Thank you for your question.
You submitted your question without a photo. And you’re describing in your question that
you’ve been on minoxidil for about 4 weeks and that it has been your observation that
your hair loss is actually getting worse to the point that you are counting over a hundred
hairs per day. And it seems that you’re asking whether or not this is caused by the
minoxidil. Well, I can certainly share with you how I discuss the use of minoxidil in
my practice for patients who like yourself are dealing with hair loss.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a
system we developed which was derived from the use of platelet-rich plasma (PRP) and
Acellular matrix during hair transplant as an additional tool in the treatment armamentarium
for men and women with genetic pattern hair loss. And we treat patients from all around
the world and we’ve been doing this since 2011.
So I spend a lot of time putting the treatment strategies into context for people who are
suffering from male pattern hair loss. And it’s important to understand that the use
of minoxidil may have a certain value based on its pharmaceutical effect but its relative
success for patients does vary. And it’s also important to recognize that the drug
which was originally a drug for hypertension, for high blood pressure, had this side-effect
of hair growth. However, there is variable expression of male pattern hair loss. So you
can understand that there are people who start losing hair early and they lose hair very
fast. There are people who start losing hair closer to their late 30s and lose hair very
slowly and there is a wide variation in between. So it is common that patients will do something
called a correlation-causation error which means that they will use a drug like minoxidil
and because their hair loss is still progressing, they feel that the drug caused the hair loss.
It’s kind of a temporal thing but not necessarily a cause and effect.
It’s also important to understand that minoxidil is not the only treatment for hair loss. And
that if you are progressing, you may want to also look at other strategies and this
is the discussion that I’ll have with my patients. Essentially, just to go over the
concept of Hair Regeneration, when we were doing hair transplants and we wanted to help
our patients for a better wound healing in the donor area as well as better graft survival,
the material that we used, Acellular matrix and platelet-rich plasma (PRP) appeared to
also stimulate hair growth and so thinning hairs became thicker that were not transplanted.
And from that, we derived a system to help patients maximize hair growth.
And what we do is essentially an injection treatment and then we watch our patients.
And routinely, we’ll also do a booster injection around 15-18 months or 15-24 months depending
on a profile that I developed from all these years of experience in treating so many patients
from around the world. And basically the profile that I am referring to is based on the gender,
the age of the patient, the age of onset of hair loss, the rate of progression of hair
loss, the degree of progression as well as other variables which is the use of different
drugs, the certain hormonal issues and other medical conditions.
That being said, it is not unusual for me to hear the story that someone tried minoxidil,
they got frustrated with it and then they abandoned it or they tried minoxidil and they
thought that it made their hair loss worse.
So when I see a patient and they learn about Hair Regeneration and they want to come for
a treatment, I also discuss with them other options that includes transplant, that also
includes for men the use of a DHT blocker like finasteride. It’s very important to
understand that regardless of the strategy where no one is curing hair loss, what we
are doing is we’re working with your genetics to maximize the longevity and coverage of
your scalp.
So a lot of my patients who are describing a scenario like yours where they’re losing
a lot of hair, if it’s a male pattern hair loss patient, then I’ll say to them well
even with Hair Regeneration where we can really, independent of other drugs, make a big impact,
I have attributed a certain level of DHT sensitivity based on a person’s profile. So for a lot
of our patients, I still have a discussion about DHT and I’ll put them also on a drug
like finasteride.
Now of course, there’s a lot of fear about finasteride and the medical community still
has a general consensus that the drug is effective and is relatively safe enough to continue
prescribing it with consistency. That being said, the key to hair loss is not just DHT.
We’ve had many patients who were on finasteride and they would still progress but I feel that
the DHT blocker did have a value in sustaining the hair follicle longer than otherwise would
have been without the pharmaceutical intervention. In those patients, I’ll do a Hair Regeneration
treatment and their hairs will get thicker. So DHT blocking will prolong the lifespan
of the hair. The stimulation of Hair Regeneration results in better coverage. So ultimately,
there's kind of a synergy opportunity there.
Now if someone has been on minoxidil for an extended period of time then I usually let
them stay on it because that’s a strategy to control a variable. However, minoxidil
has a certain pharmaceutical effect that is dependent on the drug being continuously applied
and the relative responsiveness. And I would argue that it is really dependent on relative
DHT sensitivity and the rate of progression. So if someone has, let’s say, someone in
their late 30s or really 40s is starting to lose hair to the point that they’re noticing
something, that somebody who has a later onset probably has a slower progression, someone
like that generally seems to do well with minoxidil. In contrast, a younger person with
an early onset and rapid rate of progression generally doesn't seem to find value in the
use of minoxidil.
So I would say that it is important for you to explore all the options you have to help
you with your hair loss that includes the drug called finasteride, the technology of
PRP and Acellular matrix which we call in our practice TrichoStem™ Hair Regeneration
as well as of course, what everyone knows about hair transplant and see what strategy
makes the most sense for you. And as far as the minoxidil is concerned, it is again, without
the benefit of more information and detail, I can’t say if the minoxidil is not going
to have any value in your long-term treatment strategy but I think you have to look at other
options in order to get the most optimal strategic benefit for your hair loss situation.
So I hope that was helpful, I wish you the best of luck and thank you for your question.