Q. What is Regrowth, LLC?
A. It is the trademarked name for the private practice of medicine devoted exclusively to the treatment of alopecia androgenetica, otherwise known as male and female pattern baldness. Since 1987, we have been examining and treating patients at our Los Angeles, CA, U.S.A. area office, and we maintain an Internet website at www.minoxidil.com.
Q. Who are the physicians associated with Regrowth, LLC?
A. From its inception, Richard Lee, M.D., has been responsible for Regrowth, LLC’s medical practice, and conducts research and development for new drugs. Dr. Lee also conducts electronic consultations with existing and new patients. Dr. Daniel Clifford consults with new and current patients at the Whittier, California office, and Dr. Adam Bowen serves is a consultant for Regrowth, LLC.
Q. If I live in the U.S.A., can I purchase the products listed within your Secure Order Form without being a patient of Dr. Lee or Dr. Clifford?
A. No. The FDA has determined all the drugs listed at www.minoxidil.com are available by-prescription-only, and can only be dispensed directly to patients, for their own personal use. Regrowth, LLC is not licensed as a pharmacy.
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. You will be sent medical forms. Dr. Lee will review the completed forms, answer any questions you have about your hair loss, and decide if you might benefit from using the drugs listed at www.minoxidil.com.
Q. If I live outside the U.S.A, must I 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. It’s to your advantage, however, to first consult with Dr. Lee via email. Please request email consultation forms for this purpose.
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, LLC?
A. No. Minoxidil is a single molecule rather than a compound or mixture. Using sophisticated analytical techniques, the minoxidil used by Regrowth, LLC 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, albeit there is not a directly proportional response.
Q. Why do the Rogaine®/Regaine 5% Extra Strength® solution and its generic versions feel so oily?
A. Rogaine®/Regaine® and the generic OTC 5% minoxidil solutions contain a 50% concentration of propylene glycol in their liquid base, which leaves a long-lasting greasy film on the scalp. Regrowth, LLC offers a 5% minoxidil solution that contains only 30% propylene glycol in the liquid base, and which does not have a greasy feeling to it. For the 7% of patients who have an untoward allergic reaction to propylene glycol, a 5% minoxidil solution that has NO propylene glycol in the base is offered.
Q. Are minoxidil solutions exceeding 5% more effective in promoting hair growth?
A. 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 consulting pharmaceutical biochemists and extensive clinical testing, Regrowth, LLC offers minoxidil solutions of up to 15% in concentration. They are stable and dry rapidly after they have been applied.
Q. How can I know that using a high concentration minoxidil solution and/or lotion isn’t an overdose and/or won’t be 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 and a 5-fold safety margin with the use of a 15% topical minoxidil solution.
Q. Do Regrowth, LLC’s formulations ‘feel’ any different than 2% and 5% Rogaine®/Regaine® and their generic equivalents?
A. Yes. There is proportionately less propylene glycol in Dr. Lee’s formulations than there are in 5% Rogaine®/Regaine® and its generic equivalents. 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 LLC’s minoxidil solutions. However, propylene glycol can be quite irritating to the scalp for approximately 7% of the patients. To accommodate those patients who have untoward reactions to propylene glycol, we have formulated minoxidil solutions that substitute hypoallergenic glycerin for propylene glycol.
Q. Does glycerin make minoxidil formulas less effective?
A. No. 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 continued absorption after the alcohol necessary to the base solution has penetrated.
Q. Can I expect improved results with the higher concentrations of minoxidil?
A. The 5% and higher minoxidil solutions and lotions have the potential to promote 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 with any concentration of minoxidil solution of 2% or greater.
Q. What are the possible side effects of which I should I be aware?
A. In the vast majority of patients there are no side effects. If side effects do occur, patients who have a known adverse reaction to minoxidil, should avoid using Xandrox® formulas or any minoxidil preparations. 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 such side effects occur, 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 unusual for minoxidil to cause any of these events. Any 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 using minoxidil solutions, the scalp will revert to its baseline (before-use) condition in three to four months. However, some patients can achieve acceptable 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. For most patients, the calibrated dropper works well to apply the solution directly onto the scalp.
Q. How about using a dabber-type applicator?
A. Regrowth, LLC 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 a fitted dabber top and custom cap 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 exactly 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 they 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.
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 minoxidil solutions can be applied to a dry scalp as well. 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 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 applied 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 acclimates 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.
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. Oral 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 beneficial.
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 sprayer 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 observed 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 results from 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 such 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. Azelaic acid has even been proven safe when 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 compliment the extra texture azelaic acid imparts to the hair.
Q. What is retinoic acid and why do you add it to the nighttime 5% minoxidil/Xandrox® solutions?
A. Retinoic acid (tretinoin or all-trans-retinoic acid) has been used for decades as Retin-A® in the treatment of acne. More recently it has been advocated as a treatment for fine wrinkles in the skin. 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 use it only 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 ineffective.
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 skin more sensitive to being sunburned. As such, 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 and/or use effective sunscreens.
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 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 potent anti-androgen, but 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 treating 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 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 topical spironolactone’s side effects?
A. Spironolactone is rapidly and completely 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 use of topical spironolactone.
Q. Why haven’t other doctors used topical spironolactone to treat male pattern baldness?
A. Since Regrowth, LLC made topical spironolactone available to treat MPB in 2001, numerous other medical practices have also offered it.
Q. Are there any drawbacks to the use of topical spironolactone?
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 when it’s in solution form.
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 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 solution only before going to bed at night, and then shampoo your scalp in the morning. If you apply 2% spironolactone in the morning, 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 odor associated with the 5% spironolactone lotion, although a few patients, who have 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. 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®, a 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 oral finasteride's long-term safety?
