Hair Restoration Blog

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:

I started the Propecia at the beginning of March (8 months ago), prior to the procedure last March. Should I still be on it?

A:

It is great to hear from you and I am glad you are happy with the result of your hair transplant. The final result of your hair may still get better up until one full year after your surgery if you allow your hair on the transplanted area to grow longer.

Finasteride was mostly prescribed for prevention of shock loss after hair transplant or losing native hair on the balding areas after a hair transplant. You have significant miniaturization on the front, top and crown area (90%-100%), which makes your preexisting hair on balding areas prone to further hair loss. Now that you had your transplanted hair grown, you can decide to stop Propecia. By doing that, you may risk losing your own hair on the balding area further (transplanted hair does not need Propecia for its growth) or you can continue taking the medication to increase the longevity of your preexisting hair on those areas.

The effectiveness of medical hair restoration alone with hair restoration medical options that are currently available such as finasteride or Rogaine has always been questioned.  Medical hair restoration without the surgical option (hair transplant), might work for some people, but should not be recommended to all as a cure-all solution, as you may find in some advertisements.

The available FDA-approved medications for hair loss prevention are finasteride and minoxidil.  Although both are effective, they may have different indications for male and female patterned baldness. They might not be considered a complete treatment for male patterned baldness, as pharmaceuticals may try to show.

Medical hair restoration should be seen as a preventative measure which should be considered, along with the surgical options, as part of a master plan. Most people are prone to shock loss that may happen after a hair transplant surgery and they need to be on preventative measures such as finasteride at least a few months around the time of surgery. Shock loss after a hair transplant used to be one of the biggest problems that hair transplant patients had up until the last few years. Now, most hair transplant patients go on finasteride after a hair transplant surgery.

What is Saw Palmetto?

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. It has been used in alternative medicine for a variety of indications, most notably benign prostatic hyperplasia (BPH).

Indications:

Prostate treatment

Saw Palmetto has also been used in treatment of benign prostatic hyperplasia (BPH), a condition known by enlarged prostate size to the degree that it makes urinating difficult.

Hair loss prevention

The role of Saw Palmetto in hair loss prevention has also been documented. Saw Palmetto is one of the few effective herbal treatments that can reverse hair loss process in some people to some degree and slow down the process of  balding in men. Saw Palmetto bio active ingredients prevent conversion of testosterone into dihydrotestosterone (DHT).

That is how Saw Palmetto helps to stop the process of balding on the hair follicle level. It can help increase the thickness of miniaturized hair and make them grow longer. The Saw Palmetto effect is comparable to finasteride or other DHT blockers by mechanism. Saw Palmetto is available in oil extract for topical use on scalp or as pills used for prostate enlargement treatment.

Q:

Dr. Mohebi, I had my consultation with you about two months ago and I’m still very interested in getting a hair transplant procedure done.  My question and concern is about the propecia drug.  I realize that we discussed the side-effects during my consultation and I understand your point of view, however, I am still reluctant to consider taking this medication becuase when I research the effects of the drug I get mixed responses.  The link below is just one of many out there and definately makes me think twice about considering to take it.  How will not taking the drug affect a hair transplant procedure and its results?

http://www.propeciasideeffects.com/

A:

This is a good question.  The internet is full of contradicting information.  However, you should stay away from things that are not scientific studies.

I personally have not seen any of those irreversible side effects with finasteride that they are claiming on that site.  There is also no medical document to support those claims.  The main study that was performed on the long term side effects of the finasteride proved that Propecia users do get better after one year of use. In addition, A number of patients experienced change while using libido Propecia.  Below you can find a table that compares the side effects that were seen in Propecia and Placebo patients after one year of their use.

PROPECIA N=945   Placebo N=934
1.8                          1.3                 Decreased Libido
1.3                          0.7                 Erectile Dysfunction
1.2                          0.7                 Ejaculation Disorder
0.8                          0.4                 Drop in Volume of Ejaculate
1.2                          0.9                 Discontinued due to side effects

As you can see the medication was used for one year on almost 1000 patients while placebo was given to  the other group.  The difference between the two groups can be considered the real side effect.  There has been no report of permanent sex drive effects from Propecia.

