Hair Loss Remedy FAQ - Does Rogaine work in the frontal area or is it only effective on the crown?

Hair Loss Remedy FAQ

Does Rogaine work in the frontal area or is it only effective on the crown?

All treatments that work on the crown also work to some degree in the front--just not as well. Treatments are generally more effective the further back you go. Confusion arises because of the way some studies were conducted. With Rogaine (minoxidil), for instance, studies only measured vertex balding; i.e., the traditional bald spot. Accordingly, the only hair growth results that the manufacturer is allowed to claim by the FDA is to say it will grow hair in the crown. However this does not mean that you should not use it on all areas of your hair loss as it most likely will have a positive result regardless of where its applied.

Hair Loss Remedy FAQ - Can shampoo make a difference in treating hair loss?

Hair Loss Remedy FAQ

Can shampoo make a difference in treating hair loss?

Sometimes, as a percentage of the active ingredients gets absorbed into the scalp and left behind after rinsing. For instance, seborrheic dermatitis ("seb derm," a bad case of dandruff) is now thought to play a minor role in pattern loss. In the Propecia trials, researchers had test subjects use T/Gel shampoo (one of the many treatments for seb derm) as a means of leveling the field and cutting out this factor as a variable in determining results. Also, 2% prescription strength Nizoral shampoo used 2 - 4 times weekly was shown in one study to produce hair growth results comparable to 2% minoxidil used once daily in a small group of group of test subjects. It was also shown in a larger group to increase the number of hairs in the anagen (growth) phase and to increase average hair shaft diameter.

There are almost certainly other shampoos that can positively influence hair growth, as medication can reach the hair follicle fairly easily when the scalp is in a well-hydrated state. Water is a superb penetration enhancer that is, in fact, added liberally to many medicated penetrating creams.

Hair Loss Remedy FAQ - What is a SOD?

Hair Loss Remedy FAQ

What is a SOD?

Superoxide dismutase. This is an enzyme produced by the body to neutralize the superoxide radical. Superoxide is a messenger of inflammation and is involved in the body's autoimmune response. It exists in a yin-yang relationship with nitric oxide. Nitric oxide is a vasodilator that appears to be important for hair growth, while superoxide is a vasoconstrictor that may be part of the signaling mechanism that tells hair to stop growing.

Superoxide can also interact with nitric oxide to form a highly destructive free radical called peroxynitrite, which causes protein and lipid oxidation. A few hair loss products contain copper peptides, which are SOD mimetics; i.e., mimic the effects of the body's SOD enzyme. SOD-containing products have been noted a number of times by researchers to stimulate hair growth and block hair loss in mice. Recent study data on Tricomin, a copper peptide SOD, indicates increased hair growth in MPB.

Among other beneficial things, SODs appear to help spare growth-stimulating nitric oxide, reduce damaging inflammation, and help reverse fibrosis (follicular scarring). There are a few patents for SODs as hair growth stimulators and even one for an SOD inhibitor that blocks hair growth by increasing superoxide.

Hair Loss Remedy FAQ - What can I do about the itching and flaking I've noticed since I started using minoxidil?

Hair Loss Remedy FAQ

What can I do about the itching and flaking I've noticed since I started using minoxidil?

Occasionally people will notice flaking with Rogaine (minoxidil). This can be due to the minoxidil itself flaking off, or it can be contact dermatitis if it seems like bad dandruff or the scalp feels irritated. If your minoxidil also contains Retin-A, the flaking may be due to increased skin cell turnover induced by that agent. Nizoral shampoo often helps with flaking.

If it's contact dermatitis, though, you may need to discontinue or lessen the frequency of minoxidil applications, or you can also have a compounding pharmacy make a minoxidil formula using glycerol instead of propylene glycol, which is usually the problem ingredient. If irritation persists when using minoxidil or any topical, it is probably best to discontinue usage.

Hair Loss Remedy FAQ - Is oral minoxidil safe and effective in MPB?

Hair Loss Remedy FAQ

Is oral minoxidil safe and effective in MPB?

