This is an interesting article published online yesterday focusing upon women’s hair loss, alopecia areata, and some of the interesting research being done by credible people in the field who are looking for the genes that cause hair loss and excessive hair growth.
Dr Rassman
I recently had transplant surgery at a reputable office to combat thinning hair on top and a receding hair line. I am 48 years old. I was suprised by what I believe was a fair amount of shock loss around the graft areas given my age. I was not on propecia pre-surgery but began taking it a few days following the procedure after reading your column. Now I believe propecia can also cause shedding in the early months. Could you explain the difference between shedding and shock loss and what you believe I am experiencing. Maybe a combination of both.Thank you
It sounds like you experienced shock loss and if this is in the miniaturized hair, the hair may not come back. Treating thinning with transplants is not something I do often. In many people with miniaturized hair, transplanting into that ‘unhealthy’ hair does little to really increase the fullness. I believe that for most people like you, any benefit you will get in the long term may be lost in the short term, making transplants a poor decision. I would think that Propecia should have been used in advance of your hair transplant procedure just to minimize this risk. The transplants done may offset the hair loss and the Propecia may bring some of the hair back. Only time will tell. Once the glass of milk falls and the milk spills out, it may be impossible to bring it back.
Dr Rassman, I am a 39 year old male with very thin hair. i went to Dr bernstein about two years ago because i saw a change in the texture of my hair. It was getting thinner all over, especially in the front.Dr Bernstein said I was losing my hair and was on my way to becoming bald. He took a sample of my hair also. he said i was not a candidate for a transplant since the quality of the donor area was not good. He gave me a year prescription for propecia and told me to visit him in a year.I have been on propecia for six months now , but have not seen any results. it seems my hair is getting even thinner, especially at the hairline. does this mean that if the propecia does not work, i am out of options,since i am not a candidate for a transplant ? If the propecia does work, will that make me a candidate ? I didn,t want to visit dr bernstein again until i have been on the propecia for a full year and since it has not grown hair for me, would he be able to do anything for me?
In most patients over 30 years old, Propecia will help stop further hair loss instead of growing thicker hair. However, there are some fortunate patients who will have thicker or fuller hair after about a year on Propecia. If you experience further thinning after being on Propecia for a year or so, you may be continuing on the natural course of rapid hair loss.
If Dr. Bernstein said you were not a candidate for hair transplantation and he confirmed that you are balding, AND are not helped by Propecia after a year, then I might think (I am guessing here, since I have not examined you) that you have a condition called Diffuse Unpatterned Alopecia (DUPA), which is an extensive analysis of the diagnosis process for hair loss and planning for the future. It is important to revisit Dr. Bernstein after you have been on Propecia for a year.
18 month ago I noticed my hairline was receding and took propecia accordingly.
6 month later I began to notice that the hair on my arms, legs, eyebrowns, and in the public region were thinning. At 12 months, I began to notice pigmentation on my knuckles and small bumps on my nails – even sore joints – all signs of an autoimmune disorder.
I’ve noticed anecdotal evidence on the web that this can happen.
Is there further evidence to support this?
Autoimmune diseases can attack any organ in your body, including your hair. If you think that you have an autoimmune disease and there are many skin pigmentation changes, see a good dermatologist first. What you are describing is outside of my area of expertise.
Here’s a plastic surgery question I received this week. I’ve opened the blog to questions regarding cosmetic surgery, rather than limit it to strictly hair loss questions (at least on a trial basis). If you have plastic surgery questions, please write…
I have a question in regards to rhinoplasty. I feel that my nose is relatively large and has a bump on the bridge, and I am looking for a completely new nose. I have a consultation scheduled in june with a surgeon and I wanted to know would this bring the cost higher, and is this possible?
