Prednisone and Hair Loss in Women, Follow Up

/by William Rassman, M.D./3 /,

Hi,
I am currently on prednisone and have been taking 40 mg for many months now on 30mg. I was told by my doctor that my hair loss, since July, is due to the meds. But, it is stated here in the site that this drug only impacts men w/hair loss and women. Please clarify this for me. Is there a small percentage that lose hair on this drug ?? I may be on it for a few more months and need to know this. Also if I am correct , if it’s the drug than once off it than hair would grow back and be back fully in a yr or so ??
thanks

Steroids, as you said, do precipitate hair loss in men. Women also have some male hormones, so I would suspect that there could be some association with hair loss in your situation. The reality is that you need them for medical purposes. Women rarely have permanent hair loss and usually reverse once the offending problem that created it is gone. That goes for stress, cancer drugs, and other types of processes that precipitate hair loss in women.

Another Steroids and Hair Loss

/by William Rassman, M.D./2 /

I took a steroid and my hair is falling out. I stopped it in about a month, but it is still falling out. I have been on Propecia for a few years so I thought that would protect me. What will happen to me? Have I messed up my hair?

You probably precipitated what we call a telogen effluvium, which can be caused by steroid use. Once this begins there is nothing that will reverse it until it goes its course. I always tell my patients that although Propecia may protect you somewhat, it is not a sure thing when you take steroids. I would strongly suggest that you continue with the Propecia. As the hair loss may take months to go its course, stay on the Propecia and wait it out. See your hair doctor as well, so that good baselines can be taken to compare with what will evolve over time. By having measurements to compare, at least you will know when the process has stopped, when it reverses, and what to expect. Advise your friends not to do what you did, so that you can help someone else avoid the problem you had.

Another Hair Loss Following Pregnancy

/by William Rassman, M.D./0 /

I have experenced hair loss after each one of my pregnecies. I have three kids,while I was pregnant my hair was fine. I have seeked medical advise, I was told stop having kids. Can you tell me if hair loss after pegnancy will ever correct itself, in other words will it grow back?

Some doctor’s amaze me with ridiculous comments like, “Stop having kids”. Hair loss with pregnancy is common and most women who experience it, like you, will see the process reverse within the first year after birth of the child. Have as many kids as you want. The hair loss, unfortulately, may recur with each pregnancy on a non-permanent basis, unless you have genetic female balding.

I answered a similar question about a week ago, found here.

Hair Obsession

/by William Rassman, M.D./0 /,

i have had a full head of thin, wavy hair most of my life, and am now 53 years old. I had some loss many years ago from using alcohol based mousse, and had one transplant(okay). Recently, I had some hair color (nasty alcohol based stuff from Walgreen’s)in my hair for Halloween 2004. Anyway, I left it in for a day(extremely stupid), and then had several weeks of an itchy scalp in December, which I treated with tea tree/jojoba oil. I noticed some hair loss in January, had 1000 grafts put in and now I just had another ” greater loss” bout in July and August of this year, which I am extremely unhappy about. I now have a minor tingling on the left side of my frontal area, and I am extremely parnoid I am losing more. I am using tea tree oil shampoo/conditioner. I went to back to the doctors who did my transplants, who told me I would look worse if I had not been given the 1000 grafts, which I have a hard time seeing where they are.(as some were supposed to be put in the area that has receded!)I asked to possibly get my old hairline back, and the doctor said that only celebrities and media people only wanted a “1”, and now me. They offered to put in another 1000 grafts for $4/graft, but I want an effective job this time, asI do not have unlimited donor area. The more I think about it, the more I am insulted. The doctor said I had no infection/disease in the scalp. I want more work, but done right. PLEASE, PLEASE ADVISE.

