I Read Online About Propecia Side Effects and Now I’m Freaked Out!

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

I am seriously considering taking propecia, I did a bit of research online and came across a few sites that really freaked me out, askthepatient.com propeciasideeffects.com. which report serious side effects and by some people they have not gone away. what do you say about all this, I would really like to take the drug but I am a bit freaked??? please answer me

Propecia (finasteride) has side effects that I know of, as follows:

  1. Increased libido in some men (usually older), because testosterone levels go up by about 15%.
  2. Decreased libido in about 1-2% of men, Also, erectile dysfunction is included in this group.
  3. Decreased in prostate cancer. Many people, like me, feel that this may be the magic bullet for prevention of this disease.
  4. Breast nodules in far less than 1% of men taking Propecia.

As the half life of this drug is 5 hours, it will be out of your system in a couple of days after stopping it. If you get any of these side effects, they will go away. Although I do hear some reports of other ‘not feeling well’ side effects, these may well be psychosomatic. If you need it, try it, for there is nothing to lose. If you do decide to try it, then you should give it a fair opportunity to benefit you by taking it for a full 8-12 months.

Tags: finasteride, propecia, hairloss, hair loss, sideeffects, side effects

Miniaturization Mapping vs Pull Test

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

Dr. Rassman,

I’m going to make an appointment to have the miniaturization test in your office, but someone told me about a “pull-test” which measures the ratio of hairs pulled from a sample area on top of your head to hairs pulled in a sample from the donor area. When compared to the donor area, if significantly more hairs come out from the sample area on the top of your head, then you are balding. Is this test accurate to some extent?

The pull test is not good for diagnosis of miniaturization and genetic hair loss. The degree of shaft thickness change is what mapping will show. Hairs that are in the early phase of miniaturization will not pull out. Those that do pull out, may be the hairs about to go into their telogen cycle.

Tags: miniaturization, pull test, pull, hairloss, hair loss

Do I Have Any Donor Left After My 10 Hair Transplants?

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

From 1998 to 2004 I had about ten transplant surgeries done,and each time I had between 200 – 300 grafts done. After having read your blog the last few months, I now wish I would have had fewer surgeries, and more grafts done at those times. For the most part I am pleased with the results that were achieved, but I would like to have one more transplant surgery to hit those last few problem areas. Is there any way for me to tell if there is any donor area still available? My scars have appeared to have healed well. Since the last surgery I have moved 1500 miles from where my doctor is located, so if I am to have any additional work done I will need to locate a new doctor. I would appreciate your thoughts, and I really enjoy this forum you provide. Thank you.

Your situation requires an in-person examination to learn the opportunities and risks for more hair transplant surgery. The distribution of the scars and the width of the scars will probably dictate what can be done in one more surgery. I have an airfare reimbursement program offered to those traveling from out-of-town (see NHI Travel Program). I would be happy to talk with you over the phone to define your problem and goals.

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

Any Product to Bring Color to Scarred Areas Lacking Pigment?

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

Dear Dr. Rassman:
I am considering shaving my head, however I have a very noticeable de-pigmented scar in the forelock area. I have considered transplantation in this area, but I also wish to explore the possbility of shaving the scalp and applying some type of topical cream to mask or bring back color to the de-pigmented scarred area. Can you recommend any products?

Thank you.

Depigmentation can be treated with pigmentation transplants. Dr. Pearl Grimes (see: Pigmentation Disorders) has developed ways to treat depigmented skin (common in a condition called vitiligo, which is disasterous for African Americans who have a white patch of skin in a dark sea of skin). As you can see from her site, there are creams for the treatment of this condition, so I’d recommend you explore Dr. Grimes website to learn more.

There are cosmetic powders that are used on scalp (e.g DermMatch) and provided that there is hair surrounding it, these type of products work reasonably well. They will not work for the forehead.

Also, hair transplants actually bring normal skin at the edge of the transplant into a depigmented area, filling in that white spot with some color, but again it has to be in a hairy area, not the forehead.

