For best results, follow these four simple steps when applying Roman Hair Solution Rx. Remember to use it only once daily, as directed by your healthcare provider. Using it more often, or using more than the recommended amount, can increase the risk of side effects.

Step 1: Spray it Use the spray to cover the areas on your scalp that experience hair loss, which may include the crown of the head and/or each side of a receding hairline. Do not exceed 4 sprays total. When you spray, make sure you press the sprayer firmly, all the way down.

__Step 2: Massage it __ Once you’ve sprayed on the solution, massage it into the balding areas of the scalp. Tip your head back slightly to prevent any solution from running down your forehead.

Step 3: Remove any excess medication and wash your hands Wipe away any excess medication that may have run onto your face or down your neck, and wash your hands well after you finish.

Step 4: Let it dry Let the solution dry so it can absorb properly into the scalp. If you apply the solution in the morning, try not to get your hair wet before the end of the day. If you apply at night, you can wash your hair the next morning.

Avoid getting the medication in your eyes. If this occurs, rinse your eyes with large amounts of cool water. You may apply the solution to wet or dry hair, but allow it to dry completely before applying other products.

Store your Hair Solution Rx in a cool, dark place, away from direct sunlight. When traveling, try to avoid exposure to excessive heat. If unused, discard after the date listed on your bottle.

If you miss an application for one or more days, don’t double up as a way to “catch up.” Instead, continue applying once per day.

Patients can generally expect to see improvement in hair growth after three months of consistent use, although this time period can vary from person to person. Individual responses can depend on several factors including consistency of use, severity of hair loss, genetics, age, and overall health. Generally, we recommend consistent use for six months before fully evaluating effectiveness. Hair growth is a gradual process and it’s important to have realistic expectations. Roman Hair Solution Rx may not work for everyone. If you’re concerned about the progress of your treatment, please consult with your healthcare provider.

No. Male pattern baldness is unlike many other conditions that lead to baldness (e.g., autoimmune diseases, vitamin deficiency, protein deficiency) in that once it has progressed to the point where the scalp is bald, regrowth is far less likely.

Topical minoxidil is a medication that is commonly used to treat male pattern hair loss. It’s currently available commercially and over the counter as a solution or foam. Note that the concentration of minoxidil in Roman Hair Solution Rx is 6%, which is stronger than the commercially available concentrations of 2% and 5%.

Minoxidil was originally developed and FDA-approved in the oral form to treat hypertension. One of the common side effects noted in 80% of the patients in the clinical trials for minoxidil for blood pressure was hypertrichosis, or “elongation, thickening, and enhanced pigmentation of body hair.” Thus, the idea for a novel, topical treatment for male pattern hair loss was born. Since then, topical minoxidil has been formulated and FDA-approved for androgenic alopecia for both men and women. Oral minoxidil in low doses is also used off-label for the treatment of androgenic alopecia.

The exact mechanism of action of oral minoxidil is not completely understood. It increases the length of the growth phase of hair follicles (a process called “anagen”) and increases the size of hair follicles, which determines the thickness/diameter of the hair that comes out of the follicle, which is thought to lead to promoting hair regrowth.

Minoxidil is also thought to relax smooth muscle in blood vessel walls, causing them to widen and increase blood flow. This may be one of the ways that minoxidil works to stop or slow hair loss and, in some cases, regrow hair.

Topical minoxidil is typically well-tolerated and most people use this treatment with minimal side effects. Common side effects of topical minoxidil include irritation at the site of application, unwanted hair growth, and a temporary shedding of hair.

Other rare but serious side effects of topical minoxidil include:

• Facial swelling or swelling of the face, hands, feet, or lower legs

• Blurred vision or other changes in vision

• Chest pain

• Dizziness

• Fainting

• Fast or irregular heartbeat

• Headache

• Lightheadedness

• Numbness or tingling of hands, feet, or face

• Weight gain

You should stop treatment and contact your provider immediately if you experience any of these serious side effects.

You should inform your provider if you have any of the following conditions:

• Heart disease, congestive heart failure, angina/chest pain

• Pulmonary hypertension

• Hypertension or high blood pressure or if you’re taking medications to control blood pressure

• If you’re already using over the counter treatment for hair loss (Rogaine)

Please read the full PDR for a complete, detailed overview of minoxidil.

Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT) by inhibiting an enzyme called 5 alpha-reductase. DHT causes androgenic alopecia by a process called “miniaturization,” during which hair follicles shrink and lose the ability to create new hairs. A person’s genetics determines their susceptibility to this type of hair loss. By blocking 5 alpha-reductase, finasteride stops the conversion of testosterone to DHT and therefore, stops or reduces the effect of DHT on the hair follicle. In clinical trials, oral finasteride stopped hair loss and even regrew hair for some. This effect is more significant in the scalp vertex than in the frontal scalp.

Finasteride was originally tested and approved to treat benign prostatic hyperplasia, or enlarged prostate, in a 5 mg oral dose. Later, it was approved and marketed for androgenic alopecia under the trade name Propecia, as a 1 mg dose.

Side effects in men using oral finasteride are generally minimal; nonetheless, some patients experience a decrease in semen production, decreased libido, or erectile dysfunction. These generally resolve either while taking the medication or when the medication is stopped. However, there is the rare possibility that permanent changes can occur in some patients.

Additional rare side effects that have been reported in patients taking oral finasteride include depression, thoughts of suicide or suicidal behavior, breast tenderness, and an association with male breast cancer.

Topical finasteride is an off-label treatment for male-pattern hair loss. The benefit of using topical finasteride is that it is applied directly to the scalp, exhibiting its effects locally with the aim to reduce systemic side effects. Nevertheless, absorption of finasteride into the bloodstream is possible and therefore, the risk of systemic side effects is possible.

Studies of topical finasteride are limited as compared to the extensive research of the oral alternative, but one clinical trial comparing a compounded topical finasteride concentration of 0.25% to oral finasteride and placebo showed a 34.6% reduction in blood DHT levels in those receiving the topical treatment. The study also showed that, despite the reduced DHT in the blood, the patients who used the topical finasteride were less likely to experience sexual side effects than those receiving oral finasteride. It’s important to note that the strength of finasteride in Roman Hair Solution Rx is 0.3%, which is higher than the one used in the cited study. Additionally, Roman Hair Solution Rx is a compounded spray, which also includes minoxidil and tretinoin, so it is possible that the systemic absorption could theoretically reach levels similar to that of oral finasteride.

Finasteride should never be considered for pregnant women, and there are no benefits in that population that outweigh the risk. The FDA has listed it as dangerous in pregnancy, also known as “category X.”

Children should not use finasteride and it should be kept far out of their reach (as should all medications).

If you have a history of hypersensitivity or allergy to finasteride you should avoid using this medication.

Men using finasteride should not donate blood while on the medication or for one month afterward.

Prostate-specific antigen (PSA) is a blood test used to screen men for prostate cancer. Finasteride can make the PSA level very low in men—even those with prostate cancer. A man with a normal PSA level while on finasteride may still have prostate cancer. Interpreting levels must always be done with this knowledge. Every physician involved in your care needs to know if you are on finasteride.

Finasteride may possibly increase the number of men who eventually get high-grade prostate cancer. In one study, men aged 55 and over with a normal digital rectal examination and normal PSA “taking finasteride 5 mg/day (5 times the dose of finasteride tablets used for hair loss)…had an increased risk” of higher-grade prostate cancer. Some feel that the finasteride makes it easier to detect these higher-grade cancers, but it is a risk that should be acknowledged.

Please read the full PDR for a full, detailed overview of finasteride.

While tretinoin alone is not a sufficient treatment for hair loss, it’s sometimes included with other hair loss treatments to increase their efficacy.

A healthy scalp is crucial for supporting hair growth, and tretinoin can improve the overall health and condition of the scalp. Tretinoin's exfoliating properties can help remove dead skin cells, reduce scalp inflammation, and promote a healthier environment for hair follicles.

When applied topically, tretinoin can improve the absorption of minoxidil. By increasing the penetration of minoxidil into the scalp, tretinoin may enhance its effectiveness in promoting hair growth.

Tretinoin may stimulate hair follicles in some cases. While the exact mechanisms are not fully understood, tretinoin is believed to increase the size and activity of hair follicles, potentially leading to improved hair growth in individuals with certain types of hair loss.

