XX, XY, Chromosomes and Hair Loss

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

Hi, i admitantly had a bit of a dig at the answers on this site being a little generic, repetitive and indirect in my opinion. So i have a question of my own. How accurate is the following information? This information makes sense to me. Thanks i appreciate it.

The mother has two ‘Xs’ and will always give her kid an ‘X’. The father has one ‘X’ and a ‘Y’ and will give the kid one or the other. The father, therefore, determines the sex of the child. If he gives you ‘X’ then you’re ‘XX’–a GIRL, if he gives you ‘Y’ then you’re ‘XY’–a BOY.

“X-linked” disorders are defects in one of the thousands of genes found on the ‘X’ chromosome. These disorders can range from severe mental retardation to more harmless things like color blindness or PATTERN BALDNESS. The reason that males are more susceptible to an X-linked disorder is that when mom gives her son an ‘X’ carrying the defective gene, dad gives the son a ‘Y’, which cannot back up the defective ‘X’. Women seldom get these disorders since the chances of getting two bad ‘Xs’ for the exact same gene are quite slim.

So as far as whose fault it is, blame both parents–Mom for giving it to you, and dad for not backing you up.

Now another point should be made about where to look for the bald ‘X’ in a mother’s family. You have to look at EITHER the (1) mother’s father OR (2) her brothers:

(1) Grandpa has the bald ‘X’ (and is bald) and passed it to your mom/her sisters-who give it to half of their sons. (remember mom’s brothers would only get the ‘Y’ and would not be bald in this case).
(2) Grandpa has a good ‘X’, but Grandma has bald ‘X’/good ‘X’ and gives a 50/50 ratio to kids, so half of mom’s brothers are bald.

If you are grandson of all this, then in scenario (1) you have 50% chance at baldness, scenario (2), a 25% chance.

Both (1) AND (2) are possible in the same family, but would be rare and might lead to bald women in the family (depending on other factors such as testosterone levels)

ChromosomeI am not a geneticist. I am a physician. And the genetic argument as you pose is a simplified understanding of high school biology or college biology 101 at best.

The inherited traits are far more complex than X or Y chromosomes. While it is true that the father’s XY chromosome determines the sex of the unborn child, the balding gene is not in the Y chromosome. There are things called expression that distort our understanding of the genetics. Actually, no one really knows. That is why you cannot and will not find the answer… yet.

Tags: biology, chromosomes, hairloss, hair loss

Propecia Worked Great for Years, Now I See Hair Loss — Should I Take 2 Pills Daily?

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

hi there.

I ve been on propecia for six years with great results. The last couple of months i noticed a lot of hair loss. about 100 pieces of hair per day. Do you think it stopped working? maybe I should take 2 pills per day? or switch to another drug. or even go for hair planting.

Thanks so much

Propecia does not stop working. It is just that your genetic hair loss pattern may be showing. Propecia is continuing to work by slowing the hair loss. If you stop taking Propecia at this point you will notice a more rapid hair loss. If you increase it, it may have value at double the dose. The way to determine the effect of Propecia is to do comparison miniaturization studies over time. Then you know when and if it stopped working. Counting hairs does not do it for me. Discuss the possibility of increasing your daily dosage with your prescribing doctor.

Tags: propecia, finasteride, hairloss, hair loss

Keloids from Hair Transplant?

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

Is it possible to get keloid or hypertrophic scarring from a hair transplant? How likely is it to occur? Or would the new hair hide it in any event?

Thanks in advance

A keloid is a possibility with any cut on the skin. If you have had a cut on the skin you will likely know if you keloid these cuts or not. Keloids are more common in people with African, Asian, and Hispanic skin types, and less common in Caucasians. That being said, scalp keloids from a hair transplant are very, very rare in all races.

Tags: keloid, hairtransplant, hair transplant, skin

I Had My Wisdom Teeth Removed, Now I See Hair Loss!

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

Hi Doc,
Im 24 and have seen my very thick had of hair become very depleted and thin in the past month- six weeks. It seems very strange that my hair would thin so quickly, largely in the front and the temples, but not reduced to those areas. Prior to noticing this hair loss I had my wisdom teeth removed, with complications forcing me to take percacet and T3 as painkillers as well as an antibiotic. Could these be linked to my hair loss? How can i reverse these effects?

I have seen the hair loss process start (or become more noticeable) after a major surgery, but most of the time, it can also be coincidence. I doubt that a wisdom teeth extraction or T3 painkillers would cause hair loss, but possibly the stress involved precipitated the hair loss you were destined to have somewhere down the road? I couldn’t say for sure.

Tags: dental, dentist, hairloss, hair loss, wisdom teeth

Can Some Scalp Hair Be Affected by DHT, While Other Scalp Hair Isn’t?

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

Dear Dr.

