INTRODUCTION
MINOXIDIL
RETINOIC
ACID
FINASTERIDE
SPIRONOLACTONE
AZELAIC
ACID
XANDROX 12.5% LOTION
MINOXIDIL 12.5% SOLUTION
XANDROX 15% SOLUTION
Regrowth POLICIES AND NEW PRODUCTS
Q. What is Regrowth?
A. It is the trademarked name for the private practice of medicine devoted exclusively to the treatment of male and female pattern baldness (alopecia androgenetica). Since 1987, we have been examining and treating patients at our offices in Los Angeles, CA, U.S.A. Considering that the medical and scientific treatment of pattern baldness is relatively recent, we have been and remain pioneers in the field.
Q. Who are the medical practitioners in Regrowth?
A. From its inception, Richard Lee, M.D. has been and remains the sole proprietor and is responsible for its medical practice, research and development. Dr. Daniel Clifford consults with new and current patients at our office in Whittier, California and Dr. Adam Bowen is a consultant for Regrowth.
Q. If I live in the U.S.A., can I purchase any of the products listed within your Secure Order Form without a prescription?
A. No. The FDA has stated all the drugs listed at www.minoxidil.com are by-prescription-only items.
Q. How do I get prescriptions for Dr. Lee's products?
A. Click on the email link: Regrowth@minoxidil.com and write CONSULTATION in the Subject line of your email.
Q. If I live outside the U.S.A, do I have to have a prescription or doctor's consultation to purchase the products listed within your Secure Order Form?
A. Since you live beyond the jurisdiction of the U.S. FDA, you do not need prescriptions or a doctor's consultation to place orders.
Q. How effective are products that claim to 'unclog' the pores?
A. Nearly any cleansing agent can 'unclog' pores, however none of these products will promote hair growth. "Clogged pores" have long been disproved as a cause of pattern baldness. 'Hair Restorers' based on 'unblocking blocked pores' have no substantiated worth and are based on erroneous assumptions or on a hidden agenda.
Q. Are there any treatments that improve circulation in the scalp?
A. Yes, but unfortunately, male pattern baldness is not a simple matter of poor circulation. If it were, hair transplants would never be successful and massagers would be expected to promote hair growth, which they do not.
Q. What are some other Hair Loss Myths?
A. There is a fairly comprehensive series of FAQ’s regarding Hair Loss Myths at http://minoxidil.com/myths.html
Q. Where can I get more information about hair care products and alternatives?
A. In addition to the information at www.minoxidil.com, there are several very informative and comprehensive websites on the Internet that address hair care exclusively. HairLossHelp (http://www.hairlosshelp.com/), HairLossTalk (http://www.hairlosstalk.com) and www.Regrowth.com (not associated with our site, Regrowth, or www.minoxidil.com) are constantly updated and are reliable sources of information. An excellent non-commercial site for medical and scientific information about alopecia is http://www.pslgroup.com/hairloss.htm. Another excellent site is http://communities.msn.co.uk/HairLossSolutions. A comprehensive Polish language hair loss site is located at http://www.lysienie.com
An extensive and well designed site that addresses hair loss and hair regrowth and that discusses numerous hair related products and drugs is http://www.morphollica.com
Two sites that feature information on transplants are:
http://www.hairlossdirect.com and http://www.hairtransplantmedical.com The latter URL is best accessed via Internet Explorer. Hair Loss Central is a directory and search engine for hair loss products and services. Contents include: hair growth treatments, hair loss concealers, toupee, wigs, hairpieces, and vitamins for hair loss, hair care tips and hair transplant surgeon's directory. It can be accessed at http://www.hair-loss-central.com A site with before and after pictures can be found at www.hairtransplantmagazine.com Additional sites related to hair transplants are http://www.hair-transplant-helpdesk.com/hair_loss_treatment.html, and http://www.affordablehairtransplants.com/sites.htm In the New York City area, you may want to check out http://www.bernsteinmedical.com
For information on male hair loss and baldness, and it's causes, click on http://www.haircarechannel.com/male-hair-loss
For an alopecia areata support group, click on http://www.mdjunction.com/alopecia-areata
The URL ( http:// www.hairtransplantnetwork.com) introduces you to a popular and respected hair transplantation community dedicated to helping people share ideas and experiences about hair loss treatments and hair restoration physicians. This site includes hundreds of patient photos, a recommended "surgeon finder" and a popular hair loss discussion forum. Another site dedicated to hair transplantation is http://www.hairlossresearch.com. For U.S. and international hair transplant clinics www.forhair.com is a good reference site.
The International Society of Hair Restoration Surgery can be very helpful in finding experienced and qualified hair transplant surgeons (http://www.ishrs.org/).
Of special interest in the link http://members.aol.com/hairbook/drug.htm is the chapter on drugs that may cause hair loss. Hair Loss Book - information on hair loss. Topics include hair loss in men and women, non-surgical treatments for hair loss, surgical treatments for hair loss and common drugs that cause hair loss.
A site that links to many zones of hair growth information is http://www.treatmentofbaldness.com/hairloss_resources/resource_no_53.html
http://www.hairlossadvance.com/ Hair Loss Product Facts - Offering insight, support and treatment for hair loss related issues for men and women.
www.hairlossadvances.com Your ultimate guide to hair
restoration information! Visit our Forums for lively discussions and advice.
For additional information about hair loss and how to prevent and manage hair loss, see http://www.hairlosshelper.com
Caida del Cabello - Informacion verdadera y Experiencias Verdaderas sobre tratamientos para la caida del cabello:
http://www.recuperarelpelo.comHair Loss Solutions and Treatment: http://www.hairlossatoz.com/ Complete solutions on hair loss. Learn each and every thing about hair loss from the causes to every type of hair loss including their treatment.
Site sobre caída del cabello con un completo foro de alopecia: http://www.ganarpelo.org
www.acneassasin.com is an excellent resource for Acne related information.
Q. What’s the best shampoo to use?
A. There isn’t a single shampoo that meets all needs. See recommendations in the next
Q & A below. Various brands of shampoos and conditioners differ from each other primarily in price, and the number and proportion of additives and detergents. Generally, less expensive shampoos and conditioners have fewer additives. Additives are designed to achieve specific results. They can, for example, make hair look and feel cosmetically thicker, and smell better or tangle less. But, as a rule, shampoos have nothing or little to do with promoting hair growth.
