Sex Drive and Erections

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

I am a 36 year-old male. I have been taking 1/5 of a finasteride (Proscar) pill daily for about 6-7 years. I have heard that Proscar can have harmful effects on male sex drive and erections — my question is, when this does happen, can it happen gradually or does it happen in the immediate days/weeks/months after starting the drug?

I ask because there has been a noticeable decline in my sex drive as well as the frequency and quality of erections over the years, and I don’t know if it’s normal for my age, or possibly due to the drug. I’m still quite functional sexually if I pick my spots, but those spots seem to be less and less frequent, and when I do get involved I’m prone to lose it unless I take Viagra beforehand (1/4 of a pill seems to work very well for me).

Please help! Would greatly appreciate any insight you can offer on my situation. I’m not sure but I think 36 is too young for this stuff.

Every man over 25 knows that their penis does not behave like it did when we were 15. There is an interconnection between our erections and our sex drive. If our erection is not strong enough, if we do not last long enough, or recover fast enough, then what we may call erection problems (Erectile Dysfunction / ED) may become a matter of our focus. From the impromptu polls I have done in my mostly male practice, many men in their 30s find that Viagra improves their erections. Question: Does it improve from a 15 year old vantage point or a 36 year old vantage point?

Your “sexual problem” (I only used quotes because I am not sure to what extent there is a problem) may be ED or it may be caused by Propecia (but that usually comes within the first month of taking the medication, not after years necessarily). If you stop the Propecia for a few weeks, and the ED and sex drive goes away, then you can assume it was Propecia induced. You can check your testosterone levels; hopefully they will be normal. If you have some aging effect and you are satisfied with Viagra, then use it. There are doctors that specialize in ED, so if all alse fails, you can see one of them so if you go this route, you are best starting off with your family doctor. If you decide to stop the Propecia for 2-3 weeks, the drug will be out of your system in a couple of days and within a week you should see some benefit if it is Propecia related.

Propecia And Unprotected Sex

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

Can you tell me, When using Propecia (3 months) is it safe to have unpretected sex without dangering female partner?

There is no danger to your partner from finasteride (Propecia) by having unprotected sex while you are taking this drug. Propecia’s manufacturer, Merck, does not warn of problems in this regard.

The question I am often asked is whether unprotected sex and pregnancy could cause problems for a man on Propecia. I believe that the answer to this question is that getting your lady pregnant should not be a problem when on Propecia, but if you are concerned about it, then you might stop taking it during the period when she is most fertile. I’ve written about that previously here and here.

White Scabs 3 Months Post-Procedure

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

Hello
I had a strip procedure done a little over 3 months ago and now Im starting to get a little worried. I have these white scabs in my donor and recipient area, and when these scabs come out, they carry with them 2-5 hairs. This does not seem normal…

At three months you should be completely normal. Most people have no scabs within a week or so. This may be a matter of your washing technique. I have seen men who do not wash their hair properly leaving the remnants of hair and scabs for weeks or months.

Non-FDA Approved Products

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

Dr. Rassman,

I realize as a doctor you must take the given data to insure your patients are given the “right” treatment for their condition. I do however, wonder how you can comment on products you yourself admit to know very little about. I do not know much about the product either, but a friend has used it and has had very real results with it within 12 months. I am not here to blast your opinion, but as a doctor you are compelled to research things/products that may very well put some doctors out of business. Heart disease for expample, may be a thing of the past in a decade. There are great prescriptions for heart-related conditions, but there are also great things such as diet and herbs that greatly reduce the risk of heart disease. My father was a surgeon who always put the patient first even if it was not the most lucrative choice for him. I am a bioligist with a very firm understanding of biochemistry as well. I agree that nothing is side-effect free, especially if it has any real efficacy, but check closer on some things to make sure you are not missing something out there. Something that may have potential. I am sure I don’t have to remind you that your patients are always first. You know your science works, but remember the light bulb was ignored at first also. oh yes, as far as the FDA works, I have no real comment on that. They have their own job and I am not certain how they work. They do real good things, and it has also been proven that they do real crooked things also.