A. You cannot be certain, because finasteride has only been in widespread use for less than two decades. 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 adults, except they always have a great head of hair; their prostate does not enlarge; and their incidence of prostate cancer is close to non existent.
Q. Does this mean that taking oral 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 pseudo hermaphrodite.
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. 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 become 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. What is ketoconazole?
A. Ketoconazole has been used as an anti-fungal medication for many years, both topically and systemically. One of its pharmacological actions is to inhibit biosynthesis of ergosterols and other sterols, which damages the cell membrane of fungi.
Q. Why does Regrowth, LLC have a 2% ketoconazole shampoo?
A. This same pharmacological action inhibits the synthesis of DHT in the scalp, which is why ketoconazole shampoo may be beneficial in the treatment of MPB. Sebum production is testosterone and DHT dependent. Studies have shown that the use of a 2% ketoconazole shampoo will reduce the sebum excretion rate (-6.54%) when used over a six-month period.
Q. Does ketoconazole have any side effects?
A. In 11 double-blind trials in 264 patients using ketoconazole 2% shampoo for the treatment of dandruff or seborrheic dermatitis, an increase in normal hair loss and irritation occurred in less than 1% of patients. In three open-label safety trials in which 41 patients shampooed 4-10 times weekly for six months, the following adverse experiences each occurred once: abnormal hair texture, scalp pustules, mild dryness of the skin, and itching.
Q. What is salicylic acid?
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 finasteride 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 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. 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 formulate a Xandrox® 12.5% solution, some patients find a lotion easier to apply than a liquid, especially on large balding areas. A lotion does not run, whereas a liquid can. 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 more valuable trade secrets in its formulation. The lotion changes its physical properties so absorption and penetration occur 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.
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 some pharmacists. 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 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 feasible 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 gels or lotions may not penetrate 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 little or 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. If my Xandrox 12.5% Lotion® has been subjected to excessive heat, can I send it back for a refund?
A. No. The FDA does not allow patients to return prescription drugs. Again, if you feel it’s possible that the Xandrox 12.5% Lotion® may be subjected to excessive heat, do not order it. Instead, order Xandrox 15 or Xandrox 15+ solution. High concentration Xandrox or minoxidil Solutions are not impacted by 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 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 be hypersensitive to minoxidil or have an idiosyncratic reaction to Xandrox 12.5% Lotion®. That percentage of patients is less than 0.1%, and they should not use high concentration minoxidil compounds.
Q. What should I do if I experience an idiosyncratic reaction to Xandrox 12.5% Lotion®?
A. Stop using it immediately and contact Dr. Lee 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. Several thousand patients would have to be monitored 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.
Q. How long should I wait until I know if Xandrox 12.5% Lotion® is working for me?
A. Since the Xandrox 12.5% Lotion® is recruiting previously unresponsive hair follicles to grow again; these hairs will first have to be shed. The follicle will remain inactive during the ~100 days of telogen, and will then grow back thick enough so that you can appreciate the difference. This process usually takes a minimum of 4 to 6 months.
Q. Can the increased concentration of minoxidil in Xandrox 12.5% Lotion® cause temporary shedding?
A. Yes. All minoxidil formulas can cause temporary shedding, but the amount of increased shedding is usually imperceptible. Hair that is approaching the telogen phase, or is already in the telogen phase, is prompted to shed earlier than usual due to the use of minoxidil. Rarely will much more than 10% of the hair be in the telogen phase at any given time. This means that under the worst-case scenario, approximately 10% of one's hair would be shed. If this does happen, most patients will not notice the shedding. The shedding is due to the stimulatory effect of the minoxidil and is limited only to those areas where the Xandrox 12.5% Lotion® is being applied. The replacement hair will appear in 100 or less days and is usually thicker than the hair that was shed.
Q. Will Xandrox 12.5% Lotion® cause a telogen effluvium or a permanent hair loss?
A. Absolutely not. The inciting cause of a telogen effluvium is always a systemic insult. That is not to say that there haven't been patients who have experienced shedding after using minoxidil and/or azelaic acid. On a purely statistical basis, there will be and have been patients who shed a lot of hair shortly after using Xandrox 12.5% Lotion®, but there is no sound medical evidence to show a direct ‘cause and effect’. It is most likely that those patients are experiencing a genetically induced acceleration of their male pattern baldness, totally unrelated to the use of any medication. The subject of shedding is complicated, and we have posted an article on this website entitled "Shedding and Hair Loss" that addresses these topics.
Q. Are there generic versions of Xandrox 12.5% Lotion®?
A. No. By definition, generic means identical. There are now, and will continue to be, products which try to imitate Xandrox®. However none of these products are compounded in the same manner, as is Xandrox®. It took Dr. Lee years of laboratory testing to perfect the exact process whereby Xandrox® is compounded. Xandrox 12.5% Lotion® took two years to perfect and is, and will remain, unique. There are many trade secrets, protected by pending patents, associated with the proper compounding of Xandrox® solutions and Xandrox 12.5% Lotion®.
Q. Why doesn't Xandrox 12.5% Lotion® contain retinoic acid?
A. Retinoic acid is a very powerful drug with some undesirable side effects. Some patients cannot tolerate its use or would rather not put up with the undesirable side effects. The absorption enhancer in the Xandrox 12.5%Lotion® makes the addition of retinoic acid unnecessary. Retinoic acid should only be applied at night. The absence of retinoic acid in Xandrox 12.5% Lotion® allows it to be used at any time of the day or night.
