Fincar, Forcan, and Candid-B

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

heloo sir, Well i am 21 yrs of age. 2 years back i had thick shiny and straight hair. then suddenly one day my hair started off falling very severly. i ignored it thinking it was the after effect of some new shampoo but then even after using my normal shampoo the problem continued. i let it go thinking it will get solved by itself. but then after 2 years leaving it untreated one day i saw that my scalp had become visible and my hair became thin and dry. i then went to a dermatologist. he advised me the following.

candid B lotion (made by Glenmark)
forcan 150mg (made by Cipla)

after using this for a month my hair loss stopped completely. now the problem is that i am not getting my lost hair back. and my hair is dry and thin. can i regrow my lost hairs or am i too late to do anything. please help me cause it affecting my confidence. please. reply urgently. thank you.

I looked up Cipla and found that they make a generic Proscar: Fincar launched by Cipla is a hair loss pill, indicated for male pattern hair loss or Androgenetic alopecia. Even though Cipla’s Fincar contains the exact same chemical Finasteride as Proscar (5mg of finasteride), its cost is significantly less than that of Proscar. Each film-coated capsule of Cipla’s Fincar contains Finasteride 5 mg.

Assuming this is correct, the Finasteride 5mg is a much heavier dose of finasteride than is needed to control hair loss and would therefore have more side effects unless the pill is divided into 1/4 or 1/5. I am surprised that this can be obtained in the United States, because I am under the impression that this is covered by U.S. Patents from Merck.

Forcan is an antifungal medication, which suggests to me that your doctor thinks that the hair loss may be do to a fungal infection. The use of steroid/antibiotic combinations like candid B lotion are often used to reduce the inflamation from infections, although this is not my area of expertise. If you have any questions about what your doctor is doing and why, just ask him. An open line of communication with your physician is a good step to take.

Oxycodone and Hair Loss

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

My husband is taking oxycode 40 mg. twice a day for his illness, but is losing a lot of hair. He is also on a few other meds for high blood pressure and cholesterol, and narco for pain. Could this be causing the tremendous hair loss?

If his illness is a chronic illness, I would think that this is the first place to look for hair loss causes. I need to know more about his chronic disease to answer your question intelligently. Oxycodone is not the most common drug that is known to cause hair loss, but it has been reported to have hair loss as an extremely rare side effect.

Skin Cancer and Alopecia Universalis

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

Sun

Does a person with alopecia universalis have a less likely chance cancer of getting Basal Cell Carcinoma(BCC)?

i have never heard of alopecia universalis before your blog. From research hair stem cells seem cause BCC when misregulated.

Alopecia universalis refers to a particular disease entity that is genetic and autoimmune. Without hair to shield the scalp from sun and the harmful effects of direct sun light, there will be an increased chance of UV light damage, thus leading to a higher chance of the various skin cancers that are sun induced.

Laser Brush vs Other Laser Treatment

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

Is the laser hair brush as effective as the laser treatment (sitting under the laser light) which is available?

Unfortunately, there is no information on either the value of the big sit-down laser units, the different type of sit down units or the laser brush/comb, let alone a comparison between the them. Sorry, but I can not help you here but hope that some objective studies will be presented to help us all out.

Transplanting Chest, Leg, and Thigh Hair

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

I have read some doctors preaching the use of chest and leg hair for hair transplants. I have also read your comments and general lack of enthusiasm for this. What is behind your strong opinions against this?

Scalp hair is better understood and tested for over 50 years. Although the art form has only been reasonable for the past decade or so, the facts concerning hair growth from a scalp source as donor hair are well understood. It is always important for me to inform patients about their risks, expected growth rate, and reasonable results that they should target. We have no body of evidence that hair taken from body or leg parts will work to any reasonable degree, but there seems to be (as P.T. Barnum said) a sucker born every minute. I do not want to be part of such a process, at least until it is clarified as something real.

In the book by Elise A. Olsen, Disorders of Hair Growth, the rest cycles of hair are stated. Although I can not attest for the science of these figures, let’s take them at face value for a moment and see what it means if correct. All hair cycles go through various growth phases, so the length of these growth phases are critically important to understand. For head hair, growth cycles range from 2-7 years, with a sleep period of 3-6 months. Generally it is believed that head/scalp hair is in its resting phase for about 10% of the hair population, which means that of all hairs growing on the head, another 10% is lying dorment awaiting its growth phase.

  • Leg hair has a cycle between 7-12 months, but between 62-88% of these hairs are in their dormant phase.
  • Thigh hair has a cycle of 3-5 months, but between 64-83% of these hairs are in their dormant phase.
  • Arm hair have a cycle of 3-7 months, but between 72-86% of these hairs are in their dormant phase.

