Bald Spot on Side of Head

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

My husband and I just realize that on the side of his head he has a bald spot. Its not big, its about less than half an inch. We are both worried and we dont know what might have caused it. He does smoke cigarettes about four to five times a day, could that be the cause? if you can help me by maybe telling me what could be happening I would appreciate it. Thank you very much.

He should see a dermatologist. I am assuming that he does not use a wig/hair system. Traction alocecia is a common causes of this with wigs. I am also assuming that he is not a hair picker; trichotillomania is not an uncommon finding and is an easily diagnosis with hair mapping for miniaturization. The diagnosis of trichotillomania appears with stubs of healthy ‘terminal’ hairs indicative of the picking problem. Highest on the list might be conditions like Alopecia Areata.

I Had Side Effects When I Stopped Taking Propecia

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

I was wondering how common it really is for someone to have substantial sexual side effects from Propecia. I am a young (22 year old) man who recently had erectile dysfunction and pain probems for a month or so which seemed to begin shortly AFTER I stopped taking propecia (I ran out). My urologist said to stop taking propecia because that might’ve caused them, even though I thought there might have been other causes, and even though they started once I was already done with or just ending propecia. And sure enough, the problems slowly went away. I would like to know if you think it was the propecia that caused the problem because I’ve heard the chances of sexual side effects are slim, like 2%. But I was considering taking propecia again because I know it helped me, and I now know that any problems would be reversible if I discontinued use. But my gut feeling is that it was the propecia and I shouldn’t even bother with it again, which is unfortunate. What do you think?

I tell patients that 1 in 100 men will experience a decrease in sex drive. However, I often find men are very prone to the power of suggestion, especially when it involves their manhood. For example, if there is a mention of decrease in sex drive, they may have a decrease in sex drive because they will be too worried and too obsessed about it. That being said, it is my opinion that pre-exisitng sexual dysfuction may sometimes unmask itself with a drug like Propecia. Some sexual dysfunction is present in 20% of men in their 20s, 30% in their 30s, 40% in their 40s, and so on.

Your story is unclear and it raises a red flag for me. Why is a 22 year old seeing a urologist? Did you see the urologist before or after you started taking Propecia? Do you have an underlying urological problem? Your erectile dysfuction may or may not be related to Propecia and its manifistation may have just been conincidental. There is really no way to tell. You should follow-up with your doctor to explore other possible medical causes of erectile dysfuction.

My Hair Is My Beauty and I’m Running Out Of It

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

I am a 21 year old African American female who has been dealing with Seborrheic Dermatitis and eczema since the age of fourteen. I have used everything from Mycolog, Desonide lotion to Selenium sulfide based shampoos. Now don’t get me wrong the do relieve me from the itching and greasy scaling of the skin. However in 2004 I noticed that the back region of my hair was thinning out. Also the right side had become infected due to constant scratching and became inflammed. About 2 weeks later the hair in that surrounding area started to fall out. I decided to do a biopsy so they could see exactly what was going on and hopefully remove the extra skin. I was later told that it was growing so I could either leave it in the state it was right now or try again. I chose to wait because it has really been frustrating for me and I didn’t want to make it worse than it already was. The only thing that bothers me is that I’m a young adult and I hide because of my appearance. It’s just a well known fact that a woman’s hair is her beauty and I’m running out of it. I just need some help and guidance and was wondering if you would point me the right direction. I was wondering will my hair ever grow back and how will I restore so it doesn’t happen again.

It seems you are being followed by medical doctors for the cause of your hair loss. If there is an infection on your scalp complicated by your dermatitis and eczema, most medical doctors are well trained to address your problems. I realize hair loss can be a devastating experience for both men and women, but it is my opinion to treat the underlying medical condition and your hair should return once you get your medical problem solved.

Propecia Questions, Part 1

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

Note: I’m just going to post my answer under each question to make it easier for everyone to understand. The email I received from this writer was well researched and quite long, so I’m breaking this into 2 parts. Enjoy part 1 below, and check back for part 2 tomorrow…

1. Is it easy to fake or re-create the standard Merck packaging of Propecia and/or Proscar? I’m asking because of concerns over the legitimacy of these products when purchased from online pharmacies.

Anything is possible. It is always a buyer beware market. Furthermore, you should be evaluated by a qualified doctor before beginning any medications. Propecia can only be precribed by a doctor.

2. The patent for Proscar & Propecia is expiring on June 19th of this year. Have you heard of any developments with regards to other companies wanting to manufacture the generics? Does Merck itself plan to deliver a generic version?

If you remember few years back when Prilosec (omeprazole) became generic, it became less expensive, but the company who made Prilosec then made Nexium (esomeprozole) which is basically the same class of drug and it was marketed successfully as a replacement. I assume something similar may happen, but that is just a guess. I am not in the know and I don’t have inside knowledge. I believe the patent for Proscar runs out this year, but the patent for Propecia (same drug, just 1mg) is still valid for a few more years.