Q. If Xandrox 12.5% Lotion® is effective, why even use 5% Xandrox®?
A. The 5% Xandrox® solutions are sufficiently effective on most parts of the scalp for most patients. Xandrox 12.5% Lotion® should only be used on those parts of the scalp which are stubborn in responding to 5% Xandrox®.
Q. Why is the bottle of Xandrox 12.5% Lotion® only about 3/4 full?
A. The large bottle of Xandrox 12.5% Lotion® is five ounces in size. Slightly more than four ounces are put into the bottle. The uncapped bottles weigh a minimum of 130 grams. Almost always, the bottles contain more than 130 mL of lotion. Likewise, the small 12.5% bottles are 1 1/4 ounce in size. They are filled with a minimum of 30 mL, which means that they are slightly more than 2/3 full.
Q. What is Xandrox 15% Solution®?
A. Xandrox15% Solution® is an exclusive Regrowth medication for the treatment of alopecia androgenetica, containing 15% minoxidil and 5% azelaic acid by weight. Xandrox15% Solution® is available in 125mL bottles. Each mL of Xandrox 15% Solution® contains 150mg of minoxidil and 50mg of azelaic acid.
Q. Why is Xandrox 15% Solution® considered to be a breakthrough product?
A. This is the first minoxidil solution in which the base liquid contains a concentration of minoxidil considerably greater than 5%. Minoxidil had been considered to be soluble in alcohol-based solutions only to the extent of slightly less than 5%. To make a stable, high concentration minoxidil solution required years of experimentation, research and development. The result has been rewarding. Xandrox 15% Solution® is a clear, colorless to light amber colored, solution, containing 15% minoxidil and 5% azelaic acid with a proven efficacy in the treatment of MPB.
Q. Regrowth already offers a Xandrox 12.5% Lotion®. What’s the advantage of a Xandrox 15% Solution®?
A. (1) Convenience. Many patients find a solution is more convenient to apply to the scalp than a lotion. The tip of the dropper can be placed directly onto the scalp with a minimal amount of solution wasted on coating the hair shafts. Whereas a lotion can be conveniently applied to areas of the scalp with little hair or miniaturized hair, the solution is easily applied anywhere on the scalp, including larger areas of thinning hair.
(2) Stability. Whereas the lotion has a tendency to separate at temperatures above 100 oF (38 oC), the Xandrox 15% Solution® is stable at subfreezing temperatures to temperatures above 200 oF (93 oC). There are no problems in regards to keeping the Xandrox 15% Solution® indoors, outdoors or even in your car.
(3) Efficacy. The hair promoting effects of topical minoxidil are dose related. The additional 2.5% minoxidil concentration combined with the greater absorption of the alcohol based Xandrox 15 Solution® is more effective in recruiting miniaturized hair follicles to mature again and produce a terminal hair shaft.
(4) Cost. It actually costs less in labor to compound Xandrox 15% Solution®, than to compound 12.5% Xandrox Lotion®. We pass the savings on to the patient.
Q. Is the effectiveness of Xandrox 15% Solution® superior to Xandrox 12.5% Lotion®?
A. It can be. It is well established that the effectiveness of topical minoxidil in treating MPB is dose related. In our test group, patients grew more hair using Xandrox 15% Solution® in areas where they had been using Xandrox 12.5% Lotion®. There appears to be a threshold level of stimulation with minoxidil to which follicles can be recruited to grow terminal hair again. This threshold level will vary considerably among patients depending primarily on their genetic predisposition to MPB and the length of time affected hair follicles have been miniaturized.
Q. Are there any special precautions relating to the 125 mL bottles of Xandrox15 Solution®?
A. Because of the volatility of the ethyl alcohol, the bottle should be tightly capped when the solution is not being used. The solution is extremely stable within a wide range of temperatures and has been tested to be unaffected in the range of 10o to 200o Fahrenheit (-12o to 93o Centigrade) for short exposures. Xandrox 15 Solution® is best kept at room temperatures.
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: Oral finasteride can cause sexual dysfunction in a significant percentage of patients. 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 when used systemically and intravenously.
Q. If propylene glycol is the component that makes Rogaine®/Regaine Extra Strength® and its generic versions feel greasy and take so long to dry, how is it your new 12.5% solution containing propylene glycol doesn't feel greasy and dries rapidly?
A. The non-greasy feeling and the ability to dry rapidly are directly related to the proportions of propylene glycol and 200-proof ethyl alcohol in the base. These are miscible liquids. The new 12.5% Minoxidil Solution has a fraction of the amount of propylene glycol and a larger component of ethyl alcohol than are present in Rogaine®/Regaine Extra Strength® solution and its generics.
Q. Why not compound the new 12.5% Minoxidil Solution without any propylene glycol?
A. Alcohol based minoxidil solutions with a concentration of 5% or more minoxidil require propylene glycol or glycerin or other such vehicles in the base to remain stable. Because it is so viscous, even a small amount of glycerin in a minoxidil solution will result in the solution having a bit of a "greasy feeling."
Q. Can you cite a scientific reference demonstrating that higher doses of topical minoxidil improve the results in the treatment of MPB?
A. An excellent study relating dosage to results was reported in this article: Olsen, EA, DeLong ER, Weiner MS. Dose-response study of topical minoxidil in male pattern baldness. J Am Acad Dermatol. 1986;15:30-37.
Q. Why is a 12.5% Minoxidil Solution more effective than other 12.5% minoxidil lotions, creams or gels?
A. The absorption of minoxidil from a cream, gel or lotion is less efficient than with a solution because only the molecules directly adjacent to the skin can absorb into the scalp. In a true solution, such as the 12.5% Minoxidil Solution, the solute (minoxidil molecules), move freely within the solvent, whereas in a cream, lotion or gel, a substantial quantity of the minoxidil molecules remain suspended and unavailable within the viscous base.