Q:

A friend of mine said that Propecia can cause bloody urine.  Is that correct?
A:

I think that has been a misunderstanding.  Bloody urine or Hematuria can be caused by a variety of prostate disorders.  In fact, finasteride has been researched and used for prevention and treatment of prostate gland enlargement in men.  There are many documentation that proof the usefulness of finasteride for prostate enlargement.  Puchner was the first to observe that finasteride reduced bleeding of prostatic origin. These early observations were confirmed with additional controlled studies involving larger numbers of patients.

These clinical observations led to the interesting hypothesis that an additional action of finasteride is the inhibition of vascular endothelial growth factor (VEGF) in the prostate, leading to shrinkage and programmed cell death in enlarges cells. The implications of this theory give further credence to the hypothesis that 5-a-reductase inhibition by finasteride or similar medications may be a viable preventive strategy for prostate cancer. It is known that prostate cancer is associated with increased microvascular density, which may be influenced by VEGF inhibition.

So continue taking your Propecia (finasteride).  If anything prostate protection against enlargement (BPH) or even cancer may be one of the good side effects of finasteride.  Finasteride may alter the levels of PSA, the lab test that is used to predict prostate problems including cancer.  You need to discuss finasteride use with your primary care doctor so he or she knows that your levels have been altered by finasteride use.

Demodex folliculorum is a widespread skin parasite.  Demodex folliculorum is a microscopic creature in the form of an elongated and jointed worm.  Demodex folliculorum could be found on the skin surface, particularly on those parts of the skin with large sebaceous glands and on individuals affected with acne or seborrhea oleosa.

Demodex feeds on the oil and skin sebum so the more sebum the greater the number of Demodex folliculorum. While it is sometimes found on the surface of the skin, it is more commonly encountered in the substance of hair follicle comedo plugs, where five to twenty worms may be discovered in a single follicle. A similar species which is considered to be a variety of that discovered upon the skin of man infests dogs, mice and other mammals. However, none of these related demodex species are known to be transmissible to humans.

Demodex folliculorum infection is very common and around 80% of the adult population, both men and women, have a Demodex folliculorum infection. It is believed that the frequency of Demodex folliculorum is less in children.

There have been sporadic claims made about Demodex folliculorum and hair loss for over many years. Quite recently a theory has been put forward that patterned baldness could be associated with infection of hair follicles by the Demodex folliculorum parasite. By infiltrating the sebaceous gland of hair follicles the parasite causes an immune response and inflammation of surrounding tissue - so it is claimed. Through long term invasion, the parasite “exhausts” the hair bulb and shifts the hair cycle from anagen to telogen so more hair follicles stay in resting phase rather than growth phase.  That means less hair is seen on the scalp at any given time.  This theory is promoted by certain companies that just happen to have a range of products that destroy Demodex folliculorum. At least one of the companies has conducted research that allegedly showed 88% of 240 men (more than its rate in normal population) with male patterned baldness had Demodex folliculorum infection in their hair follicles. However, there are several problems with this theory:

1. Eighty percent of the normal population has Demodex folliculorum whether they have hair loss or not. The company conducting the research conveniently forgot to study normal haired people to find the frequency of Demodex folliculorum in people with a full head of hair.
2. Research has shown that there are frequently excessive numbers of the Demodex folliculorum parasite in eyelash follicles. However, people with pattern baldness do not lose their eyelash hairs.
3. There is a clear bias towards men having pattern baldness hair loss even though women are equally susceptible to Demodex folliculorum infection and at least some children are also infected. If Demodex folliculorum infection was causing inflammation that pushed hair follicles into telogen then one would expect to see some children with pattern baldness and women would be equally affected with hair loss. Indeed, women have a stronger immune system and so one might expect more women than men to have pattern baldness, but this is not the case.
4. If Demodex folliculorum was a key cause of pattern baldness it would be impossible for hair follicle transplants to work. Given thousands of transplant procedures are done every year and 80% of men have Demodex folliculorum infection, then most of the men with hair transplants must also have a Demodex folliculorum infection. In a hair transplant, follicles are moved from the back of the head to the top of the same individual. If the individual is infected with Demodex folliculorum one would expect that the transplanted follicles would either already be infected, or become infected in their new location. However, transplanted follicles grow in every individual who has had the procedure done and pattern baldness does not redevelop.
5. there is a widely available treatment to Demodex folliculorum infection called pilocarpine gel. However, using this gel on the skin does not promote any hair growth.