3. Does DHT serve a valuable purpose in the body that is being negated by use of finasteride?

DHT plays a key role in the development and progression of benign prostatic hyperplasia (BPH). Blocking DHT is actually beneficial in preventing prostate cancer according to recent scientific papers which have been published with the 5mg does of finasteride (Proscar).

4. It has been stated that blocking the reduction of testosterone into DHT actually increases the amount of testosterone in the body.
a. Do these raised levels persist or does the body adjust?
b. Given its effects on the hormonal system, I often regard finasteride in the same light as certain steroids even though the action of finasteride on the hormonal system is indirect. Nonetheless, should I be concerned with things like HPTA shutdown, normally an issue for steroid users?

Testosterone is converted to DHT which is then converted to other metabolites. Thus, one may argue that blocking DHT formation may increase testosterone. But there are other biochemical pathways for testosterone to be broken down. It has been said that blocking DHT may slightly increase normal estogen levels (yes, men have estrogen hormones which is normal), but there have been no adverse side effects associated with taking a DHT blocker such as Propecia. Finasteride is not a steroid.

5. Should we be concerned with the effects of finasteride on the liver? I mean, if the drug is to serve its purpose, it must be taken for life.

Finasteride has been approved by the FDA and it does not have adverse effects on the liver. DHT blockers like Propecia will be less strongly metabolized if your liver is functioning poorly, so please check with your doctor for dosing instructions if you have known liver disease.

Stay tuned for part 2 with more questions and answers, which I’ll post tomorrow…

Will Propecia Thicken the Hairline?, Follow-Up

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

I sent you the question which you titled “Will Propecia Thicken the Hairline“.

I don’t have a good digital camera so I’m unable to take reliable pictures for you but I think I can help color the situation with more detail. As I mentioned earlier I’m 25 years old and have a Norwood 1.5 – 2 hairline with thinning in the area around the hairline of 2 -3 cm. The worst area is due north of my temples and isn’t a usually area to lose if your hairline is just maturing. My father is a Norwood 5 and has been since his mid 30’s. The thinning the crown area and diffuse thinning in the hairline indicate to me that I will progress like my father considering my age. I’ve been on propecia for 7 months and it has stopped my hairloss in the vertex and possible slowed the thinning in the front, although as you know it’s difficult to assess even if you are going to a doctor regularly. Taken that propecia is effective in me is it reasonable to think that I will keep the hair behind my hairline given that it hasn’t been significantly effected my MPB? I don’t expect propecia will help thicken the hair in the hairline as it hasn’t done so yet but would it be acceptable to expect I will keep most of the hair that hasn’t been effected my MPB yet? I hope there is more clarity here.

There are no guarantees that Propecia will stop the progression of hair loss. In fact, the studies on the medication show that the loss continues, starting possibly at a higher level of growth on the curves accounting for hair gains seen. Please refer to this graph (click it to see full size), which was made available by Propecia’s manufacturer, Merck. Note that the green curve (those on Propecia) has a less significant downward slope than the gray curve (the control group). This suggests to me that beyond the 5th year that the hair counts will not be droping as fast in the treated group (I wish the actual data had been made available to me).



How Many Donor Grafts Does an Average Person Have?

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

Dear Dr. Rassman,

I have been researching Male Pattern Baldness and Hairloss for about 7 years.I am 28 and a Norwood 4. My question concerns how much donor supply the average person has over their lifetime to transplant to balding areas.

I know that currently some clinics have performed, 6,000 and 7,000 strip/graft procedures in a session and that even more has been transplanted over several sessions. How much donor hair does the average person have ? It would seem that the average would have to be well over 10,000 and close to 12,000.

Thanks for taking the time to answer my question.

The answer to this question relates to a few things:

  1. Your donor density (average is 2 hairs/mm2)
  2. The laxity of your scalp (looser scalps should supply more donor hair)
  3. The balding pattern (Class 7 patients lose up to 70% of all of their hair so if this is a possible balding pattern then 1/3rd of the remaining hair number may be the maximum donor supply available to you over your lifetime)

The degree of scarring and how your body handles the movement of large amounts of donor hair may be the determining factor on your overall supply. Generally, a person may easily get 5-7,000 grafts (10,000-14,000 hairs) and that number can be pushed upward with good healing, minimal scarring, return of scalp laxity and good donor densities. On the high end, I have transplanted up to 25,000 hairs in some people (10,000+ grafts) with unusually good healing and a good scalp laxity.

Patient ZU is in his mid 60’s and had multiple procedures totalling 6,036 follicular unit grafts transplanted. The “after” photo on the right shows the results after only 6,036 grafts, but he actually had another procedure after this, bringing the total up to 8,300. Once I have photos of the results of his last procedure, I’ll post them. In the meantime, please see the photos below and click them to see full size.



