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Thanks a lot Dr. for this helpful blog site that keep us well informed about baldness. Two weeks ago, I did a HairDx test (rxr) for finasteride response. Do you think such test is accurate enough to build upon? How much it’s acurate per cent?

There are two HairDX tests — one which shows if you carry the genes for balding, and one which suggests how sensitive you are to finasteride. The statistics on both of these are not 100%, but HairDX doesn’t provide an actual accuracy percentage that I could find. I don’t have enough experience with HairDX to know how accurate they are first hand, but I would expect they’d be as accurate as possible. There are multiple reasons why accuracy could be skewed, including data collection errors, software errors, and disease.

It’s also worth noting that their Service Agreement page does say, “HairDX is providing no guarantee that the Service measurements will be successful or provide accurate results.”

Hi Dr.,

You’ve mentioned in previous posts that you don’t know of any new hair loss treatment drugs coming out in the next few years. How far in advance did you know about Propecia coming to market before it was available to the public?

Thank you

I assumed Propecia would be coming to market after it was approved by the US FDA for clinical use in December, 1997. It made it to pharmacy shelves the following month. There had been rumblings of finasteride being a hair loss treatment for many years before this (it was FDA approved as a prostate medication in June, 1992), but I had no way of knowing its approval status as a hair loss treatment until the rest of the world did after the announcement was made. There are drugs with hair growth as side effects that aren’t marketed as such, but I don’t know which of those will end up approved to treat hair loss, if any.

You’ve stated on your website that minoxidil doesn’t block DHT. How do you know this? Perhaps this is the mechanism by which it regrows hair. I’ve tried finasteride and dutasteride with virtually no results. While my result with minoxidil hasn’t been spectacular, it has definitely been superior to the other two drugs.

Minoxidil has a known side effect, in that it will grow hair when it is taken orally or applied to the skin. Women complained of the appearance of facial and chest hair when this drug was used as an antihypertensive drug. I can’t state with 100% certainty that it doesn’t block DHT, but that is not what is reported. What has been reported is that minoxidil is a vasodilator, not a DHT inhibitor.

Hi,
I have seen your website and I have a question to ask. I just want someone’s opinion on some thing. I’m 26 years old (female) and I have hair fall and I have been to few doctors and I have blood test done for so many reasons and they all show normal. I still experience hair fall and I’m still trying to figure out what to do. I was told that my hormones are very high I want to know is it anything related in having high metabolism? Is their any way to be tested or checked for high metabolism? Please let me know about this soon.

Thank You

A high metabolism should not cause hair loss.

You are stabbing in the dark to find answers, and unfortunately I won’t be able to help here either. I don’t know what tests you had done, their results, family history, etc. Go back to the doctors you consulted with and get answers from them.

This patient is in his mid 20s and showed a Norwood class 3 pattern with additional recession in the temple area. The results posted below are after one procedure of 1733 grafts, with the photos taken only 8 months after surgery. I fully expect additional growth in the transplanted area with more time, but the patient is very excited with the way things have turned out so far. I hope to have updated photos to post in a few months when we get to the 1 year mark.

It’s worth noting that the patient styled his hair forward in the corners of the hairline, and the “after” photo is not a straight line as it may appear to some. Click the photos to enlarge:

After (1733 grafts):

Before:

When attempting to find a good HT Doctor, should one that doesn’t do a Miniaturization test be a strong factor in determining whether to use them?

There are many doctors that do not map the scalp for miniaturization. It is a relatively easy procedure, and in my hands it is basic to using medications like Propecia, in determining the health of the donor area, and in developing a long term Master Plan for the patient. If they do not use a high-powered video device to examine the hair, they will miss things like diffuse unpatterned alopecia (DUPA) on many patients who have it. And to continue that example, I am sure that if they end up performing surgery on a person with DUPA, they will absolutely harm them.

I am not a fan of doctors that do not do a complete examination of the scalp before they go forward with hair transplantation surgery. Of course, you should make your own determination of that issue.

If I get a hair transplant but develop senile alopecia many decades from now, when I’m in my 70s or so, will it be a problem?

If you develop senile alopecia when you are much older, if your doctor produced a Master Plan for you, this should not be a problem. The doctor would have accounted for such a process in the plan, provided that he performed follicular unit transplants in a pattern that would give consideration to such a change.

Transplanted grafts will mimic the changes in the donor area, so if the donor area lost 30% of the hair, then the hair transplants will lose 30% of the hair in the grafts. Unfortunately, there are not statistics on this available, but this conclusion is based upon years of observations that I have made.

I purchased rogaine for women to begin the regimen but misplaced the pamphlet which provides detailed instruction for usage, especially as it relates to chemically treated hair. Can I obtain this detailed information online and if so, where? Thanks

This should be the same information that is included with the Rogaine (liquid and foam) packaging –

• For men: How to apply and Important drug facts
• For women: How to apply and Important drug facts

Here’s what it specifically says about using Rogaine on chemically treated hair: “Rogaine can be used on color-treated hair. You may blow-dry your hair, but it’s best to use medium heat or lower. On the same day that your hair is colored or treated with chemicals, don’t use Rogaine if you’re concerned about scalp irritation.”

I am having trouble finding a doctor who will prescribe Proscar to treat my MBP. Every office I call turns me down based on “liability” issues (Including my Primary Care and other Dermatologists).

I have been taking Propecia for over a year with great results (without any side effects). Thus, it seems like I would be a good candidate for Proscar. I just can’t find anyone in my town to prescribe the medication…

Any suggestions?

Keep looking! I routinely prescribe Proscar under the instructions to cut the pill into quarters and take only 1/4 pill per day. Are you explaining to these doctors that you understand to cut the pill and that it is the same medication as Propecia?

Hello,
I am turning 40 and have been on propecia for over 14 years. In the last year I have really noticed a decline in its effectiveness, and I uped the dose with no real results. I am seriously looking at switching to dustasteride and was wondering why there are a lot of safety concerns about the drug. It is prescribed for prostate patients with no real problems. At my age, would it really be a problem switching over to it? Do you think we will ever see it as a prescribed treatment for mpb?

Doctors, when prescribing medications, stay with medications that are FDA approved for the particular condition they are treating. That is because the FDA gives its stamp of approval that the drug is safe and effective for the condition that it is being prescribed for. The doctors have some restrictions in the way they use their medical license when prescribing drugs and their insurance carriers will not cover them for drug use outside the FDA approved drugs, so if something went wrong, they are bare for insurance coverage.

Let’s say that you are 21 years old, are prescribed Avodart (dutasteride) to treat your hair loss, and after 10 years of taking it you become sterile. That would not be good for you and you could take legal action against the doctor who prescribed it, which would not be covered under his malpractice insurance policy. For Avodart, there is no evidence that long term use is safe for young men and as such, it is not presently FDA approved for the treatment of hair loss. For the prostate, on the other hand, this drug is used in men usually over 60 years old who are statistically unlikely to be having children, so Avodart is approved for men with prostate problems.

As I mentioned in yesterday’s post about dutasteride, if you already had children / had no desire for children and had a vasectomy, and you’d already tried Propecia for a year or so and it was not working well, I would consider prescribing Avodart for you for off-label use. Other doctors might be more willing without qualms about it, but that is on them. There would be qualifiers that it has not been proven safe for a 40 year old man and it is not FDA approved for treating hair loss, so I would be at risk. You could also be at risk if you end up taking it for 20+ years. Usually, 60+ year old men who start Avodart to treat their prostate issues have a life expectancy of less than 20 years, so they may not even live long enough to develop problems that may not have been defined as of yet.