Anxiety, Mood Swings From Propecia?

/by William Rassman, M.D./27 /

I have been talking propecia for about two weeks and I have been experiencing wierd side effects like anxiety attacks, feeling out of it, slight mood swings, etc. However, when I asked my doctor about it, he said that he had never heard of anything like it. There are a number of people online who have complained about similar side effects and I feel that these symptoms are a direct result of propecia. I was wondering if you had ever encountered any similar cases and if so will these side effects go away. Thanks

Finasteride blocks the conversion of testosterone to DHT. As a result, there will be a temporary increase in testosterone and changes in androgens as well which might (theoretically) produce side effects like those experienced by women with PMS. One of my patients had a real complaint like this and he was a very credible physician. When he stopped the Propecia the symptoms went away. Can hormonal imbalance affect mood swings? Possibly! Some patients have repored changes in the way they feel on Propecia and I have generally discounted these report but now I will make a note of this and watch for more patient comments and blog emails that bring this up. I aleady spoke to a Merck rep about it and hopefully the verbal report will work its way back to headquarters. If I hear more of these type of complaints, I will be more vocal on sharing this with you through this blog.

My Hair Only Grows When In Braids

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

hello Dr.,

i’ve been having hair problems since a was a little girl. my hair only grew when i had braids. whenever i removed them, the hair would fall out. so, upset and in my late 20ies, i decided to shave my head and kept them short until my early 30ies.

i began hair treatment at this salon where i actually saw result. my hair was finally growing without the breads and i finally looked like a feminine black woman. after a couple of months, hell broke loose. it started falling again. now, my receeding line is pushing back and my already large forehead got even larger.

i trully don’t know what to do. you see, i am already a little tomboyish so not having hair, makes me feel very uncomfortable in my body. i rarely go out now and if i do, i either wear a hat or use mascara to cover the front of my hair.

what to do? implant for me is financially impossible but i am putting some money aside for it. i saw a Dr. in Canada, who is willing to implant for 2500$ but he has no knowlegde of what is wrong with me and doesn’t seem interested in finding out.

please take care of me. right now, i am using Ducray Anastim products. i can manage to send you a picture of the disaster if you want.

kindly!

A while ago I wrote a piece on a syndrome that may reflect an element of your problem (see What Is Body Dysmorphic Disorder?).

I can make no sense of what you are telling me, because it is not logical to my mind. If you found a doctor willing to do a hair transplant for $2,500 without a diagnosis, it is like giving that doctor $2,500 with a doubtful end point that will make you happy. If you insist on parting with $2,500, give it to a good charity and you will get more pleasure than having some ‘hack’ doctor take your money. You need to get a good doctor to help you with your possible dysmorphic situation and also get some good tests to determine what is really going on. I would be pleased to get pictures and upon receiving them, I will get back with you for some general advice, but what you need is a hands-on, caring doctor who is not trying to put his hands in your purse.

Woman Losing Eyelashes and Eyebrow Hairs

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

Hello. I am a 23 year old female who started to notice I was losing my hair about a year and a half ago – which was a half a year after having been severly ill with mono. I am not sure if that is directly related to my hair loss, but I have heard it’s true for other people. Since then, I have tried 2% Minoxidil (plus a supplement pill suggested by the Hair Club for Men and Women), Spironolactone (recommended by a dermatologist), and now a Progesterone cream plus the Minoxidil. Not only have I not seen any new hairs growing back, but I have noticed a dramatic increase in my hair loss, along with the loss of eyelashes and eyebrow hairs. I am very discouraged and am running out of hope, time, and money. Any advice as to what is wrong would be helpful and appreciated.

Thank You.

ps – I was tested for hypothyroidism, but it was negative. Also, there is no history of hair loss in my family, so I really don’t think it is alopecia.

If you feel that the medications you are taking may be contributing to your progressive hair loss, then you should should discuss stopping them with the doctor who prescribed them. You problem sounds complex, certainly too complex for internet management. Be sure that your medical work up is complete and covers eczema, malnutrition, autoimmune disease, drug reactions, infections, genetics, etc.

