From Rogaine to Generic Minoxidil

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

About a year ago I started using Rogaine to battle my thinning hair. The results were outstanding. 2 1/2 months ago I was on vacation and had run out of my Rogaine. At the local pharmacy all I could find was a 3 month pack of the house-brand generic Rogaine. It had the same concentration and I was in a pinch so I bought it. For the last couple weeks, I have noticed a lot of hair falling out when I shampoo and such, much like it did prior to my use of Rogaine. Is this a result of the switch to the generic product, something that normally happens, or is there something else at play here?

Thanks

The difference between generic and brand name drug content is controlled by the FDA, so in theory, the two are the same. My initial thought was that you got different strengths, but you said the concentrations were the same, so I’m stumped. Maybe the house-brand was fake? If it was purchased at a reputable pharmacy or store, it’s probably fine — but I don’t have all the details so I’m just speculating wildly. You might want to check with your doctor to see what is going on with your head.

Tags: rogaine, minoxidil, generic, hairloss, hair loss

Can Nizoral Cause Hair Loss?

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

Hi Doctor Rassman!

Thanks for your great and informative site.

I am an 18 year old male with no signs of hair loss and a very thick head of hair. However I recently have noticed that I may have a very mild case of dandruff. I want to begin treating it right away in order to catch it before it gets worse and I have heard the great effects of Nizoral 1% on treating dandruff and even speculation that it may actually help with hair loss.

I just want to know if there is any chance that using the recommended dose of Nizoral 1% for my dandruff will ACTUALLY CAUSE HAIRLOSS? because of the chemical ketoconazole in it? Or is it perfectly fine to use for the recommended period of time?

Thank you I value your opinion and look forward to your response!

I would doubt that Nizoral would cause hair loss. I’ve not heard/read any reports of actual loss from this shampoo. Some believe that ketoconazole, the active ingredient in Nizoral, helps stimulate hair growth, but I’m not convinced until I can find more scientific studies on this.

Tags: nizoral, ketoconazole, hairloss, hair loss, shampoo

Only the Frontal Hairline of My Transplant is Growing In After 4 Months

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

Hey Dr. Rassman. Just a quick question that maybe you can help me with regarding my recent hair transplant. I also will be making an appointment to see my doctor. I had 1200 grafts done mostly in temple area 4 months ago. At around month three I first noticed some regrowth now a month later I have longer hairs in that area, which I expect to become fuller as I get closer to the year mark. However, hair has only grown along the front line of what was transplanted. So I have a thin line of hairs connecting the front of my hair line to the sides, yet have a large gap between that and my regular growing hair. My question is, is this normal? Can hair grafts first grow in the front and take more time to grow in behind it? Is it possible that only the hairs in the front “survived” and the others aren’t coming in? I know at four months it is still too early to tell, but I thought it was odd nonetheless. Thanks so much.

The most likely answer is that by the 8th month fully 80-90% of the hair should have grown or started to grow. I never draw conclusions at the 4th month and you are correct, some parts may grow faster than other parts of the scalp. Be patient and wait another 4 months or so to see the results.

Tags: hair transplant, hairtransplant, grafts

Woman with Hair Loss After Taking Prednisone — When Will it Stop?!

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

(female)
I have been on prednisone for seven months for eustacian tube dysfunction. My hair started falling out when I weaned down to 5 mg of prednisone. I have been off the pred for four weeks and my hair is still falling out a lot. I have no other medical conditions and my primary checked my blood for anemia, thyroid etc. All very normal. My hair is so then only a few weeks away from a wig. Is there any way to stop this and will my hair grow back?

You may have a telogen effluvium and this may reverse in time with hair regrowth in 6-18 months. The use of minoxidil may help, but better do this under the direction of a good doctor.

