Topical Finasteride — Would it Work?

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

Dear sir,

i would like to try one product containing topical saw palmetto and topical finasteride !

i am only 20 years old,i would like to know if i will have the same orally finasteride side effects(reduced libido),thank you

There is no evidence that finasteride on the skin can predictably be absorbed. Interestingly, Merck (maker of Propecia) warns that women should not touch Propecia because of a threat of absorption, particularly in pregnant women, yet there is little information on this subject. I’ll try to get some clarification from Merck for a future blog post. I am also not familiar with topical saw palmetto having any value for hair loss treatment.

According to an article from the Journal of Drugs in Dermatology in 2004, 5 alpha-reductase and finasteride in pattern alopecia and acne: “Topical finasteride is well absorbed, but clinical results were minimal with this mode of drug delivery.”

The bold styling was not part of the original article — I added that to drive the point deeper. The question about topical finasteride has been asked of me many, many times, and I hope this explains why finasteride comes in an oral pill rather than a spray, gel, foam, cream, or even a suppository.

Tags: finasteride, saw palmetto, hairloss, hair loss, propecia, proscar, topical

Am I Just Wasting Time with Hair Loss Medications in My 50s?

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

Doctor

What do you suggest for a man in his 50’s with thinning in the crown, but otherwise a good head of hair? I can cover the thinning with a small amount of toppix. I started propecia a few months ago and noticed less hair in the sink but much increased shedding in the crown in the last month. At my age am I wasting my time with medication and just get a transplant or wait it out and see what happens with propecia?

Though I don’t have a frontal receding problem now I assume I may have one in a few years following my brother and father. Will a crown transplant limit my donor area for future transplants if I need them?

I know hair loss in your 50’s is unusual, but its in the family. I’m just a late bloomer. Thanks

At this point it in order to see the benefits of Propecia you have to be patient and wait at least 8 months to see if it is helping or if it is at least keeping you from losing more hair. I would not stop the medication after only a few months treatment. I would recommend you get a miniaturization study and then before you do stop the medication, follow up to see if there are clinically evident positive results from the finasteride. Remember, everyone has a limited supply of permanent (donor) hair. If you have a transplant to the crown area you will limit any donor hair that you have for future transplants. Although I would suspect if you have not had any frontal hair loss at your age, you maybe a Norwood Class vertex variant.

A good friend of mine (age 77) went on finasteride for his prostate, and his crown area (which was almost completely bald) regrew a good amount of hair. We see late balders as well, so someone of your age could start balding late in life and still get a great benefit from this drug.

Tags: hairloss, hair loss, age, finasteride, propecia, prostate

Razor Bumps

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

I suffer from occasional razor bumps/ pimples on my scalp. One website recommended using a mild facial cleaner one or twice a week on the scalp. Would you recommend this course of action if this is folliculitis?

Would also like to thank you for recommending Propecia back in February (Is It Ever Too Late to Start Propecia and Minoxidil?). Have been taking Propecia since then and am really pleased with the results seen in such a short time. Crown is
really beginning to fill in progresively!

RazorFrom your description this sounds like it may be a form of mild folliculitis, but I can not tell without properly examining these lesions. I would recommend you be examined by your physician.

From the folliculitis article at eMedicine — “For recurrent uncomplicated superficial folliculitis, use of antibacterial soaps and good hand washing technique may be all that is needed. For refractory or deep lesions that have a suspected infectious etiology, empiric treatment with topical and/or oral antibiotics that cover gram-positive organisms may be of benefit.”

For the above reason you need to have your physician make sure you do not need more aggressive treatment.

Tags: razor, bumps, folliculitis, propecia, finasteride, hair loss, hairloss

White Tissue Protruding from Recipient Area Days After Hair Transplant

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

I just had transplant surgery 3 days ago..In the crown area there is a straight white tissue protruding from the red area of the transplants..mostly just in the crown area..what is this..? Does this mean the graft came out or could this just be extra tissue or something else..thanks..

