I’ve Read that DHT is Critical for Numerous As Yet Unknown Functions of the Male Body

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

I’ve been on Propecia for about 5 years and am concerned about research showing up online, especially about the drug crossing the blood-brain barrier.

According to what I’ve read, medical research shows DHT and 5AR Type-II are absolutely critical for male libido (sex drive), maintenance of proper genital tissue structures/size/function,
seminal fluid production, keeping Estrogen/Estradiol levels in check, mental clarity/function (via assisting the conversion of various neurotransmitters/neurosteroids in the brain), and
numerous other important and as-of-yet unknown functions in the male body.

Do you feel this is all hogwash, or is the hair loss community in for a big change of opinion about the wonder drug Propecia?

Propecia (finasteride 1mg) does not block 100% of DHT. The effectiveness ranges between 60-80% of DHT blocked, which means that DHT is still around and working in the various functions you outlined. I am sure that there are many things we do not know about DHT, but we are using Propecia for what we do know. I can not give you an all clear on side effects on anything that I don’t know. If you don’t trust the FDA’s clearance, that is your prerogative. I’ve had many patients on Propecia for over 10 years now without negative issues and I can only tell you what I’ve witnessed or experienced myself.

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

Mustard and Coconut Oils for Hair?

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

What is the deal with people applying mustard oil,coconut oil and olive oil to their hair? I’ve heard theories like mustard oil and coconut oil help retain protein in the hair and such. There’s a ton of search results on google that state a variety of reasons for applying these oils to the hair,but to me it only seems like loads of myths stacked together.

MSN India recently published an article saying that boiling mustard oil with henna and curry is a home remedy to treat hair loss (see: Hair raising woes?), but I just don’t believe everything I read by my nature. There’s no science to back this up. Maybe you said it best — “loads of myths stacked together”. I tend to agree!

Tags: mustard, coconut, homeopathic, homeopathy, hairloss, hair loss, india, curry, henna

Will Dutasteride Keep My Testosterone Levels Raised Forever?

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

I used to take propecia,however i decided to change to dutasteride as propecia raised my testosterone, however dutasteride has raised my testosterone slightly higher than propecia. My question is, is there any point in taking these medications for my hairloss if they are only going to raise my testosterone inturn producing higher amounts of DHT. Do you think that dutasteride is capable of continuing to keep my testosterone higher than if i wasnt taking it. What i mean is, if i continue to take dutasteride could it keep my testosterone higher than normal for as long as i am taking the medication, if so would you think the best thing for me to do is stop taking it. Or is there a possibility that my testosterone will slowly decrease. I also have i higher sex drive than i ever did, which is due to the raised testosterone from dutasteride. What should i do. please help. Thanks

I don’t know the answer to your question. From my experience, the body often adjusts its testosterone levels downward after the initial rise with Propecia (finasteride), so I would expect the same with dutasteride, but I do not have direct experience with it.

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

I’ve Had a Bald Spot Since I Was Born — Will Medication Regrow Hair?

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

I have had a 0.5″ bald spot on the side of my head about 2″ above my right ear since I was born. Would Rogaine be a viable option to growing hair there?

If the bald spot was with you at birth, I doubt that anything short of a hair transplant into the bald spot will help. Rogaine (minoxidil) will not grow hair where none had been before.

Tags: bald spot, rogaine, minoxidil, hairloss, hair loss

Are Thinning Hairs Likely to Become Stronger with Rogaine and/or Propecia?

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

I am 22 and my hair has always been really thin, from the time I was a baby. Lately I have noticed that the left side of my temple looks pretty normal, but the right side appears to be receding. Although the area that seems to be missing hair has thin blond hair covering it. If there is still thin hair there, would Propecia and/or Rogaine possibly help to grow it back?

I style my hair using a strong gel and blow drying it. Could this be an issue?

I found pictures of myself from 18 months ago, and the left side of my head does not seem to have any loss from that time. Unfortunately I cannot find any pictures of the right side. Typically how quickly would I notice hairloss if it was a major problem?

Thank you for your time.

At 22 years old, men can develop genetic hair loss which is often worse on one side until the other side catches up. Propecia (finasteride 1mg) can increase the size of the hair shaft (making it thicker) if it is miniaturized, particularly in someone of your age. Rogaine (minoxidil) seems to work by prolonging the hair cycle, but while it might also increase shaft thickness, I can’t find evidence for that and I just don’t know. Hair gel and styling are not causing your hair loss and there’s no timetable for how fast your hair falls out (it will differ in each person depending on genetics).

Here’s what I’d suggest you look into: get your hair mapped out for miniaturization, get a diagnosis and a metric for your hair thinning, and then your doctor will probably put you on Propecia, which directly addresses the balding problems in genetic hair loss.

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

Breast Cancer and Finasteride

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

I am confused about the incidence rate of sexual side effects from finasteride. The common number quoted for Propecia (1 mg) is ~1.8%. Studies of Proscar/5 mg finasteride appear to report considerably higher rates of associated sexual dysfunction, e.g., Gormley et al. 1992, PLESS, Mondaini et al. 2007, etc. Are the SD effects that strongly dose dependent? Is this difference related to the age etc. of the treatment group for finasteride 5 mg? Could you comment?