Q. My shampoo removes DHT. Doesn’t removing DHT reverse hair loss?
A. Any shampoo will remove DHT from the surface of the scalp, but it is of no benefit in preventing MPB because it is DHT around the hair follicle that is causing the damage. Shampoos and conditioners cannot change the biochemical environment around the hair follicles, which are deep in the dermal layers of the scalp
Q. What about Nizoral shampoo? Hasn't it been proven to destroy DHT?
A. Yes, it has. With the introduction of Nizoral® 2% shampoo, there is now a shampoo that does have an impact on hair growth and regrowth. Used as recommended, Nizoral® 2% produces regrowth of hair comparable to 2% minoxidil solution. However, Nizoral® 2% is fairly expensive and requires a prescription in the U.S. Recent studies have shown that the use of Nizoral® 1% shampoo is almost equally effective in promoting thicker hair growth.
Q. Is there an alternative that is as effective, or even better, than Nizoral® 2% shampoo in treating MPB?
A. Regrowth has formulated a shampoo, simply called Regrowth Treatment Shampoo that contains 2% ketoconazole and 3% salicylic acid. The Regrowth Treatment Shampoo combines the DHT reducing properties of 2% ketoconazole with the dandruff preventive properties of 3% salicylic acid.
Q. How does ketoconazole work to reduce the DHT in the scalp?
A. One of the pharmacological actions of ketoconazole is to inhibit biosynthesis of ergosterols and other sterols which is a vital component of fungal cell membranes. This same pharmacological action inhibits the synthesis of DHT and decreases the amount of testosterone and DHT in the scalp, when Nizoral® 2% or Regrowth Treatment Shampoo is used topically.
Q. What is the benefit of having salicylic acid in the shampoo?
A. Salicylic acid is a keratolytic, i.e. it loosens and breaks up clumps of keratin (dandruff), allowing them to be more easily removed from the scalp. Salicylic acid is the active ingredient in anti-dandruff shampoos such as Neutrogena T-Sal® and Scalpicin®.
Q. Why have both ketoconazole and salicylic acid in the same shampoo?
A. Ketoconazole and salicylic acid may act synergistically. Since the salicylic acid can remove some of the dead skin layers of the epidermis, the ketoconazole can be more effective in reducing the DHT in the scalp. Using Regrowth Treatment Shampoo alone gives you the combined benefits of both Nizoral® 2% shampoo and Neutrogena T-Sal® shampoo.
Q. How should the Regrowth Treatment Shampoo be used?
A. Apply a small amount of the shampoo to the wet hair and work it into a rich lather, massaging the lather onto the scalp. Allow the lather to remain on the hair and scalp for five minutes before rinsing with warm water. This process can be repeated, if desired. Since the Regrowth Treatment Shampoo has potent cleansing abilities, it will remove most of the oily sebum from the scalp leaving the scalp deficient in oils, resulting in dry and unruly hair. To prevent this, you may wish to follow the shampooing with the application of a hair conditioner of your own choice.
Q. How often should the Regrowth Treatment Shampoo be used?
A. The 2% ketoconazole / 3% salicylic acid combination in the Regrowth Treatment Shampoo strips the hair and scalp of the natural oils, so you run the risk of scalp irritation if you use Regrowth Treatment Shampoo every day. Only use it 2 or 3 times a week.
Q. Can I use the Regrowth Treatment Shampoo as the sole treatment for MPB?
A. For those patients who are not sufficiently motivated to apply topical 5% minoxidil or Xandrox® on a daily basis and/or have reservations about the use of Propecia® due to cost and/or side effects, the use of Regrowth Treatment Shampoo is highly recommended. Since everyone with (or without) MPB is going to shampoo anyway, it is only rational to use a shampoo that has proven benefits in the treatment of MPB.
However, for most patients, Regrowth Treatment Shampoo is recommended as an adjunctive treatment for the prevention or reversal of MPB. Ketoconazole is not a substitute for the use of topical minoxidil, but it may enhance the actions of azelaic acid or finasteride or spironolactone in suppressing DHT in the scalp.
Q. Where can I purchase the Regrowth Treatment Shampoo with 2% ketoconazole and 3% salicylic acid?
A. Regrowth Treatment Shampoo is available only through Regrowth and is available only to Dr. Lee's patients inside the U.S.A., or to individuals who live abroad. If you live within the U.S.A. and are not yet one of Dr. Lee's patients, please contact Regrowth at Regrowth@minoxidil.com
Q. Is there any advantage to adding grape seed extract, stinging nettle, pygeum or other ‘natural’ ingredients to products for the treatment of MPB?
A. There is insufficient scientific testing to prove any of these ingredients beneficial. Grape seed extract is an anti-oxidant. Anti-oxidants may retard aging changes in the skin, but they do not specifically treat MPB, which is not directly related to aging. Anecdotal reports and even long-term use in various cultures may suggest benefits from some herbal treatments for MPB. But until the doses are standardized and the effects are scientifically proven, Regrowth has reservations about recommending them.
Q. Why doesn’t Regrowth add zinc and vitamin B6 to its azelaic acid formulations?
A. Whereas in vitro experiments demonstrate that the addition of vitamin B6 and zinc to azelaic acid allows azelaic acid to be used in smaller quantities to inhibit the synthesis of DHT in the skin; there are absolutely no studies in regards to the absorption dynamics of topical vitamin B6. After completing exhaustive research and having consulted the pharmacology departments of many universities, I could not find any information concerning the absorption, efficacy or safety of topical B6. Without this vital information, it would be irresponsible and irrational to add B6 to minoxidil/azelaic acid solutions for the treatment of MPB.
There are studies in regards to the use of topical zinc. However, if zinc is compounded in the same solution with minoxidil/azelaic acid, it will form insoluble salts as it reacts with minoxidil/azelaic acid, rendering all of the ingredients ineffective.
Therefore, Regrowth uses azelaic acid without zinc and vitamin B6 as a component of Xandrox® formulations in amounts that will be effective for more than three standard deviations (>99.7% of all patients).
Q. What was the first FDA approved medication for the treatment of MPB?
A. Topical minoxidil. A 2% solution with the proprietary name of Rogaine® or Regaine® was manufactured by Upjohn Pharmaceutical and approved by the U.S. FDA in 1988. Ironically, we still do not know exactly how or why minoxidil promotes hair growth. Although we know that it is a potassium channel opener, other medications that also function as potassium channel openers do not promote hair growth. Minoxidil promotes enhanced follicular size, resulting in larger hair shaft diameters. It also stimulates and prolongs the anagen (growing) phase of the hair growth cycle.
