Update: November 15, 2006
To comply with a letter I received from this product’s lawyer requesting that this review be removed, I will simply direct your attention to Google if you wish to find more information.
Hi Dr. Rassman,
I have a couple questions to ask you regarding my hairloss situation. First of all, im 21 yr old male. I recently began losing a lot of hair suddenly throughout my whole head at about 8 months ago. I have been on propecia for 7 months now. However, the majority of hairs that fall out(about 75%) has a white hard mucus substance that can be scraped off from the end of the hair. I lose about 150ish hairs and they are basically always all the same size hair. I also seem to have a lot of dandruff (im assuming, white mucus-like flakes) that fall off also with the hair.
I just went to a dermatologist the other day and had him look at everything. He looked and sifted through my temple region hairs with just his eyes but didnt really look closely at anything else (no magnifying or anything). When i asked him about the white mucus stuff, he said it was normal to have that. (For the record, i know that hair has little white bulbs on the end of a hair, but this isnt the case here. it is real scrapable stuff, NOT the bulb)I then asked him about taking a scalp biopsy and he told me that that wouldnt really show anything. I then asked him about measuring my level of DHT in my body to see if its really high and he said that also wouldnt show anything because it doesnt matter how much DHT we have in our system, it only matters how much the hair follicles react to that DHT. He then gave me a form to get my thyroid, iron, and blood glucose? tested, which i will do now.
He then concluded that the acne on my face that is deep down inside my skin (never been able to get rid of it) could have something to do with my scalp and the flakey-ness as well as the mucus on the hair pieces so he prescribed me Nizoral 2% shampoo as well as Nizoral pills to get deep down and clear out my face and anything in my scalp. He also believed that milk could be playing a part in my hair loss because of the hormones milk has and how it bypasses the DHT blockers in propecia. (I do consume a lot of dairy products) He was very adamant about it and said how americans are much more balder than other countries and how the US drinks much more milk than others, etc. and how he is planning on doing a research project on it with candidates, etc. So he told me to stop all intake of milk, cheese, ice cream, etc. and see if it improves in the 2 months when i see him for a followup appointment. I asked about the loss of calcium etc. and he said that i would be fine without it and the loss of dairy products wouldnt have that big of an effect. (i could get it from other food products, etc.)
What im wondering is if what you think of my situation and about the dermatologist. I was just a little taken back about how he didnt give me a scalp biopsy, or look in a magnified glass to see deep down in my scalp. I dont doubt his intelligence because he told me that he was one of the doctors that got the creation of Nizoral, etc. and he is very well known and popular. (takes 3 months to get an appt.) I was just wondering if you agree and what your thoughts are on what he said about the different tests and if the examination of me seemed correct because i really wanted a biopsy and DHT test since i heard it worked well. Also, what are your thoughts of the acne issue and besides the thyroid, iron, and blood glucose tests, are there any other tests or procedures done to see if my hair loss is normal. And lastly, what is your opinion on my hair loss situation and is this normal? If that white mucus stuff isnt normal, does that mean that as each one of those hairs falls out, does that mean that particualr hair will never grow back? (is that the hair follicle or something meaning permanent loss?) I will send you a picture of my hairs and of my scalp.
Thank you so much for your time in reading and replying to this, it means so much to me. Im really having a hard time trying to deal with this.
The tests that your dermatologist told you about are always a good idea, so he can be sure that you do not have other causes of hair loss (other than genetic male patterned balding, which is the most common). We generally lose 100-150 hairs per day, so seeing the hair come out does not bother me. If you are picking because of the scaling, then more hair loss with bulbs may be detectable. What I always do and think is important to do, is a thorough analysis of your scalp by region, looking for miniaturization, which is the hallmark for genetic balding and some other forms of balding as well. Any good long-term plan, which is critical for someone of your age, must have periodic follow-ups of the scalp, quantifying the degree of miniaturization and any changes over time. Without that step, there is no possibility that a diagnosis of genetic male pattern balding can be made. Hair falling out is normal, provided that your body replaces the same amount (usually between 100-150 hairs per day).
