Bunch of doubts, need help please

[striker9]

Hi!

thanks for the great forum and the blog is awesome.

I'll sended some questions to dr. rassman but of course he can't answer everyone so like advised i'm putting them here.

I'm 21, male, norwood 2/3, androgenetic alopecia and i have a bunch of questions that i can't find answer:

1) Does washing the hair more frequently makes it more oily? And washing the hair doesn't make more hair fall, isn't that bad?

2) My hair turns oily in 2/3 days, and we all know that rogaine and other topical products are better applied in a washed scalp, but the other way, the hair takes 24 hours to dry completely so washing it frequently would stimulate more oil and don’t let the hair dry, beiing wet all the time right? so, what do you recommend for a guy in a rogaine treatment: wash it everyday or once two days or once three days? What’s better for healthy hair?

3) What rogaine do you think is better? And your patients have better results? Foam or liquid? I've readed some posts of you saying foam should be better but i think Dr. Bernstein said foam stays in the hair instead of the scalp.

4) Rogaine foam and liquid says to apply 1ml or a cap, but this is because it's only for vertex. I've readed rogaine works in all head, so for covering all head i would need 4ml liquid or 4/5 caps of foam, do you have patients that use so much, or do you recommend?

5) Can i alternate between foam and liquid? Like liquid and night and foam at the morning?

6) Nizoral says we should let it be in the scalp for 3/5minutes but this is the application for dandruff, if i'm using for make my hair fight alopecia how many time should i apply it in the scalp and how many times per week, what do you recommend?

7) Based on the studies you know and read, is nizoral the best shampoo? Or revita or tricomin or revivogen are better? I know you don't endorse products but based in in vitro, clinical studies and your patients what would you recommend for a anti-hair loss regime shampoo?

8) azelaic acid:
- http://en.wikipedia.org/wiki/Azelaic_acid
"zelaic acid may be useful as a hair growth stimulant."

- http://en.wikipedia.org/wiki/Flutamide

- http://en.wikipedia.org/wiki/Spironolactone
"can be used as a topical medication for treatment of male baldness."

Do you think this information is reliable? They also say flutamide can cause severe problems, what about topical flutamide?

I'm searching for a complement of rogaine and propecia, so based in clinical studies or in vitro and your patients, do you recommend anything else? Like flutamide gel, spiro gel? Because i read so much people trying so many products in the foruns.

Sorry so much big questions and thanks for the help, those are the ultimate questions for me!

[striker9]

Hi this is a forum.

No one can really help me? I have posted 5 days ago.

A help would be very useful :D

[Mark]

Hi Striker,

I just wanted to stop in and say that I did see this post when you originally wrote it and I forwarded it off to Dr. Rassman to get some clarification on some of the questions you're posing. I believe you also wrote into the blog before you wrote this and he was working on a blog post about it. My plan was to link you to the blog post.

We'll do our best, as soon as possible. If anyone else reading has any advice or anything for Striker, feel free to chime in.

-Mark

[Mark]

Hi!

thanks for the great forum and the blog is awesome.

I'll sended some questions to dr. rassman but of course he can't answer everyone so like advised i'm putting them here.

I'm 21, male, norwood 2/3, androgenetic alopecia and i have a bunch of questions that i can't find answer:

1) Does washing the hair more frequently makes it more oily? And washing the hair doesn't make more hair fall, isn't that bad?

No, washing does not make your scalp/hair more oily.


2) My hair turns oily in 2/3 days, and we all know that rogaine and other topical products are better applied in a washed scalp, but the other way, the hair takes 24 hours to dry completely so washing it frequently would stimulate more oil and don’t let the hair dry, beiing wet all the time right? so, what do you recommend for a guy in a rogaine treatment: wash it everyday or once two days or once three days? What’s better for healthy hair?

If you have an oily scalp, I'd look into getting a shampoo formulated for oily hair. You can wash daily, but many recommend washing every other day or so.

3) What rogaine do you think is better? And your patients have better results? Foam or liquid? I've readed some posts of you saying foam should be better but i think Dr. Bernstein said foam stays in the hair instead of the scalp.

The foam is easier to apply for many people, but both the foam and liquid contain the same minoxidil so results should be equal if you're applying it correctly. The foam also may dry quicker.

4) Rogaine foam and liquid says to apply 1ml or a cap, but this is because it's only for vertex. I've readed rogaine works in all head, so for covering all head i would need 4ml liquid or 4/5 caps of foam, do you have patients that use so much, or do you recommend?

Rogaine works best in the crown, yes, but if you're going to experiment all over your scalp you will need to use more than 1 cap.

5) Can i alternate between foam and liquid? Like liquid and night and foam at the morning?

I don't see why not. As long as you're getting 2 treatments of minoxidil per day.