Q. If more minoxidil absorbs into the scalp with the new 12.5% minoxidil solution than with a lotion, cream or gel, why do you still offer Xandrox 12.5% lotion®?
A. Xandrox® formulations are notably different from minoxidil compounds. All Xandrox® products contain azelaic acid to decrease DHT in the scalp.
Q. How safe is it to use a 12.5% Minoxidil Solution?
A. Less than 0.1 % of patients experience side effects from 12.5% Minoxidil Solution. There is a reason for this high safety margin. It requires a serum concentration of 20 ng/mL of minoxidil to cause any hemodynamic or other systemic effect in the human body. Allowing for the average 1.4% absorption of minoxidil from topical application, a 5% minoxidil solution will result in 1.16 ng / mL of minoxidil in the serum and a 12.5% solution will result in a 2.9 ng / mL of minoxidil in the serum level. So, there is more than a 16-fold safety margin from the use of 5% topical minoxidil and a 7-fold safety margin from the use of 12.5% Minoxidil Solution.
Q. Can the 12.5% Minoxidil Solution be used twice / day?
A. For almost all patients, yes. The safety margin with 1mL of the 12.5% Minoxidil Solution applied twice per day allows for the recommended routine use of topical minoxidil for the treatment of MPB.
Q. Is the 12.5% Minoxidil Solution an alcohol based solution?
A. Fifty percent of the solvent base is 200 proof denatured ethyl alcohol. The ethyl alcohol allows optimal absorption into the scalp and dries quickly.
Q. Does the alcohol in the solution harm the skin or hair follicles?
A. Not at all. When you apply the recommended 1mL of the 12.5% Minoxidil Solution to your scalp, the total amount of alcohol in the dosage is, at most, 0.5mL. That's a very small quantity of alcohol, which will neither be harmful to the hair follicles nor to the skin. When alcohol, e.g. rubbing alcohol, is applied to the skin, it is quickly absorbed and diluted by the body fluids and there is no harm to the body tissues.
Q. Why is phosphoric acid an ingredient of the 12.5% Minoxidil Solution?
A. Phosphoric acid is an inorganic acid commonly used in cosmetic products to enhance their water retention. As an ingredient in the 12.5% Minoxidil Solution, the phosphoric acid serves several important functions. (1) It helps to stabilize the minoxidil, which is more soluble in an acidic base. (2) Retaining water in the 12.5% Minoxidil Solution has an effect similar to hydrating the scalp and enhances the absorption of minoxidil. And (3), Stabilizing the acidity of the 12.5% Minoxidil Solution balances the pH to approximate the pH of the skin, which is optimal at a pH of ~5.5. This degree of acidity helps the skin to ward off the advances of harmful bacteria and fungi.
Q. Are there any patients who should not use the 12.5% Minoxidil Solution?
A. Patients who have untoward reactions to minoxidil or to any of the ingredients in the base should not use 12.5% Minoxidil Solution. Also patients who are hypersensitive to the action of minoxidil should not use the 12.5% Minoxidil Solution.
Side Effects: Patients with any history of heart disease should not use Xandrox® formulas or minoxidil. Also 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 use of any formulas containing minoxidil. In our experience, these side effects have occurred in less than 0.1% of patients.
Q. If minoxidil is soluble in alcohol only to ~5%, how can you make a true 12.5% solution?
A. According to Remington’s Pharmaceutical Science (20th Edition), minoxidil is soluble to the extent of "1gm in 25ml alcohol” (4% solution). When the solution is acidified, for example by azelaic acid, the solubility is increased to approximately 5%. With the addition of propylene glycol or glycerin, a true 5% minoxidil solution can be stabilized.
Making a 12.5% minoxidil solution is much more complicated and the compounding technique is going to have to remain a closely guarded trade secret. After years of personal research and experimentation, an international patent (PCT/US2003/041196) is pending for our technique of compounding higher (much greater than 5%) alcohol-based solutions of minoxidil.
Q. If it's possible to make a 12.5% Minoxidil Solution, why not increase the concentration even more? Wouldn't a higher concentration make the medication
even more effective in treating MPB?
A. Not necessarily. As previously noted, the increased efficacy of minoxidil in promoting hair growth is not directly proportional to the increases in the concentrations of minoxidil. There are diminishing returns. In fact, in a study reported in Skin Pharmacology [Skin Pharmacol 1997;10(4):206-20] it was shown that 'minoxidil had biphasic effects on the proliferation and differentiation of normal human keratinocytes (NHK): Minoxidil stimulated NHK proliferation at micromolar doses, while antiproliferative, pro-differentiative and partially cytotoxic effects were observed with millimolar concentrations.' In other words, too much minoxidil can become counter productive in promoting hair growth.
Q. If I shouldn't use Xandrox 15% Solution® twice / day, why can I use 12.5% Minoxidil Solution twice a day?
A. The reason Xandrox 15% Solution® is not recommended for twice/day use is that the addition of azelaic acid results in a solution that has a sticky residual and may cause the hair to look unkempt. For that reason alone, it is suggested that Xandrox15 Solution® be applied at night. If a patient is not hypersensitive to minoxidil, there is no safety issue with the application of either Xandrox 15 Solution® or 12.5% Minoxidil Solution twice /day.
Q. How stable is the 12.5% Minoxidil Solution?
A. Extremely stable. Before making the 12.5% Minoxidil Solution available on the market, batches of the solution were subjected to temperatures up to 149o Fahrenheit (65o Celsius) and were also stored for months in sub-freezing temperatures with no change in the chemical or physical characteristics of the solution.
