Propecia Shedding vs Regular Hair Loss

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

I read alot of posts from medical experts and bloggers about shedding on Propecia and how it is a good sign that the drug is working. My question really is what is the difference between shedding on a drug like propecia and actual hairloss? How can you tell which one is occuring and at what point in your treatment do you accept your shedding as hairloss. Hope this is clear. I just don’t understand the difference. If 17% of males that use Propecia get no benefit did they experience hairloss that they believed was just shedding?

There is no way to distinguish shedding from Propecia (rare) vs normal shedding from continuation of male genetic hair loss. Hair loss shedding will be continuing at the same rate that you saw it prior to starting the drug if the drug is not working. Any shedding caused by Propecia should pass within 3-4 months so that by the 8th month, the benefits should be clear one way or the other.

My Hair Suddenly Got Curly in the Back

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

I am a 64 year old women, suddenly my hair is getting curly in the back of my head. What is causing this? I do have a small pea size cyst on my brain stem. Dr. is not concerned unless it grows. Could this cause the problem?

I don’t know the cause of the sudden change in the character of your hair, but most people would love to be in your situation. As we age, the hair often gets finer with less character, rather than more character. Change in diet could be responsible, but this is pure conjecture on my part. It is possible that a gene for curly hair may not express until later in life due to certain environmental factors. I would doubt that the pea-sized cyst on your brain stem has anything to with it.

African Hair and Noses

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

I am an African American man and I want my frontal hair loss fixed and a nose job. I do notice that more white people get these types of surgery than black people. Why is that?

The kinky hair of African individuals makes it slightly more difficult for hair transplants if the surgical team is not able to manage the hair grafts that are not straight below the skin. Hair transplantation is a peg in a hole skill (like fine needle work), but when the grafts are not straight, it is more difficult to put them into a straight hole. With the right skills, the team can coax the hair into the needle holes created in the recipient area.

I’ve asked Beverly Hills based plastic surgeon and UCLA Medical Center’s Clinical Assistant Professor of Plastic Surgery, Jon Perlman, MD, to answer the nose question. Here’s his response:

Black people’s noses are more difficult due to a general lack of cartilage available from the septum to build up the height of the missing bridge. Some doctors (not myself) prefer to use silicone grafts however though not unreasonable, it is associated with a much higher risk of future extrusion from within the nose. The advantage is that it comes in a package and can be relatively easily placed on the bridge of the nose to build it up.

Chemical Burn Caused Chunk Of Hair To Fall Out

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

I burned my scalp from chemical dying of my hair. I had patches where it burned and scabbed pretty good. A few weeks ago, a chunk of my hair fell out with the the scab, and now there is a smooth surface where that hair was. What can I do? If feels like a crater on my head.

Chemicals may cause temporary hair loss and the chunk of hair that came off with the ‘scab’ is what I would expect. You should allow your scalp to heal and the hair should start growing back within 6 months of the initial injury, hopefully earlier. Sometimes, the hair may not return. In any case, wait a few months to see if hair grows out of your scalp. If you prefer not to see a doctor now for the best advice, expect hair growth after 6-8 months and then see a good doctor if there is no return of the hair.

Propecia Prescription Questions

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

I want to start taking propecia. I just need to know how to get it. Do I make a appointment with a regular doctor and he’ll give me a prescription or do I need to see a dermatologist? and how long can the prescriptions be? finally about how much does a 30 day prescription cost? Thank you

Propecia is a prescription item and requires a doctor to write it in the United States and Canada. Any doctor can write it. I always tell a patient that wants to take it to get his hair mapped out for miniaturization in order to be sure that (1) he is really balding and (2) what is his baseline miniaturization from which we can measure improvement or worsening of his situation and (3) what pattern of hair loss can he expect in the future. Measurements are at the foundation of clinical science and you need to know what you are treating and where you are going. A prescription written by a doctor should be good for a year or so, depending upon laws that can vary from state to state. Propecia costs range from $60/month to as high as $120/month in some pharmacies, so shop carefully.

Lyme Disease, Female Hair Loss

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

I am female, 46 years old. I do have many lyme disease symptoms from neurological to joint and cartilage problems to nervousness…too many to list. I was previously on intravenous twice for months at a time. I was diagnosed at least 6 years too late. I have alot of raciness inside of me and I am always thinking of too many things ata time. I am so miserable about my hair. All my hormones are great and my blood tests are fine. Now what? My hair falls out all over, short and long. How do I know if it is Lyme? Can stress cause a diffuse hair loss all the timne for years? What can I do? Is there a world famous hair Dr.? I am so frustrated and unhappy. Please help, thanks!