Also, could comment on finasteride and breast cancer. The FDA finasteride info site notes two studies that show breast cancer cases in the experimental group but not the control (again, with 5 mg finasteride). This is concerning.

I am 30, with some recession of hairline (clearly progressed in my older (33) brother), and no vertex hair loss. Given the moderate effectiveness of finasteride on frontal balding, I am more concerned about side effects than I might be otherwise.

Thanks for your help!

Yes, side effects of finasteride are dose dependent.

Although breast cancer is primarily a disease of women, almost 1% of breast cancers occur in men. In 2007, it is estimated that 2,030 men in the U.S. will develop invasive breast cancer (source: eMedicineHealth.com). The study on finasteride 5mg showed that 4 of the 3047 men developed breast cancer. Another study on finasteride 5mg showed that 0 of the 3040 men developed breast cancer, but 2 men (taking a placebo “sugar pill”) developed breast cancer. This information is supplied with every Propecia bottle.

The relationship between breast cancer and finasteride is currently unknown. It is natural to have concerns and you need to have a good doctor who you trust to talk this out with, but over the Internet is not the relationship you need.

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

Scabs After Hair Transplant (with Photos)

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

So I think I am finally ready to have a procedure, on average, how long does it take for the scabbing to go away? I do not want to go back to work before it does.

The last two patients done this past week had no scabs when they left surgery or on the days following surgery. This is what we expect in over 90% of patients and most can go out into the real world without a hat on. Some people keep the scabs longer. The length of time relates to the:

  1. size of the wound (the smaller the wound the shorter the scab period)
  2. washing skills
  3. patient variables

Two of these are in control of the doctor and the patient, while the third is not controlled be addressing #1 and #2 alone.

Update: Here are 2 photos of a patient — the photo on the left was taken under an hour after the surgery of 1500 grafts was complete; the photo on the right was taken 11 days after surgery. This is the typical post-operative appearance of our patient surgeries. Click to enlarge.

 

Tags: scabs, scabbing, hairtransplant, hair transplant, aftercare

Trigeminal Neuralgia and Hair Loss

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

Dr Rassman,
I suffer from Trigeminal Neuralgia (all 3 divisions), as well as Occipital Neuralgia following an accident and subsequent surgery. I have been experiencing burning, stabbing and lancinating pains all over my entire scalp for the past 5 years, and my scalp is continually painful and tender to the touch.

The pain has been intense and my hair has been falling out for the past 4 years, virtually gone on the top, and thin on the sides and bace almost like diffuse hair loss of the entire scalp. In your opinion would the hair loss be as a result of Trigeminal and Occipital neuralgia? It is causing me much distress as there seems no end to the pain and hair loss continuation.

Since I suffer from severe neuralgia I would be extremely grateful for any advice about my hair loss and what could be done to ameliorate it, considering my medical condition. I am 34 years old and male.

There is no direct connection between hair loss and your condition. This is a rare and quite painful disease, and I would expect that hair loss would be worsened with the stress of your intense pain. Stress can accelerate genetic hair loss, so first I would get a diagnosis as to what is the cause of your hair loss and if it is genetic patterned hair loss, then I would certainly go on finasteride daily to slow, stop, and possibly reverse the hair loss. Talk with your doctor about this, as it is a prescription medication.

Tags: trigeminal neuralgia, occipital neuralgia, neuralgia, hairloss, hair loss, pain, stress

Young vs Old — Who Gets More Finasteride Side Effects?

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

Hi Dr. Rassman,
In your extensive experience, have you noticed if younger men have had more side effects from finasteride than older men? Thanks.

I don’t know the answer to this question. I would expect that the young man with a typical initial high testosterone level would have less side effects (of sexual nature) than older men who are more complex with erectile dysfunction (ED) problems that come with age.

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

Dr Rassman, Why Didn’t You Put Your Son on Propecia Sooner?

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

Here’s a question. YOu mentioned in one of your posts that your son suffered from a Norwood 4 MPB before he started taking Propecia. As a hair loss expert and his father, why didn’t you have him go on Propecia much sooner??

To be honest, my son was stubborn about it and just wouldn’t listen to reason. Like the old expression, “The cobbler’s children have no shoes”, I probably could’ve spent more time pressing him about it, but he’s an adult and it was a harsh lesson that he learned. He’s since been on Propecia to halt his hair loss situation with good results.

Tags: propecia, finasteride, hairloss, hair loss

I Want a Hair Transplant, But I Won’t Take Propecia to Maintain

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

Hi, I have read before that you will only do HTs on men who agree to take propecia, and are hesitant to do it on young people. I am 22 and cannot take Propecia due to side effects, but I now have a prominent bald spot in the front of my head. The thing is, I would be happy to get a HT very soon, and I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar. It won’t look as stupid as being 22 with a bald spot at the front. This is the prime of my life, and I’m much more concerned with my physical appearance over the next 8 years than I will be for the rest of the years of my life. So why not do HTs on people like me? Of course I want an ethical doctor, but really your 20’s are when looks matter the most.