Q. Under what conditions should the 12.5% Minoxidil Solution be stored?
A. The 12.5% Minoxidil Solution should be stored with the container's cap tightly attached, at room temperature and out of direct sunlight.
Q. Can the 12.5% Minoxidil Solution be used by both males and females?
A. Yes. For optimal results, it is recommended that male patients use the 12.5% Minoxidil Solution in combination with an agent or agents that decrease the DHT in the scalp. The 12.5% Minoxidil Solution can be used as the sole medication in the treatment of female pattern baldness (FPB), but should not be used by nursing mothers.
Q. What is Xandrox15-PLUS?
A. Xandrox15-PLUS is an exclusive Regrowth medication for the treatment of alopecia androgenetica, containing 15% minoxidil, 5% azelaic acid and 0.1% finasteride by weight. Xandrox15-PLUS is available in 125mL bottles. Each mL of Xandrox15-PLUS contains 150mg of minoxidil, 50mg of azelaic acid and 1mg finasteride.
Q. When will Xandrox15-PLUS be available?
A. June 2008
Q. Why is Xandrox15-PLUS so highly recommended?
A. This is the first hair growth product that contains 15% minoxidil, azelaic acid and finasteride in solution form. Xandrox15-PLUS is a clear, light amber colored, extremely stable solution, containing 15% minoxidil, 5% azelaic acid and 0.1% finasteride with a proven efficacy in the treatment of MPB.
Q. Why did Regrowth decide to add finasteride to the Xandrox15-PLUS product?
A. The rationale for compounding a 15% Minoxidil, 5% Azelaic Acid and 0.1% Finasteride solution is to produce the single best medication for the treatment of MPB. The use of a high concentration topical minoxidil, combined with agents that decrease the amount of DHT in the scalp utilizes the two FDA safe and proven modes for treating MPB.
Q. Xandrox15 already contains 5% azelaic acid to decrease DHT in the scalp. Why add finasteride?
A. Although topical azelaic acid will prevent the synthesis of DHT in the scalp where it is applied, it does not protect the hair follicles from DHT circulating in the bloodstream. Finasteride applied topically can and does decrease the serum DHT and, although the 5-alpha reductase enzymes in the scalp is primarily Type I, there are also Type II 5AR's in the scalp that the topically applied finasteride can inactivate.
Q. Since finasteride inhibits only the Type 1 5-alpha reductase, how do you know that the serum DHT is decreased with the use of topical finasteride?
Q. Should Xandrox15-PLUS be used by patients who are, or who are not taking oral
finasteride?
A. Xandrox15-PLUS can be used as the sole treatment for treating MPB or as a supplement to patients who are already using the oral finasteride, as oral finasteride 1mg/daily lowers the amount of DHT in the scalp by only 38% (Roger S. Rittmaster, M.D. at the American Academy of Dermatology (AAD) meeting in San Francisco, March 2000).
Q. Are there any special precautions associated with the 125mL bottles from which Xandrox15-PLUS is dispensed?
A. Because of the volatility of the ethyl alcohol, the bottle should be tightly capped when the solution is not being used. The solution is extremely stable within a wide range of temperatures and has been tested to be unaffected in the range of 10o to 200o Fahrenheit (-12o to 93o Centigrade) for short exposures. Xandrox15-PLUS is best kept at room temperatures.
PHARMACOLOGY
Q. How well are the active ingredients of Xandrox15-PLUS absorbed into the dermis of the scalp?
A. Ethyl alcohol is one of the few substances that freely permeates the skin (the permeability coefficient of ethanol across human skin in 8 x 10 –8 mol/cm2) and it transports the minoxidil, azelaic acid and finasteride with it. The penetration enhancing effects of ethanol play a significant role in minoxidil absorption. The effective absorption of topical minoxidil and finasteride depends on the vehicle composition. Greater effects are achieved when the fraction of the volatile component increases, especially at ethanol concentrations higher than 50% (and maximizing at 90%).
Q. Does Xandrox15-PLUS leave any residual matter on the scalp when it dries?
A. When the alcohol has absorbed into the scalp, there will be a slight stickiness due to the residual glycerin, minoxidil and azelaic acid. The finasteride is completely absorbed. This residual reservoir of minoxidil provides a beneficial source for the continued absorption of minoxidil even after the Xandrox15-PLUS has dried on the scalp. If Xandrox15-PLUS is only used at night and applied in small amounts, you can minimize the objections to the residual matter on the scalp, while you simultaneously maximize the absorption of minoxidil.
FORMULATION
Q. How much of the base of Xandrox15-PLUS is ethyl alcohol?
A. The base solution consists of 80% ethyl alcohol and 20% glycerin with a trace of phosphoric acid.
Q. Does Xandrox15-PLUS have a ‘greasy’ feel?
A. Since the base is 80% ethyl alcohol, the Xandrox15-PLUS solution absorbs quickly and does not leave an oily sheen on the scalp. Many patients like the extra body the glycerin gives to their hair, especially if they comb or brush their hair after the glycerin dries.
Q. Why use glycerin instead of the propylene glycol that is used in most minoxidil preparations?
A. A significant number of patients, as many as 7%, have an adverse skin reaction to propylene glycol. On the other hand, it would be extremely rare to have an adverse reaction to glycerin, which is commonly used in dermatological preparations as a humectant. Humectants attract moisture to one’s skin. Glycerin based soaps are offered at exclusive spas and resorts for this very reason.