Tags: pigment, scar, forelock, color, topical

Right Hairline Improved with Propecia, Left Hairline Has Gotten Worse

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

Hey doc, I’m a 19 yrs old male and I’ve been on Propecia for about 8 months. I’m happy to say that my right hairline has improved beyond my expectations. Unfortunately, I haven’t any improvement on the left side of my hairline, in fact it has gotten worse. I have shoulder length hair and I’m considering shaving my head (which would throw 8 months of Propecia use down the drain), for my hairline from the front appears akwardly unbalanced (one side its thick while the other is see-through). Before I make such a hasty decision, I was wondering if I should try 5% minoxodil or anything else you’d recommend? And the comb over at my age is not an option. Thanks.

What you are telling me is that the left hairline probably showed more balding than the right, so that the right side’s loss was easier to reverse (being more recent). In men of your age, Propecia works well to reverse ‘early’ hair loss. By all means, shave your head if that is what you want to do, but for your own sake, do not stop taking Propecia. If you are balding at 19, chances are that it will progress more rapidly than on those not starting as early as you, so staying on the Propecia will slow or stop it from progressing. Stopping it will just get you where you would have balded had you never started taking it and as your genetic code has planned for you.

Many young men tell me that they are losing frontal hair when they are just developing a mature hairline. The normal child’s hairline moves up about 1/2 inch in the middle and 1 inch on the corners. One side is often faster than the other side, making the hair loss appear out of balance (symmetry). Could this be what is happening to you?

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

Water with Chlorine or Shampoo with Sulfate Causing Hair Loss?

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

Hi Dr. Rassman,

I have heard that shampoos containing sulfate can cause hair loss. Is this true if you have genetic balding? I was also told to buy a shower filter b/c the chlorine from the shower water can cause hair loss. Is there any truth to these statements? I am a 26 y/o male losing his hair and I am taking every precaution to prevent any further hair loss. I appreciate your help Dr. Rassman

I researched the relationships between sulfates, chlorine, and hair loss. There seems to be many opinions, good and bad. It all sounds hokey pokey to me — no science backing up the opinions I read. Who told you to buy a shower filter? I’m just curious to know where your source got their information.

If you believe that you have genetic hair loss, my suggestion, as always, is to:

  1. get your hair mapped out for miniaturization
  2. get a diagnosis after the mapping
  3. build a Master Plan for your hair loss
  4. follow that plan
Tags: hairloss, hair loss, sulfate, shampoo, chlorine

My Doctor Advised Against Washing Recipient Area for 2 Days After Surgery

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

i had a procedure done at another clinic yesterday. they advised against washing the recepient (graph) sites for two days. essentially allowing scabs to heal and fall off two weeks later. I am in the public eye(professional speaker) and had to have a thorough celeaning today. So i di wash my scalp today against there written directions. i was able to see the removal of 75% of the one day old scabs and it looked like 8-10 graphs came out as well. I did not sit under the shower i used the cup pouring method and the gently rubbed the scabbs with my figertips..am i alright or did i maybe wash away my follicles unknowingly? again i saw about 8-10 in my scalp dislodged after the shower. did not look like many came out…no bleeding whatsoever by the way. your thoughts?

I always have the hair washed within the first day after surgery and offer that process in my office for our patients. The key to a fast recovery is to get the scabs washed off fast. The longer they stay in, the longer you must be gentle with the wash. In the hands of a professional wash, the wounds will be very clean by the very next day. We also wash it vigorously at the end of the procedure to get all of the crusts off quickly. Unfortunately, many doctors do not focus upon getting you looking spiffy in a day after the surgery.

This patient below came in one day after surgery and the pictures were taken immediately after he had his hair washed. The recipient area has an obvious pink hue against his white skin. His native hair was long enough (I told him not to cut his hair prior to the surgery) to cover the entire transplanted area when he combed it forward. White skin shows pink clearly and had his skin color been tan, the pink hue would not show much or at all. As you zoom into the picture, you can see the transplanted grafts and the hair contained in those grafts clearly without any crusts to increase the detection of the transplant in the bald scalp. People who have native hair with grafts transplanted between the hairs have automatic coverage from the native hair and the transplants can be completely hidden. Within a few days, the only evidence of a transplant will be the beard that appears in what is now the pink area. Click the photos to enlarge.



Tags: hair transplant, hairtransplant, aftercare, washing, hair wash, scab, hairloss, hair loss

My Penis Does Not Work on Propecia!