Q. Does minoxidil harm healthy hair?
A. Not at all. Although the exact pharmacodynamics of minoxidil are not well understood, the effect of minoxidil is to safely promote growth and to maintain maturity of the hair follicles. These effects are most observable in hair follicles affected by MPB.
Q. Is there a difference between The Upjohn-Pharmacia Company’s active ingredient (i.e. minoxidil) and that of Regrowth, Inc?
A. No. Minoxidil is a single molecule rather than a compound or mixture. Using sophisticated analytical techniques, the minoxidil used by Regrowth, Inc has been assayed repeatedly by Bioscreen of California to be 100% pure.
Q. Why use a 5% or higher minoxidil solution or lotion when 2% - 5% minoxidil solutions are readily available over the counter in many countries?
A. Minoxidil displays a dose-dependent effect with higher concentrations improving the responsiveness and greater regrowth of hair. The higher the effective dose of minoxidil, the better the results.
Q. Why is the Rogaine®/Regaine 5% Extra Strength® solution and its generic versions so oily?
A. Upjohn/Pharmacia’s Rogaine®/Regaine® and the generic 5% minoxidil solutions use 50% propylene glycol in their liquid base, which leaves a long-lasting greasy film on the scalp. Regrowth, Inc offers a 5% minoxidil solution that has only 30% propylene glycol in the liquid base and, for those who have irritation with propylene glycol, a 5% minoxidil solution that has NO propylene glycol in the base is also offered. About 7% of patients either have an allergic reaction or over time, develop an allergic reaction to propylene glycol.
Q. Are minoxidil solutions exceeding 5% more effective in promoting hair growth?
A. Yes. They can be. As previously stated, minoxidil displays a dose-dependent effect with higher concentrations improving the responsiveness and greater regrowth of hair. Using standard compounding techniques, minoxidil in alcohol based solutions reach their saturation point at approximately 5%. After years of intensive research, exhaustive experimentation, assistance from a consulting pharmaceutical biochemist and extensive clinical testing, Regrowth, Inc now offers an effective delivery of higher concentration 12.5% Minoxidil in a solution form, which is a stable, close to colorless, non-greasy liquid that dries rapidly after it has been applied.
Q. How do I know if using a high concentration minoxidil solution and/or lotion isn’t an overdose and counterproductive to hair growth?
A. Minoxidil has to have a serum concentration of 20 ng/mL to have any hemodynamic or other systemic effect in the human body. Allowing for 1.7% absorption of minoxidil from topical application, a 2% minoxidil solution will result in 0.6 ng/ mL and a 5% minoxidil solution will result in 1.2 ng / mL of minoxidil in the serum. So, there is more than a 16-fold safety margin from the use of 5% topical minoxidil.
Q. Rogaine®/Regaine® 2% and 5% minoxidil solutions do not contain all the ingredients that are in Regrowth’s 5% minoxidil solutions. Why the difference?
A. For positive cosmetic effects the concentrations are different in the liquid base of Regrowth minoxidil formulas, but the important and necessary component parts of Upjohn – Pharmacia’s and of Regrowth’s base solvent are the same. Ethyl alcohol is the component that allows the minoxidil to transfer through the various layers of skin. The drying effects of ethyl alcohol are lessened by propylene glycol, which acts on the skin as a humectant or moisturizer. Vitamin E has been added to Regrowth, Inc's base solutions because it is a free radical scavenger and functions as a stabilizer. The nighttime 5% minoxidil solution and 5% Xandrox® also contain prescription 0.025% retinoic acid.
Q. Do Regrowth's formulations ‘feel’ any different than 2% and 5% Rogaine®/Regaine® or their generic versions?
A. Yes. There is proportionately less propylene glycol in Dr. Lee’s formulations than there are in 5% Rogaine®/Regaine® or its generic versions. The 'greasy' feeling due to propylene glycol that is often associated with Extra Strength Rogaine®/Regaine® and their generic versions is not present when using Regrowth minoxidil solutions. However, propylene glycol can be quite irritating to the scalp for approximately 7% of the patients. To accommodate those patients who are allergic to propylene glycol or develop an allergy to it over time, we have formulated 5% minoxidil solutions that substitute hypoallergenic glycerin for propylene glycol.
Q. Does glycerin make minoxidil formulas less effective?
A. No. Not at all. Both glycerin and propylene glycol are pharmacologically inactive ingredients in the minoxidil products. They are used in minoxidil solutions because (1) they are humectants, i.e. they help to moisturize the skin and help protect from the drying effect of the alcohol; (2) they increase and stabilize the solubility of minoxidil; and (3) they keep a small quantity of minoxidil on the surface of the scalp to allow for a small amount of continued absorption after the alcohol has penetrated.
Q. Can I expect improved results with the higher concentrations of minoxidil?
A. Possibly, yes. The 5% and higher minoxidil solutions and lotions will promote the regrowth of more hair and thicker hair, but they do not change the genetic properties of the hair follicles. Although the growth (anagen) phase may be lengthened, the dormant (telogen) phase of approximately 100 days is unchanged. In order to see results, the existing thin hair shafts need to be replaced with thicker ones. This is why it usually takes between 3 and 6 months to appreciate significant hair regrowth. But there have been many anecdotal reports of earlier positive responses.
Q. What side effects should I be aware of?
A. In the vast majority of patients there are no side effects. If side effects do occur, then patients who have a known adverse reaction to minoxidil should avoid using Xandrox® formulas or minoxidil. Although rare, patients who are sensitive to minoxidil can experience a rapid heart rate, a drop in blood pressure and water retention. As a result, they may experience headaches, dizziness, chest pain and/or edema of the ankles. If that happens, these patients should discontinue any formulas containing minoxidil. In our experience, these side effects have occurred in less than 0.1% of patients.
Q. What are 'direct dermatological events'?
A. These are skin reactions in the areas to which the minoxidil solution is directly applied. These reactions may include soreness, redness, irritation, drying or flaking, etc. It is very unusual for minoxidil to cause scalp irritation. The untoward reactions are almost always due to the propylene glycol.
Q. Do I have to continue to use topical minoxidil solutions even after my hair has grown back?
A. Yes. Topical minoxidil solutions are still treatments and are not cures for MPB. If you discontinue to use the minoxidil solutions, the scalp will revert to its baseline (before-use) condition in three to four months. However, many patients can achieve good maintenance with once/day applications of 1 mL 5% minoxidil or Xandrox®.
Q. What applicator is the most effective and convenient
A. Since topical minoxidil preparations are absorbed most effectively when they are applied directly to the scalp, use whatever applicator would accomplish this task most efficiently for you. If there are ‘bald areas’, the sprayer may work well. If you still have significant amounts of hair, use the calibrated dropper to apply the solution directly onto the scalp.
