Are These Side Effects from Propecia or Stress?

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

Dr. Rassman,
I am 23, and have had diffuse thinning for the past three years. I am currently taking propecia and minox and have been for 15 months. During that period, I have not noticed any significant regrowth, but the appearence of my hair has seemed to maintain to some degree. I am also a law student and in December I had my first set of finals. During that time, I can honestly say that I was more stressed then I have ever been in my life. Since december, I have noticed that my hair has appeared to thin significantly.It used to be thin only in the back, now I can see a thinning pattern in the front. Additionally, in the month since finals ended my libido and sex drive have significantly increased. I do not know whether that increase is due to my lack of stress, however I am speculating that the propecia has stopped working for me. I was wonding if these are typical effects if it does stop working; i.e increased thinning and greater sex drive or perhaps I can attribute both the my level of stress and current lack there of. Any help would be greatly appreciated. If propecia has stopped working for me, then I really don’t know what else I could do

Stress impacts everything in our lives. Your hair loss and thinning is certainly (assuming you have genetic hair loss) being made worse by stress. Propecia sounds like it has slowed or stopped the present hair loss, but as male genetic hair loss is a progressive process, it is only a matter of time until you notice more thinning/recession. The sex drive issue relates to many things. Men can find sex to be a good outlet for frustration and hiding from problems. Propecia can initially cause an increased sex drive due to the increase in testosterone levels, but the sex drive of a man your age should already be high, so perhaps your body is just learning to deal with the stress better. Could it be that your normal sex drive is what you are now experiencing?

With regard to your thinning and possible genetic hair loss, you should get your hair mapped out for miniaturization to determine if the hair loss is genetic and to what degree it is progressing. You need a Master Plan for your future hair loss. As you are in Los Angeles, I would be pleased to see you myself at no charge in my LA office. If you are interested, please call my office at 800-NEW-HAIR to set up a free consultation with me.

Ayurvedic and Hair Loss

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

Do you know anything about Ayuervedic? It is being sold to regrow hair.

I have read much about this line of medications/herbs since I received your email. It is like many of the other potions and lotions that are promoted to regrow hair. As a clinical scientist, I always stress the need to see solid proofs before I recommend something. This line of products may work, or it may not work. I can not determine effectiveness of safety, which are not only the FDA requirements for approval of a therapeutic approach to health or cosmetic problems, but mine as well.

Is Hair Cloning Right Around the Corner?

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

I saw this article yesterday about hair cloning on the UK’s Times Online: Baldness cure firm heads for AIM

Here is an example of a business deal coming down the pike shortly which mixes the anticipation of raising a large amount of money with the excitement of hair cloning. Growing hair in a test-tube from parts of the hair follicle that might eventually produce a head of hair in a balding man is the dream. How far from reality is this? I suspect that the clinical trials will tell us that, but as you may know, clinical trials take time to get from testing to fruition and an FDA approved process that is both safe and effective. Many of these processes fail to make the final mark, so this is a high risk deal for those of you wanting to put your money behind the cloning endeavor. It is even a higher risk deal for those of you waiting and waiting and waiting for the cloning answer to your balding prayer.

Laser Treatment (LLLT) for Hair Loss (with Photos)

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

Update: We are constantly asked about the effects of Low Laser Light Therapy (LLLT) for hair loss. A man who used the laser on our office showed me the impact of the laser on his hair with before and after pictures. He went to a company called Laser Hair Solutions, which uses a proprietary laser (we have one in our Los Angeles office) and a series of solutions which are religiously applied to the scalp. Minoxidil is one of the agents in the solutions that are applied to the scalp. I would like to say that I can tell which of the treatment solutions worked to increase the evident thickness shown in the photographs, but knowing that minoxidil alone could do it (a 3-15% chance of good growth with minoxidil alone), I can not attribute the benefits completely to the laser or to the minoxidil. I have reviewed a substantial number of publications (mostly European) on LLLT, and there is a good basis to show that LLLT does increase blood supply. Possibly when LLLT is added to Minoxidil, there is an additive effect. With that said, the results on this one patient are quite remarkable in just 90 days of using the combined treatment. Again one might ask, would the same effect have occurred with either the laser or minoxidil alone? This man was thrilled and only noted that ‘the’ treatment worked.