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

I found that my penis seems to have no reaction everyday morning after take Propecia. I’ve been on Propecia for around one and half month. My doctor tels me not to worry and continue to take Propecia. He tells me the side effect is dramatic when taking it at the first month. Is it right???? I am worried that I will become sexual handicap if I keep taking Propecia. What should I do?

A small number of people get both a decreased libido and erectile dysfunction with Propecia. If you are one of these, I would suggest the following:

  1. Stop taking the Propecia for a week or two. The problem should go away.
  2. Start it again, taking a half pill a day instead of a full pill. If the problem comes back, try a quarter pill a day after stopping it again for a week or two. If the problem is still there on the lower dose, then your choice would be to give up your sex life (not a good plan) or forget Propecia and look at other options for hair loss including minoxidil and/or hair transplants.

There are a small number of people who can not take this drug because of sexual dysfunction problems. Are you sure that you do not have a sexual dysfunction problem without Propecia? Don’t blame it on the drug if you have a problem even without it. There are many causes of sexual dysfunction which might be best handled by a good doctor/urologist.

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

Hair Transplant Sales Pitch vs Patient Education?

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

It’s well documented that minoxidil may cause some initial shedding. I’ve also read this can occasionally occur with Propecia as well. My question is, will this be only an initial occurance or is it possible shedding may occur in cycles?

I’ve been using both Rogaine and Propecia for nearly eight months now. Occasionally I’ll notice greater spurts of hair loss. But in the end, I find it hard to detect any overall thinning.

I’d like to get my hair mapped out for miniaturization. But the most prominant hairloss physician in the Orlando area basically used my $60 office visit for a ten minute sales pitch for a hair transplant.

What you described is, unfortunately, a doctor who has hia/her own agenda in mind, not yours. Hair transplant physicians should bring their expertise to educate you, diagnose you and answer your questions. If, after the visit, you do not feel that you are better informed, then you have learned something important — do not go to that doctor. The sales pitch is disgraceful behavior and as you probably know, I speak strongly against doctors who just try to sell hair transplants rather than meet their patient’s needs.

With regard to your questions on shedding, I believe that once you are on either Propecia or minoxidil for 8 months, any shedding from these medications should not occur. Hair shedding, other than the normal hair cycling that everyone has which impacts about 10% of the hairs on your head at any one time, should not occur unless the hair loss process is progressing more rapidly into a new accelerated phase of hair loss.

Tags: hairloss, hair loss, miniaturization, hair transplant, sales, propecia, minoxidil

Pill Cutters and Creativity

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

People have mentioned that they cut Proscar into 1/4’s or 1/5’s…I haven’t had any luck finding a pill cutter that will cut a pill into such fractions – do they exist at all, or are all these people just using a standard pill cutter and trying to slice them up by eye? Seems like it would be very difficult to cut them accurately given the size of the pills…?! Or do multi-way slicers actually exist?

Every pharmacy I have been to has had pill cutters. Just ask them! Many of the drug companies do not want you to cut their pills (Viagra, Cialis, Propecia, Proscar) so they round the pills to make it difficult. Use your creativity and you will solve the problem. I’m sure someone out there has made a multi-split pill cutter, but I’m not familiar with any off the top of my head. Many people (and I even recommend this) will cut Proscar into 1/4 and get 1.25mg of finasteride per dosage, because it is easier to cut that way.

Tags: pill cutter, proscar, finasteride, propecia

Prozac Causing Clumps of Hair to Fall Out Within Days

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

Hello,
I’m 35 years old female. Due to my panic attacks, I was on Zoloft for 3 months and changed to Prozac for 5 days, but it’s was too strong for me and my hair was falling, so I stopped the medication and everything was great because my panic attacks also stopped, but after one month later, all of sudden, last 4 days or so, whenever i touch my hair, big clumps of hair falls out every day and I’m very concerned and worried. What should I do??? PLEASE HELP!!1

You need to see a good doctor who can figure out what is happening to you. Woman’s hair loss is complicated. Prosac or Zoloft can cause hair loss along with many other medications. You need to get evaluated by a good doctor. In New York, make an appointment with Dr. Robert Bernstein.