Q. How about using a dabber-type applicator?
A. Regrowth has always liked the idea of a dabber-type applicator, but it has one major disadvantage. The amount of solution being dispensed cannot be accurately calibrated. We have made available for the nominal price of $1.00/each a 2 oz. plastic bottle with fitted dabber tops and custom caps into which you can transfer the minoxidil and/or Xandrox® solutions. A separate label can be applied on which you can indicate the type of medication and the date.
Q. If I use the dabber applicator, how can I be sure I’m using approximately 1 mL of minoxidil or Xandrox® solution?
A. You can’t be sure. However, the exact amount of solution used is not critical and most patients have sufficient experience to estimate the amount of coverage that 1 mL affords on the scalp. It is only important to moisten the scalp in the area(s) of thinning and/or recession. Generally, four passes of the dabber over the scalp, from side to side, equal approximately 1 mL of solution.
Q. Will the solutions be as effective if I just spray them on my hair?
A. Not really. It’s important that the maximum amount of the medicated solutions be deposited on the scalp, so that it can be absorbed into the dermis to the level of the hair follicle. There is essentially no effective delivery of medications through the hair shaft. So coating the hair shaft with minoxidil is a waste of medicine.
Q. Should the scalp be wet or dry when I apply the minoxidil solutions?
A. As a general rule, medications are more readily absorbed when the skin is hydrated, but pharmacodynamic studies are performed with applications to a dry skin. So the quoted statistics in regards to absorption apply to application on a dry skin. Minoxidil is not soluble in water and there is no scientific evidence to show any appreciable advantage to the application of minoxidil solutions on a hydrated scalp. Our recommendation is to apply the minoxidil solutions to a dry scalp or to the scalp that is at least towel dried in order to avoid dilution.
Q. Will it help to apply the minoxidil solutions more than twice / day?
A. Yes, but the additional benefits will probably be minimal, especially with the Xandrox® 5% solutions, because the azelaic acid also promotes maximum absorption of minoxidil.
Q. Will minoxidil as an ingredient in shampoos and conditioners work for me?
A. No. Minoxidil must penetrate the scalp to work effectively at the level of the hair follicles. Shampoos and conditioners would have to contain very large amounts of alcohol and/or remain on the scalp for hours in order to transfer minoxidil through the scalp.
Q. What is retinoic acid and why do you add it to the nighttime minoxidil solutions?
A. Retinoic acid (tretinoin or all-trans-retinoic acid) has been used for many decades as Retin-A® in the treatment of acne. More recently it is being advocated to remove wrinkles due to sun damage and aging. It works essentially as a chemical peel and as a biologic response modifier. It allows for better penetration of the minoxidil and promotes epithelial cell growth.
Q. Why should I only use it at night?
A. Retinoic acid is degraded by strong light, so there is no benefit to using it during the day, when the bright light will render the medication ineffectual.
Q. Can retinoic acid cause side effects?
A. It’s not the side effects of retinoic acid that are irritating. It’s the direct effects. Since retinoic acid acts as a chemical peel, it may cause scaling and peeling and redness of the scalp. Chronic use of retinoic acid on the skin will make it more sensitive to being sunburned. So, patients should take precautions to wear a hat or use sunscreen even if they use retinoic acid at night and then expose the scalp to long periods of sunlight during the day.
Q. Can I still use minoxidil solutions with retinoic acid if I like to be out in the sun or get a lot of sun exposure on my job?
A. Yes, but it would be wise to wear a hat or use effective sunscreens.
Q. How long has finasteride been available as a treatment for MPB?
A. The 5mg tablets of finasteride (Proscar®) were introduced by the Merck Co. in 1992 as a medication to treat the symptoms of benign prostatic hypertrophy. Some men taking Proscar® reported improved hair growth. Subsequently, the Merck Co. announced the availability of Propecia®, the 1mg finasteride tablet, approved by the U.S. FDA in December 1997. Finasteride works by inhibiting the Type II 5alpha-reductase with resulting decreased serum levels of dihydrotestosterone (DHT).
Q. What are the side effects of taking finasteride?
A. A percentage of male patients taking finasteride report decreased libido. Although Merck claims that the number of patients who experience decreased libido is less than 3-4%, we have found that the incidence of side effects is considerably higher. About 1 or 2 percent of men report relative impotence. There have also been reports of an "ache in the groin area" by a small number of male patients. The symptoms disappear when the medication is discontinued. Even if the patient continues to take the finasteride, the symptoms usually resolve themselves for most patients.
Q. What other side effect might it have?
A. Somewhere between 20 to 25% of men report a decreased volume of ejaculate. There is no change in the sperm count or motility or morphologic features.
Q. How can I be sure of finasteride's long-term safety?
A. You cannot be certain, because finasteride has only been in widespread use for less than two decades ago. But, fortunately, there is a naturally occurring control group. There are people who have a congenital 5 alpha-reductase deficiency and they're perfectly normal, except they always have a great head of hair; their prostate does not enlarge; and they never develop prostate cancer.
Q. Does this mean that taking finasteride will help prevent prostate cancer?
A. No, that would be presumptuous. However, Merck conducted a prospective seven-year study of men taking 5 mg finasteride/day to determine whether or not they have a smaller incidence of prostate cancer as compared to a matching population and, in fact, they did.
Q. Will taking finasteride cause birth defects?
A. The probability is essentially nil and there has not been a single case report of a birth defect due to a male patient taking finasteride. The association of a lack of DHT and birth defects is that a woman who has a congenital severe deficiency of 5 a-reductase can give birth to a male child with abnormalities of his urinary tract and be born as a pseudohermaphrodite.
Q. Do you ever recommend finasteride for women?
A. There is no contraindication for post-menopausal women or for women who are sterile for any other reason. However, recent clinical trials conducted by Merck show no statistical benefit for post-menopausal women who have pattern baldness to take finasteride.
Q. Will I have to take finasteride for the rest of my life?
A. Like minoxidil, finasteride is not a cure for baldness. You should continue to take finasteride to keep the levels of DHT low and to maintain your hair growth. If you stop taking finasteride, it takes two weeks for the DHT levels to return to your baseline levels.
