COMBINED THERAPIES

The currently accepted state-of-the-art medical treatment for male pattern baldness is the concurrent use of high-concentration topical minoxidil, retinoic acid and daily doses of an anti-androgen such as topical spironolactone, topical azelaic acid or oral finasteride (Propecia). One of the most convincing reports using this combination of medications was reported from Walter Reed Army Hospital and is reproduced in totality in Additional Journal Reports . There have also been numerous enthusiastic reports in the popular press in regards to the effectiveness of this new approach to male pattern baldness. It is exciting to realize that balding is now a choice, rather than a fate.

At the REGROWTH Hair Treatment Centers, we have been utilizing 1ml of high concentration minoxidil solutions applied twice daily and recommending the addition of .025% retinoic acid in the nighttime application. Having been convinced of the safety and efficacy of finasteride from the Phase III clinical trials by Merck & Co., Inc., we are also dispensing 1mg of finasteride for daily use, and more recently, introduced 2% spironolactone solution and azelaic acid (Xandrox). The results have been profoundly satisfying for the majority of the patients. Hair growth rated 'good' to 'excellent' has been reported in 70 to 75 percent of the nearly 6000 patients who are using these combinations of medications.

In a simplified schema, the finasteride and spironolactone decrease the amount of dihydrotestosterone (DHT) in the scalp, allowing the hair follicles to mature closer to their normal size, and the minoxidil promotes hair growth. Topical minoxidil is dose dependant and the higher the concentration, the more effective it is in promoting hair growth. The retinoic acid acts as a chemical 'peel' and allows for greater penetration of the scalp. Spironolactone in topical form acts like 1 mg. finasteride in oral form to reduce the action of DHT on the follicles. The spironolactone, however, has none of the potential side effects associated with finasteride. Topical 5% minoxidil has been successfully combined with azelaic acid in a single solution (Xandrox) to provide simultaneous inhibition of DHT as well as stimulation to hair growth.

Since we deal exclusively with hair loss problems, we carefully evaluate all products purported to grow hair. There have always been numerous claims of substances and procedures to grow hair. Some may have real value, but there has not been sufficient testing under clinical situations for us to recommend their use. What we promise to our patients is to make available only those treatments that are safe, efficacious and have

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