Tags: hairloss, hair loss, zoloft, prozac

Son Experienced Hair Loss from Stressful Surgeries a Year Ago

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

My 19 year old son had two back to back, very stressful surgeries (to correct a deformaty in his chest bones) almost a year ago. He always had extremely thick hair up until the month he was in the hospital and on serious pain meds. I told him it was the anesthesia and that it would grow back. Is there something we should be doing to help it grow back? As far as I know, I do not have hair loss in my family tree. I read the other entries, but they mostly were about women and certainly not about a young man sooo young.

Just because you have not identified genetic hair loss in your family, does not mean that he did not get it. Genetic hair loss can skip generations. Sounds like he may have it. Best way to find out is to get his hair mapped out for miniaturization and then you will know. Propecia (finasteride) is a great medication for this, provided that the diagnosis is genetic male pattern balding. Be sure that he does not have any medical problems or is taking medications that have contributed to hair loss.

Tags: hairloss, hair loss, teen, stress, surgery, finasteride, propecia

Had a Hair Transplant 3 Months Ago, 80% of Transplanted Hairs Haven’t Fallen Out

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

hello
i had the strip procedure done about 3 months ago with 1500 grafts. within the first two weeks many shafts fell out as is normal, however about 80% of them have not. i am unsure if this is normal and if these grafts will eventually begin to grow.

thank you for your help and this wonderfully informative website.

If the hair is still there but not growing, it just means that the shedding has not taken place. These hairs are dead, but new ones will arise in the next few months. Those dead hairs will eventually shed.

Tags: hair transplant, hairtransplant, hairloss, hair loss

Body Hair Transplant for Alopecia Sufferers?

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

Hello Dr. Rasman
I have Norwood class 7 diffuse ‘patterened’ alopecia. I am 26. You have seen my scalp and said I am definitely not a candidate for hair transplant because my donor density is poor and I have ‘see through scalp.’ I have been on propecia since then for almost one year. My question is: what is the current success rate of using non-scalp hair for a donor region, such as chest. Do you do these procedures for people with poor donor density? Last question: When will hair cloning become available w/Aderans?
Thank you very much.

Body hair is not the solution you are looking for. I do not expect to see hair cloning for at least 5 years or more. For the moment, if I saw you only once, then you should have a yearly visit with me to follow what is happening to you. There is not much to offer other than Propecia and possibly Avodart (something that I might consider using in your case).

Tags: hairloss, hair loss, avodart, propecia, finasteride, dutasteride, cloning

A Good Hair Transplant Made Great (with Photos)

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

Once you have a follicular unit transplant (FUT), if the procedure was done with care, there is no question that the results can’t be detected in any casual encounter, or even on close inspection in most circumstances. Yet with that said, there is still a difference between patient results that go beyond the characteristics of (1) hair shaft thickness, (2) hair character, and (3) hair color.

Let’s take a look at a patient who had two hair transplant procedures. The patient is Dr. Jon Perlman, the well-known Beverly Hills plastic surgeon that has been featured on ABC’s television show, Extreme Makeover. After his first session, he had good results that nicely framed his face when his hair was groomed. But on close examination, his hair was somewhat see-through. Dr. Perlman has very fine hair, so the bulk of each hair shaft was lower than average. By undergoing a second procedure, the bulk was doubled and the results shown in the pictures below say a great deal about the change he experienced. He was more-than-satisfied after the first procedure and thrilled after the second one. A good transplant became a great transplant.

Sometimes patients will tell me something like, “I don’t want it too thick and I am afraid if I put too much hair there, it will look unnaturally thick.” In all of the years of doing this surgery, I have never, ever had a patient who told me that I had made the hair too thick in a single session. We have seen many of our patients (initially satisfied, but wanting more hair) receive another transplant and become transformed back in time to their youthful look. By performing NHI’s pioneering dense packing procedure, we can increase the density of hair in a single procedure, often reducing the number of procedures needed to obtain results like the one shown here, but when the hair is super fine (like the example below) then two sessions may be needed. For many people, hair is like money — the more you have, the better it is.

Click the photos to enlarge.

Before and After 2 procedures (2890 grafts total):

 

For more photos, click “read more” —

Read more