15 years on Minoxidil, time to change ! - advise please !

[jimjohn]

ok so you guys are saying that minoxidil doesnt stop or slow down the hair loss, it just gives you some regrowth right? because i emailed dr. lee and i asked him that i heard that minoxidil doesnt really stop the hair loss and he replied this is not true.
so did i just word the question wrong? can someone explain.

 

[rockandroll]

I think it's largely a matter of wording. Yes, both slow down hair loss. Propecia does it by blocking DHT, and Rogaine does it by jumpstarting follicles that are aimed towards death. HOWEVER. Only Propecia attacks the source of the problem, which:

a) Makes for a somewhat preventive correction rather than a corrective one, which is generally the way to go with medicine if possible.

b) Will probably make you capitalize on Rogaine more because the follicles that you are jumpstarting will not be under the "attack" of DHT miniaturization, so that the Rogaine will not have to be fighting progressive miniaturization, so to speak.

I'm also not sure of this, but I'm under the impression that Propecia is generally more effective in the long run. i'm sure a more veteran poster can elucidate that.

 

[Dave001]

Yep. How much time it buys you depends on your natural rate of balding.

That remains to be proven.

 

[Bryan]

ok so you guys are saying that minoxidil doesnt stop or slow down the hair loss, it just gives you some regrowth right? because i emailed dr. lee and i asked him that i heard that minoxidil doesnt really stop the hair loss and he replied this is not true.
so did i just word the question wrong? can someone explain.

The problem is that whenever this issue comes up, there's always a potential for misunderstanding by one or more parties. However, I think Dr. Lee should know better than to claim (apparently) that minoxidil can stop hair loss. That makes me wonder if he's read ANY of the long-term minoxidil studies. Sheesh.

Bryan

 

[Bryan]

a) Makes for a somewhat preventive correction rather than a corrective one, which is generally the way to go with medicine if possible.

But you're implying that minoxidil has a "corrective action", which it doesn't. Not in the long-term, anyway. Balding apparently continues, despite the use of minoxidil.

I'm also not sure of this, but I'm under the impression that Propecia is generally more effective in the long run.

Of course. Because minoxidil doesn't stop balding.

Bryan

 

[Bryan]

Yep. How much time it buys you depends on your natural rate of balding.

That remains to be proven.

So you don't believe the general idea that topical minoxidil only provides you with an "offset" of growth?

 

[rockandroll]

By "corrective," I meant that it deals only with the symptoms of DHT (that is, it counteracts miniaturization by stimulating follicles...a war that will admittedly be lost eventually if only Rogaine is used), and not with the underlying cause. I did not mean that it stops balding. And for that matter, neither does Propecia in the long run for most people; it only slows it down.

I'm not arguing that Rogaine is more effective than Propecia or not. I don't know (and I don't think it is) and I really don't care 'cause I use both.

The scientific data on Rogaine (and even the little instruction manual that comes with it) clearly explains that Rogaine is meant for maintenance, and that regrowth is only seen in a percentage of people out of the 100% that get to keep hair. Not only that, but even people in this forum have managed to maintain their hair on Rogaine only. Sure, it loses its effectiveness somewhat after a 5-year period, but I certainly wouldn't call 5 years a short time. Yeah, sure, Rogaine doesn't stop balding, it slows it down, but as far as I'm concerned that's pretty damn good news.

 

[Secret]

Re: 15 years on Minoxidil, time to change ! - advise please

Ok here we go, first post by me so hello guys! I need informed advise and can't think of a better bunch to ask !

Quick history. Balding since 21. Been on 1ml of 2% minoxidil twice a day consistently for @15 years - yep 15 (anyone here been consistently on it longer?) I’m 36 now and somewhere between Norwood 3A&3V. minoxidil has done a job – never regrowth but I'm certain (certain!) its slowed things down. However in last 6 months Mr male pattern baldness is winning the battle so its decision time – what do I do now ?

My options as I see them -

1)Do nothing. Continue wth 2% minoxidil and accept what male pattern baldness has in store for me. Yep it’s horrendous but I am frankly sick of my daily hair battle so maybe its time to say screw it, avoid the health risks and go with the flow.

2)Move up to 5% Minoxidil. I am thinking this is probably the safest option when weighing up between doing something to battle back and the risks of using more long term drugs.

3)Go on finasteride (and continue 2% minoxidil). However I am worried by finasteride - The side effects, shedding, cost, well I don’t need to tell you do I ? You all know the questions and concerns.

4)Go on finasteride and up to 5% minoxidil at the same time. I have a feeling this is what you guys will advise. However please think long and hard before you simply say “do itâ€. I am putting a lot of faith in what you advise me. Remember I have been 15 years on 2% minoxidil. I am worried by submitting myself to a lifetime of more and stronger drugs plus if it works I wont know if one drug alone would have done it.

