The Patient's Guide to Hair Restoration - New Hair Institute

Many patients are attracted to minoxidil because of its seeming lower cost
compared to other methods of hair replacement. However, because the effects of
minoxidil are temporary, the lifetime cost of using minoxidil can be more
expensive than the cost of hairpieces or surgical treatments for hair loss.
Minoxidil is often prescribed in conjunction with other medications such as
topical retinoic acid (Retin-A) to increase its topical penetration. These
medications can greatly increase the systemic absorption of minoxidil and may
increase the risk of potential side effects, including severe scalp irritation. The
prescribing information provided by Upjohn specifically states Rogaine should not
be used with other topical agents including topical corticosteroids, retinoids,
petrolatum and/or other agents that are known to enhance drug absorption. One
should not use Rogaine if one's scalp is sunburned or becomes irritated.
A problem unique to patients using the combined mixture of
minoxidil/Retin-A occurs when scalp irritation begins and the patient is afraid to
stop the Retin-A since this would also mean discontinuation of the minoxidil (and
the likely outcome of subsequent hair loss). These patients often continue the
mixture in spite of the development of severe scalp irritation. This can result in
infection, scarring and permanent hair loss.
The early studies with minoxidil were on balding men, but it appears that
minoxidil may actually be more effective for women experiencing hair loss. This
is probably because women usually exhibit diffuse hair loss. Minoxidil, then,
would not be applied to bald areas, but in areas of thinning. Some doctors
recommend minoxidil before and after hair transplantation to decrease or prevent
the temporary loss of hair that sometimes occurs with newly placed grafts,
however, this use has not yet been proven to be reliably effective.
Finally, although it seems that the topical preparation of minoxidil is
innocuous, the long-term safety unknown. As with many medications, the clinical
trials with minoxidil occurred over a very limited period of time. Since the
medication must be continued for years, we may presently be unaware of
potential long-term problems.
Finasteride (Propecia)
Propecia is an oral medication, manufactured by Merck, that blocks the
conversion of testosterone to dihydrotestosterone (DHT), the hormone largely
responsible for male pattern baldness. It does this by inhibiting the action of the
type II 5-alpha reductase enzyme that is present in higher concentrations in and
around the hair follicles of balding men with androgenetic alopecia.
Finasteride causes significant drops in both scalp and blood levels of DHT.
Its effectiveness is believed to be related to both of these factors. In patients
taking finasteride 1-mg/day, serum DHT levels decreased by 68.4%. Serum
testosterone levels actually increased by 9.1% but remained within the normal
range.
Finasteride was originally marketed for use in prostate enlargement in
men over 50 (the prostate also has the type II enzyme). This medication, in a 5mg
per day dose, is sold under the name Proscar. In the treatment of prostate
problems, finasteride 5-mg has produced breast tenderness and breast
enlargement. It has also caused impotence and decreased sexual interest in a
small number of men.