My Wife Has Alopecia — Will Our Children Have this Disease, Too?

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

Dear Sir, My wife is 1 month pregnant . She is alopecia patient & complete bald since at the age of 5 years old. Her 2 other sister are also bald and having the same disease. They all wear wigs.. But her parent is having full grown hair.

My worries is that will it affect our future children ? Will my future child inherit this disease from her mother. how can i be assure for that. What test can be done to confirm it. Please advice.

Regards

Alopecia totalis sounds like the diagnosis and in one form of inheritance, the problem starts appearing in the very young at between 3-4 years old. Once the process starts, all of the hair falls out within months. Angela Christiano, Ph.D., of Columbia University in New York researched this in a town in Pakistan where the population was inbred. She found that many of the children in that town lost their hair at ages 3-4 and it fell out in a distinct pattern. She took samples of their genes, and tested them at the university, finding a connection between their disease and some of the genetic patterns in our more common form of alopecia areata, a disease which she has. Your child may very well inherit the condition. See our previous post on this subject here.

Tags: alopecia areata, alopecia totalis, hairloss, hair loss, alopecia, gene, genetic

Nanominox FMS

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

NanominoxDear Doctor ,

i am thinking of buying nanominox fms , a product which combines minoxidil sulfate , finasteride and Ketoconazole. Do you think it is safe to use this topical solution on a daily basis? I would appreciate, if you could help me on that issue.

I have no experience with the combination of medications in Nanominox FMS. I am skeptical with it, because finasteride has not been shown to work through the skin. I suspect the FDA would, have a problem with any claims of a hair loss treatment from the manufacturer in the use of finasteride as a topical. Minoxidil is well known as a FDA approved topical treatment, and ketoconazole is a good antifungal medication that seems to make hair appear thicker. More info at their site. With regard to safety, your guess is as good as mine.

Tags: nanominox, hairloss, hair loss, minoxidil, sulfate, finasteride

The 5mg Finasteride In Bangladesh is Too Small to Be Cut

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

Dr. i wanted your suggestion about taking finasteride 5mg. i wanted your advice for not having finasteride 1 mg in our country bangladesh. the available finasteride is 5mg named “Prosfin”. you have researched the producing company name is “BEXIMCO”. you have found that they are producing finasteride 1mg named “Recur”. but 1thing u don’t know that “Beximco” has recently stopped production of recur. the Prosfin can’t be cut into 4 pieces, and at present i am taking Prosfin (Finasteride 5mg), 1 tablet/3 days. Now the concern is that taking finasteride 5mg 1/3days,can it cause any potential affect if i want to take a child, or want to have sexual intercourse while she is pregnant? can it affect the child? all things i am talking about taking finasteride 5 mg 1 table/3 days. i would not ask you these things if i could get finasteride 1 mg, or could break the 5 mg tablet. your blog is very informative.

This is an interesting problem. I’ve written to the drug company to find out more about their 1mg finasteride possibly being discontinued. For now, I suppose you might consider grinding the pill into a powder and taking 1/5th of that per day, assuming that the pill is the 5mg finasteride tablet. Make sure you keep it dry or it will pick up moisture.

Remember, the pill is not meant to be cut and the drug companies have designed it that way — so it’s not going to be an easy task.

Tags: hairloss, hair loss, beximco, prosfin, recur, finasteride, pill, tablet

I’ve Been Off Rogaine for Weeks While My Shipment Arrives

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

hi, i ordered 1 can of mens rogaine foam about 2 weeks ago, and still haven’t recieved it. well i have been using rogaine for about 5 months with great results, but havent been able to take any for about 2 weeks, will this effect the process? thank you for your time and help

The longer you wait, the worse the withdrawal impact will be. You want to keep those great results you’ve seen, right? Buy some locally to bridge the time gap until your online order arrives. Even if it’s not the foam, just get some minoxidil from your local pharmacy. Then, I’d contact the place you ordered from and find out why it’s taking them weeks to send your order.

Tags: minoxidil, hairloss, hair loss, rogaine

Estradiol and Hair Loss

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

I can find no information about hair recovery after stopping use of divigel(esrodiol) Have you found any information on time frames or how to facilitate recovery? Thank you.

The use of minoxidil may help. I do not have much information on it from personal experience, but you can read the following links to hopefully gain a better insight into the problems with estradiol use.