The below 1st set of photos were taken on October 10, 2005 before laser treatment. Click the photos to enlarge.




The below 2nd set of photos were taken on January 9, 2006 after laser treatment. Although I did not take these photos, a comparable set of photos were taken by me which essentially show the same effect as those taken on January 9th. I am comfortable that the photographs show what this man saw and is not a trick of the camera or lighting. Click the photos to enlarge.




Propecia Linked to Male Breast Cancer?

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

There was some reference in the 7-year Proscar study to a statistically significant increase in male breast cancer among the participants taking 5mg of Proscar daily.

Any thoughts or perhaps you have seen further research?

By the way, your visit from Jimmy and Adam on the “Man Show” was hysterical. You handled those guys with style. Well done!

Thanks for your comments on the Man Show. I fully enjoyed doing this as well as many other similar programs.

According to the New England Journal of Medicine (Volume 349:1569-1572 October 16, 2003 Number 16, Prevention of Prostate Cancer with Finasteride) there was only one case of male breast cancer in this study group of almost 19,000 men (see CNN article: Baldness drug may reduce prostate cancer risk).

Gynecomastia (breast nodules in men) is more common and is often painful when it occurs, but this is not cancer. There is no evidence that cancer is a risk, but if there is a history of breast cancer in your family, I might consider finding out if the gene for breast cancer susceptibility (BRCA1 on chromosome 17 and BRCA2 on chromosome 13) is carried in you (see Do We Know What Causes Breast Cancer in Men?). If you carry the gene, then you might avoid Propecia. The good news is that you can test for BRCA1.

What If I Shave My Head After a Transplant?

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

What is the average total cost of a hair transplant and what if I decide to shave my head, will there be noticible scars?

I’m sorry to tell you this, but there is no “average total cost” of a hair transplant. It varies from patient to patient and from doctor to doctor. However, you can usually count on a good hair transplant costing several thousand dollars because it is (or should be) a very detailed and labor intensive process with a highly trained staff.

As for shaving your head, any time the skin is cut, you will have a scar. The degree of your scar will depend both on the skill of your surgeon and how your body heals, but scars can be minimized through multiple techniques. If you plan to “go Marine” you might consider the FUE/FOX Procedure if you are a candidate (see FUE category ). This, too, will leave scars but they will be little white dots versus a thin line which will draw the eye and be more obvious with a shaved head.

For more information about Follicular Unit Extraction (FUE), please take a look at:

Switching from Rogaine to Propecia

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

Hello sir,
I am currently 20 and have over the past year and a half witnessed my hair line gradually recede. I am finding it hard to keep positive and confident, although it is not at an extreme. I am in constant fear of what the future could hold. There is no sign of baldness on my mother’s side yet my father and my grandfather are both completely bald. My brother who is only four years older than me started wearing a wig at the age of 21. I am not completely sure of what kind of level baldness he is at but I’m sure it’s not pretty. I fear that I am to walk the inevitable genetic path placed in front of me, which is getting me rather down.

I am currently using rogaine extra strength for men, which I’ve been using for around 5 months now and am still seeing a gradual thinning of the hair line and am not sure if it is working or not, or even going to work at all. I was thinking of perhaps using propecia, yet if I do I cannot afford to maintain using both treatments. I’d be very interested in what you’d have to say about my situation and whether making the jump from rogaine to propecia could have consequences.

Thank you very much.

Propecia has been shown to have better results than Rogaine in treatment of hair loss from male pattern baldness in young men. You need to get your hair and scalp mapped out for miniaturization to have a proper diagnosis, so that your doctor can develop a Master Plan for your overall situation. Both Rogaine (minoxidil) and Propecia are good treatments, but the actions are different. As you have been on Rogaine for 5 months, I would hold off until you get the examination complete. Then add Propecia (assuming the diagnosis is confirmed and metrics are in hand), and then follow-up with another examination 8 months after to see where your hair loss is at.

Can Toppik Accelerate Hair Loss?

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

Hello Dr. Rassman
Again, thank you thank you thank you for spending the time to provide this blog. It is an oasis in the desert of misinformation on MPB. I have a quick question:

Can products like toppik / couvre and / or hairsprays accelerate hair loss? Are there any negative repurcussions to using such products? I havent noticed any accelerated hairloss but I use toppik and hairspray everyday and wondered if they could be damaging my hair in any way?

