Worse Case Scenario — I’m Allergic to Minoxidil and Propecia Makes Me Slow

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

I’m allergic to minoxidil and Propecia makes me stumble over words. I’ve been off Propecia for 8 days now and I’m pretty much back to how I was before Propecia, wit wise. My hair was thinning before and it still lookes the same now.

The only other real options I have are this saw palmetto and soy/equol. If this equol does inhibit DHT from working, does this mean we have to consume soy everyday? What if we go on a month safari to somewhere in Africa where soy is not prevalent? WHat then?

I am not sure if soy/equol actually inhibits DHT. For that matter I am not convinced that even saw palmetto inhibits DHT, but there are some suggestions that it does impact the prostate and may impact the hair. It might be a good gamble to use this provided that saw palmetto does not produce the same effects on you. I have not seen any good scientific literature pointing to these claims. Here is a seemingly unbiased summary I found from a simple Google search regarding saw palmetto: Pharmacology of Saw Palmetto.

You, the consumers, drive this industry as we are all trying to find the next best thing. The cure for balding, the cure for aging, etc. We latch on to loose associations and circumstantial evidence. We read things on the Internet which are not all true. We like to believe in commercials and promotions (“looks good, sounds good, must be a true” type of attitude).

That’s my two cents worth of rambling, but if you are asking for my personal opinion as a physician, my answer is: I suppose it won’t hurt, but it probably won’t work. I always say “It’s a buyer beware market,” but maybe I should rephrase the last comment as “It’s a price is right market…”. For a few dollars (or euros, pounds, etc) we seem to think it may be worth it.

By the way, who says there is no soy in Africa?

Tags: soy, equol, hairloss, hair loss, finasteride, propecia, minoxidil, saw palmetto

Propecia Costs Per Year

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

how long does one need to use propecia to witness the benefits, and does it require continued usage–as in ad infinitum? how much does a yearly prescription cost on average?

CostPropecia runs between $700-900 / year, plus there are rebates offered by the drug company Merck. Cutting Proscar into 4 pieces will reduce the costs to about 1/3rd, but your doctor will need to be willing to prescribe that to you. Proscar is a prostate medication (finasteride 5mg), while Propecia is the same drug, but in a 1mg pill and FDA approved for the treatment of genetic male pattern hair loss.

There is a generic Proscar available, which also helps cut the cost. A generic Propecia is yet to be available legally in the U.S. due to patent laws.

Tags: propecia, finasteride, hairloss, hair loss, price, cost, medication

Doctors Disagree About Using Combo of Propecia and Rogaine

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

I’m a male in my early 20s and I noticed my temples are now going beyond a NW2 and my frontal region seems less dense. I been to my dermatologist and Dr. Bernstein and both advised me to use Rogaine and Propecia. Should I really do that? I’m ok with Propecia but Rogaine is just too much work! Do you think Propecia is enough or should I listen to those doctors? I read on this blog you don’t recommend combo treatment for various reasons. But I been reading on the net that the combo treatment is a good way to go for frontal loss. I’m confused.

There is no correct answer to your inquiry. Opinions differ. I don’t usually recommend Rogaine (minoxidil) for those of your age unless the hair loss can not be controlled on Propecia (finasteride 1mg). For those who stop the loss and get regrowth from daily Propecia, there is no reason to double the medications. When you start minoxidil you become dependent upon it, so I separate the decision, first with Propecia for 8-12 months and then I re-evaluate the situation.

There is nothing wrong with using both medications at the get-go, but you’re going to have to use both for life, and won’t know which medication is providing visible benefits (so stopping one to cut costs, etc, is going to be a risk).

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

Where Are the Published LaserComb Trial Results That Lexington Promised?

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

Has Lexington fulfilled their promise (that they made over 3 months ago on this very site) by publishing their FDA lasercomb clearance study in any peer reviewed medical journals?

You’re right. A rep for Lexington posted in the comments back in March of this year stating, in part —
“We are currently drafting a medical review of the study to be submitted to a peer-reviewed journal. We have every intention of publishing the study and making the full results available for public scrutiny.”

