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Diagnosed with androgenetic alopecia. Prescribed Mintop 5% foam and Fina. Side effects?

DOCTOR OF THE MONTH - Dec 2013
Dec 2013
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Dermatologist
Practicing since : 2002
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Question
I am a 40 year old healthy male with healthy hairs diagnosed with androgenetic alopecia last year.
I consulted a dermatologist & he advised me to use Mintop 5% foam twice daily. I have used it for 6 months & the results were not very appreciable. The doctor then prescribed me Mintop 10% foam once daily which after an initial shedding the hair loss reduced to 50 hairs daily with some hair regrowth on left temple. I am using Mintop 10% foam from last six months. Now after a total of 1 year use of minoxidil it seems its effect is somewhat slowing down. The doctor now prescribed me Fina 1 mg (finastride) once daily along with Mintop 10% foam.
I have read a lot about finastride & I am afraid of using it seeing its side effects which some are irreversible but at the same time I want to retain my healthy hairs for at least next 15-20 years.
About me:
1.     I am doing bodybuilding from the last 20 years with no supplement intake but only natural diet except whey protein from Nestle which i started recently.
2.     No medical problem except a bit of emptying bladder while urinating which I know can be cured for time being while consuming finastride.
3.     Around 20-22 years back I felt a lump/swelling in my left side chest, hence went for deep ultrasound but nothing was found & the doctor said that its just normal. Although I do feel it but it didn’t create any problem to me in the last 20-22 years.
My Questions:
1.     Should I use topical finastride + minoxidil solution like Morr-F instead of Mintop 10% foam & get better results?
2.     Or should I use minoxidil 12.5% or 15% strength to have good results?
3.     Or should I use oral Fina 1 mg along with Mintop 10% foam? (kindly advice from your experience that is it safe to use fina for long term knowing its XXXXXXX side effects).
4.     Or you suggest something else.
My aim is to have healthy hairs with minimum or zero risk. Kindly answer my queries with regard to the above statement & suggest me a risk free treatment.
Posted Sat, 9 Nov 2013 in Skin Hair and Nails
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer:
Kinldy follow deatils below

Detailed Answer:
Hello,

Welcome and thanks for posting your query to XXXXXXX

As per your query you are suffering from male pattern baldness and want to know the proper treatment.

Before I directly to you concern let me explain you some medical facts regarding hair fall.

Medically the number of normal hair falling varies from few hair to up to 50-100 per day. Now if your hair falling more than 100s per day then it is definitely a problem. If it is not then you have to understand hair fall as normal process of day to day life.

We have almost 1 lac hair on our scalp and amongst them around 5% of hair are in falling phase and then another 0.1% (around 100) of hair can fall everyday. In males this is super-added with hormonal influence of testosterone hormone ( the male hormone) which we call as "male pattern baldness" or Androgenic alopecia The most important thing is not to be worried about this normal physiological age related men's problem.

Now regarding the part of treatment:

There are innumerable products in the market claiming to be useful for hair growth. We dermatologists believes in application of Minoxidil lotion. It is one product which is unanimously used by all dermatologists. It is to be started with 2% lotion applied over the scalp once or twice in day. It is to be applied when the scalp is dry. Only 1 ml is sufficient to be applied at the root of hair in frontal region. If for one month there is no burning and irritation then we increase the percentage to 5 % to 10% gradually. The same we do to taper off the medicine. That means we do not stop the medicine at once and gradually taper it off to 5% and then 2% and then alternate day or off and application of lotion before stopping it completely.

Finasteride is given along with this topical application to reduce the effect of male hormones. If you are unmarried or sexually inactive male then there is no problem in taking this medicine but if you are sexually active then it can reduce your libido temporarily.

So after knowing all the points my suggestions for your problem is following:

1. I am not in favor of oral finasteride at all. Though many a companies claim to be reversible side effects but I am personally not satisfied with the claiming.
2. You can apply Minoxidil with Finasteride topical solution. It do not have the systemic side effects and good results can be obtained.
3. Ask your dermatologist to taper off the concentration of minoxidil gradually form 10 % to 7.5 % to 5 and then 2 % as I explained before.
4. A nutritional supplement containing Biotin and mutiple other nutrients would be a good option to take on daily basis.
5. Your dietary improvisation- eat a lot of fruits, sprouts and green leafy vegetables daily.
6. Stop any substance abuse (if any like smoking or alcohol).

Hope these informations will help you. If you have further queries I will be happy to help.

"Wish you good health"

Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with androgenetic alopecia. Prescribed Mintop 5% foam and Fina. Side effects? 1 hour later
Thanks doctor for prompt reply.
I am a married male with one child & also sexually active while bodybuilding helps me in boosting testosterone.
I also do not smoke nor take alcohol & follow a strict diet consisting of fruits, eggs, milk, lean meat, nuts, vegetables etc.
I understand that 50-100 hair fall per day is normal but at the same time the hairs are not regrowing at that rate so there is visible scalp at some points.
My questions are:
1.     Why do you want me to taper off the concentration of minoxidil from 10% down to 2%, when minoxidil is still working for me?
2.     Or you want to suggest to stop using minoxidil & instead use topical finastride with minoxidil. If yes then do suggest a good high concentration such a topical solution.
3.     If you do not suggest oral finastride then should I consult a urologist for my urine problem (I don’t have irritation or pain while urinating) for an alternative medication?
4.     Also since I want to play safe what would you suggest a hair weaving or a transplant in future as I know that someday the effect of medication will reduce & hair fall will resume at much higher rate.
In the end suggest me a COMPLETE MEDICAL PLAN with proper medication ( I still have good amount of hairs) to retain my existing hairs for atleast next 10-15 years.
Thanks
 
 
Answered by Dr. Sanjay Kumar Kanodia 2 hours later
Brief Answer:
Kindly follow the suggestion below

Detailed Answer:
Hello,

Welcome again to the forum and thanks for your prompt reply.

