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Hi Doc,

I’ve been using Minoxidil 5% for around 18 months and although results are evident they aren’t miraculous…as to be expected. My question to to you is, I’ve bought some Follicare supplement to assist with my progress. DO you know if this contains any harmful chemicals or will it cause a reaction with the minoxidil? I;ve read the chemicals are natural but to what extent? I know that follicare sells a package containing minoxidil but I wonder if it is any different to Kirkland minoxidil.

Anyway thanks for your time

I do not believe there is anything harmful in a supplement, aside from the harm it does to your wallet. If the product contains minoxidil, that’s going to be the ingredient that regrows your hair — so I’d stick to the generic minoxidil. I would not double up on the minoxidil, using the generic and the Follicare at the same time. Follicare’s various sprays and lotions also contains botanical extracts, saw palmetto, vitamins, oils, and lots of other stuff. It might make your hair shiny, but I don’t see where the treatment for hair loss is in there.

I’m looking at the Follicare website now, and I am not impressed by the tiny and blurry before/after photos. Ever notice how so many of these various hair loss products for sale are often accompanied by lots of hype, little proof, and even smaller photographs?

Hello Doctor,

For the past year I have noticed more hairs in the shower and also when I comb my hair. I am 22 and my hair loss does not seem to stop or slow down. I have noticed over the past year that my hairline has receded in the temple area. Also, the sides seem to be thinning and receding. I went to my doctor and told me the hair loss may be due to stress since he found no pathology from my blood test and he said I may use Rogaine. I have not used Rogaine. Based on my observation I am at Norwood Class II. I am worried my hair problem will get worse but not sure if I should start medication. Are these symptoms of MPB? Propecia workes best at the vertex yet I do not have much thinning or hair loss in that area. What would you recommend I do? I know that the earlier I deal with hair loss the better, but if I start early will Propecia still have its effects 10 years or more from now? Also, I do not have much money so would you recommend I take a generic of Proscar?

Thanks

You’re in LA, I’m in LA. You can come in for a free consultation and find out about your hair loss for sure. I can test your hair for miniaturization and we will be more certain if you are really balding and where you might go with it.

I can’t make drug recommendations without seeing you, but I can provide general info. Propecia does work best at the vertex, but it will halt or slow the hair loss all over the scalp. Rogaine also works best in the vertex. Propecia will still have effects for as long as you take the medication, but as hair loss is progressively a game of tug-of-war, the Propecia will possibly not be able to hold on to as much hair as time goes on. I’ve had patients that have been taking it for a decade without problems, and then there’s some that I’ve increased the dosage for due to lackluster visual benefits after 5+ years. Everyone is different. Generic finasteride 5mg (Proscar) is a lot cheaper than Propecia and is the same medication.

Dear Doctor,

You routinely advise people to stay clear of Scalp Med, Follicare, Spectral DNC and other similar products. Your reason is that all of the aforementioned products contain minoxidil and if they work, at all, it is simply due to the minoxidil contained in them. Your conclusion: Just buy plain minoxidil!

Well, I would agree that many products have probably a zero chance of working. Fabao, for example, contains nothing more that Chinese herbs and is formulated based on folklore and an ancient meta-physical concept of disease. I seriously doubt it does anything. On the other hand, products like Follicare and Spectral DNC take a known active ingredient (minoxidil) and try to improve on it. These products take many promising ingredients that have been shown to grown hair, to some degree, in certain studies, like Adenosine, Amenexil, free-form fatty acids, caffeine, etc. They also add other things like either DMSO (in Follicare) or nanosomes (in Spectral DNC) to increase absorption. Clearly, the makers are going all out to “turbo charge” ordinary minoxidil.

