Hair Loss Advice


Treating Hair Loss: Over-the-Counter vs. Prescription


Treating Hair Loss: Over-the-Counter vs. Prescription

Medically Reviewed On: March 12, 2001

Webcast Transcript:

DAVID FOLK THOMAS:  Welcome to our webcast.  I'm David Folk Thomas.  Hair loss:  In the U.S. alone, it affects tens of millions of men and women, and with all these people suffering from hair loss, it's no surprise that there are so many medications out there to choose from over-the-counter options to prescription medications.  How do you determine what's right for you, and are prescription medications necessarily better?

Joining me to discuss the various medical options are two guests.  On my left is Dr. Peter Halperin.  Peter, thanks for joining me today.  Next to Peter is Dr. Marc Avram, and both Peter and Marc are assistant professors in the department of dermatology at Weill Medical College of Cornell University and New York Hospital.  Marc, thanks for joining me and Peter here, although you guys got here at the same time.

Marc, let me start with you right off the bat.  In general, what is the difference between and over-the-counter medication and prescription medication in regards to hair loss?

MARC AVRAM, MD:  Prescription medications have had clinical trials where they've been studied, what the effect, the side effect, how effective a medication is.  Clinical trials should reflect something that's reproducible, something that you can do in a lab in New York and Los Angeles and London, and get the same results.  Something that's not a prescription means it hasn't undergone the clinical trials.  We don't know exactly what it does and doesn't do.  It hasn't been approved by the FDA, and since it's not approved by the FDA, you can make any claim you want for a medication that hasn't been regulated by the FDA as a prescription.  So an over-the-counter medication can be good, it can be very effective, and some medications we use for hair loss are over the counter, and there are a lot of other ones that someone can make up and just claim anything, what it does and doesn't do without any clinical trials and scientific basis to it.

DAVID FOLK THOMAS:  What about something like Zantac that has gone from one to the other.  Can you take us through that?

MARC AVRAM, MD:  Zantac, that's a medication -- and there are a lot of them now that have been used for years, and we know what the long-term side effects are, the safety profiles, and what the FDA does is when they feel comfortable with a medication, that it's safe and it can be used over the counter, it will take a medication and put it over the counter, meaning that they feel it poses very little potential risk and side effect.  A medication that was done for hair loss was Rogaine.  Minoxidil was for many years a prescription.  It had a very good safety profile, so it was put over the counter the way Zantac was -- it was a prescription put over the counter for the stomach, for the GI tract.  With Rogaine it's been done now for hair.

PETER HALPERIN, MD:  It was available by prescription only for five years or so.  I think one thing that pushes it back from being prescription to over the counter is that the company wants it to be over the counter.  The company can sell it to more patients, because they therefore don't need a prescription.  Somebody can just walk into the pharmacy and ask for it or buy it or pick it off the shelf without coming in with that prescription from their doctor.  So the company wants it to be over the counter in some instances, if they feel they can make more money on the product.

DAVID FOLK THOMAS:  Is there a big price drop associated with when it goes from being prescribed to over the counter?

PETER HALPERIN, MD:  In the case of Rogaine there was a large price drop.

DAVID FOLK THOMAS:  Marc, what were we talking about?  How much would your average dosage or prescription cost?

MARC AVRAM, MD:  It used to be, ten years ago, when it used to be made up in pharmacies on the Upper East Side, some people were paying $60 to $100 a month for a bottle, and now it's less than half that.  It's probably a quarter of the price, what people pay, so it's been a substantial drop in price from ten years ago to now.

DAVID FOLK THOMAS:  How is minoxidil used?  Can you take us through that, explain that?

PETER HALPERIN, MD:  Sure.  It comes as a solution in a bottle.  It often comes with a dropper, depending on which brand you buy or whatnot.  The patient puts about ten drops of minoxidil on their scalp and rubs it into their scalp, and it helps, theoretically, more for the vertex, which is the top of the scalp, and less for the frontal part, where patients also experience hair loss.

DAVID FOLK THOMAS:  Now, do they want to see their doctor before they go and buy this, even though it's available over the counter?

PETER HALPERIN, MD:  Sometimes they have questions and they want to know our opinion whether we think it will be helpful, whether we think they should use it in conjunction with other types of therapy, and what the research shows and what it means to use this stuff for the long term.

DAVID FOLK THOMAS:  Marc, if somebody uses it for the first time, when can they expect to see results, if they do see any at all?

MARC AVRAM, MD:  You need to use it for about four to six months to see the difference.  It's important that someone beginning the treatment realize what it does and doesn't do.  One thing to emphasize is that if someone's at earlier stages, when they still have a lot of hair but they're starting to thin, is that the way to think of it is that it can hold on to your hair.  If you're lucky, you may grow back some hair on the back of the scalp, but success will be if you hold on to your hair, and that's sometimes hard for people to accept.

