My Dermatologist makes false claims??

[alexmillne]

My Dermatologist makes false claims?? Help!

 

During my recent appointment with a dermatologist specializing in hair-related issues, I underwent a trichoscopy, which involved using a scalp camera to assess the miniaturization of my hair and other factors related to alopecia. With 1.5 years of experience taking Finasteride, I had acquired substantial knowledge about alopecia and felt confident discussing my hair concerns and potential future outcomes with the doctor.

 

However, I left the appointment feeling perplexed and uncertain due to the dermatologist presenting claims that appeared contradictory to what I had previously learned. As a medical professional, his unwavering confidence in his statements further compounded my confusion. Despite my attempts to question or counter his assertions, he consistently reassured me of his correctness.

 

Here are the claims he made, along with my objections:

 

1.) The dermatologist stated that there is no significant benefit in using minoxidil if I have already been taking Finasteride for over a year. He referenced studies suggesting that both minoxidil and finasteride are effective in combating hair loss, and there is no substantial difference in the degree of improvement when using them together or separately.

 

2.) I contested his claim that minoxidil prevents hair loss. I explained that minoxidil actually stimulates hair growth and increases hair thickness, but it does not prevent hair loss caused by DHT-sensitive hair follicles. However, he disagreed and argued that minoxidil prevents DHT from affecting the hair, thereby halting hair loss.

 

3.) The dermatologist provided reassurance that as long as I continue taking finasteride, I will not go bald. However, I expressed concern regarding the potential loss of effectiveness of finasteride over time. In response, he confidently dismissed this concern.

 

4.) Interestingly, he later contradicted himself by asserting that minoxidil is slightly more effective in restoring the hairline, while finasteride works better for the crown. However, when I pointed out that it is typically the opposite, he insisted that his original statement was accurate.

 

 

Given the conflicting information presented by the dermatologist, I was left bewildered and began to question the accuracy of my understanding of these matters.

 

Anyone here knowledgeable and can share some advice? What's fact and what's fiction?

 

[GoliGoliGoli]

Nearly all of what he said is varying degrees of "wrong". Some of his statements are "more wrong" than others.

Doctor's aren't always as smart as most people think they are. That's true of dermatologists, or general practitioners, and HT surgeons. You need to make sure to never take anything they say as fact. I realize that's a very broad statement and it comes across of arrogant of me to say, but nevertheless its true. They're extremely useful when you break you leg or crack your skull or need hair moved from your donor to the top of your head, but 95% of them are completely useless when it comes to preventative care (IE nutrition, supplementation, hair loss prevention).  People put way too much stock in their opinions when it comes to preventative care. 

Some Dr's are very good and very smart. A lot aren't. This is just my opinion and my experience, but if I were you I would try to find a better dermatologist. I realize this comes across harsh, but please understand that my main point is always to do your own research, and always to question things you are told by supposed experts. You are right to question the things he told you during your appointment. 

 

[alexmillne]

8 minutes ago, GoliGoliGoli said:

Nearly all of what he said is varying degrees of "wrong". Some of his statements are "more wrong" than others.

Doctor's aren't always as smart as most people think they are. That's true of dermatologists, or general practitioners, and HT surgeons. You need to make sure to never take anything they say as fact. I realize that's a very broad statement and it comes across of arrogant of me to say, but nevertheless its true. They're extremely useful when you break you leg or crack your skull or need hair moved from your donor to the top of your head, but 95% of them are completely useless when it comes to preventative care (IE nutrition, supplementation, hair loss prevention).  People put way too much stock in their opinions when it comes to preventative care. 

Some Dr's are very good and very smart. A lot aren't. This is just my opinion and my experience, but if I were you I would try to find a better dermatologist. I realize this comes across harsh, but please understand that my main point is always to do your own research, and always to question things you are told by supposed experts. You are right to question the things he told you during your appointment. 

 

Hey, thanks a lot for getting back to me. I totally agree with you. Mind helping me out with Questions 1-4? It would be super awesome if you could share your current knowledge and provide answers. I'd really appreciate it!