Although none of these ingredients are effective enough to be used as a stand-alone treatment, nor are any of them proven, they all, at some point, showed some degree of promise or effect. Dr. Peter Proctor, in a Q & A session on one of the forums, said that “any ingredient that has ever been claimed to grow hair, probably does to some degree — in some people.” With logic like that, these companies take the “best of the best” of the unprovens and add them to a proven ingredient (minoxidil.) With few exceptions, I think most of these companies have good intentions to make the most effective product they can with what is currently available to them. I think very few are outright, deliberate scams.

It seems clear and logical to me that when these extra ingredients are added to a proven minoxidil base, there is bound to be some beneficial, synergistic effect.

The Million Dollar Question: Putting aside cost and value, which I don’t think should be a factor in choosing treatment, do you really believe that one of these products is not likely to be more effective than plain minoxidil?

Could the opposite be true — manipulating the basic minoxidil may make it less effective? Where is the science here? I don’t believe everything I read and when someone or some company is self-promoting the product or process and then makes claims of benefits, what proof is there really? I need to see actual proof before I can even remotely consider giving something a thumbs up. And as you suggested, most of these products seem like they’re just combinations of every herbal that is rumored to have hair benefits, along with a proven treatment like minoxidil. So then when the minoxidil ultimately helps, they can say “See, our product works!” — but in reality, it’s just a more expensive version of generic minoxidil with added vitamins that may or may not be of any use to the hair growth process.

Good intentions or not, it is a buyer beware process and these companies are ultimately just out for your money (makes sense being a business). Cost might not be a factor for you, but I don’t think many people would agree with that notion, especially in this poor economy.

Dear Dr Rassman,
According a study done on behalf of Merck, patients treated with 0.2 mg finasteride showed approximately an increase of 61 hairs versus an increase of 77 hairs in 1 inch square treated with 1 mg of finasteride over the 6 month period. So can we say that taking 0.5 mg of finasteride may yield nearly the same results with 1 mg treatment

You are correct. We have known about this for many years (and have reported it here), though the standard dose is 1mg. For those who have unwanted side effects, taking 1/2 of the standard dose of Propecia should be considered, which we have been advising for many years.* Some of the original studies suggest that 1/2 the dose can be 80% as effective as the full dose and 1/4 of the dose could be half as effective as the full dose.

The original Merck study wanted to know the best and most effective dose, and the statistical data suggested 1mg. This was across a large population and if you assume that there is a bell curve, there is a wide range of responses. That also may mean that as many people as impacted by 1/2 the dose with 80% effectiveness, one might see that a sizable proportion of the population may require a higher dose than 1mg. When we see the response fall off, or a poor response, we are now recommending doubling the dose provided that the side effects do not appear.

*As always, discuss any changes to your prescription medication dosing with your prescribing doctor.

I started thinning in one temple at 18 and was prescribed rogaine and biotin supplements. At 20 the entire top started thinning (especially in the frontal hairline area) and I am now nearing 21 and considering propecia, however, I am hesitant to start at such a young age for a couple reasons. I am a late bloomer with no facial hair and am constantly told that I look much younger than I am. I have two questions: 1) Will propecia effect my body’s development including facial hair? and 2) Is it more likely that something other than MPB could be affecting my hair because my body is so early in its development? I enjoy your blog and would appreciate any help you can give me. Thank you

It is possible (but not probable) that Propecia will slow down body hair growth. That has not been my experience. I really don’t know the answer to your perceptions of being a “late bloomer”. Some men don’t grow facial hair well at all, but at 20 years old your body is not early in development. I can’t say for sure what you’re experiencing without an exam, but from your brief one-line description, it sounds like MPB (frontal hair loss, top thinning). Propecia is a prescription drug, so discuss your concerns with your doctor.

Dr. Rassman,

Good info is provided in this blog, I want to ask you a question regarding a previous posters comment on Generic Finasteride. Your response to the blogger was to purchase Generic Finasteride at Cosco or Wallgreens instead of ordering generic Finasteride online. How is this possible when Merck was granted an extended patent until 2013 (See Wikipedia on Finasteride)?

