Topical DHT Inhibitor?

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

Are there any topical DHT inhibitors? I know that Propecia blocks DHT and I have tried it in the past, but the sexual side effects were really severe. I’m curious why no company has tried to market finasteride in a topical solution…will it not absorb through the scalp?

There are some doctors and many companies that claim that they have a topical DHT inhibitor for sale, but to my knowledge, there is no such thing on the market at this time that has proven blood levels in any meaningful date. I would want to know how much has to be applied to the skin to get a comparable blood level to the oral counterpart. Again, I have not seen this. Logic does not tell you anything about effectiveness of a drug and that is what we must know. Claiming effectiveness and proving effectiveness are two different things.

It would be nice if there was one that was FDA approved and proven effective, like a Propecia shampoo. That might solve the side effect issue that seems to frighten so many men and cause them to not use the oral form of the drug.

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

Is What They Say About FUE Real or Marketing Hype?

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

Hi! Need your comments on the “No Touch Technique”. Is it similar to FUE. The medical group claim it to be better than the strip method. The FAQ section on their website mentions the difference between their technique versus FUE. But I am confused. Only you seem to be the qualified person to clear the doubts. Ultimately, which one is the safest and more result oriented method, which any average hair transplant patient can go through.

Thanks

There is a lot of marketing hype in the industry, because there is big money at stake. Many doctors claim what they think you want to hear. From the time you pay for the procedure until you get the results, the time-span runs 8 months, so you see that if a doctor is not honest and sells hype, then your check clears his bank account before you ever see what you bought.

In this case, it seems that this medical group has a tool that they use that removes the grafts via the FUE technique (no strip) — but at what accuracy? How successful are the grafts to grow out? They don’t state any statistics, so I don’t have any idea how to answer your question. I do not know enough about this group to make any qualitative statement about their work.

Many times tools are used by clinics that seemingly don’t care about growth rates and just want to be able to collect your money and say, “Well, the graft is in your head. — even if it doesn’t grow due to damage from when it was extracted, I did my job.” The consumer can tell how good the doctor is by asking them to discuss the amount of damage to the hairs in the grafts when they are extracted. At our clinic, we count damage per hair in the graft and can not only tell you what we got for hair yield, but show you our records of yield per hair and per graft. In a very recent article published by a Japanese group in the Hair Transplant Forum (a print newsletter), they discuss damage per hair in each graft with FUE. Their paper mirrors our formal publication back in 2002 that says there is considerable damage to the hairs in the graft in a substantial number of patients.

Watch this site over the next week and you will see ways to tell the scam artists from the good guys. You should not believe everything you read. Just because there is a doctor selling you the service, be very careful in your decision to go the FUE route without some proof that the clinic or doctor offering the procedure actually gets good results.

Tags: hairtransplant, hair transplant, fue, hairloss, hair loss, no touch technique

My Brown Hair Turned Blonde!

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

I have naturally brown head hair. This summer, however, my hair has turned light brown and even blond in some spots (the bangs). I am a 15 year old male. This has never happened before and I am wondering if it is permanent.

The human pigment created from the melanin in our hair follicle for brown haired people is a pigment called eumelanin. If you produce a lot of the brown eumelanin, your hair will be brown, but if you produce only a slight amount of it, your hair will be blond. Maybe your brown eumelanin production is less as you get older. This is almost certainly a genetic predisposition of having a lighter colored hair and a change in the pigments that your hair is producing. Being in the sun can bleach your hair to a lighter color and turn a light brown color into a blond color.

Tags: eumelanin, melanin, hair color

Taking Propecia on an Empty Stomach

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

I take Propecia daily, and have been for the last 2 years. I feel it does work, however I have a couple of worries and concerns. I take the tablet daily between 9-10 in the morning, and I always make sure I have an empty stomach, and for at least an hour after taking the medicine. My questions are, am I being over sensitive with my regime? and…

Some times I am afraid that the pill gets stuck in my throat when I swallow it. If it does, will this decrease the effectiveness of the medicine, as it will not be absorbed? How does the tablet get absorbed into my bloodstream, am I over worrying? If I spit after taking it will I lose some of the medicine? I have heard bad things if I miss a tablet that I will be back to square one!