Common side effects of tretinoin include:

• Skin irritation, dryness, peeling

• Burning, stinging, or itching

• Increased sensitivity to sunlight

• Skin discoloration

• Exacerbation of acne

• Skin sensitivity

• Allergic reactions

If you experience severe or persistent side effects with tretinoin, or if you have concerns about its use, please let us know.

The following groups should avoid using tretinoin:

• Individuals with a known allergy or hypersensitivity to tretinoin

• Individuals with certain skin conditions, such as eczema, rosacea, or open wounds, should avoid using tretinoin in those areas, unless directed by a healthcare provider

• Women who are pregnant or breastfeeding. Tretinoin is known to have the potential to harm a developing fetus when used during pregnancy. It should not be used by pregnant women, women who are planning to become pregnant, or those who are breastfeeding.

Please read the full PDR for a complete, detailed overview of tretinoin.

Androgenic alopecia (AGA), or male pattern baldness (MPB) affects 98.6% of men. Hair loss is not just a condition of the elderly. From adolescence on, those who are genetically inclined to going bald start losing hair. In fact, over 60% of men have experienced significant hair loss by 35. 20% of men are losing their hair in two places in their early twenties: the hairline and the crown. Those two areas of hair loss ultimately blend into the fully bald top of the head with which we are all too familiar. The remaining “horseshoe” pattern of hair often is all that remains.

As you will read below, even before baldness begins to appear, the process of shrinkage or “miniaturization” of hair follicles begins, and once it has progressed too far, it is irreversible—or nearly so.

For as many as 20% of men, hair loss can begin before their 21st birthday. What is it that makes men so susceptible to male pattern baldness (androgenic alopecia)? Hair loss is due to dihydrotestosterone (DHT). DHT makes the hair follicles vacate a man’s scalp by slowly destroying clusters of hair follicles. DHT causes the hair follicles to miniaturize over many years. The process may begin slowly but the progression is relentless.

At first, only thinning of hair is noticed, not clear baldness. Some men embrace the process, shaving their heads in response, but many regret the appearance of aging while they still feel young and vital. Fortunately, we have an understanding of how DHT undermines hair growth and therapies that exist to interrupt or slow the process.

First, it’s important to know that we’re born with all the hair cells we will ever have: about 5 million of them. The scalp will have the densest concentration of these hair cells and the average head will hold about 100,000 hairs, though it varies by hair color. Blondes average 150,000, brown-haired people have 110,000, and redheads have about 90,000 scalp hairs. There will never be more. The good thing is that hair can regenerate, and every time a hair falls from your head or is found in a brush, another hair stands ready to take its place. Nevertheless, once a hair follicle becomes too shrunken (miniaturized) by the effects of DHT, it becomes exceedingly unlikely that the hair-producing follicle will return to normal function. Totally bald spots will most often remain so. That’s why more and more young men are starting treatment sooner than later.

Hair increases in length by about half an inch every month or six inches each year. There are 100,000 hairs on the scalp and they are never all in the same phase at the same time—otherwise, we would shed all our hair at once and go through cycles of full heads of hair and complete baldness.

There are many causes of hair loss. While this list is not comprehensive, it gives you a sense of how vulnerable hair growth is and how more than one factor is often responsible.

Genetics Genes will determine whether you will preserve hair into your 60s or start losing it in your 20s. A recent study found that there are over 250 genetic areas that influence male pattern baldness (MPB) and they can be inherited from either parent. I may be possible in the future, by analyzing genetic patterns, to predict who is more likely to develop MPB and even at what stage of life. Moreover, knowing the various genes involved may lead to novel hair regrowth treatments.

Poor health Anemia, especially iron deficiency anemia, is a well-known cause of hair loss. Men are susceptible to iron deficiency when eating a diet low in iron. Hair cells divide more rapidly than any others and a balanced diet is essential to healthy hair and nails. One of the problems with identifying hair loss related to diet, stress, or even illness, is that the hair loss can occur months after the triggering event.

It isn’t just poor health due to iron deficiency or anemia that can be a problem. Vitamin B deficiency, protein deficiency, and even Vitamin A excess can all cause hair loss and be rectified with a well-balanced diet, though the short-term use of vitamins to treat deficiencies may be needed.