Tags: female, women, woman, hairloss, hair loss, telogen effluvium, prednisone

Can a Class 8 Person be Transplanted? (with Photos)

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

Many of you hopefully know (or at least have read) about the Norwood Classifications for male pattern baldness. I wrote the question in the title of this post, because there is no such thing as a Class 8 patient. Norwood Class 7 is the highest balding pattern defined, but I want to discuss a patient that has an extremely advanced Class 7, so to get my point across I’ve defined the Class 8 term here. He has white skin and black hair with a very, very fine hair character. I had great trepidations when he came to me three years ago to get a transplant, because he had no good quality hair and the worst color contrast possible. One thing running in his favor was a donor density 25% higher than normal. He’s had three procedures with me over the years. First one was 3908 grafts, then 3177 grafts, then 1525 grafts… for a total of 8610 grafts, and as the density dropped with each procedure, the yield also dropped. Of interest, his scar was minimal and the rest of the donor fringe area maintained its height to reflect the dropping density of the fringe hair with each successive hair transplant. He is tickled over the results and could not be happier. The fine hair is see-through, but he loves to comb it and keep it styled.

Click the photos below to enlarge.

Before:

 

After 8610 grafts:

 

A few weeks ago he came in and we tried an experiment. We applied concealers (Toppik) to try to manage the see-through hair. The results of this experiment can be seen in 3rd set of photos below. What we concluded was that the concealers made him appear too thick and if he dyed his hair a light brown and then used Toppik, his overall look might be better. His eyebrows are light brown, so that would fit.

After 8610 grafts (and Toppik):

 

This is a very important piece for BaldingBlog and the first time this patient has agreed to show his results on the Internet. In my opinion, this is one of the best “miracles” we have pulled off in this practice. It took courage for him (see his before picture) to trust me to make this happen and I was honored with his faith in me. With good doctor/patient communication, almost anything is possible. This man is soft spoken and often comes to our open house events to speak with patients and show off his results in person.

Here’s the side-by-side of his before and after (8610 grafts over 3 hair transplant procedures and Toppik), and you can see the results are just amazing!

Before and After

 

Tags: hairloss, hair loss, hair transplant, hairtransplant, photos, miracle

Finasteride and Type I Collagen

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

Hello Dr. Rassman
Please tell me what is the effect of Finasteride on type I collagen (I think its the same which is found in skin) as stated in this study in simplified manner

Perifollicular Fibrosis: Pathogenetic Role in Androgenetic Alopecia (PDF file)

thanks!

That is quite an article. I am not sure that I can extract the answer to your question from reading the article quickly. Those individuals with miniaturization seem to develop a thicker capsule to the follicular unit, but the effects of finasteride on this finding are not clearly stated in the article. The impact of DHT appears to be about 5 times more sensitive on the androgen receptor than with testosterone alone.

The study requires an astute understanding of the biochemistry of androgen receptor activity on the collagen in the dermis. I recommend the reading of this article for those scientists in the audience. I’m the wrong person to simplify this study, but if anyone else wants to contribute, please feel free to post a comment.

Tags: collagen, finasteride, hairloss, hair loss

After 6 Weeks, The Transplanted Hairs Didn’t Fall Out But Also Didn’t Grow

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

Hi Dr. Rassman,
It has been exactly 6 weeks today post off, for a FEU of 2000graphs. Now I had experienced a some shock loss after my operation for a while, still have but has been minimized a little, but with that being said most of the hairs that were transplanted have no ‘shed’. Infact they are still in tract but the only problem is that they are not growing. I was told by my doctor that all the transplanted hair would fall off within the first month. Should I be worried? Does this mean the procedure is working slower on me?

Thanks

Your doctor advised you correctly — they will shed sooner or later. I have seen some hairs remain up to a year and the hair transplants grew around them. If you pull on those short hairs, they usually come right out with no traction on them, because they are not attached to a bulb or to the underlying tissue, and have no muscle attachment on them. The shock loss you are talking about is independent of the short hairs that remain.

Tags: hair transplant, hairtransplant, hair loss, hairloss, shed

Gray Hair in a 7 Year Old

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

Hi, My son is 7 years old and I noticed a strand of grey hair on his head. Please let me know as to how this is happening and what can I do to prevent it further.

