Sperm Quality and Finasteride

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

Hey Doc

You run a super little website on the gamet of hair topics. If I could pick your brain or seek your opinion.

Merck wont be too forthcoming. Obviously there is some info floating out there that there is no real toxicological risk if man conceives with a woman. However are there now reports out there stating that the “quality of the sperm” is affected by taking finasteride. Meaning number of sperm, motility and I even wonder if you have a higher ratio of having a female birth over a male

What are your honest thoughts on this topic? Mighty thanks

From what I am aware of, finasteride 1mg does not affect sperm quality or have a propensity to increase the chances for conceiving a female child. There is no scientific basis behind this.

As I am not adding much information for you, I will write to Merck for a response to your question and appropriate references and then post the answers that they send me.

Tags: sperm, quality, hairloss, hair loss, merck, finasteride, propecia

Does Minoxidil Lose Effectiveness Over the Years?

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

Dear Doctor,

I have been on minoxidil 5% for about 6 years. It has been alright this while holding on to the hair i have without much regrowth. Recently, i feel that my scalp starts to get immune to minoxidil and i can see patches of baldness. Do you know if the effectiveness of minoxidil actually decreases over the years? How long can the effectiveness sustain?

So far, this is the only treatment i have received. Could you kindly advise me on what i can/should do?

For you advice and opinion please. thank you

People who have benefited from minoxidil will continue to sustain some benefit over time, but if your hair loss is progressive, the benefits vary with the status of your hair loss. I don’t know anything about you, so I can not advise you on what you should or should not take.

Tags: minoxidil, hairloss, hair loss, rogaine

My Leg Hair Just Disappeared — My Father Has the Same Condition

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

Hello there,

I’m a 34 male. I’m a non-smoker, very moderate drinker, healthy in every respect. I have lost almost all hair on both of my calf muscles. I’m not excessively hairy, but I do have a full head of hair. This hair loss is the cause of some embarrassment. Now, interestingly my father (62) has the same condition, though a lot more advanced. His legs are totally almost bald! My younger brother (32) has no signs of such loss. But like my father he has experience a good deal of head hair loss. I’m puzzled. And help that you might be able to offer me, would be enormously appreciated.

Many Thanks.

It seems like you have inherited the same gene from your father. The process of apoptosis (cell death) is genetically programmed in hair follicles. See Wikipedia for more on this.

Tags: apoptosis, hairloss, hair loss, leg hair, leg

What Makes a Norwood Class 7 Not a Good Transplant Candidate?

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

I have heard many people say that Norwood 7s are not good hair transplant candidates. However, two of the most successful hair transplants (Bobman and Jotronic) from another medical group were both Norwood 6’s heading towards level 7. What stops them from progressing further after their transplants? If you get a transplant as a 6, is it really that noticeable if you slowly progress to a 7? Is there something I’m missing altogether?

I have many Class 6 and 7 patients with great results from a hair transplant, so yes, it can be done well, but this is an issue of supply and demand with regard to donor hair. In other words, is there enough supply in the back of the head to meet the demands of the bald top? Take a look at Patient ZU from a past blog post (photos below) — now he has 9900 grafts and yet still has plenty of donor hair for more transplant procedures (which he does not need now) and that is because of two reasons:

  1. His scalp had a great laxity to it.
  2. He had a donor density which reflected an original hair population of 175,000 hairs on his head (normal is about 100,000 hairs).

Not everyone is a candidate and the issues that the doctor and the patient must face are one of realistic expectations and an excellent doctor/patient relationship.

Patient ZU – Before:
 Patient ZU – After:

 

Update: More photos! Click to enlarge.

 

Tags: hairtransplant, hair transplant, hairloss, hiar loss, supply, demand, laxity, density

Seasonique and Female Hair Loss

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

Up until last week i was on inderal (for about two months) and went off of it becuase I noticed my hair starting to fall out recently. I also started taking seasonique (birth control) a month ago. Assuming it was the inderal, will my hair grow back? Im also still losing some hair and wonder if it was in fact the seasonique causing it. How long should i wait and see if it was the inderal. If it was the seasonique will it grow back?