As I am not able to see what you are describing, I would recommend you see your hair transplant surgeon to make sure you are not developing problems with the transplant. I would hate to guess at the problem and give you an answer that leads you in the wrong direction. Most people who shampoo will see some whitish coloring of the grafts which they get if water logged and this color usually goes away when the grafts dry. Most of the time people ask me about a series of white dots at the transplanted area — this is what it is. In your case, you are asking about something protruding from the recipient area and that could be a graft.

Tags: hair transplant, hairtransplant, tissue

Stomach Pain and Bloating from Propecia

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

Hi Dr. Rassman,

I just wanted to say thank you for providing some very useful information and answers to questions on your website.

Although I have full coverage, I have been experiencing thinning hair throughout the top of my head since my early 20’s (Im now 25). Finally, I decided to visit a dermatologist last year. After asking questions about my family history (my father has experienced hair loss), he recommended that my hair loss is from genetic factors and prescribed Propecia. However, there was no miniaturization performed.

My 6 month experience with Propecia has been fairly unique. Within the third month of taking Propecia, I experienced a pretty good shed. I also noticed after a few weeks that my hair was becoming very oily (I have never had oily hair in my life). Around that same time, I was noticing that I had some abdominal bloating which was very uncomfortable. In the 4th month, I stopped taking the medication (due to the stomach pains) and within a week these pains went away.

My dermatologist encouraged me to resume propecia as I was simply “connecting the dots” to link cause and effect. After doing so, within a couple of weeks the stomach problems returned. At that point, I discontinued the medication. It seems I am worse off then when I started as the hair caused by shedding never fully returned and the scalp is now more visible (however, my hair is no longer oily).

Have any of these problems been reported or am I experiencing a very unique situation?

Thanks for your help.

Although what you are describing is not common and is not usually one of the side effects of the medication, you may be having an adverse reaction to the medication. With the half life of Propecia (finasteride 1mg), one would expect your side effects to disappear sooner than one week after you stopped taking the medication. Have you tried taking half the dose you were taking to see if you have any side effects? I would also make sure you have a miniaturization study done by a specialist in order to properly diagnose your hair loss problem.

Tags: finasteride, propecia, bloating, bloat, stomach, hairloss, hair loss

Can Propecia Cause Dementia?

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

Does propecia cause dementia/depression?

I read the following article:
Finasteride causes reductions in allopregnenolone, a potent, endogenous positive modulator of the GABA-A receptor, in very large doses in rodent studies.

5alpha-reductase, which finasteride inhibits, is a critical enzyme in the conversion of several steroids such as testosterone, progesterone, aldosterone and corticosterone in the brain. This enzyme converts testosterone to the most natural potent androgen DHT, and also it acts an important role in conversion of progesterone to dihhydroprogesterone (DHP). DHP is further converted to allopregnenolone (5alpha, 3alpha-tetrahydroprogesterone) by 3alpha-HSD. Allopregnanolone is a modulator of gamma amino butyric acid type A receptor (GABA-A), and increases chloride conductance. This neurosteroid has been found to exert anti-convulsant, anesthetic and anxiolytic effects. Moreover, change in the levels of allopregnanolone is found to be associated with depressive disorders.

I have used propecia for 7 months now and have not been depressed or experienced dementia. What is going on here?

The article you’re quoting is: Finasteride induced depression: a prospective study

First off, we are not rats or rodents. Well, not all of us. The article may point to a theoretical possibility, but there are no observations in the clinical literature that would support this. Some drugs have these “potential” side effects. If you look hard enough, I’m sure you can find this type of research on many types of drugs. I really don’t know the clinical “real life” significance of this study.

Tags: propecia, dementia, depression, finasteride, hair loss, hairloss

Massive Hair Loss in Just 2 Weeks!

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

my husband has recently experienced sudden hair loss.he had a thick full head of hair and within 2 weeks he is almost completely bald.he was hospitalized for a few days and they ran several tests,everything i could think of.nothing has shown up so far.there is no history of baldness in either side of his family.he has a follow up appt with his doctor and an appt with a dermatologist but i would appreciate any other help.thank you!!!

