Dr Lam's Hair Restoration Forum

Hi doctor Lam,

My hair first started thinning around the age of 21. It was visibly noticeable and many people often commeted on this. I was thinning at the front mainly.
I read about Rogaine and gave it a try. I started off on the regular strength (2%) and then quickly progressed to the extra strength (5% minoxidil) version. The results were just short of amazing. After 3 years of using it everyday I had regrown ALL of my lost hair and there were no signs of any hair thinning at all. I was aged 24 at this point.

However, after about the 3 year point I did start to see signs of thinning in the front again. The one thing that always bothered me while using Rogaine was that it gave me an itchy head and dandruff. At this stage I decided to use a supplement based product instead called Nourkrin.
So I started using this instead of Rogaine. My hair loss progressed gradually. I lost quite a bit of hair during this period. After probably around 8 months I decided to stop using Nourkrin as it didn't work well and started using Rogaine again. However it seems that Rogaine has lost its effectiveness on me.

At this point I am aged 25 and my hair loss is progressing further, even after continuing to use Rogaine everyday. One thing I can also say is that I was finding Rogaine quite expensive to use and did try out a Generic Kirkland version of minoxidil but I questioned it because it was very oily compared to the Rogaine version, so I wondered if it was a lower quality. I therefore have continued with the expensive Rogaine version.

I am now aged 28 and have really lost a lot of hair and I would say I am at Norwood type V.
Other things I have tried within the past 6 months or so include: shaving my head daily, taking Biotin and Saw Palmetto, and using the HairMax lasercomb. I have seen some sexual side effects while using 1000mg of saw palmetto daily, which includes diminished libido and erectile dysfunction (to a tolerable degree). I have wondered if this means that Saw Palmetto is working in the same way that Propecia does?

I am now seriously thinking about starting to use Propecia. Firstly though I would like to ask about any possible interactions with nutritional supplements that I take daily and if these supplements could possibly interact with Propecia then I would stop using them before I start taking Propecia.

thanks for your detailed history. here are my thoughts:
1. nothing will stop hair loss especially if you are young and rapidly losing hair but medications can help.
2. the generic rogaine and the brand have the same effectiveness or should if it contains 5% minoxidil. when you said 2% was regular strength and 5% was extra strength, a better way to phrase that is 2% is for women and 5% is for men. if you were having any scalp issues with brand rogaine, the risk of generic really is that it can be more irritating but effectiveness wise should be about the same. i cannot speak of the Kirkland brand per se.
3. propecia works very well and works through a different pathway than minoxidil so that they work together synergistically. you should have a much better outcome with combining these two medications. however, as you may know propecia has about 1.5% higher incidence of sexual side effects as compared against placebo.
4. i am not aware of any negative interactions with the medications you have listed. however, i would bring that list into the doctor prescribing your propecia so that you can get his or her medical advice.
5. as far as saw palmetto is concerned, my understanding is that it truly works more on the prostate than on the scalp hair. however, i know of one alternative medical journal that says it does work on the scalp. i think the jury is out on this and i am personally not convinced it works for hair but if it is doing something for you that is encouraging.
best,
s.

Hi Dr. Lam, thank you for your response. I have a few follow up questions. I have highlighted them with ##.

RE. 1.
## I recently heard about stem cells for hair regrowth, do you know if there has been any advancements in this area yet? ##

I watched a video clip about this which sounds encouraging, see the link below:
http://www.youtube.com/watch?v=sO6jgkW9c8E&feature=results_main&playnext=1&list=PL47E5AC37F504DDF6

RE. 2.
## Why does minoxidil lose its effectiveness over the years? ##

Is it that Minoxidil becomes less effective over time with increasing DHT levels such that the minoxidil is no longer potent enough to keep the follicle from shrinking? This is my educated guess.