With chest, arm, and body hair, the above numbers suggest that there is a large number of sleeping follicles at any one time. If this is true, then there will be questionable value from a hair transplant using these body parts from fullness or coverage point of view. Add to that the pain of hundreds or thousands of small wounds created all over your body might produce. I wonder about the doctors who are routinely performing this type of surgery and ask about their motives. I have concluded that any doctor who offers this must let his patient know that this is not a tested procedure, falling in the experimental rather than the clinical hair transplant offerings. I’d also hope they reveal the figures related to sleep cycle of the hairs from the various body parts as discussed above so that their patients are well informed.

Redness and Hair Loss After Transplant

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

I had a transplant one month ago and am now very nervous. I was told that shock was NOT permanent yet on one of your blogs from 2005 there is mention of shock loss in balding areas as most likely being permanent. Yet if you took propecia prior to surgery, this shock could be prevented. I had not been given that instruction and have not only been experiencing shock loss in the frontal area, but still have redness that I thought would be gone after 7-10 days.

Is there a risk that the redness is permanent? Was I given bad advise about the prevention of shock loss (does propecia work in the frontal area). I wish I didn’t sound like I’m going off the deep end but this is all pretty unfamiliar territory for me. Please let me know your thoughts.

Redness will almost certainly go away with time. You might try hydrocortisone cream 0.05% and apply it to the red area in three or four 12 hour applications per week. Do not use it chronically, because steroid creams do get absorbed by your body.

If you are a young man and had transplants without taking Propecia, you run a high risk of shock hair loss that can be permanent. The loss usually commences with surgery or a few weeks after the surgery and runs its course over a few months. If the loss is in the area where the transplants were done, or in an area where you were balding prior to the surgery, the risks are higher. You might try to get a prescription for Propecia and maybe you can still save some of that hair.

I Lose Hair In The Shower, But My Friends Say They Don’t

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

Dear Dr. Rassman,
Im 17 an i have been noticing when i shampoo im losing quite a bit of strands, i know its common to loss up to 100 strands but i ask my friends if they lose any strands of hair in the shower an they all say no. Also none of my family members have ever gone bald, so does this mean that i can or cant go bald?

ShowerYou are correct in that 100 (and even as many as 200) hairs a day and is normal to lose. Hair grows in cycles, so sometimes you may notice more hair loss. If your hair loss is within that range, I wouldn’t be worried. Your hair may be in a cycle where it is in its shedding phase, but when we go into a hair loss cycle associated with genetic hair loss, the loss in the shower may be higher. The best way to judge is to:

  1. compare what you are seeing to what you had been seeing in the past
  2. see a good doctor who will map our your scalp for miniaturization looking for the findings that are always present in genetic hair loss

Hair loss in your genetics can skip generations, so even if you do not see it in your immediate family, it does not necessarily mean that nobody in your family has experienced balding to some degree. And chances are that your friends do lose hair in the shower and it goes down the drain. I couldn’t tell you for sure though — I do not shower with your friends.

Paxil and Hair Loss

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

Hi Doctor,
I started taking Paxil about 3 months ago and have recently been expieriencing increased hairloss. Prior to taking paxil I hadn’t expierienced hairloss for about a year. Do you think there is a connection between the paxil and the hairloss, and is the hairloss irreversible if it is?

It is not clear if you are male or female, which is important in the way I construct the answer. I will assume that you are a male. If you had hair loss 1 year ago when you were not on Paxil, maybe this a coincidence, maybe not. Hair growth and hair loss both go in cycles, so perhaps you just kicked in the loss cycle.

As I stated in a blog entry from just last week, but it is worth repeating —

I have three important points to make with regards to medications causing hair loss:

  1. Before identifying a drug as a possible cause of hair loss, you should find other medical causes.
  2. People take medications for a health problem. You should not stop taking a medication just because you think it may be causing hair loss. Your health should come before your hair (especially if you are not certain that the medication is causing the hair loss).
  3. Most importantly, you should follow up with your doctor for medication changes and concerns.

Buyer Beware

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

Are all balding men transplant candidates?

BaldJust the other day, a 31 year old man came to my office wanting a hair transplant using the Follicular Unit Extraction (FUE) method. He had already seen 3 other doctors and I was 4th on his shopping list. I’m not knocking that — it’s a good idea to meet with more than one doctor before chosing your surgeon , even if you feel comfortable during your first consultation because comparison shopping in this industry is the best way to protect yourself. Whether I was 1st on his list or 4th on his list — I’m just glad he eventually made his way to my office. During the examination I noticed that his balding was more prominent in the front, but there was thinning everywhere, even in the donor area. His hair was light brown and his skin had moderate skin tones and people with this contrast usually show a good fullness in the ‘donor’ area, so I was immediately concerned that something was wrong with this picture. I mapped out his scalp for miniaturization and found that the hair groupings in the front, top, and crown rarely had two hairs per follicular unit, averaging half of the normal healthy hair population. The donor area had a density of 1 hair per mm square (normal for a Caucasian is 2) and there was significant miniaturization throughout the donor area, worse on the sides, but bad enough in the back of the head.

