[Mark]

Hi Everybody.

I decided to write this FAQ because after having these forums up and running as long as we have, I've started to notice that a lot of the same questions tend to come up and it would be handy to have this information easily accessible. Another factor is just how relatively simple the problem of patterned hair loss really is. You likely wouldn't guess it by reading around on the internet, but there are only two drugs that are FDA approved to treat hair loss and they work pretty well and tend to have very low instances of side effects. So lets start there shall we?

I think I have male patterned baldness! What do I do!?!

The first thing to do is RELAX! Believe me when I say that I understand how stressful losing your hair can be, but being stressed out about it can only make things worse. You can actually lose more hair simply from the stress alone. And on top of that, people who are extremely stressed out about their hair loss tend to have unpleasant experiences that are solely a result of their stress. So first things first, try and get a hold on your stress and paranoia! This will make the following steps MUCH more bearable.

The second step is, if possible, for you to see a doctor. Preferably a doctor that specializes in hair loss as the science of hair loss is not well understood by many doctors in family practice. Remember step 1? Seeing a doctor is a big step in making sure that you stay worry-free as you'll have an expert to speak with who can either confirm or deny your fears. This is important because most of the stress we see in people is because they simply get an idea into their head about something bad happening and they just keep mulling it over with no real resolution to it. It's similar to hypochondria, but I think it's more accurately called "googlechondria" these days.

Now, if you've determined that you actually have MPB and aren't simply worrying too much about nothing, then the solutions that are out there are pretty simple. There are only two FDA approved drugs for the treatment of hair loss: Minoxidil (brand name Rogaine) and Finasteride (brand name Propecia). These are the drugs that we regularly prescribe and recommend to our patients for the simple fact that they have been scientifically proven to work in a large majority of the population, have very few side effects, and the side effects they do have are not permanent and only occur in about 2% of the population.

Ok, I've relaxed and I'm thinking clearly now. Is there any way for me to tell whether I'm losing or gaining hair?

Great question! While it's always best for someone to see a doctor who specializes in hair loss if they think they're losing hair, we understand that's not always possible. So we came up with a way for you to objectively and accurately determine the health and density of your hair follicles: the miniaturization test. By doing a miniaturization test on yourself, you can compare the density of the hair on the sides and back of your head (where hair is not lost to Male Pattern Baldness) to the density of the hair on the top and front of your hair. By doing these tests regularly, you can accurately judge whether you're actually losing hair to begin with, and you can even track whether a particular drug you're taking is working or not. Very valuable considering the price of some of these drugs!

If you don't want to purchase a digital microscope to evaluate your hair on the follicle level, the next best option is to take regular pictures of your scalp so that you can compare how your hair looks over time. This can be much more difficult however due to various reasons such as lighting, angles, and hair length and style being different from picture to picture. So to maximize the accuracy of your photos, here are a few guidelines.

Always take the picture using the same lighting conditions and angle. It doesn't really matter what those conditions are, as long as they're the same from photo to photo. Also, try to keep your hair cut to about the same length by getting regular monthly haircuts. As an example, I've taken three different pictures, all within 5 minutes of each other, using different lighting.







As you can see, as the lighting changes, the appearance of my hair density changes as well. This is why it is so important to have the same angle and light for your before and after photos.

Here's my advice for getting the right photos. Use the same camera every time, on the same settings, in the same room of the house, without any sunlight. What this will do is ensure that your camera will probably use all the same automatic settings for every shot so they'll come out consistent. By taking these photos once a week or twice a month, you can go back after a few months and really see how your hair is progressing or regressing.

Because hair growth is such a slow process, it's very difficult for individuals to objectively tell whether they're losing hair simply by memory. You know how you can go to a family get-together and see people you haven't seen in years, and they'll point out how you've gained or lost weight, but you didn't really notice yourself? It's just like that, but with hair.

I heard that there are pretty severe side effects from Propecia and Rogaine!

The horror stories that we've read on the internet about erectile dysfunction and other side effects from taking Propecia are, in our experience, extremely overblown. Here's an incomplete and small list of side effects I've read about.

Watery semen
Firm, but not "hard" erections
No longer waking up with "morning wood"
Semen smelling different
Inability to achieve an erection once or twice

If these side effects sound like they're happening to someone who is obsessing in an unhealthy manner over their semen and their penis, I would have to agree with you there. And I don't mean that as a pejorative against the people who are suffering these side effects. For those who are experiencing these effects, I'm sure they feel very real. But the fact is that these drugs have been studied in double-blind tests and the number of people actually experiencing side effects similar to what I described above is nearly the same in the people taking the placebo. This is all of course aside from the fact that we see these issues in a VERY small portion of our patients.

Interesting fact: There was a study done with Proscar (5mg finasteride, the same ingredient in Propeica) where doctors prescribing it told only some of their patients that there is a chance of erectile dysfunction. Those that were told this were 50% more likely to experience erectile dysfunction than those who were not told! So remember, people can and do psych themselves out on a regular basis about this stuff.

