Take Finasteride and Dutasteride Together?

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

Dear doctor
I have been using finasteride since 7 years and planning to use dutasteride now.Can I use both of them together in order not to lose what I had from finasteride ?

As dutasteride is used off label for treating hair loss, I rarely prescribe it for various legal reasons, but if your finasteride is not working to maintain your hair like it once was, then a trial of dutasteride might be a reasonable idea based upon information provided in this study. In that case, I would stop finasteride when using dutasteride. The mechanism of action is similar between the two medications, so benefits from finasteride should carry over if taking dutasteride. It’s not like when stopping minoxidil to switch to finasteride, where you will lose those minoxidil benefits (or vice versa), since the drugs work in entirely different ways.

Remember though, you do run a greater risk of significant side effects with dutasteride, like reduced sex drive and sexual performance issues. And the drug stays in your body for much, much longer than finasteride, so if you do see any of those side effects it’ll take quite some time for you to get rid of them. You should discuss your plans with your doctor.

Tags: dutasteride, finasteride, propecia, avodart, hairloss, hair loss

Young Men with Hair Loss — MTV Wants You!

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

MTV True LifeMTV’s documentary series, “True Life,” is casting young people who are losing their hair.

Are you too young to be losing your hair? Do you have thinning hair due to unlucky genetics or stress, and it’s affecting your self-esteem? Are you hesitant to go out in public and interact with people because you think they’ll stare at you? Do you try to cover your head with hats, or are you obsessed with hair products that promise to regain growth? If you have answered ‘yes’ to any of these, then MTV would like to hear your story!

If you appear to be between the ages of 17-28 and are losing your hair and would like to share your story, please email us at: BodyImage@mtvn.com. Please include your name, age, your story, a phone number and a photo.

A producer at MTV contacted me to help her reach out to our audience of young men for an upcoming MTV documentary program. If you fit their profile and want to share your story, contact Elyse Neiman at the email address above. I am not involved in the project, but I’m just relaying information.

Want to learn more? Read more

Hot Topic on the Web — Do Medications Work in the Frontal Hairline?

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

I have a question that I really need answered. I have been on propecia for around 10 years. I’m in my mid 30’s. No one can tell I’m sure that I have lost hair. My hairdresser of course keeps the top a little longer, along with some strategic gel placement I’m good. My crown is still thin looking when it’s wet though. I also started using rogaine a few years ago too. But here’s my question: Do propecia/rogaine work on frontal hairloss? I know it’s a hot topic on the net. Neither of the companies claim they do. My family is kind of all over the map (pardon the pun) with loss, but my uncle (moms side)has a solid front with a mpb crown.My dad of course has Elvis thick hair!! I talked to you before about coming to LA to get an fue to fix my crown. My front is totally solid with some slight recession but I’m worried that it might be the drugs that kept it intact…. I know it’s hard for you to tell without seeing it, but in your opinion, do these drugs work that well on frontal loss?

Thanks

Both drugs (finasteride and minoxidil) do work in the frontal area to varying degrees. Finasteride can slow down hair loss in the frontal area and minoxidil can grow some baby hairs in the frontal area, as well. I’ve gone over this before:

I still think that you need to get your scalp mapped out for miniaturization as a first step.

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

IGF-1, Capsaicin, and Hair Loss

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

Dear Doctor. I have been reading on pubmed that IGF-1 has a strong influence on hair and follicular health and growth. I have read that research indicates IGF-1 stimulation has increased hair count and hair weight. Capsacin, applied topically in 0.01 percent concentration for 5 months, increased hair counts in over 60% of the participants. This information is as of 2008, so it is current. What are your thoughts on this subject and do you think the combination of 5% minoxidil and 0.01% capsacin would be of benefit? Thanks!

PepperWhen I eat hot chili peppers they make my mouth burn, which is caused by the capsaicin in the pepper. Yet rubbing chili peppers on one’s head won’t stop testosterone from converting to DHT (and the DHT is what causes genetic hair loss in men). I would think it might make their hair fall out rather than regrow it, but I really do not have enough knowledge about this. If you send me the reference, it might help me research the quality of the study better.

Tags: pepper, capsaicin, hairloss, hair loss, igf-1

What If I Haven’t Seen Regrowth Results from Propecia At 9 Months?

