Two Cases of Significant Sperm Count Reduction While on Propecia

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

See Propecia-induced spermatogenic failure: A report of two cases. by Liu KE, Binsaleh S, Lo KC, Jarvi K.

The conclusion of the article states:
Two cases of infertile patients with azoospermia or severe oligospermia who showed significant improvements in sperm concentrations 6 months after the discontinuation of finasteride. In one case, improvement in semen parameters prevented the need for testicular biopsy and corrected the azoospermia. Stopping finasteride in the infertility population may improve semen parameters, and may allow for less invasive fertility treatments.

We have already heard about similar, more frequent side effects with Avodart (dutasteride). While I am not completely surprised, I suspect the frequency is very low. I’ve written about sperm count and Propecia in the past:

Tags: finasteride, propecia, sperm, count, fertility, infertility, hairloss, hair loss, proscar

Can Scalp Exercises Cause Traction Alopecia?

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

Hello doctor

Could exercises that many doctors are recommending to increase the looseness of the scalp, when performed for a long time, cause any problems ( e.g. traction alopecia ) ?

Thank you

Scalp exercises are used to increase the laxity to the scalp, as shown in this video:

 

As long as you are pushing down on the scalp and not creating constant pull 24 hours a day, you should not have traction alopecia from this. Traction alopecia occurs when you keep your hair pulled or braided too tight constantly over the course of many months. Traction alopecia and scalp exercises are two different things.

Tags: traction alopecia, alopecia, scalp, exercise, laxity, hairloss, hair loss

Can the LaserComb Cause a Mole to Become Malignant?

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

Dear Dr. Rassman,

I have two questions about the use of low-level laser light therapy (laser combs). I have forwarded these questions to the makers of the Hairmax and they could not answer them or even venture a guess. I was disappointed because they advertise this big team of highly touted medical advisors, but their customer service department would not even check with one of these so-called advisors for an educated guess. So, what good are they?

Anyway, here are my questions. If a clear, ready answer is not available, can you please use your medical and scientific education, training and experience to venture an educated guess? Please.

1.) If a person has a mole on their head, could the use of a laser comb somehow “activate” the mole and cause it to become malignant? Should this be a concern and is it even a remote possibility?

My next question is in regards to the use of a laser comb along with the use of photo-sensitive medications.

2.) As you know many medicines, and even some herbs, such as St. Johns Wort, have photo-sensitive properties. This means that if someone is taking a medicine or an herb such as St. Johns Wort, they should limit their sun exposure time and avoid tanning beds. If a person is taking something with photo-sensitive properties, what will the effect be using a laser comb? Is there a contraindication? Can the use of a laser comb, in this case, be harmful or contraindicated?

On the other hand, it has crossed my mind that it might actually enhance the benefits of the low-level laser therapy due to the synergistic effect of the medication potentiating the effect of the laser light.

Bottom line: Will the effect of using low-level laser therapy, along with a photo-sensitive agent be detrimental (adverse effects/use with caution?), beneficial (it will synergistically increase the benefits of the product?) or neutral (no effect either way/it doesn’t matter?)

Your email raises good questions that haven’t been asked here before, but I wish I had answers for you. Any answers to your questions would not have the proper data that can be depended upon. I would suspect that the amount of time exposed to the LLLT is not sufficient for the problems you are asking about, but that is just an assumption.

Tags: laser, lllt, lasercomb, mole, malignant, low level laser light, hairloss, hair loss

Bald Spot Started As Small Spot Months Ago, Now It is Growing

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

I have a spot on the left side of my head. It appeared in the summer as small as a pea and know is about 2 inches. The hair that falls out looks like an exclamation point it is thick and then really thin near the scalp it also is discolored. My hair is dark black so the ends near the scalp are light brown. The bald spot is very smooth no hair or subble. What might this be and what kind of doctor should I visit my doctor has no clue.

I think that this is a test of my knowledge. ‘Exclamation point hair’ is a telltale sign found in certain diseases like alopecia areata (see Exclamation point hair). If the spot is expanding, then that may be your diagnosis. You need to see a dermatologist for your condition. Different diseases can cause this type of patchy hair loss, but the most common in western countries is ringworm (a fungal infection problem).

Alopecia areata is an autoimmune disorder in which hair is destroyed by the body’s defense mechanism. For those that have it, there is a genetic component which can be identified in the DNA. Hair loss could be seen anywhere in the body and is more obvious on the head and face, because of the density of hair in those areas. Recovery is spontaneous, but may take several months to years and it may not reverse. Some medications may facilitate recovery from this condition, but the best treatments are in the hands of a few doctors who have a particular interest in this disease.

Tags: alopecia, exclamation point, hairloss, hair loss, alopecia areata

Transplanting Back Hair to Your Scalp

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

I have heard that you can take hair from you back, yes “Back” and put it on your head for transplants?? Is this true and how does it work?

