Frequently Asked Questions (FAQ's)
PROPOSED TREATMENTS FOR MPB
Q. How effective are products that claim to 'unclog' the pores?
A. Nearly any cleansing agent can 'unclog' pores, however none 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.
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 vibrators would be.
Q.. What's the best shampoo to use?
A. It stands to reason that if there were a 'best' shampoo, there would only be one shampoo on the market. Various brands of shampoos and conditioners differ from each other primarily in price, and the number and proportion of additives and detergents. Generally, less expensive shampoos and conditioners have fewer additives. Additives are designed to achieve specific results. They can, for example, make hair look and feel cosmetically thicker, and smell better or tangle less. As a rule, shampoos have nothing to do with promoting hair growth.
Q.. Do you recommend any specific shampoo?
A. Not really. However most patients are benefited by using shampoos/conditioners which contain humectants (moisturizers). It may be to the patients' advantage to use two totally different shampoos in succession or on subsequent days, e.g. use Neutrogena's Clear shampoo, which gently cleanses the scalp, and subsequently or alternatively, Nexxus' Therrapy shampoo. If two such shampoos are used together on a daily basis or on alternative days, the hair will likely look and feel its best. However, it is not necessary to wash your hair on a daily basis.
Q. What about Nizoral shampoo? Hasn't it been proven to destroy DHT?
A. Yes, it has. The use of Nizoral shampoo with 2% ketoconazole has been shown to have an effect on hair growth comparable to the use of 2% minoxidil solutions.
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. Perhaps. But there is insufficient scientific testing to prove any of these ingredients beneficial. Grape seed extract is an anti-oxidant, but so are azelaic acid and vitamin E, both of which are present in our Xandrox formulations. 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, Dr. Lee has reservations about recommending them.
Q. What was the first FDA approved medication for 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. Is there a difference between The Upjohn-Pharmacia Company's active ingredient (i.e. minoxidil) and that of Dr. Lee?
A. No. Minoxidil is a single molecule and not a compound or mixture, so it does not vary. Using sophisticated analytical techniques, the minoxidil has been assayed to be 100% pure.
Q. Why use a 5% minoxidil solution or a 12.5% minoxidil lotion when 2% - 5% solutions are readily available in many countries over the counter?
A. Minoxidil displays a dose-dependent effect with higher concentrations eliciting a more rapid response and greater regrowth. The higher the effective dose of minoxidil, the better the results. The operative word is "effective dose". The minoxidil has to be delivered to the hair follicle.
Q. What do you mean by 'effective dose?'
A. There are other high concentration minoxidil potions being dispensed. The question remains, is the minoxidil in them actually being absorbed and delivered to the hair follicles? In other words, are these other potions effective? As a result of years of exhaustive research and development, and undisclosed formulating secrets, we know our minoxidil solutions and lotions are effective at the level of the hair follicles.
Q. Why is the Rogaine 5% Extra Strength solution so oily?
A. Upjohn uses 50% propylene glycol in its base and it leaves a long-lasting greasy film on the scalp. About 7% of patients are allergic to propylene glycol. Regrowth, LLC offers a 5% minoxidil solution that has only 30% propylene glycol in the base and, for those who have irritation with propylene glycol, a 5% minoxidil solution that has no propylene glycol in the base.
Q. Are minoxidil solutions exceeding 5% more effective?
A. No. Minoxidil in alcohol based solutions reach their saturation point at approximately 5%, which is the reason why higher concentrations have not been made available in liquid form. Minoxidil lotions are available with effective concentrations up to 12.5%. 'Effective' is the operative word. Unless minoxidil is highly micronized, it is not effectively absorbed. If vendors claim to supply micronized minoxidil, the minoxidil particles should be less than 25 microns in size. The laboratory equipment necessary ultrafine micronization is expensive, and not generally available in most pharmacies.
Q. How do I know if using a high concentration minoxidil solution and/or lotion isn't an overdose and counterproductive to hair growth?