My goal is to keep what I have, anything else is a nice plus !
So which way to go ? ….My gut feeling is 5% minoxidil for 6 months with finasteride as a fall back. What do you think guys ? and thanks for bearing with me on this.

Gosh I'm similar to you mate.
I have always had fine hair but with no body. When I hit 21 I started receding so I hit the Regaine 2% (but switched to 5% when it became available) Cost £30 a month back in late 80’s so I've been on minoxidil for over 18 years. It worked like a dream until I hit 35 then I noticed I was fast becoming a Norwood 2.5. So I researched the hair loss sites and found this site. I spent months going through each post reading the good and the bad. I decided to go on the big 3 plus Centrum and within 2 months I had the big shed, my crown almost slick bald. After 7 months I noticed my fringe getting longer until one day I found something in my eye and it was hair. My crown has now thickened up enough to feel thick when I style my hair, which is now cosmetically good. Where my fringe had become to miniaturise before I started on Proscar, I now have the original texture of hair on my forehead before my loss. I switched to Kirkland minoxidil about 8 months ago, which pays for my finasteride by itself so I couldn’t be happier.
You must get on finasteride as DHT will get your hair as you get older. Don't forget its easier to maintain what hair you have now, rather than to regrow any new hair.

 

[Dave001]

Yep. How much time it buys you depends on your natural rate of balding.

That remains to be proven.

So you don't believe the general idea that topical minoxidil only provides you with an "offset" of growth?

Well, an "offset" is a convenient way of explaining the aggregate results from some studies, but it doesn't tell us for whom it works best. I think it is probably more complicated on an individual basis. Especially because so many people in their early twenties come here in a state of panic as a consequence of premature and aggressive balding, I think we should be careful not to discourage anyone from pursuing a treatment that could potentially help quite a bit, when we don't *really* know whether such persons are more or less likely to be responsive to treatment.

It's probably safe to say that all else being equal, a slowly progressing pattern of alopecia is easier to treat than its counterpart, but all else is seldom equal. What about those few individuals who actually regrow substantial hair (that photo on Dr. P's Web site comes to mind) on a formerly bald area? Strictly speaking, their loss was not progressing at all (at least in that region) because they had nothing left to lose. ;-) I suppose it could be argued that the follicle continues to miniaturize and/or fibrose long after the hair is no longer visible (I would guess that it does, but that's actually an interesting question).

 

[Dave001]

The scientific data on Rogaine (and even the little instruction manual that comes with it) clearly explains that Rogaine is meant for maintenance, and that regrowth is only seen in a percentage of people out of the 100% that get to keep hair.

That must be something new. Just a few years ago they were making prevention their selling point. Can you quote or cite the manual to which you're referring?

 

[Bryan]

By "corrective," I meant that it deals only with the symptoms of DHT (that is, it counteracts miniaturization by stimulating follicles...a war that will admittedly be lost eventually if only Rogaine is used), and not with the underlying cause. I did not mean that it stops balding. And for that matter, neither does Propecia in the long run for most people; it only slows it down.

But Propecia certainly has the potential to stop balding in the long run for some people, and slows the process in the remaining ones. That puts it in a different class from minoxidil.

I'm not arguing that Rogaine is more effective than Propecia or not. I don't know (and I don't think it is) and I really don't care 'cause I use both.

The word "effective" as used in this context is rather ambiguous, because the two drugs have such different actions. The evidence seems to show that topical minoxidil produces somewhat better improvements in haircounts and hairweights per unit area of scalp where it's applied than Propecia in the short-term, but as time goes by, Propecia inevitably overtakes and surpasses it. That's because Rogaine doesn't interfere with the fundamental balding process, and Propecia does.

So minoxidil is more "effective" in one sense, but Propecia is more "effective" in another.

The scientific data on Rogaine (and even the little instruction manual that comes with it) clearly explains that Rogaine is meant for maintenance, and that regrowth is only seen in a percentage of people out of the 100% that get to keep hair.

I think that's false and misleading, although I'm not all that surprised that they would say that in something intended for a lay audience. Rogaine doesn't "maintain", except (as I said before) in a rather superficial sense. If I were calling the shots at the FDA, I'd make them change that statement to something a little more accurate! :wink:

Not only that, but even people in this forum have managed to maintain their hair on Rogaine only.

I doubt that anyone here "maintained" their hair on Rogaine alone. I think what happened is that their natural rate of balding didn't happen to progress during that period of time. It _does_ happen, you know: sometimes balding will progress to a certain point, and then stop. Or it may stop for a while, and then start to progress again at a later time.

Sure, it loses its effectiveness somewhat after a 5-year period, but I certainly wouldn't call 5 years a short time.