Aside from my concern, I strongley recomend toppik to anyone with thinning hair. I’ve found it really helps for cover up / concealing purposes.

Thanks Again

I totally agree. Toppik (color-matched keratin protein fibers) and hair spray (glue, basically) are excellent additions to any hair loss sufferer’s cosmetic arsenal. I also highly recommend trying different styles to maximize the hair that you have (one of the reasons women’s hair loss is underdiagnosed is because they take the time and try different tricks to camoflage it well). As for these adjuncts causing hair loss the answer is “No” – there is no evidence that these affect your loss in any way. Chemical hair loss CAN occur with chronically chemicaly treated hair, but these two products do not fall into this category so you can continue to use them without fear.

Appropriate Amount of Grafts in Frontal Area

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

Dear Dr Rassman,
I am a 24 yo male who has experienced hair loss in the frontal region and am told that i am a Norwood type 4. I went to see a surgeon/dr in Australia. He told me that the best treatment was to have one large megasession and that he would use 2500 grafts on the frontal region. I am curious as to know whether this is an extreme amount in that region and your feelings on megasessions. I was also wondering that given my age how many sessions in my lifetime will i need and how frequently do people my age have to have more done. If i had a megasession would there be enough hair in my donor area if i did suffer more hair loss. Is there any way of doing a procedure, where you have existing hair, to transplant it to that area to prevent it if it was to fall out. Does one procedure in people’s liftime exist if they stay on propecia (which I am on, and doesn’t seem to be working that well).

Sorry for so many questions Dr Rassman. Thank you very much for your time.

For a Norwood 4A balding pattern, 2500 grafts in a single session sounds like a reasonable number that might meet all of your needs, depending how large the area is. Most people have about 6,000-8,000 grafts available in their donor area, but the actual number may vary. That is why we measure everyone’s density to determine a Master Plan for the worse case scenario of hair loss. Your age is a bit young, but if the pattern of loss is relatively complete and did not reverse after taking Propecia on a trial basis for 8 months, then a transplant could be reasonably done. Hopefully with Propecia that is consistently taken, the hair loss will at least slow or stop, stalling any need for further transplants for some time. Provided that you keep the work done to the frontal area, there is little worry about running out of donor hair for most people. I would discourage work in the crown at your age.

My Son Has Been Losing Hair Since 18 Months Old

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

Hello Dr. Rassman.

My son began to lose patches of hair since he was 18 months old. Doctors say that can be due to stress or Alopecia Areata. His father was diagnosed with that a few years ago and he was also told that his own father had it too when he was stressed. My son’s grandfather and father recovered their hair, but they didn’t begin so young. I am extremely concerned about this. My son has also dark lines under his eyes and is a very picky eater. The only thing he loves is milk. My son began losing hair in his top right side, it spread down then it happened in the left side, after that he lost a couple of patches on the back of his head, and now, he lost a big patch in the middle of the frontal part and the last is on the top of his head… Please give me your advice. Thank you very much.

Alopecia Areata is found in family lines, like yours. The treatment of this disease must be done by experts who specialize in this. Check with a good Dermatologist for the appropriate referral. I have little to offer you via the internet for this problem.

Continued Balding After Hair Transplant

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

I have read a lot about mega sessions and micrografts, etc, and don’t doubt that they can produce satisfactory results if done properly. My question is: what happens as time goes on and balding continues in the untreated areas? I assume a patient would have to keep coming back every so many years to fill in the newly balding areas. How many times can someone go “back to the well” as it were. I am 43 years now, and have a receding hairline (especially at the temples). My concern is that when I am 60 or 70, I will look ridiculous with a perfect hairline but balding at the crown.
Thanks

This is a good quesiton which I have answered in many ways before. Generally the hair loss for most people tends to plateau after the age of 35, and by the time someone reaches your age, the final pattern can be estimated by mapping out the scalp and hair for miniaturization so that you do not play ‘blind man’s bluff’ with your hair. If you will advance to a very balding pattern, then some of the hair in that pattern will be miniaturizing now, so it will be easy to see under high powered imaging.

If you take drugs like Propecia, it has several advantages, including reduction of the progressive nature of the hair loss, and probably preventing prostate cancer. Both are desirable side effects of the drug.

