My Dermatologist Said My High Testosterone Is Causing My Hair Loss

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

I am 23yrs, male losing hair from 8th months. I don’t have any bald spots. Right now I might fit into NORWOOD II classification( I can easily cover my frontals with the hair). Though I am losing hair all over I can notice more hair loss at sides and back. When ever I put my fingers thru the hair I see atleast 2 hairs come out. Most of my colleagues say I still had pretty much hair, but I know how much I lost from last 10 months or so..

I went to dermatologist last month and she ordered some tests, my testosterone level is high, which is 869 ng/dL (normal 241-827) she said this was the reason for my hair loss. I am not totally convinced since it is DHT that cause hair loss but not high testosterone. Shall I go for DHT test? If so do I need to have any other tests along with DHT? They suggested me to take Propecia which I am concerned of side effects. When I asked her about Miniaturization she said that she never heard about it. Is there any doctor you know in Denver Location that does this Miniaturization.

And also one more thing, while I am searching internet I found these DHT blocker shampoos. Do you think that these shampoos really work? Please tell me what to do. It is been so hard for me to concentrate on other things due to this problem. I really appreciate your advise. Thanks

If you do not have the balding genetics, a high testosterone level will not cause genetic hair loss. If you’re losing your hair, it is in your genetic makeup, not due to your testosterone level. If you have balding, then map out your hair for miniaturization and make the diagnosis. That’s really the best “test” you can have done — and it’s a simple task. You can even do it yourself — see Mapping Your Own Scalp for Miniaturization. I’m not sure if there’s a doctor in Denver that does it, as some doctors unfortunately have difficulty understanding the importance of such a study.

There are two types of DHT (Type I and Type II), and I believe most of the DHT blocking shampoos only take care of one of those types. Taking finasteride under a good doctor’s guidance will be your best course.

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

In the News – Cold Cap for Hair Loss From Chemotherapy

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

Snippet from the article:

Medical science has made great strides recently in developing successful cancer treatments. But there hasn’t been a lot of progress in dealing with one of the most distressing side effects of cancer therapy – hair loss.

A clinical study is underway on a system that just may help patients keep their hair as they fight for their lives.

Read the full text — Cold Cap Therapy

I read this with interest, but I have no knowledge of it first hand. The article does say that the “cold” in “cold cap therapy” means that they are stored at -22 degrees Fahrenheit, which I’d imagine could be quite uncomfortable. There’s one quote in the text that was a little alarming to me, unless I’m just reading into it too much. The inventor of the therapy, a British scientist, said, “I’ve got husbands calling me saying thank you because their wives who have hair down to here are saying I won’t do chemo, I’d rather die than lose my hair.”

They’d rather die? Hopefully that’s just a figure of speech…

Tags: hairloss, hair loss, chemotherapy, chemo, cancer, cold cap therapy, cold cap

Testosterone Levels Rise with Finasteride?

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

DHT is the byproduct in the breakdown of testosterone. So more testosterone will produce more DHT, but if the DHT is blocked, the effect of the increase will be mitigated. What actually does happen is that testosterone levels rise by about 15% when you take finasteride and that is the body’s way to dealing with the change in DHT levels. Some people get an increased sex drive from this change (in my experience about 10% of the population). Does this mean that because testosterone levels rise by about 15% does that make more DHT. if my testosterone increases does it mean i will loose more hair?

Testosterone levels do go up by about 15% by taking finasteride. What is happening is that the drug competes with the enzyme, and although the enzyme may rise to offset that competition, the competition for the receptors is brisk enough to reduce the binding and the production of DHT. The overall drop in serum DHT levels is more significant than the rise in testosterone levels. The higher testosterone levels will not cause more hair loss because of the process discussed above.

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

Propecia and Peripheral Neuropathy

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

Dear Dr. Rassman,

I was recently diagnosed with a peripheral neuropathy in my feet. Although, i feel it mostly in my right foot. I am mailing you because i have been taking propecia for a year now and thought that maybe finasteride could have be causing my neuropathy? I recently took a blood test(diabetes,hiv,lyme disease,etc), a 24 urine sample, a chest x-ray, a pulmonary test, and a brain MRI. Everything has come back normal, except my cholesterol was a little high and out of range and my enzyme count( i can’t rememember the exact name?) was out of range. When my neurologist saw my enzyme test was out of range she mentioned it could possibly be sarcoidosis, and just to make sure to have a chest x-ray and pulmonary test to rule them out. The x-ray and pulmonary tests were both normal.

