Hair Restoration Blog

Q:

What do you think about starting Minoxidil if you want to help speed up hair growth?

A:

There is no evidence that minoxidil (Rogaine) can improve the growth of transplanted hair after a hair restoration surgery.  However it could minimize the risk of shock loss which is losing hair when you are transplanting close to the areas that you are supposed to lose more hair in the future. Minoxidil should be started at day four after hair transplant surgery.  We most often prescribe finasteride for our patients to prevent shock loss;  adding minoxidil to finasteride may slightly add to the positive effect of finasteride.

Q:

Dr. Mohebi,

I was trying to buy minoxidil 5% from a pharmacy but the pharmacist told me that 5% minoxidil foam is only for men.  He told me that I should use 2% solutions instead.

I am pretty sure you recommended 5% for me, is that correct?

A:

Minoxidil or Rogaine is one of the FDA approved medications that is used for treatment of many hair loss conditions in men and women. It has been available to the hair loss patient over the counter for many years now.  It is available in 2% and 5% as over the counter solutions or foams, but higher doses should be prescribed by hair specialists.

A study that was published in the Journal of the American Academy of Dermatology in April of 2004 compared the result of hair loss treatment with 2% vs. 5% minoxidil in women with female pattern hair loss after 48 weeks of treatment. The result showed that 5% minoxidil was more effective in regards to increased hair number and patient and overall hair growth.

As you mentioned it is written on the boxes of 5% version that is it for men only. The reason for that is the 2% concentration is the licensed for women initially. It is not that women cannot use minoxidil 5%, but it means higher than 2% concentrations require a physician prescription.  This is mostly a safety measure for manufacturers since the medication is sold over the counter. The over-the-counter manufacture labeling instruction is superseded by your attending physician’s prescription and monitoring of your treatment. It is important to reiterate my point here; minoxidil should be always started after you are examined by a hair specialist.  As medical doctors we monitor the patient’s response to the treatment through follow up evaluations and comparison of miniaturization numbers and pictures.

Medical hair restoration: Hair transplants are the most successful form of hair restoration.

The advanced modern techniques used today in hair transplant surgery are a proven, natural  and preventative method to slow down and/or stop further hair loss. It could be used with or without hair transplant surgery. When you talk to friends and family about hair loss treatments, you will find a lot of do-it-yourself hair loss methods or products such as creams, ointments, lotions, nutrition supplements, scalp products and other herbal, all promising to stop hair loss and re-grow hair.

Among all the many so called remedies for hair loss  for nonsurgical treatment of hair loss for men and women (pattern baldness), you will find that only two that have been approved by the U.S. Food and Drug Administration, and are recommended by physician hair restoration specialists. Hair loss products not approved by the FDA are often enriching the manufacturer but too little to help the man or woman suffering with hair loss. Some actually even harm the individuals who experiment with these unproven methods.

The FDA approved finasteride (Propecia) and minoxidil (Rogaine) are the only two medications presently that directly address hair loss. The other products that are considered effective as hair loss treatment usually contain either of these medications or similar chemicals as ingredients.

There are many other options that are touted out in the marketplace. These products do not have enough evidence based information.  It is best to consult with your doctor about all options before committing to any of these types of treatments.

US Hair restoration combines medical treatment of hair loss with surgical options or hair transplant to create a master plan for obtaining the best final results.

Q:

I am to have a hair transplant surgery with you this early July. I’ve noticed increased shedding lately and thus have been researching additional pharmacological adjuncts to add to my daily regimen. I am currently taking 1.25 mg Finasteride and shampooing with Nizoral 2% a few times a week. I’ve read online that topical Spironolactone has been used by some with some results, and wanted to know your thoughts. I’ve also found other topical medications ( especially Monoxidil) that I cannot use due to my daily use of concealer. Are there any other medications, topical, shampoos etc. that you can recommend?

Thanks ,

A:

Minoxidil and finasteride are the only two FDA approved medications for hair loss treatment.  Nizoral (ketoconazole 5%) is an antifungal and anti dandruff medication that can also affect hair loss in male patterned baldness.  Nizoral is not one of the FDA approved medications for hair loss treatment.  Spironolactone or Aldactone is primarily a medication for treatment of hypertension, but it has some anti-androgenic effects.  Systemic administration of spironolactone has been shown effective in some forms of female hair loss. Spironolactone in its systemic form is not recommended in men due to its side effects such as sexual dysfunction.  There have been limited studies on the topical spironolactone for treatment of acne and hair loss so we don’t recommend topical spironolactone for treatment of hair loss for androgenetic alopecia in men.

If you want to do everything possible to minimize the hair loss, you can add minoxidil to your daily regimen of finasteride.  Minoxidil is recommended to be used twice a day, but once a day could be used as well.  You can use it in the morning before you put on the concealer or at night after you wash them off.  Minoxidil does not double up the effect of finasteride but can add to it as an adjunct treatment.

 Also See:

Finansteride, Minoxidil Or Both and  Ketoconazole for Male Patterned Hair Loss

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,