Still Confused About Minoxidil and Propecia Used Together…

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

Hi Dr.-

I am a 30 year old male who had a 1700 graft transplant 8 months ago. I’ve been on propecia for 9 months.

My transplant helped my receding hairline, however, my crown is still thin (no bald spots, just thining). I am constantly reading about different topical ‘solutions’. Are all these just different variations of Minoxidyl? Is there one you would recommend that is compatible with Propecia and does in fact regrow hair? Procerin seems to have a good reputation from what I’ve read- is this a valid option?

I am considering a 2nd transplant, but if I can go more affordable route I would prefer to.

Thanks so much for your time!

Minoxidil comes in a variety of forms (2% and 5%) and types for women (has alcohol base) and for men (more oil based and harder to groom and style). It also comes in a foam, which appears to be better and easier to apply in the 5% concentration. If you add minoxidil to your Propecia routine, then you should wait a full 8 months to see if there is enough benefit. I am evolving into believing more and more that the use of both minoxidil and Propecia have more value than one alone in some men. If Propecia is working well and meets your goals without minoxidil, then adding minoxidil with all of the compliance issues, may not be in your long term best interest. Propecia, which is a pill a day, is an easy routine to stick to. In your particular situation, adding minoxidil might be a less expensive way to address your crown loss, if it works for you. The problem I see with minoxidil is that putting it on twice a day is a difficult routine for many men to adhere to, so long term compliance may be a problem.

Procerin has been discussed before.

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

Pimples Along the Hairline

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

I have these pimple like bumps on my head but they are only around the frame of my face where the hair line starts. They started with just one st the top of my forehead and I thought it was just a pimple so I tried to pop it and now they are spredding along my hair line: behind my ears, bottom of my neck at the hair line, and at the temples. Also they only itch when they first show up and after I itch them the first time it stops itching, but doesnt go away. They stay there and scabb up. I want to know what they are and what to do to make them go away! Please help me!

I am assuming that you have not had a hair transplant. If you have pimples that had white heads on them, you may have developed folliculitis. You are best served seeing a dermatologist to make the diagnosis, but any good family doctor should be able to address the problem. Scratching it will make the folliculitis spread from one area to another.

Tags: pimples, folliculitis, hairloss, hair loss

I Stopped Laser Treatment and My Hair Growth Benefits Went Away

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

My hairline is VERY uneven and has always been much higher and thinner on the right side of my head. I would say around 1.5″ higher on the right.

About 2 years ago I had laser treatment that lasted for about a year and it worked for a while (Although it never evened out totally i did notice some new growth). However I was told once new growth started I could cease treatment. I did this and the new hair has died again. I dont think i am losing hair as i have quite thick growth all over, i think its just a birth defect in that area. I’m 25 and it is really affecting my confidence. Should the laser treatment have been permanent? Would it be cheaper for me to have a hair transplant in such a small section? Finally, would a hair transplant be self sustainable or are pills required permanently after the treatment?

Many thanks

If there is a benefit of the laser, it will not be permanent. Remember, hair loss is a progressive process and nothing stops the progressive nature of the process for any long time frame. Sorry to disappoint you.

Tags: laser, hairloss, hair loss

Is There a Rogaine Pill?

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

What are the effects of taking rogaine and propecia together? Are any positive effects negligible? Does rogaine only come in topical form (no pill)?

Minoxidil was originally an antihypertensive pill that did not have a consistent response for the treatment of high blood pressure. It grew hair on some of those who used it. It is not recommended today for oral use in the treatment of hair loss. It was more effective growing hair when it is applied to the skin directly and is certainly safer.

Tags: minoxidil, rogaine, hairloss, hair loss, pill

Finasteride at 1mg and 5mg Dosages

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

Is propecia at 1mg as effective as finasteride at 5mg ? thankyou

What was published in the original work on Propecia was that the 1mg dose was just as effective as the 5gm dose for treating hair loss. One might suspect that there is a dose response relationship and that a higher does might have more of a benefit than the 1mg dose, but that is strictly guess work. I only know for sure what I read about the subject and that data is well documented in the literature and through the FDA approved trials.

Tags: propecia, finasteride, hairloss, hair loss

Chances of Nerve Damage from Strip Excision?

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

Haemorrhage, vascular and nerve damage is a risk of strip excision?? can we see some of these implications in patients? what are the chances of this to happen?