It is not clear if Lyme Disease is associated with your hair loss, but it may have triggered a stress response that may have set off a cascade that may not be reversible. Stress in itself can be a cause of hair loss. It seems to be a vicious cycle, and unfortunately there is no “cure” for hair loss in women about 80% of the time. If you are this concerned you may want to see a good dermatologist or possibly even a hair transplant surgeon who will map your scalp for miniaturization to make a diagnosis. Be wary of eager doctors who want to sell you a hair transplant surgery.

Rogaine on Eyebrows?

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

Hi Dr. Rassman,

I have started losing my eyebrow, I am on both propecia and rogaine, they work fine on my hair, what can I do to stop eyebrow loss?

Can I use Rogaine on my eyebrow?

There are many causes of eyebrow hair loss such plucking, hypothyroidism, anemia, contraceptives, psoriasis, and any skin inflammatory process going on. Rogaine may help for some of these. Get yourself in the hands of a good doctor to make the diagnosis. If eyebrows are lost, a hair transplant can work to restore them, provided that there is no autoimmune cause of the hair loss and you are in good health.

Livon for Dry Hair and Minoxidil

/by William Rassman, M.D./46 /

i have been losing hair from either side of my forehead.now im using minoxidil 5%.i was using other oil and wash it was before using minoxidil.but i came to know that if we use other oil it wont allow minoxidil to penetrate into scalp.so i stopped using it.but now my hair has become dry and is difficult to comb.there is a hair fluid called livon which instantly smoothens and softens dry hair.it is usually used on towel-dried hair.so i wanted to know whether i can use it and if i use will it stop minoxidil to enter into scalp or should i use the hair fluid after applying minoxidil.please advise.

While there is no way to be sure, but I would think using minoxidil at least 30 minutes prior to using the softening product (Livon) would be the best compromise.

Can I Use Minoxidil To Keep Hair Saved By Propecia?

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

Hi Dr. Rassman,
You are true credit to the Medical Community, and your blog, and expertise are greatly appreciated by many.

Two quick questions…If after using Propecia for 2 years, and going off of it at that point (the point of diminshing returns) would continued use of Minoxidil support the hair that was produced by the Propecia?? I’m 53, have been using Minoxidil for 8 years, and Propecia for 4 months, and the Propecia is already working well on my thinning crown area. I thought after the propecia loses its effectiveness, I would just stay with the Minoxidil, & let the Minoxidil take over. Please advise

Also, are FOX grafts more expensive, than the more established FUT grafts, since this procedure is more difficult for the Surgeon?

If you are getting a benefit from Propecia and then maximize it, whatever benefit you received will be lost when you stop taking it and minoxidil will not save that benefit for you. I assume that you are trying to save money. That would make your investment to date valueless as you go backward.

FOX/FUE grafts are more expensive than standard FUT harvested through the strip method. In my opinion, they are not better, just different.

Fungus on Eyebrows

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

i’ve been having my right eyebrow loss since a month ago. i dont know what is the real cause. both my parents had some fungal infections on their head and moustage but with treatment and applying lime juice the area affected had recovered. i’ve tried to apply the same technique but it didn’t work. i’ve met my clinician and he prescribed me with some antifungal tablets and some vitamins and still it is in bad condition. i do have some occasional itch on the eyebrow affected. i’m very worried as my right eyebrows also started to fall off . both my eyebrows appear oily and i don’t use any special cleansing foams please help me what should i do

How long have you been taking the antifungal medication? Do you truly have a fungal infection on your eyebrows? Do you have any other type of skin problem such as eczema, psoriasis, or another inflammatory disease? Have you done any blood work to rule out hypothyroidism, anemia, and other chemical inbalances which can effect your eyebrows? You may want to see a dermatologist for this problem and have some blood worked up. If there is no regrowth of your eyebrows after you have seen the dermatologist and you continue with your treatment plan as prescribed for around 6 to 8 months, then look at a transplant as a possible option.

Is Triangular Alopecia Genetic?

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

Dr. RASSMAN

I am 24 years old, female, and I have triangular alopecia, two questions that I have for you are will transplant stay in or continue to fall out and will I pass this on to my children. My hair loss began when I was 15. Thank you for being concerned about a disease which may not be terminal and to some people not that big of a deal. To me sir it has destroyed my self esteem,and in so many ways left feeling all alone.

