Missing Propecia and Minoxidil Dosages, in Theory

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

A group of experts in the hair restoration field, were polled on the issue of dosing minoxidil and finasteride. What I am quoting below are some unofficial opinions that are not the standard FDA line for these drugs. I present them for the interested readers on this blog. The authors of these thoughts would rather not identify themselves, as these opinions are not in-line with standard treatment recommendations, even for the doctors who believe what is written below…

Comments on minoxidil:

Once a day topical dosing with minoxidil is probably close to, or equivalent to, twice a day. When given orally, minoxidil has a relatively short half like of several hours, but when topically applied, it has a half life of 22 hours in the skin. This makes once a day dosing a very reasonable option which I often suggest to patients.

Comments on finasteride:

Unfortunately, there are no references in the literature, that I am familiar with, concerning the “functional” half like for finasteride.

The serum half life of finasteride is only 4-6 hours. If we assume the worst, 4 hours, then there is far less remaining from a 5 mg dose 48 hours after dosing than there is from a 1 mg dose 24 hours after dosing. Similarly, a 2.5 mg dose does even less well. So, from a simple serum level of finasteride standpoint, every other day 2.5 or 5 would not maintain consistently high enough serum levels.

It gets interesting though when you consider the half life of the finasteride / reductase complex. The half life of this blocked enzyme complex is around 30 days. This is the most likely reason that when you stop taking finasteride (after chronic dosing), it takes 3 months for your DHT levels to return to baseline. This part of the story implies that, once you get up to steady state levels, every other day dosing would surely be enough..

I just think that there might not be enough of the drug around to keep the enzymes saturated using chronic alternate day dosing. These are the reasons that I recommend daily dosing but point out to my patients that it doesn’t matter if you miss a dose now and then.

Tags: hairloss, hair loss, propecia, finasteride, proscar, minoxidil, rogaine

My Daughter’s Hair Won’t Grow

/by William Rassman, M.D./56 /,

My 5 year old daughter’s hair will not grow! I have tried almost everything and it still seems to be the same length since her birth–very short, course hair. I have recently resorted to extensions (braids) in an effort to give her hair a break from everyday styling, but nothing appears to work.

Could she have a medical problem?

Hair on the scalp grows in cycles. They have three phases of growth:

  1. Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
  2. Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
  3. Resting phase (Telogen phase) which lasts about 1- 6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

I do not know why your daughter’s hair has not grown in 5 years. There is a peculiar genetic condition that impacts children of her age causing hair loss and balding. There may be variants of this condition worth exploring. You should discuss this issue with her Pediatrician and determine if she has any medical conditions that may be contributing to such slow hair growth. The use of hair extensions may cause the hair she has to fall out from the traction it causes. If her hair is not growing as you reported, then she may become bald at the point the ‘extensions’ are attached.

Tags: traction alopecia, child, hairloss, hair loss, hair growth, slow

How Long Does It Take To Go Completely Bald?

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

Hi doctor, I started balding right around my 17th birthday. Both my grandparents and dad are bald, yet all of my 5 uncles have hair. I am almost 18 now, and i am on both propecia and rogaine. Exactly how long does it take to bald completely??? If it continues at this rate i will be completely bald in two years ( I had an absolutely enourmous amound of hair a year ago). I still have a lot of hair and none of my friends notice and think im crazy. I am just wondering how much time you think i have. I started taking propecia 1 1/2 months ago and rogaine this week. My hair loss rate has not decreased. I am very very anxious.

For genetic balding, the baldest of men on the Norwood chart (see below) know that they will be bald by the time they are in their mid-20s (VI and VII). Those with lesser balding patterns take longer to evolve and may not complete the entire patterns show here.

Norwood Chart

Mapping out your scalp for miniaturization will tell you what is about to happen to you. Find out!