[TheGreatPretender]

I think point 3 he's right. Most people don't really bald on Finasteride in the long term but him telling there is no benefit in taking Minoxidil is plain wrong.

[Gatsby]

I would consider changing dermatologists. I mean this seriously. What he is saying has some truth to it but he sounds very attached to his convictions. All the best. 

[GoliGoliGoli]

56 minutes ago, alexmillne said:

Hey, thanks a lot for getting back to me. I totally agree with you. Mind helping me out with Questions 1-4? It would be super awesome if you could share your current knowledge and provide answers. I'd really appreciate it!

1. He's right that both fin and min are effective at combatting hair loss, but they work synergistically through different mechanisms. So using both together will get you better results than using one or the other. Basically they compliment one another. 

2. This is a bit of a semantics question. Neither fin or min truly "prevent" hair loss, both delay it. The main cause of hair loss is DHT, so fin is more effective than min at delaying it. Some people think that Min works on a hormonal level (Combatting DHT) and there is 1 study that showed that might be true but tbh I've looked at the study and find it very unconvincing. 

3. Excluding dutasteride, Fin is probably the best medicine available to slow hair loss. Again, "prevent" is kind of a tricky word to use so that's why I'm saying "slows down". Lots of guys continue losing ground despite being on heavy doses of fin so you can't say fin truly "prevents" hair loss, but again it's a question of semantics. Fin doesn't take your DHT to 0%, so some DHT will still find it's way to attach to the hair follicle. Nevertheless, used colloquially, some guys I think do find that fin basically does "prevent" hair loss at least to the naked eye. Even though technically they still might be losing hair on paper, visually there is no change because fin is so effective for them. But that isn't the case for everyone. Some peoples hair follicles have such a high affinity for DHT that they still lose ground fairly rapidly even on fin. It depends patient to patient. Lots of guys do claim that fin loses effectiveness over time too. Who knows, it really varies patient to patient. 

4. I've had what I think are GREAT results with minoxidil on my hairline. I've never used fin so can't comment on that. Medicines work differently person to person, everyone's results will vary so I don't have much to add here. Both are good for hair follicles overall regardless of where on your head they are. 

Edited June 2, 2023 by GoliGoliGoli

[shiba1985]

There are dermatolgists that "know" hair, and then there are dermatolgists that "REALLY KNOW" hair. Every dermatologist will get exposure to alopecia during their training. So when they come out, they can market themselves as hair loss treating doctors, which is true for the average population they have enough knowledge to tackle 95% of the patients, and the patients will be satisfied. 

 

But the average patient on THIS forum is obsessed with our hair loss, and we know stuff that the average patient doesnt. For patients like you and me you have to go to Dermatologists that live, breathe and treat hair conditions. They are not as common. 

Edited June 3, 2023 by shiba1985

[Turkhair]

Finasteride does NOT lose effectiveness over time. Finasteride increases its effectiveness over time. He is 100% correct.

On point 2 he is also correct, there are some people who use minoxidil alone and get growth and maintain for as long as they use Minoxidil. 

[A_4_Archan]

You need to look for a better doctor ..bdw medication cannot prevent but can only slow down the progress so the statement that"you will not get bald as long as you continue taking Finasteride" is totally wrong....and minoxidil does work on hairlines as well as hairs all over the body...it has nothing to do with slowing down your baldness as it will promote hair growth everywhere on your body....and everyone has different biology so medication will tend to give varying results from person to person..

[TheGreatPretender]

9 minutes ago, A_4_Archan said:

You need to look for a better doctor ..bdw medication cannot prevent but can only slow down the progress so the statement that"you will not get bald as long as you continue taking Finasteride" is totally wrong....and minoxidil does work on hairlines as well as hairs all over the body...it has nothing to do with slowing down your baldness as it will promote hair growth everywhere on your body....and everyone has different biology so medication will tend to give varying results from person to person..

Actually there are 10 year studies demonstrating that hair count goes up while being on the drug so it's very likely that the average patient will be able to stop the hair loss in its tracks on the worst case scenario. 