This is a genetic process, so my initial thought was that genetics would be the likely cause. Something has probably triggered the premature graying. Some people feel that this is an errant gene, like a chimerism in your son. There are a series of vitamin deficiencies that could also cause it, including vitamin B-12, although these are found in many foods. Some disease syndromes can be associated with it as well. See DrGreene.com for more information.

Tags: gray hair, child, chimerism, chimera, vitamin, grey, gray

I Have Dense Body Hair — Experiment on Me!

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

This is for Dr.Rassman. You have done a great job having this blog for awareness and information but I was hoping if you could help me out or advise me regarding hair transplantation. I have already mentioned this a while ago to you that I didn’t see the 100% growth on my crown area because the Doctor i had done it from was just making money out of me. He didn’t inform me that my donor area is not sufficient to provide good follicles. Anyhow, i have seen your replies on BHT. As an east Asian (Pakistan) I have the genes of being hairy, my back,chest,abdominal areas are just hairy. And they are pretty dense. I guess this is my last chance because cloning is not even near. I am going to be married next year but i have told every one that my hairs are back because i didn’t want to be embarrassed. My only question to you is How much is BHT and please Dr. is there any way I can be your object,trial,experiment? i am student and facing the worst time of my life. Thought you may have something for me.

In my opinion, results of body hair transplants are not well documented. I appreciate your desperate cry for some solution, but sometimes the best advice a doctor can give is just by making the patient aware of limitations in medicine. Moreover, I don’t like to experiment on patients when I know the the technology and the results may well be very poor.

Tags: bht, body hair, body hair transplant, hair transplant, hair loss, hairloss

Bald Spot In Beard After a Broken Jaw 2 Months Ago

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

hi i broke my jaw about 2 1/2 months ago and now there is a small bald spot in my beard. hair has always grown there before, i did not break the skin on my face or even bruise from the incident. is there anything i can do or take to solve my problem

This is probably a coincidence and the spot has nothing to do with the jaw problem. You need to see a dermatologist to determine the diagnosis and cause or just wait it out. If the spot gets bigger or new spots appear, then you may regret not seeing a dermatologist sooner.

Tags: dermatologist, broken jaw, jaw, bone, hairloss, hair loss

Taking 1 Propecia in the Morning, 1 Propecia at Night?

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

Hello Doc. My question is this. I’m currently taking propecia 1mg tablet daily. Since propecia has a half life of 8 hours, will taking it in the morning and then 12 hours later at night increase it’s effectiveness? My concern is that I take propecia in the morning and take it every 24 hours like is intended. But doesn’t the drug work only 8 hours out of 24? So the other 16 hours dht is attacking the hair follicle? Please clarify. Thank you for your time doc.

The drug fixes to the tissues and the hair follicles, which lasts longer than 24 hour. The half life is the time in the blood stream, not fixed to your tissues. Just stick to one Propecia pill a day.

Tags: propecia, finasteride, hairloss, hair loss

Blocking DHT in Post-Menopausal Women?

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

What is the best form of DHT blocking for post menopausal women. Is it safe to use propecia in my case?

Stop DHTDihydrotestosterone (DHT) does not usually cause hair loss in women. As mentioned before (Female Genetic Hair Loss Is Different From Male Genetic Hair Loss), the common causes of women’s hair loss are different than typical causes of men’s hair loss.

Although the DHT blocker Propecia (finasteride 1mg) is not approved by the FDA for use in women, there are doctors that will sometimes prescribe it for women, but these are highly individualized cases that require patient education and informed consent. First, the woman should make sure that they are not carrying the breast cancer genes. If they are not, then there is little downside that I know of. Many, many doctors are prescribing Propecia for post menopausal women because the protective effect of estrogen is reduced. The reports, however, are anecdotal and not trustworthy.

Tags: dht, menopause, women, woman, female, hair loss, hairloss, propecia, finasteride

Galeatomy Procedure

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

Dear Dr. Rassman,

The question is in regards to the galeotomy procedure – originally pioneered by Dr. Lars Engstrand out of Sweden – I believe. The procedure was also popularized by the late prolific health writer Paavo Airola in his many writings.