Is it possible to have around 50% of hair that is not affected by DHT while others become miniaturized in the same area? I am a 28 year old male and the reason I ask is that, when my hair is wet it becomes very apparent that i have lost hair. My scalp looks very shiny to the point where I look baldish. When all my hair dries, I still look like I have a full head of hair because my hair is moderate length and very dark. Will this miniaturization continue and affect the left over hair? I wish I had caught this earlier but it seems that it has snuck up on me over time. Also, part of me is still in denial
but slowly it is hitting me. Thank you

Propecia (finasteride) impacts all of the DHT receptors in the hair about equally. It is possible that some hairs may make more DHT, but I don’t believe that there is evidence that this is the case.

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

I Picked a Blackhead at My Hairline and a Hair with Root Came Out

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

i woke up today, and noticed i had a whitey yellowish blackhead on my hairline, and of course i had to pick it, and when i did i noticed it was attached to the root of a hair, a little blood came out and the actual follicle now looks red, what is this condition? and will the hair grow from that follicle again?

This is a bizarre question. We all have blackheads once in a while and they are no big deal. I doubt that you will lose the hair in the long term, but what is the value (or lack of value) of one hair?

Tags: pimple, blackhead, hairloss, hair loss, acne

Finasteride Does NOT Increase the Risk of High-Grade Prostate Cancer!

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

I saw you recent post on finesteride. There is a new study by Redman MW et al that looks pretty positive for those on the drug. Check it out!!

Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer: A Bias-Adjusted Modeling Approach (PDF file)

ProstateYou’re referring to the post from last week — My Doctor Said Finasteride Makes Prostate Cancer Untreatable!

In 2003, the New England Journal of Medicine published a study (the trial was called the Prostate Cancer Prevention Trial — or PCPT) that concluded a daily 5mg dosage of finasteride reduced prostate cancer risk by 25% (see Finasteride Reduces Prostate Cancer Risk). In fact, the number was actually closer to 28% — and that has since been revised to nearly 30% in the study you sent from the American Association for Cancer Research. An article published in ScienceDaily about that later study points out:

“From a new analysis of PCPT data using advanced statistical modeling techniques and a complete assessment of prostate tissue biopsies, they concluded that these concerns are now resolved: finasteride actually reduced the risk of developing prostate cancer more than researchers had originally thought, did not increase development of more aggressive cancers, and the majority of tumors prevented were those that could spread and cause death.

Thanks for the reference, as it goes along with my way of thinking. And just for clarification, Propecia is a hair loss treatment that is 1mg of finasteride; Proscar is a prostate treatment that is 5mg of finasteride.

Tags: finasteride, proscar, propecia, nejm, cancer, hairloss, hair loss

Should 18 Year Old With Early Hair Loss Use 2% or 5% Minoxidil?

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

I am 18 and experiencing hair loss in the past month. I have hair loss all across the top of my scalp. My scalp is also itchy in that area. My doctor prescribed me minoxidil 5%, even though I still have full scalp of hair. Is it safe for me to apply it considering that I’m 18 and that it’s still unknown how it works (what if in about 10 years, study will show that it actually causes some serious disease)? Would it be better to take minoxidil 2%? Thank you for your answer.

Rogaine 5% - Extra StrengthI think either 2 or 5% minoxidil is relatively safe to use, as it has been used to treat hair loss since the 1980s. However, why are you using something without firmly knowing what you are treating? For those who follow this site on a regular basis, you can imagine what my next sentence would be…

Get a miniaturization study to know what you are treating and if you have miniaturization indicative of male pattern baldness, then Propecia is the best, best, best drug to treat it — not minoxidil. Also, minoxidil is an over-the-counter medication (sold as Rogaine Extra Strength, among other names), so there is no need for a doctor to prescribe it.

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

1mg vs 2.5mg vs 5mg Finasteride

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

Dear Dr Rassman,

I know this has been asked more than a couple of times in your splendid blog, but you have never gave a definite yes or no answer to this dosing question.

I have been on finasteride for some time and although it worked well for the early few years, im starting to recede pretty aggressively this year. Will increasing the dosage from propecia (1 mg) to taking half proscar (2.5 mg) or even 5 mg even helps at all to fight the losing battle?

Thanks so much for your time!

I thought I’d answered this many times before, but if I was too vague, I’ll try it again —

The FDA says that 1mg finasteride is all you need to treat hair loss, but perhaps 2mg for those people who are losing the effect of the drug may be better (discuss this with your prescribing physician). Side effects must be titrated. Try it and see. If there is no increase in side effects (and with your doctor’s knowledge), you might go for it. The more finasteride you take, the higher the risk of side effects.

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

Can Rogaine Foam Lower Blood Pressure?

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

FoamI have been using Rogaine foam for 2 months. I have also been on a lower sodium diet for about 3 months. I’m seeing a really nice improvement in my BP (I have been in the pre-hypertensive range). The question, I know monixidil in pill form is a high BP medication, but can topical Rogaine foam also contribute to a lowering of BP? Or should I just chalk it all up to lowering my sodium intake?

