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Hair loss treatments

Man with male pattern baldnessA patient asked me recently if I would prescribe low-dose oral minoxidil for hair loss. I had never heard of such a thing, so I decided to do some research. To my surprise, there was a fair amount of information on it, and since I take Propecia, I decided to review every treatment and turn it into a page. Finasteride and topical minoxidil are FDA-approved for hair loss, while dutasteride, spironolactone, and low-dose oral minoxidil are used off-label. See the links below for more.


Woman with insomniaMillions of people battle insomnia. Professional guidelines state that biofeedback is the preferred first-line therapy, but I have to admit, I wouldn't even know where to send someone for that, and I suspect most patients would find it odd, so I typically prescribe a medication. Several new insomnia medications have become available in recent years, and there are now two main classes of drugs - GABA modulators and orexin antagonists. Lunesta, Sonata, and Ambien act on GABA receptors and have been available for many years. Belsomra, Dayvigo, and Quviviq antagonize orexin receptors and are newer, with the original member Belsomra being approved in 2014. Rozerem, a melatonin agonist, is also available, and the antidepressants mirtazapine and trazodone are often used.

Medical therapy for coronary artery disease (CAD) - In 2020, the groundbreaking ISCHEMIA Trial (N=5179) was published that found optimal medical therapy to be noninferior to revascularization (PCI or CABG) in patients with stable CAD. This year another study comparing medical therapy to an invasive strategy was published. The REVIVED-BCIS2 Trial (N=700) randomized patients with CAD and heart failure (EF ≤ 35%) to PCI or medical therapy. Once again, medical therapy was found to be equally effective as PCI. Reviews of both trials are available below.

A 55-year-old woman comes to see you for follow-up on a recent hospitalization for her first unprovoked DVT. She says the hospitalist stopped her estradiol and told her she should never take it again. Since then, she has been miserable with hot flashes and mood swings. She is taking Eliquis for the DVT and wants to know if you will restart her estradiol.  

Do you tell her it's absolutely contraindicated and decline her request? Do you prescribe it as long as she is on Eliquis? Are there any professional recommendations or studies that offer guidance?

Find out more here - Hormone therapy after venous thromboembolism