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.

There is just another study on a potential new medication that could be used for treatment of hair loss. Currently, there are only two FDA approved medications for male patterned baldness or typical men hair loss in United States. The two medications that we have extensively discussed on this web site are finasteride (Propecia) and minoxidil (Rogaine).

The article “Effect of Cuscuta reflexa Roxb on androgen-induced alopecia” was published in the Journal of cosmetic dermatology September 2008. The research is done in India and the authors discuss the significance of hair loss in men and the effect of androgenetic alopecia on millions of men and women. They classify typical men hair loss as androgen-driven disorder. They used Cuscuta feflexa Roxb for hair growth activity in androgen-induced alopecia.

The authors of the article used petroleum ether extract of C. reflexa for its hair growth-promoting activity on albino mice. They induced male patterned alopecia in mice by testosterone administration for 20 days. The inhibition of baldness by simultaneous administration of the extract was evaluated using follicular density, anagen/telogen ratio, and microscopic observation of skin sections. To investigate the mechanism of observed activity, in vitro experiments were performed to study the effect of extract and its major component on activity of 5alpha-reductase enzyme.

The researchers announced that petroleum ether extract of C. reflexa exhibited promising hair growth-promoting activity as reflected from follicular density, anagen-telogen ratio, and skin sections. Inhibition of 5alpha-reductase activity by extract and isolate suggest that the extract reversed androgen-induced alopecia by inhibiting conversion of testosterone to dihydrotestosterone. They concluded that the petroleum ether extract of C. reflexa and its isolate is useful in treatment of androgen-induced alopecia by inhibiting the enzyme 5alpha-reductase.

This hair loss research needs more research on human volunteers on a long period of time before it can be considered as a balding treatment. There must also be more research done on the application of the product on human in terms of medication side effects and its comparison with currently available medications for treatment of hair loss.

We at US Hair Restoration continue to follow on the most advanced investigations and researches on hair loss treatment. We keep our patients and the readers of hair restoration blog updated with the new information and medical technology to improve the quality of our hair restoration treatments at our Los Angeles hair restoration clinics.

Q:

How are you doing? All I have to say is TGIF.

I was doing a little bit research on hair loss, and I stumbled over retinoic acid. I read about it and have a basic understanding. Have you heard any claims that it could possible revive hair loss?

Have a great weekend!

A:

This is a good question. There are several claims on therapeutic effect of all-trans-retinoic acid (tretinoin) alone and in combination with 0.5% minoxidil for hair loss based on limited studies.

In one study the combination of tretinoin and minoxidil was used for 56 patients who had androgenic alopecia (male pattern baldness) and hair growth was followed. The growth of terminal hair was studied after one year of treating balding scalp with combination of topical tretinoin with 0.5% minoxidil. Increase in hair growth was reported in 58% of the patients who could complete the study.

Although tretinoin has been stated as a promoter of cell proliferation and vascular creation, which are both important in hair growth, there is still not enough scientific evidence from large studies to prove these effects. Also double blind studies on the efficiency and adverse effects of the product is lacking.

Q:

Dear Dr. Mohebi,

I hope all is well with you and the family. I wanted to see your opinion about something. Along with proscar, I use Murad shampoo (i dont know if you have heard of it) but it supposedly strengthens your hair and brings nourishment to the hair, therefore promoting hair regrowth. Remember how short my hair was when we first met, well now its relatively longer. Do you think i should keep it short for several reasons: easier to clean my scalp, exposure to vitamin d (sunlight). When my hair is long, I can see it shed, but when its really short it doesn’t seem that way. However, the downside to cutting my hair that short is that it will become pretty apparent that im experiencing hair loss. Thanks doc! take care!

A:

I hope you are doing well. Last time we met, we decided that you wait on doing a hair transplant procedure until your pattern of hair loss becomes more obvious. Here are the answer to your questions in the order you asked them:

• Murad shampoo has following active ingredients: Pomegranate extract, artemia extract, alpha hydroxy acids, phytantriol and Saw Palmetto. From all these only the last one or Saw Palmetto is proven for its anti hair loss properties through blocking DHT. However, the rate of penetration of this ingredient on deeper layers of skin where follicles reside is not completely clear. I don‚Äôt think it hurts to use it in general, but for someone like you who takes systemic form of DHT blockers (finasteride), I am not sure it can add anything in slowing your hair loss process.
• On whether or not keeping your hair short, it is up to you, you have to try them both and decide, long hair should not create any problem with cleaning hair. Do whatever you are more comfortable with. Neither of the two can affect the speed of your hair loss. If I wanted to choose, I would kept my hair long so layering can help covering the thin areas.
• Vitamin D could be absorbed from everywhere, especially in the sunny State of California.