This sounds more like a statement than a question. Your points are well taken. In my formal capacity, I do not recommend medications/herbs/potions/lotions that I do not know to work. You are correct in that not every medication is good and safe (just look at Vioxx), but the tradeoff between benefits and risks just need proper informed consent for each person using it. I know that Vioxx helped many people handle the pain of crippling arthritis, but some of them paid for that benefit. The issue really is, did they know what the risks were? We all know that the drug Thalamide caused babies with no arms or legs when their mothers took the medications while pregnant, but did you know that this drug was a miracle drug for many problems today in the non-pregnant female? The drug was taken off the market, so some people with particular types of bone cancer go through hoops and loops to get some to help them. It is now being considered for people with advanced HIV infection and body wasting, yet to pass FDA safety and effectiveness clearance. The drug has many uses in the third world.

I believe that we all have the right to know and balance (1) the benefits and (2) the rewards of taking a medication or herbal remedy that is heavily promoting its products. There are two sides of that equation. I do not know if some of these products are safe or effective, so I read the material supplied by many of these companies. When I see poor photographic representations, or scalp coloring agents used to promote benefits which are only created by a ‘can of spray paint’ on the scalp below the miracle new hair (or something similar), then I can not endorse these products. They may be great products, but they burned their bridges with me as a product endorser.

If I’m Completely Bald, Do I Still Have Follicles?

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

Im completely bald! I have heard that Curis can stimulate the transition of hair follicles from the resting to the growth stage of the hair cycle.
(line picked up from a proper source). Does this mean it can help grow hair on my bald scalp too?

My question may be silly, but if im completely bald….do i have follicles on my head?

I’ve written briefly about Curis previously.

There are many steps that initiate hair growth in a hair cycle. I have heard that some people believe that there are 200 separate steps. If any one step is impacted by some disease or genetic balding process, the hair may not grow. This suggests that the elements of the hair are present even in the very bald person and there is much research going on to identify each step in the hair growing process and the critical proteins or genes that are needed to fix the process when it goes wrong.

Simply put, the answer to your question is a probable yes. How to get the hair to grow is another process completely. The good news is that there are many people and research groups working on the problem, but at this time there is no answer to each and every defect that has been identified, even in the experimental mouse trials that are being most used.

Hair Loss Medication Side Effects

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

Hello Dr. Rassman
I have always thought about doing something for my loss of hair which is mainly in the front. I hear about all these products (propecia, procede, avacor) they all sound so great but it’s hard to trust on any of them since they don’t mention any possible side effects. I read about the gentleman who loss a lot of his hair when he used procede and I’ve heard that propecia may cause low sperm count. Are these side effects common? Is there any place where I can find such information? I guess most products (like medicine) have possible side effects. I just need to know how common this occurs. Thank you

I have no direct knowledge about ProCede. Avacor’s main active component appears to be minoxidil, which is cheaper if you buy it as generic minoxidil. Propecia does not reduce the sperm count, but can reduce the volume of the ejaculate that goes with the orgasm. Your sperm count should be as potent for getting your lady pregnant as before you took Propecia. The good news about Propecia is that it stays in your body less than a day (90% is out of your system in a day and effectively 99% is out in the second day). Keep priorities, do your research, and get a good examination by an expert doctor.

Am I Going Bald?

/by William Rassman, M.D./5 /

When I was younger, I always had very thick hair. Never a concern at all. Recently, I ran my fingers through my hair and noticed that I could see my scalp quite easily by pulling the hair vertically or to the side. I usually have a very short haircut, not military style but certainly less than an inch in length. I’ve been paying more attention to my hair lately because I’ve been growing it out, and that’s really the only reason I’ve noticed. It seems like the hair on the side is thinning more…I’m not really noticing a maturation pattern where it’s receding, just thinning.

My uncle on my mother’s side is almost entirely bald, my father has a bald spot on the back of his head and thin hair…so genetic predisposition is possible/probable. I’m wondering what I should do at this point. I may be over-reacting but I’d like to find out. I use gel/comb my hair regularly, but I’ve never seen hair fall out. I can run my hand through my hair several times without seeing any hair fall off.

I’ve also started wearing a hat recently, which is reasonably tight…and may only be coincidence. I’m just not sure what to do/who to see.

Thanks for your help/site…it’s much appreciated.