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

You always say at the 8th – 9th month mark you should see Propecia’s regrowth/thickening of hairs. If you haven’t seen anything by then does it mean there is no possibility of thickening of miniaturized hairs or regrowth after that? I read that Propecia can take up to 1 year to see it’s benefits, so what’s the deal here?

I do not believe I said Propecia will make your hair thicker or regrow new hair all the time. Medication works differently for each person, so I couldn’t guarantee that. You must understand that there is no magic cure for hair loss and all drugs have limitations. As such if you are not noticing growth, you may notice less hair falling out. Less hair falling out still means it is working.

Tags: finasteride, propecia, hairloss, hair loss

Arimidex and Hair Loss?

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

Hi
First a little background of my problem. i am a male of 26 years of age. I was suffereing from Erectile Dysfunction. My urologist diagnosed me with hypogonadism. He prescribed me arimidex (estradiol blocker). My current dosage for this medicine is 0.5 mg per 2.5 days. My sexual life has improved a lot after taking arimidex. For the last few weeks I am facing tremendous hair loss. On searching internet about it, I found that one cause could be high DHT. It is possible with arimidex to have high DHT? arimidex increases testosterone and reduces estradiol. The extra testosterone in my blood converts to DHT.

I am looking for solution so that the extra DHT doesnot damage my hair follicles. I am also concerned that if I use some kind of DHT blocker, how it will effect my sex life. I am under impression that less DHT can cause havoc in sex life eventually even causing erectile dysfunction. I am not sure about this behaviour of less DHT. Please help me to understand whether if DHT levels directly affects the sex life?

Although erectile dysfunction (ED) can be induced by finasteride (a DHT blocker), it is very rare. With proper treatment for your hypogonadism, you might ask your doctor about the use of finasteride which may not interfere with your treatment for ED. Arimidex (anastrozole) itself can cause hair loss in some rare cases — see Drugs.com for more.

Tags: arimidex, anastrozole, hairloss, hair loss, dht, hypogonadism, finasteride, proscar, propecia

Neuralgia and Hair Loss

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

DR Rassman, can I first congratulate you for having the pre-eniment hair loss site on the internet. My problem is that I suffer from a Congenital Anomaly of the Cranio-cervical junction at the skull base, and this coupled with Occipital Neuralgia and Trigeminal Neuralgia is causing me intense pain all over the Head and Scalp. The pain is of a Stabbing, Burning, Lancinating and Compressive character, and at first I was just worried about the severe pain and it’s impact on my quality of Life.

However, Three years ago the pain got progressively worse, and my hair started falling out in clumps. It did not appear to follow the pattern of MPB, as the loss was sudden, and diffuse on the top and sides, and not affecting the back. Lately it has affected the back as well and I am left with very fine hair on the sides and back, and little hair on the top almost like DUPA. Despite attending my Doctor for the past 3 years, I have not even been referred to a Dermatologist, despite numerous requests on my part. Consequently , I am left at a complete loss at where to turn and am in great distress. Please can you help me, as my pain, combined with the hair loss is making life unbearable.

Many good hair transplant doctors are able to tackle problems like yours without offering a hair transplant. Many of them are dermatologists as well. This is where you might go for more advice.

Tags: hair transplant, hairloss, hair loss, neuralgia

Is Tea or Coffee Bad for Your Hair?

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

It’s well documented that caffeine increases stress hormone levels in the human body i.e. cortisol, adrenaline, etc. My question is, is consuming products with caffeine like tea or coffee detrimental to our hair, as you’ve indicated before that stress can cause hair loss?

Also another random question — should we be asking questions here now or at the forum?

CaffeineThis topic comes up every year or so. Depending on the flavor of the month tea/coffee/caffeine is both good and bad. Some studies say that excessive caffeine is bad, some home remedies include direct application of coffee or tea on the scalp. There’s even caffeine shampoo now. I don’t have a definitive answer to your question. To my knowledge, no peer-reviewed, published studies have been done that prove hair is effected by caffeine negatively. Consider this — caffeine is one of the most widely consumed substances in the world and the most common cause of hair loss is genetics (with or without coffee, tea, energy drinks, sodas, etc). Minor stresses shouldn’t cause hair loss, and certainly caffeine wouldn’t raise stress levels (unless you’re really overdoing it) to the point that you’d experience loss. Live your life in moderation.