You are hair obsessed. Please don’t take this comment the wrong way, but you are probably causing your own problems because of this obsession. I too would be insulted if the doctor who precipitated reactive hair loss with the second transplant (that is what it sounds like), told me that I needed another one at a discounted price to solve the failure of the last transplant (which was supposed to solve your problem). Sounds more like a huckster is playing you for your hair obsession and selling you hair like you needed a new car.

On this blog, I often say that you need to have a good doctor make an assessment of what is really happening to you. This is a buyer beware field and it is easy to sell hair to a hair obsessed person like you. I am not saying that you did not need a hair transplant, but it sounds like you were not clearly informed of what you were buying into. I often take a stand against transplants when I am not convinced that hair transplants will address the problem. I am rarely wrong but some of the patients who I turn down just go to another doctor who might be enthusiastic to take his money. Talk to a good doctor, not a huckster and find out what happened and what is going on with your hair problem.

Lowest Donor Density?

/by William Rassman, M.D./0 /,

What is the lowest donor density a person can have in their late twenties, in order to have a successful transplant?

There is no simple answer to this question on donor density. First, I would want to make sure that the person should not have Diffuse Unpatterned Alopecia, which would reflect a depletee donor area in a young man (1-2% of the male population). Then, the size of the balding area (the area of the demand) and the eventual pattern of balding that would have to be maintained must be balanced in a well defined master plan with a worse case scenario put together. A good doctor can make a judgment on the value of the donor density.

Propecia Allergy?

/by William Rassman, M.D./2 /

I have been taking Propecia for about two years. It has always worked fine until roughly six months ago when certain side effects began to appear. My lips were swelling quite frequently and I would get hives on my body. I was able to combat this with a daily dose of claritan. I am worried though that these effects could be dangerous to my body, even though the hives never appear while taking claritan and the lip swelling is only a few times a month at most. Also, I was curious to know if there is any correlation to these side effects and the ineffectiveness of propecia. I have noticed an increase in hairloss over the past six months, but still nowhere near as bad as before I went on the drug. Any light you could shed on this matter would be great. Also, I thought I would add that I have experienced no sexual side effects.

Thanks

You need to have a good dermatologist take a look at you. Although some of the symptoms are reflective of a drug allergy, you may also have some other medical problem. Don’t play doctor. There is an old adage: a person who treats themself has a fool for a doctor. Adhere to good common sense and have a professional look at you.

No New Growth 10 Months After Transplant

/by William Rassman, M.D./0 /,

Hi Dr. Rassman,

About 3 months ago, I wrote to you concerning my situation at 7 months post-op. I had diffuse thinning in the frontal area and was a norwood 3 prior to surgery, and had 1700 grafts put in. At 7 months I was looking thinner than before my surgery, and could only find a few new hairs that were growing in, all very small (less than 1/2 inch).

Now, at 10 months these hairs (i can find only about 10) all seem to be the exact same size as they were at 7 months, and I have seen no new growth. This is very frustrating for me and I was wondering what your thoughts were. I took your advice and went to see one of your colleagues in San Jose, and he told me that I should wait until a year has passed to judge my results. But why do these hairs seem to be growing in so incredibly slowly if at all? If you could just mention what some of the possibilities may be I would greatly appreciate it.

Thanks for your time.

To keep the blog readers up to speed, your original question (and my answer) can be found here: Transplant Failure To Grow.

You should see growth by this time. I would suggest that you make an appointment to see me personally. I will try to judge what has happened. Please try to get the preoperative pictures from your doctor so that I can make a judgment as to how much original hair was there at the time of the transplant. That will help a great deal because sometimes when people report these complaints, they lost much of their natural hair and the loss may cancel out the gain. Alternatively, the growth of the transplants can be estimated by someone experienced in this field.

Steroid Shots for Female Hair Loss?

/by William Rassman, M.D./2 /,

Dr. Rassman,
I am just about bald. I am on blood pressure and thyroid medication for oven several years. Every five weeks over a three year period I have received steroid shoots to my scalp, still my hair is melting away. All the doctors I have visited suggest steroid shoots. HELP !!!!