I have seen an accredited hair specialist/hair transplant surgeon and a reputable one i might add….and after telling him about my neuropathy he tohught i should stop taking propecia for 3 months to see if it goes away…actually i had already decided to stop taking it, but, i w anted to see what he thought. Anyway, i have read your blog and respect you and your words and knowledge. If it isn’t an inconvenience could you please let me know what you think. Also, i asked my doctor if stop taking propecia cold turkey would that be okay and he said yes. I also asked if i started propecia would it still be effective and he said yes. he just said i might lose some hair but it should still work if i decided to use again.
By the way, i am in my thirties and have good general health. I am also a Norwood 2.

Thank you very much

I really am not in a position to give you advice here. I am unaware of peripheral neuropathy being a known side effect of Propecia. If you stop the medication, you will lose the value of it over a 2-3 month period of time, some of which may come back if you restart it by then. Any decision to do this and any schedule on restarting it needs to be made between you and your prescribing doctor.

Tags: finasteride, propecia, peripheral neuropathy, hairloss, hair loss

I Want More Chest and Underarm Hair

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

I am interested in getting a lot of chest hair..Now I have some fuzz and sporadic hairs. My FSH is rising and I am diagnosed with hypogonadism, early testicular failure- at 55 years young. Transplanting chest hair (from where may I also ask?) must be a lengthy- and costly transplant process. Is it possible? I also desire more underarm hair.

I have a free place to stay in L.A. if there is hope to do these procedures.

Thanks..

First, you should see an endocrinologist to see if hormone replacement therapy can get you the hair you want on your chest and in your underarms. Then, if this fails, a hair transplant should be your last option (hair would come from the scalp).

Tags: chest hair, body hair, hairloss, hair loss, underarm, armpit, hair transplant, hairtransplant

My Stylist Changed Chemical Relaxers and I Lost Hair!

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

On 8/28/08 my hair stylist changed relaxers without my knowledge. As a result, I have experienced hair loss, hair breakage and thinning. I was told that I will need to have the overprocessed hair cut. I was hoping this issue would resolve itself. By using leave in conditioners and taking vitamins. However, my hair remains damaged. My normal hair length is long and coarse(well at one time). I have been told that I will need to cut most of my hair and allow it opportunity to grow healthy again. Do you think it may grow healthy again?

The good news is that the damage was probably not impacting the hair below the skin, so eventually, the hair that is damaged will be replaced by new hair growing at the normal rate of 1/2 inch per month.

Tags: hairloss, hair loss, chemical burn, chemical, damage

John Cleese Had a Hair Transplant

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

John CleeseActor/comedian John Cleese, possibly best known from his days with Monty Python, has made a public admission to a hair transplant he’s had. It’s difficult to tell how much of an effect it has had though, since I can’t seem to find good photos to compare. So popular, particularly in the UK, that it warranted 2 articles in the same paper about it:

Even so, going public about a hair transplant is courageous, but it should not be. Public embarrassment is a result of an old association that hair loss reflects a lack of masculinity and with that hangover from the old days, that image remains. In addition, doing a hair transplant suggests that the men who do it are vain, yet this is really a take charge issue in getting the man in the mirror to look like he wants to look. No one likes paying the price of aging, so a hair transplant which often subtracts years from a person’s appearance, allows the man in the mirror to look more youthful. Try to imagine him without hair and I think that you will get his message.

Tags: john cleese, actor, monty python, fawlty towers, comedy, comedian, celebrity, hair transplant, hairtransplant

Water Retention from Minoxidil

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

Dr. Rassman,

Hello.

Question for you. I wrote you before, and so have others, about puffy or “swollen” faces from minoxidil use. You said if this happens it would be due to an allergic reaction. I was reading the clinical side effects and it listed water retention as a side effect. Wouldn’t this be the cause and NOT an allergic reaction? Also, if your answer is a “yes” could this also be the reason for the weight gain which is also listed as a possible side effect or would that be caused by an entirely different mechanism?

Have you seen this “puffy face” thing in any patients? If yes, is it common? And if you have, does the side effect remain as long as you are using minox or does your body eventually acclimate? Finally, if one did develop this, does the symptom last the whole day or does it abate after so many hours of last usage?