Nose jobs (rhinoplasty) are one of the more difficult and artistic plastic surgical procedures. Some plastic surgeons do not take them on, while others feel that they have the artistic skills to create the nose that the patient wants. Costs vary significantly between surgeons and locations; the well known 5th Avenue (New York docs) and the Beverly Hills plastic surgeons are probably more expensive. You have to check out your doctor by finding out his/her experience with nose jobs, see many pictures of their work, speak to a few patients if that is possible, get to see that the number of patients he/she has done, etc.. Make sure you understand the risks from his/her perspective. Fixing the bump on the bridge of your nose is more common than other types of nose jobs where missing ‘bony’ infrastructure needs to be brought in. Do you bond with your doctor? Do you like the doctor as a person? Does he/she spend enough time to answer your questions and address your concerns, dealing with your worries with compasion? I use these rules for selecting any and all doctors.
Good luck.
I am in my early twenties, with two toddlers. A little while after my second child turned 1, my hair started to thin through out the length of my hair. At first, it was only on one side in the back. Then it kinda started to thin on right side. What I am left with is hair that is growing back unevenly and a very small amount that has not broken off. I know my hair grew too fast when I was pregnant. It was so long and all one length, but its not now. I have a very small amount of really long hair that remains, but the rest is shorter. I don’t have bald spots, just a lot of broken hairs. My question: Is this post pregnancy hair loss or some form of it, and how long can this expected before it completely stops. I have never had hair loss issues until now and my daughter is almost 3 now.
What you are experiencing right now is postpartum hair loss and the shorter hair should eventually get longer. You will have to wait (possibly a year or two) to see if your hair becomes fuller. Sometimes, we see changes in the character of hair as we go through different aging periods. Infants have one type of hair, children another, young adults still another, and aging adults will see a thinning of the hair shaft. Although the last phase takes years, it does occur sometime in people in their 20s and 30s. You might see a doctor and get your hair mapped out for miniaturization just to get a base line in case things do not go the way you want. Measurements are important to document when you look for change.
I am 21years old and I am starting to look like my dad. According to your balding classification, my pattern is now like a a Class 4a pattern but my dad is a Class 6 or 7 pattern. I went to a hair transplant doctor and he said I was too young. I already have no hair halfway down my head, Would you transplant me?
First, you must recognize that this process is an important lesson in planning for both you and I. I believe that young men like you can receive surgery, but before that happens, you need to have a Master Plan that takes into account all of those elements that make a 20 year old different than a 26 year old or a 50 year old. These would be my criteria:
- Propecia: I would want you to be on Propecia. Would you be willing to stay on it? I would want to know if you had any side effects from the drug.
- Hair: I need to assess your donor hair supply and be sure that it meets your present and future need for donor hair over time. I would also need to know your overall hair and scalp characteristics as a hair transplant candidate.
- Health: I would need to have a complete medical and psychiatric profile on you.
- Maturity: I do not do surgery on anyone who does not do their research and understand what they are getting themselves into. I must be assured that you understand what is happening to you and what may happen to you as you continue to bald in the future. By the way, did you elicit the advice of others (parents, close friends, some older, wiser person)?
- Finances: Have you lined up the financial resources to follow the surgery to a reasonable stopping point? What if the balding progresses to a Class 7 pattern?
- Reasons: I need to know much about you — I’d need to know if your expectations are realistic and reasonable? What is the goal in terms of what you expect to obtain? I would want you to meet patients and understand just what you will look like if you had a hair transplant.
I must be sold on taking you on as a patient. I must have faith that you know enough about the process (over time) to appreciate the things I said above. Although I rarely do a hair transplant on someone under the age of 25 (I do some), the concept of your becoming a Class 7 balding man is the worst case for both of us. You do not have to become bald to get hair as that would be unreasonable on my part. Are you prepared to manage the worst case in a cooperative manner with me?
To state emphatically that you are not a candidate for a hair transplant is an unduly hard position. Each and every patient needs to be assessed individually, weighing all of the elements above (and everything else that is relevant) before any decisions are made. I try not make decisions about any of my patients on any one issue, including age. I want to get to know the person inside the head, well beyond what is evolving on top of the head.