With regard to the milk focus that your dermatologist is referring to, I am not familiar with it, nor have I found that others in the hair restoration community have developed such focus. I was a dairy farmer many years ago, and I do not believe that we are allowed to use the type of hormones in these cows that would produce more hair loss, but it’s been many years since I’ve last milked cows. As for Nizoral, I’ve discussed this previously here: Nizoral Shampoo.
It sounds to me like you need some real assessment of the balding process by a hair specialist, like me. On the east coast, Dr. Robert Bernstein in New York (phone – 201-585-1115) would also be able to do such an examination for you as well.
Hi I used propecia 3 years ago & it was very good for my hair growth, but for one year I couldnt find propecia and I lost my regrown hair. then I found propecia in my country and now I use it again, but it does not work for me. why?
Once you lose your hair, getting it back is difficult. In your case, it sounds like Propecia caught the hair loss early in the hair loss process. By the time you had resumed using Propecia, you’d already lost the benefits you gained by using is early in the hair loss process. You probably resumed where you would have been had you not started it at all so you now have a new baseline. In your case, you could not go back to where you were after the first course of Propecia. Transplantation sounds like your best option now, but a proper diagnosis needs to be made first.
Think about a car that rusts with time. If you keep it from rusting, it will stay rust free, but if you let it rust, then the rust is there and you just can’t take it away as if it never happened. In this metaphor, the rust is like your hair loss; you are the car. Now that the car is rusty, all you could do is to repaint it (or in the case of hair, transplant it to get it back). That is why I always tell people who I start on Propecia that they must never stop it, or they will experience what you experienced.
Too many men, after taking Propecia for a year, stop it thinking that it is not working, even though it stopped their hair loss. They come to see me a year later, crying over what looks like more hair loss than they had ever experienced, even dating back to the time they had started to take Propecia. It looks worse because they lose what benefit they got in a few months, then on top of it all, they continue on the march of progressive hair loss.
My hair has been thinning for some time now, right in the temple areas, but especially on my right side. I do, however have some fine hair in these areas but it will not grow long, and also in these areas some spots are just simply bald, clean, bare skin.
Will hair every grow their again, and how can I get the short hair that is there to grow long again?
Hair transplants work well for this problem, but first a diagnosis must be in hand. Assuming that you do not have an autoimmune cause of the hair loss or some problem that will cause a hair transplant to fail, then the transplant option is a good one. Some examples of temple hair transplants can be seen in the NHI ‘other’ photo gallery, which contains before and after photos of crown, temple, sideburns, eyebrows, and female transplants.
Hello Doctor,
Thank you for your blog !
I have a few questions. I am 24 yr old male with no history of hair loss/thinning. But my dad started balding at 34. I have a full set of hair as of now but the chances seem high that I will eventually start losing/thinning. My brother is only 21 and he is already thinning. I was wondering if I should be proactive and start on propecia/minoxidil so as to delay/avoid the hair loss? What are the downsides to this (if any)? Will the fact that I take minoxidil or propecia even though I have full set of hair affect my hair in any negative way or initiate the process of hair loss ? Even if any of those medications grow further hair .. will I lose all that hair or even my original hair if i discontinue taking them? Please advise. Thanks!
There is an old American saying “If it ain’t broke, don’t fix it”. That fully applies to you. You are correct to be slightly concerned at this time, so the best way to find out what will happen to you is to obtain a good hair doctor’s examination and get yourself followed yearly to detect the very first signs of miniaturization. You should not start treating it now, but if or when the process begins, then Propecia will probably be the best approach to preventing or slowing the process down, that is, unless another better drug comes on the market by then. It is not infrequent for generations to be skipped, so please do not obsess over the balding prospect.
What constitutes a good way to follow genetic balding? So far it seems to be a vague art that varies between doctors, and not something that will give an intelligent person an understanding of what is happening to them.
Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s and they are in wide spread use today. Socially detectable hair loss is not evident until more than 60% of the hair has been lost and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).
When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following thousands of patients with the Hair Densitometer, we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active.
