I’m Taking Generic Finasteride and Dutasteride on Alternate Days — Hair Loss Hasn’t Slowed Down

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

Hello

I started to notice that I was losing my hair in late 2005. I started on Propecia (in qutie a panic) as soon as possible. Later I switched to Fincar and now take that on alternate days with Dutagen (generic dutasteride). However my hair loss has not even slowed or stopped. Is it possible that I am immune somehow to both?

My apologies if this is posted elsewhere. Many thanks for your help

Hair loss does not occur overnight and you should not panic or make hasty decisions based on fear. I doubt that you are immune to these drugs. In other words, I doubt that they aren’t working. I am sure that you are getting some benefit, albeit possibly too small a benefit for you to notice (assuming that you have genetic MPB).

I do not generally recommend finasteride and dutasteride in combination. More importantly, you may be doing you body more harm than good by choosing and experimenting with different medications no matter how safe you may perceive these medications to be. Dutasteride has many negative side effects and it does not necessarily grow more hair than finasteride. Please read the recent post, Update on Dutasteride.

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

Question Regarding the Norwood Scale

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

I have a question regarding the Norwood scale. The Norwood 2 scale shows the temporal hairline just slightly past the front edge of the side burn. With no frontal loss of hair on the crown or widows peak. The Norwood 3 shows the temporal area receeded far past the front edge of the side burn and almost to the ears.

My question is that if the widows, or crows peak area has not receeded or thinned along the front edge, and if the temporal area is not further back or just slightly past the front edge of the sideburn, would this always indicate a 2?

Because my hair shows the above listed signs of a Norwood 2, but when I part my hair you can see the curve of my head, and it seems like it’s worse then a 2, but the front edge hasn’t receeded or thinned like the Norwood 3. Am I just one of those guys with a Norwood 2 that the crows peak just looks lanoger then in the scale? My hairline is very much like that of the actor, Jude Law.

The most widely used classification scale for hair loss is a generalization based on what Dr. O’Tar Norwood observed in men. It was originally created by Dr. James Hamilton in the 1950s and then revised and published by Dr. Norwood in 1975. There are many variables to the Norwood classifications and other variants of the male hair loss pattern. You may not fit in to the Norwood 2 or 3… and that is perfectly normal. The Norwood scale can be found below:

Norwood Chart
Tags: norwood, scale, hairloss, hair loss, classification, chart

Look at These Procyanidin B-2 (from Apples) Before and After Photos — Are They Fake?

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

Hello Dr. Rassman,

Thank you for always replying to my questions.. you’re truly a great doctor, for taking the time to maintain this blog for us balding men.. it’s a huge job, and you’re doing it well!
Anyway, I came across a site citing the benefits of apple polys for hair growth.. applypoly.com

There’s 2 before-after pics they provided. Can you tell if it’s doctored (no pun intended)? It looks a little fake to me, but I’m not sure..

Thanks!

I am aware of Procyanidin B-2 from Apple Poly and I personally inquired with the company a year or so ago for more information. There were a few journal articles published that seemed promising, but that is about the extent of it. My old adage of “buyer beware” still stands, but I am also open to new discoveries.

I cannot validate their claims or their before/after photographs, although they are impressive.

Tags: apple, procyanidin b-2, hairloss, hair loss, applepoly

How Long Can I Expect Female Hair Loss to Continue After Gastric Bypass?

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

(female) I know this has been asked before regarding hair loss and gastric bypass surgery but I have not seen my specific questions answered. I had VSG surgery the end of August 07…I started losing a lot of hair in December…it is January now and even more hair is coming out then it was in December. I have even ordered some hair extensions because the loss is so great.

My questions:

1. How long can I expect this loss to continue?
2. Is there anything I can be doing to promote hair growth or to prevent any further hair from coming out?
3. I am doing everything textbook..taking all of my supplements..getting in 70-80grams of protein in daily…taking my vitamins and just recently started taking Biotin 5000mcg daily.