I’ve yet to see anything of the sort. We are all waiting…

Tags: lexington, hairmax, lasercomb, laser comb, hairloss, hair loss, laser, fda

Can Toppik Fibers Clog Scalp Pores?

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

Hi Dr. Rassman,
Not sure if you’ve heard of any negative feedback about Toppik fibers, but I’ve been using Toppik for approx. 1 month now just to help camouflage the thinning areas. As we know, not all of the fibers adhere themselves to the hair shaft and many will fall to the scalp. I also use hair spray to keep my hair in place. My question is, will the Toppik fibers on my scalp along with the hair spray on top of the fibers, suffocate the existing hair and also will it keep any new hair from growing due to the possibility of clogging the pores on my scalp?

Note: I don’t use much Toppik, but when I should scratch my scalp in the area where I’ve applied the fibers, I’ve noticed the fibers under my finger nails.

Thank you in advance.

Toppik takes time to get completely out of your hair, possibly a number of good hair washes. If you wash regularly, Toppik should not cause you problems. Clogging a hair pore is highly overrated as a cause of hair problems, as the direction of sebum movement is from the inside out. The sebum in effect keeps the foreign particles out of the pores.

Tags: hairloss, hair loss, toppik, fiber, pores

After 10 Months on Rogaine Foam, My Hair Characteristics Have Changed Drastically

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

Dr. Rassman,
I actually asked a question on this site before. I’ve been using Rogaine Foam since September 2007, on the back of my head and the hairline. I was 15 then.

My hair was always somewhat thick, and soft. My hairline had been receding and a dermatologist also said that I had a growing bald spot on the back of my head, based on pictures he took. It worked fine, and in January the dermatologist was actually amazed at the results, especially in the bald spot which was practically eliminated by new, albeit smaller hairs.

Now it’s July 2008, almost 10 months later, and my hair has turned from consistently straight and thick to almost two different hairstyles: the back and sides have all become black, and curly. Really curly. And the rest has become thin and weak and lighter than before. My hairline is straight, but right in the center the hair is especially thin and it looks almost liek a second bald spot.

Whereas when I started, no one could notice the bald spot in the back of my head (although some pointed out a receding hairline), everyone can tell that the hair in the front is thinner than normal.

What’s wrong with my hair?

I would need to examine you to understand the variety of problems you are showing in your hair. I’m sorry, but in your case I simply can’t provide much without seeing the problem in person. It sounds like you haven’t seen your dermatologist since January — I’d setup another appointment for a follow-up.

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

Inherited Father’s Oily Scalp — Will I Also Have His Hair Loss?

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

Hi Doctor,

Just a quick question. My cousins and I are curious about the likelihood of us inheriting our fathers’ hair. Our curiosity was piqued after we (all three of us) had sebaceous cysts removed from our scalps in the last year. My father and uncle have also had cysts removed from their heads several times over the decades. Despite the presence of all this sebum (I understand an over-production is related to high-levels of DHT), and the not-so-clinical removal scars, the two men have full heads of jet-black hair – not bad for guys in their seventies!

What we’re asking: we’ve obviously inherited the oily scalps. Is there any relationship between this and a resistance to the effects of DHT with regard to hairloss. I’m 26 and have the same hair-colour and widows-peak hairline as my father. My cousins are in their early thirties and similarly show no sign of baldness. Just curious. Thanks.

These are probably related to different genes, but your probability of inheriting it from the male side of the family may be reasonably expected. I don’t know of any way to tell for sure, so you may just have to wait it out.

Tags: oily scalp, hairloss, hair loss, genetic, gene, father

Dutasteride vs Propecia

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

Is dutasteride better for treating hair loss than Propecia?

In the Journal of the American Academy of Dermatology (Volume 55, Issue 6, December 2006), a 24 week randomized placebo-controlled study compared the two medications. DHT levels went down and testosterone levels went up on dutasteride. The results of this limited study suggested that in high doses, dutasteride had more hair growth than Propecia (finasteride). A total of 416 men were tested. There were more side effects on the higher doses of dutasteride.