A. Patients using 2% topical minoxidil twice/day have 5% of the serum concentration of those taking oral minoxidil. Patients using 5% topical minoxidil twice/day have about 10% of those taking oral minoxidil. Patients using Xandrox 12.5 once/day have about 12% of the serum level of those taking oral minoxidil. It is well established that the serum levels of minoxidil in patients taking oral minoxidil promotes hair growth better than any topical applications. So, using 5% and/or 12.5% topical applications of minoxidil is safe and effective.
Q. Rogaine 2% and 5% minoxidil solutions do not contain all the ingredients that are in Dr. Lee's 5% minoxidil solutions. Why the difference?
A. The important and necessary component parts of Upjohn's and Dr. Lee's base liquid are the same. Ethanol is the component that allows the minoxidil to transfer through the various layers of skin. The drying effects of ethanol are lessened by propylene glycol, which acts on the skin as a humectant or moisturizer. Vitamin E has been added to our base solutions because it is a free radical scavenger and to extend the product's shelf life. The recommended nighttime minoxidil solution also contains prescription 0.025% retinoic acid. Our 5% minoxidil solutions and Xandrox 5% solutions contain 0.025% betamethasone valerate (an anti-inflammatory), but are also available without betamethasone valerate.
Q. Do Dr. Lee's formulations 'feel' any different than 2% and 5% Rogaine?
A. Yes. There is proportionately less propylene glycol in Dr. Lee's formulations than there is in 5% Rogaine. The 'greasy' feeling often associated with Extra Strength Rogaine is not present when applying Dr. Lee's solutions
.
Q. Can I expect faster results with the higher concentrations of minoxidil?
A. Usually not. The 5% solutions will promote the regrowth of more hair and thicker hair, but they will 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.
Q. What side effects should I look for?
A. Multiple clinical trials have established that other than direct dermatological events like those experienced with 2% and 5% Rogaine, the side effects are the same as are those with placebo. In other words, there are no proven systemic effects caused by using topical minoxidil solutions in any concentration.
Q. What are direct dermatological events?
A. These are skin reactions where the minoxidil solution is directly applied, and may include soreness, redness, irritation, drying or flaking, etc. It is very unusual for minoxidil to cause scalp irritation. The untoward reactions are almost always due to the propylene glycol.
Q. Do I have to continue to use the higher concentrations of minoxidil solution even after my hair has grown back?
A. Yes. Topical minoxidil solutions are still treatments and are not a cure for baldness. If you discontinue to use the minoxidil solutions, the scalp will revert to its baseline (before-use) condition in three to four months. However, many patients can achieve good maintenance with once/day applications of 1 mL 5% minoxidil or Xandrox.
Q. What applicator is the most effective and convenient?
A. Since topical minoxidil preparations are most effective when they are applied directly to the scalp, use whatever applicator that would accomplish this task most efficiently. If there are 'bald areas', the sprayer may work well. If you still have significant amounts of hair, use the calibrated dropper to apply the solution directly onto the scalp.
Q. Will the solutions be as effective if I just spray them on my hair?
A. Not really. It's important that the maximum amount of the medicated solutions be deposited on the scalp, so that it can be absorbed into the dermis to the level of the hair follicle. There is essentially no 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 pharmacodynamic studies are performed with application to a dry skin. So the quoted statistics in regards to absorption apply to application on a dry skin. 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 promotes maximum absorption of minoxidil anyway.
Q. Will minoxidil shampoos and conditioners work for me?
A. No. Minoxidil must penetrate the scalp to work effectively at the hair follicle. Shampoos and conditioners would have to contain very large amounts of alcohol and/or remain on the scalp for hours in order to transfer minoxidil through the scalp.
Q.What is retinoic acid and why do you add it to the nighttime minoxidil solutions?
A. Retinoic acid (tretinoin or all-trans-retinoic acid) has been used for many decades as Retin-A in the treatment of acne. More recently it is being advocated to remove wrinkles due to sun damage and aging. It works essentially as a chemical peel and as a biologic response modifier. It allows for better penetration of the minoxidil and promotes epithelial cell growth.