Many thanks for your help

Where are you hearing these things? You can take Propecia anytime during day or night. As long as you remember to take it once a day is all that matters. I have written in the past you can take it in the morning when generally there is a high testosterone level, but there is no firm proof if this is actually of real benefit. If you feel the pill gets stuck in your throat drink a cup of water. If you miss a tablet, you’re not instantly going back to square one. I wouldn’t make it a habit to miss a tablet, but it isn’t going to negate everything by missing a single dose.

Tags: propecia, finasteride, hairloss, hair loss, food, water, throat

Do Miniaturized Hairs Turn White and Curly?

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

Hi Im a 23 y.o male (using propecia for slight receding hairline)
Over the course of a year random hairs have started to shrink, turn curly and white from hairline to crown, sometimes in clusters. Its not noticable to strangers and I have been able to pluck them out so far. Of course I thought that this might be normal miniturization but my hair has a thick white base with a thin tip instead of the “beige/straw colored fading away” I identify with miniturization. And of course I have considered whether this is normal graying, but you see many full heads of gray hair and if this keeps up I will instead be left with a head of small white wiry growth. Any suggestions ?
Thanks

As you are in Los Angeles, I would be happy to do a miniaturization study on you and let you know if what you are observing is the beginning of the balding process. I have an office in Los Angeles. Generally, miniaturizing hairs don’t change color. I’m not sure what you’re seeing.

Tags: hairloss, hair loss, miniaturization

Can I Get a Proscar Prescription Over the Phone?

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

Hello, I am a 26 year old male and have thinning hair in the frontal and top-mid portions of my scalp. I am currently taking Hydrochorot and Lisinopril for hypertension. I would like to know if Finasteride (Proscar) will interfere while taking these hypertension medications? Also, I noticed in a prior blog, I can call(800)-NEW-HAIR to setup a phone consulation and be taken as a patient over distance, with photos provided. Would I be able to get a Proscar prescription this way? If not, can you recommend a hair specialist in Phoenix, AZ that will be able to help me?
Thank you.

You can see your family doctor or just check the yellow pages for hair transplantation and find a doctor. Also, the physician search at ISHRS.org is a good place to find a doctor. I will not prescribe it over the phone for someone I have not met, but I can give you an opinion.

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

World Anti-Doping Agency to Remove Finasteride from Prohibited List!

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

The World Anti-Doping Agency (and subsequently the US Anti-Doping Agency) will be removing finasteride from its list of banned substances at the start of 2009. I can’t find any news items about this yet in the media, but according to the WADA website, the updated prohibited list won’t be made available until October 1.

So how do I know early? Well, I was forwarded a letter dated a few days ago, written by the USADA legal affairs director that states in part, “USADA has confirmed today that as of January 1, 2009, finasteride, the substance for which your client tested positive, is being removed from the WADA Prohibited List.”

Some background on the World Anti-Doping Agency from Wikipedia — “The WADA is an independent foundation created through a collective initiative led by the International Olympic Committee (IOC). It was set up on November 10, 1999 in Lausanne, Switzerland to coordinate the fight against drugs in sport.” The WADA had placed finasteride on the list of banned substances in 2005, because it was being abused by some as a way to mask steroids in urine testing. Meanwhile, the ban was punishing those balding athletes that wanted to take control of their hair loss problems. I’m glad they’ve come to their senses about this.

Tags: finasteride, proscar, propecia, doping, drugs, olympics, hairloss, hair loss, steroid, wada, usada

Doctor Offers 4000+ FUEs in One Session

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

Hi there… I am a female who has had a 1600 graft transplant using the strip method and am considering a second procedure of 1,000 grafts with a different surgeon. I am very concerned about shock loss, which I did have after the first transplant. Below is an extract from a doctor’s website. I would be grateful to hear your opinions on this.