To determine if you are balding, you need to have your head mapped out for miniaturization which will show if your have developed or are developing a pattern of thinning that will eventually lead to frank balding. Any topicals you place for combing your hair may make it look fuller, but it will not change the process that is going on. Propecia is the best medication to slow or stop the hair loss and some times it even reverses it, but first you need a diagnosis. The hat will not make a difference in the hair loss, unless is is very tight and causes pulling of the hair.

Post-Operative Questions About Telogen

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

First, I would like to appreciate your online service, for freely accepting questions and comments and for your valuable answers. Thank You.

I have had my hair transplant about 12weeks ago of approx. 1,650 grafts. My donor area took quite some time to heal, approx. 9-10weeks, before the occasional swelling in a few spots which have now completely subsided. During the first 10 days I had some grafts fall out, which I was told was normal, over the next few weeks I lost more of these transplanted grafts as has been considered normal procedure after a hair transplant. I have had to deal with pimples/puss modules in the transplanted region occasionally and again I read that this is normal. I have used Neospirin ointment to treat these modules and it has helped quite a bit. I am also taking finasteride 1mg for about 17weeks (started 5weeks prior to the procedure as recommended by the Doctor). It is now 12 weeks, and my questions are:

  1. Is it possible that not all the transplanted hair has fallen out? Because when I touch the transplanted region with the palm of my hand, I still feel a few spikes here and there. Just today I noticed a couple of hairs with scab attached at the bottom fall out. Should i be concerned that even after 12 weeks not all of the transplanted hairs have fallen out?
  2. As I do not see much new hair in the transplanted area as yet after 12 weeks, should I be concerned, when I have been reading that by 2-3 months the new hair would start appearing.
  3. I am considered type VI and 35yrs of age. Even with taking Finasteride, I seem to lose at least 50-75 hair everyday after the two daily showers. Do HOT water showers have a negative impact?

Your valuable comments are much appreciated. Thank You

I am fairly sure that you are not losing hair transplants, but what you are seeing may reflect poor cleansing of the recipient area where the scabs stayed on too long. Without seeing you, I am assuming that what you are seeing is the hair from within the old grafts that is coming out (the hair that should have fallen out earlier). The ‘root’ of the transplanted graft is secure in a couple of days after a transplant until the scabs are all off. Rarely will a transplanted graft come out after the scabs are gone (in our hands in just a few days the wounds lock the hair graft into position because of the small needles we use). We have researched this extensively, and found that they can not be pulled out the earlier of (1) after 10-12 days, even if you try to pull them out, or (2) the disappearance of the scabs (usually a couple of days in our practice). In patients who do not comply with our washing protocol, the scabs may last for weeks.

Hair roots start taking hold and growing hair in 10-20 weeks after the transplant procedure, so I would not worry at this stage in the transplant growth cycle.

Hot showers will not cause hair loss, but if you are losing hair, then there may be a shock effect from the original surgery which should be about over shortly. You need to ask your doctor to map out your remaining hair for miniaturization to determine if your class 6 pattern will progress to a more advanced pattern. That should have been in the discussion when you and your doctor made a Master Plan for what was about to happen to you with a hair transplant.

Hair Loss in Young Teen Male

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

Dear Doctor,
I have this very close friend who is 15 years old. He is suffering from hair loss and has been since about the age of 11. I’ve talked to him about it many times and he says that the amount of hair he loses after showers is unbelievable. Even when he runs his fingers through his hair strands come out. I really would like to do what I can to help him, he has trouble talking to people so I’m basically the only one who can help. He also gets made fun of at school sometimes and no one likes to be teased. I’ve read up on different causes of hair loss but nothing really is directed to younger teens. Please help me help him.

Young men as young as 13 can have genetic hair loss. He needs to see a good doctor, get his hair and scalp mapped out for miniaturization and find out if he is genetically balding. Assuming it is genetic hair loss, then the drug that is best to hold on to his hair is Propecia. He must get help and get proper management; the price of premature balding is too grave a consequence for denying the problem.

Hair Transplant for Patient with Oily Scalp

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

Is a patient with an oily scalp a good candidate for a hair transplant? My scalp is very oily. I want to enchance my hair density by doing hair transplant. However, I am worry about the oil excreted from the scalp will affect the newly transplanted hair grafts.