Triangular alopecia is an inherited genetic defect in the area near where the temple prominences are located. Sometimes it is on just one side and sometimes it is on both sides. It tends to run in families, but not always and it does not often ‘express’ itself in the first generation of those who have it. It may skip many generations so those that have it can not find the family link to it. It might be spontaneous, but there is no way to be sure that it is not somewhere in the family line. This condition is easy to diagnose because of its characteristic appearance and can be transplanted quite effectively. There is no need to have your self esteem destroyed, just get a hair transplant by a good physician who knows how to work with the temple prominences.

About to Undergo Chemo — Anything To Minimize Effects on Hair Loss?

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

Good Afternoon Doc,

This question is not for me, but rather my brother, who was recently diagnosed with testicular cancer and will undergo a fairly strenuous (and stressful) 9 week session of chemo, followed by a major surgery to take out some of his lymph nodes.

He’s 23, has a perfect hairline, and no signs of male pattern baldness or thinning (unlike myself) so far. His good looks are definitely an asset and he’s concerned that his hair may go for good because of the stress and trauma he will soon experience. He’s already buzzed his head in preparation.

Now granted his hair is minor relative to the rest of his health, but is there anything he can do to minimize negative effects to his hair from cancer and stress? Would propecia help at all or would it simply get killed off by the chemo (or maybe the two drugs don’t interact at all and propecia would help)? Any other advice?

Thanks for the help!

There are no offerings that are approved for people on chemotherapy to prevent the hair loss that is associated with the treatment. The reason that the hair falls out is because most chemotherapeutic agents try to ‘knock out’ cells that are growing fast (cancers are essentially cells that grow out of control and that is almost the only thing they do). The cells in the body that normally grow very fast are also impacted by these drugs and these normal cells include: certain blood cells, platelets, intestinal lining (causes nausea and vomiting), and hair cells (causing hair loss). The cancer cells could die (that is the hope) while the other cells that get impacted by such drugs also die, but as these normal cells have a source for new cells (like stem cells) the populations usually recover after they go through their natural recovery cycle. Blood cells are relatively short cycled (they grow from a kind of stem cell), but a person may need blood transfusions while the recovery cycle kicks in. Intestinal cells usually re-grow in a matter of days to a week or so (nausea and vomiting stops at about that time) and hair re-grows when it passes through its normal telogen cycle (3-6 months when it re-grows hair probably from some type of stem cells as well).

I have recently been made aware of two new drugs in clinical trials that will target the protection of hair during chemotherapy. That means we might see some new breakthroughs in the next few years, far too long for those on chemotherapy today, but maybe in time for others who go this path.

Intense Weight Lifting Causes Hair Loss?

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

Rassman Buffhello Dr. Rassman

I read on a Wikipedia article that intense weight lifting can increase hair loss. I weight train frequently, and I’m concerned that this may accelerate my loss. Is there any basis to this claim? Please help. Thanks so much.

If you do not take exogenous steroids, being fit will not cause hair loss. Take a look at me. I never got hair loss when I was acquiring that body! HA!

From Bowling Ball to Gorilla (with Photos)

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

Patient ZU is in his mid 60’s and he is what we call a Class 7 Norwood scale balding person (click name to see his before picture). He came to an open house last week and he has now filled out nicely. He told every person at the open house that he looked like a ‘bowling ball’ before his hair restoration, smiling as he made that reference. I talked about him before on this site (and posted some photos), but when last I spoke of this patient, I had said I’d post updated photos of results from his last procedure when I got the pictures. Well, now I have them. He had a total of 8,300 grafts. Would you believe that he still wants more hair? The crown area needs more fill and his comb-back styling is now working well for him, but he believes that with more hair it will work better. I guess when you have been deprived of hair for 40 years, you may over-react. Patients continuously tell me that when it come to hair, like money, more is better.




Seborrheic Dermatitis Recovery?

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

Hi, Dr. Rassman,

I would like to say that it is extremely generous of you to be extending help to thousands people out there who are troubled with hair problems.

I just have one short question for you and hope you may help me with it: do people generally recover from seborrheic dermatitis? It has been plaguing me for nine years, and I sometimes wonder if I will ever recover from it.

Thank you for your kind attention!

Yes, people do recover from seborrheic dermatitis if they are compliant with the treatment plan devised by their dermatologists. Some people heal slower than others and some of them do get better. Maybe the question you are asking is if there a cure for it? To that question, I would say “no”, but there are treatments that make it better and more manageable.