SeasoniqueYour birth control Seasonique (levonorgestrel / ethinyl estradiol) does have hair loss listed as a side effect — though it also has increased hair growth as a side effect (see Drugs.com). I really couldn’t say for sure if your hair loss was caused by the your birth control or the hypertension medication Inderal (propranolol), though hair loss is a side effect of many beta blockers (see WebMD). I wouldn’t know if your hair will grow back to its normal state, and though I realize that this answer may sound frustrating, regrowth is not a guarantee for each person. Each person reacts slightly different to each medication.

You need to discuss these issues with the doctors who prescribed these medications to you, and you should not stop or start any medication without discussing it with your physician.

Tags: bcp, seasonique, estradiol, hairloss, hair loss, seasonale, inderal, propranolol, hypertension

My Doctor Told Me I Needed to Take Propecia to Make My Hair Transplants Grow

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

I just had a hair transplant (2 procedures) with a total graft count of about 4100. The area in the crown and just above it only grew partially. My Dr. told me to take propecia to see if it would help. The question is, if it does help and the new transplanted hair begins to grow, will i need to continue the propecia because that hair is “genetically programmed’ to last? Is there any reason that the transplants in that area didn’t grow?

Propecia (finasteride 1mg) will not do much with the transplanted hair. It may help with preventing the shock loss associated with a hair transplant and keeping your native (non-transplanted) hair from falling out, but the story that you need to take Propecia to grow your transplanted hair is just not true. You need to ask your doctor about this and have him/her explain to you WHY it is being recommended. Maybe you misunderstood your doctor’s advice.

If transplants in an area fail to show any growth after a year, there was something terribly wrong with the surgery. As always, I am flattered you would ask me, but having had surgery twice, you should have a good relationship with your doctor to ask questions pertinent to hair growth.

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

Pain, Inflammation, then Hair Loss

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

About a year ago I noticed I had some pain in my vertex. No itching. I went to my dermatologist who said it was seborrheic dermatitis – as my vertex was red and inflamed. It is uncomfortable to the touch, and touching the hairs there hurts. Since then it has come and gone, but I have started to thin quickly on the vertex, and see scalp now even when dry. I have no hairloss in my father or older brother, and I am 33. I know you’ll say get mapped for miniaturization, but my derm said the loss wasn’t bad, saw no MPB and would not prescribe propecia yet. He said MPB is not associated with pain. Still it is thinning quickly, and only in the spot it hurts – the vertex. So, 2 questions. Is it normal just to have pain on the vertex and be thinning there from just from SD? And in your practice, have you ever seen pain associated with MPB? I just want my hair back and the pain to go away so I can touch my scalp.

Thanks!

Your dermatologist is correct in stating male pattern baldness (MPB) is not associated with pain. It seems you have some sort of inflammation on your scalp and I would follow up with your dermatologist to treat the underlying problem. You may have some hair loss and have seborrheic dermatitis (SD) at the same time, though if you do, the SD may not be the cause of the thinning hair. If it is not related to the MPB, your hair should grow back. The mapping of your scalp tells the health of the hair in the crown, something that you should want to know.

Tags: seborrheic dermatitis, hairloss, hair loss, mpb, inflammation, dermatology

If Propecia Can’t Stop Progressive Hair Loss, How Can it Regrow Hair?

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

If Propecia eventually can’t stop the natural hair loss progression, then how does that explain it growing hair again in people who take it?

Every drug has limitations. Propecia (finasteride 1mg) has its greatest effect in the first two years, but it’s important to note that it still works even after those first two years by slowing the hair loss. The drug may reverse hair loss in younger men, particularly if the loss occurred within the past couple of years.