Chronic illness The physical and emotional stress of any chronic illness can start a cascade of hair loss. Not only the stress but chronic illnesses itself (e.g., cancer, cancer treatment, autoimmune disease) can result in hair loss. Inadequate calorie consumption can cause hair loss. It’s often seen in anorexia nervosa and eating disorders. Thyroid conditions can alter hair growth dramatically. Uncontrolled diabetes is also a cause. Realistically, while some conditions are more frequently associated with shedding hair, any illness can cause hair loss, even something as common as the flu.

Autoimmune disease Autoimmune diseases like lupus are notorious for causing hair loss, occasionally damaging skin so deeply that baldness results. Alopecia areata is an autoimmune disease (sometimes brought on by stress) that can cause areas of complete baldness. Seborrhea and psoriasis are two skin conditions that can occur in multiple locations on the body and can cause hair loss when they affect the scalp.

Scarring from acute injury or chronic inflammation Damage to the skin from any chronic inflammation or from a deep injury like a burn or a deep widespread injury can damage hair follicles. Some autoimmune diseases can cause “scarring alopecia” and hair regrowth will not occur. Unlike almost all the other conditions described, hair will not usually regrow over a deep scar.

Infections Tinea Capitis, a commonly known fungal infection caused by ringworm, is usually seen in children and presents as single or multiple round patches of baldness with broken hairs. Sometimes these patches can be difficult to distinguish from seborrhea or psoriasis. Less familiar are the two types of Piedra (Translation—Stone), which is caused by a fungus and can lead to hard nodules on the scalp.

Hormones Hair growth cycles are very sensitive to hormone levels. Men who use testosterone to bolster their athletic performance (unprescribed) can see male pattern baldness develop rapidly in the same way.

Medications Medications like chemotherapy that affect rapidly dividing cells (like hair cells) will cause anagen effluvium and the sudden loss of hair. Other medications cause hair to go into the resting phase and result in telogen effluvium.

Ultimately, the names of the hair growth phases may not matter, but the list of medications below and the hair loss they may cause matter a great deal. Note if you’re taking any and if they might be playing a role. Other medications may cause hair loss other than those on the list below. If you noticed hair loss after starting a medication, even months later, it’s worth considering whether that medication could potentially be responsible.

Anticoagulants (blood thinners): Hair loss typically begins about 3 months after starting the medication. Drugs include warfarin (Panwarfarin, Sofarin, Coumadin) and heparin injections.

Gout medications: Allopurinol (Lopurin and Zyloprim)

Beta blockers: Beta blockers include Atenolol (Tenormin), Metoprolol (Lopressor), Nadolol (Corgard), Propranolol (Inderal, Inderal LA), Timolol (Blocadren) Nonsteroidal anti-inflammatories: Ibuprofen (Advil, Motrin)

Angiotensin-converting enzyme inhibitors: These are most often used to control blood pressure. Examples include Captopril (Capoten), Enalapril (Vasotec), Lisinopril (Zestril, Prinivil).

Acne medication: Vitamin A can lead to hair loss and Accutane is made from Vitamin A

Antidepressants: Amitriptyline (Elavil, Endep), Amoxapine (Asendin), Clomipramine (Anafranil) Desipramine (Norpramin, Pertofrane), Doxepin (Adapin, Sinequan), Fluoxetine (Prozac), Haloperidol (Haldol), Imipramine (Janimine, Tofranil, Tofranil PM), Nortriptyline, (Pamelor, Aventyl), Paroxetine (Paxil), Protriptyline (Vivactil), Sertraline (Zoloft), Trimipramine (Surmontil)

Anti-seizure medications: trimethadione (Tridione) and valproic acid (Depakote).

Stress-related hair loss Stressful life events (e.g., death of a loved one, illness, or divorce) can lead to hair loss, resolving completely when the stress is relieved.

Lastly, an inability to control the urge to pull repeatedly on hair can lead to hair loss. This is an impulse control disorder called trichotillomania.

Inappropriate grooming Even a good thing can be overdone. Excessive pressure placed on hair follicles by pulling hairs too tightly, as with ponytails or cornrowing, can cause hair loss.