Thanks and hoping not to go bald here :-)

You must be careful that you have a good diet. Gastric bypass produces weight loss… and weight loss with dietary changes may keep your hair down. This may be the price of the surgery. I don’t know that the hair loss will get much better quickly. Only time will tell.

Tags: gastric bypass, hairloss, hair loss, diet, weight, female, women, woman

Bald Spot After a Large Bump on Head

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

My son hit the side of his head a few months ago and got a rather large bump. I have noticed a bald spot right where he hit it and was wondering if this has anything to do with that?

Direct trauma can sometimes cause hair loss. If you are concerned I’d take him to see doctor, but otherwise I would give it 8 months or so to see if hair will grow back.

Tags: trauma, injury, head, scalp, bump, hairloss, hair loss

Does Hair Transplanted from Head to Pubic Area Change Characteristics?

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

I read one of your blogs re: Pubic hair transplant, which refers to Head to pubic area. I assume this means that you use hair from the head to transplant into the pubic region. Does the transplanted hair take on the characteristics of pubic hair (thicker, coarser etc) or does it retain the charactistics of scalp hair (finer, longer growing)..

Thank you

The hair character generally is maintained like its original location. I have seen some more waviness in those with straight hair when it is moved to the pubic area, but it does not become kinky.

Tags: pubic, hairtransplant, hair transplant, hairloss, hair loss, character

Propecia Gave Me Side Effects — How Can I Get My Sex Drive Back?

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

I am concerned about the loss of sex drive from taking propecia. I took propecia for about 6 months and my sex drive was non existant. I stopped taking it over a year ago and it has returned, some what, but not nearly where it was before. Is there a product that will help it return, or anything that can be done? I would rather be bald with a strong sex drive, than a head full of hair without one.

Sex driveYou need to go see your doctor for a physical examination and possible testing. While Propecia can cause a decreased sex drive (in 1 to 2% of men), it is temporary since the drug only lasts in your blood stream for about one day. After one year, I hardy doubt your sexual problem is due to Propecia. You need to see a doctor for further evaluation. In fact, erectile dysfunction may be one of the first signs of an underlying medical problem.

Here are a few facts about sex drive / erectile dysfunction / impotence that I found at Minnesota Men’s Health Center:

  • One in 10 men (10%) in the world have erectile dysfunction.
  • 30 million men in the United States have erectile dysfunction.
  • 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
  • The likelihood of erectile dysfunction increases with age: 39% at age 40, 65% over the age of 65.
  • Smokers have a higher likelihood of erectile dysfunction.
  • Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age.

And from the Mayo Clinic:

Nonphysical causes:

  • Psychological problems. The most common nonphysical causes are stress, anxiety and fatigue. Impotence is also an occasional side effect of psychological problems such as depression.
  • Negative feelings. Feelings that you express toward your sexual partner — or that are expressed by your sexual partner — such as resentment, hostility or lack of interest also can be a factor in erectile dysfunction.

Physical causes:

  • Nerve damage from longstanding diabetes (diabetic neuropathy)
  • Cardiovascular disorders affecting the blood supply to the pelvis
  • Certain prescription medications
  • Operations for cancer of the prostate
  • Fractures that injure the spinal cord
  • Multiple sclerosis
  • Hormonal disorders
  • Alcoholism and other forms of drug abuse

The physical and nonphysical causes of erectile dysfunction commonly interact. For instance, a minor physical problem that slows sexual response may cause anxiety about attaining an erection. Then the anxiety can worsen your erectile dysfunction.