Thanks

“[FUE] allows for the extraction of 4000+ follicular units in a single day session. Removing individual follicles with a microscopic instrument allows the skin to heal quickly and naturally. Patients receive greater freedom regarding hair styling choices and a diminished healing time, allowing them to return to the normal activities of life sooner.” [note: quote edited]

Firstly, 4000 FUE grafts in one session without damage to the grafts during extraction is something that I simply don’t believe. I would have to see it and judge the transection rate under this surgeon’s hands. As for this doctor discontinuing the use of the strip harvesting method “due to its highly invasive nature” as his site states, well, this is more a marketing ploy than anything else. If the doctor could successfully do the amount of grafts using FUE that he claims, that’s great — but as I said, I highly doubt 4,000 FUEs can be done in one session with minimal transection rates. Plus, if you were to have this done, you would have to shave your head. I don’t know that most people would be prepared to do that. You’d have good reason to be skeptical.

In your case, shock loss will probably happen again. Shock loss in women often happens on the second and third procedure, but it usually grows back. Even the anesthesia can cause it in some women.

Tags: fue, hairtransplant, hair transplant, hairloss, hair loss, shock loss, female, women, woman

Propecia and Infertility

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

Hello Mr Rassman.
I have found your web site and by the way , I find it really useful. I would like your opinion on one specific point. I have now been on propecia since February 2005 .

My partner and I have been trying to conceived since 10 month without any result . I did a sperm test wich showed a problem with living spermatozoon after 4/6 hours and a decreased (not huge but right on the limit) in the volume of semen being produced …. Can you tell me if other studies have recently been made on the effect of the finasteride on young male fertility ?

Thanks and best regards

I have written to Merck concerning this question and they have a good history showing a wide safety margin for male fertility. I looked up some sites for you with case reports that focus on your question. What it means is anybody’s guess, but I believe this is where you and your doctor come into play:

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

Writing Off Miniaturization as MPB When There’s a Possible Disease Causing It?

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

Hey Doc,
Today you mentioned that there are other causes of miniaturization besides mpb. If so, then how would you be sure it was caused by mpb as opposed to a disease? Couldn’t you theoretically write off miniaturization as mpb when there’s a more serious underlying issue? What diseases might cause this? How do you tell the difference? If there’s a receding hairline at the temples and thinning in the crown is this defenitely mpb? What about if it’s diffussed thinning? Just wondering how one might tell. Thanks!

The easiest answer is that genetic hair loss in men occur in patterns… and these patterns are almost always diagnostic of genetic hair loss (male pattern baldness) and follow the Norwood classification chart either with thinning or frank balding.

The rest is the art of the practice of medicine and that is why a doctor adds value when you are being evaluated. Hair loss occurs with many other diseases, such as alopecia areata, ringworm, a variety of autoimmune diseases, drugs, etc…

Tags: hairloss, hair loss, mpb, disease, miniaturization

Brain Surgery Scars, Burr Holes, and Hair Transplants

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

Dear Dr. Rassman, I have two burr holes on my temples from an operation when I was a baby. My temples receded to a mature hairline whe I was 25 & the scars are now visible (I’m 32). I don’t suffer from hairloss & seem to have the same hair as my dad who still has a full head of hair at the age of 60 (temples slightly receded). I was considering a HT to get back to my original hairline & cover the scars. I was wondering if the holes in the skull underneath could be a problem during the operation. Is there any danger (I don’t know how deep the needles go)? Thanks!

I have performed hair transplants on many post brain surgery scars and burr holes. Skills in such a situation is critical in placing hair into scars or burr holes to be sure that it does not penetrate into the brain. If the normal hairline will cover it, then this is a wonderful solution to the problem.

Tags: trepanation, trephination, burr hole, brain surgery, brain, scarring, hair transplant, hairtransplant

Intercytex – September Update?