It sounds like he has developed an acute telogen effluvium (hair went into its sleep phase) and it should reverse in a matter of weeks or months. See a good dermatologist to be sure, but I do not know of anything other than this that would make such a radical change. See this excellent article at eMedicine for more about TE — Telogen Effluvium.

Tags: hairloss, hair loss, telogen effluvium

Hair Pull Test

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

Dr. Rassman,

If propecia has been successful treating my Diffused Patterned Alopecia, should I still have a positive result from the Hair Pull Test (i.e., still find hairs after conducting the Test in the balding areas)?

Thanks.

Hair pullThe hair pull test should be done by the physician, and not by the patient, as it is more complex than the name makes it out to be. Just pulling on some hairs and seeing clumps of hair fall out does not mean you have a positive hair pull test. The hair pull test is performed by taking a few strands of hair between the thumb and forefinger and pulling on them gently. Hairs in anagen (growing) should remain rooted in place while hairs in telogen should come out easily. You then figure out what percent of the hair is in the telogen stage. For more information on the cycles of hair growth, see Hair Follicle Cells Growth Stages.

Shedding of hair can be variable from day to day and is greater in certain seasons (spring and autumn). Washing you hair prior to having a hair pull test can also affect the results. Genetic hair loss does not cause a positive hair pull test. And it should go without saying, but the image to the right is NOT the actual hair pull test, and you shouldn’t have to worry about your doctor doing this to your head when conducting the test.

Tags: hair pull test, pull, hairloss, hair loss, propecia, dupa, finasteride

My Scalp Itches So Bad, I Sleep with an Ice Pack

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

(female) My scalp itches and stings all day but seems to get worse at night while I sleep. Ocassionally it will wake me. I will sleep with an ice pack on my neck just to relieve some of the burning. Most of the hair falls out while I am doing my hair in the morning.All of the hair that comes out has roots attached.Could this be a fungal infection?

Ice packWithout examining you, it would be hard to determine what is causing your hair loss. It could be a fungal infection, however, often these type of infections lead to patchy hair loss and are not diffuse as it seems to be in your case. Irritants such as chemical dyes and relaxers (along with anything else that can be applied to the hair/scalp) can cause a skin reaction called contact dermatitis. Hair loss can often accompany severe cases of contact dermatitis usually caused from scratching it. You will need to see your regular doctor to determine if there are any systemic causes of the symptoms you are having such as autoimmune diseases (i.e. lupus).

Tags: itch, sting, infection, fungus, scalp, hairloss, hair loss

Accutane (Isotretinoin) and Female Hair Loss — I’d Rather Just Have Acne!

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

(female) My hair loss is due to a 5 month regimen of Isotretinoin. My last treatment was Dec. of 2006. I am still experiencing persistent hair loss. I realize the medicine has significantly reduced my sebaceous glands. Is there any possible way to enlarge, inflat, manipulate, or to boost or increase my sebaceous glands so that I may began producing sebum again? I would much rather battle acne than hair loss.

With Kind Regards

You are in a predicament that many patients run into with regards to medication usage and adverse effects. Hair loss is a known adverse effect of using Accutane (isotretinoin). Often times these effects are increased as the dosage of this medication increases and can persist even after the medication is discontinued.

I am assuming that in your battle with acne, your doctor has exhausted other treatment options prior to putting you on isotretinoin. Unfortunately, I am not aware of any medication or procedure that would allow the sebaceous glands to be manipulated in the ways that you mentioned.

Tags: hairloss, hair loss, accutane, isotretinoin, female, women, woman

Non-Genetic Hair Loss from Stress?

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

I tried to find this on your site but was unable to. You talk about stress pushing along what is already genetic. but I was wondering can stress cause hairloss even if you are not genetically predisposed?

In general, stress can cause hair loss in those that are genetically predisposed, as well as those who are not predisposed to the classic patterned balding. Any type of stress — physical (recent surgery, illnesses, even childbirth) or emotional (death of a loved one, work or family related) — can trigger or exacerbate hair loss. Women seem to have some syndrome where they get stress hair loss that cycles with the stress, growing after the stressful period and falling out when the stress increases. I have not seen this in men. The term telogen effluvium does apply.