Q. Will taking finasteride have any effect on the hair on other parts of my body?
A. Theoretically, it can. Hair on the top of the scalp is genetically encoded so that it is negatively affected by dihydrotestosterone (DHT). Ironically, mustache and beard growth are promoted by DHT. Elsewhere on the body (chest, underarms, pubis, etc.), the hair is affected by testosterone. Taking finasteride can elevate the levels of testosterone in the body by 10 to 20%. There have been rare reports of increased body hair (reflex hyperandrogenicity).
Q. Does finasteride help to grow hair in the frontal area of the scalp?
A. It can, although it is not as effective as Xandrox® in doing so. A recent study was done specifically to evaluate the effectiveness of 1 mg finasteride daily on the frontal area and the results were fairly comparable to regrowth at the vertex. Frontal regrowth is greatly enhanced when oral finasteride is taken concomitant with topical minoxidil.
Q. Does finasteride accumulate in the body?
A. No. Finasteride has a biological half-life of 6 hours. So, in six hours, half of the finasteride that you took has already been eliminated from your body.
Q. How long does it take to see any results from taking finasteride?
A. As a rule, three to six months.
Q. What is the recommended dosage of finasteride to promote hair growth?
A. Clinical trials demonstrated that effective doses varied widely. It was found that in some patients from 0.2 mg to 5 mg daily had similar results on the scalp. With 1 mg doses, it was found that everyone within three standard deviations (99.7% of patients) responds to treatment.
Q. Do I have to take finasteride with food?
A. No. Finasteride is easily absorbed in the small intestine with or without food. It’s best to take it at about the same time each day, so taking it becomes routine.
Q. Will finasteride change the level of testosterone in the body?
A. There is an increase in the amount of testosterone in the serum, because a fraction of the testosterone is not being converted to dihydrotestosterone. On the average, the increase in the serum testosterone level is 10 to 20% and usually remains within normal limits. The feedback mechanism in the pituitary eventually stabilizes the testosterone level back to baseline levels.
Rare cases of ‘reflex hyperandrogenicity’ have been reported with increased body hair and oily skin.
Q. Why does finasteride work better in conjunction with minoxidil solutions?
A. These medications work in two entirely different ways, so their effects are more than synergistic; they’re additive. It is not known exactly why or how minoxidil promotes hair growth, but experience shows that using both medications is much more effective than using either one alone. As an example, although castration will stop the balding process, very few castrated men grow back much hair unless minoxidil is also applied to the scalp. The combined therapies have been found to be successful in the stump-tailed macaque (the only other animal that exhibits MPB). However, competing pharmaceutical companies are unlikely to fund a human trial for competing products.
Q. How do I get Propecia® (1 mg finasteride)?
A. You can make an appointment at the Regrowth office for a doctor's consultation or see your family doctor for a prescription.
Q. Are there manufacturers of finasteride other than Merck Pharmaceutical?
A. Yes. The patent for Proscar®
expired on 19 June 2006. Teva Pharmaceuticals has been approved by the US FDA
to market a 5mg finasteride tablet. Generic 1 mg tablets may also be
available. If you shop around you should be able to find the best price.
The finasteride is homogeneously distributed throughout the 5mg tablet of
Proscar® and generic finasteride tablets. Use a pill cutter or any sharp blade
and cut the hard tablets into four pieces. You will undoubtedly also create some
powder and many smaller fragments. It really makes no difference if the pieces
are of unequal size. The range of effectiveness is very wide and has been shown
to vary as much as from 0.2 mg to 5 mg of finasteride. Furthermore, there is
such a tight bond created between the finasteride and the Type 2 5AR, that even
if you discontinue taking finasteride altogether, it will require two weeks for
your DHT level to return to your baseline levels. So, a variation in the daily
dosage is really inconsequential. There is probably no increase in the
likelihood of having side effects by taking 1.25mg of finasteride as opposed to
taking 1.0mg of finasteride. So, take just one quarter of a tablet once / day.
The time of day doesn't really matter. Nor does it matter if you take it with or
without food.
When you are
getting a physical examination or are having laboratory tests on your blood,
inform your doctor that you are taking finasteride. Finasteride will decrease
the PSA (Prostate Specific Antigen) level by approximately 50%. Assessing the
PSA level is a screening test for possible prostate cancer.
Q. Are there any other topical medications that are effective as anti-androgens and that will prevent or reverse MPB?
A. Yes. There are several, but not all are safe. The two safe and effective ones are preparations of spironolactone and solutions of azelaic acid. Some are not proven safe: Cyproterone is a potent anti-androgen and has been tried as a treatment for women with acne, but cyproterone is not available in the U.S. Flutamide® is also a very potent anti-androgen, but has not been proven safe as a topical medication. Flutamide® is a very potent anti-androgen, but it can have very serious, even life-threatening side effects.
Q. What is spironolactone?
A. It’s a medication that has been used for more than 30 years to treat hypertension and fluid retention. Regrowth offers a 2% spironolactone in 60 mL bottles with a dabber applicator and a 2oz jar of 5% Spironolactone Lotion. The pharmaceutical effects of topical spironolactone are local to the skin where it is applied and there are no systemic effects from its use on the scalp.
Q. What does spironolactone have to do with male pattern baldness?
A. There are three distinct benefits of topical spironolactone in its use as a treatment for MPB. (1). Spironolactone significantly reduces the amount of DHT in the scalp by inhibiting the conversion of precursor steroids to DHT. (2). Spironolactone reduces the DHT in the scalp by converting localized testosterone into estrogen, which is thought to be protective of the hair follicles. (3). Spironolactone blocks the follicular androgen receptor sites, thereby rendering any residual or circulating DHT harmless to the hair follicles.
Q. What are the side effects?
A. Spironolactone is metabolized in the skin and does not affect any other organ system. In about 1% of patients, a rash can develop. If this happens, the patient should discontinue the use of topical spironolactone.
Q. Why haven’t other doctors used topical spironolactone to treat male pattern baldness?
A. Although topical spironolactone is pharmacologically one of the most effective topical treatments for MPB, there are inherent drawbacks, e.g. spironolactone has a disagreeable odor, which is enhanced by evaporation of the alcohol in the solution.
Q. Why didn’t you put spironolactone directly into your minoxidil solutions, so it would have been more convenient to use?
A. When minoxidil and spironolactone are combined in the same solution, they will chemically react within a few days and degrade each other, causing a particularly offensive odor. Since this chemical reaction requires many hours to occur, the reaction does not occur if minoxidil and spironolactone are applied to the scalp one after the other from separate containers.