I can reflect on these from only experience in my practice:

  1. Bleeding after surgery — I sometimes see some wound ooze beyond a day after a surgery (I would guess 1 in 300 patients). I handle this with a simple pressure dressing over the donor wound. Bleeding is never a problem beyond a day in the recipient area.
  2. Bleeding significantly during a surgery (by “significantly”, I mean enough to impact blood pressure – more than a few ounces of blood) — Risk for this is close to zero. Every patient bleeds during the surgery as the scalp is very vascular (might lose a few ounces of blood), but it should not be meaningful bleeding that risks anything. Bleeding may be a problem if a patient is on anticoagulants, Aspirin, or if they might have a clotting/bleeding disorder that stops blood from coagulating (this last one should be known by taking a good history from a patient for hemophilia).
  3. Vascular damage — There is no risk of direct vascular damage in a normal person unless the patient has had many scalp reduction procedures or many hair transplant procedures, or the surgeon does not have experience in doing this type of surgery.
  4. Nerve damage — There are two types of nerve damage that may follow a hair transplant. The fine cutaneous nerves are cut in almost everyone both in the recipient area and the donor area. This might leave some numbness above the wound and this usually disappears in days or weeks. The second type of nerve injury occurs when and if the surgeon accidentally cut a major nerve (‘greater or lesser’ occipital nerves). This is a surgical error in technique when it occurs. In my practice, I have never seen it in a surgery I have done, but I have seen this injury in patients who came to me from other doctors who may not have been skilled surgeons in the first place.
Tags: hairtransplant, hair transplant, nerve, vascular, blood, bleeding, damage, hairloss, hair loss, surgery

Propecia and Cancer

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

My question concerns Propecia and Melanoma/other cancers. I’m a 28 year old male with moderate MPB. 2 years ago I was taking Propecia with positive results. After about 8 months on the drug I was diagnosed with a Stage 1 Melanoma. The biopsy showed no sun damage and I have no family history of the disease. I immediately made several life changes (diet etc.) including stopping Propecia. After lots of cancer research post diagnosis I noticed the correlation with hormone change/imbalance and cancer development (fertility drugs, pregnancy etc.). Studies also show that men that develop prostate cancer while taking dutastaride develop a more aggressive form of the cancer. My question is, what do you think the odds are that Propecia had a hand in the development of my cancer and have you ever heard of this before? Also, do you think it would be safe for me to start taking the drug again?
Thanks for your time

There is no evidence that Propecia (finasteride) impacts any cancer other than prostate cancer. The studies on finasteride (5mg daily use over 7 years) showed that men that took it (over placebo group) has a decreased risk of cancer by 25%. The statement of more malignant cancers has not been born out with follow-ups on these patients, as reports show that those patients that were thought to have a more aggressive cancer lived just as long as the other group of men. I do not believe that there is any connection between Propecia and your melanoma and would not hesitate to recommend it to one of my patients with your history, but if it worried you, then you can elect not to take it.

Tags: cancer, melanoma, hairloss, hair loss, finasteride, propecia

No Hair Where Mole Was Removed from Scalp

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

When I was about 16 years old I had a mole surgically removed from the back of my head because it was growing larger and the doctor said it could become cancerous. I am angry about this because I don’t know if it was necessary at the time or not. Anyway I am 22 now and no hair has grown in that spot since. I don’t under stand why but lately it has consumed me and I am extremely depressed and obsessed with it. Am I able to get a hair transplant and make the hair grow back? Also will I be loosing one bald spot and creating another one at the donor area if I can have a transplant?

Scars from removal of growths or just lacerations are common in the scalp. It depends upon the surgical technique and possibly more important is the general direction of the wound. Linear scars that run front to back tend to scar more than those that run side to side, but everything in the scalp can scar. With a good hair transplant surgeon, a decision can be made how best to address the scar. Some of these scars can be fixed with a simple surgical excision of the scar and proper closure techniques, while others may be fixed best with a small hair transplant (always works). See an expert.

Tags: scalp, mole, scar, hairloss, hair loss, hairtransplant, hair transplant

Someone Told Me About a Home Remedy for Treating Head Fungus

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

My sister-in-law has a one year old daughter. She was born with a head full of hair and she combed her hair everyday like she was supposed to and greased it. She used rubber bands to put braids on her hair and now all of a sudden at the top of the child’s head her hair has come out in big hunks, but just in that one section. So we took her to the doctor and he said it was a head fungus. It looks like big puss bumps and then they bust open by themselves and the puss and blood come out of them. The doctor gave her two types of medication for the fungus and a hair shampoo and he told us to grease her hair with vaseline everyday. But I was told by someone that I could mix Monostat Seven and vitamin E oil together to help it and it would make her hair grow back healthy and even thicker this time. Is this true or do you all have any other suggestions that you could tell me. She now has to wear hats everyday with her hair all down and vaseline on her scalp daily. Please help us if you can.

Treatment of scalp fungus could take a long time and even after treating it, you need to wait a few months for the hair follicles to generate new hair. My recommendation to you is to stick to the recommendation and treatment plan of your dermatologist.