Q. Why should I only use it at night?
A. Retinoic acid is degraded by strong light, so there is no benefit to using it during the day and have it become ineffectual.
Q. How long has topical retinoic acid and topical minoxidil been used together?
A. At least since 1986 when an excellent study by Bazzano, Terezakis and Galen published and article entitled, " Topical tretinoin for hair growth promotion" in the Journal of the American Academy of Dermatology.
Q. Can retinoic acid cause side effects?
A. It's not the side effects of retinoic acid that are irritating. It's the direct effects. Since retinoic acid acts as a chemical peel, it may cause scaling and peeling and redness of the scalp. Chronic use of retinoic acid on the skin will make it more sensitive to being sun-burned.
Q. Can I still use minoxidil solutions with retinoic acid if I like to be out in the sun or get a lot of sun exposure on my job?
A. Yes, but it would be wise to wear a hat or use sun screen.
Q. Are there any scientifically sound current investigational treatments for Male Pattern Baldness (MPB)?
A. Yes. Many. And the pace is accelerating. Since the FDA's approval of topical minoxidil to stimulate hair growth, many pharmaceutical companies have instituted intensive research and development programs for medications that could arrest or reverse MPB. For example, topical azelaic acid is close to 100% effective in inhibiting the synthesis of DHT where it is applied on the scalp.
One of the most heavily advertised DHT inhibitors is finasteride (Propecia from Merck Pharmaceutical). Merck claims it inhibits Type II 5alpha-reductase with resulting decreased levels of dihydrotestosterone (DHT). In at least 66% of patients, it can allow atrophic hair follicles to regenerate. Merck Pharmaceutical now distributes 1 mg. finasteride called Propecia. As a pioneer in the hair growth practice, Dr. Lee has been dispensing 1 mg. finasteride to selected patients since December, 1996.
Q. What are the side effects of taking finasteride?
A. A percentage of Dr. Lee's male patients report decreased libido and about 1 percent of men report relative impotence. There have also been reports of "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 subside for most patients. More recently there has been disturbing reports of significantly increased shedding of hair (telogen effluvium) several months after taking finasteride. Fortunately, the hair follicle is not harmed and the hair does grow back.
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. As with any anti-androgen, there may also be a period of shedding. If there is, it is proof-positive that the anti-androgen is working to replace older hair shafts with vibrant new ones. As the new ones come in, they may be thin. But in due time they will be shed again and again until they become ever thicker and more robust. Simply stated, this is how anti-androgens work to restore 'normal' terminal hair.
Q. How can I be sure of finasteride's long-term safety?
A. You can't because it 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, except they always have a great head of hair and their prostate does not enlarge. They also do not develop prostate cancer.
Q. Does this mean that taking finasteride will help prevent prostate cancer?
A. No, that would be presumptuous. However, Merck is conducting 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.
Q. Will taking finasteride cause birth defects?
A. There is only a theoretical possibility that it can. The probability is close to nil. There has not been a single case report of a birth defect due to taking finasteride. The association of a lack of DHT and birth defects is that a woman who has a congenital severe deficiency of 5 alpha reductase can give birth to a male child with abnormalities of his urinary tract and present as a pseudohermaphrodite. It has not been demonstrated to be caused by taking finasteride either by the father or the mother. We have had many patients, whose wives have conceived while the father was taking finasteride without any reports of birth defects or any other complications.
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 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 have to continue to take finasteride to keep the levels of DHT low. When you stop taking finasteride, it takes two weeks for the DHT levels to return to normal. However, there are alternative ways to inhibit 5-alpha reductase in the scalp, such as the use of topical of azelaic acid.
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 affected by dihydrotestosterone (DHT) as is the mustache and beard. 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, and is almost as effective as Xandrox in doing so. A recent study was done specifically to evaluate the effectiveness of 1 mg finasteride daily on the frontal area and the results were very comparable to regrowth at the vertex. Frontal regrowth is greatly enhanced when oral finasteride is taken in conjunction with topical 5% minoxidil solutions.
