Hi…Thanks a lot for this perfect blog that answered many questions that concerns hair loss and balding. I had a HairDX test for Finasteride response and my score of CAG was 24. The dermatologist who did the test told me that I have a negative result regarding finasteride response.

1- What do you think of Hairdx test regarding F.R.?
2- Do you think I should take finasteride though I got CAG of 24 ?

Thanks

I do think the HairDX for Finasteride Response test is a good idea, but it can open people up to the idea of taking medication when it is not necessary. Just because the test tells you that your response to finasteride would be good, it doesn’t mean you should automatically get on the drug if you’re not experiencing hair loss. In your case, I don’t even know if you have any degree of balding. Do you have a full head of hair and afraid of going bald or are you already seeing hair loss? If you are bald or have definite signs of balding, then what do you have to lose by taking finasteride regardless of the CAG score? Were you prepared to not take finasteride (Propecia) if the test was negative?

In any case, it is something that needs to be discussed with your doctor who knows you better than I do, as our communication has been limited to an email. If your dermatologist told you the result was negative, perhaps he/she meant you aren’t likely to have great success from the medication. It is worth noting though that you may still see some beneficial response from finasteride with a CAG score of 24. According to HairDX, “Scientists discovered that among men that had the best response to Finasteride approximately 70% had a CAG score below 22 while among men that had a subtle response to Finasteride approximately 70% had a CAG score above 22.”

Dr R

Do you have any opinion on Azelaic acid as a dht inhibitor when used topically by itself or in minoxidil tandem?

Thanks

I do not think there is real evidence that azelaic acid inhibits DHT or works for genetic balding. I am aware that there was a study which was published in 1988 (22 years ago) titled, “Inhibition of 5α-reductase activity in human skin by zinc and azelaic acid“. The testing was not carried out in humans, but in a test tube, and the information is floating around on the Internet (our everyday source of good solid medical information *note sarcasm*).

Aside from this study, I do not know of any other information with regards to azelaic acid and its “theoretical” treatment for balding, yet the legend of one decades-old study will propagate down the immortal path of the internet. For further reading and other physician opinions on this, take a look at this post from a few years back.

my situation is - I’m a 28 year old male. I’ve been balding since i was about 21. i’ve been using rogain with pretty good success but in the last year it seems like it just stopped working and i’m developing a pretty noticable bald spot about 3″ in diameter. I’m going to try out propecia and see how that goes. that said if it doesn’t regain enough hair i would really like to get a transplant to sturdy things up in the back. my problem is the cost. i just graduated college and really don’t have much money, but my degree was in motion graphics and i was wondering how receptive transplant doctors would be to do trade for service, doing instructional videos, info graphics or graphic design…is it worth asking?

A trade, in these recessionary times, is difficult. The recession has impacted all forms of cosmetic surgery and hair transplantation is no different. I suppose it is worth a shot if you want to try contacting various clinics, but I wouldn’t expect trading design services for cosmetic surgery to be a tantalizing offer amongst surgeons. It wouldn’t hurt to ask, though.

Give the Propecia a try (or to save money, ask your doctor for a prescription for the generic 5mg finasteride and cut the pills into 4 pieces).

I am a 33 year old woman with a diagnosis of AGA. I have found out that skin atrophy is a very rare side effect of oral spironolactone, one which I am experiencing on my facial skin. This is frustrating as spiro is definately working for me. Do you think topical spiro would have the same effect? Also, it seems Cyproterone Acetate can have the same effect so that isn’t an option for me. What do you think of trying Bicalutamide, as it is a non-steroidal antiandrogen? Many thanks.

I wish I could offer some real help, but I don’t know much about the side effect risks of spironolactone beyond what I have read, as I do not prescribe it (or the other medications you mentioned). Spironolactone is a prescription medication, and as such if you’re seeing skin irritation you should immediately notify your prescribing doctor about this.

Cyproterone acetate lists hair loss as a rare side effect (as possible with many medications), but bicalutamide has hair loss listed as a common side effect, so I don’t know why you’d take that as a hair loss treatment.

Dear Dr Rassman,
In your last post you wrote the following in regards propecia.. “It does not work for frontal hair loss in most instances other than possibly slowing the process down, but is it the only real medication to address what you are going through”. However in December 2005 you wrote that “Propecia slows or stops hair loss throughout the head”.

I was just wondering if in the intervening years you have become more pessimistic about the effectiveness of Propecia on frontal hair loss?

Regards

I’ve not become pessimistic about Propecia. I have seen a few cases where the drug has reversed frontal hair loss to some degree (regrew hair), but it is not common. What is common is that this drug can slow or stop frontal hair loss, and stabilization of hair loss is a real benefit for those who are actively losing hair.

Dr. Rassman,

I have several questions about hairloss. I´m 22 and have receding hairline and thining hair, less than NW2. Please tell me about preparations containing minoxidil with liposomes and topical finasteride.

1. What are exactly liposomes? How do they work?
2. Topical finasteride, effectiveness? Would be effective a home made lotion mixing crushed up proscar pills (i read about how to make it in a blog)and “shake” the bottle? I think that´s a
   waste of money. But adding liposomes in the same or a similar lotion could make the finasteride worked topically. I´m right?
3. I´m currently applying minoxidil 5% twice a day and 15-20 minutes after night application y apply retin-a cream (0.05%) only at temples and hairline. I agree with you that tretinoin burns
   the scalp so I prefer apply it separately from minox and only on temples at night. Do u think it´s a safe way to use tretinoin?
4. And finally, is nizoral 2% the best way to keep you scalp free of sebum? Does minoxidil penetrate better on this way?