Tags: hairloss, hair loss, norwood

Stem Cells in Hair Identified

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

Reprinted from UPI:

Scalp tissue might become stem cell source

PHILADELPHIA, July 12 (UPI) — U.S. researchers have isolated a new source of adult stem cells in scalp tissue that might be able to differentiate into several cell types.

University of Pennsylvania School of Medicine scientists say if their research proves to be safe and effective in animal and human studies, it might eventually provide the tissue needed for treating such disorders and peripheral nerve disease, Parkinson’s disease and spinal cord injury.

“We are very excited about this new source of adult stem cells that has the potential for a variety of applications,” said senior author Dr. Xiaowei Xu, an assistant professor of pathology. “A number of reports have pointed to the fact that adult stem cells may be more flexible in what they become than previously thought, so we decided to look in the hair follicle bulge, a niche for these cells.”

Xu and colleagues report their findings in the American Journal of Pathology.

Many people who are doing work with hair regeneration or cloning are working on the areas that contain these stem cells. In fact, many of the experiments that are successful in producing some hair, also produce other organ tissues like bone and muscle. But the real value of the hair for a health focus is the easy access to stem cells, that is, if we can really harvest them and get them to just replicate themselves. If hair stem cells can grow a heart or liver, or fix an injured spinal cord, or repair a brain in a stroke patient, that value will be far greater for society that just growing hair on a bald man. The value of this article shows that stem cells from hair has great promise for medicine and human health. It will be far easier for legislators to approve organ regeneration as an application for hair stem cells than for vanity purposes in cloning hair.

Tags: stem cells, hair, science

Reducing Visibility of Transplant Scar

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

Dr. Rassman,

I had 1 hair transplant procedure 2 years ago. I am only 22. I feel like the propecia is not working and I am ready to shave my head, but I want to reduce the appearance of the scar from the procedure. I am currently using Mederma. Are there any other products you could suggest to reduce the visibility of the scar? Thanks!

If you had only one transplant procedure, you should not be facing a significant scar. I am bothered not only about your scar, but your age. What drove you to have a transplant at 22? A good, honest, and competent transplant doctor should look at your scar and advise you. Consider sending me digital photos and maybe I can help, but send me photographs of your entire head as well (your photos will be kept confidential and will not be shown on this site). As well, please reference this blog posting when/if sending the photos.

Tags: scarring, hair transplant, scar, hairloss, hair loss

Appropriate Propecia Dosage

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

I was prosribed propecia two months ago to have every other day. My hairloss already seems to be beginning to stabilize over this short time. Hopefully I might get some regrowth in the coming months! I was told the 5 alpha reductase reduction with propecia is still just as effective as if I was taking it every day. However I have read elsewhere that you need to take it every day. While I don’t doubt the advice of my medical professional, I have read here, and elsewhere that I need to take it every day to get maximum benefit. Are there two schools of thought as to the appropriate dosage? Or is it that, as the onset of my MBP is very recent my medical advisor is of the view that I would get an effective response on a less frequent dosage. He claims to have many patients who get a good response taking propecial every other day. Thanks for your help

The recommended Propecia dosage is one tablet once a day.

Some doctors may prescribe half a tablet once a day or one tablet every other day, however these are not the official recommended dosages. One reason is that official clinical research has found that the once a day dosing gave the maximum benefit from male pattern hair loss. Another more important reason is that the half life (the time it takes for half of the drug to be eliminated by the body) is only 5 to 6 hours. So theoretically on the days you do not take Propecia, your thinning hair will have no benefit from the drug. You should always follow the advice of your primary doctor and discuss these concerns with him or her, especially before stopping or changing any drug regimen.

Tags: propecia, finasteride, dosage, hairloss, hair loss

Contact Dermatitis and Hair Loss

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

Can you please help me? I have a contact dermatitis and have been picking it- is the hair loss permanent or temporary?

Can you also recommend a good dermatolgist and endorcolgist in London? We have bupa but my gp is not good with hair problems.