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. But we have had many patients who reported small new hairs within a month of taking finasteride when it was combined with the topical application of 5% minoxidil and 5% minoxidil with .025% retinoic acid.
Q. What is the recommended dosage of finasteride to promote hair growth?
A. Clinical trials demonstrated that effective doses as widely divergent as 0.2 mg and 5 mg daily had similar results on the scalp. Most dermatologists agree on a 1 mg daily dose and Propecia by Merck Pharmaceutical is a 1 mg tablet.
Q. Do I have to take finasteride with food?
A. No. Finasteride can be taken and 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 it becomes routine.
Q. Will finasteride change the level of testosterone in the body?
A. There is a small increase in the amount of testosterone in the serum, because a small fraction of it is not being converted to dihydrotestosterone. On the average, the increase in the testosterone level is 10 to 20%. For most patients, the level is still within normal limits and is regulated by the feedback mechanism with the pituitary gland. 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, it is difficult to fund a human trial with products from competing pharmaceutical companies
.
Q. What is Xandrox 5% solution?
A. It is Dr. Lee's exclusive formulation in which a 5 % minoxidil solution is combined with 5% azelaic acid, a topically effective inhibitor of 5-alpha reductase, and the anti-inflammatory agent, betamethasone valerate. The Xandrox solutions are available with and without the addition of 0.025% retinoic acid.
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 a potent inhibitor of 5-alpha reductase in the human skin. 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 contain eighty eight times the amount necessary for 98% inhibition of Type 1 and Type 2 5-alpha reductase. Both types of 5alpha-reductase are present in the 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 as well to the Xandrox solutions?
A. In a 5% concentration, azelaic acid does not need zinc to inhibit up to 100% of the DHT where applied.
Q. Should I take the zinc and pyridoxine separately?
A. You can, but there's no reason to do so. Zinc and/or vitamin B6 deficiencies are rare almost everywhere in the world and 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.
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, it is used to treat acne.
Q. Does azelaic acid have any side effects?
A. It can cause slight depigmentation of the skin if you are applying it to areas of abnormally dark complexion. 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 for melasma or vitilago. On application, it may cause a mild transient burning sensation that may last for up to twenty minutes
.
Q. How much more effective are 5% Xandrox solutions as compared to using plain minoxidil?
A. Unfortunately, after almost two decades of use and evaluation, it is obvious that minoxidil solutions used alone have not been significantly effective for reversing MPB for the majority of patients. However, when minoxidil is combined with an inhibitor of 5-alpha reductase, the majority of patients will have positive visible results in growing scalp hair
.
Q. What were the results of Dr. Lee's own clinical trials with Xandrox?
A. There was a study group of 24 on Xandrox alone and a comparison group on 5% minoxidil / 1 mg finasteride. The age range was 26 to 49 y.o. 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 have not been good studies to prove it. However, after more than two years of Xandrox use in women with MPB, we have found it to be just as effective as it has been in men
.
Q. Should I continue to take finasteride to lower the DHT level in the body?
A. Finasteride works systemically and will lower the serum level of DHT. Xandrox works only where it is applied. It may be advantageous to continue taking finasteride to protect the hair on the scalp not yet affected by MPB, but which remains 'at risk.' For patients with large areas of thinning hair, it may be advantageous to take finasteride in addition to using Xandrox 5% solution
.
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 it may be advantageous.
Q. If I discontinue finasteride, should I taper off the dosage?
A. It won't be necessary. The biological effect of finasteride is so prolonged, that the levels of systemic DHT will not return to baseline for two weeks after discontinuation
.
Q. Why is it necessary to use minoxidil in addition to a 5-alpha reductase inhibitor to treat MPB?
A. Simply stated, it's much more effective. 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 and used as treatment, the results are very impressive indeed. About 70% of patients report significant 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's more effective. Topical minoxidil is dose related. Using Xandrox containing 0.025% retinoic acid allows for better penetration and enlarges the follicles from which the hair shafts grow. Recent reports even suggest that chronic use of topical retinoic acid reduces the number of androgen receptors on the hair follicles by 30% or more
.
