Do I need to stop saw palmetto now that I take dutasteride?
Saw Palmetto is a very weak DHT blocker while Dutasteride is a very strong DHT blocker. Yes, stop the Saw Palmetto. Many experts like me, don’t believe that Saw Palmetto works for hair loss at all
Why with eyebrows raised up? Is that how the rule of 3rds supposed to work? Distance from bottom of nose to eyebrows line should be the same as the distance from eyebrows line to hairline? But that should be properly done with eyebrows lifted high?
The hairline ends at the frontalis muscle when you are 5 years old. Ask a 5 year old to lift their eyebrows and you will see their upper middle hairline touch the highest crease of their furrowed brow. The juvenile hairline is always located there. and as a male matures his hairline without balding, it will go up one finger breadth above that highest crease and change its shape from concave to convex taking in a V-Shape. That is why I I always ask my patients to raise their eyebrows, to determine the proper location of the hairline.
Sulfotransferases is an enzyme that enhances the conversion of Minoxidil to Minoxidil Sulfate, the active form of minoxidil for hair growth. Sulfotransferases is found both in the liver and and in the ‘outer root hair sheath’ of the hair follicle and when present in the hair follicle, it means that the person will be a good responder to minoxidil. About 40% of people are responders to minoxidil. Because it is also present in the liver, the conversion of oral minoxidil to minoxidil sulfate in the liver with the oral minoxidil may help people who do not have this enzyme in the hair follicle, making them more responsive to oral minoxidil than to topical minoxidil. See Discussion Here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9326921/
Have you seen any of patients who ended up getting COVID after their transplants. What was their results like ?
I have not seen anyone who developed Covid after a hair transplant but I would suspect that nothing would happen to the transplant, if that is your concern
Hello D Wrassman, I’ve tried to contact you on your Website, but it did not work. I have a question regarding topical finasteride a possible contamination. My girlfriend works in a nursery school (Kindergarden). Obviously she has a lot of direct contact to children (including changing diapers etc.) I know that Finasteride can be problematic for children, therefore I want to make safety precautions. My plan would be: -dont use Topical Finasteride whenever I sleep in the same bed as my girlfriend. -Change bedsheets often – Wash my hair often to remove any remaining Finasteride My question is: Is it safe to use topical finasteride that way? I don’t have any direct contact with the children myself. Is something like “second-hand”-Contamination even possible? Thank you very much.
I think that if you apply it in the morning, you can wash it off in the shower before going to bed. This way you don’t have to worry about pillow cases and sheets. Caution is always good.
I’m considering switching to Dutasteride, as I’m still, slowly, losing hair, I’ve been on Fin for 8 years (currently on 1/3 of a 5mg proscar tablet daily) – Do you know of any issues regarding male fertility while on Dut? I read a medical paper a while back stating that it affects sperm, and since reading that I’m hesitant to make the switch, at least before having children.
Dutasteride is more potent than finasteride. There is no data addressing fertility on young men on dutasteride and that is one of many reasons I don’t prescribe it.
Hey Doc! Was just wondering, if you considered it safe to apply dermmatch shortly after microneedling? I tend to microneedle once a week, on one of my days off from work, however I want to know how long I should wait before applying dermmatch? I know it’s generally deemed as safe to apply without iritating the scalp, but wanted a pro opinion.
Dermatch is a concealer that is rubbed into the scalp to make it darker. I would wait a couple of days after microneedling before applying Dermatch
Hey Dr. Can microneedling cause scarring that prevents a successful hair transplant in the long term??
The needling’s don’t go deep enough to cause damage below the skin provided that you keep them 1.5 or 1.., nothing longer, The hair follicle goes down between 5-7mm
Why did my brothers hair start thinning two years before mine. Also I think he got telogen effluvium and then two years after I got telogen effluvium which accelerated our hair loss. I was diagnosed with telogen effluvium but I didn’t get a scalp biopsy(it was a pull test). I want to know if I have retrograde alopecia or chronic telogen effluvium. If it was retrograde alopecia wouldn’t we thin at the same time? And telogen effluvium can thin the same areas as retrograde
I have dealt with identical twins and hair loss for years. Usually they are in sync. I had one set of twins where one wore a hair system and pulled out a good deal of his hair (permanently) ending up with a hair transplant. Stress could accelerate hair loss on one of the twins. Also look to other causes such as vitamin deficiencies (Vitamin D or even Iron). I would check your thyroid function. In other words, see a good doctor and get evaluated properly.