In my opinion, topical minoxidil doesn't lose its effectiveness after 5 years. I believe it probably continues to provide an "offset" of growth for as long as you use it.

Yeah, sure, Rogaine doesn't stop balding, it slows it down, but as far as I'm concerned that's pretty damn good news.

It "slows" it only in a superficial sense.

Bryan

 

[lucky Horseshoe]

Again, a big up ! to everyone for their postings on this, very informative indeed.

Opinions here seem to be leaning towards me going the finasteride route at the moment….it’s a tough call but this is all helping.

Secret – I was very interested in your comments as you went onto finasteride after a prolonged period on minoxidil, like you say, very similar situation…would you mind elaborating a little more on your experience? You mention you were close to N2.5 when you started finasteride. What would you say the Shed took you to ? Also how many years have you been on finasteride now and what would you say your rating is now ?

Any other guys out there who also went onto finasteride after a prolonged period on minoxidil ? It would be great to hear from you as I am sure I not alone in wanting to learn from your experience.

 

[Bryan]

Yep. How much time it buys you depends on your natural rate of balding.

That remains to be proven.

So you don't believe the general idea that topical minoxidil only provides you with an "offset" of growth?

Well, an "offset" is a convenient way of explaining the aggregate results from some studies, but it doesn't tell us for whom it works best.

No, but that's a separate issue, having nothing to do with whether or not minoxidil provides an "offset" of extra growth.

I think it is probably more complicated on an individual basis. Especially because so many people in their early twenties come here in a state of panic as a consequence of premature and aggressive balding, I think we should be careful not to discourage anyone from pursuing a treatment that could potentially help quite a bit, when we don't *really* know whether such persons are more or less likely to be responsive to treatment.

I totally agree with you! Considering how relatively inexpensive minoxidil is these days, there's no reason not to give it a try, if you want to stimulate some extra growth. However, it's rather pointless if you don't use it in conjunction with other things that can get more to the root of the problem.

Bryan

 

[Dave001]

Well, an "offset" is a convenient way of explaining the aggregate results from some studies, but it doesn't tell us for whom it works best.

No, but that's a separate issue, having nothing to do with whether or not minoxidil provides an "offset" of extra growth.

Uh, I suppose the connection isn't readily apparent on rereading. You said earlier that "[h]ow much time it buys you depends on your natural rate of balding." What I meant was that one's natural rate of progression may not be the only (or even the greatest) factor in determining how long minoxidil is able to arrest the process. But you're right: that's separate from the issue of whether or not the results from some of the studies can be explained as an offset. One cannot argue with experiment.

I think it is probably more complicated on an individual basis. Especially because so many people in their early twenties come here in a state of panic as a consequence of premature and aggressive balding, I think we should be careful not to discourage anyone from pursuing a treatment that could potentially help quite a bit, when we don't *really* know whether such persons are more or less likely to be responsive to treatment.

I totally agree with you! Considering how relatively inexpensive minoxidil is these days, there's no reason not to give it a try, if you want to stimulate some extra growth. However, it's rather pointless if you don't use it in conjunction with other things that can get more to the root of the problem.

I certainly don't think it's optimal, but I wouldn't say it's pointless, either. Some people have maintained since minoxidil's inception as a 2% topical by prescription (anyone know offhand when that was? ~ 20 years?), though controlled studies suggest they're probably the exception. In all cases, they're probably better off than having used nothing at all. However, a minoxidil only treatment regimen isn't a good idea if maintaining hair over the long run is a big concern, if only because there are relatively inexpensive add-ons such as topical spironolactone that will greatly increase the probability of success.

It would be interesting to see whether at least part of minoxidil's declining effectiveness over time is due to chemical tolerance, but I don't expect that we'll be seeing controlled trials of minoxidil with groups arranged into various cyclical patterns of use.

 

[Bryan]

Well, an "offset" is a convenient way of explaining the aggregate results from some studies, but it doesn't tell us for whom it works best.

No, but that's a separate issue, having nothing to do with whether or not minoxidil provides an "offset" of extra growth.

Uh, I suppose the connection isn't readily apparent on rereading. You said earlier that "[h]ow much time it buys you depends on your natural rate of balding." What I meant was that one's natural rate of progression may not be the only (or even the greatest) factor in determining how long minoxidil is able to arrest the process.

Well, I suppose you mean that the size of the offset itself is obviously also a factor! Yeah, those would be the two determining factors: your natural rate of balding, and the size of the offset that you get (how well you respond to minoxidil in the first place).

I totally agree with you! Considering how relatively inexpensive minoxidil is these days, there's no reason not to give it a try, if you want to stimulate some extra growth. However, it's rather pointless if you don't use it in conjunction with other things that can get more to the root of the problem.

