Anyone Taking Propecia for a Decade? (with Photos)

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

Hi, I just want to know: do you have many patients who have been on propecia for 8-10 years and yet still have a healthy head of hair on their heads?

Alternatively, do you have many patients who have taken propecia for a long period of time and have gone bald?

I have a number of patients who went to Mexico to get Propecia (finasteride) before it was sold in the United States (maybe 10 years or so ago). One in particular (24 years old at the time), who was balding in the crown, reversed quite nicely on Propecia and maintained that reversal without any progressive miniaturization over the 10 years. Because he was young, the drug worked beautifully. His crown was never transplanted but he did receipve alightly over 6000 grafts in the frontal area. He now has a crew cut.

I have not seen anyone who stayed on Propecia go bald, but I have seen many, many men who were taking it and decided to stop, who then went either very bald or very thin.

Before Propecia on left; After Propecia on right:



Tags: propecia, finasteride, crown, decade, photos, hairloss, hair loss

22 Year Old Male Taking Avodart

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

hi ive been reading your forum all morning, and im really impressed by the site, if you replied to me it would be greatly appreciated. im a male 22 yrs old. and have been takin avodart for 4 months,my hairline is slightly receiding on the side but the front of my hair is at the right height my problem is my hair seems to grow longer, but continurs to thin. on the top. will avodart cause my hair to shed then grow back thicker? or will once its fallen out will it never grow back?? thanx 4 any response.

It is my general opinion that you should not be taking Avodart (dutasteride). It is a powerful medication with a very long half life in the order of weeks/months (half life is the time it takes for a drug to be out of your blood stream). It is not approved or indicated for male pattern hair loss and more importantly, it has not been studied on young men who may potentially (intentionally or unintentionally) be fathers.

If a doctor prescribed you Avodart, you should discuss these matters with him/her.

With respect to growth and shedding, there is no way to tell or predict your rate of hair loss or the contributions of shedding as a cause of it (I suspect shedding is rare). At the least you may want a baseline study, so I would suggest that you map your scalp for density and miniaturization to objectively record the hair loss/gain.

Tags: avodart, dutasteride, hairloss, hair loss

Hair Loss on Top of Head, Hairline is Fine

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

PorcupineI am 29, male. Recently I got my hair cut rather short, and it has kind of spiked up, somewhat resembling a porcupine, i guess you could say. I notice when looking at my head from above that my hair seems thinner, like there are some areas not as full as others. Is this a sign of hair loss? My hair line is not receding, and my hair is fine at the crown/point at back of head, where you usually see bald spots in people going bald. Do you have any idea what I am seeing in the mirror? Is there a pattern of baldness where you start to lose hair on the top or in the middle of your head? Thanks in advance for your comments.

Some people will develop thinning behind the hairline, leaving a normal hairline. We also see thinning in the crown with no problem in the frontal area as well. The first 3/4 inch from the highest crease or the wrinkled brow is the juvenile component of the frontal look. Behind this first 3/4 inch starts what I call the mature hairline.

The shorter you cut your hair, the more you will see of any thinning that is present. To find out what this means, map out your hair and scalp for miniaturization so that you can know if this is a genetic pattern for you. If it is genetic, Propecia works well in the crown.

Tags: hairloss, hair loss, hairline, thinning, crown

Child Attacked By Dog, Lost Most of Her Scalp

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

A friend’s 3 year old grand daughter was attacked by a dog and she lost most of her scalp. What remains is a small portion on the right side of her head, and the rest was replaced with skin grafts from her back. What kind of hair replacement / regrowth options are available for her? If it makes any difference in treatment options she is african-american.

Everything depends upon how much good scalp she has left and the amount of good hair that remains. If, for example, a person lost 20% of their scalp (replaced by skin grafts), then the other 80% could possibly be stretched to cover the missing part, and in an ideal situation the stretched skin (that contains hair), might produce enough cover with artful surgery. If however, the proportions are the reverse (80% of the scalp was lost and replaced by skin grafts), the likelihood is that there may not be enough hair or scalp to move around to cover the defects. I would like to see a set of good pictures of her. If the child’s family does not have the means to pay for surgery, this can be done with minimal to no charge for those who could not afford this type of work. First, a doctor needs to make a careful examination, starting off with sending pictures if she is outside of California and can not be seen by me in person.