Hey Dr. Rassman,
I’m a 21 year old guy who’s concerned about balding in the future. The main reason for that is that I’ve got hair that falls to my hips, so losing my hair would really suck! I wanted to reach out to you to kinda see if there was any way for me to predict if I’ll go bald or not since I’m so nervous about it.
My dad is 55 and he has a full head of hair. All 5 of his male siblings still have a full head of hair and his dad had a full head of hair when he died, albeit with a little bit of thinning. On my mom’s side things are a bit weirder. None of my mom’s brothers nor her father lost hair in their 20s or 30s, but both of my mom’s brothers as well as her father began developing a bald spot on their crowns in their late 40s/early 50s.
I know it’s basically impossible to really predict balding but I just am scared of losing my hair in my 20s or 30s since it’s my crowning glory! I also know this is basically just a random lottery when it comes to whether or not you will lose your hair. At the moment my hairline looks fine and I don’t see any signs of balding. Do you think it would be worth it for me to start propecia/finasteride ASAP to preemptively counter potential genetic baldness?
At 21, the hair cycle often decreases in men, so if your hair grows to your hips that might mean that you have more than a 3 year cycle as hair grows 1/2 inch per month. Measure the length of your hair and if you don’t regularly cut it, then the length of the hair cycle will be easy to calculate. A two feet hair length, for example would suggest a 4-year cycle. If you were shortening your hair cycle, maybe the long hairs will be falling out and look like more hair loss. Seeing a doctor with a trichoscope, will define if you have miniaturization which would suggest genetic hair loss. Before you commit a lifetime to drugs, be sure that you have genetic balding and that is why a good doctor examining you with the proper instruments, is the only way to go so that you get a proper diagnosis.
Hello sir! Big fan! I wanted to ask if hair shedding can happen if I was to wake up 3-4 times every HOURR and eating less food? I use to eat 3-4 meals a day but then I started eating a meal a day or so. And then 3.5 months later my hair started to shed. So far I’m 4.5 months into shedding. Can this mean I’m balding?
Very rapid weight loss can do this. Are you losing weight at a rate of more than 2 lbs/week?
Have you seen 1.25mg effective for growth? Or do you like to go higher?
Yes, I have seen good growth at 1.25mg. Sometimes if there is little or no response I go up to 2.5mgs of oral minoxidil. Remember, only about half of people are minoxidil responders but that number reflects the topical dose. Responders with the oral dose are in the neighborhood of 95%.
I took finasteride for about 3 months and started having a series of side effects including but not limited to fatigue, trouble sleeping, depression, weight gain, and slight libido loss after 3 weeks. I first began to take it and felt great for about 2 weeks and then started feeling depressed and fatigued. I would wake up in the morning and feel pretty down but I would tell myself it was probably the finasteride and got back up and went about my day. In addition, When I would go to work I could pull off an 8 or 10 hour shift with no problem but after 6 weeks on fin I was exhausted around 6 hours and had to call out early with anything past 7 hours. It was like this for about 3 months until I had to stop for a week due to a moving and I noticed that I felt like my old self again, had loads of energy, great sleep, and became much happier. If I had stayed on finasteride would there be a point where I could “push through” the side effects and let them subside on their own?
Finasteride, I believe, works on better than 95% of men, but that means it slows, stops or reverses hair loss. Sometimes it is difficult to see it slowing it down, but good studies show that control groups lost more hair than men on it. Sometime, the side effects go away and sometimes that don’t. If they don’t, I wouldn’t stay on the systemic drug, but if you are committed to it, try the topical liposomal versions of finasteride which mostly stays in the scalp. I have great experience with this approach with many men that just will not take the oral finasteride.
This man went on oral minoxidil after he was diagnoses with Lupus and Hypothyroidism. Hair loss occurs with both diseases. He had an amazing response to minoxidil
I got hair implants a while ago and I like my hairline now. I started TRT a month ago but I’m scared that it might make the implanted hair fall. Do you have experience in this regards?
The transplanted hair will be fine, but the native hair could be subjected to balding if that is the way your genetics dictate. I generally think that it is risks to take TRT if you have genetic balding