After I Stopped and Restarted Propecia for a Few Months Last Year, My Hair Loss Hasn’t Stopped!

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

Hello Doctor – and many thanks for keeping this very informative website. My question is a point of clarification with respect a question that answered earlier (the original question was care of “a very stressed out medical student).

I had been taking propecia for several years and stopped approximately one year ago. My hair loss began fairly soon thereafter and has been fast and steady ever since, despite the fact that I started taking propecia again in November. Can you explain why this is the case?

Thank You.

You are likely experiencing “catch-up” hair loss, which occurs when one stops taking Propecia after being on it for a period of time. The hair loss noted when the drug is stopped will be the same as if you were never on it at all. By stopping it, you are bringing yourself back to the same degree of hair loss that you would have had anyway. Stay on the medication now that you have restarted it. It is possible that the hair loss you are currently seeing (despite being on the medication) is a result of the “catch-up” loss phenomena.

Your experience is one that our readers on Propecia/finasteride should take note of. This is a medication that you need to take for life, unless you come to a time when you are willing to lose your hair.

Tags: propecia, finasteride, hairloss, hair loss, catch-up, drug, medication

What Is This Pimple in My Recipient Area — Infection, Lost Graft, or Something Else?

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

I had a transplant almost 4 weeks ago, and last night, I had a pimple start to bleed in the transplanted area, without having touched it at all. Is this a sign of an infection, lost graft, or something that just happens, thank you

It is very difficult to make such a determination without examining you. Based on my experience, this sounds like an epidermal inclusion cyst, which refers to a cyst that develops as a result of the implantation of epidermal elements (i.e., hair follicle) in the dermis. If this is the case, it is not an infection. However, another more serious process (such as folliculitis) can be the culprit. This too can develop after a hair transplant procedure and with this, patients typically require antibiotics along with possibly “opening” up the infected areas to remove underlying infected material (pus). Whatever the cause in your case, make sure to follow up with your transplant doctor.

Tags: infection, pimple, cyst, hair transplant, hairtransplant, hairloss, hair loss

How is Miniaturization Normal for People Without Baldness?

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

Hi doc, I just want to know why even people without baldness also have miniaturized hair in their heads,you stated that 20 per cent of miniaturization is normal,can you explain this please.

It has been my observation that people who are not balding can have thin hairs, which I call miniaturized. They may reflect long vellus hairs and are not actually “miniaturized”, but measured from the scalp where the hair exists the skin, it is impossible to note the length of the hair, so I call every hair that I see which has a reduced diameter as miniaturized. From a disease or balding perspective, that may not be accurate, but from an observational point of view, it is backed up by many, many years of experience in my hands.

Tags: miniaturization, miniaturized, vellus, hairloss, hair loss, balding

Dermal Fibrosis and MPB

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

Is Dermal Fibrosis, a Critical Factor in MPB? See website Hairloss-research.org

From the information noted in the link, it sounds logical that dermal fibrosis can be considered a cause of male pattern baldness (MPB), but is it a finding that goes along with MPB or a cause of it? Also, as noted, more investigation into the many underlying causes of hair loss needs to take place before dermal fibrosis can be deemed the critical factor in MPB.

Tags: dermal fibrosis, fibrosis, hairloss, hair loss, mpb, male pattern baldness

Will Couvre Come Off On My Pillow Like Toppik?

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

Hi, I had a question about masking lotions and concealers.

I was visiting your website the other day and did a search for different types of masking lotions and concealers and came across some pictures of a man and saw that you had a before and after picture of him with and without something called Couvre, i believe it was called. The effect was somewhat miraculous….it worked to a degree and made me curious enough to think I should begin using this.

My hair is thinning a bit–not a lot, but a bit. And I have used another concealer in the past–something called Toppik. It was terrible. It came off on the pillow if I layed down, it came off on my fingers if I ran my fingers through my hair, and, most importantly, it was CLEARLY visible even though the company i bought it from said it was hardly detectable. My question is, would Couvre come off on my fingers if I ran my fingers through my hair? would it come off if i scratched my head? is it somewhat visible? if I have a shaved head–like the fella in the picture–would Couvre be more visible as opposed to not having a shaved head? does Couvre work best with some hair, even if it’s thinning? would you happen to know how long it takes for the application?

I know I got a bit long-winded…but I’d be happy to hear any and all input on the matter.

Thank you.

CouvreI haven’t used it, but I did a quick glance for reviews and they seem mainly positive (see reviews on Amazon). None of them complained about the Couvre coming off on the pillowcase. You may want to try it for yourself. It is not terribly expensive (around $20 or so) and you will get your answers right away.

Tags: couvre, toppik, hairloss, hair loss, lotion, concealer

Glaucoma and Propecia

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

Hi

Firstly, thank you for a fantasic site.

My question relates to taking finasteride whilst also taking Xalatan drops for pressure on the eyes. I have recently been diagnosed as having glaucoma and was wondering if my taking of finasteride could have contributed to my diagnosis or in any way effected the pressure on my eyes.