Tags: child, attack, dog, scalp, hairloss, hair loss

Broccoli and Hair Loss

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

Is it true that broccoli causes hairloss?


BushNo, there is no connection between broccoli and hair loss.

Broccoli causes a great deal of gas that seemed to bother even former US President George Herbert Walker Bush (aka Bush Sr.), who waged a war of sorts on the vegetable, famously saying “No more broccoli on the White House menu” after he took office. He’s also been quoted as saying, “I do not like broccoli. And I haven’t liked it since I was a little kid and my mother made me eat it. And I’m President of the United States and I’m not going to eat any more broccoli.”

But no, broccoli doesn’t cause hair loss. In looking at this photo (at right), I see that his corners are reflective of some genetic hair loss, which according to his many photographs was present for many years. I wonder if his hair loss reflected a deficiency of broccoli in his daily diet?

Tags: broccoli, hairloss, hair loss, bush, george

Australian Doctor Recommends Buying Generic Propecia Online

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

Dear Dr Rassman,
I am a hair restoration surgical trainee(I am thankful to say that my mentor is a very well respected Australian ISHRS member).

I would like to respond to one of your recent patient questions regarding the availability of generic Propecia.

It appears that generic Propecia IS currently available from some online pharmacies under the brand names Finpecia and Finax(as an example visit this link- https://www.unitedpharmacies.com/Hair_page_3_c_3.html).

It appears that there are legitimate ways that some countries can get around the relevant patent laws.

With kind Regards

I am presenting this as it was sent to me. The consumers must determine if this approach works for them. I would not recommend it for US-based people (due to it not being quite legal), but my opinion isn’t shared by everyone.

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

IndiaTimes Says Dandruff Causes Hair Loss

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

Hello Dr,
I found this new article from India Times that says dandruff is a hair loss cause. You said it wasn’t.

IndiaTimes.com

This reads like a brief article with bits of truth and bits of confusion all mixed together. I would doubt that this was written as a means to educate by someone who is an expert. The term trichoanalysis (or as the article calls it, Tricho Analysis) indicates the analyzing of hair (tricho) which is really not informative on any level. Look at one of my recent posts on dandruff for the real scoop — What is Dandruff and Why Do I Have More of It Than My Friends?

Tags: hairloss, hair loss, dandruff

I Missed a Week of Rogaine, And Now See Significant Shedding

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

I am a 29 year old male who began taking Rogaine 4 years ago with some strong results. Feeling that the Rogaine was beginning to lose the battle, I eventually switched to Propecia and experienced rapid loss of my rogaine hair. Panicked, I got back on the Rogaine along with the Propecia, which worked great (even better than my first rogaine experience) for a few months. Now, out of nowhere, I’m noticing significant hair shedding, and I’m confused as to why this is happening. Any ideas? The only thing I can think of is missing a week or two of Rogaine about one month ago.

There may be factors involved other than just Rogaine or Propecia. A good medical history and physical exam including a miniaturization study would be helpful. I would suspect missing a week or two of Rogaine should not have a significant effect unless you are extremely sensitive and dependent upon the medication.

Tags: hairloss, hair loss, minoxidil, rogaine

Rapunzel! Let Down Your Long, Golden Hair

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

How long can the human hair grow?