Again, thanks for good questions,

Good Luck and have a great weekend
Dr. Mohebi

hey doctor!

As I read through forums and articles, people mention that propecia works better in conjunction with something else, such as rogaine for exmaple. At the moment, the vertex area of my scalp seems emptier than than the crown and minoxidil works well with the vertex. Do you recommend me go back on minoxidil for the vertex, or should I just focus on propecia?

Answer:
I generally prescribe finasteride to most of my patients who have significant miniaturization whether they are getting hair transplants or not. There are several studies on using Rogaine (minoxidil) and Propecia (finasteride) as single therapy and in combination with each other or with other medications.

Comparing minoxidil and finasteride for treatment of male pattern baldness clearly shows that treatment with only finasteride is more effective than treatment with only minoxidil. Combination of finasteride with minoxidil and with some other medications shows improved outcome, but the rate of improvement is not significant enough that I can convince myself to prescribe combination therapy to all my patients for the rest of their lives, considering difficulty of using topical minoxidil (topical spreading of medication twice a day on the balding area of scalp).

If you want to do everything possible to prevent or slow down further hair loss and maybe grow some, you can consider combination therapy, but remember when you start minoxidil you are committed to continue it for the rest of your life or until there are better alternatives.

Question:

Dear Dr. Mohebi,

Dr., I had a question: say I would use proscar now and took it for a while, after how long based on studies is it possible to see adverse side effects, if any? The reason why I ask is because when I went and read the messages on the forums, I saw positive and negative feedbacks. One person used proscar for 7 years and saw nothing but great results. I would like to give it a shot and see if I am lucky, hopefully. Thank you! Have a great weekend,

Answer:
The side effects of finasteride (Propecia/Proscar) could be seen anytime from right after starting it to months after starting finasteride. If you read the articles on adverse effects of finasteride you can clearly see that there is a small difference between the rates of side effects from the people who took placebos to the ones taking finasteride.

Let’s face it; you are prescribing a drug to a patient telling him that it works through altering your male hormones. What do you think the chances are that the patient will have problems with his sex drive?

The good news is that the side effects of finasteride are few and the most problematic one (decreased sex drive) is only seen in one out of a hundred patients. The other good news is that even if you are in that one percent category and you decide to continue using finasteride anyway, after one year of using finasteride the rate of side effects decreases to about the rate that was shown in people who only took a placebo.

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, formed primarily in the prostate gland and hair follicle cells. Hair follicles contain DHT receptors. Over time as males produce more and more DHT, the DHT molecules cause hair follicles to miniaturize and eventually fall out permanently in people who are genetically prone to baldness. In other words, some males have more hair follicles with these receptors than others.

DHT is the primary contributing factor in male pattern baldness. Unlike men with male-pattern baldness, women with female-pattern baldness are usually not characterized by increased production rates of DHT. Women with increased levels of DHT may develop certain male secondary sex characteristics, including a deepened voice and facial hair. Hair in the Crown and top of the head are usually loaded with these receptors in men with male pattern baldness. But the hair on the sides and the back, termed the permanent zone or donor area, are not affected by DHT. This allows us to transplant hair from the donor area into the frontal area without fear of it falling.

The transplanted hairs keep their resistance to DHT after hair transplant. Propecia is a drug that decrease the production of DHT by blocking the enzyme 5-alpha reductase that converts testosterone to DHT. This is how Propecia is effective in treating hair loss. Hair loss patients will decrease levels of DHT when they are on Propecia and this will help maintain and un-miniaturize hair follicles or even increase the size of hair shaft within the first year of using them.

Question:

Hi, My boyfriend here wants to know what he should do to prevent more hair loss. He has hair now but it’s receding a bit on his front at right and left sides.  He’d be most grateful for some advice. (Or I could just listen on Saturday!!)

Answer:

The Saturday radio show is going to be a 55 min program on hair loss with a focus on male pattern hair loss. I am sure you will find it useful. Also we have an online consultation page on our website that allows patients from all over the world to ask questions about the characteristics of their own hair and hair loss.

As a general rule, most young men can use Propecia (generic: finasteride 1mg/day), if they do not have any contraindication (allergic reaction or other negative side effects) for its use to prevent further hair loss or slow down the hair loss process. I generally do miniaturization studyies on all my patients to map out their hair loss pattern before starting them on Propecia or any other hair loss prevention medication. This way we can measure their response to the effect of treatment and optimize the medical or surgical treatment if needed.