BaldingForum allows other many people to see your questions and to add their input. If there are problems, as I read the forum, I will enter the process and give my opinion. So the forum offers two avenues for information: (1) the audience of readers, and (2) myself and Dr. Pak. The forum isn’t a replacement for BaldingBlog, so feel free to continue asking questions here… or there.

Tags: coffee, tea, caffeine, stress, hair loss, hairloss

Sertraline and Hair Loss

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

I am a 19 year-old male living in Turkey. At age 13 I’ve been diagnosed with depersonalization / derealization disorder and was prescribed half a dose of a sertraline-based anti-anxiety drug (known as Lustral here) daily.

I used it for about two years and since then used it on and off for a few weekly periods, including for about two months when I was 17. I heard about antidepressants causing hair loss and in the periods that I used the drug, I noticed that my hair strands were generally thinner and weaker, but no balding visible. And when I ceased using it, my hair returned to its normal strength and thickness. So my question is that, do these antidepressants really cause irreversible harm to hair (thinning / balding) or is it always “back to normal” when medication ends?

Thanks Doc, I’m really curious about this.

ZoloftThe medication you know as Lustral (sertraline) is also commonly known as Zoloft. And as you may know, many antidepressants (including Zoloft) can cause temporary hair loss, possibly even permanent loss in those genetically inclined to lose hair. I can’t say for sure whether the stop/start method you’re using with the medication will always continue the same hair loss/regrowth you’re seeing.

The consumer drug information for sertraline mentions hair loss as a side effect when overdosing, but I suppose it is possible to see loss with normal dosing as well (possibly even half dosing like you were prescribed), depending on how sensitive your body is to it.

Tags: zoloft, lustral, sertraline, antidepressant, depression, depersonalization, derealization, disorder, hairloss, hair loss

My Trichologist Said White Blood Cells Were Attacking My Follicles

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

I recently went to a trichologist following some increased hair loss and he did a miniturization test and said I have very little miniturization of hair. I asked him how much – he said maybe 2 or 3%. Hence I have no genetic thinning/minturization.

However in addition to this the trichologist prescribed tyrosine (amino acid) for me. He noted there was redness/swelling around my hair follicles caused by white blood cells attacking the stem of the hairs (according to him). I noticed this redness when he was doing the miniturization microscopic test – the redness is not visible to the naked eye but quite evident around the follicles under microscope.

I want to know if this is the right course of action? What is this redness exactly? Is this what is causing my more than usual (but not excessive) shedding?

Additional info: I’m 23 and my dad is the only one of my relations with hair loss. He is probably a norwood V and lost most of his hair in his 30s.

I felt the need to bulletpoint four important points I want to make here:

  1. Trichologists are not doctors. They do not prescribe medications or diagnose medical conditions.
  2. I do not know of such test that can see redness and white blood cells attacking follicles (even under a microscope).
  3. Tyrosine as you know is an amino acid, but it really has no role in balding. You don’t need a supplement as it is plentiful in meat, dairy, eggs as well as almonds, avocados, bananas, etc.
  4. If you want a real medical opinion about skin redness, see a dermatologist.
Tags: trichologist, hairloss, hair loss, redness, dermatologist, blood cells, tyrosine, amino acid

Treatment for Scarring Alopecia?

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

I was diagnosed with scarring alopecia. It has caused a dramatic amount of hairloss mostly located on the back of my head. Is there ANYTHING I can do about it? Please help, I’ll do anything!!

You need to discuss this with your doctor. Scarring alopecias (also known as cicatricial alopecia) have many causes and your doctor knows what is happening to you, certainly better than I could without seeing you or knowing more about your history. Unfortunately, I can not advise you over the Internet.

For more general information, you might want to check out the Cicatricial Alopecia Research Foundation frequently asked questions page.

Tags: scarring alopecia, cicatricial alopecia, alopecia, hairloss, hair loss

Finasteride and Inflammation?

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

I’ve been on Finasteride for 3-4months now and I’ve been going through and immense shed. I’m losing hair on my crown , on my middle area , temples have receded 1 inch and my front sides are thinning. I’m 19 years old and understand that my hair loss is quite aggressive. One thing that I cannot understand is why my inflammation has not declined since I have introduced Finasteride.

Since Finasteride inhibits DHT , and DHT is the cause of inflammation (immune response to DHT attacking follicles) Shouldn’t a reduction in DHT cause a reduction in inflammation?