An oily scalp will not effect a hair transplant, as transplanted hairs grow in either a dry or an oily scalp.

Xanax and Hair Loss?

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

I am a 33 year old male and am convinced that I am losing my hair at the front of my head. I have thick hair, but it is certainly thinner, i.e. I seem to have less hairs per square cm. I can also see my scalp at the front, which I could not around 1 year ago. When I comb my hair, or wash it I notice hair in my hands or in the comb. I would say that the number of hairs is around 5 or 6. This is also something pretty new to me. What I would like to know is, am i going bald and how can I determine the rate? Also I take Xanax in small doses and what like to know if this has an effect. Would Rogaine help for frontal hair loss?Finally, how long should I wait before I have a hair transplant. I don’t want to go bald before I do. Thanks.

Xanax can cause hair loss, but I would think that if you are thinner in the frontal area, then you may be having genetic male patterned hair loss. As I have said many times in this blog, a diagnosis includes an examination for miniaturization, which would be evaluated throughout the head to determine what your genetic pattern might be. At 33 years old, your pattern should be evident when your scalp hair is mapped out. I am ingorning your 6 hairs per day loss as that is low and probably a wrong estimate, but the thinning of the hair in the front is more of a concern for me. If you have male pattern balding, the hair in the front will be heavily miniaturized and will show up nicely on magnification imaging. If that is the correct assessment, then Propecia may help slow or stop the hair loss.

Taking Propecia and Viagra

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

First off I have learned alot from your web site. I’m sure all your readers are very greatful. I know I am!! My question is If someone already suffered from impotence and taking viagra or a simaler product for this would mixing propecia with it for hair loss be a problem. Is it a safe mixture in other words?

There is no difficulty taking Viagra and Propecia. They do not interact with each other. This way you can enjoy both good sex and great hair. That is a winning combination.

Penis Dysfunction- What To Do?

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

Thank You doctor for the advice on Propecia. I have started taking it now and within days my hair has improved. Yes, i do get proper erections but when i think of my penis….i dont…so i guess psychology is playing a part in not getting erection.

Anyways, can you please suggest some tests which i need to keep doing to check if my testeterone levels are normal (what i mean to say is tests which can check if my sexual organs are normal).

Thank You

There are doctors that specialize in sexual problems in men. If you are penis-focused, you may be causing your own sexual dysfunction, that is why a doctor who specializes in sexual problems may be a good starting point. They will be able to help differentiate between physical and emotional causes. You can have your doctor measure your testosterone levels to see if they are normal.

I am glad to hear that Propecia is helping, but I would expect that the benefits of it will take months, rather than days.

Transplanting with Limited Donor Area

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

I have had several transplants over the last 20 years. My donor area is generally depleted and cannot support any large procedures. I have 1-2 very small (quarter size) areas that if some additional transplants were done only in these strategic areas my hair would appear much fuller. Considering the small amount of donor plugs needed could these be provided by smaller more random/scattered donor sites as opposed to the larger harvesting rows that are more concentrated in one area. Thereby minimizing the thinning effect we see in a typical donor area.

There is an art to making less hair look like more hair. I have many patients like you who have paid the price of the old antiquated procedures of the 1970s and 1980s. I have already written articles on the subject, but what I do for each patient is a one on one determination that takes the years of experience I have spent to develop the Master Plan for such person. Simply put, a good doctor, upon examination, should be able to determine the answer to your question.

Eqyss MegaTek

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

Hi Doc:

I am so sorry to bother you again. Can you please tell me if you ever heard of Eqyss Megatek? It is a conditioner & Shampoo for horses that folks claim grows hair stronger & faster. As I have mentioned before, I recently thinned rapidly and I need some help. I am hoping you have heard of this and can comment.

Interestingly, this is the second question I have received on horse hair products (see also: Mane-Tail-Groom Hair Products). I have no practical experience with horse hair products in humans, but from the inquiries I have made, some Europeans who had association with horses know about these products and swear by them. I would add horse hair grooming to what I offer my patients, but they may think that I am a horse’s ass for doing so.