I certainly don't think it's optimal, but I wouldn't say it's pointless, either. Some people have maintained since minoxidil's inception as a 2% topical by prescription (anyone know offhand when that was? ~ 20 years?), though controlled studies suggest they're probably the exception. In all cases, they're probably better off than having used nothing at all.

Yes. If my general theory is correct, then they're better off by the size of the offset (assuming that their hair still exists at all, of course).

It would be interesting to see whether at least part of minoxidil's declining effectiveness over time is due to chemical tolerance, but I don't expect that we'll be seeing controlled trials of minoxidil with groups arranged into various cyclical patterns of use.

Dave, my fundamental point here is that minoxidil DOESN'T decline in effectiveness over time (according to my theory). Other factors in the scalp worsen, so the balding process eventually overtakes the effect of the minoxidil.

Bryan

 

[Dave001]

Well, I suppose you mean that the size of the offset itself is obviously also a factor! Yeah, those would be the two determining factors: your natural rate of balding, and the size of the offset that you get (how well you respond to minoxidil in the first place)..

No, I wasn't limiting the variability in response to any specific factors.

Dave, my fundamental point here is that minoxidil DOESN'T decline in effectiveness over time (according to my theory). Other factors in the scalp worsen, so the balding process eventually overtakes the effect of the minoxidil.

But it does decline in effectiveness according to the declining hair counts in the studies.

 

[Bryan]

Dave, my fundamental point here is that minoxidil DOESN'T decline in effectiveness over time (according to my theory). Other factors in the scalp worsen, so the balding process eventually overtakes the effect of the minoxidil.

But it does decline in effectiveness according to the declining hair counts in the studies.

Haircounts decline, but that's because of the continuation of the balding process per se, not any declining effect of the minoxidil (according to my theory).

Bryan

 

[Dave001]

Haircounts decline, but that's because of the continuation of the balding process per se, not any declining effect of the minoxidil (according to my theory).

Your theory?? No! Not you too! It's not too late; you can still resist the Dark Side. (Unless of course your theory is based on contact inhibition, in which case there is no hope of recovery. Ever. But I have enough confidence in you to know that's not the case.)

I assume you mean that follicular damage continues during continued minoxidil use. I'm warning you that I will continue to play dumb on this issue until you concede that "tolerance" is not synonymous with chemical/drug tolerance (the former includes, but is not restricted to the latter). Failure to heed this warning may result in serious repercussions, including condemnation to an eternity of severe torture, which includes lectures on the Dermal Hydraulic Model of Balding and readings from My Favorite Letters: Current Leading Hair loss Researchers are Thinking Along the Same Lines.

 

[Dave001]

Re: 15 years on Minoxidil, time to change ! - advise please

Quick history. Balding since 21. Been on 1ml of 2% minoxidil twice a day consistently for @15 years - yep 15 (anyone here been consistently on it longer?)

I know a guy who has been on minoxidil from the time it first came out as a 2% topical by prescription. Does anyone know when that was offhand? About 20 years ago? (I hadn't even reached puberty back then.) He claims that it has prevented further progression, and unlike the people that post to Internet forums, I don't doubt his ability to make a reasonably accurate judgement (i.e., there is no visually apparent progression).

 

[Secret]

Again, a big up ! to everyone for their postings on this, very informative indeed.

Opinions here seem to be leaning towards me going the finasteride route at the moment….it’s a tough call but this is all helping.

Secret – I was very interested in your comments as you went onto finasteride after a prolonged period on minoxidil, like you say, very similar situation…would you mind elaborating a little more on your experience? You mention you were close to N2.5 when you started finasteride. What would you say the Shed took you to ? Also how many years have you been on finasteride now and what would you say your rating is now ?

Any other guys out there who also went onto finasteride after a prolonged period on minoxidil ? It would be great to hear from you as I am sure I not alone in wanting to learn from your experience.

I went from a N 2.5 to about a 3 which I have to admit I certainly didn’t enjoy at the time although I was expecting it after researching how your hair needs to shed the damaged hair and then to rest while the follicle increases its size to grow back stronger and longer. Don’t forget this has to happen many times before it gets to an acceptable thickness and length. I’ve been on finasteride for 18 months now and I do not regret a single day. I now have hair at a cosmetically good length. My crown has filled in perfectly and has never looked better. My hair looks the same as when I was in my mid twenty’s (I’m mid 30’s now) and its still improving.
My only advice to you is to start taking finasteride + 5% minoxidil and have patience. Also keep to the same dosage and don’t miss a day.
This will take a long time before you get any cosmetic benefit, at least a year before you can be really happy with results. Also don’t stand in front of the mirror every day examining your hairline or trying to see how many hairs you can pull out or even worse counting the hairs in the sink. Good Luck
P.S
I'm now below a N 2 and very happy