Also do you think its safe cutting the 5mg into 4ths which will be 1.25mg approx? Thanks!

Generic Propecia (1mg finasteride) isn’t legally available in the US due to the U.S. and International patents held by Merck, but generic Proscar (5mg finasteride) is available in the US and that’s what I was referring to. When cutting the 5mg pill, you’ll likely have some crumbs, so it might be a little less than 1.25mg. Regardless, I don’t think it’ll be a problem. If you can cut it into 5 equal pieces, that would be ideal… but not practical and the dose clearly does not have to be exact (as discussed elsewhere on today’s posts).

hello doctor,

My question is ive been doing both rogaine and propecia for almost ten years. All of a sudden a couple months ago i started to get some dandruff (mild case). i am now using dhs zinc shampoo. the dandruff is still there but im controlling it and its not too bad. should i stop using the rogaine as it may be causing the dandruff? and if i use rogaine having some dandruff will that cause hair loss? (i did see my dermatologist and he didnt seem to concerned about me having the dandruff plus using the rogaine)

Thank you for your time

Rogaine (minoxidil) can cause scalp irritation and give you flaking. The use of zinc shampoos like Head and Shoulders works to control dandruff, so you’re on the right path. You will not develop hair loss from the dandruff.

Dear Dr. Rassman,

If you watch the attached videos of Eric Lindros (former professional hockey player), would you assume that he has had a hair transplant or is that a hair piece? I would estimate that the videos are 5-8 years apart. If it is a transplant, the results are exceptional. In the first video, he clearly has signs of a receeding/thinning hairline. Conversely, in the second video (interview after his retirement) he has a full head of hair. What are your thoughts?

- Youtube - Eric Lindros in 1997
- Youtube - Eric Lindros in 2007

Thank you in advance for your time. Best Regards.

Here are side by side still shots from the videos you linked to:

The comparison with the 1997 pictures show Eric Lindros is a Class 3 Vertex balding pattern (front and crown). From the pictures, I can not tell if it is a hair piece or a hair transplant, but he is doing something to give himself hair. When the hair is combed forward, a lot can be hidden. Perhaps he started on medication like Propecia or Rogaine. Propecia was FDA approved in late 1997, so he could’ve started it soon after. I really am just speculating, of course. For all I know, it could’ve been witchcraft (though I’m 99% convinced it wasn’t).

Have you ever seen anybody end up going completely bald while on Propecia?

Interesting question. Some men start Propecia when they have advanced balding patterns and few start when they have a full head of hair with early miniaturization. Those that started Propecia with a full head of hair (with some miniaturization) are slowing losing hair to some degree, but I do not recall anyone that became completely bald. I suspect that there are patients who will develop a Norwood Class 7 pattern of balding even on the drug, but these are few and far between. This does not mean you are guaranteed to not go bald on Propecia. I suspect I have not followed someone long enough in the last 10+ years to have seen it (or if they became bald, they never followed up with me).

Dr Rassman,

I’m in my mid-30s and have been experiencing hair loss for the past 5 years. I feel like I’m at the stage where I need to decide if I want to take finasteride or not. My biggest concern is the side effects.

It seems that more and more I hear (both on the news and from friends who are doctors) how doctors are seeing a greater prevalence of male gynecomastia. The often sited reason for this is due to the increased use of finasteride (both for prostate treatment and hair loss treatment). Of course, it could just be that gynecomastia in men makes for an interesting story on a slow news day…

My question is, do the number and types of side-effects experienced by your patients on finasteride agree with published studies?

In reading this blog you do make mention of how some of your patients experience side effects, but you’ve never made mention if the number of side effects you’ve seen clinically are more, less, or the same compared to the numbers posted by Merck.

I’ve had 2 patients in the past 2 years that had gynecomastia. Both stopped finasteride and it went away. Most of my patients are on Propecia/finasteride. I would tend to agree with the statistics published by Merck.