This question has come up over and over again. We are waiting for the results of the Korean study to understand the meaning of the above publication. To get to the root of the question of effectiveness, we must know the results of dutasteride over a long time period and we must know the risks. There are reports of not only increased side effects such as more impotence or decreased libido, but there is also a significant impact on sperm count and possibly fertility in men. As there is a long half life of the dutasteride, the reversible nature of decreased sperm counts are not known. I would not suggest that every person rush to get this medication unless Propecia is a failure and there are reasons for trying the alternative. Please note that dutasteride is FDA approved to treat the prostate (marketed as Avodart), but it is not approved to treat hair loss, so it would be off label for the doctor to prescribe it and most doctors will not take the medical-legal risk for this off label use.

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

I Want Hair Transplanted to Grow Forward

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

Dr. Rassaman

I’ve never posted on this site before so i’ll try to make this question as understandable as i can.

Im a 33 yr. old male who up until about the age of 25 had a female type looking hairline that grew straight up and backwards very close to my eyebrows like a wall of hair,and hair on the sides of my head in front of the temples that grew very close to my eyebrows that came up to meet my unusually low and thick hairline.However i never liked having a hairline that low and that thick,and quite frankly i never liked that it grew straight up and backwards.It just didnt compliment my face at all.I hated it.The hair behind my hairline grows what seems to be almost straight forward in comparison to the hairline which grew straight back.

When my hairline matured and receded along with the sides leaving only the forward growing (yet thick and still full head looking)hair left it totally changed the way my face looked for the better i was in heaven.But now that hair behind the hairline is starting to recede and thin out badly.

My question is is it possible to receive a hair transplant that only replaces the forward growing hair that was originally behind the hairline and the hair on the temporal area only rather than having to have a full thick straight up and back growing looking hairlne???

I ask this because as foremontioned i never looked good with that full thick straight up and back growing looking hairline and i always force combed my hairline forward and i want to be able to only have that hair back that naturally falls forward and not that straight back and low;wall of hair hairline.All of the hairline transplants photos i’ve seen all look like the Dr. tries to give you back that straight up growing looking hairline when you were a teen which never suited me.But i never find someone whos transplant looks like the hair naturally falls forward without that thick straight up wall of hair hairline…………. Is this possible to achieve at this point in time Dr.????

Thank you for your time,it’s very much appreciated.

Men with window’s peaks or even the juvenile hairline may have hair that does not point in the normal forward direction. I have never seen it as a problem for the hairline reconstruction, but I would be hesitant to make a comment about your unusual hairline without examining you personally. When I do a hair transplant in the frontal hairline, the hair is placed pointing forward parallel to the floor and when I go back further, that angle increases upward slightly. If some of the hair is sticking up, I might conclude that the hairs that point up will just follow the ‘crowd’ of the thick transplant hair and be outweighed.

I’d have to either see you in person or if you have access to a video camera and can upload the video somewhere like Youtube, that’d be a great way for me to see your hair (make sure the lighting is good).

Tags: hairtransplant, hair transplant, forward, growth, angle, direction, hairloss, hair loss, widows peak

Adding Rogaine Years After Starting Propecia

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

Dr. Rassman,
I have been on propecia for roughly 6 years. I recently felt that it had lost a little bit of effectiveness, although I am also obsessive compulsive which probably played into that line of thinking. My question is if I begin to add rogaine to my regimen will I have some benefit. I guess I am confused whether or not any lost hair is salvageable after 6 years. Would the propecia keep some hairs salvageable for rogaine to take effect after this long?

Lost hair is likely not “salvageable” after many years. Remember that there is no cure for genetic hair loss. Drugs such as Propecia (finasteride 1mg) will slow the process. Propecia is not losing its effectiveness, your hair loss process is continuing so that your genetic predisposition is showing through. Or, as you said, your OCD may be causing you to over-examine your hair to try and find fault where there is none. I couldn’t say beyond speculation.

