In What Case Is Avodart Better than Propecia?

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

Hi Doc,

In what situation do you think that Avodart may be better than propecia. For users of propecia who have been on it for more than 5 years and its effectiveness diminishing do you think that switching to avodart is ok? Obviously if propecia was still working then there would be no need to switch but what if propecia results were fading?

I am just speculating here, as I don’t have the definitive answer to your question. Avodart (dutasteride) may be more powerful that Propecia (finasteride) in treating hair loss at higher doses than are usually used (2.5mgs/day rather than0.5mgs/day), but it almost certainly has more side effects as well including significantly reduced sperm counts. The best dosing is unknown in the use of Avodart as a hair loss treatment and until the manufacturere comes up with a recommendation that the FDA will accept with regard to effectiveness and safety, the drug must be assumed not be be safe for young men who wish to have children. It is quite possible that many doctors are overdosing the medication at this point as the known half life of the drug is 5+ weeks. If/when the FDA approves this medication, more information will be available.

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

Post-Op Questions After Hair Transplant 6 Weeks Ago

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

I recently had a hair transplant (approx 6 weeks ago). The doctor cut 5 strips and transplanted into the vertex and front hairline, leaving the top of the head alone.

Since then I have noticed a lot of shedding (counting about 50-60 hairs in the shower as opposed to the typical 10 before). I realize there will be shedding after a procedure, however, I notice considerable thinning directly on the top of my head. A lot of the hairs that are shedding are long and thick.

I have 2 questions:

  1. Is it common for hair not in the donor site or the recipient site to shed so much?
  2. How much longer is this going to keep going on for?

Assuming you are male, then you may be experiencing shock loss, as it seems to relate to your recent hair transplant. Shock loss in young men often does not reverse. Were you taking finasteride (Propecia) which tends to protect against shock loss? Most importantly, I think these questions should be addressed to your doctor who performed your surgery and/or these things should have been explained to you in advance. At the very least, they should’ve been written out in your pre and post operative hand out.

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

Norwood Class 3 Hair Loss in Women

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

Norwood Class 3Male pattern balding is thought to only affect males and rare indeed is the female with this type of balding, according to popular belief. Yet, I have seen some relatively young females (in their twenties at most) with a hairline resembling a Norwood Class 3. What is this about? Perhaps I should buy myself a set of spectacles, or is it really true that females may develop male pattern balding to a certain degree?

Many women get a very thin corner that develops over time. The hair is miniaturized, but most often not lost. It grows slowly and rarely bothers the women. It has been suggested that women with this corner thinning, may have some form of genetic balding like the Class 3 males with corner recession.

Tags: norwood, hairloss, hair loss, women, female, woman

Biotin and Propecia

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

Hello Dr. Rassman,

Would there be a negative effect in taking Propecia and a dietary supplement called Biotin 2500, which has about 2500 mcg of biotin, at the same time?

Thanks for your time.

I do not see a problem combining Propecia (finasteride 1mg) with biotin.

Tags: biotin, propecia, finasteride, hairloss, hair loss, supplement

Management of Progressive Balding

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

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted on. I am curious what his Norwood classification was before he had the corrective transplants. Is balding in this particular pattern common? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

 

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old, so I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants, which may require another procedure, but taking Propecia (finasteride 1mg) may help to prevent that. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.

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

How Long For Grafts to Take Hold After a Hair Transplant?

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

I have a question after the procedure of a hair transplant.

How many days does it take for the bulb/graft to take and settle? So even if the scabs and hair fallout it won’t be a problem.

THANK YOU FOR YOUR TIME

Dermatologic SurgeryDr. Bernstein and I wrote an article in the February 2006 issue of Dermatologic Surgery that essentially says that when the ‘scabs’ come off, the grafts are anchored. That can take 3-14 days and is determined by the aggressiveness of your washing process. The abstract of the article is available here — Graft anchoring in hair transplantation.

In an ideal world, the grafts are relatively permanent after the first 48 hours unless you actually work them out. In the real world, I would generally say about a week (just to be safe). If you are determined enough, I am sure you can get a tweezer and pick them out, though I’m sure you are trying to avoid doing.

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

Takotsubo Syndrome and Hair Loss

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

(female) I started losing my hair a year ago just before being hospitalized and diagnosed with Takosubo Syndrome. I took nutritional supplements and used Nioxin on my hair. The bald spot filled in but my hair is much thinner now and now starting to bald behind my ears. Why is this happening and what can I do about it? Would appreciate your input.