With kind regards.

This is not a known side effect of Propecia. It is very unlikely that Propecia caused or contributed to your development of glaucoma. Check with your opthamologist.

Tags: glaucoma, hairloss, hair loss, propecia, finasteride, pressure, eye, opthamologist, xalatan

Scalp Tattooing

/by William Rassman, M.D./6 /,

I came across your post “Horror story with a happy ending” and I would like more details. I have had several surgeries beginning in the early 90s, from plug work to micrografts and FUE. Most of this was corrective work. Unfortunately it wasn’t particularly successful, and the distribution of hair is abnormal. Fortunately though my donor scar isn’t that bad, as I was careful with the scar revisions to minimize a bad outcome. I am left with approximately 1 scar from my last revision, where a trichophytic closure was used. It runs from ear to ear and varies in width from 2 mm to 8 in a few places. Overall, considering the number of surgeries I’ve had it’s remarkably good. I’d like to fill in the thin spots with the “stippling” type of tattoo you mentioned in your post. However I am very concerned with the discoloration over time. Can you provide contact information of the dermatologists who had the tattooing done, or some more information about it (eg. type of ink, who did it, etc.). I’d much rather put my faith in the hands of someone who has seen success with this than take chances on an unknown. FUE, etc aren’t really options for me at this point for filling in the scar.

Thanks

TattooAlthough I don’t have any information about the tattooers of the patient you mentioned, from what I’ve seen, tattoos on the scalp and scars have turned green over time. While it may not occur every time, this is a real problem for the two patients that come to mind. For that reason, I would hold off doing the scalp tattoo for the time being unless you are sure that the color will last and this is what you want, as today’s tattoos are not reversible (laser removal is quite painful and may take many sessions to get a decent result).

A new product is coming sometime later this year that is reversible, so if you did not like it after getting it, then you can make it go away a lot easier. It doesn’t make the pain any less intense, though. For more general information, see InfinitInk from Freedom2, Inc.

Tags: scalp tattoo, tattoo, ink, infinitink, freedom2, hairtransplant, hair transplant, repair

Leg Hair Toxins?

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

Is leg hair made up of the same organisms that head hair is? Can leg hair be cleansed of toxins the same as head hair?

What toxins in your hair? I do not understand what you are asking.

Scientists and doctors sometimes use hair samples to detect drugs (marijuana) or lead, as your hair “records” the exposure. Sort of analogous to the rings in the trees or coring ice samples. I do not believe there is a process to clean or rid of these toxins — short of cutting your hair. Remember hair is dead tissue, so any toxins in the hair like lead, will have already harmed your body. You leg hair or body hair should act the same way as scalp hair, but your leg hair is not constantly growing to the lengths as your scalp hair is and it may not record the exposure to the chemicals as for the historical time frame you took toxins like lead in the scalp hair.

Tags: toxin, leg hair, scalp hair, drug test

Will FUE Make the Back of My Head Look Moth Eaten?

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

Hi,
I was wondering if you could tell me if it would be better for me to get strip or fue? I have already had 1 strip procedure 5 years ago (3300) and feel I need more hairs to fill my thinning frontal area. I am worried about fue because I heard the back of your head may appear as if moth eatin. Also, I exercise so I want to recover as quickly as possible. I used [name removed] before and that’s who I plan to use for my next procedure. Any recommendations? Thanks.

MothThe things that make a follicular unit extraction (FUE) surgery produce a “moth eaten” donor area include:

  1. the use of larger punches
  2. low density donor hair

If you already had a strip procedure, another strip may be a better choice for you, but if you are a hair transplant ‘virgin’ (not your case) then FUE is a much more clear decision process. Going the FUE route will make for a very fast recovery with full activity, including swimming, scuba, and professional level exercise. I do not generally make recommendations for doctors here.

Tags: fue, follicular unit extraction, hair transplant, hairtransplant, hairloss, hair loss

I’m 18 Years Old and My Crown Is Getting Thinner

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

hi. im an 18-yo and i have been having alot of paranoia about my hair. it seems that in many phases since jr. high ive noticed rapid hairloss and then following up it will grow back to normal. but this last shedding phase it seems to be really affecting my hair. i have a mature hairline in the front and i am comfortable with it because it hasnt changed whatsoever, but the crown where the part of my hair is getting noticeably thinner. you can see my scalp and the area around my part is noticeably thinner. i have always had very thin hair in the first place but in my entire family line that i know of on both sides there is no genetic hair loss, just thin hair. would taking a percription drug like propecia be right for me? or is there an alternative method?

There are 2 drugs that are FDA approved to treat hair loss — minoxidil (Rogaine) and finasteride (Propecia). These are the only 2 medications that I recommend, as they have been proven safe and effective. I can’t tell you if Propecia is right for you without seeing what you’re dealing with, but if you do have early hair loss from genetic causes (do a miniaturization study of your scalp) then Propecia is likely to give you benefits. You’ll have to discuss this with your doctor, though.