Thank you . I am very impressed with the time you give others with this awful, life destroying conditon

Contact dermatitis usually is not related to hair loss. However, you seem to describe a condition of compulsive hair-pulling (called trichotillomania) and it may be secondary to your contact dermatitis. Hair loss from pulling is often permanent if it goes on for any length of time. Fortunately if you stop pulling at it, your hair may still grow back. People who pull at their hair often have some obsessive/compulsive elements in their personalities and may require medications to stop the process.

Tags: trichotillomania, hairloss, hair loss, dermatitis

12 Days After Transplant And Hairs Haven’t Fallen Out Yet

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

First – thanks for a wonderful blog!

It’s been 12 days since the transplant procedure and while almost none of the transplanted hair have fallen out yet, much of the transplanted fat tissue (I assume) is still clinging in small beads to the hair. Is this the “crusting” that many people write about? Any suggestions as to how to remove it – or is it just a matter of time before it comes off.

Also curious is that the small hairs have not fallen out yet… assume this is normal and just be patient and wait for them to fall out? Seems like the key to this whole process is to get on with your life and check your head in 8 months!

The crusting by this time can be removed by washing and then with the hair wet for a good 10 minutes, layer conditioner on the crusts and let it sit there about 10 minutes. Then, gently with your finger tips, rub these crusts — you should see them fall out. There is little danger in losing the grafts at this stage in time as long as you are gentle. The little hairs will generally fall out between 10-25 days after the surgery.

Tags: hair transplant, aftercare

Patient Letter to Dr Rassman

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

Every now and then I’ll receive an email from a patient years after seeing them and it brightens my day. I thought I’d share this one I just received…

Dear Dr. Rassman,
I am [name removed for privacy] and I had a procedure for almost 2 years now (2280 grafts).

WELL!!! By looking at every single FOLLICULAR UNIT you had transplant onto the front of my head, I couldn’t tell that I had a hair transplant. Man, that is how good you are. I am so glad I got you as a Doctor. It changed my life forever because I feel more comfident about myself now and a lot more of the man I know I am because of you, Dr Rassman.

You know what my dream is Dr. Rassman? My dream is to have another TRANSPLANT from you but my girl friend doesn’t let me because she witnessed what I been through and she was so scared. To me I feel great and I would do it over and over again. I guess she just cares for me too much and I thank you GOD for that. Who ever reads this, please bear with me. It sound like I am a super pussy. Maybe, I will do it again without letting her know. If you do my surgery, that would give me more motivation to convince my girl friend to let me have another procedure.

Thank you for all the staff. You are part of my life.

What a nice letter. I can not tell if you are worried about pain from the surgery or from your girlfriend who may not be backing you for a second surgery. If you are worried about any pain, since your last surgery, we have made substantial changes in the anesthesia protocol we use with the use of a medication called Versed. This medication is a type of narcotic which does make the local anesthesia far less painful if you had trouble with it before. We have also added a stronger narcotic for the first night when the muscle spasm hits so that the first night is more tolerable for those who experienced pain. With these changes, you should think twice about any pain fears that I think you are expressing here. With regard to your girl friend, well most men either have wives, girlfriends or significant others and these folks do get involved in decisions we make like undergoing still one more transplant.

For the blog readership: this patient has agreed to let me post his photographs and he will be coming to see me shortly so that we can not only discuss the email posted here, but also take recent post-surgery photographs so that we can all know just what he is sooooo excited about.

Tags: patient, letter, hair transplant, rassman

Rapid Weight Loss and Gain Caused Female Hair Loss?