I asked him about the three doctors he had visited and he went on to tell me about their surgical recommendations and how many grafts each had suggested was the appropriate number. I asked him if they mapped out his scalp and he said each had put their hand over his donor area and told him that his donor supply was good. None had used magnification in examining the donor area, certainly not mapping out his scalp. In one pf the doctor’s offices, he only met with a salesman, who recommended the largest number of grafts of all three offices.

This patient had a disease called Diffuse Unpatterned Alopecia (DUPA) and if there is ever a contraindication for hair transplants, this is one of them. I found it more than interesting that all three of the other doctors recommended surgery and I told him that he was not now or ever going to be a hair transplant candidate. Had he undergone surgery, his donor area would have been wrecked and he would’ve had an awful result, losing more hair than any gain he could’ve possible had. The only advantage to having surgery was that the doctors who recommended it could adequately pay for that new house and car they are driving. Let the buyer beware.

Penis Is Not Hard with Propecia Use

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

I took propecia for almost two months and noticed immediately a change in the hardness of my penis during sexual encounters. They were not as hard. At my doctor’s advice, I switched to taking it every other day, but still the same result. I have since quit taking the drug and my hardness has returned, but I wish to gain the benefits of propecia. Any suggestions. I have heard that going on and off the drug can cause increased thinning of hair. Please help. Should I try rogaine instead?

BuffProblems with erections are a known side effect with Propecia. In normal young men, this rarely happens, but if you are like most men, your sexual performance is going to be less spectacular as you get older. This problem normally impacts 20% of men in their 20s, 30% in their 30s, 40% in their 40s and over 50% in their 50s. Where your performance may be at the verge of showing this change, Propecia can accelerate the process. The solution for most men is taking one of the sexual enhancing drugs like Cialis (works a full 36 hours) or Viagra (lasts for about 12 hours). This way you can get the best of both worlds (hold your hair and keep up good sex). Ask you doctor to write you a prescription and if you try it you may like it.

Using Non-FDA Approved Medications As Last Resort?

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

Hello Dr.

  1. 27 yr old male, Norwood 2~2.5
  2. use propecia regularly for 3 years. This has helped greatly in preventing mpb.
  3. use minox once a day (used to do 2x a day) 1ml on hairline and 1ml on crown
  4. Within the last year my temples have drastically recided (sp?) and now my hairline is starting to go.
  5. I am noticing even beyond my hairline there is diffuse thinning and it’s frightening to look at.

Do you offer any advice on any other medication to add to the propecia and minox mix? It seems one would have to try a non-fda med as a last resort before surgery.

I was considering adding revivogen (non-fda approval considered) but I am unsure of how it’s anti dht properties will affect my hormonal levels (i.e. will the combo of propecia and revivogen cause a severe loss in the production of dht that would lead to make gyno?). Obviously propecia is a systemic medication, but what of topicals such as minox, revivogen, spiro, etc.? Are they systemic or only confined to the scalp.

As a Norwood Class 2, I think that you should be tested for miniaturization to see if there is balding behind the hairline. First, you need to measure just what is going on to determine if you really have the problem that you think that you have. Second, if the Propecia is working, why go to non-FDA medications and put yourself at possible risk? You need a doctor to take charge of you and give you the guidance you need.

Donor Hair Supply and Cell Therapy

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

Id like to get a transplant by your clinic soon, but do not have enough donor to produce the illusion of full coverage… Can you tell me if cell therapy will be available within a few years so i dont have to worry about donor depletion? i understand it will be in phase 2 trials at the middle or end of this year through ADERANS…. I want to get a transplant now, but will only do it if it this new donor supply or cell therapy will be out… can you give me some info?

Cell therapy is not going to be on the market for a few years at the least and there is still no guarantee that it will work yet. Hair transplantation for some very bald people is still the best way to go. Sooner or later, alternatives to transplants will be available. Depleting the donor supply is a real concern for some people and that is why you need a good doctor who can design a customized master plan for you to be assured that your ‘worst case’ scenario is covered.

Why do you feel that you do not have enough donor hair? Consider sending me pictures of yourself to evaluate you more fully.

Does Lisinopril Actually Cause Hair Loss?

/by William Rassman, M.D./21 /,

My Dr. told me that lisinopril doesn’t cause hair loss. You say it does. It is not listed as a side effect, so are you sure it does? I freaking out cuz my hair is falling out. I am 53 years old and had all blood work done and all came back fine. I always had thick thick hair and so does everyone in my family. I am wondering is it menapausual? I have no other syptoms and my periods are still very regular. Will it grow back in or what should I do??? Im so confused because everyone tells you somthing different.