Monitoring Your Stress Level and Hair Loss

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

Hello Dr Rassman,
Let me first state that I am so thankful for this free service. All of the posters on this board are richly rewarded to have access to a service like this.

I realize the following, somewhat meandering, question may be vague, but I will ask it anyway, as it is of considerable concern to me. (I am a 23 year old male.) Do men with the genetic potential to experience MPB at some point in life need to be constantly monitoring their stress level?

I run my own small business, and find that during the busiest weeks of the year, I become extremely stressed. Usually this stress lasts only for 2-3 weeks, and then I take some time off to de-stress. I always worry that those periods of stress will do permanent damange to my slightly receding hairline(between Norwood 1 and 2. If 5-8 weeks of high stress a year is dangerous to my hair health, I would immediately begin taking on less inventory and earn less money. I know myself well enough to realize that I’d rather be an average income earner with hair, than a business tycoon without! And their isn’t a shred of doubt about it!

Thank you Good Dr.

MeditateGood question! Stress is part of life. Managing stress is a matter of balance and there are many ways to manage stress properly. As the Bobby McFerrin song from the late 80s says, “Don’t worry, be happy!” Not a bad philosophy, so the key is to manage stress better without necessarily changing your life direction to address the fear of going bald, for example.

I would never be so bold as to suggest that potential hair loss is something that you need to worry about. If you wish to take that extra step, then get your hair mapped out for miniaturization from time to time, which is a way to show (with good measurements) if there is anything to worry about with regard to genetic balding. It only takes a few minutes and it will give you peace of mind. Meditation is also a good way to manage stress, so spend some of that money you are making and learn the art of meditation. That might give you the best of all worlds.

Steroids in Animals and Hair Loss

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

Hello Doctor!
Great site you have I really like all the info on it, it seems to be like a great library of info…most of the information on the internet can be found but it is scattered everywhere and has to be pieced, so I thank you for having it all available here…Now with regards to my question. In this era, I’m sure you know that sometimes there are a lot of animals being pumped full of steroids. Couldn’t this have something to do with hairloss? It would elevate testosterone, as if I recollect, steroids are lipid soluble, so they would tend to be found more accumulated in lean meats such as chicken…again correct me if im wrong, but this is just what I recollect from Bio class. I am starting to think it had some kind of effect on me, because I did enter puberty much earlier than my parents, everyone in my family was fairly resistant to acne, well I tend to be moreso, and I grew up to be much taller than anyone in my family…I am a full 5 inches taller than my dad and noone in my family has ever broken the 6 foot barrier. I do realize that there is such a thing as recessive genes that may not be expressed, but my younger brother who has lived a somewhat different lifestyle than me, seems to be in much better shape overall. Whats your take on this doc?

Your theories are interesting, yet there are plenty of vegetarians who are bald. While it is true that some animals may be subjected to anabolic steroids, I doubt any significant levels (if any at all) would be found in the consumables. Even if it is, heat would denature (or make ineffective) any steroid in the meat. Futhermore there are strict guidelines that the United States FDA sets on meat and poultry products.

With respect to your second question, genetics may play a part in your physical appearance, but other factors such as your lifestyle and even pure randomness will also play a part. It has been noted that first generation Americans are almost always taller than their parents, with a larger frame as well. This is even taken to second generation Americans, as the diet is more and more Americanized.

Transplanted Hair From Leg To Forehead

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

Female – Hi, I had a body hair transplant (300 grafts)four days ago. I had leg hair moved from my legs to the the top of my forehead to get my forehead to look smaller. I don’t have a hairloss problem, I have a naturally high hairline and am trying to lower it. After the procedure I had lots of numbness, even 3 inches away from the recipient area. Today I have numbness around the recipient area only. Up to an inch away. I am very concerned about shock loss. Does the numbness indicate trauma and that the existing hairs in the numb area will fall out? I’m very worried about this. If there’s something you can tell me that I can do to prevent this, I’d greatly appreciate the help. Please let me know.

