Coalition Surgeons

Jerry Cooley MD · #11 **Top** 09-30-2008, 04:09 AM

Bill

Every topical drug has a certain rate of penetration and a time required for absorption for it to have any effect. I don't know the specifics of ketoconazole but I'm sure much, much more gets down into the hair follicle with a leave-on foam compared to a shampoo. If minoxidil worked as a shampoo, it would be much more widely used. Ketoconazole (and zinc pyrithione) help dandruff by eliminating a yeast from the surface of the scalp and by being anti-inflammatory, so being in a shampoo form that stays on the skin a few minutes will have a positive effect. When it comes to penetrating the hair follicle and helping hair loss, I've always worried that ketoconazole in the shampoo form probably doesn't get left on long enough to have that much effect. I'm sure much more of the ketoconazole gets down into the follicle as a leave-on foam, where it can have a positive effect for hair loss. Extina foam has the same feel as Rogaine foam. Alot of guys don't want to use anything topically for hair loss because of the hassle factor, but if they do, I start with minoxidil. If they want to use something in adddition to that, ketoconazole (Extina) foam is the next logical choice. For guys who don't tolerate finasteride because of side effects, I push the minoxidil AND ketoconazole foam. Just my opinion.

cheers,

Jerry

Bill - Managing Publisher · #12 **Top** 09-30-2008, 03:36 PM

Thanks for your professional opinion Dr. Cooley.

Best wishes,

Bill

sandip · #13 **Top** 10-02-2008, 03:01 PM

Dr. Cooley,

I am little confused...
1) So do you suggest that Finastride should be taken everyday or thrice a week?
2) How would one come to know what dosage is helpful i.e. daily or thrice a week.
3) Would using Nizoral shampoo give the same benefit as provided by finastride.

Regards,
Sandip

Dewayne · #14 **Top** 10-02-2008, 06:51 PM

Quote:

Originally posted by sandip:
Dr. Cooley,

I am little confused...
1) So do you suggest that Finastride should be taken everyday or thrice a week?
2) How would one come to know what dosage is helpful i.e. daily or thrice a week.
3) Would using Nizoral shampoo give the same benefit as provided by finastride.

Regards,
Sandip

fwiw, Dr. Cooley prescribed me Proscar 5mg, with instructions to cut into 1/3 size doses and take Monday, Wednesday, Friday. So, in effect it's 1.66mg 3x per week.

Rick055 · #15 **Top** 10-06-2008, 04:27 AM

DeWayne-

How's it working with the androgel?

I understand androgel can raise DHT pretty good.

HealthyLiving8 · #16 **Top** 10-06-2008, 09:11 AM

YES you can take it every other day.

You SHOULD take it every other day.

Fin stays in the bloodstream and keeps DHT lowered for 48 hours before it begins to rise appreciably again. Taking it every day would be a waste of money.

latinlotus · #17 **Top** 10-06-2008, 06:25 PM

Quote:

Hi guys. I do have an opinion on this topic. Propecia is approved by the US FDA for once a day use. This does not mean it is the best dosage, only the one that was studied and approved. The average serum "half-life" of finasteride 1mg is about 5 hours in young men and 8 hours in older men. This does not mean that half of the medicine is out of your body in that time period though. The finasteride molecule is distributed throughout the body where it binds to the type II 5-alpha-reductase enzyme, thereby inhibiting conversion of testosterone to dihydrotesterone. Serum DHT is reduced about 65%, and less DHT means less balding. But several studies show that a single dose of finasteride suppresses serum DHT for 7 days or more (Eur J Drug Metab Pharmacokinet. 1991 Jan-Mar;16(1):15-21, J Clin Endocrinol Metab. 1990 Apr;70(4):1136-41, Prostate. 1989;14(1):45-53). So the finasteride is leaving the bloodstream, entering the tissue throughout the body, and binding to the typeII 5AR enzyme, resulting in long lasting DHT suppression.

I do not "recommend" my patients take finasteride daily, every other day, twice weekly, etc. Rather I feel it is my duty as their doctor to advise them of the known facts about this medication. Most of my patients choose to take it on a Mon-Wed-Fri schedule, which is rational from my point of view. Many of my younger patients take it daily 'just to be sure' while my older patients are happy to take it two or three times a week. There are no clinical studies showing that less than daily dosing is as effective at treating hair loss as daily dosing and for obvious financial reasons, the pharmaceutical company making finasteride has no incentive to fund such a study.

I hope this information is helpful. It is up to each patient to make an informed decision about which dosage is right for them.

Hi Dr. Cooley:
Thanks for this analysis. I have no side effects from Propecia. Money is not an issue as I use Proscar and it is reimbursed by my insurance. However, I do want to take as little as possible of Propecia, since to this day, there is still no long-term study on Propecia. The less stuff in my body, the better. Currently, I take 1/4 of Proscar, daily and skip the 5th day but I will probably lower my dosage to every other day shortly.

surkhabi · #18 **Top** 10-08-2008, 10:47 PM

hi Dr Cooley,
i have started using finastride 1mg/day sine one month and witnessed really good result. but i m worrying about its sides, i heard besides of have effect on sexual ability it can bring some changes on ur body as well like your chest gets longer or some...
one of the doctors here in Afghanistan prescribes progesterone lotion mixed with betametasone lotion to apply on the scalp 2/day and says it is very useful and those who has used is satisfied. what is your idea about?

surkhabi · #19 **Top** 10-08-2008, 10:52 PM

hi Dr Cooley,
i have started using finastride 1mg/day sine one month and witnessed really good result. but i m worrying about its sides, i heard besides of have effect on sexual ability it can bring some changes on ur body as well like your chest gets longer or some...
one of the doctors here in Afghanistan prescribes progesterone lotion mixed with betametasone lotion to apply on the scalp 2/day and says it is very useful and those who has used is satisfied. what is your idea about?

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