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 the prescription 5% minoxidil solution or 5% Xandrox solution should be applied twice a day. Using either the spray or the calibrated dropper, dispense a total of 1mL to the area(s) of the scalp of thinning hair. The fine mist sprayer dispenses 1 mL with four pumps of the sprayer.
Q. Up to what age is it worthwhile trying Xandrox solutions for MPB?
A. That's a difficult question and there's no simple answer. Whereas treatment is almost always more effective when the signs and symptoms of MPB appear relatively early, we've had patients in their 70's who have had satisfactory results with treatment consisting of combined topical minoxidil and a 5-alpha reductase inhibitor. In fact, the impetus to developing Propecia was the observation that men with enlarged prostates, which doesn't usually occur until men are in their 50's or 60's, stopped their balding process and that some of the men grew back terminal hair while taking finasteride. The new Xandrox 12.5% lotion, when used with 5% Xandrox solutions. has shown some very gratifying results
.
Q. If I've already been using minoxidil, do I still have to wait at least three months to see improved results?
A. Yes. Thicker hair means replacing existing thin hair shafts. This entails shedding of the thin hair shaft, waiting through the resting (telogen) phase of the hair cycle, and growing enough thicker hair shaft 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. Generally, 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. Does that mean that I can obtain better results in reversing MPB by using 5% Xandrox solutions, which incorporate 5% minoxidil and 5% azelaic acid, than using 5% minoxidil with finasteride?
A. Possibly, yes. Most patients will have better results using Xandrox than any other single medication. But as with everything else in medicine, in any one individual, the reaction to any specific medication cannot be predicted.
Q. Are there other advantages to using 5% Xandrox solutions as compared to Rogaine Extra Strength and finasteride?
A. Sure. There are many advantages. (1) Cost: a one month supply of 5% Xandrox costs considerably less than a one month supply of Rogaine Extra Strength 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 small percentage of patients. 5% Xandrox solutions have no side effects. (4) Safety: the long-term effects of finasteride are not yet known. Minoxidil has been in use for decades and azelaic acid has been ingested as long as mankind has been eating whole grains. It has even been proven safe used systemically and intravenously.
Q. Does 5% Xandrox leave a residue on the scalp or hair?
A. The azelaic acid coats the hair shafts and gives the hair the feeling of extra body comparable to a hair spray. It may also leave a fine, white, powdery residue which is the unabsorbed minoxidil and azelaic acid. Brushing or combing the hair after the Xandrox has dried will reduce the extra texture the azelaic acid imparts to the hair and will remove the powdery residue.
Q. What is Xandrox 12.5% Lotion?
A. Xandrox 12.5% Lotion is an exclusive formulation by Dr. Lee of topical 12.5% minoxidil and 5% azelaic acid with an absorption enhancer. It has been designed for the treatment of MPB, is trade marked, and there is a patent pending on it.
Q. If 5% Xandrox is effective in treating MPB, why produce a Xandrox 12.5%?
A. The 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. Minoxidil is soluble in alcohol bases only to a maximum concentration of 5%. Xandrox 12.5% is an opaque, white lotion.
Q. If Xandrox 12.5% is an 'opaque, white lotion', won't it leave a visible residue on the scalp?
A. Not at all. Using one's fingertips and with minimum massaging, the lotion disappears almost immediately into the scalp. There is almost no visible residual on the skin or hair. This is due to one of our most valuable secrets in its formulation. The lotion changes its physical properties so absorption and penetration occurs when activated by normal body heat.
Q. On the Xandrox 12.5% bottle label it says that the bottles should be refrigerated. What happens if it takes a while for the product to arrive from the shipping facility in Los Angeles, or if I go on a month's vacation where there isn't an available refrigerator?
A. It shouldn't be a problem. Xandrox 12.5% lotion is best kept refrigerated, under which conditions it has a shelf life of at least 24 months. At room temperatures between 59 to 86 degrees Fahrenheit 15 to 30 degrees Centigrade, Xandrox can be kept for six to eight months 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 effect the potency of the drug?