I have questions regarding Avodart. It is approved by FDA for benign prostatic hypertrophy, so if it is ok with FDA for this, why does it matter if it is not approved for hair loss? It shouldn’t matter what reason you take the medication. Once you take it, it goes in you. So if FDA gave the OK for one thing wouldnt this make the drug safe? It is my understanding that everybody is wondering about FDA approval for the drug but GlaxoSmithKline doesnt seem to care about marketing it for hair loss. So how can FDA approve it if the company doesnt want to target the market?
And i know you cant have all the answers but whats your personal feeling about new drugs that might have very strong result for preventing hair loss from frontal line to back? Something that might stop hair loss 99% if it is taken early enough. How long will take to see something like this? Just your opinion. Thanks.
Avodart is in use on older men with prostate problems. If it is used for younger men, then things change:
- If there is a negative sexual side effect, it may last months rather than days like Propecia.
- Effect on pregnancy is not known. Does it pass in the sperm, and if so, will it be in the woman or fetus for months?
These potential negatives are offset by the probability that Avodart is more effective than Propecia. My feelings on this subject are mixed. First, if Propecia works, why push the Avodart solution with the unknowns defined above? Second, what does the drug company know that I do not know? I can postulate that their reason for not pushing Avodart for hair loss reflects an uncertain profit bottom line, but I really do not know. From what I hear in the physician pipeline (unofficial), Avodart is probably more effective than Propecia and may play a role in those patients who do not get a good response from Propecia, or where Propecia just plain stops working over time.
Dear Dr Rassman,
I’m a 26 year old male who has experienced some frontal hair loss for the past 3 years. I used to where my hair slicked back in high school and some time after, but I noticed my forehead increased in length and I started to get a higher hairline. I guess being of English/French descent, I would have to deal with this soon enough. I never slicked my hair back ever again,because my forehead is just too long. I leave my hair natural and lay it foreward, but i have to have bangs just to keep the attention away from my forehead. It helps, but i don’t care to have long bangs. It sometimes makes my forehead breakout. I wish I had alot of money so I can take care of this, but i live on $8.00 per hour in the Bush era. Plus I need LASIK eye surgery because I look a lot better without glasses. My eyes are the only decent thing about me. The rest of me is 6’1 1/2″ of high foreheaded European human waste. Looks are almost number 1 on the priority list for me, but its difficult when u don’t have successful genes to help u in the long run.
I do not want to rub your financial predicament with more salt to the wound of $8/hour wages. Sometimes, you have to figure a less expensive way out. The least expensive way for you is:
- Start taking Propecia to reduce the loss further. This will run you between $55-80/month, something you probably can afford to do.
- Change your combing style (forward to hide the long forehead). This will cost you a good 10 cents for a comb.
Be creative, and when your time comes for a hair transplant, reach out to us for our Standby Program where our prices are lower and more affordable for those that are more flexible with their schedule.
On October 31, 2005 you wrote a piece and appeared to criticize the marketing of some of the companies that you mentioned. You are high and mighty with your condemnation of these companies, yet you did the same thing by calling your company NEW Hair. Why are you any different than they are?
You are referring to my blog entry, Recapeen, FUE Plus & Lasers for Hair Loss?, in which I discuss the word “NEW” used in advertising. I may not like the tone of your question, but I relish tackling the answer. Marketing is not a bad word. The business community looks at marketing as the sum of product research (or service research), development of products and process, public education and advertising, and sales. The scope of what falls into marketing reflects the value of a product or service as it impacts the consumer.
You seem to be angry about my exploitation of the word NEW in our market branding for a hair transplant medical group. Well, putting aside the clever exploitation of a proven adjective in marketing, sales, and promotion of our service, I believe that the term NEW is appropriate for our business and the massive publications that led the world of hair restoration. I would direct you to the Medical Publications page on the New Hair Institute website, where we have posted the papers that originated much of what was NEW in hair transplant standards and now have become the standard of care today. Few terms would be more appropriate for our many contributions in this industry. We even pioneered an outspoken position on medical ethics, which was not a popular position to be in at the time. Please read Comparitive Shopping for Hair Restoration, Doctor Availability, and Low Laser Light Therapy, which I feel are all relevant to my answer.
