Fentanyl Transdermal Patch and Hair Loss

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

(female) I am thinning alot on the top, front of my hair. Could it be caused from going off of the Fentanyl Transdermal patch? My doctor is slowly lowing the dose. I was wearing two 100mcg and now I am down to 25mcg.

Hair loss shouldn’t be a direct result of fentanyl. I could probably better help you if I knew why you have been on fentanyl. For example, some diseases, major surgeries, or traumas can cause generalized hair loss in men and women. If this is the case for you, your hair loss could be temporary and your hair may grow back in a few months. Talk this over with your doctor and get to the root of the problem.

Tags: fentanyl, patch, hairloss, hair loss

Propecia and an Infected Prostate

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

I am 23 years old and have been losing my hair for nearly two years now. I am very interested in starting on propecia, but I had an infected prostate a few months ago. With anti-biotics it went away after a month. What should I do?

I would think that taking Propecia (finasteride 1mg) after a prostate infection is cured should not be a problem. Please though, check with your doctor.

Tags: prostate, propecia, infection, hairloss, hair loss

Balding After 30 Years Old

/by William Rassman, M.D./9 /,

Dear Dr,

Great website. I had a question. You have stated in the past that the balding process tends to end at the age of 30. Can you elaborate on this? It has been my experience that most men lose more hair in their 40’s, 50’s and 60’s.

The very bald person loses most of his hair in his 20s, although this is just a general rule. There are different patterns of balding and these patterns often slow their progression as a person ages. But of course, the older you are, the more balding you will see in the overall male population. That means that the 20 year old with early signs of advanced balding may be that Class 7 pattern man by their late 20s. Some of the patterns of balding do start later in life, but these men rarely get very advanced hair loss patterns. The key to good control of the balding process is early detection, early diagnosis, and early treatment. The earlier the treatment for genetic male pattern balding, the better the medication works (like Propecia).

I often see men in their 30s start thinning and then progressing slowly to a balding pattern like the 3V pattern shown below. Over time, the crown balding in these men may expand to a larger area as they get into their 40s and 50s. Propecia works very well at slowing, stopping and possibly reversing the hair loss in those men who have this 3V pattern appear in their 30s or 40s.

For your reference, here is the Norwood Chart that shows the different patterns of male genetic hair loss. One rarely sees the Class 7 pattern start appearing in men past 30 years pf age.

Norwood Chart

Tags: hairloss, hair loss, norwood, chart, age, propecia, finasteride, pattern

Recreating the Hairline

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

my hairline seems to be moving back about an inch.. I know you describe this as a maturing hairline.. It seems that my hairline is now more of a zone. where if you pull back my hair the scalp slowly dissapears over the course of another half inch. It seems more of a zone. Have you done treatments where you recreate the line.. I dont wish to move the hairline back down but to just make it more of a line. Can transplants be placed that close together? If so, would you normally do this procedure on a 27 yr old? or would I have to wait until I’m older

There are many patients who have slight thinning of the frontal hair line. Hair transplantation to the thinning frontal line works well, but a correct diagnosis has to be made and the surgeon and the patient would be wise to make a “Master Plan” for future hair loss. At 27 years old, I would suggest that you have your scalp mapped for miniaturization to assess the current health of your hair and possibly determine your future hair loss scenario.

Assuming that the diagnosis of genetic balding is correct, you can increase the fullness of hair in your frontal area by having hair transplants. I generally tell my transplant patients to put the hairline where it belongs, not to shoot for a higher hairline. When high hairlines are created 1-2 inches higher than normal, they do not look natural because a strong higher-than-normal hairline is not normally found in nature.

Tags: hairline, hairloss, hair loss, hairtransplant, hair transplant

My Family Doctor Told Me That After 10 Years, Propecia Users Are as Bald as If Never Taking It

/by William Rassman, M.D./4 /

Dear Doc,

I am 22 years old and I am starting to lose my hair. There is history of baldness in my family, and my older brother is bald as well. I am thinking of going on Propecia, but I am weary about committing to a drug for life. Also, my family doctor said that Propecia tends to lose its potency after five years, and after ten years people who take it end up as bald as they would be without the medication. Any thoughts?