There are many causes for balding. There are many other diagnosis that must be considered tnat could be indicative of a more serious problem. For example, for diffuse hair loss must rule out the diagnosis of Diffuse Alopecia Areata, not uncommon in women. If your hair is really being lost all over, you might need a biopsy performed looking for a process responsible for the hair loss. Do not play doctor yourself.

Computer Imaging for Balding Patients

/by William Rassman, M.D./0 /

Dr. Rassman:
Do you use computer imaging with your patients, to manipulate a current patient picture into a “target goal” picture? I did not see any info about this on your website, but it certainly seems to me the best way to ensure both patient and doctor share the same vision. Thank you.

We have been offering open house events for 14 years so that prospective patients can see, first hand, what the actual results are from hair restoration surgery. The use of computer imaging is frequently misleading, just as photography can be, because it shows what the operator wants to show and does not take into account the real elements that make ‘coverage’ for hair replacement surgery. Things like hair thickness and hair character can not accurately be portrayed with computer imaging. The view can also be misleading. Frontal views, for example, are often better than top views for showing more fullness.

Setting patient expectations is at the core of what I do. I have written extensively on the artistic elements in the hair restoration process and published these observations in prestigious medical journals and text books. I do not believe that correct expectations can be set by the imaginary world created by computer images. As a side note, although many doctors do computer imaging, few will give the patient a picture of what they might look like from such imaging systems. The reason is simple: such a picture is like a contract, which can be used in court against the doctor if the result in that picture is not obtained. If the correlation between computer generated images poorly defines the differences between projected results and the actual results, then this tool does not set proper expectations for the bald buyer. It is clearly better when you examine a person up close, who has actually had a surgical hair restoration procedure and holds his ‘before’ picture for you to examine with his ‘after’ presence in person.

This computer imaging is vastly different for a nose job where a nose is altered in length, or taking out a bumb. A breast augmentation is also a simple computer image to demonstrate because size and location with support or poor support is easly altered on the computer as it would be in surgery. Most patients who show at the open house, will let you feel the thickness of their hair and then you can compare your thickness with theirs. In addition, the hair character (curly vs straight) will be evident. You can look from many views, even the worst view so that you absolutely know what will happen to you. What you see is going to be what you are going to get.

Hair is very different and that is why we rely on the open house format. I do not want to mislead anyone.

Harvesting More Grafts with FUE

/by William Rassman, M.D./0 /,

I’ve had two procedures with your group and I just read your posting about the progressive nature of hair loss. My hair is really thin now and getting worse.

With the new procedure FUE, is it possible to extract more grafts than the old method all things being equal? If so, could you please explain.

Thanks.

To answer this question would be mostly speculation, as each case is different. If you already had strip harvesting, then at some point if you needed more hair, FUE can harvest hair above and below the point where the strip was harvested. So, yes there should be more hair that can be harvested in combination with the strip harvesting you had. Also, make sure you are on Propecia to slow down or stop the hair loss. If you are not on this drug, you should be.

Hair Gel and Hair Loss

/by William Rassman, M.D./1 /,

Hello there sir how are you! I hope everything is fine. I am 16 years of age and have been usiing HAIR GEL for the past 8 years (mostly non alcholic) my hair are starting to fall, around every shampoo or when ever i wash my hair i lose arond 5 to 6. do you think that is normal and is it ok..and what can i do to improve my hair strenght and quality besides using pills, like shoud i put oil on and stuff like that, also is hair gel ok for hair. Pleaase help i dont want to be bald by 18!!!!! THANKS please do reply on my email that i have given thanksss

The average person loses 100-150 hairs per day, most noticable when it is washed or brushed. If you believe you are losing hair or thinning out your hair, you should have a doctor who specializes in this field evaluate you. Sometimes, although rare, genetic hair loss can start in the early or mid-teens. I think you need peace of mind, so seeing a good doctor is important.