Tags: estradiol, divigel, hairloss, hair loss, female hair loss

What Does a Laser Comb Actually Do?!

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

Here’s my question — what the hell does a laser comb actually do? Something to do with blood circulation?

In my opinion, it does not too much. The theory is that it increases the circulation, but I do not believe that any impact on circulation will last but a few minutes if there is heat generated.

Tags: hair laser, laser, lasercomb, laser comb, hairloss, hair loss

In the News – LashFood, the Alternative to Latisse?

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

From the article:

The company’s product, called LashFood, looks like regular eyeliner, but it contains some ingredients that you might expect to find in a nutritional supplement, including the vitamin biotin, the amino acid arginine, extract of irises (the flowers, not the eye parts) and a blend of 15 herbs. Biotin and arginine are widely marketed as vital nutrients for hair growth.

LashFoodRead the full review at the Los Angeles Times.

Basically, what I get from the review is that this LashFood is marketed as the alternative to the newly FDA approved Latisse (bimatoprost)… but it’s just more quackery. It doesn’t contain the proven drug that works for the eyelash growth. Now I have no personal experience or any basis to determine the value of this product, so please read that full review and draw your own conclusions.

There will always be someone marketing a “natural alternative” to the latest FDA approved prescription drugs. Do they work as claimed? I guess folks will have to spend some money to find out for themselves, because no matter how many online reviews people read (from reliable sources, even), many will still have that “What if…” thought in the back of their heads.

Tags: lashfood, latisse, bimatoprost, hair growth, eyelash, eyelashes, fda, natural

Surgical Hairline Lowering + Hairline Transplant?

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

Dr. Rassman,

I recently read some posts regarding the surgical hairline lowering procedure vs. a hairline transplant. I was wondering whether it would be synergistic to do both?

If you are male (with a NW2 receded hairline due to MPB) with an inherited high hairline, wouldn’t it be better to get the surgical hairline lowering procedure done in addition to a hair transplant? Wouldn’t this conserve donor hair because you are essentially reducing the size of the forehead (less area to worry about transplanting hair follicles to…).

Thus, this would remedy the high forehead and restoration of the hairline, with enough donor hair in case of any future hair loss.

Hairline lowering procedures should only be done on women or on men who do not contain the balding genes. That means that men wanting this surgical option should be genetically tested first, perhaps using something like HairDX. For women who do not usually lose hair (as they do not have patterned baldness), the hairline lowering procedure has value since there is no significant danger of the hairline rising above the point of surgery.

The advantages of the surgical lowering procedure (like a brow lift in reverse) is that the results are basically instantaneous, a week or two after healing is complete. The hair was there prior to the surgery (just a few centimeters lower), so you do not have to wait for the hair to grow out like with a hair transplant. If you need more than one inch lowering, then the transplant option may be better. Some people with the hairline lowering procedure will develop a scar at the hairline and may require transplants to hide it.

Tags: hairline lowering, hairtransplant, hair transplant, hairloss, hair loss, genetic, hairdx

Shaving the Recipient Area Before a Hair Transplant

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

Dear DR. Rassman,

I notice that unlike other transplant doctors you don’t shave or buzz the donor or recipient sites. What is your feeling about this. If you’ve already answered this somewhere else, I apologize.

I know how difficult it is for a person to undergo a buzz cut in the frontal area just to accommodate a hair transplant, so I have learned how to do this over the years without that close cut. This has, of course, helped my practice as people have built in camouflage with no forced haircut. I have been working in this field for 19 years. I know other doctors don’t do it this way, but I also know how important it is for patients to preserve the privacy and return to work rapidly after the procedure.

Over the past dozen years, we have also done other things that make the hair transplant undetectable. The swelling that was initially a major problem, now is almost completely gone and the graft hole sizes are so small, that they are nearly invisible in the first couple of days unless there is a significant pink color in a very white skinned person. The crusting which has been an annoyance for up to 2 weeks, now is washed away and most of my patients have an undetectable surgery within days of the procedure, enough to return to work in a couple of days.

Tags: hair transplant, hairtransplant, haircut, shave, buzzcut, buzz

Why Wouldn’t Finasteride Work as a Topical If Women Can’t Touch It?