I have had transplants from the normal donor sites – but have never seen or heard of it from the back. I have a hairy back and would use such if this was viable.

In theory, you can move hairs from the scalp or the back and transplant it to any part of your body. In my opinion, body hair transplantation is not as effective as scalp hair transplant, because the life cycle or the growth phase of body hair is very different from scalp hair. Think about it — you need to get a hair cut every month or so. When is the last time you had a body hair cut? Body hair is finer, so it has less value and its growth phase is not 90+% like scalp hair, but 30-60%, which means that far less of the hair that is transplanted will be visible all of the time. There are doctors who perform body hair transplants and some report moderate success. I personally have not been impressed with the results on most of the ones I have seen, but I have seen one patient with nice results, and as it is an exception to the rule, I want to see more to be converted.

Tags: hairtransplant, hair transplant, back hair, body hair, bht, hairloss, hair loss

My Hair Is Miniaturizing All Over

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

Hello Doctor. I have been reading on your website about miniaturization. I was under the impression that it just occurred on the top of the head but I believe that it is affecting me on my whole head. Is this possible? I am already on Propecia and Rogaine, and I know that you don’t endorse any other products, but a doctor told me to try Biotin. Is it possible that this would help with thickness at all? I also would like to start taking a multivitamin in morning (when I take Propecia). Would either of these take away from the benefits of Propecia? Thank you for all of your help doctor!

It is possible that miniaturization can occur all over, but how do you know your hair is actually miniaturizing? Miniaturization can only be seen under a microscope, so getting a detailed microscopic assessment of your hair throughout your scalp is the way to confirm what you are suspecting, if it is true. If you are miniaturizing all over the head then you probably do not have male pattern baldness (as a male you might have diffuse unpatterned alopecia, also known as DUPA) and drugs such as Propecia will likely not help!

I don’t see a problem taking biotin or a multivitamin with Propecia in the morning.

Tags: dupa, alopecia, hairloss, hair loss, propecia, rogaine, minoxidil, finasteride, miniaturization

My 18 Year Old Daughter Is Losing Hair — What Should I Do For Her?

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

Could you please tell me what type of doctor you should take your 18 yro daughter to if they are experiencing considerable hairloss. Her hair is thinning all over her head, and especially on top in the front. Our general practitioner sent us to a derminatologist. We went to the dermatologist for around 6 months without any progress. He tried to tell us it was hereditary hairloss, yet no women in the family on either side has thin hair.

They finally ordered blood work that I got a copy of. They never even called us with the results. It showed her MPV was low, 6.4 fL and her Ferritin was only 12ng/ml. Not sure what MPV is, but I know ferritin is iron. I’m having her take a multivitamin in the morning and an iron supplement at night. I would like to get her into a good doctor who gives a darn and could help her out. She is very athletic and does a lot of working out and sports. Any reccomendations would be greatly appreciated.

Also, should I have her give Mens 5% Rogaine foam a try to see if we can accelerate the progress?

Ferritin of 12 is in the low side of the normal range. The best thing you can do is to see a good internist to treat iron deficiency if present and also to check for other medical conditions that can cause hair loss in women, including thyroid disorders, immune diseases, and PCOS. If there is a genetic component, then having her hair mapped out for miniaturization will show the classic signs of the genetic process in women.

Tags: hairloss, hair loss, female, women, woman, ferritin, iron, teen

Seeing Results from Rogaine Foam After 2 Weeks?

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

hi,
i have been using the foam for about 2 weeks on my receding hairline to see if it will work and there has been shedding. i heard that was normal for some. i don’t know if I’m crazy but i feel like there are hairs already growing in my receding hairline somehow even though its not intended for that area. can this be true or am i just seeing things?

I highly doubt that you are seeing any effect of Rogaine Foam after 2 weeks. These things take months to notice. You may be seeing fine vellus hairs (also known as “peach fuzz”) that were already there, but only now are you paying more close attention to them. If I am wrong and you are seeing effects from the minoxidil after only 2 weeks, then you should have outstanding results over the next few months.

Tags: hairloss, hair loss, minoxidil, rogaine, foam, vellus

Will Minoxidil Have Any Effect Now That I’m In My 60s?

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

I’ve read that minoxidil works best in the early stages of balding and when someone is in their 20s into the mid-30s. After the mid-30s it is less effective. I’m in the mid-60s and began loosing hair when I was in the Navy in my late teens and early 20s. What’s the chance that minoxidil will have any effect? Is there anything else available other than an expensive transplant?

It is true that minoxidil and finasteride work best in the early stages of balding, but this is more true for finasteride (Propecia) than minoxidil. If you do not have any hair at all, minoxidil may not work as well, however, it may still be worth a try, as there is very little to lose.

