DHT and Impotence

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

Hi Dr Rassman,

Once Propecia is stopped, will DHT levels return to thier high levels prior to the introduction of Finasteride to the body? Is it true that impotence is associated to low levels of DHT?

DHT levels return to their normal level upon stopping finasteride. I do not know why some people on finasteride lose their sex drive (less than 1%). DHT is a less potent male hormone than testosterone and when people are started on Propecia, there are reports that testosterone blood levels rise. Some older men reported to me that their sex drive went up on Propecia and I know that they are telling the truth because their wives (some of them) complained about it to me.

Tags: dht, testosterone, impotence, finasteride, propecia, proscar, hairloss, hair loss

Can Rogaine Damage Hair If It’s In Too Long?

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

Can rogaine hurt, damage and or cause hair to fall out if it remains in the hair for a long period of time? I don’t wash my hair everyday because my scalp becomes so dry from rogaine. Rogaine always gets stuck in my hair when I apply it to my scalp. Can the rogaine that remains in the scalp harm my remaining hair? Thank you! sorry if this question seems stupid!

Providing that the Rogaine does not ‘cake’ and cause hair to stick together, there should be no impact on leaving it on the hair shafts. Always be gentle when brushing the hair.

Tags: rogaine, minoxidil, hairloss, hair loss

What Happens When a Doctor’s Car and Mansion Payment Is More Important Than You?

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

Here is a man who had hair transplant surgery some years ago. He had hair then and the doctor put in about 600 grafts throughout his thinning area. After the surgery, his hair loss accelerated and when the grafts grew out, other than seeing some small plugs, he did not find any value to having had the surgery in the first place. Since his surgery, he lost all of the hair on the top and crown of his head. Now all he has left is the transplanted grafts that are now unnaturally scattered over his head. The doctor who did this was either ignorant or immoral. A properly done hair transplant should stand on its own, or the doctor should tell you otherwise. That is what is required of the doctor by law. There was NEVER a possibility that this patient had anything of value and now he has negative value that he will carry around for the rest of his life unless someone completes his hair transplant in a logical way. Even with a properly done job, he will not have enough hair to cover his crown. Still, the man he sees every day in the mirror should be much more normal looking after his ‘fix’. Unfortunately, too many doctors are quoting small and large transplant sessions where and when they are NOT NEEDED. These doctors are just out for the almighty dollar. Immorality has not been wiped out and the crooks are still out there. Don’t be fooled by slick ads and particularly watch out for doctors that use salesmen to push, push, push you into making a decision. Again I say, “Let the Buyer Beware“.

Click the photos to enlarge.

 

Tags: hairtransplant, hair transplant, photo, hairloss, hair loss, doctor

What Publications Are There for Hair Loss Developments?

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

Dr. Rassman,

What would you recommend to readers who would like to try to stay on top of developments in the treatment of hair loss? For example, what sorts of publications do you follow to keep up on the field yourself? It’d be nice to get an idea of what research groups are out there attacking the problem, what they’re trying, what kinds of results they’re seeing, etc. Any ideas?

The Hair Transplant Forum is a publication that comes out every other month. The time from submittal to publication of any article is relatively short, so this is something that has value for me. Although there is an editorial staff that review the articles, it is not subject to the strict standard like other more formal publication like Dermatologic Surgery. The field of dermatology has adopted hair transplant science into its foundation, so articles that focus on dermatology often discuss breakthrough ideas. I belong to an email group of about 34 doctors from around the world and this group supplies me with up-to-date breakthroughs well in advance of more formal publication sources. At times, I am shown articles that get published in journals that I do not receive, so that helps me even further. Also, through the emails I receive from BaldingBlog, many of my readers comb the literature and news and they have been able to point me in important directions for more research. In conclusion, there is not any single source for staying up on breakthroughs, but staying tuned to industry sources get me to the forefront of what is going on.

Tags: hairloss, hair loss, hairtransplant, hair transplant, publications, journals

How Long For a New Hair to Emerge Through the Scalp?