PropeciaAt the age of 22 (unless you are already completely bald) you would generally not be a good candidate for a hair transplant surgery, particularly with your attitude, which appears immature to me. Surgery can sometimes accelerate hair loss and you may look worse after a surgery. Hair transplantation is a permanent process. 10 years from now you will be 32 years old and you will definitely care how you look. Three of the contributing editors on this site are in their 30s and I don’t believe any one of them would agree with your comment, “I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar“. Even at 64 years old, you will care how you look. Trust me. I have seen plenty of men with your mentality who regret having had a bad surgery in their early twenties and having had accelerated hair loss.

I am not saying you should absolutely not have surgery, because I do not know your specific situation and degree of hair loss, but there has to be some maturity and understanding and realistic expectations with a hair transplant surgery. You should start with a good consultation with a doctor you trust. If it seems that I have been harsh with you, it is because I’m not trying to make a sale, but I am absolutely certain that 90% of the hair transplant doctors out there would love to get your money.

Tags: hairtransplant, hair transplant, propecia, finasteride, hairloss, hair loss

Since There’s Pulling Involved in Closing the Linear Scar, Won’t It Look Like I Had a Face Lift?

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

Any recommended surgeons for this procedure.. so its not so much “hair transplanting”. it more involves cutting your scalp and pulling your hairline forward..Since there’s pulling involved..wouldnt this cause the skin of your faced to be pulled also, making it look as though you had a face lift. Please explain the procedure?. What are some of the side effects of this surgery?? What are suturs, what is the purpose and why does it have to be removed? This sounds dangerous.

Thanks

Your question is very good and I suggest that you read the Single Strip Harvesting page on the NHI website, which explains the fundamentals of the surgery in better detail.

The donor hair from a hair transplant procedure is taken from the back of your scalp and as only about 1/2 inch width is taken, this will not pull your face back like a face lift, not in the slightest. If it did, then my business would boom and I could offer two types of surgery for the price of one!

Sutures are stitches that a doctor uses to close a open wound in surgery. Hair transplant is a very safe outpatient procedure.

Tags: hairloss, hair loss, face lift, hairtransplant, hair transplant, surgery, procedure, outpatient

Crunching the Numbers: Propecia and Frontal Hair Loss

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

My hairline had receded slightly over the years and more so on the corners but was in pretty good shape as of my 45th birthday. But over the past 10 months I’ve noticed a lot of thinning on the hairline and in the area behind it, which I know now is called the mid-anterior scalp. I went to see a local dermatologist/hair transplant specialist who told me that propecia wouldn’t work in that area as it was only effective on the crown. However, he did offer to restore my hairline with 900 grafs for $5,000.

Luckily, I found your site and later read Merck’s report on propecia’s effectiveness for frontal hair loss. After crunching the numbers it seems to me that it works just as well in this region as it does in the back, although it may not be as apparent. Here’s how I got there. At the start of Merck’s vertex study, the average patient’s hair count in a 1 inch circle was 876. After one year of use the average propecia user gained 86 hairs. If we assume that the pre-baldness count per square inch was 1,400 than the average guy restored 16% (86/(1,400-876)) of his lost hair. In the frontal study the average starting hair count per inch was more dense at 1,096. One year later there was a mean gain of 49 hairs so the percentage restored was 16% (49/(1,400-1,096), the same as in the vertex study. Doctor, am I overlooking something? If not, why do so many dermatologists continue to believe that propecia won’t work for frontal hair loss?

If you are thinning in the front (and have some hair there), Propecia is worth a try, but it is not as simple as crunching numbers, as you will still have thinning in the corners. I think you are on the right path of doing research on the matter. Just remember that even a hair transplant procedure will not completely give you back what you lost.

I always tell patients that going to a hair transplant surgeon requires a buyer beware caution. I’m glad that you’re taking charge and believe that Propecia is worth a try for the area you are focusing on before looking for a hair transplant. As to why many doctors believe Propecia will not work at all in the hairline, I’ve addressed this before in Why Is It Difficult to Regrow the Hairline?.

Tags: propecia, frontal, hairline, finasteride, hairloss, hair loss

Allergic to Minoxidil

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

I was put on minoxidil by my dermatologist, but after a few weeks I had an allergic reaction to it, so I stopped it. These little bumps appeared on my upper forehead and on my ears and around my hairline all around my head, and they itched pretty bad. I used Cortaid hydrocortisone 1% for about 5 days afterward to soothe the itching b/c I couldn’t sleep! My question is if the use of the corticosteroid each night before I went to bed for those 5 days is enough to progress my hair loss?

Thanks. Great blog by the way!

Five days of topical steroids should have not long term impact on your hair thinning or loss.

What you think is an allergy to minoxidil actually might relate to the additives in the product (like propylene glycol), not the minoxidil itself. You might try a skin test of something like the Rogaine Foam on your shoulder for a small 1cm patch and see if you get a reaction. The foam is different than the minoxidil solution, putting aside the minoxidil itself.

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