HI I understand that hair transplant is not favorable for black man. it causes spots pimples and scarces!
do you know of a procedure that would work! I am located in montreal Canada
Simply stated, you are incorrect. Black people do great with hair transplants, often better than white people because the color contrast between hair and skin is low, and the hair has a very curly character which is a far better characteristic than the straight hair of an Asian, for example. Also, scars and pimples are rarely a problem. Sometimes, surgeons do not want to perform hair transplants on people with African hair because it is a more difficult job for the surgical team and requires a high degree of skill, more than on Asians and Caucasians.
Hi, I wonder if you could help me, I am 28 years old and I have always had slight thinning in the temple areas of my scalp. I have always been able to hide this with a fringe etc but since I have been using hair straightners I can’t put my hair up in a pony tail as you can see the thinning more and I have started to receed. Could this be because of using straightners that it has become worse or could there be an underlying cause. Both my parents have full head of hair and hair thinning doesn’t run in the family.
Without seeing a photo of you it is tough to tell, but given your age and the circumstances you describe, I suspect you have some degree of traction alopecia, which is hair loss caused by pulling at the root. This is commonly caused by tight braiding, ponytails, etc., and as you can imagine it is more common in women. Any mechanism that pulls excessively at the hair may cause this (even clip-on or glue-in hair pieces) and over time if the hair continues to be pulled, it can become permanent. You also mentioned that you have begun straightening your hair. Sometimes, the chemicals in hair treatments can damage the hair and cause loss. In addition to that, though, when you straightened your hair, the problem worsened since straight hair covers less area than curly or wavy hair does. Pulling your hair back into a ponytail not only pulls at the hair at the temples, it would also expose the areas that already have loss making it look worse. Without examining you I cannot tell how much of your hair loss is due to chemicals or to traction, but loss at the temples is a hallmark of traction alopecia all by itself. Neither of these is genetic by the way.
What I would suggest is that you stop using any styling that would cause excessive pulling (i.e. traction) on your hair and also stop using straighteners for at least 6 months to give the hair a chance to grow back. If your hair does not grow back in a year, you may be a candidate for hair transplant in those areas.
Hi,
I have male pattern baldness. it started at age 18 from my temples and has been receding terribly over the years, and more esp over the last 5 years. I am now 43. I used to have severe psoraisis on the face and scalp and was told the hair loss was because of that. Now the psoraisis has gone down considerably, alomost completely but the receding continues. i also have thick scabs on my scalp on and off that do not look like psoraisis scabs, i think it could be symptomatic of systemic yeast/eczema?
I used to have a very thick full head of hair, more than the average person so the hair loss over the years was more apparent to me than to others. Now, it is apparent to everyone. i just have a strand or two to cover my unnaturally high forehead, the hair on top is very thin, weak and sparse, there is more at the back but that too has recently thinned a lot.
In the last 3-4 months, my hair has been falling out in clumps, and is extremely coarse, dry and brittle. Please dont tell me it is age because this has been happening throughtout my adult life , but has has gotten much worse recently and esp since my first ever perm a year ago. But the frontal hair has been receding steadily since age 18. It has been very distressing and depressing for me, and nowadays, i dont even like to look in the mirror and see my unkempt hair. No matter what i do – hair oils, etc, it is as dry n weak as ever and receding all the time. help would be very welcome and appreciated.
This is an area where I have first hand knowledge, with the worst form of scalp psoriasis one can have. Mine, like yours, burned out in the scalp and I have almost none of if at this time. But I never lost hair because I was careful about not pulling off the plaques which would have almost certainly produced traction alopecia. Psoriasis does not cause hair loss unless the plaques are pulled off and the hair comes out with the plaques regularly.
With regard to hair transplants, I am frequently asked by people with psoriasis, if the psoriasis can be moved from one part of the scalp to another. In my experience, psoriasis can not be transplanted from the affected area to an unaffeced area, but any surgery done on active psoriasis, can make it worse, unless it is treated topically prior to the surgery.