Q. Why wasn’t retinoic acid added to Xandrox15-PLUS?
A. Retinoic acid was an important additional ingredient, when minoxidil solutions only contained 2% minoxidil (Rogaine). With higher concentration minoxidil solutions, there is no need for retinoic acid, which can have more drawbacks than benefits. Retinoic acid acts as a chemical peel and can cause drying, scaling, redness and irritation of the scalp. Moreover, chronic use of retinoic acid makes the skin more sensitive to sun damage.
DIRECTIONS FOR USE
Q. How is Xandrox15-PLUS applied to the scalp?
A. 1mL of Xandrox15-PLUS should be applied to the scalp once daily. Each bottle of Xandrox15-PLUS is accompanied with a calibrated 1mL medicine dropper that allows the patient to conveniently apply 1mL of Xandrox15-PLUS solution onto the scalp, and an optional dauber. Dropper: Place the tip of the dropper onto the scalp and squeeze the rubber bulb to release a small amount of Xandrox15-PLUS. Divide the total 1mL quantity into as many doses as are required to moisten/wet the scalp in all the areas affected by MPB. The fingertips can be used to spread the liquid within the desired areas or to restrict the flow to other areas. Wash hands thereafter.
Q. Is there an alternative method of application other than using a dropper?
A. Regrowth offers a 2oz. plastic bottle with a custom fitted dauber applicator with protective overcap. Xandrox15-PLUS can be transferred to the applicator bottle and dispensed by simply inverting the dauber and gliding it across the scalp. It has been established that four side-to-side passes over the scalp approximate 1 mL of dispensed solution. This is, by far, the most convenient way to apply topical minoxidil solutions. Although the amount being dispensed cannot be precisely calibrated, if only enough liquid is applied to moisten the affected areas, there is minimal chance of utilizing excessive amounts of Xandrox15-PLUS.
Q. Should the scalp be dry or wet when Xandrox15-PLUS is applied?
A. The scalp can be dry or hydrated, but the scalp should not be wet to the degree of diluting or washing off the minoxidil/azelaic acid/finasteride.
Q. How soon after applying Xandrox15-PLUS can one shower or shampoo?
A. For optimal absorption of the minoxidil, azelaic acid and finasteride, allow one hour. The high concentration of ethyl alcohol in the base allows for rapid absorption of the minoxidil, azelaic acid and finasteride.
Q. Will wetting the hair for styling purposes affect the efficacy of Xandrox15-PLUS?
A. No, assuming you are not going to get the scalp so wet that you will wash off the Xandrox15-PLUS.
Q. Will blow-drying the hair affect the efficacy of Xandrox15-PLUS?
A. It would be advisable to blow-dry the hair before the application of Xandrox15-PLUS. Otherwise, blow-drying will cause most of the Xandrox15-PLUS to evaporate rather than to absorb. Applying 1mL of Xandrox15-PLUS to the scalp should not significantly alter the appearance of one’s hairstyle.
Q. What do I do if a precipitate forms in my bottle of Xandrox15-PLUS?
A. Since the Xandrox15-PLUS is a highly saturated solution of minoxidil, there may be rare occasions when a precipitate will form in the bottle. If and when this happens, the tightly capped bottle of Xandrox15-PLUS should be placed in a bath of water that has been heated to a gentle simmer, and shaken vigorously. As long as the bottle of Xandrox15-PLUS is kept tightly capped, it can be kept in heated water until all the minoxidil goes back into solution.
USE WITH OTHER PRODUCTS
Q. Wouldn’t it be more beneficial to use Xandrox15-PLUS twice daily, rather than to alternate its use with a lower concentration minoxidil solution?
A. Possibly, but it’s neither necessary nor advisable to do so. The potency of Xandrox15-PLUS in combination with a 5% Xandrox or a 5% Minoxidil solution is usually sufficient to obtain optimal results in treating MPB. Applying more than 1mg of finasteride does not improve its benefits.
Q. Can Xandrox15-PLUS be used in conjunction with 5% Xandrox?
A. Yes. Apply 1mL of either solution once/day. The applications should be at least 8 hours apart. If nighttime Xandrox solution containing 0.025% retinoic acid is used, it should be applied at night and Xandrox15-PLUS should be applied in the morning.
Q. Can Xandrox15-PLUS be used in conjunction with the 5% Minoxidil Solution?
A. Yes. Apply 1mL of either solution once/day. The applications should be at least 8 hours apart. It does not matter which solution is used at any particular time of day.
Q. Should one use the 5% Spironolactone Lotion in conjunction with Xandrox15-PLUS?
A. For most patients, it shouldn’t be necessary. The azelaic acid and the finasteride in Xandrox15-PLUS should provide adequate reduction of DHT in the scalp.
Q. Should one use Xandrox15-PLUS, if already taking oral finasteride?
A. There is no contraindication to doing so. Oral finasteride 1mg/daily lowers the amount of DHT in the scalp by only 38%, the topical finasteride will lower the scalp DHT even further.
Q. Should a patient initiate treatment for MPB with Xandrox15-PLUS?
A. No. As a rule, most patients will have a satisfactory response to Xandrox 5% solutions or to the combination of a 5% Minoxidil solution with the use of the 5% Spironolactone Lotion. If, after at least six months of treatment with either of these regimens, the improvement is not satisfactory, then the patient may want to consider the use of Xandrox15-PLUS on those areas of the scalp with inadequate regrowth of hair.
The second reason why a patient should not begin treatment of MPB with Xandrox15-PLUS is because topical minoxidil can allow hair that is already in the telogen phase to shed before the end of the phase. Although the hair is replaced with thicker hair shafts, the observation of increased shedding, however temporary, may have a psychologically damaging effect on those patients who are already traumatized by the balding process.