Some people have used oral minoxidil (Loniten) for treating their hair loss, but this is a much more risky treatment than topical application. Use at your own risk. Side effects of excessive minoxidil intake (either orally or topically) include racing heart and salt and water retention. Oral minoxidil in any significant quantity ordinarily has to be taken with a loop diuretic and is best done under a physician's care.

Hair Loss Remedy FAQ - Is it OK to apply minoxidil after shampooing?

Hair Loss Remedy FAQ

Is it OK to apply minoxidil after shampooing?

Yes. In fact, you will have enhanced absorption after shampooing, as a well-hydrated scalp is more permeable and will better absorb topical hair loss agents. Just be sure to towel dry the hair first to remove standing water. The only precaution is to be attentive to signs of excessive absorption, such as a racing heart.

Hair Loss Remedy FAQ - Are higher strength Rogaine formulas better than lower strength ones?

Hair Loss Remedy FAQ

Are higher strength Rogaine formulas better than lower strength ones?

To a degree, Rogaine response is dosage dependent. For example, 5% Rogaine (minoxidil) generally grows more hair than 2%. But you can also apply 2% more liberally, or more frequently, and deliver a comparable daily dosage of minoxidil. While more minoxidil sometimes helps, beyond a certain threshold, additional minoxidil makes little if any difference.

Hair Loss Remedy FAQ - What's the difference between Rogaine and minoxidil and are these actually helpful for thinning hair?

Hair Loss Remedy FAQ

What's the difference between Rogaine and minoxidil and are these actually helpful for thinning hair?

Rogaine is just a brand name for minoxidil. Minoxidil can be purchased from numerous sources and in varying strengths from 2% to 5% liquid and even in a 15% solution. It also comes combined with Retin-A, which improves results by increasing the absorption of minoxidil. (Retin-A also apparently exerts some antiandrogenic effects over time.) MiNOxidil's name betrays its relationship to nitric oxide, an important hair growth messenger that appears to be diminished in balding scalp. Minoxidil can be helpful in male pattern hair loss, but it is not a panacea. It is best used as part of an overall program that attacks the hair loss problem from different angles.

Hair Loss Remedy FAQ - Are there topical antiandrogens I can use instead of taking something internally such as finasteride?

Hair Loss Remedy FAQ

Are there topical antiandrogens I can use instead of taking something internally such as finasteride?

Yes. Some things have been used topically to either bind up receptors (spironolactone or estrogens) or reduce androgens or diminish hormonal impact (azelaic acid, pyridoxal B6, zinc, free fatty acids). There is much debate about the efficacy of these agents. The problem is a lack of study data regarding their use in male pattern hair loss, though there are studies suggesting why these agents may help.

Hair Loss Remedy FAQ - What's reflex hyperandrogenicity?

Hair Loss Remedy FAQ

What's reflex hyperandrogenicity?

When the effects of androgens in the body are lessened, e.g. through lowering DHT or by systemic hormone receptor blockade, the body seeks equilibrium through a process called upregulation. This can take the form of increased hormone production and/or increased tissue sensitivity to the remaining hormones. The reason side effects usually gradually disappear with finasteride is probably due to such upregulation.

In a small percentage of individuals, it may be that this process overshoots the mark, resulting in significant hyperandrogenicity. This is marked by such signs as greatly increased facial oil, increased pimples, and greatly elevated libido. It's possible that in certain cases such hyperandrogenicity overcomes the hair-protective effect of, say, finasteride, though this does not appear to be the case for the vast majority of people.

Hair Loss Remedy FAQ - Is it true that the herb saw palmetto is better than finasteride (Proscar/Propecia) and has no side effects?

Hair Loss Remedy FAQ

Is it true that the herb saw palmetto is better than finasteride (Proscar/Propecia) and has no side effects?