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

Quality of Shedding Hair

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

Doctor,

I’ve been searching this blog for some time and can’t find the answer to this everlasting question: Can the “quality” of the shedding hair tell anything about what’s happening with the hair loss? Does losing shorter, miniaturized hairs say that one is balding more rapidly than one who sheds healthy terminal hairs? I’m saying this because you diagnosed me with an early Norwood 3A pattern last year, and I have been on Propecia ever since. But it seems that the hair that I shed from the front is thick on the end, and thinner near the root. Does this indicate miniaturization or just the hair cycle?

I don’t think I’ve miniaturized further since you last saw me on October of 2007, but only a re-exam from you would tell.

Thank you for your time.

Clearly you should see me at about a year for your annual re-examination. The thick hairs you are shedding are most likely part of the normal cycling that we go through. We generally lose about 100 hairs/day and that it probably what you are seeing. It does not make sense to me that the hair thickness on the scalp side of the shed hair should be finer than the distal end. If you bring the hair into the office, I can measure it for you with a micrometer.

Tags: hairloss, hair loss, shedding, quality

Zadorin (Doxycycline Hyclate) and Hair Loss?

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

I have been taking an antibiotic called zadorin for back acne for approximately 2 and a half months. While its common to have hair loss in Dubai (apparently because of the water) it appears that in the recent two months the hair loss has accelerated. Could the cause of this acceleration be the antibiotics. If so, is this a temporary hair loss?

This is almost an impossible question for me to answer. I would have to examine you and understand what is happening on your head and to your hair before I can render an opinion. I doubt that the antibiotic would cause hair loss, but any medication theoretically can. If the water in Dubai is that bad, consider using bottled water.

Tags: zadorin, doxycycline hyclate, doxycycline, doxine, hairloss, hair loss, antibiotic, dubai

Small Bald Spots Developing On Two Cousins — Is this Heredity or Is the Barber Spreading It?

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

I’m a barber, and one of my clients (male 27) is developing small bald spots all over his head. The hair is not completely gone, but it is very thin and slightly lighter then the rest of the hair. I think its alopecia, but his cousin (male 28) is developing the same thing. He comes to the same shop as well however the other barber cuts his hair. My question is could this be something that I’m passing to my clients, or is this heredity?

I am not sure what you are describing. Ringworm, head lice, or other contagious skin problems can be spread in a barber shop or in a household. I would need to see them to make a diagnosis.

Tags: ringworm, lice, hairloss, hair loss, bald spot, hereditary

AutoloGel System by Cytomedix for Hair Regrowth?

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

Dr. Rassman,

I enjoy reading your blog and it gives me some comfort seeing other people out there with the same issues as me. I wanted to ask your opinion about this product which I only just heard about called AutoloGel by a company called Cytomedix. They released a share holder update yesterday as below: Cytomedix CEO Issues Shareholder Update.

Its been FDA approved, and they believe it can be used for hair growth and are actively seeking partners and strategic allies for hair growth and hair transplants according to the release. For your reference, this is the patent, dated back to 19 would imagine based on a 15 year time frame that they are probably fairly convinced about their product: USPTO — Patent #5,178,883

What is your opinion on this? And would you be interested in implementing it in practice at some point in future?

AutoloGel SystemI have not been able to find any clinical studies involving AutoloGel and hair regrowth. According to the shareholder update letter (linked above), is is suggested that this gel could be used in such applications as hair growth and hair transplantation.

AutoloGel has been studied extensively for the treatment of non-healing ulcers and has showed positive results — and they received FDA marketing clearance for use on these types of wounds (not for regrowing hair). Until we see a well done clinical study to support that AutoloGel will help with hair regrowth, I think it is far too premature to assume that we could use in practice one day.

Tags: autologel, cytomedix, ulcer, hair growth, hair regrowth, fda, patent

Why Is Hair Bleach Dangerous to Hair?

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

If I added blonde streaks to my hair (bleached it), then dyed it back to dark brown the next day, am I at risk for any hairloss because of this? I did this about 7 weeks ago and there are no problems at all — I’m just wondering. Isn’t hair above the skin level dead anyway, so I could put paint and it wouldn’t affect the follicle?

Hair dyes use chemicals to set color into the hair. If you can get the effects you want from a water soluble solution, it should not hurt your hair. As a result of the abrasive nature of the heavy peroxide based dyes, they can cause damage to the hair and the hair follicle with a person who does not have experience with it. Some of these chemicals can cause local scalp irritation and allergic reactions which should be tested against a small part of your scalp skin to see if you are sensitive to the chemicals before applying all over the head. It sounds like your treatments did not cause you any bad outcomes, however, that is not to say that you are safe from hair loss from repeated dye sessions if they are anything more than a good commercial hair rinse.

Tags: bleach, dye, hairloss, hair loss, danger, chemical, burn, streaks