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

(female) I have been on Topamax 200mg twice a day for over a year now, I have also been taking Ritalin 20mg twice a day for the same lenght of time, and taking Xanax 2mg three times a day and Baclofen 20mg three times a day for about six months. I have also had a problem with anorexia and Bulimia for quite a number of years now and been up and down on my weight from about 72 pounds to around 145 to being stable at around 90 pounds for quite awhile now. I am a strick vegetarian and am now taking 65mg of iron twice a day and drinking a protien drink every morning. But for about the last four months my hair has been falling out all over the place, it falls out when I shower,in my sleep, when I run my fingers through it, blow dry it, brush it, on my clothes, ect..I am taking all the vitimans I can think to take but it just keeps falling out…and I had stopped taking my medications to see if that was the problem but it hasn’t helped. Could you please advise any helpful information on what I can do to stop the hair loss and get it to regrow, your help would be greatly appreciated.

You have “been there and done that” with things that are known to cause hair loss, including the medications, severe changes in diet with weight loss, and dietary problems that could lead to a variety of vitamin deficiencies (too many to list here). These stem from your weight problems. Looking over your list, I would not know where to start. I think that you should find a good doctor that you trust and can form a bond with, and then tackle your hair loss problem as a matter of focused attention. This is not something for internet medicine. I wish I could offer more, but I’m limited to what I can do through text on a screen.

Tags: hairloss, hair loss, weight, bulimia, anorexia

Anabolic Steroids, Propecia, and Rogaine

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

I was wondering Dr if you take steroids at a young age (19) (I know certain steroids are more harmful to your hair than others), and you do start to loose your hair but after 4 years you still have very thick hair but you do have mild hair loss and you still have enough thick hair to cover up bald spots, what does that mean? Are you predisposed to loosing all your hair or the hair you lost while on steroids is that it, has the hair loss stopped? Mind you, I have been on propecia for close to 2 years but I did stop for close to 6 months and none of my hair in the back fell out but my frontal line receded a bit.

Also, can rogaine cause hairloss? Because I was using rogaine and I did get some growth but I also felt I had some hair loss so I went off of it (I was on for about 6 months) then I have started to lose more hair. I am on propecia, so what is going on? PLEASE HELP ME.

Steroids, especially anabolic steroids (the kind bodybuilders use), may cause hair loss. Unfortunately for reasons not clearly understood, once you start losing hair it seems to continue as if a “switch” has been turned on.

Finally, the hair loss you are noticing may just be your natural course of hair loss indendent of Rogaine or Propecia. Propecia and Rogaine may have slowed down your hair loss to a certain degree, but we will never know the degree of how much of gain or loss you had because you did not continue the drugs for an extended period of time. My opinion is that you may want to continue the Propecia and/or see a hair specialist who may better assess the degree of your hair loss and its balding pattern, hopefully by mapping our your hair for miniaturization to obtain measurements on what is happening to your hair.

Tags: hairloss, hair loss, steroids, propecia, finasteride, rogaine, minoxidil

I Think I Have a Diffuse Alopecia

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

Hi Dr. Rassman,

I’m a 20 yr old white male and I’ve seen my beautiful dense hair reduce it’s volume to about 40% over a 7 months period. It all started about a month after I relocated to another city. 2 months ago I went to a dermatologist. She gave me this treatment: Hairgrow 2% Minoxidil, Ducray Sabal shampoo and some vitamins. I don’t think it’s working because I’ve analyzed my scalp and I have less hair than 2 months ago. The thing is, I don’t have MPB but rather a diffuse alopecia. I honestly have no idea what the cause is because I have a healthy life style with balanced meals and workout. My father has MPB so in the worse case I should have developed MPB as well.
I would be forever grateful if you could shed some light on my problem. Thanks in advance.

When you describe a diffuse alopecia, I really do not know what you are seeing. When I describe a diffuse alopecia, I expect to see miniaturization of hair throughout the scalp, including the rim of hair around the sides and back (we call this the permanent hair zone). When miniaturization occurs in the permanent zone in a man, this is a very bad omen for long term deteriorating hair loss, something that is not easily managed with drugs and certainly not transplants. Rather than go into the complex area of the real diffuse alopecias, their diagnosis and management, I would suggest that you get your scalp mapped for miniaturization to find out what is really going on. Is this real? Is this a disease that you are manifesting?