Saw palmetto has been used successfully in prostate enlargement. Accordingly it may have utility in male pattern hair loss, though it has not been formally tested for this. Saw palmetto and finasteride are not really equivalent, since saw palmetto has a much broader range of anti- hormonal activity than finasteride. As for side effects, these are certainly possible with saw palmetto, though everyone will respond uniquely.

It must be borne in mind that saw palmetto is as much a chemical concoction as finasteride; it was merely produced in Nature's laboratory instead of a conventional one. Like anything, if it's potent enough to cause a biochemical change in the body-- especially involving hormones--it's potent enough to cause side effects in some people. Saw palmetto may be useful as a topical hair loss treatment.

Hair Loss Remedy FAQ - What kind of side effects can you get with Propecia or other systemic DHT inhibitors?

What kind of side effects can you get with Propecia or other systemic DHT inhibitors?

Propecia (finasteride) is the best documented of the DHT inhibitors and most people notice no side effects from it. Some people do, however, experience a reduction in libido or notice more watery semen. Some get some noticeable hyperandrogenicity, as evidenced by increased facial oil, pimples or unusually high libido.

Testicular ache is occasionally noted, probably due to increased testosterone output, and the body takes time to adjust to this. (Increased testosterone levels--15% on average in finasteride users--are likely in large part a compensatory response to reduced DHT.) Most often any side effects dissipate within 2 or 3 months. If they do not, things should return to normal after discontinuing finasteride, although this may take a couple of weeks, as finasteride has a relatively long biological effect, although a short serum half-life.

Hair Loss Remedy FAQ - What's this I keep hearing about Dutasteride, a dual 5AR inhibitor?

What's this I keep hearing about Dutasteride, a dual 5AR inhibitor?

DHT is produced from testosterone by two 5-alpha reductase isoenzymes, called Type I and Type II. Type I 5AR is much more prominent in the scalp than Type II. However, immunostaining techniques reveal that Type I is abundant in sebaceous glands, while significant Type II is present in the dermal papilla itself. Glaxo Wellcome has created a medication called Avodart (Dutasteride) that inhibits both isoenzymes.

It is noteworthy that Dutasteride also appears to inhibit more Type II 5AR than finasteride does. What remains to be seen is whether the incidence of side effects will increase with the dual inhibitor above the level seen with finasteride and whether results will be greater or not.

How effective is Propecia for treating hair loss?

How effective is Propecia for treating hair loss?

Propecia (Finasteride) is not a miracle hair loss treatment, but it works reasonably well for many people. Results tend to be slow, and it appears to be much better at retaining than regrowing hair. But as treatments go, it's fairly effective. Recent longer term results indicate that it continues to work well for responders (i.e., the majority of users) a few years into treatment. Like all treatments discussed here, it is typically best used as part of a multifaceted hair loss treatment program.

Hair Loss Remedy FAQ - Is there a problem if my wife gets pregnant while I'm taking finasteride?

Is there a problem if my wife gets pregnant while I'm taking finasteride?

No. Originally Merck decided to err on the side of caution and warned against the possible problem of finasteride transfer in semen. This warning has since been removed. At issue is the theoretical danger that there could be genital birth defects in the male fetus. However, women who are or could get pregnant should avoid finasteride ingestion and the handling of broken finasteride tablets.

Hair Loss Remedy FAQ - How come some people take less than the standard 1 mg dosage of finasteride?

How come some people take less than the standard 1 mg dosage of finasteride?

Early dose ranging hair loss studies showed that much smaller dosages, such as 0.5 mg and even less, inhibited DHT on average almost as well as much higher dosages, such as 5 mg. One 6-month study comparing a placebo group, which lost hair, to users taking differing dosages of finasteride found that 0.2 mg of finasteride increased hair counts about 81% as much as 1 mg when compared to the placebo.

Similarly, 1 mg increased hair counts 82% as much as a full 5 mg compared to placebo. The tiny 0.2 mg dosage did about 66% as well at regrowth and retention as 5 mg. Accordingly, the 1 mg dosage was probably a compromise designed to be high enough to pick up those who may not respond as well to the lower dosages, but low enough to minimize side effects. Many of those who take less than 1 mg opt for either 0.5 mg or 0.625 mg (1/8th of a Proscar tablet).