RapunzelI was once told a story about a beautiful princess (Rapunzel with golden hair, of course) who was imprisoned in a high tower for many, many, many years. Maybe someone will remember the fairy tale better than I, but to the best of my memory (I am now 64 years old) I seem to recall that she was saved by a prince who climbed up on her long hair to save her. There were missing pieces in the fairy tale that my age now brings into focus, like how she got food up there, possible toilet facilities, showering or general cleaning for many years (any prince who climbed up her long hair must have lost his ability to smell, for there were no perfumes in the story to hide what must have been a smelly lady). Sorry, I’ll focus on the original question…

The human hair growth cycle is believed to be between 2-7 years. As I have mentioned in the past, there are three phases to hair growth cycles, telogen (falling out), catagen (about to fall out) and anagen (the growth phase). Each individuals hair cycle is impacted by genetics, hormones, stress and any medications the person takes. You can imagine the difficulties of plotting the growth of individuals hair in different parts of the hair cycle and documenting the factors that address growth rates (impossible) so much of the research is either conjectural or taken from animal models that are not really compatible.

Now I remember my great grandmother (age 114) when I was a young man. On occasional Sundays, the granddaughters would take her hair out of a bun and wash it. I remember it went to the floor and beyond. There was great care in managing the hair wash. Now as a hair surgeon and expert in the hair field, I have to reconcile my memory of her hair with what I know about hair cycles. Could her hair be greater than 5 feet long. The answer I believe to this conundrum is that the hairs that fell out, weaved themselves into the remaining hairs (like dreadlocks) and that although the hair appeared to be greater than 5 feet long, had the granddaughters really brushed the hair when they washed it, most of that long hair would have come out simply because it was not attached at the root.

To really answer the Rapunzel story tale with academic precision, one would have to find a woman (men’s hair usually does not grow the length of women’s hair) who actually washed and brushed her hair so that all of the broken and loose hairs were brushed out. This would have to be on a few hundred women to make the data statistically significant. That would tell us how long a female hair can actually grow. The average hair grows at about ½ inch per month and for 7 years which means that the longest hairs should be no more than 42 inches (a bit over 1 meter) long. Can any of my readership tell me a ‘reality based’ Rapunzel type of story where the actual hair length exceeded 42 inches?

Now that was a bit long winded, but I guess I do get carried away with a form of ‘love’ for this growing baldingblog readership. Thanks for feeding this ‘young’ blog with your questions.

Tags: hair growth, rapunzel, fairy tale, hair cycle

Woman Wants Propecia — Medical Community Needs to Think Outside the Box!

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

I have been losing my hair for the past 8 years. My nature pathic doctor would like to prescribe propecia but isn’t authorized because my test results indicate a great benefit. I have 3 teenagers and my husband had a vascetomy ten years ago. I also have hirsutism. How can I get a prescription for propecia when the medical community won’t think outside the box???

I am confused what a “nature pathic” doctor is and how he/she is credentialed. Is he/she a medical doctor? Do you possibly mean naturopathic doctor, which is a specialty (does not have to be a person with an M.D. degree)? See Naturopathic.org for more on that.

I disagree with your statement that the medical community is not thinking outside the box. On the contrary, there are a few studies and some women who do take finasteride (Propecia). However, the studies are not well designed and not all women respond to finasteride, because women have a different mechanism of hair loss (see Treatments Available for Female Hair Loss)

Most importantly, there is no study that looks at the potential dangers of finasteride (Propecia) on women with respect to the risk of women’s cancer (such as breast, ovary, cervical). This is more relavant, because finasteride affects certain hormone pathways. Are you willing to risk a potential long term negative consequence (like cancer) for a possible (no guarantee) hope of hair growth? In summary, the medical community is looking out to protect your health, rather than your vanity.

Tags: finasteride, propecia, women, female, woman, hair loss, hairloss

Confusion About Generic Propecia

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

Hi Dr.

This is a follow up question to the statement you just posted about generic 1mg finasteride. You mentioned a little while ago that Dr. Reddy’s lab received the right to make generic 1mg finasteride and that you called to find out when it would be available and said it may take a “couple of months” to get it out. Now you just said that the patent hasnt expired with Merck and it would take years. Im a bit confused now?

Sorry for the confusion. It was confusing for me as well. After doing more research and personally calling a Merck (makers of Propecia) representative, the story is that Propecia (finasteride 1mg) is still under patent protection. The confusion came from the FDA, which gave permission to allow generic Propecia on the market, but with patent monopoly controlled by Merck, the legality to sell it is in the hands of Merck. At least, this is how it was explained to me by Merck. If things change and generic Propecia becomes available (legally) in the US, I’ll certainly post about it here.