First, you should go back to the doctor who did your transplant and ask him/her if there were any issues the time of surgery that may have caused problems. Some sensory defects are often present and usually go away within a few days after the surgery. At times some small nerve endings are severed with the needles used and this can last (rarely) a long time until other nerves take over. There is little to do but to wait it out.

I am curious why you elected to do a leg to forehead hair transplant? This is unusual and probably experimental and you should have been informed of this by your doctor. There is no real data for leg to forehead hair transplants, so predictable results are not something that you can depend upon. I would hope that your doctor told you this.

Is There a Link Between Shape of Head and MPB?

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

Hi Dr, I’m 19 years old and I was diagnosed a few months ago with MPB. I’ve noticed something that I told to my doctor that laugh at me. My question is : is there a link between the shape of your forehead and MPB? I explain myself. A few months ago when I start to lose my hair, I’ve noticed that it was preceded by a change in the shape of my forehead : two bumps appears in the middle and two lines or holes are reaching the side. It’s a very agrresive shape that makes feel I’m going to be bald very fast. I can give you some examples of celebrities who have this shape and started to lose their hair very early such as prince william, pablo puyol, tony blair… I’ve noticed that in the university where I’m studying medicine, a great part of the young people like me who are becoming bald have this shape of forehead. My cousin started to lose his hair at 17 and he has this shape of forehead whereas his brother who is 30 has got a full head of thick hairs and he hasn’t got this shape of forehead. can you give me you opinion on this…

ConeheadsThere is no connection between shape of the forehead and balding. I believe that what you are observing is the normal shape of the individual’s forehead, which was covered by hair until the hair receded. Most hairy boys have so much hair that you have no idea what shape the skull is below the hair, but when it goes from genetic balding, then its shape dominates. For some people like you, the forehead shape seems to be a surprise.

One very famous celebrity that I transplanted about 8 years ago focused upon his flat head as the main drive for getting hair. He had crown balding and did have a flat skull. I placed the hair in such a manner as to give the back a good lift and the illusion worked well. He has strong wavy hair so his hair type helped a great deal and he was never bothered by his flat head again. I know this because we do talk from time to time and have maintained a cordial relationship over the years.

Female with Hair Too Thin For Transplant

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

I have thin hair all over, I have spent a lot of money on wigs, that are really pretty, but I am severely depressed over my extremely thin hair. Do you know anyone that could help me? I am not a candidate for hair transplant, I went to Bosley Medical and was told my hair was to thin all over to get donor hair. Although I can wear a wig, I want my own hair. I am very sad over this, I am a pretty 34 year old woman with a wig, but without it I feel i look horrible. Please do you know anyone who can help me? Thank You!

Not many women are candidates for hair transplantation, especially those with diffuse telogen effluvium (thinning throughout the scalp including the donor area). Have you tried Rogaine for Women? It would be valuable to you to see a doctor to be absolutely sure that you have no medical conditions that can cause hair thinning. They would be the same conditions as discussed here.

Hair Loss from Accutane

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

Hi Dr. Rassman,
First off, thanks for the helpful site. My question is regarding accucate-induced hairloss. I am a male and started losing my hair in a diffuse pattern, all over the head but more severe on the top, after a course of accutane when I was 15. It has been a very slow, gradual loss but now at age 21 it is extremely prononunced. I probably have a little less than 50% of my original density. I wasn’t sure that the hair loss was a direct result of accutane until I had a scal biopsy done by a dermatologist recently and she confirmed that it was accuate-induced (not sure how she knew that from the biopsy but that’s what she told me – I think it was something about the “properties” of the follicle). I’ve attached 2 pictures – these were from about 8 months ago and the hair loss is considerably more now than it was then.

My first question is whether there are any clinics/hospitals/studies you are aware of that are studying the side effects of accutane – either in order to test treatments or just to track users that are experiencing side effects. I’m pretty sure that my condition is untreatable and I’m just going to have to live with it, but I would be open to trying experimental treatments in order to help others out. Second, do you think there is any use in using propecia/minoxidil to try to slow the loss, or would they be useless since this loss is probably acting by a totally different mechanism? I have used both in the past without evident results, but it’s hard to tell if they were slowing the loss or doing nothing at all.