I ask your advice also after being on propecia for 1 month I quit the medication because typical side effects, but fortunately they disappeared and i´m going to go back on 0.5 mg propecia EOD (every other day) within a pair of month. What do u think about this issue? Thanks Dr. Rassman, I hope your answer and it helps to other people.

If your hair loss is less than a Norwood 2, are you sure what you’re seeing is actually hair loss and not just a mature hairline?

1. According to Wikipedia, “A liposome is a tiny bubble (vesicle), made out of the same material as a cell membrane. Liposomes can be filled with drugs, and used to deliver drugs for cancer and other diseases.”
2. Some have marketed topical finasteride, but I have yet to see a good study that indicates if it even works. It is a good way to sell a product to those who do not want to (or are too scared to) take it orally. Don’t let liposomes fool you, but in my opinion it is a brilliant marketing idea.
3. I do not think tretinoin (Retin-A) helps with any hair loss treatment. Some use it with minoxidil apparently for better absorption, but I don’t know if that is truth or wishful thinking. I do not recommend doing this.
4. Nizoral is a shampoo. They did a great marketing campaign to promote it to people with hair loss. There are various shampoos that work for removing the oily sebum from the scalp, but I can’t say which one is better than the other. I haven’t seen a study that shows minoxidil works better after a shampoo.

I am sorry to hear you had side effects while taking Propecia, but I am glad your side effects are gone. As you said, you can try 1/2 dose or take it every other day and see if it helps. You might also wish to try 1/4 of a pill each day instead of 1/2 a pill every other day, as the half life of the drug is about 4-5 hours.

Dear Dr. Rassman, My question is about dilantin. I know that it is often cited as a possible cause of hair loss in women. Can it cause hair loss in men and if it does does it manifest itself as slow diffuse thinning all over.

thanks for your time.

If the hair loss is from a medication (rare), it can happen in both men and women. In rare cases, Dilantin (phenytoin) is even known to cause body hair growth.

Slow diffuse thinning all over does not sound like male pattern baldness, but slow diffuse thinning can be from many other causes as well (and not only from medication). What I am saying is, you need a good medical diagnosis. At this point, it seems you are trying to establish a cause and effect relationship that may or may not be related. For those patients on Dilantin, it may be impossible to stop or switch the medication, but this is a decision for the patient and his/her prescribing doctor.

Hello Doctor,

I want to thank you for a great blog that I visit nearly daily. I visited your offices around 5 months ago and had a consultation with Dr. Pak, who was very informative and understanding. Since then, I’ve been on a daily regimen of Finasteride 1.25 mg/day but am going to wait until the follow up appointment before I make any judgments (superstition does that to you).

I have two questions. I already know that Finasteride does not completely stop hair loss. It just provides its patients an outlet for growing old gracefully (under my impression). Have you seen or heard of any patients who took Finasteride while also including Minoxidil in their regimen to maintain for longer than 10 years with good results?

My second question is how big a part does diet factor into the MPB process? I’m already exercising 6 days out of the week even before MPB hit me but diet (what kind of foods to eat) has always escaped me. I would like to know if there is any information a professional such as yourself can provide pertaining to what kind of diets would promote hair growth and what kind of diets work best in conjunction with Finasteride and Minoxidil to maintain hair.

I apologize for the long message and sincerely appreciate all the help you have given.

Best regards!

I believe that for some people, the use of both Propecia and minoxidil has value when used in combination, but that may depend upon a variety of factors including age, appropriate use of the medication, where the minoxidil is applied, and where on the head the balding is that you are treating. The crown generally does better with combined treatment compared to the frontal hairline. I have seen patients using both medications with good results after a decade of use.

I do not believe that any particular diet works better than another, provided that the diet is well balanced.

Hi,
I’ve recently had a blood test by my dermatologist which indicated a high level of DHEA (about 1343 ng/dL) Can this be the cause of my hair loss for the past 3 years? I have always had thick, thick hair that was very strong up until a few years ago. Now I have a patch of hair near the left center of my crown that refuses to grow back (There is no scarring) The dermatologist thinks he has found the cause but I’m not so sure. He prescribed Spironolactone (100mg) and Rogaine 5% (for men) How can I be sure it’s DHEA? Should I have further testing? I’ve just set an appointment with an Endocrinologist. The hair on my head is thick except the one section and I see some “female pattern baldness” as well near the top part of the crown (hair is very thin) Any suggestions? Other than the high levels of DHEA my blood screening was normal.

P.S. - I am about 90 pounds overweight. Can you help me?

Without seeing you it is almost impossible for me to determine the diagnosis. You report a limited bald area which should not be the case with a hormone problem, as this often produces a more generalized hair loss process. DHEA (an androgen like testosterone) can bring on balding in those individuals genetically prone to losing hair, so the use of spironolactone can reduce the impact of such an androgen if this is a cause of the hair loss.

I would want to know what is going on elsewhere on your scalp (perform mapping of the scalp for miniaturization to show the genetic signs I would expect to find) before I jump in to validate your working diagnosis. Internet opinions without a direct examination for someone like you has marginal value.

I been taking Propecia for frontal hair loss for almost 2 years & it stopped it completely from receding. I did catch it early so everything is there except some mild thinning on the corners and in the middle too bad that didn’t thicken up as I hoped. DHT causes MPB so Propecia can stop and thicken hair loss anywhere on the scalp not just the crown.

Thanks for the comment. Not many people write to report about good results to us (as I’ve said before, those with complaints are often the loudest). Propecia is generally used for thinning in the top/crown area, but rarely it does seem to work for the front as well.