Two websites list Merck’s drug patent on Propecia expiring this summer:
1. Drug Digest
2. RX SolutionsAccording to RX Solutions, the exact expiration date for Propecia is June 19, 2006.
Brand Name: Propecia
Ingredient Name: Finasteride
Patent Number: 4760071
Expiration Date: Jun 19, 2006Is this accurate? Thanks.
These reference sites are what they are and say what they say. I have looked up finasteride on the United States Patent office website and found issued Method patents for finasteride — #5,571,817, granted November 1996 “Methods of treating androgenic alopecia with finasteride” and #5,567,708, granted October 1996 “Methods of treating androgenic alopecia with finasteride”. Clearly, this is a treatment method for hair loss defined for this drug and if these publication dates hold, they would be good for 17 years from the date of issue (for patents filed at that time), but as a method patent they may have limited value. In March 1999, Merck received patent #5,886,184 for the process of manufacture of finasteride and it may be this process that is the enforcing patent, as I understand that method patents can not be enforced in providing a service related process for healthcare in the United States. Another process patent for manufacture was published in November 1995 again following the 17 year rule.
It was an exhausting read, so rather than digest it for you, may I suggest that you do your own research. Go to: Patents – Merck AND Finasteride or just to USPTO.gov.
What everyone wants to know is whether this change brings on generic finasteride into the US and Western European Market? I have confirmed with a Merck rep that the drug does go off patent this summer, but I am told that other patents will be enforceable. If generics come into the market, will the pills be scored so that it is easy to break into 1mg sizes?
We are not far from the answer to this question. My capitalistic nose tells me: Follow the money!
I found this article that goes to show that just because there are claims that a supplement does something, it doesn’t mean it actually works. The article shows what happens when credible science is focused upon hyped-up natural supplements. This is why FDA approval is a critical step and why I can’t in good faith recommend products which do not have this type of clearance. Even though this article isn’t related to hair loss products, it is something you should think about when trying some of the “cures” for hair loss out there…
Dear Dr. Rassman.
I write today about a nagging issue concerning propecia. I started it just a couple of weeks ago, with no side effects so far, but my worry is this that I read around the web, about propecia eventually losing its effectiveness after five years. I thought it would work by diminishing A-5-Reductase and therefore it would reduce DHT as well. Why would it lose its effectiveness? Or is this just a rumor? I wouldn’t mind having to take it for the rest of my life as long as I can keep my hair with it. Of course I plan to get a transplant eventually to recover some thinning areas in case it can’t fix it, in addition to some other treatments available today. If it’s only going to work for five years, what’s the point of taking it? Wouldn’t it be better to blow it all in a transplant? Or is there the chance to keep most of my mane by simply taking Propecia?
Thanks, and keep up the great work.
You should approach the question as Propecia not losing effectiveness, but having limitations and possibly not managing all of the hair loss to your satisfaction. Propecia will not restore your hair back to when you were a teenager. Even hair transplant surgery will not do that. Propecia slows down the male pattern hair loss process. The 5 years is not a magic number, but it does reflect the published 5 year study by Merck, the makers of Propecia. Patients not taking Propecia had a much greater rate of hair loss in the five years that the process was studied. If your question is based on pure monetary economics, you are correct in stating that hair transplant is the only permanent solution, but a solution to what? I often tell young men not to transplant if the drug holds off the hair loss and the hair loss does not bother them a great deal. I make my living doing hair transplants, yet I tell more people to take Propecia than suggest hair transplants, because I am honest… and honesty is the best policy. But if your question is based on hair economics, Propecia with a hair transplant (in some people) will maximize your hair density and give you a better cosmetic result. Just be careful who you talk to. When someone wants to push you to a hair transplant, take your time and remember: Let the buyer beware.
Hi Dr.Rassman,
I’ve heard that caffiene is bad for the hair and may cause hair loss. So does that mean that Green Tea is also bad since it contains caffiene?
Also, does propecia lose it’s affect after five years?
Caffeine does not cause hair loss. If it did, I would be bald by now because I drink 5 cups of coffee a day! I have also heard sex is bad for hair, but I wouldn’t give that up either. With regard to green tea, see past blog entries here.
Propecia does not lose its effects after five years.