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

Under normal circumstances once a hair has been through the resting stage and fallen out, how long does it take for a new hair to emerge through the scalp. Thanks

You should be aware of the various hair cycles, as follows:

  1. Growth phase (Anagen phase) — lasts anywhere from 2-6 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) — 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) — 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.

Freshly transplanted hair will emerge from the scalp anytime within 6 months of the time that it is transplanted. In about 5% of patients, hair growth is immediate, but largely the hair takes about 3-5 months to start growing at about 1/2 inch per month.

Tags: hair cycle, hairloss, hair loss, hair growth, anagen, catagen, telogen, hairtransplant, hair transplant

Taking Avodart and Propecia Together

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

Doc,

I’m a little alarmed after reading a few posts by some people who are taking both avodart and propecia simultaneously. You’ve written before about how the combination sounds redundant, but I’m wondering if it can hurt anything besides our wallets. Isn’t there a possibilitity that the two drugs could compete with one another and perhaps be counterproductive?

You should always speak with your doctor before taking or stopping any prescribed medication. I am not your doctor. Generally speaking, you should not be taking Avodart (dutasteride) and Propecia (finasteride) together for hair loss. Avodart and Propecia taken together may push the side effects such as suppressed sexual drive, breast enlargement, etc.

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

Herpes Medication and Hair Loss

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

I recently, was diagnosed with herpes, not sure if its 1 or 2. I heard this medication can reduce symptoms pretty well…Valaciclovir, do you know if this medication can cause hair loss?

There are various unconfirmed reports from people that have taken Valtrex, which suggest that there is some hair loss in some people that take the antiviral medication. I do not know the answer to your question, though… I just have what I read. I haven’t seen anything officially linking Valaciclovir (or Valacyclovir) and hair loss.

Tags: valacyclovir, valaciclovir, valtrex, hairloss, hair loss, herpes

Difference Between Open House and Seminar?

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

Looking at the NHI event schedule I see open houses and seminars. Will you explain the difference between these two types of events?

Thank you.

Generally, the open house events are located in one of our offices and we almost always perform a surgery during the open house event so that prospective patients can actually go into the surgery room and speak to the patient while he is undergoing a hair transplant. It is easier to understand the process when a live surgery is going on. In the seminar format, we often hold them at hotels where we obviously cannot perform a surgery.

For a list of upcoming NHI open houses and seminars, please see Upcoming Events.

Tags: hairtransplant, hair transplant, surgery, open house, seminar, nhi, new hair

Does DHT Play a Role in the Sex Drive?

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

Why does Propecia have such a significant effect on the sex drive? Does DHT play a role in one’s sex drive?If a 1 mg dose has such an effect on one’s sex drive, will 5 mg have an even greater effect?

I have heard that there will be a generic propecia, can you confirm? Thanks.

At 1mg of finasteride, the suppression of the male sex drive is about 1% of men taking the drug. The U.S. patent held by Merck for the 1mg tablet has years still left, so I doubt that there will be a legally available generic 1mg pill anytime soon.

Tags: propecia, proscar, finasteride, dht, sex drive, sex

Topical DHT Inhibitor

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

Is there no proven topical dht inhibitor? How long have you been taking propecia?

There is no FDA approved topical DHT inhibitor. Many claims to the contrary exist so it is a buyer beware process. I have been using Propecia for a number of years.

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

Transplanting Hair in the Correct Direction

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

doctor my question to u is regarding direction.while transplanting grafts into the balding areas of the scalp how do u determine the direction in which it will grow, the depth or angle? the hair is trimmed so short before a surgery is there a sureshot way to determine the direction of hair will grow after a transplant??

The direction the hair will grow in is determined by the surgeon as he/she puts in the recipient sites. The direction and angle of the instrument in making the ‘hole’ is the direction that the hair will grow in. Almost 100% of the hairs between the parts point forward. At the part, the hair changes angle and the surgeon’s skills here are most important. I have seen far too many patients have a ‘radial’ direction to the hair where the hair is directed more like the spokes of a bicycle wheel. For those patients with straight hair, any faulty placement of the hair direction will be magnified.