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

Hair Coloring and Propecia

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

Dr. Rassman,
I have used “Just for Men” hair coloring in the past and am starting on a treatment of finasteride. Could you recommend a hair coloring product, “Just for Men” or any other, that will not damage my hair or that has ingredients less likely to cause damage

Hair coloring will not affect genetic balding or damage your hair as long as you use the product as directed and it is a commercial grade product purchased from a reliable source. Taking finasteride and coloring your hair are unrelated. I don’t know much about coloring agents to advise you further.

Tags: hair color, hair dye, finasteride, propecia, hairloss, hair loss

Acupunture and Hair Growth?

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

Acupuncture, and hair regrowth? is it possible? is it safe?

I believe acupunture is safe, but I highly doubt it will grow hair. If there is good scientific evidence to the contrary, I would love to hear about it.

Tags: acupuncture, accupuncture, hairloss, hair loss, hair growth

Sodium Lauryl Sulfate and Hair Loss

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

Dear Dr Rassman,

I am a regular reader of your blog, so first of all let me congratulate you on the highly informative and useful resource you have created.

I am a 21 year old male with thinning at the crown and right-had side of the scalp. My question regards shampoo and hair loss.

I came across this article which describes the alleged effect of Sodium Lauryl Sulfate (SLS) found in most commercial shampoos nowadays. Apparently due to the acidic nature of the chemical, it could be blamed for accelerated hair loss.

First of all, I’m not suggesting that MPB in men is caused by this chemical, otherwise we’d all be bald! The bit of the article that interests me is the part which suggests that it (SLS) can cause damage to hair follicles which have just shed their minaturized hair due to MPB, thus accelerating the balding process.

All in all, I’m simply seeking your medical opinion on this issue and asking if you think it’s worth trying an SLS-free shampoo.

Keep up the good work

ShampooBased on the article link you sent, sodium lauryl sulfate (SLS) does not look like a safe additive in shampoos, BUT by using the powers of the Internet (*cough* Google search), I have found that this is nothing more than an urban myth. Yes, it is true that SLS is used in de-greasers and yet is also found in shampoo (and toothpaste), but it is found in the personal hygiene products at much lower levels than the stuff used to clean your garage floor. If you have very weak and miniaturized hair, you can try using an SLS-free shampoo to see if that makes a difference. I don’t have an answer one way or another, and if you are concerned, using SLS-free shampoo shouldn’t be a problem. There are a number of shampoos that do not contain SLS, marketed perfectly for people that buy into hysteria. However, I think it is way overblown and wouldn’t concern myself with it.

You can find much more information about SLS at Snopes.com, a great site for debunking myths. Also, HairSite.com has a good point / counterpoint breakdown showing both sides of the argument. Even the American Cancer Society has spoken out on how the SLS rumor is completely false.

Tags: sodium lauryl sulfate, sls, hairloss, hair loss, myth, shampoo, cancer

Pantogar and MPB?

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

I’m a 27 year old male with slight receding hairline and hair loss on the top of the head which already has slight balding. Currently i’m taking Pantogar for around 2-3weeks, although it’s stated i need to wait for around 3 months for results but instead of seeing some improvements it seems to have a reserval effect instead. Is Pantogar really suitable for all? Is it suitable for someone of my age? If not, what is? Preferably without side effects please. Seek your kind advise on this please.

PantogarPantogar is a supplement made by German pharmaceutical company Merz (not to be confused with Merck, the makers of Propecia). It does not offer anything that taking chicken soup won’t cure. In other words, I don’t see anything in Pantogar that will treat your male pattern baldness. The active ingredients of Pantogar, according to the product’s website, are vitamin B1, calcium D-pantothenate, vigar-yeast, L-cystine, keratin, and para-aminobenzoic acid. None of those will regrow your hair or halt your hair loss if you have male pattern baldness.

Propecia (finasteride 1mg) and minoxidil are the only medications I’ll recommend for hair loss treatment, as they are the only products FDA approved and proven to treat hair loss. Side effects do not occur in everyone, and Propecia is a prescription medication so you should see your doctor about this.

Tags: pantogar, hairloss, hair loss, mpb, keratin, propecia, finasteride, minoxidil, rogaine, supplement, merz

What Percentage of Middle Age Men Experience Each Norwood Class?

