well. My name is XXXX. I came in last Saturday for consultation. I forgot to ask you about shampoo use and hair loss. Does the brand of shampoo have an effect? Do you have any recommendations? I use baby johnson, the goldish yellow one. My friend suggested Nioxin, do you know anything about this brand. He gave me one bottle numbered with a 1 for early stages of thinning and the other numbered 2 for noticeably thinning. Should I make use of it? And which bottle would I make use of? Sorry with all the bother and questions.  Thank You so much I really appreciate it. Have a great weekend. 

A:

There are many shampoos currently on the market which have claimed to be useful for hair loss treatment and/or prevention.  Some of them may have active ingredents like minoxidil which is a proven hair loss topical medication.  However,  since shampoos don’t stay on the scalp for an extended amount of time and are rinsed off after only a few minutes, the active ingredients do not have adequate time to be absorbed from the skin level.  Minoxidil is the most effective ingredient of these shampoos.  We do recommend its use as simple topical solution which is to be applied twice a day and left on scalp for its maximum effectiveness.  Most other products and shampoos that contain minerals and vitamins do not help since the active ingredients are not even absorbed from the scalp skin.  You can see more on this in our several posts on hair loss shampoo and the brand shampoos for hair loss that are in the market of different brand.

Q:

Hi Dr.,  I saw your TV show, and would like to ask you if it is ok for me to buy minoxidil and dissolve it in the shampoo?
Also there are products that says gradually will change the color of my hair to natural color, are they safe to use? wouldn’t they interfere with my scalp respiration?

Thanks a lot

A:

Minoxidil mixed with shampoo

Minoxidil is one of the FDA approved medications for balding prevention and hair loss treatment.  The recommended dose and method for its use is applying it topically on balding area twice a day and leaving the product without washing it off.
Although combination of minoxidil with shampoos are available commercially, I don’t believe you can get a complete result by using them because:
1.    Minoxidil would be diluted with shampoo and water and that will reduce its strength.
2.    The active ingredient (minoxidil) would be rinsed and it would not get enough time to have contact with the scalp skin.
3.    It would be less likely that it is used twice a day, which is the recommended method for its maximum result.

Hair product for white hair

To answer your second question, there are many products that are claimed to change the color of white and de-pigmented hair to a normal one.  Most of them are herbal extracts and there is just not enough long term studies that prove their safety that I am aware of.

Q:

I’ve been using 5% topical minoxidil in liquid form for five months and see some positive results (I think) but I have two side effects:

1) itchiness–it’s mild, I can live with it

2) a crust forms that’s dry and I can pick it off, little dry flakes–that is.

Questions are simple:

1) Can/should I still use it?

2) is the foam better to avoid these symptoms?

3) Is there an inexpensive hair conditioner or shampoo I should use? Appreciate your feedback/thoughts…thanks

A:

1) Can/should I still use it?

Minoxidil use is lifetime in most cases. If you stop using it, you may lose the hair which grew from its effect. This is called shock loss and many people experience it when they get tired of minoxidil use and stop it after using it for a few years.

2) Is the foam better to avoid these symptoms?

To avoid the itching, the foam is better based on reports I am gathering from my patients who tried them both.

3) I am not aware of any conditioner and shampoo that can be used to help the growth of hair. There are some shampoos with active ingredients such as minoxidil. However, they efficiency in comparison to minoxidil topical solution is questioned.

Q:

Dear Dr. Mohebi,

Thank you for taking the time to see me on Saturday! Your correspondence providing a summary of our discussion was very comprehensive and is much appreciated!

Since our meeting on Saturday, I have done some research and would like to trouble you with a few more questions:

1) Is Alopecia the correct term to describe my hair loss pattern?

2) Would you consider cortizon shot treatment for me?

3) Would you consider laser therapy?

4) If I were to use monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

I wish to thank you again for all your time and patience!

Best regards,

A:

Hi,

Here are your answers in the order you asked:

1) Is Alopecia the correct term to describe my hair loss pattern?

Alopecia is a general term that means hair loss. We have many different patterns of hair loss or alopecia, like male pattern or female patterned alopecia or alopecia cicatricial. Your pattern is similar to a male pattern because you lost your hair on the frontal area while you kept your hair on the donor area intact, which is why you might be a good candidate for a hair transplant procedure considering that your medical evaluation is negative for any medically treatable cause of hair loss.