[A_4_Archan]

12 minutes ago, TheGreatPretender said:

Actually there are 10 year studies demonstrating that hair count goes up while being on the drug so it's very likely that the average patient will be able to stop the hair loss in its tracks on the worst case scenario. 

Actually from what i have seen and knew by talkin to some good knowledgeable surgeons that medication will decrease your dht bt will not make it 0 so there would be some dht which will going to effect the hairs...the hair count ofcourse increase as the miniaturised hair will be able to grow due to decrease in dht levels...so if someone lets say is nw2 and widout medication he will head to nw5 in 5 yrs thn with religious use of medication and if he is reacts positively to it than he may reach to nw5 after 10-15 years...still i understand this all are theories and are debatable and thats why i believe "science will always chase the nature"

Edited June 3, 2023 by A_4_Archan

[TheGreatPretender]

Just now, A_4_Archan said:

Actually from what i have seen and knew by talkin to some good knowledgeable surgeon that medication will decrease your dht bt will not make is it 0 so there would be some dht which will going to effect the hairs...the hair count ofcourse increase as the miniaturised hair will be able to grow due to decrease in dht levels...so if someone lets say is nw2 and widout medication he will head to nw5 in 5 yrs thn with religious use of medication and if he is reacts positively to it than he may reach to nw5 after 10-15 years...still i understand this all are theories and are debatable and thats why i believe "science will always chase the nature"

While it's true that there will still be circulating levels of DHT the reality is that from my understanding there needs to be enough of it to actually kill the hair. 

And let's not forget that the older you get the less DHT you have do it will all depend on your sensitivity to the hormone itself. 

This video kind of sheds some light into it. 

https://youtu.be/LsF9MwIM_AM

But like you said, no 100% correct version exists for this. 

I have been on the drug for 3 years and this is my fourth. My hair is defo thicker then my baseline and when looking back at my old pictures I can clearly see signs of improvement among maintenance. I can't really say I have lost "a hair" while being ok fin tbh. 

But as always, experiences differ because I am an optimistic by nature when it comes to maintaining on meds and also because I have responded fairly well to medication. 

[A_4_Archan]

9 minutes ago, TheGreatPretender said:

While it's true that there will still be circulating levels of DHT the reality is that from my understanding there needs to be enough of it to actually kill the hair. 

And let's not forget that the older you get the less DHT you have do it will all depend on your sensitivity to the hormone itself. 

This video kind of sheds some light into it. 

https://youtu.be/LsF9MwIM_AM

But like you said, no 100% correct version exists for this. 

I have been on the drug for 3 years and this is my fourth. My hair is defo thicker then my baseline and when looking back at my old pictures I can clearly see signs of improvement among maintenance. I can't really say I have lost "a hair" while being ok fin tbh. 

But as always, experiences differ because I am an optimistic by nature when it comes to maintaining on meds and also because I have responded fairly well to medication. 

Yeh even i responded very well and it played an important role ...but with same medication my friend who tried for more than one year kept on loosing hairs...he started it around 15-16 months back...he was nw4 and right now nw5...and jst 2 days back he told me that he is feeling like quitting it as there is no positive effect so i advised him to talk to his doctor and see what else can be done..so thats the "nature you can fight with but can't win"

Edited lines

So medication is extremely helpful to some,helpful to many and barely helpful to few

Edited June 3, 2023 by A_4_Archan

[TheGreatPretender]

1 minute ago, A_4_Archan said:

Yeh even i responded very well and it played an important role ...but with same medication my friend who tried for more than one year kept on loosing hairs...he started it around 15-16 months back...he was nw4 and right now nw5...and jst 2 days back he told me that he is feeling like quitting it as there is no positive effect so i advised him to talk to his doctor and see what else can be done..so thats the "nature you can fight with but can't win"

I guess there is also a dice rolling in there for your friend that didn't go his way. 

But he can still use Dutasteride to fully stop it since it's the most potent drug out there in the market. Just because fin isn't for him doesn't mean he needs to give up. 