Thanks

Stress (both emotional and physical) can cause hair loss. There is not much you can do about it other than addressing your stress. I know that the diagnosis sounds bleak and not promising, so your level of stress must be high. Read below for information on this terrible disease:

  1. Takotsubo.com
  2. Takotsubo Syndrome: A Bayesian Approach to Interpreting Its Pathogenesis
  3. Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma?
Tags: takotsubo, syndrome, hairloss, hair loss, stress

What Dosage of Beta Blockers Triggers Hair Loss?

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

Dear Dr. Rassman, I’ve read on your blog that beta blockers can accelerate hair loss in men with MPB. Is there a specific amount (on average) of this medication that usually triggers balding? For example, someone taking beta blockers for high blood pressure would probably take a higher dosage than someone taking it for performance anxiety. I take it for performance anxiety. Are the people who take a higher dosage for blood pressure the people who usually see hairloss as a result?

Also, do certain types of beta blockers cause more hair loss than other types?

Thanks!

There is no particular dose of beta blockers that would cause more hair loss. More importantly, you may be confused by my prior posts. Many drugs can cause your ot lose hair, but medication is the LAST thing on the list of other, more common causes of hair loss. Medications (including beta blockers) do not cause androgenic alopecia (AGA) or male pattern balding (MPB).

You should not start or stop or change any medication regimen without consulting your doctor.

Tags: beta blocker, hairloss, hair loss, medication, betablocker

12 Year Old Has Alopecia — Is a Hair Transplant Possible?

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

Hello Dr.

I hope you answer my question. My 12 yrs. old daughter has been diagnosed with Androgenetic Alopecia at UCSF. Her hair has been thinning in the front and at the temples. We have been using the 2% Rogain for 3 weeks, as recommended by her Dermatologist. The hair in the back of her head seems normal. CBC, TSH, Iron, ANA were normal.Ferririn was 18, a bit below normal.

This is starting to affect her emotionally.

Is it too soon to think about hair transplant? should we wait until she is 18 or more? Please let me know.

Thank you for your time

It is extremely rare or unheard of for a 12 year old female to have androgenic alopecia. Androgenic alopecia (AGA) generally affects men past their puberty who are genetically susceptible to the effects of dihydrotestosterone (DHT). Does your daughter have hormonal irregularities? You need a good dermatologist to make an evaluation of her and I am not saying that the docs at UCSF are not good doctors, but a second opinion may have value. There are other forms of Alopecia and considering her age, I would want to explore all possibilities.

Tags: hairloss, hair loss, dht, angrogenic alopecia, aga

Hair Loss from Braids?

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

I washed my hair one day after pulling out braids. I went to my personal hairdresser to get my hair redone only to be told “Honey you know you have a bald patch” then she proceeded to rub it with her finger. It was as smooth as could be. It now has a few strains of hair and i have bought things specifically described for hair loss near to the neck. It itches a the bottom of the spot. Just tell me what exactly to do please cause it really bugs me out.

You describe a condition known as traction alopecia, where hair follicles are permanently damaged with constant traction (in your case braids). That area may never grow hair back. You need to see a hair specialist (a good hair transplant surgeon may help), but you should wait for 6 months to see if it does grows back.

Tags: traction alopecia, braids, hairloss, hair loss, alopecia, traction

Herbal Shampoo and Rogaine for Women

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

my mother takes rogaine. i have found a herbal shampoo system that is supposed to enhance hair growth.

the ingredients are: cetearyl alcohol, dimethicone PEG-8, meadowfoamate, cocamidopropyl, pg-dimethiconol, lecithin, borago officinalis seed oil, caprylic/capric triglyceride, retinyl palmitate, tocopheryl acetate, ascorbyl palmitate, phosphatidyl choline, panthenol, glycerin, phopholipids, niacin, sodium riboflavin phosphate, calcium pantothenate, pyridoxine hcl, carbomer, papain, hydrolyzed algae extract, biotin, salvia officinalis(sage) leaf extract, ezuisetum hiemale extract, juniperus communis fruit extract, hypercium perforatum extract, arctium lappa root extract, symphytum officinale extract, m humulus lupulus(hops) extract, uirtica dioica(nettle) extract, thymus vulgaris extract, serenoa serrulata fruit extract, yucca schidigera extract, glycyrrhiz glabra extract, rosmarinus officinalis leag extract hydrolytzed wheat protein, benzyl nicotinate, guar hydroxypropytrimonium chloride, citric acid, hydroxyethylcellulose, safflower, sessssssssame seed oil, stearamidopropyl dimethylamine, quaternium-80, methylchloroisothiazolinone, methylisothiazolinone, butylene glycol, menthol, mentha piperita.

can she use this with the rogaine?

Yes, I don’t see why not.

Tags: rogaine, minoxidil, herbal shampoo, shampoo