We're used to taking medications and having clear results.  You take an antihypertensive, your blood pressure drops.  You take something for cholesterol, your cholesterol drops.  You take an antibiotic for a sore throat, the sore throat goes away.  In this case, success is just holding on to your hair in most people who take it.  Some people can actually grow back hair.

DAVID FOLK THOMAS:  So then the earlier somebody uses this, the better.

MARC AVRAM, MD:  Absolutely.

DAVID FOLK THOMAS:  Once they've gone on in the process, it's not designed, or you're going to expect to --

MARC AVRAM, MD:  Someone without hair on their scalp, I wouldn't recommend it.

DAVID FOLK THOMAS: What about shampoos, Peter, as far as remedies for hair loss?

PETER HALPERIN, MD:  Shampoos, David, are completely non-helpful for retaining hair or growing hair or doing anything other than cleaning hair.

DAVID FOLK THOMAS:  Are there shampoos that are out there that promote that they help?

PETER HALPERIN, MD:  Sure.  Like Marc said, there are things out there where manufacturers put labels on things that are not FDA-approved, so they can really say whatever they wish to say.

DAVID FOLK THOMAS:  Do they risk penalty from the FDA, or are they just --

PETER HALPERIN, MD:  They don't risk penalty because they don't fall under the classification of medication.  They risk penalty only if they're shown to be harmful to the patient.  Then the FDA can go out and police them, but not before.

DAVID FOLK THOMAS:  Marc, what about other over-the-counter options out there for hair loss?

MARC AVRAM, MD:  The only one that's been shown to be effective that's over the counter is the minoxidil, the Rogaine that we spoke about.  There are dozens and hundreds that are over the counter that you can find in the Internet, on store shelves, and there's too many to really make definitive statements on, when patients come and ask me about them.  But I usually put it this way:  If something was truly effective for hair loss, you would want to do a clinical trial, and if it did work, everyone in the country would know what it is.

DAVID FOLK THOMAS:  How do you get a clinical trial?  Do you petition for one of those, or do you pay your own team to do it?

MARC AVRAM, MD:  Anyone who wants to manufacture something, to do a clinical trial is a matter of finding different medical centers and different experts in the field of hair who are willing to follow scientific scrutiny and have statistically meaningful results.  It can be done.  I just think if something is really going to work you would want to.  If I developed something in my office or if Peter did or you did, and it truly was as effective or more effective than anything that we have today that is FDA-approved, we would want to show that in a clinical trial, because everyone in the country knows Rogaine and Propecia, because those are two things that have been shown, and there's hundreds of other s that people don't know because they probably don't work as well as they claim.

DAVID FOLK THOMAS: O.K. Propecia and other prescription drugs available for hair loss.

PETER HALPERIN, MD:  Propecia is a medication that's been out now for about two or three years.  It's meant to be used only by men, and it's meant to help retain hair and it is considered to be really, I think, the gold standard of what we have today in terms of treating hair loss medically.  It seems to me more effective than Rogaine, which is the topical medication, and it seems to be better than anything else we know about at this point in time.

DAVID FOLK THOMAS:  Then why is it not available over the counter like Rogaine is?

PETER HALPERIN, MD:  There are some side effects that patients need to be aware of, so their physician will inform them about the side effects, and if they apply to them.  Also, Propecia is considered to be fairly dangerous in the hands of a pregnant woman.

MARC AVRAM, MD:  It's a once-a-day medication.  You take it with or without food.  There's no monitoring necessary in terms of blood tests.  There's no known allergic reactions, no interactions with other medications, so it's really straightforward.  Side effects, Peter mentioned, are important for a patient to be aware of, and they also have to be aware that once you start using it, if you want to maintain the benefit of the medication you have to continue using it.  If you don't use it, it won't punish you.  It won't cause you to lose more hair, but the hair that it did grow or it did help you hold on to you will gradually lose over several months once you stop it.

DAVID FOLK THOMAS:  I'm sure it varies from patient to patient, but quickly, as we wrap up, overall, would you say Rogaine versus Propecia, one of them do you give the nod to?

PETER HALPERIN, MD:  Propecia seems to be more effective in my practice, and also from the studies that have been done, so overall I would say Propecia is more effective for men with male pattern hair loss, and it seems to be in the lead at the moment.

MARC AVRAM, MD:  I think they both can be effective, and I agree with what Peter said about Propecia.  I think it's also an individual thing.  Some people just find it a lot easier to take a pill, and some people really don't want to take a pill, so it's an individual thing, also, because the main thing with these medications is compliance.  Whatever you decide to do, you have to be committed to doing it daily and for the long term.

DAVID FOLK THOMAS:  Thank you both for joining us.  That's all the time we have on this webcast.  I hope you've learned something.  I'm David Folk Thomas.  We'll see you next time. 

Treating Hair Loss: Over-the-Counter vs. Prescription