Thanks

Low blood pressure can be just as dangerous as high blood pressure, but if you have had borderline hypertension that has dropped to normal levels on Rogaine (minoxidil), then there may be a connection for you. Rogaine Foam should not lower blood pressure in general, but I suppose it could be a side effect. I would definitely follow up with your doctor regarding your concerns.

Tags: rogaine, minoxidil, foam, blood pressure, hbp, hairloss, hair loss

Small Craters Where Hair Was Transplanted

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

I had a surgery from another doctor about 4 months ago (2,000) and I still see small crater pockmarks where the hair was transplanted, will that ever go away. I think it looks almost worst then before.

Craters in the skin reflect larger wounds and larger grafts with lots of skin in the grafts. Craters very rarely happen (almost never) with correctly done follicular unit transplants and the use of small needles in trimmed grafts. It sounds like a poor job was done with the transplant.

Tags: crater, cobblestone, hairtransplant, hair transplant

Prescribing Finasteride Online?

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

Hi
I was wondering if it is in your power to prescribe proscar or propecia for people online. I ask because my doctor refuses to prescribe me either and I don’t really want to just buy it online. Thanks

Sorry, but what you’re asking of me is illegal in the US. I would try to find a doctor that will prescribe it to you locally.

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

Once You Stop Propecia, Won’t DHT Be Overproduced?

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

I read on your site, that when you stop using finasteride after several years, you will lose many hairs because your genetic aging will catch-up, to the point where you would be when you never used it. But is this right? Because I would think that your DHT-hormone, after being suppressed for several years by the drug, and when you stop using it, it will go “over-producing” (like for example: 200%) and that would make your hair losing rapidly. Can I be right about that?

Yes, I suppose you could be right, but somehow it does not make sense to me scientifically. Testosterone is the source of dihydrotestosterone (DHT), and after you have been on Propecia (finasteride 1mg) for several years your testosterone levels should be normal. Therefore, one can potentially make the leap that the DHT will also be normal after you stop taking the Propecia.

I really can’t get into all the genetics and biochemistry aspects of why Propecia works or why you can have rapid “catch up” hair loss if you stop taking it. If you want to know the exact reason, well, it’s been many years since I took my biochemistry courses, so I’d not feel qualified to get into it (hey, I’m being honest). As a physician who treats patients and sees patients who lose hair when they stop taking Propecia, I can tell you that this happens.

Tags: dht, testosterone, hairloss, hair loss, finasteride, propecia

Hair Cloning and Hair Transplant Failures?

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

Doctor,

Firstly, do you think we will see any radical new baldness tretments in the next five-ten years (such as hair cloning)? Do you think if hair cloning (or another procedure) becomes a reality it would be possible to have a full head of hair if a man was extensively bald (only hair at the back and sides of his head)? If this is possible would it be necessary to continue taking dugs such as propecia? I would imagine if the hair is DHT resistant it would not be required. Finally, how often is there failure in hair transplants? By that I mean when hair is taken from a donor area but fails to grow when transplanted (I’m assuming a competent doctor)?

Hair cloning procedures available to the general public are still many years away. Maybe there will be medications required, maybe not. At this stage, no one knows. Any cloned hair would have to be DHT resistant or what is the point in cloning hair that is susceptible to falling out again?

Complete failure of a hair transplant is rare when the team that does it is very experienced. I just had one about a year ago and then repeated the surgery at my cost and everything worked the second time. I just saw the patient 8 months from the date of the second surgery and things look fine now. I was stumped about the earlier failure and still do not understand it. Most of the problems of failure to grow is the result of diseases like diffuse alopecia areata. Skin biopsies might help make that diagnosis.

Tags: hair cloning, cloning, hairtransplant, hair transplant, failure, propecia, finasteride

Why is a Piece of a Proscar Pill Smaller Than a Propecia Pill?

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

I know this may seem like a really insignificant question, but it’s been a looming one none the less:

If you cut a 5mg finasteride into 4 equal pieces you would have 1.25 mg of finasteride correct? Why, then, is a 1/4 size of 5mg smaller than a 1mg Propecia pill? Especially taking into consideration theres more finasteride in a 1/4 piece.

Thanks for taking a moment to answer such a ridiculous question.

PropeciaPills have fillers and the drug companies determine how to make it and what type of fillers there are. These fillers are called excipients (see Wikipedia, and basically make it easier for consumers to handle the pill.

From what I’ve read, the excipients in Propecia are: lactose monohydrate 110.4 mg, microcrystalline cellulose, pregelatinized starch, sodium starch glycolate, docusate sodium, magnesium stearate, talc, hypromellose, hydroxypropyl cellulose, titanium dioxide (color E171), yellow and red ferric oxide (color E172).

Tags: excipient, filler, propecia, proscar, finasteride, hairloss, hair loss, merck