6) Nizoral says we should let it be in the scalp for 3/5minutes but this is the application for dandruff, if i'm using for make my hair fight alopecia how many time should i apply it in the scalp and how many times per week, what do you recommend?

7) Based on the studies you know and read, is nizoral the best shampoo? Or revita or tricomin or revivogen are better? I know you don't endorse products but based in in vitro, clinical studies and your patients what would you recommend for a anti-hair loss regime shampoo?

I don't know, as we don't recommend Nizoral for regrowing hair. It is a good dandruff shampoo, however. The only drug treatments Dr Rassman recommends are minoxidil and finasteride, as they are FDA approved to treat hair loss.

8) azelaic acid:
- http://en.wikipedia.org/wiki/Azelaic_acid
"zelaic acid may be useful as a hair growth stimulant."

- http://en.wikipedia.org/wiki/Flutamide

- http://en.wikipedia.org/wiki/Spironolactone
"can be used as a topical medication for treatment of male baldness."

Do you think this information is reliable? They also say flutamide can cause severe problems, what about topical flutamide?

I'm pretty sure Dr Rassman has written about each of these on the BaldingBlog before. You can use the search in the top right of the blog to find more.

I'm searching for a complement of rogaine and propecia, so based in clinical studies or in vitro and your patients, do you recommend anything else? Like flutamide gel, spiro gel? Because i read so much people trying so many products in the foruns.

Sorry so much big questions and thanks for the help, those are the ultimate questions for me!

You're trying to "compliment" Rogaine and Propecia how exactly?

I really really really worry about guys who get really into this hair-loss stuff without the help of a doctor. When you start mixing all these drugs together, especially ones that aren't FDA approved (and therefore leass clear about interactions with other drugs), you do run the risk of causing some problems at the worst, or at the least simply spending a ton of money on stuff without being able to tell what's working and what's not. After all, if you start taking propecia, minoxidil, and all the rest of that and your hair starts looking better, how are you going to know what ended up being the solution for you?

-Mark

[striker9]

Hi mark, thanks for your time and for forwarding this to dr. rassman.

Continuing my doubts :)

- Why people recommend to wash a day or so? Why is this better to alopecia? I'm currently trying to decide between: wash every day (less scalp blocked, more hair pulled, more nizoral applied, less sebum) or wash every other day (more dirt, less hair pushed, less shampoo applied, more scalp rubbed)

- So it's normal to apply more than 1 cap in all my head, what are the normal values? i think i'm using 5 caps or more, but i think i'm not getting sides, but at long term i don't know.

No, washing does not make your scalp/hair more oily.
You're trying to "compliment" Rogaine and Propecia how exactly?

I really really really worry about guys who get really into this hair-loss stuff without the help of a doctor. When you start mixing all these drugs together, especially ones that aren't FDA approved (and therefore leass clear about interactions with other drugs), you do run the risk of causing some problems at the worst, or at the least simply spending a ton of money on stuff without being able to tell what's working and what's not. After all, if you start taking propecia, minoxidil, and all the rest of that and your hair starts looking better, how are you going to know what ended up being the solution for you?
-Mark

My idea was to make my hair regimen even better, i just want to regrew hair and don't lose anymore. About shampoos nizoral is said to make hair thicker, and i also bought revita because of the irritation that nizoral gives. But i was thinking if it's going to add any other products that could also stimulate hair growth. And i see dr. lee and other doctors recommend those azelaic acid, flutamid and spironolactone that is said to grow new hair, so i can make my regrow even better and don't lose hair.

Thanks one more time!

[Mark]

Hi mark, thanks for your time and for forwarding this to dr. rassman.

Continuing my doubts :)

- Why people recommend to wash a day or so? Why is this better to alopecia? I'm currently trying to decide between: wash every day (less scalp blocked, more hair pulled, more nizoral applied, less sebum) or wash every other day (more dirt, less hair pushed, less shampoo applied, more scalp rubbed)

I think most people recommend washing your hair every time you take a shower. So if you shower daily, may as well wash your hair too.

Now, it's a bit different for those of us who have issues with our hair. If you feel that you're pulling hair out more by shampooing it daily, then you might want to switch to every other day.

I don't think there's a "right answer" that can be applied to everyone. I think you just need to use some good judgment and evaluate things yourself. Is your hair unacceptably oily when you don't shampoo it enough? That may be a reason for you to shampoo more.


- So it's normal to apply more than 1 cap in all my head, what are the normal values? i think i'm using 5 caps or more, but i think i'm not getting sides, but at long term i don't know.

It's normal to apply more than one cap if you're covering more scalp than just your crown. People typically use one cap on their crown, so if you're doing more than you'd use more. Approximate the area of your crown and then compare that area with your whole scalp that you're covering with minoxidil. That should give you a good idea of how much to be using.