Water retention seems to be present in 7% of people starting on the minoxidil therapy. There are reports of weight gain as well. Most of the severe side effects come about when minoxidil is taken in pill form for the treatment of high blood pressure and the reports do indicate cardiac side effect, fluid buildup around the heart, etc.

As some of the minoxidil is absorbed through the skin, I would expect that the systemic dose should be less when used topically, but I can imagine that in some people absorption could be very high and the sensitivity to this drug high as well. Best to stop the medication and see a doctor in the case that this may be pointing to some silent heart disease and very early congestive heart failure.

Tags: minoxidil, rogaine, regaine, water, retaining, retention, hairloss, hair loss

My Doctor Prescribed 1% Minoxidil

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

Dear Dr. Rassman,

i recently came across your blog and i am already finding it extremely useful. I am 29 male experiencing hair loss for the past 4-5 years mainly in the crown and the vertex region with a receding hairline which has started receding since last year. I had seen a dermatologist who diagnosed my condition as Male pattern baldness and categorized me on stage3 Hamilton-Norwood scale. He has prescribed 1% minoxidil solution along with a multi-vitamin suppliment. I want to ask if you believe that would atleast help me retain my current condition? (on your blog i see most people taking 2-5% minoxidil) Also should i worry about minoxidil side-effects? or is it something that had been blown out of proportion with very few people actually experiencing them. Basically is it safe for most people?

Thanks for your time Doctor.

I do not mean to be harsh, but you should be asking your doctor why he prescribed you the medication. In general I recommend 5% minoxidil, but there may be a reason why your doctor has prescribed you only 1%. I don’t think the multivitamin will do much for your hair loss, unless you happen to be lacking something in your diet.

The side effects of topical minoxidil include skin irritation and sometimes dizziness (from a drop in your blood pressure), but this is very rare. It is safe, but just be aware of the potential side effects so you know what to look for.

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

I’m Supposed to Wait a Few Months to See Hair Transplant Results?

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

Hello Dr. and thank you for your reply ( the 14 days after surgery question).

I did get the do’es and dont’s and i did follow them, except for that one day that i had insufficient cover and that’s how it happened. I dont think i had a second degree burn, it’s more like light first degree.

My question is – if there is a way that i can tell ( i’m 2 months post op now ) if the hair is growing or not – cause right now i have a very poor growth and i fear it’s because what have happened although i’m reading every where that i should wait few months before seeing results….

It may take 4 months to see very early signs of hair growth. It can take up to 8 months on average to see 80-90% of the growth and a full year to see the full results. I am surprised that you are not aware of this and this was not explained to you by your surgeon. Just take care of your scalp in the manner your doctor told you (hopefully you at least got post-op instructions) and you should be fine. There’s not much you can do at 2 months post-op except waiting.

Tags: hair transplant, hairtransplant, hair growth

Why Did My Transplanted Hair Change Character?

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

You said on one reply, in reference to sleeping on transplanted hair, “On occasion, transplanted hair will become more curly and even wiry, so look carefully at the transplants and see if the character is the same as the non-transplanted hair.”

My transplanted hair has become more curly and even wiry like you said. Why has my transplanted hair done this, it didn’t used to be like this, and sometimes isn’t. Is it permanently damaged now, or does it just sometimes happen. How did it happen.

Your hair transplant is likely not damaged. Sometimes the texture of the newly transplanted hair can be different. It can be permanent, but it should grow out normal as it goes through a full hair cycle (2-3 years). It is one of the nuances of the hair transplant surgery that should have been explained to you before the surgery, although it is rare.

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

Getting Shock Loss on Sides of My Donor Scar

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

At 4 weeks post op i have significant shock loss on the donor area primarily just behind each ear where the loss is. Not so bad in middle but still some. Is it normal for more loss behind the ears and will it grow back?? Is that area more prone to shock loss than the middle of the back of the head.

Thanks

Sometimes the donor area can experience hair loss from the stress and/or tension from the surgery. Unlike the shock loss in the recipient area, the hair loss in the donor area should grow back in a few months to a year. I would follow up with your surgeon and have him/her further evaluate it.

Tags: shock loss, shockloss, hairloss, hair loss, hairtransplant, hair transplant, donor, scar

How Soon Can Shock Loss Start After a Hair Transplant?