Some people also skip days periodically based on the fact that finasteride suppresses DHT for up to several days and also on the old pharmacological rationale that it may help preclude any possible tendencies toward tolerance, which sometimes happens with continuous long-term use of medications.

Hair Loss Remedy FAQ - How come some people take less than the standard 1 mg dosage of finasteride?

How come some people take less than the standard 1 mg dosage of finasteride?

Early dose ranging hair loss studies showed that much smaller dosages, such as 0.5 mg and even less, inhibited DHT on average almost as well as much higher dosages, such as 5 mg. One 6-month study comparing a placebo group, which lost hair, to users taking differing dosages of finasteride found that 0.2 mg of finasteride increased hair counts about 81% as much as 1 mg when compared to the placebo.

Similarly, 1 mg increased hair counts 82% as much as a full 5 mg compared to placebo. The tiny 0.2 mg dosage did about 66% as well at regrowth and retention as 5 mg. Accordingly, the 1 mg dosage was probably a compromise designed to be high enough to pick up those who may not respond as well to the lower dosages, but low enough to minimize side effects. Many of those who take less than 1 mg opt for either 0.5 mg or 0.625 mg (1/8th of a Proscar tablet).

Some people also skip days periodically based on the fact that finasteride suppresses DHT for up to several days and also on the old pharmacological rationale that it may help preclude any possible tendencies toward tolerance, which sometimes happens with continuous long-term use of medications.

Hair Loss Remedy FAQ - What's the difference between Propecia and Proscar?

What's the difference between Propecia and Proscar?

Both medications contain finasteride and are made by the same company, Merck. They differ only in strength. Propecia has 1 mg of finasteride, while Proscar has 5 mg. Proscar has been around for a while for the treatment of prostate enlargement, which, like male pattern hair loss, has been linked to DHT. Because of the price disparity between the two medications, some people procure Proscar and divide the tablets into smaller dosages instead of buying Propecia.

Hair Loss Remedy FAQ - How long does it take to see results from any hair loss treatment program?

How long does it take to see results from any hair loss treatment program?

A: At least 2-3 months, though usually significantly longer. Many do not notice any apparent improvements until well after a year. Best results are often seen after the two-year mark. This is because hair follicles undergo a relatively long dormancy period in between hair growth cycles (usually about 3 months). In addition, hair only grows about 1/2 inch per month in non-thinning areas and usually considerably slower in thinning areas. Since it generally takes several cycles of growth/fallout/regrowth, with the hair getting thicker and longer each time, it can take a great deal of time to see noticeable improvement. Note that best regrowth results are seen with hair that was lost within the last five years and in areas of the scalp in which there is still some fine hair.

Hair Loss Remedy FAQ - What's the best hair loss treatment?

What's the best hair loss treatment?

There is no simple answer to this. No one treatment offers spectacular hair growth for all people who use it. However, there are a few treatments that yield decent results for a majority of people. (Decent is defined here as cessation of further hair thinning and perhaps some regrowth, ranging from a little to moderate.) Some people do respond unusually well--but then some don't respond at all. Most fall somewhere in between. Since there are multiple factors in male pattern hair loss, it is wisest to approach the problem from several angles to maximize results, as some treatments are complementary and address different underlying causes. A common fundamental approach is to use an "antiandrogen" of some kind, whether systemic (such as finasteride) or topical (such as spironolactone or azelaic acid), and a growth stimulant such as minoxidil (Rogaine). To this basic program many add a topical SOD.

Other options include therapeutic shampoos, such as the antimicrobial and growth stimulant shampoos. Still other approaches that may help include dietary and nutritional considerations and even lifestyle modifications. There are many adherents to such a "kitchen sink" approach. You can also start with a single hair loss treatment, though due to the long lag time before you can actually verify efficacy, this can be very hit and miss and may bring less than optimal results by only addressing one aspect of a larger problem.