We live in better times then people who were born in the 80s. 

Can you imagine what would be like to been balding on that era with maybe just Minoxidil as a monotherapy?

We'd probably be belder then Vin Disel. 🙃

In a way, we are quite lucky to be alive in this fight...

[A_4_Archan]

5 minutes ago, TheGreatPretender said:

I guess there is also a dice rolling in there for your friend that didn't go his way. 

But he can still use Dutasteride to fully stop it since it's the most potent drug out there in the market. Just because fin isn't for him doesn't mean he needs to give up. 

We live in better times then people who were born in the 80s. 

Can you imagine what would be like to been balding on that era with maybe just Minoxidil as a monotherapy?

We'd probably be belder then Vin Disel. 🙃

In a way, we are quite lucky to be alive in this fight...

I am fine geting 100% more balder thn Vin Diesel even if i get 50% success and fame of him..😅

Yeh you are right that we are lucky to get options and resources this days...i gave info to him about dutasteride bt i cannot tell him to try it without consulting doctor as its a potent drug so need to be careful and do required reports before starting it...

[TheGreatPretender]

1 minute ago, A_4_Archan said:

I am fine geting 100% more balder thn Vin Diesel even if i get 50% success and fame of him..😅

Yeh you are right that we are lucky to get options and resources this days...i gave info to him about dutasteride bt i cannot tell him to try it without consulting doctor as its a potent drug so need to be careful and do required reports before starting it...

I actually am "kinda" self medicating on Fin since a local surgeon recommended me. 

So basically all I do is fill up a form and get the drug delivered to me by post, easy and simple. My brother started balding in the last few years and I knew straight away from the pattern it was MPB. So I gave him a box of my Finasteride and showed him how to order online. So he started doing the same. 

When I really saw him getting bad I just thought to myself "no you don't, not on my watch" so I made sure at least he could be saved from my troubles. 

He started with a dose of 3 timed a week, now he's taking it every other day. I told him to keep monitoring the situation and make sure he doesn't bald any further and at least for now he seems to be good with no side effects to report either. 

I don't obviously advocate anyone to self medicate, but in my case it was just too much to see my brother go thorough the same so I had a moral obligation to help him. 

[A_4_Archan]

14 minutes ago, TheGreatPretender said:

I actually am "kinda" self medicating on Fin since a local surgeon recommended me. 

So basically all I do is fill up a form and get the drug delivered to me by post, easy and simple. My brother started balding in the last few years and I knew straight away from the pattern it was MPB. So I gave him a box of my Finasteride and showed him how to order online. So he started doing the same. 

When I really saw him getting bad I just thought to myself "no you don't, not on my watch" so I made sure at least he could be saved from my troubles. 

He started with a dose of 3 timed a week, now he's taking it every other day. I told him to keep monitoring the situation and make sure he doesn't bald any further and at least for now he seems to be good with no side effects to report either. 

I don't obviously advocate anyone to self medicate, but in my case it was just too much to see my brother go thorough the same so I had a moral obligation to help him. 

Yeh i can understand your feelings for him..but sometimes in trying to help someone and do good for someone we end up messing things ..so i wanted to be safe for him..actually its not always that dht is the root cause ..there may be some underlying issues with other things so just to be on a safer side its better to get checked evrythng and than if we find that dht is the root cause than we can target it with medications like finasteride and dutasteride....

[TheGreatPretender]

Just now, A_4_Archan said:

Yeh i can understand your feelings for him..but sometimes in trying to help someone and do good for someone we end up messing things ..so i wanted to be safe for him..actually its not always that dht is the root cause ..there may be some underlying issues with other things so just to be on a safer side its better to get checked evrythng and than if we find that dht is the root cause than we can target it with medications like finasteride and dutasteride....

We thought the same, problem is that he was actually receding for a couple of years already and we noticed it was getting worse. Considering that my family history is strong in hair loss it was literally the only solution I could think off to keep him safe. 

He is healthy overall even more then me and has no issues with alimentation or any other thing. Chances that it was MPB are pretty much 99.99% imo. 