In most men of your age, chasing the hair loss is unusual. It is usually more of a problem with men in their 20s who get a transplant, are destined to become very bald, and who do not take Propecia. With a good Master Plan, you should never look ridiculous at any age after having a transplant, providing that you have the conversation with your surgeon and he/she is honest about his/her answers and not a salesman going for the cash that is your bank account and wanting it to be in his instead.

Himalaya Hair Loss Cream

/by William Rassman, M.D./10 /

Dear Dr.Rassman,
I am 18 years old.I had a normal hair growth around 4 months back.I stayed in a place called shimoga and for the past six months,I am staying in bangalore pursuing my studies.I have been suffering from hair loss for the past 3 months.I wish to confirm that nobody else in my family is bald.I have a receding hair line and this is worrying me a lot.At present,I am using Himalaya Hair loss cream for the past one month.I even consulted a doctor and he said that it was normal at this age.Is the hair loss due to any diet deficiencies or due to change of water and weather as such?How can I regrow my hair and make it stronger.Please tell me how I can increase the density of the hair follicles.Please reply.Sir,I will send the photos within a week.I am losing approximately 60-70 hairs per day and the hair line has receded considerably.Please help

This is the hair loss cream I am using. https://www.himalayahealthcare.com/products/hairloss_cream.htm

Himalaya Hair Loss Cream is another of the herbal medications for hair loss with lots of claims and no proof for its impact. The site does not suggest that there is anything new there.

It sounds like you are undergoing male patterned hair loss, but the loss of your frontal hair line may just be the maturing process that occurs in young men through the age of 29. Normal daily hair loss is between 100-150 hairs in the average caucasian, less for Indians or other Asians. Get your hair checked out first and stop the panic. Send me those pictures you were talking about to the address on the Contact page.

Female Balding from Weave

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

My daughter is 18 years old. She wore a hair weave on a consistent basis for almost a year. This has resulted in her severe hair loss. She is bald due to hair loss on 70% of her head. I did take her to a dermatologist, and he has prescribed a steroid base ointment for her to put on her scalp. Currently, she is wearing a wig. This helps with the mental aspects of losing her hair. I would like to do more. The research that I am reading concerning her conditions says that her hair may not grow back. How can I reassure her that her hair will grow back? Do you know how long it takes for hair regrowth?

Unfortunately, using a wig may forego recovery. This is a catch 22, which means that she might have to avoid wigs and let her hair recover first. The question is: Is her traction alopecia permanent? One may never know unless you give it 8-12 months. Be sure that the diagnosis is traction alopecia, for there are many causes of Female Hair Loss which need to be screened for.

Contrast Between Scalp and Hair

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

Female – I have been thinning for years and as a result, have been bleaching my hair. My rationale is that this lessens the contrast between the scalp and the hair and makes the hair loss less noticable. Recently, I went to a new stylist who told me that my theory is false and that dark hair will make the hair less transparent and therefore less noticable. It’s been three days since she did my hair and I have to say that I think I was right. I think the new darker shade makes the hair loss more noticable. Am I nuts? Should I go back to being a blonde or should I stay a brunette?

When the scalp and the skin are closer in color (white skin and blonde hair) the impact of thin, see-through hair is less obvious. Styling with puffed-up hair styles are popular in women who also dye their hair to get a fuller look. That is more of a styling issue. Don’t worry, you’re not nuts. If you’re more comfortable with being blonde, I’d say you should go blonde. Go with what you’re comfortable doing, and with what you think looks the best.

Female with Hair Recession

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

I saw your post on January 20 with the brow lift repair. It was amazing. I am a 34 female and my problem is that my corners have disappeared like a man’s corners. Is that common and can it be fixed like the example you showed?

You are referring to the post I made titled Female Hairline Restoration After Brow Lift (with Photos).

Corner hair loss is actually very common in women, but it is often not complete. The corners will thin while the rest of the hair (in the non-genetic balding female) will stay strong, making the thinning more noticable. Yes, the female hair line can be created just like the patient in that blog posting from January 20. However, I must caution you — you must be very careful in chosing your doctor, for the art of female hairline rebuilding is difficult unless the doctor is exceptionally trained in building such hairlines.