RE. 5.
## Do you think that the sexual side effects I have experienced while taking Saw Palmetto suggest that it works to block DHT? ##

I am very interested in this for two reasons:

Firstly, when I started to take Saw Palmetto I was unaware of any possible side effects at all, in fact I did not know anything about Saw Palmetto other than that it is a herb available in supplement form and some have said it is good for hair loss. My point here is that I had no previous knowledge about Saw Palmetto so this completely rules out the possibility of the side effects I experience being some kind of a placebo effect.
Furthermore, I had not started taking anything else either and also my lifestyle, diet, etc. had not changed in any way.
I also stopped taking Saw Palmetto for a few days and the sexual side effects went away, and then came back once I started taking it again.

I find it interesting how the side effects I have seen with Saw Palmetto match the side effects some people report while using Propecia. These include:

- less sexual desire
- more difficulty getting an erection
- watery semen

It seems that my body has adjusted to Saw Palmetto now and I only get the above side effects at tolerable levels.

The second important thing I would like to note while using Saw Palmetto is that I have seen a little bit of hair regrowth (new very fine baby hairs have appeared around the hairline that were not there before) and I have not noticed any further hair loss. However, I have also been using the hairmax lasercomb, as well as biotin, so I cannot accurately pin-point the exact causal effect of my hair regrowth. Although it is thought provoking none the less.

## You did mention one alternative medical journal that says it does work on the scalp. Could you point me in the direction of this? I would very much like to read it. ##

Thank you Dr. Lam, I look forward to hearing from you.

ANSWERS ARE IN ALL CAPS BELOW:

RE. 1.
## I recently heard about stem cells for hair regrowth, do you know if there has been any advancements in this area yet? ## SO FAR WE ARE REALLY NOT CLOSE YET.

I watched a video clip about this which sounds encouraging, see the link below:
http://www.youtube.com/watch?v=sO6jgkW9c8E&feature=results_main&playnext=1&list=PL47E5AC37F504DDF6

RE. 2.
## Why does minoxidil lose its effectiveness over the years? ## IT REALLY DOES NOT. YOU JUST CAN'T STOP HAIR LOSS ESPECIALLY IF YOU ARE YOUNGER BUT MINOXIDIL CONTINUES TO WORK JUST AS WELL OVER THE YEARS AND IS A VERY IMPORTANT PRODUCT TO HELP WITH HAIR LOSS IN MY OPINION.

Is it that Minoxidil becomes less effective over time with increasing DHT levels such that the minoxidil is no longer potent enough to keep the follicle from shrinking? This is my educated guess.

RE. 5.
## Do you think that the sexual side effects I have experienced while taking Saw Palmetto suggest that it works to block DHT? ## NO, BECAUSE SINCE THE SAW PALMETTO DEFINITELY WORKS ON THE PROSTATE, IT CAN AFFECT YOU SEXUALLY BUT THAT IS NO EVIDENCE THAT IT WOULD HELP THE HAIR ON YOUR HEAD.

I am very interested in this for two reasons:

Firstly, when I started to take Saw Palmetto I was unaware of any possible side effects at all, in fact I did not know anything about Saw Palmetto other than that it is a herb available in supplement form and some have said it is good for hair loss. My point here is that I had no previous knowledge about Saw Palmetto so this completely rules out the possibility of the side effects I experience being some kind of a placebo effect.
Furthermore, I had not started taking anything else either and also my lifestyle, diet, etc. had not changed in any way.
I also stopped taking Saw Palmetto for a few days and the sexual side effects went away, and then came back once I started taking it again.

I find it interesting how the side effects I have seen with Saw Palmetto match the side effects some people report while using Propecia. These include:

- less sexual desire
- more difficulty getting an erection
- watery semen

It seems that my body has adjusted to Saw Palmetto now and I only get the above side effects at tolerable levels.

The second important thing I would like to note while using Saw Palmetto is that I have seen a little bit of hair regrowth (new very fine baby hairs have appeared around the hairline that were not there before) and I have not noticed any further hair loss. However, I have also been using the hairmax lasercomb, as well as biotin, so I cannot accurately pin-point the exact causal effect of my hair regrowth. Although it is thought provoking none the less.

## You did mention one alternative medical journal that says it does work on the scalp. Could you point me in the direction of this? I would very much like to read it. ##
I DON'T KNOW WHICH ONE BUT YOU CAN SEARCH FOR IT ON MEDLINE. JUST GOOGLE MEDLINE.