SIDE EFFECTS AND CONTRAINDICATIONS
Q. What is the margin of safety from having systemic effects due to minoxidil when dosing with Xandrox15-PLUS daily?
A. Minoxidil requires a serum concentration of 20 ng/mL to have any hemodynamic or other systemic effect in the human body. Allowing for the average 1.4% absorption (range 0.3 - 4.5%) of minoxidil from the topical application of 1 mL of Xandrox15-PLUS, there will be a serum concentration of minoxidil of ~4 ng / mL of minoxidil in the serum. So, there is an estimated 5-fold safety margin from any systemic effects of minoxidil due to the use of Xandrox15-PLUS, when it is used once/day as recommended. For optimal results, it is suggested that topical minoxidil be applied twice/day. One dose should be 1mL Xandrox15-PLUS and the second dose, at least 8 hours apart, should be 1mL of the lower concentration Xandrox 5% or 5% Minoxidil.
Q. What are the systemic effects and possible side effects of minoxidil use?
A. Oral minoxidil is used as a medication to lower the blood pressure. The most common systemic effects associated with oral minoxidil intake are tachycardia (increased heart rate) and orthostatic hypotension (dizziness on standing). Other side effects may include fluid retention, chest pain and facial edema. There have been rare reports of pericardial effusion (fluid collection around the heart) with the use of oral minoxidil.
Q. Wouldn’t the amount of alcohol used in Xandrox15-PLUS be harmful?
A. Not at all. At most, 1mL of Xandrox15-PLUS and 1mL of another minoxidil solution would be applied daily. The percutaneous absorption from an 80% ethyl alcohol solution would be less than 50mg. By comparison, this is the amount of alcohol in less than 1 mL of wine (10% alcohol by volume). Skin exposure is not a safety concern.
Q. What should a patient do, if he or she experiences any of the systemic side effects associated with the oral administration of minoxidil?
A. The patient should immediately cease using all topical solutions, which contain minoxidil. Side effects should abate within days. Report your side effects immediately to Dr. Lee via email to RichardLeeMD@earthlink.net. Following cessation of the topical application of minoxidil, approximately 95% of systemically absorbed minoxidil is eliminated within four days.
Q. Are there patients who should avoid using Xandrox15-PLUS?
A. Yes. Patients with any history of heart disease should not use Xandrox15-PLUS. Also patients who have a known adverse reaction to minoxidil, azelaic acid or finasteride should avoid using Xandrox15-PLUS.
Herr Doktor Lee forscht weiter, testet neue Medikationen und Techniken und wird diese erhältlich machen, wenn sie wissenschaftlich als sicher und wirksam bestätigt wurden. Währenddessen setzt REGROWTH seine Bemühungen fort, Patienten mit den effektivsten Produkten zu erschwinglichen Preisen zu versorgen. Xandrox 15 Plus mit Finasteride wird Ende Juni erscheinen.
Q. Do you take before and after photographs of patients’ hair?
A. No. Photographs can be extremely subjective and with the advent of digital photography and programs such as Adobe PhotoShop, they are so easy to retouch or 'morph' that they are the mainstay of scam artists who profess to grow hair. Regrowth’s philosophy has been that you are your own best judge and critic. If our treatments work well for you, you’ll use them. If they don’t, you won’t. Patient satisfaction and word of mouth, not photographs, substantiate Regrowth’s track record. However, we have been sent very impressive, unsolicited before and after photos and we’re grateful to have received them. If you wish to send us such photographs, we welcome them. We will not share them with others, unless you state we can, and sign a release to this effect.
Q. Do you include patient testimonials in your web site?
A. No. Such testimonials are even easier to fictionalize than are photographs. If you wish unbiased reports on our products, you may wish to log on to newsgroups about hair. Other informative Internet sites relating to hair loss include www.morphollica.com, www.hairlosshelp.com, www.hairtoday.com and www.hairsite.com. Also, there are forums and chat groups within www.regrowth.com (in no way associated with Regrowth, LLC). The caveat with chat groups is that participants who are content with a product, and/or with their progress seldom post to them.
Q. Do you offer a money back guarantee on your prescription products?
A. No. There are no guarantees in life, and certainly none in medicine. Products that offer money back guarantees are playing one of the oldest scams in the business world: Namely, no matter how egregious the product, statistically only one in three individuals actually ask for their money back. So, even if money is returned to every third consumer, the vendor is already two sales ahead of the game. Beware of these 'money-back-scam' products. Prescription medications are never guaranteed in regards to their pharmacological reaction on any patient. There are too many biological variabilities to predict results. For example, penicillin may work wonders in one patient, but may induce a serious allergic effect in another. We do not claim that our products will work successfully for all patients. However, we can guarantee that the products are properly compounded, using the finest ingredients available. If a patient wishes to submit any of our products to a certified, licensed biochemical testing lab, he/she can arrange to have a licensed courier service pick up the stock product(s) from the Regrowth office and deliver it/them to the testing lab. If the active ingredients are found to be less than what is stated on the label, Regrowth will pay for the testing, the courier service, and of course, will reimburse the purchase price.
Q. What is the advantage of becoming a patient of one of the physicians associated with Regrowth, LLC?
A. Cost, convenience and the ability to obtain the following drugs without having to constantly renew your prescriptions: Minoxidil 5% solution (with or without 0.025% retinoic acid); 12.5% Minoxidil Solution; 2% spironolactone solution; 5% spironolactone lotion; Xandrox® 5% solution (with and without 0.025% retinoic acid); Xandrox 12.5% Lotion®, and Xandrox 15% Solution®. Xandrox15-PLUS® will be available in June 2008. The quality of all products is superb..