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

Hi Doctor,

I was wondering why finasteride is considered to be ineffective when applied topically? There are many warnings advising that women who may be pregnant are not to come into contact with crushed or broken finasteride-containing medication. If the risk of absorption is that probably, then why has the topical approach been largely dismissed as being an effective delivery method?

Thanks

BobI personally doubt there are issues with Propecia if women simply touch it. It is not about the absorption issues, but rather it is medical-legal issues. As you can imagine in our litigious society the field day lawyers would have if a woman who touched Propecia claims her baby was affected.

Finasteride has not been proven to work topically. Just as Viagra has not been proven to work topically — that is, unless someone else is applying it for you!

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

Traction Alopecia from Scratching My Head?

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

Hello. I have experienced thinning on my scalp and my transplant surgeon who did 2 of my eyebrow transplants & is now doing a third was going to put me on propecia, but I seriously doubt I have MPB. I think I have a bad case of traction alopecia because I believe I have sebhoraic dermatitis and in the past I used to scratch my head a lot and used a comb on it and I believe that is the cause of my recent thinning. it thinned at the time my scalp was extremely itchy and I have an intense itchiness in the thinning areas, however this was a few months ago. When i wet my hair it looks like it breaks into streaks. I read that you said that traction alopecia is reversible with most cases but since this was several months ago do you think there is still hope? How is traction alopecia reversed? I still have to see a dermatologist. My last question is, I have read that massaging your scalp with essential oils is good for your hair but I am afraid of massaging the thin areas since I don’t want to cause traction alopecia.

Seborrhea does not cause hair loss. Rubbing any oils into your scalp will only pull out the hairs that are already damaged from genetic causes. Once a person has real traction alopecia, is is usually permanent, but the pulled hair from one or two episodes of picking or scratching should reverse. Get a good doctor and establish a good working relationship with him/her.

Tags: traction alopecia, hairloss, hair loss, seborrhea

Female Hair Loss from Birth Control — Should I Switch Pills?

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

I have been on birth control pills (Orthotricyclen Low, Loestrin FE, and now Yaz) since 2004. I’ve noticed what seems to be androgenetic alopecia on my scalp since about 2005. Since starting on Yaz a year ago, it has increased and become VERY noticable. Would it be safe to get off birth control pills altogher or would that make my thinning worse? Should I try a different pill? I started taking BC because I had severe menstrual cramps to the point of fainting and am very scared to discontinue the pill.

This is a medical issue which needs to be discussed with your doctor. I am not your doctor and can not make recommendations on medication options for you. You’ve got a prescribing physician — talk with him/her, please.

Tags: bcp, birth control, female hair loss, hairloss, hair loss

Stomach Pain and Bloating from Propecia, Follow-Up

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

Follow up to “Stomach Pain and Bloating from Propecia” —

Hello Dr. Rassman,

Thanks very much for posting my previous message “Stomach Pain and Bloating from Propecia”. As per your suggestion, I tried to take the half dose of Propecia everyday. This reduced the bloated feeling somewhat but after a few weeks I felt discomfort in the groin region. I had taken the full dose previously with no pain/ dysfunction but some noticeably watery ejaculation.

At this point, I think I am finished with Propecia. I am one of a few people who feels that they were better off not taking the drug in the first place. I lost a great deal of hair in the middle of my head and this area of the scalp is particularly visible (and never was before prior to starting the drug). Although my hair was thin and has been thin for several years, it has remained the same for about 7 years with little or no change in density. Propecia initially created some increase in thickness but the middle area of the scalp that was lost through shedding never returned.

Doctor, do you think that after ceasing the drug, the hair that I once had in the middle of my head (and didn’t appear to be going anywhere anytime soon) will return? Over the course of a year I used Propecia off and on for about 7-8 months.

I have booked an appointment to visit my dermatologist at the end of the month. This is a very frustrating result for a drug that is supposed to help grow hair (not shed it away). Thanks so much for your feedback. I do appreciate all your help and support.

It sounds like you medication schedule has been erratic. As such, I can not tell you what will happen with stopping the drug. I doubt that the hair you lost will return. Minoxidil might have value for you.

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

Is FUE the Best Choice for Someone That Has Had a Lot of Transplant Work Already?

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

I have followed this site for a few years now and I am so impressed. First off, your integrity seems to be apparent in how you run this site. There is none of the cheap salsmanship common to some of the hair replacement surgeons with whom I have spoken. You provide so much disclosure that it is obvious that you truly want educated patients. It seems to me that the medical hair replacement industry was crying for someone like you.