Basic rule of thumb: If you really, truly feel like you're experiencing these side effects, they'll stop if you stop taking the drug. But again, I would really think long and hard about whether you're really experiencing side effects or whether they're just in your head. Because in our experience with our thousands of patients, these side effects are EXTREMELY rare.

I heard that taking these drugs can cause shedding! I'm not taking these drugs to lose more hair!

Shedding is something that can happen to people taking finasteride or minoxidil, but like ED issues, it is very rare and tends to be overblown on the internet compared to how often it actually happens. So what causes shedding? Here's a quote from Dr. Rassman:

"Hair growth works in cycles. When Rogaine causes hair shedding it may induce the hair shaft to fall off; the follicle would then enter a dormant phase in the cycle (temporarily) while the matrix is restructured for future growth, hopefully with a thicker and stronger hair shaft. "

So yes, shedding CAN happen, but it's very unlikely and not something that we think should make or break a patients decision to use finasteride or minoxidil. Typically if you simply keep taking the drug, the shedding will cease and you will grow back all the hair you lost due to shedding and more. Because it's such a long process (nine months to a year to grow new hair), it can seem like a lifetime, but you can't change time!

If Finasteride and Minoxidil both work to treat hair loss at their recommended dosage, if I raise the dosage it should make me grow even more hair, right?

WRONG! Wrong wrong wrong wrong wrong!

The fact that Finasteride and Minoxidil both have relatively harmless side-effects, and certainly not life-threatening ones, should not lure you into a false sense of security that they're completely harmless. They are drugs. Drugs that are regulated by the FDA for a reason. Taking too much of anything can be bad for you, and these drugs are no different.

Not only is it simply bad practice to take drugs in any dose aside from what's prescribed for basic health reasons, it can actually prevent these drugs from growing any hair at all! Or even worse, to actually make you lose MORE hair! Not a really smart idea if you're trying to grow more hair huh?

In addition to the problems that it can cause, there's an even more basic reason to not take too many drugs at once. Lets say you start taking propecia, avodart, and finasteride all at once and you actually DO grow hair. You'll never really be able to tell what it was that ended up working for you. This is why we recommend that people start taking one drug, see how it works, and then go from there. That way you're really able to say definitively whether a drug works for you or not. We all wish that there is a silver bullet for hair loss, but wishing it will not make it so.

I'm 20 years old and my hair doesn't look the way it did when I was 15! Am I losing my hair?

Short answer: Probably not. There is a distinct phase of hair growth that all men go through whether they have MPB or not, and that's moving from a juvenile hairline to an adult hairline. Dr Rassman has a great blog post here discussing exactly what that is.

http://www.baldingblog.com/2006/10/0...d-with-photos/

As you can see, everyone has a hairline that goes from juvenile to mature, and you should carefully consider whether that's happening to you before jumping to the conclusion that you're going bald. If you are in your early 20's and your hairline is higher than it was when you were younger, but you're not seeing a lot of hair coming out in the shower (truly a lot, not simply 20 or so hairs, but much more), then the likely chance is that you've got nothing to worry about.

My *insert relative here* was bald! Does that mean I'm going to be bald too?!?!

Not necessarily. Baldness is indeed a genetic trait that is passed down from your mother and father to yourself, however there is not any surefire way to be positive that you'll end up bald simply because your father or grandfather was. Nor does it mean that you won't be bald simply because your father wasn't bald! That's very important to note, because a lot of men incorrectly think that the fact that their grandfathers were not bald, that it's impossible for them to be bald as well. Not true!

Just like eye color, hair waviness, and skin tone are all traits that are passed down from parent to child, and so is the gene for balding. As of now, there is only one way to see if you've got that gene, a HairDX test, but even that test comes with a catch because it can tell whether you have the genetic predisposition toward balding, but it can't be sure whether that gene is recessive or dominant. So the test will tell you whether you have the gene for balding, but it cant' predict whether that gene will actually cause you to bald. You may be wondering what the point is of the test if the results from it seem so vague, but it can also tell you that you don't have the gene, which means that you can be certain that you won't suffer from MPB. That has a tremendous amount of value to some men. Whether it does to you is a personal choice.

So to simplify things, family history of baldness is certainly an indicator, but don't let that worry you because there's really no way to predict baldness based solely on family history. The best way we know how to check for balding is by actually watching the progress of your hair growth to monitor for the well-known stages of MPB.

I know that Finasteride and Minoxidil work best in the crown, but will they work in the hairline as well?

It depends. People tend to think of these drugs as silver bullets that just stop hair loss but that's not really accurate. It can be said that they work best in the crown because that's where most people will see the best results. However, some people see great results all over their scalp. Smaller numbers may see no improvement at all. There is no real way to tell exactly how well, or in which location you will see the benefits of using these drugs, they simply need to be tried out to see how they work with you. If anyone tells you that they can guarantee that these drugs will work, or more specifically that they will work in a particular area of the scalp, watch you wallet!

That being said, most people will see some improvement from these drugs, and with the side effects being as low as they are, there is little reason to not try them if you're serious about rolling back or preventing hair loss.