Filling In Thinning Areas

/by William Rassman, M.D./0 /

I have a question. I would like to know if areas which are only slightly thinning can be filled in as most doctors will not do this. Also laser therapy,does it actually regrow hair and is it worth spending my money on. I hope you can answer my questions. Thank you kindly

Transplantation of hair is generally not a good option to take just to thicken an almost normal head of hair. Hair lasers (called Low Level Laser Therapy) is gaining popularity. Many article writtin in Europe indicate benefit from LLLT and one new article in the US in a new medical journal has suggested benefits to this therapy. A study I am aware of is presently being done will conclusively establish the value of this modality shortly.See my extensive written piece on lasers here.

Propecia Thickens Hair

/by William Rassman, M.D./0 /

I have a question for you … on merck site it says hair mass can thicken up to two yrs… but I was told it can thicken up to three yrs… is that true??? and when is the best time to take propecia am or pm???please let me know your answer… thanks

Propecia is best taken in the morning. The thickening of the hair shaft will, almost certainly, vary with the patient. In some patients the best fullness may be obtained in one year, in others it could take two years, and in some possibly three or more years.

Propecia and Sex Drive

/by William Rassman, M.D./7 /

I went on Propecia about 2 years ago and my sex drive increased to the point that I could not manage it. I am generally sexually active, at about once per day. On Propecia, I found that I needed to have sex at least twice a day and my girlfriend could not / wound not cooperate. So I stopped the Propecia and went on Minixodil. After stopping Propecia, my hair loss pattern went from a Class 4 to a Class 6 pattern. Any thoughts? I am 46 years old.

Minoxidil is not as good as Propecia for preventing hair loss. If you have miniaturization in the areas behind and to the side of the balding area, then Minoxidil may not stop further progression. As a rule, people your age are not in very active hair loss. You are an exception.

Increased Sex Drive: Although I find an increased sex drive in about 1% of the patients I put on Propecia, no one has ever had your degree of increase. Again, you are an exception. You might consider higher doses of finasteride to see the impact on your sex drive (up to the Proscar-level dosage).

Decreased Sex Drive: About 1-2% of men report a decreased libido with Propecia. At times we confuse libido (the desire for sex) with Erectile Dysfunction (a performance issue). If a man has a performance issue, he is often ‘gun shy’ about failure in performance and then the libido goes down in response to it. But it is all not that simple. The physical causes for decreased libido or erectile dysfunction include: alcoholism (quite common); abuse of drugs – such as cocaine; anaemia – unusual unless the man has been bleeding for any reason; hyperprolactinemia – an uncommon disorder in which too much of the hormone prolactin is produced by the pituitary gland; obesity – quite common and simply slimming down will often help; some prescribed drugs – particularly Proscar (finasteride), a tablet used for prostate problems in doses of 5mgs rather than 1mg as with Propecia; low male hormone level (testosterone) – contrary to what many people think, this is rare; and any major ‘generalized’ disease, such as diabetes. There are also psychological causes of libido decrease including: depression – very common; stress and overwork; sex hang-ups; or a serious relationship problems with the wife/partner.

Medications for Diffuse Unpatterned Alopecia

/by William Rassman, M.D./0 /,

Hello. I am 24 year old male, who believes I am suffering from diffuse unpatterned alopecia. My hair is thinning evenly over the top and the side of my head to from the classic horseshoe pattern of a Norwood class VII. I have been taking Propecia since January and i do not believe its working as the thinning has progressed. My dermatologist did not seem to concerned and told me to continue taking it for the full year before asking for any other options. Are there any other effective options available? I have read about Avodart and minoxidil, or the possibily of a chemical imbalance, but I do not know if they are effective for this condition.

I believe that DUPA can be reversed with Propecia. I see this in about half of the patients who are taking it. For those like you, it may be worthwhile, after trying Propecia for a year, to consider Avodart, but I have said many things about this drug which you should review.