Tags: finasteride, minoxidil, hairloss, hair loss

My Hair Sheds in the Winter

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

I have very healthy hair and whenever I consistently go to a hair dresser it grows to a considerable length. Instead of me paying the money to a hair dresser, I decided to do my hair myself at home and save money this way, however I notice that during the winter months my hair sheds a lot. Is this normal among African Americans? My hair will not grow to a considerable length because it sheds so much during the winter. Is there anything I can do to prevent this?

Humans have asynchronous hair growth, which means that we do not shed in seasons, but do so relatively uniformly over the year. I can not explain your situation, but an examination is a good start, because your time frame view may not go back to every winter.

Tags: hairloss, hair loss, winter, season, asynchronous

17 Year Old Concerned About His Hairline (with Photos)

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

Dr. Rassman,

I am a 17 year old male concerned about hairloss. I have not noticed any receding or thinning or extreme shedding or any typical symptoms of hairloss. However, I have always had a very high hairline ever since I was 2. And from the front my hairline looks like a U shape when I pull my hair back. However, as you can see from the pictures my hairline lines up perfectly even with the side of my hair and does not go farther back like the diagram of the “receding” hairline does. I just want you to tell me if my hairline is a receding one or if it is the normal mature hairline that 95% of all caucasians get. What do you think? I have always and still do have a very thick head of hair, I just need to know if you think my hairline is abnormal or balding, or does there appear to be nothing to worry about. PLEASE Respond. YOU MAY USE MY PICTURES ON YOUR SITE!

Thank YOU SO Much!

 

Thank you for your permission to post your photos.

A high hairline at your age is most likely genetic and not a sign of hair recession or balding, particularly since you’ve had it since childhood. If you look back at your family tree, you could probably find someone in the family (either side) with a similar hairline. If you are happy with your hairline and there is no sign of hair loss in the area immediately behind it you don’t need to do anything. If you are unhappy with having a high forehead or you think the appearance of recession make you look older, you can treat it with either a hairline lowering procedure or hair transplants — but these solutions are not for a 19 year old male who may bald as he matures. This restriction does not include women.

Tags: hairline, hairloss, hair loss, maturing, mature, recession, balding, genetic

Did Propecia Effect My Liver?

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

I am a 25 year old male experiencing signs of thinning in my temples and hairline region.

I took propecia for about 6 months with no noticeable side effects. After 6 months I had to have a minor surgery, and they had me do a routine pre op exam with my doctor. My blood work came back with elevated liver enzymes (the were elevated to a level that made my doctor cancel my surgery date.) I have no history of liver disease, or any past issues with my liver at all. They tested me for all the usual liver problems and they all came back negative.

The only medication I was on was Propecia, so my doctor told me to stop taking it, and they would redo my blood work in a couple of weeks. Over the next month and a half (after discontinuing Propecia) my doctor monitored my liver enzymes on a weekly basis as they slowly returned to normal.

My doctor told me not to take propecia any longer because it obviously was the cause of the elevated liver enzymes…and that was very dangerous to have them that high.

I was wondering, is this a common occurrence? Are there any reported cases of this? If so, how come it is not listed as a possible side effect to propecia?

Since propecia seems out of the question for me, what other options are there for long term goals of maintaining the hair I have now (In both the temples/hairline and the vertex? ) Perhaps another form of dht inhibitor that does not metabolize in the liver (if such a thing even exists)?

Thank you

I cannot be sure if Propecia (finasteride 1mg) was the cause of your elevated liver enzymes. Propecia is not associated with liver problems, but this has been addressed in the past on this site a couple of times:

There are may other causes of elevated liver problems, including lab error, alcohol, genetic liver disease (which you may not be aware of), recent viral illness, hepatitis, gall stones, etc. I am sure your doctor considered these and other factors. In the end you should confer and follow your doctors recommendations.

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

I Stopped Washing My Hair Because I’m Worried About Losing It!

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

Hello, I started receding about a year ago and recently its getting worse, everytime i go in the shower and wash my hair there is about fifty or so hairs on my hands which didnt happen about three months ago, my scalp also itches but i dont want to wash it too hard because more and more hair will fall out, i need help bad, im avoiding washing it at the moment, there is also some white stuff on my scalp in some places which i can scrap off with my nail and doesnt smell too good. can you give me some advice please. thanks

You need to see a dermatologist soon. Several conditions could be causing your hair loss. Having extensive dandruff and scalp itching is a sign of inflammation of the scalp and seborrheic dermatitis. Seborrheic dermatitis is an inflammatory disease that can involve scalp skin and other areas. Although seborrheic dermatitis does not generally cause hair loss, if you are genetically predisposed to baldness, inflammation can accelerate your patterned hair loss. Some other inflammatory conditions, such as infectious disorders of the scalp, can do the same to the follicles. Find a good physician who can diagnose and treat the condition so that you can limit your hair loss or even regrow your hair. For an accurate diagnosis of genetic hair loss, if that is what you have, you need to get your scalp mapped out for miniaturization.

Tags: washing, clean, wash, dermatitis, hairloss, hair loss, inflammation