We ship to patients in almost every country on earth. Orders can be picked up at our Los Angeles area headquarters in Whittier. Credit card orders can be FAXED to (562) 696-2707, and orders can be placed via the Secure Order Form found at www.minoxidil.com. If you use the Secure Order Form, select your country from the pop down menu, and then select the products you wish to order. Orders can also be sent via Air Mail. Send the printed order, with payment, to:
Regrowth, LLC
Orders Department
7049 Greenleaf Avenue
Whittier, CA, 90602
U.S.A.
Please make personal checks (U.S. residents only) or International Money Orders payable to Richard Lee, M.D. Include a note indicating what it is you are ordering, how many you are ordering, the postage (calculated for you from within the Secure Order Form), your name and mailing address, and enter your email address twice. Why twice? To better insure its' accurate entry.
Q. If I become a Regrowth patient, am I obligated to purchase Dr. Lee’s products?
A. Absolutely not. You should purchase what you want wherever it's the least expensive for you. However, we intend to make our medications available at the lowest prices. Our commitment to keep costs at a minimum includes the one-time-only doctor's consultation of $20.00 - for as many hair related online consultations as you wish, for as often as you wish. An in-office consultation costs $20.00, and subsequent in office consultations cost $10.00 per visit. The 5% - 15% Xandrox® solutions, the 12.5% Xandrox Lotion® and the 12.5% Minoxidil Solution are dispensed exclusively by Regrowth, LLC. The non-greasy feeling 5% minoxidil solutions are also dispensed exclusively by Regrowth, LLC.
Q. I've found a place where I can buy Rogaine®/Regaine Extra Strength® 5% minoxidil solution or its generic version for less than Regrowth's 5% minoxidil solution. Will you match the price?
A. No. The products are not the same. Most patients prefer the non-oily, alcohol-based 5% minoxidil solution that Regrowth compounds. Our 5% minoxidil solutions are non-taxable, prescription-only formulae. Our 5% minoxidil solutions for night time use also contain prescription retinoic acid.
Q. If I become a patient of Regrowth, LLC, will Dr. Lee write prescriptions for me, and then mail or telephone these prescriptions to a pharmacy of my choice?
A. Generally, “No”. Dr. Lee must monitor his patients' use of drugs. The only way he has of effectively monitoring what and how many medications his patients take is through that aspect of Regrowth’s database which tracks patients' purchases. If a patient wishes to purchase drugs elsewhere, he/she should ask a local doctor for prescriptions, so proper monitoring can take place.
Q. Can I ask Dr. Lee questions?
A. Yes. During your initial consultation any and all questions relating to your hair and the regrowth of hair are answered. If you have medical questions relating to your regrowth therapy after the initial consultation, e-mail Dr. Lee at RichardLeeMD@Xandrox.net. All such questions are promptly responded to at no additional charge.
Q. I have a question about shipping products to me. Will Dr. Lee respond to shipping questions?
A. No. Please direct all shipping questions to Shipping@minoxidil.com. If you send 'buckshot' emails to every address associated with Regrowth, LLC, you may not receive a response. Pick the correct department/email address, and send to it, and it alone.
Q. How do I obtain Xandrox® solutions or lotion, or the other listed drugs if I’m not in Regrowth, LLC’s patient database?
A. Make an appointment to consult with Dr. Lee online, or Dr. Clifford in the Whittier, CA, office. Requests for online consultations can be emailed to Regrowth@minoxidil.com. In the Subject: line of the email, please write CONSULTATION if you reside in the U.S.A., or CONSULTATION FROM ABROAD if you live outside the U.S.A.
Q. Do I need to consult Dr. Lee if I don’t live in the United States of America?
A. No. Almost all countries allow importation of prescription medications for a patients' personal use. Residents of EU countries will want to send an email to Regrowth@minoxidil.com on how to obtain our medications for their personal use.
Q. If I live abroad, may I consult with Dr. Lee?
A. Yes. If you have questions about your Regrowth therapy, please contact Dr. Lee at RichardLeeMD@Xandrox.net. There are no charges for these consultations. Please write CONSULTATION FROM ABROAD in the subject line of the email.
Q. What is the future of Regrowth, LLC?
A. We anticipate a continued and enthusiastic future in the diagnosis and treatment of alopecia androgenetica in men and women. There is promise of many new drugs, which may utilize new pharmacological approaches to hair loss, e.g. molecular signaling proteins and NEOSH101, a tetrapeptide aldehyde proteasome inhibitor (http://www.clinicaltrials.gov/ct/show/NCT00418730). Hair multiplication may also become a reasonable treatment in the near future. It's an exciting, new, and specialized field of medicine.
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 Hair Loss Myths, which you can access by clicking on ‘Hair Loss Myths’ here, or from our home page.
Q. What’s the best shampoo to use?
A. There isn’t a single shampoo that meets all needs. See recommendations in the next two Q & A’s, 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, 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. Where can I purchase the Regrowth Treatment Shampoo with 2% ketoconazole and 3% salicylic acid?
A. Regrowth Treatment Shampoo is available only through Regrowth, LLC 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, LLC at Regrowth@minoxidil.com, and in the Subject line write CONSULTATION.
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, LLC has reservations about recommending them.
Q. Why doesn’t Regrowth, LLC 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 no known studies in regards to the absorption dynamics of topical vitamin B6. After completing exhaustive research and having consulted the pharmacology departments of many universities, Dr. Lee has not found 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 the active ingredients ineffective.