My idea was to make my hair regimen even better, i just want to regrew hair and don't lose anymore. About shampoos nizoral is said to make hair thicker, and i also bought revita because of the irritation that nizoral gives. But i was thinking if it's going to add any other products that could also stimulate hair growth. And i see dr. lee and other doctors recommend those azelaic acid, flutamid and spironolactone that is said to grow new hair, so i can make my regrow even better and don't lose hair.

Thanks one more time!

You really should beware of going overboard. So many people think "Hey, if one drug will help my hair loss, then a bunch should really help right!?!" but in fact, the opposite can be true. A little bit of minoxidil can help your hair, but dumping it on your head willy-nilly can give you pretty bad irritation and can increase your hair loss.

In addition, if you ever have any trouble down the road it will be hard for you to tell what exactly is causing the problem. It's good to start these drugs one at a time to find out what may or may not cause you issues.

[striker9]

1) but pushing hair ir really worses you condition with time?

2) """Approximate the area of your crown and then compare that area with your whole scalp that you're covering with minoxidil. That should give you a good idea of how much to be using.""" -> thanks for the great answer :) But if with 1ml the makers of rogaine advert to side effects, isn't 6 caps/ ml (the same proprtion to the vertex) bad? I mean at long term, for the hearth and the body?

3) "azelaic acid, flutamid and spironolactone" -> I see, so this is just drugs used by desperate people right?

4) i have done my dht exams before starting with propecia and it gave me 1136 pg/mg in a referece scale of 250-1000, isn't this too high? And it could be a sign that propecia will work better, because one of my problems could be too much high dht even with small sensibility to it (i hope) ?

5) Does using Ketoconazole at long term causes liver problems?


By the way, is for forums and blogs that dr. rassman is the doctor that everyone should choose, i really recommend it and thanks for the great support!

[Ernie Primeau]

I think most people recommend washing your hair every time you take a shower. So if you shower daily, may as well wash your hair too.

Now, it's a bit different for those of us who have issues with our hair. If you feel that you're pulling hair out more by shampooing it daily, then you might want to switch to every other day.

I don't think there's a "right answer" that can be applied to everyone. I think you just need to use some good judgment and evaluate things yourself. Is your hair unacceptably oily when you don't shampoo it enough? That may be a reason for you to shampoo more.




It's normal to apply more than one cap if you're covering more scalp than just your crown. People typically use one cap on their crown, so if you're doing more than you'd use more. Approximate the area of your crown and then compare that area with your whole scalp that you're covering with minoxidil. That should give you a good idea of how much to be using.





You really should beware of going overboard. So many people think "Hey, if one drug will help my hair loss, then a bunch should really help right!?!" but in fact, the opposite can be true. A little bit of minoxidil can help your hair, but dumping it on your head willy-nilly can give you pretty bad irritation and can increase your hair loss.

In addition, if you ever have any trouble down the road it will be hard for you to tell what exactly is causing the problem. It's good to start these drugs one at a time to find out what may or may not cause you issues.

Mark,
You are absolutly right. I tried Minox to see if it would enhance my method. Contrary to instructions, I applied it all over my scalp. My scalp became inflamed beyond belief and I lost most of the regrowth I had achieved. Always follow directions, there is a reason for them. Ernie

[striker9]

Hi please, still waiting an answer, i know this things take time so thanks for your patience :)

[Lain]

I will try to give some clarifications to your questions since you seem to be desperate for some answers. Mark will then give additional comments and maybe modify some of my answers. He appears to be always extremely busy and he cannot give answers right away.

1) Pulling on your hair too often is certainly not very healthy for it. That means rubbing really harsh while washing or having certain hair styles that put too much pressure on your hair roots. (dread locks, hair extensions, tight pony tails) However I honestly doubt that anyone would rub so hard he would really cause damage while shampooing. When you use shampoo daily gentle massage it into your scalp and with that no hair loss should occur. (I wash daily since 10 years and I am a Norwood 1-2 with 25)

2) A doctor I work with says that you should not apply more than 3 caps per usage, meaning not more than 6 caps daily. If you go beyond this recommendation you should check your blood pressure and monitor it over a certain time frame. Considering your blood pressure is low I would stick with the FDA approved dosage of 2 -3 ml daily. Dr Rassman once had a blog post about possible heart problems and minoxidil:

http://www.baldingblog.com/2009/04/08/has-anyone-died-from-using-minoxidil/

Not too scary, but still always be careful.

3) Flutamide:
http://www.baldingblog.com/2008/10/20/flutamide-vs-flutagel/

= I would not use it

Spironolacton:
http://www.baldingblog.com/2009/03/26/spironolactone-as-hair-loss-treatment/

= better take Propecia

So yes you are right it’s only for people who are desperate and want to do more harm than good.