Tags: merck, propecia, finasteride, generic, hairloss, hair loss

Hair Gel and Hair Loss

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

You responded to a post saying “good commercial” hair gel does not cause hair loss. Ok, what about cheap ones? And what is your conclusion based on, can you provide me with any studies supporting this position? How has this “myth” survived for so long, other than how most do in general – stated differently, what do proponents of this accusation base their claims on and why are they wrong?

Thanks in advance

OK, you got me on language and meanings. “Good and cheap” commercial hair gel should not cause hair loss. Otherwise they would be sued and go out of business or possibly go into a hair removal business. There is no medical study I am aware of to support my claim — it is just my opinion. I never knew there was a myth about gel and hair loss. I use gel everyday, as do millions of people.

Tags: hairloss, hair loss, hair gel, gel, myth

Magic Shaving Powder

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

I once used a product by softsheen carson “magic shaving powder” on my head as to go bald for the summer but ever since i used the product, i have a small patch in frontal area of my head that grows thin. its like v-shaped patch. please advise

MagicConsider two possiblities:

  1. You always had that V-shaped patch, but never noticed it before because your hair was longer. After going bald (with the “magic powder”) it is more apparent now that it is growing back in.
  2. Magic Shaving Powder has real magical properties (not good ones of course) that you have not anticipated.
Tags: hairloss, hair loss, magic, powder, shaving

I Have Shingles a Month After My Hair Transplant

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

Hi Dr. Rassman,

I had an all FOX procedure at your San Jose office in August and am anxiously waiting for my grafts to grow. I just found out I have a case of the shingles (2nd time — first was six years ago) and am worried that this might affect my results.

Is this something I need to be concerned about? The shingles are confined to a small area of my lower back. I’m 41 and in good health otherwise. I’d appreciate your feedback.

Shingles (otherwise known as herpes zoster) is a painful, blistering rash caused by the chickenpox (varicella) virus. You can only get shingles if you have previously had chickenpox. After having chickenpox, the virus lies dormant in the nerves, and shingles occurs when it is revitalized in one particular nerve to the skin, thus explaining the way it affects a clearly demarcated band of skin only (in your case, your lower back). Having shingles does not mean you have active chickenpox or are contagious.

With respect to shingles affecting your hair transplant, you should not be concerned. It should not affect your transplants or your hair growth.

Take care of your shingles, and I wish you well with the recovery.

Tags: hairtransplant, hair transplant, shingles

Suggestion for 19 Year Old with Thin Hair

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

Hi, I am 19 years old, I have experienced hair loss since about 16. My receding hairline is getting really bad, and i have a bald spot thats just getting bigger in the back. The entire top of my head is also thin now. It is extremely embarrasing and depressing. I feel like I always have to wear a hat. I have been using Rogaine extra strength for about a year now, and its not working, but im afraid to discontinue since I may lose even more hair. If I try to style it, it comes out in large amounts (at least 10-20 hairs), so i dont anymore. My parents are telling me this is normal, but my dad didn’t start losing his hair till his mid 30’s. Im also afraid a doctor visit will be too costly ( I pay for my own college and parents wont help with doctor bill if I go). Please give me some suggestions. Thanks

You are playing with fire with regard to your hair loss. First, find out what is wrong with it by getting your hair mapped out for miniaturization and establishing a diagnosis. If you see me (in California), I will not charge you for the visit and I will map out your hair for miniaturization as well. If you are not able to see me, you can find a doctor in your area by using the physician search at ISHRS.org. Some doctors offer free consultations, but not all. With a diagnosis, you can have either peace of mind or a treatment plan with a Master Plan for your future hair loss. From that point, you’ll have a better understanding of what your future holds (in terms of your hair loss) and what your options are.

Tags: hairloss, hair loss, teen, miniaturization