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

Hi Dr. Rassman and thanks for a great website. I’m curious about the September update Intercytex said they would provide. I know you don’t work public relations for Intercytex so this could be kind of an annoying question, but when in september do they plan on updating us? seeing as it’s already half over.

Here’s what I found posted to their site last week in their September 18, 2008 update —

    ICX-TRC – hair regeneration
    Data from the Phase II trial shows increase in hair count in 11 out of 14 (79%) evaluable subjects at 24 weeks

A little lackluster for those that have been waiting, but that’s all they have made available this month about their hair project.

Tags: intercytex, hair cloning, cloning, multiplication, hairloss, hair loss, icx-trc

Hair Loss After Hysterectomy a Month Ago

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

I am 62 years of age. At the beginning of August I had a prolapse repair and a vaginal total hysterectomy. I have recovered very well from the operation but have noticed that I am experiencing some hair loss which is more than normal upon combing and washing my hair.

You probably have a telogen effluvium which will eventually resolve when you hair goes out of the shock caused by the surgery. This is not uncommon.

Tags: hysterectomy, telogen effluvium, stress, hairloss, hair loss

Necrotic Tissue After 3rd Transplant

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

I had several hair transplants that went well, so I decided on a 3rd which led to necrotic tissue damage. The doctor told me it well be ok. i had 3 holes w/ necrotic tissue, which i would treat for several months getting worst. fortunately after 3 months, the holes got as big as a quarter and black. went to the emergency room, when they said this is your lucky day after removing the black. and 3 years and 4 surgeries later, i finally got everything corrected. now i have 3 bald spots in the front of my head. i use the dark particles to hide it. any recommendations. what to do besides surgery ??

Necrosis causes the skin to turn black (it is called gangrene). I would love to know more details, like who was your surgeon and what did he/she tell you caused this? I might be able to help, but I’d need to examine you first. As you are in Los Angeles, you should consider paying me a visit in my LA office (no charge for the consultation). You can call my office at 800-NEW-HAIR (or 310-553-9113) to setup the consultation.

Necrosis was not uncommon in the early days of megasessions when the surgeons used large punches and too many of them. This did devascularize the scalp and parts of the scalp died. There were numerous reports published that condemned the procedure because of this risk, but as the world was trying to make up its mind on the risks, I had published large series of huge megasessions with not one case of necrosis in the recipient area. Eventually the doctors learned that small holes were critical to getting not only good growth, but no damage to the skin of the scalp.

There are non-surgical solutions, including Toppik, DermMatch, Couvre (all are concealers)… and of course, hair pieces.

Tags: necrosis, gangrene, hairtransplant, hair transplant, surgery, hairloss, hair loss

Ejaculation Volume Increased from Finasteride?

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

Hi Dr,
I have a problem like this. I am Taking 5 mg finasteride 1 tablet/3 days due to the difficulty to cut it and here i also don’t have any 1 mg finasteride production. Now the problem is i am taking finasteride for 3 months. some times i feel lack of libido and sometimes i feel high sex drive.There is no stability.Many times i feel high sex drive and i can stay without masterbation. the problem is the volume of my ejaculation has also been increased significantly.Is it possible due to finasteride. Really ti has been increased. But i feel it’s a bit watery i feel than before.Is it possible due to finasteride? Does it mean decrease of my sperm count?

SpermThere are reports in the literature of a reduction in ejaculate volume from finasteride, but I don’t remember reading of the reverse effect and I confirmed this with some more research. I can’t seem to find any cases to match your findings. In those with a decreased ejaculate volume, sperm counts were generally as good as before taking the medications, but there are reports that suggest a decreased sperm motility with finasteride. See this study (The Effect of 5α-Reductase Inhibition with Dutasteride and Finasteride on Semen Parameters and Serum Hormones in Healthy Men) from 2007 that was published in the Journal of Clinical Endocrinology & Metabolism — PDF file. Also see this past blog post — Propecia and Sperm Count.

Tags: sperm, finasteride, propecia, hairloss, hair loss, ejaculation