Many drugs can potentially cause hair loss. Most of the times scientists cannot find the exact mechanism of why this happens. Likewise, scientists cannot find the exact cause of hair loss either, because there are so many different factors involved.

I have three important points to make with regards to medications causing hair loss:

  1. Before identifying a drug as a possible cause of hair loss, you should find other medical causes.
  2. People take medications for a health problem. You should not stop taking a medication just because you think it may be causing hair loss. Your health should come before your hair (especially if you are not certain that the medication is causing the hair loss).
  3. Most importantly, you should follow up with your doctor for medication changes and concerns.

If you are taking Lisinopril, you likely have high blood pressure. You should NOT stop taking Lisinopril just because it has a rare side effect that you may or may not be experiencing. Stopping high blood pressure medications puts you at risk for strokes and other serious medical complications. There are other drugs that work just as well for controlling blood pressure as lisinopril. Recent studies suggested some relationship between lisinopril and lung cancer increasing its risk by 14%.

Some women who have genetic hair loss have it appear at about your age. The best way to make this diagnosis is to have your scalp mapped out for miniaturization. If you have genetic female hair loss, then there will be miniaturization over the thinning areas and miniaturization in the ‘rim’ of hair around the side and back of your head. Mapping out your scalp is the key to this diagnosis.

If I Forget To Take Propecia, Will I Lose More Hair That Day?

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

Hey Dr. Rassman. Thanks for the blog. I know you must get tired of answering the same questions over and over…but we appreciate it. A few propecia questions for you…

I am 23 years old and have been taking a generic propecia compound containing finisteride and something abbrivaited “biot”…don’t know what it’s called though. My primary care physician prescribed it for me because it’s a little cheaper but he says it’s the same thing. Is it just as good? Also, I know that if you stop taking propecia that your hair loss will “catch up”. My question is how long after you take a pill does this happen. If you forget to take a pill one day will you lose more hair that day? Is it a 24 hour thing where hair loss will start creeping up on you without taking another pill…or does it take a matter of days or weeks to fully get out of your system before you start experiencing the increased loss. One more for you…since Propecia is really only real effective for about 6 or 7 years would it be wiser for me to wait and take it when I am experiencing hair loss where it would be most effective. Right now I have a full head of hair but a receding hair line that is not really noticable if my hair is combed the right way. Since propecia really doesn’t help the temple areas should I hold off for awhile and save my years of effectiveness of the pill when I need them? Thanks.

MagicianPropecia is under U.S. Patent laws and there aren’t any generic brands legally available in the U.S. While I realize many people may take the generic brands, there is no way for me to assure you that you are getting what you are paying for. Furthermore, I cannot comment on a drug which you do not know the name of — I am not a magician or a mind reader.

Forgetting to take Propecia for a day or two should not make you lose more hair that day. I do not know how long you would need to not take Propecia to see its effects disappear. I suspect it is in the order of weeks or months.

Finally, there is no data to suggest that Propecia is effective for only 7 years. I do not believe for one minute that Propecia becomes ineffective at 7 years, but it may not be as effective as the progressive process of hair loss moves on its own timeline. Propecia blocks hair loss as the daily hormone testosterone is converted to DHT, and the DHT then ‘hits’ the hair that is genetically impacted by whatever the genetic defect that causes hair loss is. There is no magic here and the drug must be taken daily to be really effective. If you stop it after 7 years, you will almost certainly play ‘catch-up’ hair loss.

24 Year Old Woman with Thinning Hair

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

Im am currently 24, both my parents are sixty, with super thick hair still. The past three years i was stressed due to a new job, was dieting, took Yasmin for birth control, used a left over home straightener (relaxer) that i had saved for future use, was in a wedding and had a dresser basically use a curling iron, more like burning iron, and i had wisdom teeth surgery that had nerve damage and i could not eat for several months and still took birth control (Yasmin) during my healing of my curly hair, I was confident that anything i would do would never cause baldness, however, here i am with excessively thin hair at the front and sides of my head. i’ve already been told that i look like i’m in my 30’s instead of 20’s. Will my hair ever restore to its normal thickness? right now it is growing out straight and i have bald spots in the back of my head and the sides of my head are extremely thin and straight, I do not see hair filling in aprocess, and to top it all off I have trichotillomania. Obviously I have issues, but due to the excessive thickness and volume t the sides and front of my head only in the back. i have been eating food with flaxseed. is there anything else i can do to help my hair grow back, and will there ever be a chance for full restoration?

To answer you, I would have to write a book. Yes, you have issues and what you described in your questions cover almost every imaginable problem a woman can have with their hair. If you are honest in this communication, you need to get good medical care. If you have bald spots in the middle of normal hair, then you could have alopecia areata. If you are pulling my leg to test my ability to sort through such complexity, I am sure that some of the readers will not sympathize with your dilemma. Good luck to you.