Take a look at an article I co-authored back in 2002, The Art of Repair in Surgical Hair Restoration. In the images shown in this article, you can see some of the wrong directions and how to do the work correctly. Particularly, take a look at figure 3 from the article which shows the wrong direction (below for convenience) and the right direction in a schematic form:

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

Hair Loss and Autoimmune Diseases

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

I am 42 years old and have had progressive thinning of my hair for about 12 years. Thinning is mostly on the top of my head. I have been to Rheumatology who has referred me to Dermatology. I am a University of Michigan patient. I have had every lab possible (I think) drawn. Only thing that is positive is my ANA. My nuclear antibody titer is >=1:2560 NAB pattern is HOMO. ADNA is negative. Do you think I should ask to have my androgen levels tested? Should I be asking to be referred to Endocrine? I’m at a loss. I’m ready to visit a hair loss center but before that I want everything else ruled out. I NEED YOUR HELP!

If you have an elevated ANA titer, one might worry about autoimmune diseases that can cause hair loss. Please see Lupus.org – My ANA Is Positive… What Does That Mean?

First, I would get your hair mapped out for miniaturization and see if your pattern shows one that is typical for male patterned loss (I am assuming that you are male, if not then there are many other things that can play in the causes of hair loss). Working with a good rheumatologist should shed light on any autoimmune component. Keep with the good doctors you seem to have and pump them for information, adding to it what you might learn from a miniaturization analysis of your hair shafts.

Tags: autoimmune. disease, hairloss, hair loss, ana

The Beard After a Hair Transplant

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

Hey Dr.,

I’m coming in for about 1000 grafts next month. I do have a slight concern, however. I’ve seen pictures of this “beard” effect, in which you can noticably tell there is a dark area where there has been transplants. How long is the beard usually visible? Would it be as drastic with just about 1000 grafts in the front?

Thanks.

The beard effect you talk about is from the short transplanted hairs that are visible immediately after the hair transplant. It usually lasts one to four weeks before it sheds. It is not readily detectable if you have other hair to cover it, but if you are a class 6 (completely bald) obviously you cannot hide it. I would then suggest that you clip it short or let your facial hair grow out as this will detract from your head viewing. If you already have facial hair (a beard or mustache) shave it off for the shock value and it’ll draw less attention to the top of the head. This works very well.

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

Hair Shedding After Stopping Propecia — Is It Lost Forever?

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

Hi Doctor, I had a question regarding Propecia. I know you mentioned on your blog that the good thing about Propecia is that the side effects should stop once you stop the treatment. I started Propecia but after a few months I was having sexual disfunction so I quit. My question is, will all the hair that’s been falling out from shedding be lost forever? Does some of the hair have more growth cycles left or is all the hair that falls out, hair that was destined NEVER to return? I recently had blood tests to make sure something else wasn’t going on, but they all showed I was healthy. The shedding has continued far past me quitting Propecia (3 weeks). When should it stop, and will any of that hair grow back? Thank you so much for your help! I have a lot of anxiety about this issue.

Shedding of hair after stopping the Propecia will take its toll on the weak hairs. There is a time when the hair will fall out and Propecia alters that time by delaying it. When you stop the drug, your normal hair loss will occur and continue until the worst of the miniaturized hairs fall out. Many of the hairs that fall out may not return. You may see shedding for months. I know this is not good news, but hair loss is a progressive process.

Tags: finasteride, propecia, hairloss, hair loss

Training for a Marathon — Is the Extra Testosterone Going to Speed Up My Hair Loss?

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

Hi Dr. Rassman,
I am a 38 year old male with recent thinning at the vertex. I’ve been training all of last year for the LA Marathon with weight and long distance running. Would all the extra testoterone from working out have an effect or speed up the process of mpb? Thank you.

PotatoI doubt your exercise and training will result in the progression of MPB, even with a slight elevation in your testosterone level. If you are genetically predisposed to lose hair, you will lose hair. Even if it has a slight effect would you do anything differently? Would you not run a marathon or not exercise and become a couch potato? Perhaps a couch potato with more hair?

Tags: hairloss, hair loss, exercise, marathon, testosterone