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

Hello,

I am a female, 26 years old who just had a hair transplant ( 1000 grafts). It is 16 days post-op and Im starting to lose alot of hairs ( not the transplanted ones). Can shock loss occur this early on? Or is this something else ?

thank you very much in advance

Any hair loss between 2-12 weeks after surgery is often a sign of shock loss, so what you’re seeing fits within that timeframe. Check with your doctor.

Tags: shock loss, shockloss, hairloss, hair loss, hair transplant, hairtransplant

Critical Artery Was Cut During a Hair Transplant Surgery!

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

Dr. Rassman,

About 15 months ago, I had a transplant procedure done in another state and they severed the left posterior branch of the artery that runs up by the ear and feeds the scalp from the side of the head. To make a long story short, the artery was coterized but , the frontal hair on the left side used to be adequate and now it has thinned to the point where it is a significant social problem.

Have you had any experience in trying to transplant into this area after this artery has been severed or is it likely that the blood supply is much more spotty in the area?

Thanks for the help!

The artery was often cut in a type of surgery called scalp lifts (a type of aggressive scalp reduction which is not done today) and these people generally did well, even with both sides cut. The nerves to the side of the head which lie close to the artery were also cut in many of these surgeries. The purpose of these now outdated procedures was to be able to remove large sections of bald scalp. In theory, the artery on the other side and the occipital arteries (which are in the back of your head) should have an increase in blood flow since the problem was created, and as such, I would think that you should have enough blood supply to support a hair transplant on the cut artery side. A Doppler study (used to study blood flow and muscle motion) of the vessels might confirm my opinion.

Generally, when a flap is built one side of a critical blood supply to the flap is severed incrementally and the flap is lifted and then put back at least once until the dependency on the blood supply switches. The body seems to be pretty smart when it comes to these things. If you see a vascular surgeon for an opinion (a vascular surgeon is probably the best one to determine adequacy of blood flow) the added information he/she might supply would be helpful.

Tags: artery, hair transplant, hairtransplant, blood flow, doppler, vascular, surgeon, doctor, physician, hairloss, hair loss

Hair Problems from Wearing a Hat 10 Hours a Day, 6 Days a Week?

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

Hi i’m a 27 year old male, I am currently undergoing a hair growth/maintenance program through a hair clinic in australia. Although not really receeding much, my hair has become thinner than before. I started the program and saw some significant results, but then stopped after six month and picked it back up again but now using only 1/4 tablet a day of PROSCAR and a topical solution (prescribed by them) applied daily to the scalp. I have not seen much difference at all and still experiencing slight shedding of my hair, noticeable because it gets stuck on my body after showering and occasionally falls into my mouth. I do however miss a day or two of use throughout the course of 1-2 weeks, as i don’t come home for a few days when i go out on weekends. I am thinking about dropping the program as it is quite costly and time consuming to apply topical solution daily and am experiencing slight to mild stomach discomfort (don’t know if it is related to the PROSCAR). I’m comfortable with the state of my hair is at the moment as it is not too different from when i first started the program (Mostly slight thinning of frontal and mid region of scalp, no receeding so far).

What i’d like to ask is if i was to take just the proscar or propecia alone, how effective would it be to retain the conditions of my hair at the moment, and would it help prevent receeding of my frontal hairline? Also i’d like to ask although hat wearing has does not cause hair loss, does wearing a hat head for almost 8-10 hrs a day, 5-6 days a week for the last 3 years (due to laziness of grooming while out or working, on many occasions my hair/scalp would be drenched in sweat) have a direct affect on the health and growth of my hair?

Propecia (finasteride) should help halt hair loss, even in the frontal hairline. If you abandon the program outline by your doctor, I’d still keep up with the finasteride, for if you have genetic balding, that is the best thing you can take to treat it. Finasteride works differently for different people, so I can’t say with 100% certainty whether it’ll maintain your hairline. As I don’t know what topical solution you were using, I can’t be sure if stopping it will make a difference. If it was a minoxidil-based topical and you saw results, stopping it will result in a loss of those benefits (hair that grew will fall back out).

The use of hats 10 hours a day or even 24 hours a day are neither positive or negative, providing that they are not tight enough to rub and produce traction on your hair.

Tags: hat, cap, hairloss, hair loss, propecia, finasteride