I know Ketoconazole in products such as Nizoral and Revtia will help with inflammation , but I was curious to see if there would be a drop in inflammation.

If you truly have inflammation, I would strongly suggest you see your doctor for a physical exam. Normal male pattern baldness (MPB), otherwise known as androgenic alopecia (AGA), is genetic and DHT is responsible for it, but it does not cause inflammation that you can see. DHT does not cause an immune response or attack hair follicles. The source of the information you have is not reliable.

Tags: inflammation, finasteride, dht, hairloss, hair loss, ketoconazole

Are Transplanted Hairs as Strong as Natural Growing Hairs?

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

Are transplanted hairs at least a year after the transplant theoretically more fragile and not as strong as in the root of the hair compared to natural hair that hasn’t been transplant and isn’t miniaturizing. I sometimes itch my transplanted section of my head, sum times rigorously, not too hard but itch it. could i damage the tranplsnted hair by doing this or becuase the hair grows beneath the skin it wont be doing damage because the hair starts to grow from beneath the skin?

Both transplanted hair and the non-balding hair are equally strong. If you had your transplant with small needles rather than large ones, there should not be itching. On occasion small nerves are damaged which may produce itching. This eventually goes away.

Tags: hair transplant, hairloss, hair loss

What Percentage of Men Lose Hair After 5 Years on Finasteride?

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

I have a question about the post from 12/5 3:35pm. You mention that some people see hair loss continuing again after 5 years on finasteride, while others have been taking finasteride for 10 years without any changes.

Could you quantify these a little, e.g. in your experience, for what % of people who take finasteride and it stops hair loss temporarily does it suddenly pick up again after 5 years, and, in your experience, what % of people who have been taking it for 10+ years did not have hair loss pick up again.

I thought that if Propecia works and successfully stops hair loss, a master plan would consider all the present hair as safe, and allocate potential hair transplants to other areas that have suffered hair loss prior to taking Propecia. In the light of this post, even if Propecia works for a given patient, it seems that despite Propecia, it is possible that hair loss does continue, so one should not deplete all possible donor hair on areas currently affected?

I do not have numeric data for you. Instead of focusing on statistics, try to understand the big picture. If I tell you that 1 percent will have no results, and you happen to be that 1%, it is 100% for you (in your particular case). My main point was that everybody is different and we all try to maximize our chances of keeping our hair. Propecia is one of those things we use to maximize the odds in your favor.

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

Especially on TV, Your Appearance is Everything

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

Hi Doctor. My hairline has been the same for about 20yrs and about a year ago noticed a slight change on one side. I haven’t seen much of a change in a year and a half. To me, it looks like my hairline never finished maturing. I’m now 37 years old and recently made my debut on national television. My hair is black and curly with good density. I did see a doctor who said that at this point, if I got a HT, it would look like I had hair on my forehead. She said the measurments were normal etc. I am also starting to get gray hair and will probably start dying it soon. Is it possible when you go gray your hairline might change slightly? If I wanted, would you lower my hairline if it continues to recede? People tell me that at age 37 if you aren’t showing signs of baldness, or have mild recession you probably wont lose your hair; is this true. Just concerned about my new career on tv, where your appearance is everything. Thanks.

George ClooneyFirstly, grey hair and balding are not related. Look at the beautiful head of hair on George Clooney for an example.

At one time I had transplanted a number of men who were in their early 20s and had soap opera stardom, with hair loss starting as you described. The entertainment field demands that many of its male soap opera actors look almost like boy toys, apparently that being the look most women like. So getting hair transplants to maintain a career look is not an unusual request and I would be happy to render you my opinion upon examining you. I’d argue that for many people, appearance is everything — so that isn’t limited to just entertainment-based careers.

If you are receding slightly and want to do something proactive (due to TV careers, personal preference, etc), a choice to have a hair transplant surgery is an option, but it is one that you must fully be educated on with respect to its limitations and expectations. At your age (37), if you don’t have significant balding, your chances of further balding may be slim. You may continue to recede in the front corners, but I really cannot tell. You should have your hair examined under a microscope for miniaturization. If appearance in front of a camera is important to you and you are conscious of your frontal hairline, you can also consider using makeup products (like DermMatch or Toppik) that make your hair look fuller.

Tags: hairline, hair loss, hairloss, tv, television, entertainment, career, proactive