Also, the doctors here in the UK are always adamant to directly prescribe Finasteride so for me was the situation of being better safe then sorry...

The bald patch over his head still persists but ain't much noticeable since he has similar caliber as mine (medium,dark,wavy) so he conceals it well. 

I think he could be a candidate for topical Minoxidil and told him to try if he wanted but as far as now goes he remains stable. 

[consequence]

11 hours ago, alexmillne said:

1.) The dermatologist stated that there is no significant benefit in using minoxidil if I have already been taking Finasteride for over a year.

 

2.) However, he disagreed and argued that minoxidil prevents DHT from affecting the hair, thereby halting hair loss.

 

3.) I expressed concern regarding the potential loss of effectiveness of finasteride over time. In response, he confidently dismissed this concern.

 

4.) Interestingly, he later contradicted himself by asserting that minoxidil is slightly more effective in restoring the hairline, while finasteride works better for the crown. However, when I pointed out that it is typically the opposite, he insisted that his original statement was accurate.

1. There is a benefit to using minoxidil and finasteride together. This has been shown in multiple peer reviewed studies.

2. Minoxidil is a nitrous oxide free radical inductant. Theorized to work by dilating blood vessels, particularly in areas with early scalp fibrosis.

3. Finasteride decreases in effectiveness over time because the follicles become more sensitive to DHT and inflammation; remember, fin only reduces DHT by 70%. This was shown with Merck's original long term studies and follow up data has endorsed it. There is even progression with Dutasteride, which reduces DHT by 95%, though to a lesser extent than finasteride.

4. Finasteride works for both the crown and frontal line. It can cause regrowth at the crown, but more slows recession at the frontal line.

With dermatology literally being the most competitive subspecialty of any field in medicine to get into in the USA, it's very surprising that he wouldn't know these points as they are extremely basic medical facts that any second year medical student would know. Are you sure he was an actual MD? Was this somewhere outside the states? And are you sure that you completely understood what he was saying?

4 hours ago, Turkhair said:

Finasteride does NOT lose effectiveness over time. Finasteride increases its effectiveness over time. He is 100% correct.

I've never heard of a study endorsing this view and it makes zero mechanistic sense. You're really spreading a lot of misinformation on the forums. This is in direct contradiction to Merck's own gold standard studies from years ago. Provide a peer reviewed double blinded trial from a high impact factor journal. Otherwise lighten up on the broscience.

 

 

Edited June 3, 2023 by consequence

[alexmillne]

2 hours ago, A_4_Archan said:

Yeh even i responded very well and it played an important role ...but with same medication my friend who tried for more than one year kept on loosing hairs...he started it around 15-16 months back...he was nw4 and right now nw5...and jst 2 days back he told me that he is feeling like quitting it as there is no positive effect so i advised him to talk to his doctor and see what else can be done..so thats the "nature you can fight with but can't win"

Edited lines

So medication is extremely helpful to some,helpful to many and barely helpful to few

From my understanding, taking Finasteride early, specifically at the Norwood 2 stage of hair loss, can potentially prevent visible signs of balding for a lifetime. However, there is an important caveat. If you start taking Finasteride when you are already at the later stages of the Norwood scale, such as Norwood 4, the likelihood of Finasteride stopping your visible balding becomes significantly diminished. In fact, it is almost guaranteed that you will experience baldness at some point.

The reason for this difference lies in the fact that at the Norwood 4 stage, there is already a noticeable reduction in hair volume. Consequently, the small amount of hair loss that occurs while using Finasteride becomes more apparent over time. This means that the balding process accelerates between Norwood 4 and 5, whereas it progresses at a slower pace (in terms of visible hair loss) between Norwood 2 and 3, even up to the point where you actually have no visible signs of bolding for a lifetime.

I hope this explanation clarifies the concept for you. I came across this information in a recent YouTube video where Matt Dominance discussed the topic:

 

 

[consequence]

3 minutes ago, alexmillne said:

From my understanding, taking Finasteride early, specifically at the Norwood 2 stage of hair loss, can potentially prevent visible signs of balding for a lifetime. However, there is an important caveat. If you start taking Finasteride when you are already at the later stages of the Norwood scale, such as Norwood 4, the likelihood of Finasteride stopping your visible balding becomes significantly diminished. In fact, it is almost guaranteed that you will experience baldness at some point.