4) This is something Mark / Dr Rassman must answer. Sorry I am not sure about these values. According to my knowledge they are above average. Considering they are too high Propecia might be an effective option for you. I am not sure if type I and type II 5 alpha reductase isoenzyme equally produce DHT. And since Propecia only blocks one of them hair loss might still occur. (Ok ok very careful with my answer - double check that content with someone professional)

5) Ketoconazole may cause liver damage long term when taken orally. When applied topical it is save to use.

[Mark]

1) but pushing hair ir really worses you condition with time?

2) """Approximate the area of your crown and then compare that area with your whole scalp that you're covering with minoxidil. That should give you a good idea of how much to be using.""" -> thanks for the great answer :) But if with 1ml the makers of rogaine advert to side effects, isn't 6 caps/ ml (the same proprtion to the vertex) bad? I mean at long term, for the hearth and the body?

Are you having side effects from the 1mg dose? If so, I'd assume you'll see more if you start applying more.

You certainly don't want to put TOO much on, considering Minoxidil can lower your blood pressure. However, from everything we've looked into, if you simply apply the same amount of the drug to the rest of your scalp as you do for the vertex.

3) "azelaic acid, flutamid and spironolactone" -> I see, so this is just drugs used by desperate people right?

Desperate sounds like an unnecessary pejorative. I think there is a lot of bad info out there by people selling products whose efficacy does not really need to be checked.

I could mix together a bunch of honey and olive oil and sell it as a hair loss remedy. It wouldn't work, but I could do it legally.

But more to the point, we here at NHI haven't really found any evidence that's not anecdotal which supports the idea that these drugs do much to keep hair.

4) i have done my dht exams before starting with propecia and it gave me 1136 pg/mg in a referece scale of 250-1000, isn't this too high? And it could be a sign that propecia will work better, because one of my problems could be too much high dht even with small sensibility to it (i hope) ?

Propecia could certainly help you. Finasteride (the active ingredient in propecia) does not work to reduce the level of DHT in the blood, but changes the way that DHT reacts with your hair follicles.

5) Does using Ketoconazole at long term causes liver problems?

According to some sources, liver problems can be caused by Ketoconazole (http://www.medicinenet.com/ketoconazole/article.htm)


By the way, is for forums and blogs that dr. rassman is the doctor that everyone should choose, i really recommend it and thanks for the great support!

Thanks, we do our best.

-Mark

[striker9]

Lain and Mark, thank you very much for your answers :)

Yes i'll continue to apply carefully but i see no sides what so ever.

1) "But more to the point, we here at NHI haven't really found any evidence that's not anecdotal which supports the idea that these drugs do much to keep hair."

I see, so there's no evidence that they work?

2) by the way about keto, See this for example:

http://home.arcor.de/gekkehenk/HW/Ketoconazol/10.01.2007.Reversalofandrogeneticalopeciaby%20topi cal%20ketoconzole%20-%20Relevance%20of%20anti-androgenic%20activity.pdf

3) And Doesn't propecia reduces the level of dht in the blood? I though it was an dht blocker. It just changes the way that DHT reacts with your hair follicles?

About the ketoconazole i think it's safe to use it topical.


Thanks!

[Mark]

Lain and Mark, thank you very much for your answers :)

Yes i'll continue to apply carefully but i see no sides what so ever.

1) "But more to the point, we here at NHI haven't really found any evidence that's not anecdotal which supports the idea that these drugs do much to keep hair."

I see, so there's no evidence that they work?

Well, define "evidence". I'm sure you can read a bunch of testimonials on the internet that rubbing onions on your head will cure balding, and maybe the person writing that thinks that rubbing onions on their head cured their balding. But that doesn't mean it's what actually happened.

So no, there really aren't any scientific studies that show those treatments work.

2) by the way about keto, See this for example:

http://home.arcor.de/gekkehenk/HW/Ketoconazol/10.01.2007.Reversalofandrogeneticalopeciaby%20topi cal%20ketoconzole%20-%20Relevance%20of%20anti-androgenic%20activity.pdf

I just read through that, and while it's encouraging to hear, it's just a sample of 6 men, most of whom the product did not help. Half of them didn't experience any help from it. If you feel that Ketoconazol will help you, then by all means try it out, but go into it with the understanding that it's not really prescribed for the purpose of curing hair loss and that it's only marginally helpful in that area.

3) And Doesn't propecia reduces the level of dht in the blood? I though it was an dht blocker. It just changes the way that DHT reacts with your hair follicles?

About the ketoconazole i think it's safe to use it topical.


Thanks!

Finasteride reduces the level of DHT in the scalp, not necessarily the blood.

And I'm not trying to say that Ketoconazole is unsafe or anything, just that I haven't seen any evidence that it's all that great of a medication to use to prevent hair loss.

-Mark