A theory for Demodex folliculorum infection in people with pattern baldness is that the sebaceous glands of alopecia affected hair follicles become larger and more active, producing oils at a faster rate, under the influence of dihydrotestosterone (DHT). The oils combine with dead cells from the hair follicle to make sebum. The sebum is a rich source of nutrients and this is the food that Demodex folliculorum eats. The oily food supply increases in most hair follicles affected by pattern baldness so these hair follicles can accommodate a greater number of Demodex folliculorum parasites. Rather than the parasites causing pattern alopecia. The parasite infection could be simply a consequence of pattern baldness rather than a cause of the hair loss.

I just read a new article presenting an interesting case presentation and thought it might be useful for the readers of our hair restoration blog.  The article is published in the Journal of American Academy of Dermatology this month (July 2009).

It goes over mesotherapy, a remedy that has been proposed for hair loss and its adverse side effects.  Mesotherapy has recently become an advertised method for the treatment of different types of alopecia despite the lack of any data regarding its efficacy and possible side effects. The substances injected into the scalp include “cocktails” of natural plant extracts, homeopathic agents, vitamins, vasodilators, and drugs that may stimulate hair growth such as finasteride and minoxidil.

The authors report two cases of patchy alopecia that developed after mesotherapy for the treatment of androgenetic alopecia. In the first patient, alopecia developed after injections of the heparinoid vasodilator mesoglycan; the 3-month follow-up examination revealed a small residual area of cicatricial alopecia. The second patient developed reversible alopecia after multiple scalp injections of homeopathic agents. These cases underline the possible risks of mesotherapy as a therapeutic technique for hair loss.

This could be considered another modality that was presented for male hair loss without a solid value like many other similar hair loss products.  We have always said in this blog that the hair loss product market is a “buyer beware” market and you need to do your research and, preferably, discuss with your doctor before you try any new modality for treatment of your hair loss.

Q:

Hello,

I did a search for hair re-growth, hair loss, etc. and I found your email address.  These internet searches are definitely far from perfect, in fact sometimes they are way off!  So if this is not the type of business or practice you’re in, I apologize and please disregard this email.

I’m a 43 year-old male.  I started losing my hair, very slightly, at age 27.  I really haven’t lost a whole lot since then, however, my hairline has receded a little and I have been using Rogaine pretty faithfully.
I’m trying to find the best way or multiple ways of re-growing my hair.  First, I am curious to know if it is okay to use Rogaine (5%) and take Propecia?  Do you know if Nioxin or any other shampoos or hair thickeners are helpful?  Would you recommend any?  Are there any other factors that make a difference in re-growing hair such as: vitamins, hormones, foods or physical exercise?

Do you think these types of remedies are all stop-gap solutions and I will need to look for something more permanent? Do you have any insight or additional thoughts or sell any products or services that I can purchase that will help?

Thank you,

A:

Thanks for your email.  You have asked many questions which most have been answered in our Hair Restoration Blog.  There are many hair loss products in the market, but most of them do not have any active ingredients that can help your hair loss condition.  There are only two FDA approved medications that have been approved and proven to be effective and safe for hair loss treatment and prevention.  Those two medications are Rogaine and Propecia.  If you are suffering from male pattern baldness, hair transplant surgery may be the only option that can improve or eliminate the appearance of baldness by bringing good quality hair from the permanent zone to the front and balding areas.

I do not have any particular hair loss product nor recommend many different lotions and potions that are out there in the market for hair loss.  You can find other valuable information on our postings in our blog and can answer your questions on:

• Nioxin - hair loss product
• other shampoos for hair loss
• vitamins for hair loss
• balding and hormones
• foods for hair restoration
• physical exercise and hair loss

I recommend that you find a good hair restoration doctor who can evaluate you and come up with a master plan for your condition.  This may include medications, surgery or even cosmetic changes that you need to bring your hair and beauty back to your life.  We do offer an online consultation for hair restoration through pictures and if decided that you are a candidate and you choose to have a hair transplant with us, it could be easily done.  Our California offices of hair restoration can arrange your trip to our Los Angeles office for your hair restoration surgery.

You can contact our office at 888-302-8747.

Good luck,
Parsa Mohebi, MD