2) Would you consider cortizon shot treatment for me?

No, steroid shots are sometimes used for Alopecia Areata (AA), which is an autoimmune disorder. Alopeica Areata is a hair loss condition with patchy hair loss spots. Your condition does not seem to be Alopecia Areata.

3) Would you consider laser therapy?

I do not recommend laser therapy for hair loss in the form of laser comb or laser machines because of the lack of solid medical evidence that support their effectiveness at this time.

4) If I were to use Monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

You can start with 2% and then you need to be re-evaluated in six to 12 months and a treatment plan might need to be adjusted at that time.

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

Any good internist or endocrinologist could follow through with the lab works that you need.  Our letter includes the list of medical conditions that should be considered and lab works to rule out those women like you who have hair loss. You can share my letter with any good internist or endocrinologist and he or she should be able to follow through with your lab result and treat any treatable conditions that could possibly be found.

Have a great day,

Dear Dr. Mohebi,

I was doing a quick research on the hair loss solution, that I came across your weblog. I wanted to ask you regarding my hair loss problem. I am 28, with history of hair loss in male members of my family. My hair loss started more than 10 years ago, and I started using Minoxidil (first 2% and then 5%). At the time, I was told that Minoxidil will just postpone the total hair loss. Well, I never went bald that much. About four years ago, I started taking Finasteride 1mg, and I think it worked out really well. But the concerns regarding the side effects for men made me stop it about a year ago. Now, I am seeing more hair loss. I was just wondering how careful should one be in taking Finasteride, especially when all the researches are doomed to an inherit uncertainty, and that the side effects might prove much more severe only in future.

So, I would appreciate if you please advise me and let me know about the solutions that is out there for my case.

Thanks very much,

Patient’s name

A:

I understand your concern. You have stopped finasteride (Propecia), despite of experiencing good results. Finasteride has been out in the market and widely used for prevention of hair loss in past 10 years. Finasteride has a few side effects that they are all reversible with discontinuation of the drug. The most problematic side effect of finasteride is decreased libido that if occurs should go away in about 3-7 days after stopping the medication. I have seen this side effect mostly in elder patients who recently start taking finasteride. I have never seen any patients who won’t recover from this side effect within a few days. In fact, instead of stopping the medication, I usually change the dose to half or prescribe it in alternate days and that way I have been able to manage the side effects in the most cases.

You are concerned with delayed Propecia adverse effects that may have not been discovered or reported and could potentially be a cause for concern in the future. That could be brought up for almost every medication, but I believe we had better stick to the proven facts. All medications that are used in the United States are regulated by the FDA after thorough evaluation of solid results from extensive clinical research.

There are other medications that are prescribed by some doctors for hair loss treatment. Some are currently being evaluated for hair loss prevention such as Avodart (dutasteride), which works through a mechanism similar to Propecia. Avodart is even more effective for hair loss prevention in comparison with Propecia, but it also causes more side effects and that is why the FDA has not yet approved it for hair loss treatment. I do recommend Propecia to most of my patients with male pattern baldness because even if you want to treat your hair loss with hair transplant, you are still better off doing a lesser number of sessions and preserve your own natural hair as much as possible.

hey doctor!

As I read through forums and articles, people mention that propecia works better in conjunction with something else, such as rogaine for exmaple. At the moment, the vertex area of my scalp seems emptier than than the crown and minoxidil works well with the vertex. Do you recommend me go back on minoxidil for the vertex, or should I just focus on propecia?

Answer:
I generally prescribe finasteride to most of my patients who have significant miniaturization whether they are getting hair transplants or not. There are several studies on using Rogaine (minoxidil) and Propecia (finasteride) as single therapy and in combination with each other or with other medications.

Comparing minoxidil and finasteride for treatment of male pattern baldness clearly shows that treatment with only finasteride is more effective than treatment with only minoxidil. Combination of finasteride with minoxidil and with some other medications shows improved outcome, but the rate of improvement is not significant enough that I can convince myself to prescribe combination therapy to all my patients for the rest of their lives, considering difficulty of using topical minoxidil (topical spreading of medication twice a day on the balding area of scalp).

If you want to do everything possible to prevent or slow down further hair loss and maybe grow some, you can consider combination therapy, but remember when you start minoxidil you are committed to continue it for the rest of your life or until there are better alternatives.