I Think I Am Going Bald

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

Hello,
I am a 21 year old male who seems to be having rapid hair loss. My hair has always been very thick and within the last 8 months my hair just began been falling out. My hair is beginning to become very thin and noticeable. I can run my hand through my hair and have 20-30 hairs in my hand. Both sides of my family still have alot of hair. I am just wondering if it is just genetics or maybe because of a desease. What do you think I should ask my doctor???

It is normal to lose up to 100 hairs per day. You can quantify it by collecting the hairs in a bag for 24 hrs and then counting them, but unless you stay home and follow yourself around catching every hair that comes out, you will not get them all. We generally lose hair with the wind and just walking around doing the normal things people do. To better evaluate for your hair loss, you should have your hair mapped out for miniaturization to get a diagnosis in hand. Don’t panic quite yet, but be smart on what you do now.

I’m New to Hair Loss

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

Sir,
I am 27 year old from Bangalore, India. I have lost most of my hair due to male pattern baldness. You can say i am almost bald. I would like to get my hair back. Is there any way I can? I am not sure who to concact for this. Please advise.

I do not know where to start. First, please review newhair.com, as I believe it is as a fairly complete directory for hair loss and hair restoration information (possibly the largest and most complete site anywhere on the internet). Then review this blog site, which now has over 1300 questions and answers to various problems people have experienced with their hair. Then with that education, seek professional help. You can use the physician search at ISHRS.org to find a doctor in your area. You must exercise your brain and do good research to avoid the scams that are widely promoted around the world. Many of them are identified on this blog site, by people like you who do good research and share that research with me. This is a buyer ‘beware business’, but there are many good things that can be done for the average person with hair loss (which impacts almost 50% of all men and women in their lifetime). Good luck with the research and target me with questions once you are more informed.

Problems from Fincar (Generic Finasteride)

/by William Rassman, M.D./9 /,

Dr. Rassman: Fincar Caused Bizarre Problems for me-please advise. I have used 1/4 proscar daily for 8 years I decided to try Fincar for a while. Supposedly Fincar is identical to Merck’s proscar. After starting Fincar my left testicle started aching. I had read numerous about such a paid although I had not experienced it.

In 30 days of Fincar use, bare spots appeared in my beard and the hair on my left arm diminished significantly. The outer third of both eyebrows have thinned drastically and my skin has gotten dry and wrinkly. I know this all sounds crazy but it’s scary.

I went to my family doctor and he just blew me off and said Im getting old since I’m 48.

Doctor-What did the Fincar do to me? I’ve been of Fincar 3 weeks. No testicle pain. Will I return to normal? I’ve resumed the Merck proscar daily but am scared. I wish I had never touched Fincar. Please tell people to never touch the non-Merck finasteride.

Thanks

From my understanding finasteride formulations like Propecia and Proscar is still under U.S. Patent protection thereby restricting the manufacturing of this drug in companies which are under patent treaties with the United States. Generic versions of finasteride like Fincar are made by a pharmaceutical company called Cipla in India and is not available in the U.S. (although I suspect internet sales makes this possible). I am not familiar with International Patent laws so I am not qualified to comment on patent issues. I do know that foreign manufacturing of drugs are not governed by US FDA regulations, so I do not know if the formulation meets the same criteria. There is real no way for me to know if your symptoms are a direct result of taking Fincar. I also do not know about the additives and other inactive ingredients in the formulation. I am not aware that the official, U.S. brand of Propecia is associated with aching testicles or thinning eyebrows or dry, wrinkly skin. I am curious to know why you took the medication if you had read “numerous” reports that such drug will cause these problems.

Fincar may have caused your symptoms, but it may also have been coincidental. I suspect you do not want to take another chance. It is always a “buyer beware” market. Seek competent medical advice. I hope you return to “normal”

Post-Op Questions About Redness

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

Hi Dr. Rassman,
Thank you for having this site and thank you for taking our questions.
I had hair replacement surgery a month ago. I received 2700 grafs. I still have redness on top of my head as well as an itching from time to time.
How long will the redness remain and how long for the itching to go away?
Also, is it okay to scratch my scalp in the area where the transplants were placed. I currently scratch with the tips of my fingers, very, very lightly? Is that okay?

Thank you.

Redness is generally minimal for most people. For those few individuals with a tendency to get red (having histamine positive skin), the redness may take weeks to completely go away. There are no straight rules. Topical steroids work to minimize redness or to treat it if it appears, but minimal use should be encouraged (speak with your doctor). Scratching vigorously is always a bad idea, because it tends to produce trauma to the delicate areas where the transplants were placed and increases your risks for infection at the hair follicle level. What you described sounds ok, as that is not scratching. Make sure your fingers are clean, that you do not pick your nose and then go to scratch your head, because the bacteria from the nose will seed the transplanted area for infection (don’t laugh, as this happens frequently).