Tags: hairloss, hair loss, sex drive, side effect, ed, erectile dysfunction, propecia, finasteride

Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

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

Dr. Rassman,

I’m a 32-year-old with a Norwood 2-3 pattern in the front and some very mild but immistakable loss in the Crown. I very recently started taking propecia and am strongly considering trying that in conjunction with Rogaine Foam. Your esteemed colleague, Dr. Bernstein recommends the use of both of these products simultaneously, right off the bat. You suggest that one hold off on Rogaine until propecia has been shown to be ineffective, as it causes “dependencies”…

Not to create friction, but what is the source of your disagreement on this? What do you mean by “dependencies”? I don’t understand because doesn’t propecia create a dependency as well? (i.e. if you stop taking it, you lose all of the benefit)…

There is no disagreement. I would also recommend Propecia and Rogaine. But, think ahead for a second:

  1. Once you start both Propecia and Rogaine, you need to take both for life.
  2. You will never really know which medication is working more or less if you start both at the same time.
  3. Rogaine can be difficult for many men to follow the twice a day application (a pill like Propecia is easier to deal with and faster to take).

If you can accept the above, I agree you should take both Rogaine (minoxidil) and Propecia (finasteride 1mg). Both create the same dependencies and I’ve never tried to downplay that. If you stop either medication, the benefits received (maintaining or regrowing hair) will be lost, therefore you will depend on both to keep your hair loss in check. The medications work differently, so finasteride can’t retain hair grown by minoxidil and vice versa.

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

Mistaking a Large Hair Whorl with Crown Hair Loss

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

I want to express my appreciation for a good website to Drs. Rassman, Pak, Gazoni, and Zeballos. As a daily reader on this site, I see that Drs. Pak, Gazoni, and Zeballos never get any notice though they are contributing editors.

I have two questions:

The first being that does balding on the crown always start in the center or can it start on the right or left sides and progress to the other side? It seems (what I see everyday) that crown balding starts in the dead center of the crown.

Secondly, is it common for most men to mistake the beginnings of balding on the crown as the result of having a large “hair-swirl” which can give the appearance of miniaturization? I notice some men have large “hair-swirls” and some have small or even hardly detectable “hair-swirls.”

Even if you cannot answer these questions due to the many you receive, thank you for providing this informative website! If you do answer these questions, thank you in advance!

A good analysis for miniaturization with microscopic examination will show what is balding and what is not. Generally, crown balding does not start in the center of the crown, but just in front of the swirl (or whorl, as it is also known). The actual swirl and the hair behind it may vary with different degrees of miniaturization. It is not unusual for the hair behind the swirl to be stronger and less miniaturized than the hair immediately in front of the swirl, and this distinction may point to the final pattern of hair loss in a particular patient.

Tags: whorl, swirl, crown, hairloss, hair loss, balding

How Long Can Propecia Slow the Balding Process?

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

When you say that Propecia slows down the balding process, are you talking months? Years? Decades?

Does this differ by person? If so, what’s the most common occurence for young men in their early to mid twenties with early MPB? Do they keep their hair for just a couple more years or do the effects last until their 40’s?

Yes, it differs in each person. Propecia can work wonders on men in the early balding years 20s to 30s, but it can also work wonders on men in their 70s (which I have seen). Some readers report that they don’t see the same resistance to DHT after 5 or 6 years, some report that Propecia is still working perfectly fine for over 10 years. Please understand that this is very individualized and I do not know of any statistical breakdown of age groups. Also keep in mind that even if you are still losing hair when taking Propecia, the RATE of hair loss is likely still slower than if you were not taking the medication at all.

Tags: finasteride, propecia, hairloss, hair loss

Hair Transplants for Long Hair?

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

I have long hair, and I’ve been taking Propecia for around a year. The results seem to be good, however, I am considering a transplant. In all the pictures I have seen, men receiving transplants tend to have very short hair. My question is this; do I need cut my hair short for a transplant? Please let me know if pictures would better assist your assesment.

Thanks

No, you do not need to cut your hair short for a hair transplant. Actually, long hair will cover up the surgery in most people and we routinely recommend keeping the hair as long as possible. You may set up a telephone photo consultation with us by filling out the form here or calling 800-NEW-HAIR. If you’d like to send photos, please use the address on the Contact (and reference this post).

Tags: hairtransplant, hair transplant, length, hairloss, hair loss, long hair

Hey Doc!