Your doctor is wrong. For more information about this, including a good example, please see Propecia and Hair Count. Finasteride (Propecia) is a great drug to keep control of the hair loss and it is clearly protective against prostate cancer. Some doctors are just plain foolish about this drug and many patients who read the information online are far more aware than these ignorant doctors.

Tags: propecia, finasteride, hairloss, hair loss

Hashimoto’s Disease

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

I was just recently diagnosed with Hasimoto’s Disease. I just turned 21 and my hair is falling out on my head, I have bald spots on my scalp, mustache, and also my chin. Also my eyelid is missing hair in the middle and my left eyebrow hair has also fallen out. I’v been taking Synthroid now for 8 months and just last month the doctor told me that my thyroid hormone levels are back to normal, I’m at 125 mcgs as my daily dosage. I would like to know will my hair ever grow back to the way it use to be and how long would it take before i notice any differences?

You are experiencing balding spots in several areas of your body. Although hair loss could be seen in the conditions that thyroid function is diminished, your patchy hair loss could be due to alopecia areata. Alopecia areata (AA) is an autoimmune disease and it could be associated with other autoimmune diseases like Hashimoto’s. Thyroid disease is reported in about 8 to 11% of patients with alopecia areata. You need to see a dermatologist for confirmation of your diagnosis with a biopsy if it is thought to be appropriate. As we discussed in previous posts, recovery from alopecia areata is spontaneous in many cases, but could be facilitated by injection of local steroids or other medications in the hands of an expert on AA.

Tags: alopecia areata, alopecia, hashimoto, thyroid, hairloss, hair loss

Arm Hair Grew in Very Thick After Removing Cast

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

Hey Doc,

I broke my arm 2 years ago and had a cast for 4 months. After removing the cast, I noticed that the hair on my arms were REALLY thick and sprouted all over the place. It was kind of scary, but after about 2 months all the hair returned to normal.

Can you explain what caused this? I have always been curious.

Many people that are required to wear a cast see what you’ve reported. This occurs because the arm hair which sheds frequently as the short hair cycle pushes out old hair (a half to one inch in length) is protected in the cast so that it does not fall out day be day. Most people with normal bathing and showers will get these old hairs to fall out by a simple scrub.

Tags: arm hair, case, broken, hairloss, hair loss, thick

Olux Foam and Dandruff

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

male – 15
Hey, Ive had dandruff on my hair for quite some time now. it is curly,black and kind of dry and short… recently the dandruff has seemed to be getting worse and my hair thinning ALOT… also it gets REALLy itchy when i start sweating (i do alot of sports..) and it is thinnning alot along the top and sides, it isnt itchy so much all the time, but the hair loss is very visible.. It also is itchy at times. i have been using ‘head and shoulders intensive treatment’ and was prescribed ‘olux foam, 0.05%’ which seemed to help, but havent gotten it re-prescribed for about 6 months to a year.. any help would be helpful.

Olux Foam is a topical steroid and it should not be used frequently as it will be absorbed by the body and eventually it would impact adrenal gland function. This medication is used for psoriasis (a disease which causes dandruff amongst other things). I believe if you read about it, you will learn more about what you are doing: Drugs.com – Olux Foam

Tags: oluxfoam, olux foam, dandruff, hairloss, hair loss, steroid

Blurred Vision from Minoxidil?

/by William Rassman, M.D./5 /

Hello, I’m using Rogain 5% and I’ve noticed some minor signs of blurred vision, mostly at farsighted objects.

Considering it may be a minox side effect, should I:

– Continue Rogaine 5% and wait weeks/few months because it it’s temporary (and not a really bad blurry vision) and will not damage my permanent vision.
– Change to Rogaine 2%
– Change To Rogaine Foam
– Quit using Rogaine?

Thanks for your help and amazing blog

The purpose of this site is to educate, not to become a treatment substitute for your doctor. With that said, minoxidil is known to cause blurred vision. How you react to it is either to get medical advice from your doctor or experiment as you suggested above. As a doctor, I would want to know what you are treating, whether it is the best medication for you, what your goals are, etc.