Q. Will my hair have an unpleasant odor if I use spironolactone?
A. It may. We've worked with a well-known pharmacologist and a reliable biochemical laboratory to produce a 2% a Spironolactone solution that minimizes the offensive odor and remains under control at room temperatures. Nevertheless, do not apply spironolactone solutions before strenuous exercise, as excess body heat can degrade the spironolactone resulting in an unpleasant odor. To avoid this odor, apply the spironolactone solutions only before going to bed at night, and then shampoo your scalp in the morning. If you apply 2% spironolactone in the morning, then you may swim, rinse, wash or shampoo your hair an hour after application. Most of the medicines that absorb into the dermis do so within an hour after application.
Q. Does the 5% Spironolactone Lotion has an unpleasant odor associated with it?
A. We seldom have complaints regarding the odor from 5% spironolactone lotion. But patients with a heightened sense of smell have complained. When spironolactone is incorporated into a lotion form, the odor is minimized because there is no volatile substance to disperse the scent.
Q. What is Xandrox® 5% solution?
A. It is Regrowth’s exclusive formulation in which a 5 % minoxidil solution is combined with 5% azelaic acid, a topically effective inhibitor of 5-alpha reductase. The Xandrox® solutions are available with and without the addition of 0.025% retinoic acid. The compounding of all Regrowth medications, including the Xandrox® solutions, is performed by our chief consulting physician, Dr. Richard Lee.
Q. What is the 5-alpha reductase inhibitor that is incorporated in the Xandrox® solutions?
A. Azelaic acid. Azelaic acid has been proven to be an inhibitor of Type 1 and Type 2, 5-alpha reductase in the human skin. Azelaic acid has also been demonstrated to 'inhibit the synthesis of all of the hormones in the 17-hydroxy group', resulting in decreasing the levels of DHT in the scalp when used topically. In a study reported in the British Journal of Dermatology (Stamatiadis. 1988;119: 627-632), inhibition of 5-alpha reductase is virtually complete (98%) at 3 mmol/l. The Xandrox® solutions and Lotion contain eighty eight times the amount necessary for 98% inhibition of Type 1 and Type 2 5-alpha reductase in vitro. Both types of 5alpha-reductase are present in the human scalp with Type 1 being the predominant isoenzyme. Allowing for the usual 4 or 5% absorption into the dermis and epidermis upon topical application, the amount of azelaic acid at the level of the hair follicles is at least 3 times the amount required for virtually complete inhibition of DHT synthesis.
Q. The scientific article in the British Journal of Dermatology also added zinc and pyridoxine to the solution to inhibit 5-alpha reductase. Why didn't Dr. Lee add them to the Xandrox® solutions?
A. In a 5% concentration, azelaic acid does not need zinc to completely inhibit the synthesis of DHT where applied. Besides, when a zinc salt, azelaic acid and minoxidil are mixed together, there is an eventual precipitate that forms, compromising the desired pharmacological effects of both the minoxidil and the azelaic acid.
Q. So, would you recommend taking the zinc and pyridoxine separately?
A. You can, but there's no reason to do so. The amount of azelaic acid in the Xandrox® is already sufficient to achieve virtually complete inhibition of 5-alpha reductase and the conversion of testosterone to dihydrotestosterone. Zinc and/or vitamin B6 deficiencies are rare almost everywhere in the world.
Q. What is azelaic acid?
A. It is a naturally occurring substance found in whole grains. Not only does it have mild antibiotic and antiviral properties, it is also a scavenger of free radicals, which have an accumulative deleterious effect on the skin. In most prescription forms, azelaic acid is used to treat acne.
Q. Does azelaic acid have any side effects?
A. It can cause slight depigmentation of the skin if you are applying it to areas of abnormally dark pigmentation. Curiously enough, it won't affect normal melanocytes, so it won't change the normal color of your skin or lighten freckles, but it can be used to treat melasma or vitilago. On application, it may cause a mild transient burning sensation that may last for up to twenty minutes. Eventually the skin accommodates and patients don’t notice any sensation.
Q. What's the advantage of using 5% Xandrox® over Regrowth's 5% minoxidil along with 2% or 5% spironolactone?
A. Better patient compliance. It's more convenient, since each topical dose only requires a single 1 mL application from one bottle. 5% Xandrox® is odorless as compared to the offensive odor that can be associated with spironolactone. However, in terms of efficacy in treating MPB, topical minoxidil combined with either azelaic acid or spironolactone often yields the same results.
Q. How much more effective are 5% Xandrox® solutions as compared to using plain minoxidil solutions or the combination of minoxidil and spironolactone solutions?
A. Unfortunately, after almost two decades of use and evaluation, it is obvious that minoxidil solutions used alone have not been significantly effective for reversing MPB for the majority of patients. However, when minoxidil is combined with an inhibitor of 5-alpha reductase, the majority of patients will have positive visible results in growing scalp hair. The major problem with the use of topical 2% or 5% spironolactone is lack of compliance in its use rather than effectiveness. Admittedly, it is inconvenient, malodorous, and requires special handling because of its apparent odor at higher temperatures. For these reasons, we suggest that it be used at night (whereas twice/day application would be more beneficial).
Q. What were the results of Regrowth’s own clinical trials with Xandrox® as compared to the combination of Rogaine®/Regaine® 5% and Propecia®?
A. There was a study group of 24 on Xandrox® alone and a comparison group on 5% minoxidil (Rogaine®/Regaine Extra Strength® / 1 mg finasteride (Propecia®). The age range was 26 to 49 in both groups and observations were noted for six months. None of the patients could be on any previous treatment prior to the study. The results were similar with a slight edge to Xandrox®.
Q. Are Xandrox® solutions also recommended for women with alopecia androgenetica?
A. A qualified ‘yes’. In theory, the physiologic causes for MPB in women are the same as in men, but there are many observable differences. Women have only 1/10 the amount of DHT in the serum as do men. However, after more than two years of Xandrox® use in women with MPB, we have found it to be just as effective in promoting hair growth as it has been in men.
Q. If I’m using Xandrox® or topical spironolactone, should I continue to take finasteride to lower the DHT level in the whole body?
A. Finasteride works systemically and will lower the serum level of DHT throughout the body. Xandrox® works only where it is applied. If you are not having side effects from finasteride, it may be advantageous to continue taking finasteride to protect the hair on the scalp not yet affected by MPB, but is 'at risk.' For patients with large areas of thinning hair, it may be advantageous to take finasteride in addition to using Xandrox® 5% solution and/or topical spironolactone.