Thanks very much for your advice.

Unfortunately, there are no solutions to your Accutane problem, other than to stay away from that drug. If you have genetic balding on top of the Accutane problem, then you should get your hair analysis for miniaturization to be sure one way or the other, the status of genetic balding compounding the problem you already have. I do not have any people to recommend who are experimenting with problems like yours. Also, please see previous Accutane related posts.

Kevis and IntraUterine Device (IUD)

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

Dear Dr. Rassman,
i have had andorgenetic alopecia for year now. it started at the age of 12 or 13 and now i am 26. i have lost more than half of my hair. it is really devastating. i have been on kevis for about a year now. in the beginning, i felt my hair loss problem was going to be a thing of the past but now i am experiencing a great amount of hair loss. i am confused as to what is the reason. i have had an IUD inserted also about a year ago- it caused great amounts of bleeding. could it be that i now have acquired a low serum ferritin count that is causing this imbalance? i also have irregular menses, could it be a hormonal imbalance caused by the IUD (it was a copper IUD). The reason i ask this is because the IUD caused me to have delayed periods and bleeing for more than a week.
i am really stressed out and do not know if to continue the kevis or not. i am so thankful that you have a website like this for people like me.
thank you

Bleeding and anemia can cause hair loss. Low ferritin can also contribute to hair loss, as well as hormonal abnormalities which you seem to have. Kevis is incidental, I suspect. The active ingedient in Kevis is minoxidil, so I would suggest that you switch to it and simplify what is happening to you. You need to get your doctor very involved in this problem.

Haircut After Strip Procedure

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

Scarring from a strip procedure is a big concern of mine. What method do you use to close the donor area, and how noticeable would this scar be? For example, would my barber notice it while cutting my hair if he cut it to 1/2 inch length?

The person above is talking about removing a stip of skin for donor area harvesting, the common standard surgery for today’s hair transplant. Only about 5% of the population will have a scar wider than 2-3 mm on a single surgery. With a deep fascial closure and trichophytic incisions (see Techniques to Minimize Donor Area Scarring ) these numbers should show a smaller incidence. Even with a 2-3 mm scar, you should easily be able to cut your hair to 3/8th of an inch without being observable.

Promel – New Drug For Graying Hair?

/by William Rassman, M.D./4 /

See this link from NewTechSpy.com — World’s First Drug to Reverse Gray Hair

It sounds interesting, but I cannot find any other source of information on this ‘new’ drug. I am not familiar with the drug but I wonder how it would affect skin color since melanocytes are what gives us pigment in our skin as well as hair. I would be interested in seeing clinical studies or pharmaceutical data and FDA clearance addressing the critical safety and effectiveness issues before I jump on this bandwagon. If the drug is not safe, I would rather be gray than dead. Not to say it would go that far as that would be quite an extreme example, but at this stage I do not have more information and safety is always the critical element in the decision to take a drug.

I Stopped Propecia and My Hair Fell Out — I Want It Back

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

Hello Dr. Rassman,
I have a question about using propecia. I am now 26 years old. I started noticing hair loss at about 22 years of age and started taking propecia at 23. I took propecia for about two years and it worked very well. My hair loss stopped completely and it appeared to me that I even experienced regrowth. I stopped taking propecia about one year ago. Since that time, I’ve lost a considerable amount of hair. I did not react well to my hair loss and so I have started taking the propecia again. I’m wondering how much, if any, of the hair I’ve lost in past year may return? Also, I’m interested in hanging on to every last hair in my forelock that I can. Is there any chance that adding minoxidil to my treatment could aid in maintaining my hairline while I wait for the propecia to take effect?

This is the classic thing I warn patients about. Propecia is a lifetime commitment, else balding is the consequence. You will most likely not regain all of what you lost since stopping the drug, though possibly some of it may come back. Holding on to what you have may be the thing you now need to focus on now. Any return of the hair will be a bonus. I hope that this message reaches anyone thinking about stopping their Propecia, even if they think it is not working (it most likely is working, at least in slowing or stopping the progressive loss).