With that, I am happy to share with you my story and ask you my questions. I am a 45 yr old male who began losing his hair at 19. I was told early on by a few surgeons that I was an excellent candidate for hair transplantation because my donor hair was so good (it was rated a 9 out of a possible 10). I believe that I am a Norwood 6 but I know that I have long lost all the hair that I was to lose. I have had 13 hair transplant procedures with Dr. X [editor’s note: name removed] and 2 scalp reductions with another doctor. The procedures were performed between 1989 and 2001. In total, I had 1679 “large” grafts, 379 “medium” grafts, and 321 “single” grafts. My hair provides decent coverage for someone who by this time would have been left with only what I call “clown fringe” (I am sure the visual will resonate with you) but I do use a concealer (Fullmore) to hide some small patches of my crown which show, and some of the scarring. My goal is to surgically get more coverage – or at least more uniformity in my existing coverage – so that I can stop using the concealer. I would like a good evaluation on what surgical options may be open to me, as I have already had so much work already performed and donor hair is not so plentiful. These are my questions:

  1. Do you ever do any work in NYC/LI?
  2. If the answer to #1 is no, can you recommend any good and caring surgeons in the NY/LI area?
  3. It seems like FUE2 would be a natural choice for someone who has had so much work performed already and where so much donor hair might not be harvestable in one strip. Is this a correct assumption?
  4. Is it possible to do many smaller strips so as to increase yield for someone who has had so much work performed already? Does it matter from where the strips are taken? I think that I may have some donor hair on the high sides.
  5. I have not heard of too many people having as much work as I have had. Does the work I describe sound like it is so much? Are you aware of many people who have had more work?
  6. I have been using a concealer for 15 years – just during the week and just during the day. Are there any health affects of such prolonged use?
  7. How does the cost of the FUE2 compare with the normal strip method?

Any of these questions which you can answer would be appreciated.

Keep up the site.

  1. At the moment, I only have offices in California and do not plan on going to New York.
  2. Dr. Robert Bernstein is a caring and competent doctor with a Manhattan location.
  3. Follicular unit extraction (FUE) is less productive when donor densities are down from multiple surgeries and when there is lots of scarring.
  4. With regard to taking high strips, it is generally not a good idea as high strip scars tend to show and they may not be in the permanent zone, so the hair may not last your lifetime.
  5. I have seen many patients that have had more than a dozen surgeries plus scalp reductions. One patient I met had 27 procedures, of which I believe most were sham surgeries. Without seeing you, I can not comment on what you did and did not get.
  6. Your approach with the use of concealers is well defined in my new book, Hair Loss and Replacement For Dummies, for the readers who do not know much about them.
  7. FUE costs are high compared to the strip method, but more important, they may not be very productive. FUE costs roughly 2x the amount of strip procedures, per graft.

The problem with your situation is donor scarring and your donor area must be a mess. It’s difficult to make any real advisable points without first seeing what I’m dealing with, but you might be able to excise the highly scarred donor area (probably using a balloon expander) if that is bothersome to you. Good luck.

Tags: fue, repair, strip, hairloss, hair loss, hair transplant, hairtransplant,

How Can I Detect Propecia Side Effects?

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

I’m going to start taking Propecia for hair loss. I’d like to be vigilant about identifying any side effects early on. It’s pretty easy to find a list of side effects, but I’m not sure how I’d go about detecting some of them.

Is there a comprehensive list of checks I can perform every week (or even every day) to make sure everything’s going ok? I suppose there’s a potential psychological effect of constantly
looking for side effects, but hopefully I can be objective about it.

The listing of rare, uncommon side effects of finasteride use is as follows:

  • Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue)
  • Breast enlargement, lumps, pain, or tenderness
  • Nipple discharge
  • Testicular pain

If you take the drug, the side effects will be evident within 2 weeks on average. Once you stop the medication, the side effects (except for breast issues) will be gone within that same 2 week period. I have seen the breast tenderness last a few months and often recommend that you see your doctor if it does not go away in a few weeks. You’ll be able to easily identify any of those side effects because they’ll be out of the norm. Most are uncommon though.

Tags: propecia, finasteride, side effects, hairloss, hair loss