Tags: minoxidil, vision, blur, hair loss, hairloss

Sunscreen Caused Eyebrows To Fall Out

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

I used a sunscreen on my face (one of the new sprays) and while playing tennis, the sunglasses that I was wearing literally disolved and the eyebrow hair underneath the area where the glasses were over a period of three months fell out. In some places, small, very thick black hairs grow, but fall out after about 2-3 weeks. It has been over 6 months now and the area has not filled back in on either side. Is there any hope that this will grow back or should I consider having an eyebrow transplant? Thank you for your response.

Sounds like what you used chemically damaged your hair. I would doubt that it would come back, but wait it out for a year, just to deal with the cycling of the hair to be sure. Transplants are a good option to consider.

Tags: eyebrow, sunscreen, chemical, damage, hairtransplant, hair transplant, hairloss, hair loss

Alopecia Areata Gene?

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

Dr you responded to one of my questions suggesting that I get tested for the alopecia areata gene…i contacted the naaf & the person i spoke with said she is not aware if testing for the gene is possible, can you tell me if you know otherwise and where i can get this testing done?

Angela Christiano, a researcher at Columbia University, studied alopecia areata and alopecia totalis in populations of families. She found genetic evidence that made people prone to this disease. I found this article in the Journal of The American Academy of Dermatology, Alopecia areata: current state of knowledge, which could be another starting point for your research. Here is an abstract of the article:

Blaumeiser B РJ Am Acad Dermatol Р01-APR-2006; 54(4): 627-32, From NIH/NLM MEDLINE, NLM Citation ID: 16546583 (PubMed) Full Source Title: Journal of the American Academy of Dermatology Department of Medical Genetics, University Hospital of Antwerp, Antwerp, Belgium. bettina.blaumeiser@ua.ac.be Authors: Blaumeiser B; van der Goot I; Fimmers R; Hanneken S; Ritzmann S; Seymons K; Betz RC; Ruzicka T; Wienker TF; De Weert J; Lambert J; Kruse R; N̦then MM

Abstract: BACKGROUND: Familial aggregation of alopecia areata (AA) has been previously described, but systematic studies with information obtained directly from family members have yet to be undertaken. OBJECTIVE: We sought to study the pattern of familial aggregation of AA by assessing the affection status of patients’ relatives. The study included 206 index patients with a total of 1029 first-degree and 2625 second-degree relatives. METHODS: First-degree relatives were directly interviewed, whereas information on second-degree relatives was obtained by interviewing the index patients and their first-degree relatives. RESULTS: Estimated lifetime risks were 7.1% in siblings, 7.8% in parents, and 5.7% in offspring. The risk in second-degree relatives was slightly higher than the reported population risk. Age at onset in index patients and first-degree relatives was significantly correlated. LIMITATIONS: Using patients drawn from specialized hair clinics may have produced results showing a higher proportion of early onset and severe cases. CONCLUSION: The familial aggregation of AA supports the role of genetic factors in the development of the disease. In addition, our data indicate genetic factors might contribute to the age at onset of AA.

For a Complete Review, you might locate the following article: Alopecia areata: current state of knowledge. Norris D – J Am Acad Dermatol – 01-JUL-2004; 51(1 Suppl): S16-7 From NIH/NLM MEDLINE Journal of the American Academy of Dermatology University of Colorado Health Sciences Center, Denver, CO 80262, USA.

Tags: alopecia, areata, totalis, hairloss, hair loss, gene, genetic

FUE on Women?

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

I am one week away from my 8th month post-op. 1600 hairs were transplanted into my top scalp. I also asked the surgeon to take care of a thin area around the crown would sounds much like the person who wrote to you about: “Diagonal Balding Line on Scalp ….. It starts about where my cowlick is and runs diagonally for about 4-5 inches…..”

The area does not seem to be improving so I am getting my mind around getting a FUE procedure done when I reach the 12 or 15 month mark.

What do you think about FUE on females?

I am worried about shock loss as I did have a noticeable amount.

Please write …

God Bless

Hair transplantation in women is often unwise unless there are certain situations where the transplant can actually benefit the patient and the donor hair is normal. Many women do not have normal donor hair, impacted by miniaturization, which means that the hair will grow in weak and most of the miniaturized hairs will not grow. Sounds like you may have a problem with goals, diagnosis, and setting expectations that are realistic. I find that if a transplant doctor does work on many women patients, that doctor is often less reputable. I find that less than 20% of women qualify for a hair transplant, which means that the donor hair is healthy in adequate quantities and the goals are realistic and confined to small areas. FUT or FUE can be done on women and men, but first you need to probably get a second opinion before going down that road again.