Tags: hairloss, hair loss, diffuse, alopecia

Virtual Reality Hair System

/by William Rassman, M.D./11 /

You seem like a wonderful person to spend so much time answering people’s questions and helping us. My question is about “Virtual Reality Hair”. This seems to be a hair system that claims to be undetectable to the sight as well as feel. The base is suppose to be like a contact lens…very very thin. The maintenance is very high and it is expensive. Can you let me know if it is unhealthy for the skin? I am only 23 with a receding hairline or a maturing hairline and this would save my social life if it works. Thank you for your time.

I cannot comment specifically on the Virtual Reality Hair system, as I have not seen it and have no experience with it. Generally though, these hair systems should not be “unhealthy” for the skin. However, sometimes these systems may cause local irritation or even contact dermatitis in rare cases. The way such systems fit to your hair and scalp can cause traction alopecia from the rubbing of the hair system and the pulling upon your hair. You should also be aware that as you wear them for periods of time, you will sweat and need to clean and maintain them from developing that worn-in odor (as with your favorite hat). As you stated, the maintenance cost is very high and expensive.

Tags: hair system, wig, toupee, hair piece, hairpiece, hairsystem, virtual reality, hair

Why Am I Losing Hair At Only 17?

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

Dear Dr. Rassman,

I am a 17-year-old male that is experiencing moderate hairloss. I’ve had this problem since I was a pre-teen have gone throughout highschool with this embarrassing feature, as it has increasingly gotten more and more noticeable. The problem is I don’t know why or how this happen as the hair loss take on no typical male pattern hair loss pattern and is thin throughout my entire scalp. I’ve been to a doctor and a dermatologist and all they did was prescribe rogaine and propecia. I’ve tried rogaine for a series of months with no results and propecia’s outside of my budget. Can you please give any clue as to why this is happening to me at such a young age and how i can treat it. I have no medical conditions.

thankyou for your time.

There are many causes of thinning. These can include changes in your hair character itself, something that happens as a person matures. I have seen young men with a coarse hair character change to a finer hair. If this is your situation, then this is the new you. Of course, the first thing you must do is get a diagnosis. Genetic balding, the most common cause of hair loss in men, can easily be diagnosed with a process I call mapping our your hair for miniaturization (which most regular readers know that I mention quite a bit). Even without patterns of hair loss, miniaturization does occur in a variety of medical conditions. I never tell people to go at this blindly. Get your diagnosis first, then go from there figuring out how you might deal with the problem, that is, if there is really a problem there.

Tags: hairloss, hair loss, teen

Propecia and Androgenicity

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

I have been on propecia for the last three month. I am bout to end month three and have noticed that my temple hairs have become noticably thinner than before I started propecia. I have increased sex drive and more morning erections. For a while I was having some scalp irritation which has gone away. Is it possible I am being affected by androgenecity? Prior to taking propecia I had my total test. checked and it was at about 250. I am 24 years old. I am hoping that my temple hairs have been pushed into telogen and this is why I have thinned in these areas. I have a good amount of hair on my head and want to maintain it. What do you think? Also, many of my hairs that have been falling out look to have a white type of pulp on the end near root.

Your report of an increased sex drive is a well known side effect of Propecia (most people seem more concerned and worried about the decreased sex drive which occurs in 1/100 to 1/200 patients). Men generally get an increased testosterone level of about 18% on Propecia in the initial month or so. This often returns to normal after 1-3 months. Testosterone is a far more potent that DHT as a male hormone for sex drive.

Your hair loss may just be a normal progression of your male pattern hair loss and Propecia may actually be slowing its progression (even if it seems you are losing hair). If you are concerned about hair loss, you may consider visiting a hair specialist who is able to quantitatively record the miniaturization of your scalp hair and perhaps even determine the degree of future hair loss.

Tags: hairloss, hair loss, propecia, finasteride, sex drive