Tags: hairloss, hair loss, stress, emotional, physical

My Mom is Allergic to Minoxidil — Might I Be Too?

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

Hello,

My question is in regard to Minoxidil. About ten years ago my mother tried the product and ended up having a very severe allergic reaction. Her face and throat swelled greatly and she was convinced she was going to die. Thankfully, she ended up ok after several months of treatments and recovery. Doctors told her that because she applied the product after scraping her head, it most likely entered her bloodstream and resulted in the reaction she experienced.

I am now 28 years old and have been losing my hair for about 5 or 6 years. I would very much like to try Rogaine, but I am afraid of having an experience like the one I just described. My question is whether an allergy to Monoxidil is hereditary, and if there is a way to be tested in advance to determine whether or not I am allergic.

Your response is greatly appreciated, and please accept my apology if this topic has been covered before.

Most medications reactions are not true allergies. A true allergic reaction to a medications cause, itching, rash, swelling, difficulty breathing. From your description it sounds like your mother had a true allergic reaction. A family history of reaction to a specific drug does not mean that one has an increased chance of reacting to the same drug. You can do a skin test where you apply minoxidil to the skin (a very small area on your arm, possibly the size of a pea) and then wait to see if you react to it.

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

I Lost 50% of My Hair Thickness as a Teenager

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

Hello

When i was about 14-15 years old, my hair began to thin all over. It did not recede at all and i probably lost 40-50% of the thickness of my hair. I am now 33 and my hair, in the last 18 years, has never become thinner or thicker.

What do you think could have caused this, i am now in the armed forces and have regular medicals/bloodtests which show i am fit and healthy. It has always baffled me how my hair thinned and then just stopped, without ever recovering or getting worse.

Thanks

There is often a change in hair thickness as we pass teenage years. Most people recognize the bulk that they had when they were young, not the density. Hair usually gets finer to some degree as we age. The question to ask is: “Is the hair shaft thickness uniform all over the scalp?” If it is uniform, then you accept this new hair shaft thickness as the mature you and if you want to thicken it, you can use styling adjuncts for that purpose. If you have a diffuse alopecia like DUPA, then you should be examined and get your hair mapped out for miniaturization and it will show up on the video images.

Tags: hairloss, hair loss, hair character, thinning

Little Richard’s Hair

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

Little RichardI am amazed at how young Little Richard the entertainer looks.His hair looks unusually full and straight for a black man at his age.

Is this his hair or does he use a system similar to Michael Jackson’s?

I’ve never met the man, but after looking at his pictures, it really looks like a good afro with lots and lots of styling… but more probably, it is a hair piece or wig. I don’t know how similar it is to Michael Jackson’s though.

Tags: singer, musician, little richard, richard penniman, wig, hair system, hair piece, celebrity

I Read that Propecia Won’t Work In the Hairline

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

I been reading that Propecia doesn’t help on receding hairlines. But what does that mean? Does it mean if you are a NW2 which is normal and you start to recede beyond that, Propecia won’t stop that or help you get back there?

My case: I’m 22 years old and am on a little more then a NW2 which is fine with me. But 3cm into my hairline the hair is less full (not obvious but I know) and the hair around the temples are becoming short. So Propecia won’t help me there? I noticed this problem like 4 months ago and just started Propecia. I have no family history of MPB except my father but he was in his 40s when it began.

Directly from the Propecia.com website: “There is not sufficient evidence that PROPECIA works for receding hairlines at the temples.”

It has been shown to treat hair loss primarily affecting the vertex (top of the head) and the anterior mid scalp area (where it sounds like you are having some of your problems). This does not mean that Propecia won’t help you. You need to be on it at least 8-9 months before you see any benefits of the drug. For you, there may be a beneficial effect on the frontal hairline, temples, etc and I have personally seen some wonderful results on the frontal area (including the hairline), although it is not common. Its best effect is on young men who have miniaturization in the frontal area that is not advanced. In these patients, the frontal hair loss may reverse. People can react differently to the same medication. You will also benefit from a miniaturization study to determine exactly which areas of your scalp that are mostly affected, thus determining if you indeed have male pattern baldness.

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