I am a 41-year-old mother of five who’s been experiencing male pattern hair loss (similar in pattern to Dr. Rassman’s photo) for three years. In the past 15 months, the hair loss has advanced significantly. My scalp itches incessantly, especially in the areas of concentrated loss (temples), often waking me at night. I’ve seen three dermatologists, all of whom summarily dismissed me; only one testing my hair, another sending me off with $100 shampoos. I’ve traveled to NYC to see a specialist only to be shuttled out the door with a $950 bill. Extensive bloodwork by an internist showed normal range results.I’ve tried Rogaine 5% and 2%–but scalp irritation intensifies without results. Two questions: (1) Is there a topical or oral product that will eradicate the unbearable itching–I’ve been told itching is characteristic of hereditary hair loss. (2) Could you recommend an ethical, knowledgable expert colleague on the East Coast–would like to know honestly if I’m a candidate for hair transplant or will be taking the wig route. Hair loss certainly stinks! Many thanks for your response.
You may want to look up Dr. Bernstein in New York. He is compassionate and very knowledgable. I can not recommend a treatment when I do not have a diagnosis. It does sound like you are not getting a serious evaluation. Certainly with a $950 bill for an office visit, I would expect far more value than you seem to have gotten.
In my daily research, I came across 2 articles worth mentioning…
When I read the stories in these links, it was clear that I, the reader, was being hyped. But when you are desperate for hair — losing more and more of it each and every day, depressed when you run your fingers through it and notice that there is less today than yesterday, see the hair go down the shower drain or come off on your fingers when you shampoo, and when you see the person in the mirror you immediately wonder, “Could that be me? NO WAY!” — you take notice of each and every story out there that could possibly lead to the solution. Are you getting the picture here? Put these thoughts in your head and then read those above ads posed as actual news and all of a sudden, there it is, the cure you have been looking for. Yeah, right. The hope offered by this Arizona-based hair center is about as refreshing as a glass full of air. At least it says they offer a money-back guarantee. I have reviewed the limited published results of these hand held lasers and there is no evidence I could find that indicates that they actually work. Hey, maybe I am wrong — I’ll continue to hold onto hope but I am not going to get into a fight to get my few hundred dollars back when the reality of this hand held laser hits me and I find out that the business entity that made the guarantee is in bankruptcy. That would just make me lose more hair thinking less of the guy in the mirror and more foolish.
Dr. Rassman,
I had 3 HT’s, the last approx 2 yrs ago . I have seborrheic dermatitis, & am trying to control it. 4 months ago I had 2 cortisone shots in my right shoulder & started to notice a consistant shedding of transplanted hairs. I have very fine hair, 61 yrs. old & am concerned. Can hair fallout be affected by cortisone injections, will it grow back? Thank you so much!
Only time will tell. I suspect that it will grow back. Men in your age group have ‘strong’ hair able to handle many insults. A couple of shots of steroids should not be a big enough insult to knock out the hair permanently (my opinion). Write to me in 3-5 more months and let me know if the hair returns.
Hi there Dr. Rassman,
I had some serious breakage due to over processing. The stylist I went to used bleach on tons of hair rather than a “10 hair test strand” as she called it. The test strand was done because I told her my hair was previously bleached and processed since then and that I was too scared to do what she recommended. Her so called “10 hair test strand” turned out to be some 50,000 hairs after she was done! My hair is now super thin and I had to cut off a foot and still thin. I even have a bald spot in front where it has receded. So I read that M-T-G (not mane and tail at the drugstore) used on horses can help with the growth process. But I am worried because the 1st ingredient is sulfur. And the 1st ingredient in color removers/strippers is also sulfur. And yet I was told that color removers are harsh on damaged hair and *will* caused very processed hair to break. So now I am worried about using Shapley’s M-T-G. What do you think? Thanks!
Be careful who you listen to. When I do not know something, I say so. I do not know much more about MTG products than I stated here. I don’t like the concept of using sulfur in any form on damaged hair. Be careful, you may be taking to many risks as you experiment with your hair.