A. No. But it surely can effect the appearance of the lotion. When the lotion leaves the shipping facility 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 take on the consistency of "liquid on top of the bottle over a glob of white stuff." If this happens in your climate zone, vigorously stir and mix the contents (for example, with a chop stick) in the bottle until it becomes a smooth, white lotion again. Then refrigerate the lotion to maintain the desired consistency.
There have been other mechanical methods of reconstitution, which patients have discovered. One such method is reported on by a patient whose bottle "was completely liquefied" upon arrival. "I shook the bottle vigorously for about 5 minutes and then placed the bottle in the freezer for a few minutes, took it out and shook it again. Worked perfectly. It's once again a nice even lotion consistency. The freezer part between shaking is what I think did the trick. I would recommend it to others."
One thing is certain. If it has been subjected to temperatures above normal body heat and you don't reconstitute it back into an homogenous lotion, you will have problems with the pump.
If the lotion has been subjected to super-heated temperatures for long periods of time, it still retains its potency, but the "glob of white stuff" will now contain large 'sandy' crystals which cannot pass through the pump. This happens almost automatically when the lotion is taken on summertime automobile trips and is left in the trunk of the vehicle. If you end up with a quantity of this type of lotion, throw the pump away, remix as best as possible, and transfer an amount about the size of an American penny to the palm of your hand.
Use your index finger to apply the lotion to your scalp.
The reason for the change in appearance of the lotion at temperatures above ~35 degrees C is because the lotion is designed to liquefy and absorb into the skin at normal body temperatures. When subjected to similar temperatures while still in the bottle, it will change in its physical appearance. There is no change in its chemical structure or pharmacological action, however.
The lotion should be refrigerated or kept in a cool environment after it has been reconstituted into a homogenous lotion.
Q. Why didn't you simplify this whole process and just make a high concentration gel or cream which wouldn't be heat sensitive.
A. This is the compounding method used by others. However, such compounds don't allow for the type of liquefaction necessary for absorption. The concentration of the minoxidil in the suspending agent is important, but if proper absorption does not take place, the minoxidil is ineffectual.
Q. How about others who try to duplicate the ingredients in your formulae. Will these products work for me like Xandrox solutions and 12.5% lotion?
A. No. There are many trade secrets associated with the proper compounding of Xandrox solutions and 12.5% lotion. These techniques are protected by applications for patents, which have already been filed. The name 'Xandrox' has also been trade marked to protect against generic formulae which claim to be Xandrox.
Q. Why is there a slight abrasiveness to the lotion?
A. By design. You may experience a slight abrasiveness designed to abrade and remove the epidermal layers of the skin to allow for improved penetration of the minoxidil and azelaic acid.
Q. What is the absorption enhancer used in the Xandrox 12.5%?
A. Benzyl nicotinate. It is chemically related to niacin and can cause a temporary 'flushing' of the scalp where it is applied.
Q. If benzyl nicotinate is such a good absorption enhancer, why isn't it used in the 5% Xandrox solution?
A. The 5% Xandrox does not need an absorption enhancer because it has an alcohol base. Minoxidil in a 12.5% concentration is not compatible with a base that is primarily alcohol. Therefore an absorption enhancer was incorporated into the Xandrox 12.5% formula to make the absorption rates equivalent.
Q. If you put benzyl nicotinate into any high concentration minoxidil gel or lotion, wouldn't the resulting gel or lotion absorb like the Xandrox 12.5% lotion?
A. Not necessarily. The minoxidil suspended in any gel or lotion may not get released to the scalp as we know 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. You indicate that the minoxidil used in Xandrox 12.5% 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 coarse and hard, similar to table salt. Costly precision equipment at Dr. Lee'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% should be used with each application?
A. Because the concentration of minoxidil is so high, we suggest that no more than 1 mL of Xandrox 12.5% be used per day. The 30 mL bottles of Xandrox 12.5% 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% 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. Please see FAQ's above, for possible correction of heat-related problems.
Q. Where should Xandrox 12.5% be used?
A. Only 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 only be used in areas unresponsive or poorly responsive to 5% Xandrox solutions.