Hair Loss Treatments and Cures in the Future?

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

What hair loss treatments and cures can we look forward to in the future? When will these treatments be ready for use?

There are many drug presently working their way through the FDA. I have become aware of two of them recently, but have signed non-disclosure agreements so I can not identify them. The mechanisms of how they work out seem to be different than the drugs that are available today, but great clarity in their mechanism of action will take time to define. Drug testing can take between 5-10 years.

Intercytex / Hair Cloning, Follow-Up

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

I agree with you that cloning is not going to be available anytime in the immediate future, but why do you say 10 years just for safety issues? According to Intercytex, they have already completed the phase I safety trial. Also, isn’t the fact that scientists have successfully transplanted hair into mice and are now putting it into humans a breakthrought? According to Intercyted Seven human individuals from phase I trial currently have “cloned” hair on their heads. Isn’t that pretty huge?

MouseIf a doctor thinks that he can find a stem cell on you and move it to your head in the hope that it will grow hair (it actually might) then the doctor may be allowed to do this if he does this in his office. He has to pay attention to the medical licensing board’s rules on human experimentation, but he will not be going through a hospital-certified facility.

If he takes something out of your body (or even worse, from a mouse as you suggest) and then does something to it, following that by reinjecting it into you, then he is using a ‘drug’ which would then be covered under FDA regulations. Safety and effectiveness for a drug takes many years (15 on average) and cost about $800 million. Thousands of people must be tested and safety and effectiveness must be confirmed according to FDA rules and under FDA guidance. That is why I said 10 years. A cloned mouse hair on a human head fits that timeline for me, but if that happens on your head, be sure to stay away from cats.

I Was Told To Put Vaseline on My Transplanted Grafts

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

VaselineI am a 33 year old female and just had a hair transplant 3 days ago. I was told that I had to put vaseline on the grafts and on the donor site twice a day for about a week. This keeps my whole head really greasy and I can’t go out without a bandana or hat on. I washed my hair with shampoo (very lighly where the grafts are) but it seems that it doesn’t get clean. Is this really necessary? How can I get the vaseline off my hair? If I could have clean hair, I would be able to go out and it would “hide” my transplant but I feel like the vaseline just plasters my hair to my scalp and the “wet” look really makes the transplant stand out. What would you recommend?

I never use or recommend Vasoline, because it is difficult to manage and remove. The general purpose of the Vasoline is to keep the grafts moist to prevent crusting, but I generally believe that it is best to take off the crusts by a good washing technique before they form and get fixed in place. It is impossible for me to get to you in a timely manner and it would be inappropriate for me to give you advice on a piece-meal basis without a doctor/patient relationship established and the internet is not the place for this activity. As you have a doctor, best to follow his recommended course. You might ask him why he does what he does so that you can understand his/her thought process.

Eczema

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

Hi, ever since I have been in grade school my hair has grown healthy past shoulder length. I am 20 now and for the past4 years I haven’t been able to grow my hair the way I use. I have ezema on my face and sometimes it comes up on the back of my neck and takes out my hair. Well it has cleared up in the past 4 weeks or so and now the middle of my hair is coming out. I am almost bald on the right side of my head. I have constantly growing on the top and a little in the back. What do you think could be causing my hair to come out on the right side

There are many things that could be responsible for your hair loss, so you need to see a dermatologist. This is something that requires direct observation by a skilled physician. Speak with your family doctor to get an appropriate referral. If you do not have a family doctor, you can find a dermatologist at the American Academy of Dermatology website.

Only 50% of My Hair Grew Back After Chemo 6 Years Ago

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

Dear Dr. Rassman,

I had a chemotheapy in 2000 and lost all my hair. Then it didn’t fully come back and now I still have diffuse alopecia. I can say only %50 of my hair came back. I also had lots of grey hair but they are now replaced by black colour hair, my original hair colour.

Do you think if I use Pantogar Capsules 3 times a day, will I get any results? If not, which medicine do you suggest to use?

Thanks a lot!

Hair loss from chemotherapy usually grows back without any supplements. I am not aware of any supplements or medication that will accelerate this process. The only treament I know of is “time”. I realize chemotherapy has the stigmata of cancer and is often devastating and depressing for your morale and self image. You must be sure that you do not have other systemic causes of hair loss and your treating doctor should advise you on this.

The time you are taking to grow your hair back appears much longer than most. This may indicate that you will not return it all. If you are disease free and you have what we call a positive nitrogen balance (good diet adding calories to you), then you are doing the most that you can do. There are many organizations or some hospitals have great hair piece or wig programs for their chemotherapy patients.

As I have written in a previous blog entry, I am not familiar with Pantogar, but did find this site which mentions it: EHRS.org