Ask Dr. Lam

Hi.

A New York Times article said that there's no evidence that chlorine can lower the number of hair follicles. However, maybe that conclusion was based on studies concerning only terminal hairs. Do you think chlorine might have a negative effect on vellus hairs? In other words, is there any reason to wonder if chlorine is bad for those who have male-pattern baldness and makes it harder for minoxidil and finasteride to bring back hair? Chlorine still sticks tenaciously to skin and hair long after a swimmer gets out of the pool and showers. (I had already started my second quarter of a swim class before it became obvious that I was losing hair fast. Age 33.)

Do you think shaving one's head daily, i.e. the shaving cream and razor going over the scalp every day, is likely to have an adverse effect on vellus hair follicles, making it harder for minoxidil and finasteride to bring back terminal hairs? (While waiting and hoping for hair to come back on the front of my scalp, I'd prefer to shave my head. I can't hide minoxidil there anyway, and I don't bother putting any on if I'm leaving the house.)

Do you have an opinion on the effect of fish oil supplements on hair and skin?

Is it alright to use a generic brand of minoxidil (e.g. Safeway), or is it better to use Rogaine? (I was hoping to see you about scars in the summer, but now my extra money is being wasted on minoxidil and Propecia.)

The literature that came with some generic brand minoxidil says that minoxidil can cause a little hair loss during the first couple of weeks, before it causes hair growth. I noticed something about this in an online article as well. Is it true that minoxidil can initially cause a little bit of hair loss? And if it's true, do you happen to know what causes this paradoxical effect?

Thanks for setting up these forums.

Hi.

A New York Times article said that there's no evidence that chlorine can lower the number of hair follicles. However, maybe that conclusion was based on studies concerning only terminal hairs. Do you think chlorine might have a negative effect on vellus hairs? In other words, is there any reason to wonder if chlorine is bad for those who have male-pattern baldness and makes it harder for minoxidil and finasteride to bring back hair? Chlorine still sticks tenaciously to skin and hair long after a swimmer gets out of the pool and showers. (I had already started my second quarter of a swim class before it became obvious that I was losing hair fast. Age 33.)
HONESTLY, I HAVE NO IDEA ABOUT CHLORINE. I DON'T THINK IT SHOULD HAVE ANY NEGATIVE EFFECT, BUT YOU SHOULD ASK YOUR DERMATOLOGIST.
Do you think shaving one's head daily, i.e. the shaving cream and razor going over the scalp every day, is likely to have an adverse effect on vellus hair follicles, making it harder for minoxidil and finasteride to bring back terminal hairs? (While waiting and hoping for hair to come back on the front of my scalp, I'd prefer to shave my head. I can't hide minoxidil there anyway, and I don't bother putting any on if I'm leaving the house.)
NO, SHAVING SHOULD HAVE NO ADVERSE EFFECT ON VELLUS HAIRS.

Do you have an opinion on the effect of fish oil supplements on hair and skin?
I THINK FISH OIL IS GREAT FOR YOU. I TAKE IT EVERY DAY. WHETHER IT COMBATS MALE PATTERN BALDNESS, I DON'T THINK SO. FOR GENERAL GOOD HEALTH THAT MAY TRANSLATE INTO HEALTHY HAIR AND SKIN, SURE.
Is it alright to use a generic brand of minoxidil (e.g. Safeway), or is it better to use Rogaine? (I was hoping to see you about scars in the summer, but now my extra money is being wasted on minoxidil and Propecia.)
GENERIC IS FINE.
The literature that came with some generic brand minoxidil says that minoxidil can cause a little hair loss during the first couple of weeks, before it causes hair growth. I noticed something about this in an online article as well. Is it true that minoxidil can initially cause a little bit of hair loss? And if it's true, do you happen to know what causes this paradoxical effect?
THE REASON IS THAT HAIRS ARE SHIFTED FROM TELOGEN TO ANAGEN SO AS HAIRS LEAVE TELOGEN THEY MUST FALL OUT. AS HAIRS ENTER ANAGEN, THE NEW ONES START TO GROW.
Thanks for setting up these forums.
YOU ARE WELCOME!

Hello again.

The generic minoxidil causes a ridiculous amount of dandruff if I use it twice a day. Could this be counterproductive to hair growth? Or is a dry flaky scalp somewhat irrelevant to the health of the hair?

Things like caffeine, sex, and exercise are said to effect testosterone levels. Does that mean they effect DHT levels? And therefore balding? I get the impression no real research has been done on such things, but can any educated guesses be made, any practical conclusions be drawn?

They say it doesn't matter what time of day you take finasteride, and that it doesn't matter whether or not you have it with food. Have you noticed any reason to believe otherwise? One website has a doctor saying that even though there's no evidence, it might make more sense to take finasteride in the morning when testosterone levels are higher.

Is it common for people who get back some hair with finasteride to continue to lose hair during the first few months? I'm on month five of finasteride, and I look somewhat worse than when I started.

My problem is toward the front of the scalp, and I've heard that's more difficult to stop than the crown. Is that true?

Thanks a lot.

HI,
ANSWERS ARE IN ALL CAPS BELOW:
The generic minoxidil causes a ridiculous amount of dandruff if I use it twice a day. Could this be counterproductive to hair growth? Or is a dry flaky scalp somewhat irrelevant to the health of the hair?
NO, THAT SHOULD MAKE NO DIFFERENCE.
Things like caffeine, sex, and exercise are said to effect testosterone levels. Does that mean they effect DHT levels? And therefore balding? I get the impression no real research has been done on such things, but can any educated guesses be made, any practical conclusions be drawn?
YOU ARE RIGHT: NO REAL RESEARCH. EDUCATED GUESS IS THAT IT DOES NOT MATTER.
They say it doesn't matter what time of day you take finasteride, and that it doesn't matter whether or not you have it with food. Have you noticed any reason to believe otherwise? One website has a doctor saying that even though there's no evidence, it might make more sense to take finasteride in the morning when testosterone levels are higher.
HONESTLY, AGAIN NO RESEARCH ON THIS BUT I WOULD SUSPECT OVER THE LONG HAUL IT MAKES NO DIFFERENCE.
Is it common for people who get back some hair with finasteride to continue to lose hair during the first few months? I'm on month five of finasteride, and I look somewhat worse than when I started.
POSSIBLY, BUT THAT IS TYPICALLY SOMETHING THAT OCCURS MORE WITH MINOXIDIL THAN WITH FINASTERIDE. COULD JUST BE A COINCIDENCE IMHO.

My problem is toward the front of the scalp, and I've heard that's more difficult to stop than the crown. Is that true?
NO, THAT I THINK IS PROBABLY FALSE INFO. THE ORIGINAL STUDIES DOCUMENTED THAT FINASTERIDE AND MINOXIDIL WORK IN THE CROWN REGION BUT THAT IS BECAUSE THAT IS THE ONLY FOCUS OF THE STUDY. SUBSEQUENT STUDIES HAVE SHOWN THAT THE FRONT WORKS WELL. HOW WELL? THAT IS A MATTER OF SOME DEBATE AND SPECULATION. SUFFICE IT TO SAY, THAT IT WORKS IN THE FRONT AND IT WORKS WELL. HOWEVER, THE YOUNGER YOU ARE WITH HAIR LOSS THE FACT IS THAT THERE WILL STILL BE PROGRESSION OF HAIR LOSS DESPITE MEDS.
thanks for the questions!
sml