I find this sunbject very interesting and have noticed an increasing interest for this procedure on the hair-loss forums, but very little information exists. I have heard that this procedure is quite effective and yet it seems to be totally ignored (or suppressed) in this country. What do you know about this procedure? Do you think it works? Do you have any first hand experience with anyone who has had it done? Do you, or can you, perform it? Does anyone in the U.S. perform it?

Please take the time to share what you know about this interesting topic.

GaleaThe galeatomy has been around for years. For those of you who do not know, above the skull lies the periosteum (the living membrane above the bone) and then the galea. Above the galea lies the scalp, which is very mobile (try to move your scalp around and you will see just how mobile it is). The scalp has a clear blood supply coming from the front, sides, and back of your head. The blood supply lies above the galea, so cutting the galea makes no sense. It is not easy to get to the galea unless you cut open the scalp. We have done galeatomies years ago with scalp reductions and today’s hairline lowering procedures, and brow lifts will frequently dissect the galea as part of the mobilization of the scalp. As working below the galea is relatively bloodless, it is a terrific surgical plane to work in. Cutting the galea will not increase the blood supply to the scalp, but will just produce morbidity if it is done in isolation of some good surgical reason to do it.

Competent doctors do not do perform this barbaric procedure for the treatment of hair loss.

Tags: galeatomy, galea, scalp, hairloss, hair loss, surgery

What Should I Do After Propecia?

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

I’m 22 and have early frontal hair loss which I noticed 6 months ago and been on Propecia for 2 months now. I got a miniturization study done and the doc said I have it in the frontal area and a little on my mid anterior and he said it’s significant for my age (well in my opinion any thinning my age shouldn’t happen!). You always say Propecia works best for young men my age and we have a good chance of reversal and halt the hair loss but since men who start thinning my age are usually the baldest and have faster hair loss the others, how good in the long can Propecia work then? I know I’ll be fine for about 2-3 years but what then?

And it’s funny how weak MPB is in my family. Nobody except my father and mom’s brother had MPB but not until theirs 30s. My father is a NW5 at age 64 and my uncle is a NW3 with mid anterior thinning as well at age 40.

I have many male patients that first got great benefits from Propecia at your age, and now 10 years later they still have those benefits. I’m not sure how to answer your question — as I’ve said before, I can’t tell the future. Maybe there will be another drug available? Maybe your hair loss stops completely? Maybe you decide in 10 years that you hate hair and would rather shave your head? For now, stick with what is proven to work (Propecia).

There are patient results statistics for after 2 years and after 5 years on Propecia available here, and hopefully that will give you a little more peace of mind.

Tags: propecia, finasteride, hairloss, hair loss

Forehead Feels Cool, Seeing Wrinkles After Using Minoxidil

/by William Rassman, M.D./12 /

I have used minoxidil for my hair thinning on the vertex and hairline and it is working great! Except I’m noticing a disturbing, growing sensation on my forehead since I have been using it.

Whenever I would apply the minoxidil, my forehead would have a cool, wet sensation for about 20 minutes as if cooled water was running over it but it wasn’t the minoxidil or water. Nevertheless, I have been using it for 2 months and my forehead feels STIFF and I’m noticing wrinkles! I’ve read the 2 archived topics about wrinkles & minoxidil (i.e.”Using Propecia at Temples, Wrinkles From Minoxidil…” ) but I found documented studies about how it effects collagen synthesis (see: Medscape & Investigative Ophthalmology & Visual Science)

I’m assuming that minoxidil would be the cause of my facial stiffness (so bad, it feels like my forehead is duct taped) and gradual appearance of wrinkles. I’m a 25 year old male. I would greatly appreciate it if you could reply. Thank you so much!

Aside from that previous post from a reader, I’ve never heard complaints about wrinkles being caused by minoxidil. None of my patients have reported that to me. The studies you sent are interesting, but I’m not convinced that minoxidil will cause wrinkles. You might have some kind of allergic skin reaction to an ingredient in your formulation of minoxidil. I’m just speculating, of course.

Tags: minoxidil, rogaine, wrinkles, forehead, hairloss, hair loss, allergy