You may have a skin condition and this must be defined by a good dermatologist. The rest of your needs are easily dealt with through traditional hair transplantation, which is extensively discussed in my book, The Patient’s Guide to Hair Restoration.
hi doctor,
Iam 22 years old male and my hair has been thinning for about 3 years. I took many medications especially vitamins ( biotine B5, zinc, Durance, Nutri-cap,……….), only the zinc had reduced the hair loss but not the thinning. I used minoxidil 5% but I had an excessive dandruff on my scalp ( even Nizoral didnt eliminate it. I didnt try proprcia since to its sexual sideeffects and others bad feedbacks about sexual disfunctions ( btw my friend had a bad reduction in his libdo and a raise in testesterone)….. Any advice please professor to any alternatives to stop my hair thinning.
Thanks and I appareciate your effort…
Just because your friend had a decreased libido with Propecia, does not mean that you will. If you try it and you don’t like it, you can stop it at any time and the problem will correct in a week or so. It is the BEST approach to hair loss in a young man, and there are no other proven therapies that work as well on young men. Alternatively, you can become bald, but then it you do, transplantation will be your only recourse.
Try it; you might find that Propecia is not a bad experience at all. Very few of my patients tell me that they feel anything at all on the drug. Some reported an increased sex drive. Men are highly suggestive, so if you truly believe that Propecia will reduce your libido, then it might do just that.
I am a 23 year old guy. I have been using minoxidil solution for past 6 months. I keep my hair short coz i feel my roots will have to bear lesser weight. Minoxidil 5% once a day was helping me for 5 months, then suddenly since in the past month my hair has become rough and has started falling out again. One of the dermatologist says that you should use minoxidil for 3 months… then stop usage for 1 month… then again use for 3 months… then again stop for 1 month. Does this sound ok to you?
He is not allowing me to use Finasteride 1 mg, because he says it can give impotency problems. And I’ve been losing hair from sidelocks too. I never knew this happened in male pattern baldness.
My dad is bald. He became bald at 28 due to side effects of medicines, but he always had thinning hair. My mothers side… all have thick hair, but on my dad’s side, although people are not bald, they have very thin hair (and many have cancerous disease on my dads side). My doctor still maintains I have male pattern baldness. Is there a way to test if this is male pattern baldness or something else?
I am having problems with your dermatologist’s opinions. All doctors have a right to a medical opinion, but I am going to take a contrary view to his recommendation, because what he is telling you is not supported in the literature. Finasteride (Propecia) has to be the best hair loss medication for a young man (read the many blog questions and answers on this very subject). The decreased libido sexual side-effect is relatively rare (less than 2%) and if it were to happen, you could stop the drug and the problem would be gone in a matter of days. I strongly disagree with his opinion on Minoxidil and Finasteride.
The diagnosis of male patterned genetic balding is easily made with a densitometer (magnifying instrument used on the scalp) which will show the miniaturization of hair in the balding areas affected by the ‘defective’ genes. Diagnosis is first and foremost in your overall MASTER plan for your hair loss. A good doctor needs to perform this test and then outline the plan with you.
Hi Dr. Rassman,
I’ve just started using Propecia, and Minoxidil 12.5%, but have seen that Proscar has much more of the active ingredient for the same price. Would you recommend Proscar, and how come if it’s so much stronger, and better value for money, it’s not as popular?! Also I read about one of the active ingredients in Minoxidil burning the scalp
Is this true? If I’m using Proscar which is 5 times the strength of Propecia, do I need to worry about minoxidil at all? I don’t really like having to apply the cream every night anyway! I do appreciate your time, & look forward to your reply!
Proscar is the 5mg version of Finasteride and Propecia is the 1mg version of the same drug. They do cost about the same and both require a doctor’s prescription. Many people buy the 5mg dose and then split it up. That is not very convenient, but there is no medical reason for me to tell you not to do it. The drug company’s studies show that for hair loss, the 5mg dose is just as effective as the 1mg dose, but the side effects go up as the dosage rises. So if you elect to take Proscar, be sure to use a pill cutter to reduce the dose so that you do not increase the possible side effects of the drug.
Minoxidil does have skin irritation as a side effect, but if you do not experience skin irritation of more flaking(or some of the other side effects), then you can continue using it. The old saying applies: Try it, you might like it!
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