Tags: fungus, infection, hairloss, hair loss

6 Weeks with the LaserComb — No Results

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

I found this new video about one user’s experience with the Lasercomb: Gizmodo.com – Lab Rat: HairMax Laser Comb Final Results

Any time you want to see results of anything that you use for hair growth, it takes a good 8 months of treatment to see the results. I know that the people who manufacture this product suggest that you get results in 90 days, but that claim is what I find unbelievable, not that there are benefits after 8 months.

Tags: lasercomb, laser comb, hairmax, hair max, hairloss, hair loss, hair growth

Are There Foods to Make Hair Thicker?

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

I’m receding and using certain supplements to control it, with some amount of success.

However, I seem to be growing lots and lots of thin, dry hair. What are the best foods to make my hair thicker and give it more moisture.
Many thanks

I do not believe that there is a one to one connection between certain foods and hair thickness or growth rate, provided that you are eating a healthy diet. The body is a wonderful regulator of growth. With that said, there are many articles that say otherwise and many products being sold that promote better hair growth through nutritional supplements.

Tags: diet, food, hairloss, hair loss, hair growth, moisture

I’ve Lost Leg Hair

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

(male)
I have lost all of the hair on the outside of my legs from the knee down. I do not have any medical conditions that should affect this. Thank you

I do not know enough about you — like your age, for starters. If you know you have nothing wrong with you, then what value can I have? I think you need to link with a good doctor and then let him/her tell you that you have no medical conditions, and/or possibly identify something that is wrong.

Tags: hairloss, hair loss, leg hair

Aminexil vs Minoxidil

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

Hello,
can you please explain the difference between “Minoxidil” (Regaine) and “Aminexil” (Dercos SP94)? I am having troubles choosing between these two products.
Many thanks.

Aminexil is made by the large cosmetics company L’Oreal and is reported to act in a similar manner as minoxidil. As L’Oreal is behind it, there is an aura of credibility to it. Aminexil is not tested according to the FDA, so there is no way for me to judge from reading the material if there is value similar to minoxidil, as stated in the various publications I read.

Tags: aminexil, minoxidil, hair loss, hairloss

Touch-Up Hair Transplants

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

What are your thoughts on “touch up” transplants? I am currently 27 yrs old and have had thinning in my front forelock since I was 18. When I was 24 I started Propecia and although it has progressed (from the size of a dime to a quarter) It has been slow.. This makes me think that my problem could be solved with 800 or so grafts. The rest of my head has good thickness. I realize you’re going to recomend a “master plan” and “hair mapping”, but if you could include your thoughts on touch up’s. It would be appreciated. Most importantly on what criteria you would recomend them, if any.

thank you.

It is impossible for me to tell you about your hair loss and treatment plans from a simple blog posting. You seem to know about the importance of a Master Plan and miniaturization mapping and with any transplant work that you are considering, anticipating the future direction of the hair loss is critical to balance things like:

  1. Supply/demand of donor hair use
  2. The rate of hair loss for following your progressive hair loss over time
  3. Budgeting appropriately to follow-through with what you start

If you are concerned about your hair loss, your next step is to see a good, honest hair transplant doctor. If you saying that you already had a hair transplant or two or three, and this is a touch-up (meaning another small hair transplant procedure) you should ask your doctor how many more of these are needed to make sure that you know where it will all end sometime.

Sometimes patients come to me with a preconceived number of grafts they need. Often times these numbers do not match their expectations and the real needs to achieve the goals. Everyone’s needs and the criteria for choosing the numbers of grafts are different based on hair color, skin color, hair texture, head shape, etc, etc. See Patient’s Guide — How Many Grafts Will I Need?

I do not understand what you mean by a “touch up” transplant. You should either have a hair transplant to meet your goals or you should not have a transplant at all. There are some patients who may come back a year later for more fullness or address other areas and as there may be a risk of shock loss, you need to prepare a worst case scenario. You may see this as a “touch up”, but as you can see, it is related to the goals and expectations of a hair transplant program.

Tags: hairtranspant, hair transplant, hairloss, hair loss, touch-up

Lack of Sleep Causing My Hair Loss?

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

Dear dr.
i am 19, and sleep only four hours a night. this has gone on for years. i also have a lot of stress. a friend told me this is why my widdows peak hairline is so drasticly receding, is this true?!

would sleeping more and stressing less do any good?!!!! Thank you soo much for your time doctor.

BedSome people get along just fine on 3-4 hours of sleep a night, and while that might be stressful for some, others (like me) get along on little sleep without stress.

Stress can cause hair loss. A maturing hairline also occurs in people between 19-29 years old. Look at the photos in Maturation of a Hairline — Moving From Juvenile to Mature and you will see the different between a balding and a maturing hairline. See a doctor and make sure that he/she gets your scalp mapped out for miniaturization to see just how far back the change in your scalp is occurring. If you are balding, then stress reduction and probably Propecia is a reasonable alternative.

Tags: sleep, hairloss, hair loss, hairline, stress