Hairs grown or maintained from Propecia will not be maintained using Rogaine, so if you stop taking Propecia, you will likely have “catch up” hair loss. In other words, your hair loss will progress to be as if you never took the drug in the first place. I believe Rogaine (minoxidil) can help, but it is the same story as Propecia on its limitations.

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

Get a Scalp Biopsy!

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

(female)
Could you please make sure you tell everyone to get a Scalp Biopsy in all of your replys. It took 3 years of different “doctors” before I asked for one. Immediately it determined what type of Baldness I had and I was given appropriate drugs for the diagnosis. Many thanks

Some women have telogen effluviums, diffuse alopecia areata, and other conditions. The use of scalp biopsy for some women is part of the diagnostic work-up. Be sure that the doctor who does it is a dermatologist and works with a good dermatopathologist who knows how to read what he/she sees under the microscope.

Tags: hairloss, hair loss, biopsy, scalp biopsy, telogen effluvium

Teen Dyed Hair 6 Times in 8 Months

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

hi, I’m 17, and about 8 months ago i started dying my hair. I am naturally ginger and have dyed it around 6 times in the last 8 months. I have noticed alot recently that my hair is falling out around the crown, but the hair that falls out appears to have a root on but does not have ginger half to it. whereas if i tug a hair out it is half guinger half black. This is causing me alot of concern and im frequently being bullied about my thing hair at the back. I am growing the colour out back to my natural colour hoping that the dying is causing my hair to fall out. But I dont think it is this because the roots are falling out, plaese advise me and help me. It will be appreciated so much

Thankyou.

Leave your hair alone and wait until it replaces itself. Your frequent dying may have damaged some of the hair. Use a good quality shampoo and conditioner, no dyes. Hair grows out at a rate of 1/2 inch per month, so it will take you 6 months to grow out 3 inch long new hair.

Tags: dye, chemical damage, hairloss, hair loss, teen

Does Rogaine Foam Cause More Shedding than the Rogaine Liquid?

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

I have read all over that Rogaine Foam causes vast more amounts of shedding than the liquid form. Is this true or do both cause the same amount of shedding (which of course varies by person)? I would like to know this because both are using the same growth agent in Minidoxil so I do not see how one could cause more shedding then the other. I have used the liquid form of Minidoxil for 2 months and have not experienced great amounts of shedding so I do not want to switch to Rogaine Foam if it will cause alot more.

I have not seen this in my patients, so I can not comment on the shedding comparison between the Rogaine foam and the liquid. If any readers want to share their experience with this, please leave a comment.

Tags: minoxidil, rogaine, foam, liquid, hairloss, hair loss, shedding

In the News — Prescription Drugs Can be Dangerous!

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

Snippet from CNN article:

The U.S. Food and Drug Administration Tuesday ordered the makers of certain antibiotics to add a “black box” label warning — the FDA’s strongest — to alert patients of possible tendon ruptures and tendonitis.

“The new language will strengthen the existing warnings,” said Dr. Edward Cox, director of the FDA’s Office of Antimicrobial Products.

The FDA is requiring the label warnings and a medication guide for fluoroquinolone drugs, which include Cipro, Levaquin, Avelox, Noroxin and Floxin.

CiproFull article — FDA orders ‘black box’ label on some antibiotics

This is another non-hair loss related post, but an important one that needs to be addressed. One of my most challenging problems are requests by friends to just prescribe an antibiotic for them for their flu symptoms. These friends feel that what they asked had no side effects and no risks so I should not be concerned. It just makes me slap my head sometimes.

The above referenced article shows that commonly used antibiotics which include Cipro, Levaquin, Avelox, Noroxin and Floxin have dangerous side effects. If we really knew all of the side effects, I am sure there would be more. The best thing to do is to take NO DRUGS unless the doctor knows what he/she is treating and the risks of treatment. Too many drugs that were thought to be safe are now known to be unsafe. Many of these drugs are killers. A good doctor earns his wage by not prescribing drugs at the drop of a hat. Mull that over.

Tags: prescription, drug, flu, fda, fluoroquinolone, cipro, levaquin, avelox, noroxin, floxin, antibiotic