Now regarding your further queries:

1.     Any of the medication doesn’t matter how simple it is always has a tendency to cause side effects. The same is with Minoxidil too. Though there are least of side effects but with higher concentration it can cause local irritation, redness and dryness of skin and hair. So it can lead to further falling of hair after sometime. It is dermatologically prone that Minoxidil concentration should be reduced gradually over a period of time to reduce the local as well as systemic side effects.

2.     As you are sexually active male so it is important for you to stop finasteride by mouth. I am against using finasteride by mouth in sexually active male. So it is better to use it topically. Though the best of results are still to be published but I have seen good results. As we need finasteride to reduce the effect of testosterone hormone so it is better to use it at local site. Morr-F is a better option and that too you use in foam form. I have observed that foam gives less side effects than lotion form.

3.     You can consult urologist to get replacement of finasteride with safer mediation. Tell and discuss him about your sexual activeness so that the things should be better dealt with.

4.     For the part of hair weaving or transplant – it should be the last option for every of hair fall patient. You yourself would feel a need for the same on recession of scalp hair. Weaving is temporary but a good option before you plan for transplant surgery. So always think of weaving first before going for hair transplantation. Nevertheless, as you have good hair till now so pros and cons of transplant are beyond our discussion. But whenever you go for transplant always chose the best of surgeon and technique available at that point of time.

For the part of complete regimen-

-Apply Morr-F in foam application
-Take oral vitamins specifically containing biotin in it. There are good products available such as Keraglow men, hairbless, follihair etc.
-Eat best of diet as suggested before.

Hope these informations will help you. If you have further queries I will be happy to help.

"With good hair wishes"

Regards,
Dr Sanjay
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with androgenetic alopecia. Prescribed Mintop 5% foam and Fina. Side effects? 1 hour later
Thanks for your answers.
Doctor,
Asp per your advice I will follow the below mentioned routine-
1.     I will stop using Mintop 10% foam once daily application and switch to Morr-F foam ( please advice whether to apply it once or twice daily. Also what is the strength of minoxidil in Morr-F foam? ).
2.     The vitamins you have suggested.
My questions:
1.     Approx. how many months/ years will Morr-F will be useful for me before loosing its effect ?
2.     Will Morr-F work in the same way as oral finastride 1 mg work for 5 to 10 yrs with good results?
3.     Since on topical application the medication mixes with the blood, so can Morr-F cause any serious side effects?
4.     Any other advise if hair fall still continues when using Morr-F?
Thanks
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer:
Kindly follow the suggestion below

Detailed Answer:
Hello,
Welcome again to the forum.

Regarding your further queries:

-I searched out for combination of Minoxidil with finasteride in India but only one company is making the product in the concentration of 3 % only that too in lotion form. So my suggestion is to use Morr F 3% lotion in day time and the foam of 10% at night time.

-The effect of Minoxidil is present as long as you use it. The basic problem in our treatment for hair therapy is the rebound fall after stopping it. So you can use it till you feel there is no local irritation to the product.

-The concept of using topical finasteride is new. I have found good results in my patients with 3 % lotion. The only part is bit dryness of scalp. That too is taken care by adding some lipids to it. So you can use it for 3-4 months and observe the result accordingly.

- For the part of systemic absorption of finasteride, as with any of drug used topically there is very very little amount absorbed which is totally negligible. So there are no systemic side effects absorbed with this agent.

Rests of the suggestions are as before. I can make out that your daily routine as well as the dietary pattern is very good so you need not to do any changes in the same.

Hope these informations will help you. If you have further queries I will be happy to help or if not then can close the query and rate the answer.

"With good wishes"

Regards,
Dr Sanjay
MD (Dermatology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with androgenetic alopecia. Prescribed Mintop 5% foam and Fina. Side effects? 16 hours later
Thanks doctor for prompt reply.
As regard Morr-F, I have checkd that Morr-F 5% solution is also available which contains minoxidil 5% & finastride 0.1% in total 60ml content.
My questions are:
1.     Should I use the Morr-F 5% solution in morning along with Mintop 10% foam at night?
2.     Or Should I use the Morr-F 3% along with Mintop 10% foam as advised by you?
3.     In any case wont be the total concentration of minoxidil will be high like 3% + 10% = 13% approx? Kindly guide on this & suggest suitable dose so that minoxidil side effects will be less like irritation etc.
4.     Currently I am using Sebowash + Klosh shampoo together on alternate days but when using the above topical (minox+ fina) soluitions (since they are of different concentration & composition) how often & which shampoo should I use? Should I daily shampoo my hair in this case?
Kindly advise me the correct strength of topical medications & how often should I shampoo along with any new shampoo you want to suggest.
Thanks
 
 
Answered by Dr. Sanjay Kumar Kanodia 1 hour later
Brief Answer:
Kindly follow the suggestion below

Detailed Answer:
Hello,

Welcome again to the forum. Thanks for asking further queries.

Regarding your further queries:

You can start with lower concentration of 3% lotion in the morning and 10% foam in the night. Applying at different time will not give you any side effect and even on simultaneous application also it does not make the concentration as 13 %. This is simple mathematical thing that when 10 % is added with 3 % of anything makes effective concentration of below 10 % only.

You can continue with your shampoos. These are very good products and I am myself personally quite satisfied with these. You can shampoo on daily basis, there is no harm in daily shampooing.

I hope all these informations will guide you best towards maintain good hair.
"With good wishes"

Regards,
Dr Sanjay
MD (Dermatology)
Above answer was peer-reviewed by
 
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