The reason for this is that follicles become much more sensitive to DHT and inflammation with aging.

As a thought experiment think about the flip side: if you gave a 70 year old man anabolic steroids vs a 20 year old man, the older man would experience AGA at a much more aggressive rate than the younger.

[Turkhair]

2 hours ago, consequence said:

No, incorrect. You're really spreading a lot of misinformation on the forums.

 

 

https://www.ishrs-htforum.org/content/32/4/130.full

 

 

Edited June 3, 2023 by Turkhair

[consequence]

The picture you posted is stable from 1 year, not "getting better over time". So I can again correct your misinformation and tell you you're wrong.

The study is only in Japanese men.

Merck's original studies were in a larger and more general population and showed a lack of getting worse for many, but that about 15-30% progressed with time regardless of fin.

Spend more time on the results and methods sections and resist the impulse to just cut and paste sentences from the abstract. Remember the evidence hierarchy. Poster presentations from a conference are never going to be vetted as carefully as meta analyses and position statements from high impact factor journals.

Edited June 3, 2023 by consequence

[alexmillne]

6 minutes ago, consequence said:

1. There is a benefit to using minoxidil and finasteride together. This has been shown in multiple peer reviewed studies.

2. Minoxidil is a nitrous oxide free radical inductant. Theorized to work by dilating blood vessels, particularly in areas with early scalp fibrosis.

3. Finasteride decreases in effectiveness over time because the follicles become more sensitive to DHT and inflammation and propecia only reduces DHT by 70%. This was shown with Merck's original long term studies and follow up data has endorsed it. There is even progression with Dutasteride, which reduces DHT by 95%, though to a lesser extent than minoxidil. Turkhair

4. Finasteride works for both the crown and frontal line. It can cause regrowth at the crown, but but more slows recession at the frontal line.

With dermatology literally being the most competitive subspecialty of any field in medicine to get into in the USA if this guy is in the States, it's very surprising that he wouldn't know these points as they are extremely basic medical facts that any second year medical student would know. Are you sure he was an actual MD? And that you completely understood what he was saying?

 

I live in Switzerland. It was a Swiss doctor, and it was the second Swiss dermatologist I visited who specialized in hair conditions. The first doctor was even at the University Hospital in Zurich, where they have a special "Hair Consultation" service. I left that doctor because he was reluctant to prescribe Finasteride and wanted me to use Minoxidil first for a year, believing that if my hair grows with Minoxidil, there is no need to take Finasteride until the hair loss progresses further. I refused because I told him that I don't want to "artificially" grow my hair with Minoxidil and keep the DHT from further damaging my hair.

I have read your points, and I already know everything you're saying. I am aware that DHT reduction is only around 70% and so on... It's so frustrating that I feel like I know more than the doctor. In my view, this Swiss doctor is relying more on his clinical experience treating patients and may not be up-to-date with the latest numbers. Moreover, what made me suspicious is that he was offering PRP treatments at his clinic. This makes me think that perhaps he always claims that combining Finasteride with Minoxidil would yield similar results as using a monotherapy, like only Finasteride or only Minoxidil. Maybe he says that to encourage patients to opt for his PRP treatments. But okay, this is just me speculating and having negative thoughts about people.

As you can see, it has been quite a struggle. What is your opinion as to where Minoxidil works best on the head? I read that Minoxidil is most effective at the crown and back, and less so at the front. But im not 100% sure if this information is correct

[consequence]

2 minutes ago, alexmillne said:

What is your opinion as to where Minoxidil works best on the head? I read that Minoxidil is most effective at the crown and back, and less so at the front. But im not 100% sure if this information is correct

This is correct.

I also found oral minoxidil to be more effective than topical for me and w fewer side effects, though I haven't looked too much at the literature about this.