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

Hi,

I just wanted to know if there were any solid statistics on what percentage of men are norwood II, III etc. in middle age?

Thanks

There are two studies that I know of that were published on the subject. Drs. O’Tar Norwood and James Hamilton both did studies and each came up with different numbers.

Although there’s no general agreement on the statistics for the frequency of balding, it’s believed that advanced balding (defined as a Norwood Class 5, 6, or 7 pattern) occurs in about 35% of balding men. Balding itself is present in approximately half of all men over the age of 45. For those that fall into the 35% of Class 5, 6, or 7 pattern balding, this doesn’t mean that there’s a complete absence of hair in the balding area, as some hair may remain. Norwood Class 2 and 3 patterns appear in about 42% of middle aged men, however, I do not look at Class 2 patterns as much more than men with a mature male hairline.

Update: I removed the statistical breakdown from Dr. Hamilton’s study that I initially posted, because they’re unclear and they are widely different than other published statistics.

Tags: norwood, hamilton, hairloss, hair loss, statistics, stats, percentage

Is My Alcohol Increase Related to My Hair Loss Increase?

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

I’m a Korean male 34 yrs old and began noticing 2 years ago that my hair was beginning to thin out. By thin out I mean that it was falling out and many of the hairs were now thinner. I’ve always had a very thick head of hair and never thought that baldness would ever be something I’d have to worry about. Concerned I went to a dermatologist who seemed to think I was a bit crazy with this concern but suggested that I begin using propecia and rogaine as they have a synergistic effect. At first there seemed to be a slow down of loss but recently it seems to have accelerated. The hairs that fell out in the past seemed to all be rather thin or thinner at the root end now the hairs falling out seem to be thicker otherwise healthy looking. My routine and diet have not changed except for an increase in alcohol intake. I wonder why I’m seeing an increase in loss all of a sudden and why thicker hairs are now coming out in greater volume. It seems that medications are doing little to maintain my hair and certainly are not resulting in any new growth. Is it possible that I’m seeing an increase in loss due to a natural shedding rhythm? I’d estimate that in the last 2 years I’ve lost 25-35% of my hair. My hairline is still in tact and to someone not looking for the loss it would not appear that I have anything to worry about, but I notice. It’s especiallly noticable when wet. My scalp is expossed all over whereas it used to be even with a wet head you would not be able to see much scalp. Furthermore I’m adopted so I have no genetic history available. One last thing regarding the increase in alcohol; could this contribute to the loss or lack of result from the medication?

Thanks for your time.

I very much doubt that alcohol is related to your hair loss… unless your diet is compromised, which could then make it an offending cause of hair loss. Even alcoholics can have full heads of hair, though.

I am a bit confused what you are saying about the dermatologist who thought you were “crazy” and prescribed you Propecia. Is there a definite diagnosis of male pattern baldness or are you just taking these medications without a diagnosis? What are you really treating? It sounds like you need a good miniaturization study to find what pattern of hair loss you have and how you are losing hair. It may be just a cycle, but I really cannot say. Unless you have male patten baldness (MPB), Propecia will not help.

Tags: propecia, finasteride, hairloss, hair loss, alcohol, alcoholic, diet

Is Long Hair More Susceptible to Falling Out?

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

So it isnt true that hair is more susceptible to fall out when its longer? I ask you this because i am from a pretty bald family, and i grew my hair out pretty long when i was 17, and three years later my hair has never been the same density wise as it was before i had long hair. I was only wondering if growing ones hair out longer could kick start the genetic balding trait, if youve ever heard of that happening.
thanks!

That is a myth. The length of your hair has nothing to do with genetic balding, unless of course you are pulling on your long hair or getting it caught in things and having it ripped out… but that is another story.

Remember that as you age, if you do have male pattern baldness (genetic hair loss), your hair will thin until your final pattern is achieved. Get yourself checked out for miniaturization if you think that you may have genetic hair loss.

Tags: hairloss, hair loss, long hair