Q. But will it be harmful to use Xandrox® solutions and continue to take oral finasteride?
A. Not at all. There are no contraindications to using both and doing so may be advantageous.
Q. If I discontinue finasteride, should I taper off the dosage?
A. It won’t be necessary. The biological effect of finasteride is so prolonged, that the levels of systemic DHT will not return to baseline for two weeks after discontinuation. So, in essence, the effect of finasteride slowly declines on its own.
Q. Why is it necessary to use minoxidil in addition to a 5-alpha reductase inhibitor to treat MPB?
A. The combination is more effective than either medication used alone. Minoxidil solutions alone, even in 5% concentrations, have a disappointing result in reversing MPB. Likewise, even virtually eliminating testosterone and DHT in the body doesn’t have much positive effect in regrowth of scalp hair. For example, men who are castrated will invariably halt the progress of MPB, but very few will regrow their hair. However, when the modalities of topical minoxidil with an anti-androgen are combined, the improvement in results is significant. About 70% of patients report regrowth of hair and an additional 13% report a halt to the balding process.
Q. Is it still necessary to use retinoic acid with Xandrox®?
A. Again, it’s not necessary, but it may be more effective. Topical minoxidil is dose related. Using retinoic acid allows for better penetration of the minoxidil. This was important when 2% minoxidil solutions were the only preparations available. With higher concentrations of minoxidil, the addition of retinoic acid to the mixture is less important.
Q. What’s the best way to apply minoxidil solutions?
A. The method of application is not as important as an established routine. For optimum results, 1 mL of minoxidil or Xandrox® should be applied twice a day and 8 to 12 hours apart. Using either the spray or the calibrated dropper, dispense a total of 1mL to the area(s) of the scalp of thinning hair. The fine mist sprayer dispenses approximately 1 mL with four pumps of the sprayer.
Q. Up to what age is it worthwhile using Xandrox® solutions for MPB?
A. There’s no simple answer. Whereas treatment is almost always more effective when the signs and symptoms of MPB are recent, we have patients in their 70’s who have had satisfactory results from combined treatment of topical minoxidil and a 5-alpha reductase inhibitor. In fact, hair regrowth was initially discovered in older men in their 50’s or 60’s who were being treated with finasteride for enlarged prostates. That discovery was the impetus for developing Propecia®
Q. If I’ve already been using minoxidil, do I still have to wait at least three months to see improved results with Xandrox® preparations?
A. Generally, yes. Thicker hair means replacing existing thin hair shafts. This entails shedding of the thin hair shaft, waiting through the resting (telogen) phase of the hair cycle, and growing enough thicker hair shafts to appreciate the difference. Since the telogen phase is approximately 100 days, new thicker hairs are most often seen 4 to 6 months after initiating therapy.
Q. Do I also have to wait at least three months to see improved results with Xandrox® 5% solution if I have already been using a 5% minoxidil solution and a 5-alpha reductase inhibitor such as finasteride.
A. Again, yes. The increased percentage of 5-alpha reductase inhibition can recruit more follicles to enlarge. But, again, these additional follicles will have to shed their small hair shafts, rest through the 100-day telogen phase, and subsequently grow a visibly thicker hair shaft.
Q. Are there other advantages to using 5% Xandrox® solutions as compared to Rogaine®/Regaine Extra Strength® and finasteride?
A. Yes. There are many advantages. (1) Cost: a one month supply of 5% Xandrox® costs considerably less than a one month supply of Rogaine®/Regaine Extra Strength® (or its generic version) plus a one month supply of finasteride. (2) Convenience: instead of applying minoxidil twice/day topically and taking finasteride orally, 1 mL of Xandrox® is applied topically twice/day. (3) Side effects: finasteride can cause sexual dysfunction in a significant percentage of patients. 5% Xandrox® solutions have no side effects. (4) Safety: the long-term effects of finasteride are not yet known. Minoxidil has been in use for many decades and azelaic acid has been ingested as long as mankind has been eating whole grains. It has even been proven safe used systemically and intravenously.
Q. Does 5% Xandrox® leave a residue on the scalp or hair?
A. The azelaic acid coats the hair shafts and gives the hair the feeling of extra body comparable to a hair spray. Brushing or combing the hair after the Xandrox® has dried will reduce the extra texture that the azelaic acid imparts to the hair.
Q. What is Xandrox® 12.5% Lotion?
A. Xandrox® 12.5% Lotion is an exclusive formulation by Regrowth of topical 12.5% minoxidil and 5% azelaic acid with an absorption enhancer. It has been formulated for the treatment of MPB, and is trade marked.
Q. If 5% Xandrox® is effective in treating MPB, why produce a Xandrox 12.5% Lotion®?
A. The stimulus effect of minoxidil on hair follicles is dose dependent. Xandrox® 12.5% Lotion has been successful in halting and/or reversing MPB in cases where other therapeutic measures have not worked well. There appears to be a threshold level at which some hair follicles will become responsive to minoxidil in regenerating terminal hairs.
Q. Why isn't Xandrox® 12.5% a solution?
A. Although it is possible to formula a Xandrox® 12.5% solution, some patients find a lotion easier to apply than a liquid. on large balding areas. A lotion does not run, whereas a liquid can. The lotion is formulated for the convenience of those patients who prefer the cosmetic effect. Xandrox® 12.5% is an opaque, white, smooth lotion.
Q. If Xandrox® 12.5% is an opaque white lotion, won’t it leave a visible residue on the scalp?
A. Using one's fingertips and with minimum massaging, the lotion disappears almost immediately into the scalp. There is almost no visible residual on the skin or hair. This is due to one of our most valuable secrets in its formulation. The lotion changes its physical properties so absorption and penetration occurs when activated by normal body heat.
Q. On the Xandrox® 12.5% bottle label it says that the bottles should be refrigerated. What happens if it takes a while for the product to arrive from the shipping facility in Los Angeles, or if I go on a month's vacation where there isn't an available refrigerator?
A. It shouldn’t be a problem. Xandrox® 12.5% lotion is best kept refrigerated, under which conditions it has a shelf life of at least 24 months. At room temperatures between 59 to 86 degrees Fahrenheit (15 to 30 degrees Centigrade), Xandrox® 12.5% lotion can be kept for six to eight months or more without deterioration or loss of efficacy.
Q. I live in a warm climate where Xandrox® 12.5% lotion may be subjected to heated delivery vehicles or storage facilities for extended periods of time. Does this affect the potency of the drug?
A. No. But it surely can affect the appearance of the lotion. When the lotion leaves Los Angeles, California, it has a smooth, creamy consistency. As it travels over hot desert areas or remains in heated delivery vehicles and warehouses, it may change consistency or separate into layers. If you live in a warm climate, don’t order the Xandrox® 12.5% lotion. Instead, order the Xandrox® 15% solution, which is more effective, and costs slightly less.