Q. Why not just use Xandrox 12.5% lotion everywhere and forget about the Xandrox 5% solution?
A. It's a matter of dosage and safety. Even 5% minoxidil solutions have been known to cause rare side effects such as dizziness and headaches. The most innocuous substances can be harmful in large doses. For example, vitamin A is essential to good health. Hypervitaminosis A causes bone pain and hair loss.
Q. Can I overdose or have systemic effects from using such high concentrations of minoxidil?
A. For essentially all patients, there is not sufficient absorption of minoxidil into the blood stream to cause any systemic symptoms. In fact, allowing for the average amount of absorption (1.4%), the safety margin is almost ten-fold, using topical 12.5% minoxidil. However, there will be those few patients who will have unavoidable idiosyncratic reactions to Xandrox 12.5%. We anticipate the number will be less than 0.1%.
Q. What should I do if I experience an idiosyncratic reaction to Xandrox 12.5%?
A. Stop using it immediately.
Q. Is there any way to screen for patients who are hypersensitive to Xandrox 12.5%?
A. Unfortunately, no. By definition, idiosyncratic reactions are peculiar to the specific patient. Rare, mild side effects related to lowered blood pressure have been reported by test subjects.
Q. When should I apply the Xandrox 12.5%
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. 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% is working for me?
A. Since the Xandrox 12.5% 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% cause temporary shedding?
A. Yes, it can, 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 even notice the process. The shedding is due to the stimulatory effect of the minoxidil and is limited only to those areas where the Xandrox 12.5% is being applied. This is another reason why the Xandrox 12.5% should be used only on targeted areas. If it is used in place of 5% Xandrox, the shedding could be excessive. Although the shed hair will be replaced in several months, patients will find it very distressing in the interim.
Q. Will Xandrox 12.5% cause a telogen effluvium or a permanent hair loss?
A. Absolutely not. 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.
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% makes the addition of retinoic acid unnecessary and allows the Xandrox 12.5% to be used at any time of the day or night.
Q. Does this mean I no longer have to use 5% Xandrox Night formula which contains retinoic acid?
A. Although retinoic acid does allow for better absorption, that is not its only reason for being in the 5% night formula. Retinoic acid encourages rapid cell division. Rapid cell division can lead to larger follicles which are capable of producing thicker hair shafts.
Q. If Xandrox 12.5% is so 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% should only be used on those parts of the scalp which are stubborn in responding to 5% Xandrox. Save money and only use the Xandrox 12.5% lotion where directed. It's a powerful drug. Use it sparingly.
Q. My bottle seems to be only about 3/4 full.
A. That's right. The large bottle of 12.5% Xandrox 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 actually 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. Now that you have reviewed all the available medications, what do you consider to be the single, best-possible therapy available for treating pattern baldness in men and women?
A. Now that high-concentration, 12.5% minoxidil topical lotion is available, the 'state of the art' therapy consists of applying 1 mL of 5% Xandrox solution (containing 5% minoxidil plus 5% azelaic acid) in the morning, and 1 mL of 5% Xandrox (containing 5% minoxidil plus 5% azelaic acid and 0.025% retinoic acid) in the evening. This simultaneously promotes scalp hair regrowth and prevents dihydrotestosterone (DHT) from miniaturizing the hair follicles. The Xandrox 12.5% lotion should serve as a supplement to the 5% Xandrox solutions. It should not replace them, but should be used in conjunction with them, and should be applied to those areas of the scalp not adequately responsive to other therapies.
Q. Do you take before and after photographs of patients' hair?
A. No. Photographs are subjective and so easy to retouch or 'morph' that they have been the mainstay of scam artists who profess to grow hair for money. Dr. Lee's philosophy has been that you are your own best 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 Dr. Lee's track record. However, we have been sent some very impressive, unsolicited before and after photos and we're grateful to have received them.
Q. Will 5% Xandrox solutions be available anywhere other than from Dr. Lee?
A. No. Xandrox is exclusively formulated and dispensed by Dr. Lee.
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