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

DoctorHello Doctor.
I notice that a lot of questions here start with “hey Doc,” or “Wassup Doc,” or something similar.

Does this bother you at all? I’m sure if I had spent years in education and training to get my M.D. and everyone kept referring to me as “Doc” rather than “Doctor”, i’d be slightly annoyed but maybe that’s because my ego is larger than yours. It seems only polite to refer to a professional such as yourself by your proper title, or at least, Mr. Rassman.

I also notice your hairline seems quite healthy. If you don’t mind me asking, are you on medications yourself or are you simply one of the lucky healthy-haired males?

I really don’t have a doctor complex and many people get familiar with me and I don’t mind. As long as they aren’t calling me something vulgar…

My frontal hairline is natural, but the crown of my head is transplanted.

Tags: doctor, doc, medical, hairloss, hair loss, education

What Causes DUPA and Can Hair Be Restored?

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

If Diffuse Unpatterned Alopecia is not related to DHT, the main cause of hair loss, then what causes DUPA. So if DHT level’s are not related to Diffuse Unpatterned Alopica, then that means that there should be some hope of restoration since DHT is not the cause of DUPA.

We do not know what causes DUPA. I have had some success with finasteride with patients having DUPA, but as it is not statistical and more anecdotal, I can not even recommend this approach with any real certainty of success.

Tags: dupa, diffuse unpatterned alopecia, hairloss, hair loss, dht, propecia, finasteride

Hair Loss Clinic Told Me That It’s Illegal to Prescribe Proscar Since I Don’t Have Prostate Problems

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

ive recently went to a hairloss clinic in west covina to see if i would beable to get a prescription for proscar. and he tells me thats its illigal to prescribe if i dont have prostate cancer… i dont think he was a doctor because he kept trying to sell me shampoo and saw palleto for 40 bucks..a month. i pass cuz im poor.. anyways is it true? what can i do

ProscarIt sounds entirely possible that the person you met with was not a doctor. Neither shampoo or saw palmetto are scientifically proven to work in treating male pattern baldness. Finasteride is a medication that has been proven to help MPB, but only a doctor can prescribe it. Finasteride is the generic name for Propecia (for hair loss in 1mg strength) and Proscar (for prostate in 5mg strength).

It would be illegal for a patient to claim a prescription for Proscar under most insurances (when prescribed for hair loss), but you should look to your insurance policy and see the benefits of your plan. However, it is not illegal for doctors to prescribe Proscar for hair loss and it is most proper for the doctor to tell the pharmacist that the pill should be cut into 4 pieces to come close to the recommended, 1mg dose (easier to cut into 4 equal parts, rather than 5 parts). Generally if a doctor prescribes Proscar to treat hair loss, they will instruct the patient to cut the pill into 4 equal pieces for the treatment of male pattern baldness.

To clarify another misconception, Proscar in full strength (finasteride 5mg) is used to treat certain prostate conditions, but not prostate cancer. In fact, Proscar has been proven to reduce prostate cancer risk by up to 25%!

I would recommend that you see an actual doctor and not a salesman.

Tags: proscar, propecia, finasteride, prostate, hairloss, hair loss, clinic, doctor, salesman

Body Hair Transplant — A Case of 100% Failure

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

I saw a patient earlier this week who had a well known surgeon place hundreds of body hair grafts into a bald area of his scalp about two years ago. This surgeon is one who promotes his body hair transplant procedures quite heavily, particularly on various websites and hair loss forums. No, I won’t name names (do your research and you’ll probably figure it out). There was 100% failure for the body hair to grow. Yes, a complete disaster. As one might expect, this patient was quite angry because he spent $11,000 and had great hope for this procedure, as he was depleted of donor hair from the back of the scalp.

Those looking to use body hair to transplant into their scalps should strongly consider other options if they are available, as this is not the first time something like this has occurred. I’ve read various reports and have heard quite a bit about this level of growth failure before.

Respectfully, the patient has requested that his photos not be published here.

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