Use your index finger to apply the lotion to your scalp.
The reason for the change in appearance of the lotion at temperatures above 95 degrees F (~35 degrees C) is because the lotion is designed to liquefy and absorb into the skin at normal body temperatures. When subjected to similar temperatures while still in the bottle, it will change in its physical appearance. There is no change in its chemical structure or pharmacological action, however. The lotion should be refrigerated or kept in a cool environment after it has been reconstituted into a homogenous lotion.
Q. Why didn't you simplify this whole process and just make a high concentration gel or cream, which wouldn’t be heat, sensitive?
A. This is the compounding method used by others. However, such compounds don’t allow for the type of liquefaction necessary for absorption. The concentration of the minoxidil in the suspending agent is important, but if proper absorption does not take place, the minoxidil is ineffectual.
Q. How about others who try to duplicate the ingredients in your formulae. Will these products work for me like Xandrox® solutions and 12.5% Xandrox® Lotion?
A. There are many trade secrets associated with the proper compounding of Xandrox® solutions and 12.5% Xandrox® Lotion. These techniques are protected by applications for patents, which have already been filed. The name ‘Xandrox®’ has also been registered and trade marked to protect against generic formulae, which claim to be Xandrox®.
Q. What is the absorption enhancer used in the Xandrox® 12.5% Lotion?
A. Benzyl nicotinate. It is chemically related to niacin and can cause a temporary ‘flushing’ of the scalp where it is applied.
Q. Why isn't benzyl nicotinamide used in the 5% Xandrox® solution?
A. The 5% Xandrox® solution does not need an absorption enhancer because it has an alcohol base. With standard compounding techniques, minoxidil in a 12.5% concentration is not compatible with a base that is primarily alcohol. Therefore an absorption enhancer was incorporated into the Xandrox® 12.5% Lotion formula to make the absorption rates equivalent to liquid formulas with similar concentrations.
Q. If you put benzyl nicotinate into any high concentration minoxidil gel or lotion, wouldn't the resulting gel or lotion absorb like the Xandrox® 12.5% lotion?
A. Not necessarily. The minoxidil suspended in any gel or lotion may not get released to the scalp, as it does in the Xandrox 12.5% Lotion®.
Q. Has Xandrox® 12.5% been tested?
A. Extensively. It required more than a year just to produce the body temperature-activated type of lotion that met the criteria of effectiveness, safety and cosmetics.
Q. What have been the results of clinical trials with Xandrox 12.5% Lotion®?
A. Although many San Diego area patients were test subjects for over a year, we do not consider this to be an adequate clinical sampling to qualify for conclusive data regarding end results. We do know from these limited tests that the majority of these patients regrew considerable amounts of hair in problem areas where other therapies had little or no effect. We have had many unsolicited positive reports via e-mail and chat groups, which validate what the San Diego test group found to be true, i.e., that minoxidils’ effectiveness is, indeed, dose dependant, and that the combination of azelaic acid with targeted doses of 12.5% micronized minoxidil lotion is the key to regrowth in areas like the frontal hairline and/or temples where other therapies had no effect.
Q. You indicate that the minoxidil used in Xandrox 12.5% Lotion® is micronized. What does this mean, and why is it done?
A. The natural form of minoxidil crystals that are used in formulating 2% - 5% minoxidil solutions are white, coarse and hard, similar to table salt. Costly precision equipment at Regrowth's compounding lab is used to pulverize these crystals so they are less than 25 micron in size (similar to talcum powder). Micronization results in improved dissolution, and in a smooth lotion, which, because it is heat activated, is better, absorbed as evidenced by an almost total lack of residue where it is applied.
Q. How much Xandrox 12.5% Lotion® should be used with each application?
A. 1 mL, applied in a very thin layer. We suggest that no more than 2 mL of Xandrox 12.5% Lotion® be used per day. The 30 mL bottles of Xandrox 12.5% Lotion® have treatment pumps that dispense ~0.25 mL of lotion with each complete depression of the pump. The 125 mL bottles of Xandrox 12.5% Lotion® dispense ~1.0 mL with each full depression of the pumping spout.
Q. The pump on my Xandrox 12.5% Lotion® bottle doesn't work. Will you send me new pumps?
A. The pumps must be primed in order to function correctly. If priming them in the bottle takes too long, prime them in water, and then affix them to the bottle. The first depression of the pump will produce water, but thereafter lotion will be dispensed. If proper priming does not work, your lotion has almost certainly been subjected to excessive heat.
Q. Where should Xandrox 12.5% Lotion® be used?
A. On those areas of the scalp that are refractory to treatment of MPB by any other means. For most patients, this means the areas of both temples and/or the frontal hairline. But some patients will want or need to use it in the vertex and/or on the crown. It should not take the place of 5% Xandrox® for general application on other parts of the scalp.
Q. Do I use it in addition to 5% Xandrox®?
A. Optimally, yes. The Xandrox 12.5% Lotion® is meant to be used as a supplement and not a replacement for the use of 5% Xandrox®. The Xandrox 12.5% Lotion® should be used in areas unresponsive or poorly responsive to 5% Xandrox® solutions.
Q. Can I overdose or have systemic effects from using such high concentrations of minoxidil?
A. For essentially all patients, there is not sufficient absorption of minoxidil into the blood stream to cause any systemic symptoms. In fact, allowing for the average amount of absorption (1.4%), the safety margin is almost ten-fold, using topical 12.5% minoxidil. However, there will be those few patients who will have unavoidable idiosyncratic reactions to Xandrox 12.5% Lotion®. The number is less than 0.1%.
Q. What should I do if I experience an idiosyncratic reaction to Xandrox 12.5% Lotion®?
A. Stop using it immediately and contact Regrowth at RichardLeeMD@Xandrox.net.
Q. Is there any way to screen for patients who are hypersensitive to Xandrox 12.5% Lotion®?
A. Unfortunately, no. By definition, an idiosyncratic reaction is uncommon and peculiar to the specific patient. We would have to treat several thousand patients to find a similar reaction.
Q. At what time of the day should I apply the Xandrox 12.5% Lotion®?
A. At any time of the 24-hour cycle when it can best be left undisturbed on the scalp for the longest period of time. Since the lotion becomes virtually invisible within minutes of application, it can be applied at any time of day without unflattering results. As a matter of convenience, most patients apply it at night, shortly after applying the Xandrox® 5% solution.