Tags: hairtransplant, hair transplant, female, women, woman, hairloss, hair loss

Why Would Libido and Breast Side Effects Occur with Finasteride Use?

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

Dr. Rassman,

Is it unhealthy for a young man with a normal size prostate to take a drug (finasteride) which shrinks his prostate? It seems as though shrinking an organ that is a healthy size is a bad idea?

Also, since propecia actually causes more testosterone to be released in a man’s body, why is breast enlargement (which seems like too much estrogen), and loss of libido, etc a potential side effect? It seems more logical to me that with increased testosterone, a man would have an increase in libido, stronger erections, more ejaculate, more muscle (smaller breasts), etc.. But the reverse side-effects are listed as being caused by finasteride. Could you explain why?

There is no evidence that finasteride (Propecia) shrinks normal sized prostates, but to the best of my knowledge, the prostate size in young men has not been studied. The reason that testosterone levels rise simply reflects the brilliance of the human body, which recognizes that DHT levels are dropping on Propecia so it compensates with increasing the levels of testosterone. Men need a certain level of male hormones and the human body regulates that level by pushing the testicles to make more or less testosterone to achieve those levels. Testosterone levels rise an average of 15-18% when a person is on Propecia, which does increase the sex drive in some men (about 10% in my experience). That happened to me when I started my Propecia, so I know this from personal experience. One possible explanation for the other effects you asked about might show that finasteride might directly antagonize androgen action in breast tissue. If that was the case, it might indirectly increase the estrogen concentration in the body and cause these effects, but this is strictly a guess on my part as there is no evidence for this. I can not explain the other things you asked about. Sorry.

Tags: finasteride, libido, breast, side effect, propecia, hairloss, hair loss

African Scalp Pigment Different in Balding Area

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

1) Is there a point of no return that it’s pointless to attempt to regrow hair, like an age or length of baldness?

2) I have accepted my baldness, but NOT the two-tone scalp that comes with it, even with close against the grain shaving, the scalp pigment/melanin makes my hair loss obvious. I’m light-skinned black and would prefer that the side and back lighten to the rest of skintone rather than darken entire body to remedy this. Cost effective solution?

To answer your first question, the skin from under the scalp (the skin that is balding now) was protected from sun exposure (the sun adds color to the skin by increasing pigmentation). The lighter color you are seeing resulted from the protection of the hair cover that is now disappearing. When the hair is disappearing, the skin also changes. It becomes progressively thinner and as the fine hair get finer, the lighter appearing skin shows up more. The skin also loses its support infrastructure made up by many of the blood vessels that were there to support the hair follicles that were growing. At this point, only a hair transplants can bring back the hair. The vascular infrastructure that comes from stem cells and fat located in the transplanted hair, will also return more of the supporting infrastructure that supports a hair transplant.

Obviously the less contrast between the hair and skin the better the less noticeable will be the lighter skin. You can do two things to improve this contrast. You can either increase the darkness of the scalp using topical cosmetics like DermMatch (this requires some hair to be present or it acts like a can of spray paint) or have a tattoo (I do not recommend a tattoo), or you can dye whatever hair you still have left (add bits of white color to it) or even cut it very short (afro style). I can give you a referral to a doctor in Los Angeles who can help if you want pigment cell transplants instead of hair transplants.

Tags: african, black, pigment, tone, skin, balding, hairloss, hair loss

Is Facial Hair Growth Related to DHT?

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

I always had little facial and body hair until I was about 20. Now my facial hair grows faster and thicker. Coincidently my hairloss is much worse then before and itches a lot more. Is facial hair growth related to DHT fluctuations do you think?

I believe that DHT is one of the hormones that stimulate our male sex characteristics, like voice change, beard and chest hair, and hair loss in the unfortunate men who have the ‘genetic hair loss’ curse. I have seen in very rare cases some patients that have disappearance or decrease of body hair with Propecia use.

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