14 Weeks Into Finasteride Treatment, My Permanent Zone is Starting to Thin

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

Hey Doc,

I have been on proscar split into 5 for 19 weeks. At about week 14 I noticed a lot of hair loss at the back of my head in the permanent area. The hairs that fall out are full thickness/growth and have a ‘bulb’ of skin from where it was joined to my scalp. I now lose more hair from here than anywhere else on my head and running my fingers through my hair just above my neck results in 5-10 hairs to come out at once.

Would you think this is TE? And if so would you recommend me to let it run its course? It doesn’t worry me because it is the permanent area I am just curious.

Regards

Norwood 7For those that aren’t familiar with the “permanent zone” of hair — it is the sides and back, as seen in the remaining hair of a Norwood Class 7 balding person (see image at right). We call it the permanent zone (or “donor area”) because the hair is not effected by male pattern baldness.

I cannot say if you have telogen effluvium (TE) just from your description. It is quite unusual for finasteride to cause thinning in the permanent area… and in fact, I’ve never heard of it happening. I would go back to the doctor you received the medication from and have him/her reassess your permanent area that you are concerned about. Your description of seeing 5 to 10 hairs fall out when you run your fingers through your hair is subjective not scientific… and it will not give you the answers you need.

You should have gotten a donor hair density measurement, which shows how many hairs you have in a given area. You also should have gotten a miniaturization study evaluation to see if there were hairs that were thinning. Of course, this may be an ideal case scenario for some, but that is the standard way I run my medical practice.

Tags: proscar, finasteride, hairloss, hair loss, permanent zone, donor area

Scalpure

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

Scalpure, this has to be a con right?

Scalpure.com

ScalpureThis is a new one to me. I enjoy when readers bring products to my attention, and it seems like a new unproven hair loss product is available every day. And just like many of these unproven products, Scalpure claims to be a “natural” and “breakthrough” treatment. The ingredients listed do not seem to be anything breakthrough: various oils and apple cider vinegar, none of which are likely to do anything for treating genetic hair loss. The makers claim that it pulls DHT out of the scalp like a magnet, but offers no proof of this. I don’t want to call it a “con”, but here is what it seems to be offering — buzzwords. What does it lack? Science and proof.

If you want to use this, it’ll set you back about $55 for 2 months of Scalpure, including shipping. The price isn’t terrible, but how much is your patience, your time, and your hair worth to you?

Tags: scalpure, dht, hairloss, hair loss, natural, apple cider vinegar

Mature Hairline and Race

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

hey im really concerned because i noticed the corners of my hairline has went back a little. im only 17 and im african american and i heard its not just a maturing hairline because that only happens to caucasians. please help

The hairlines of different races do vary and the mature hairline of an African American is different than a Caucasian. You need to see a good dermatologist to determine if you are now balding or if this is a maturing hairline you’re seeing. I would be happy to evaluate you if you’d like to send photos to the address on the Contact page. Otherwise, you can find a hair transplant doctor in your area by checking the physician search at ISHRS.org (I’m not suggesting you have surgery, but these doctors will know a lot about hair).

Tags: race, mature hairline, hairline, hairloss, hair loss

Coarse vs Fine Hair

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

How can you tell the difference between course hair and fine hair. Does course hair have a kind of messy, split end type of look, whereas fine hair feels very smooth and silky? Also, does course hair have more volume than fine hair?

Yes, coarse hair has more volume than fine hair. Split ends occur when you abuse your hair with straighteners, hot blow drying, and too much junk on your hair. Your overall treatment of your hair should include a good shampoo with a conditioner added. Letting your hair dry by itself is always best.

Tags: hair characteristic, split ends, hair care

My Results from Rogaine are Leveling Off After 3 Years

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

I’m 61 years old and have been using Rogaine for about 3 years. I have had positive results, but they recently have been leveling off as I still have some bare spots where my hair simply won’t grow. Could this be because the hair follicles have miniturized to the point where they have simply vanished?

I would need to map out your scalp for miniaturization to determine an answer to your question, but it is not unusual for minoxidil to level off on its value over time.

Tags: minoxidil, rogaine, hairloss, hair loss

My New Dermatologist Prescribed Propecia for My Female Hair Loss

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

Hi. I just came home from seeing a new dermatologist. She said if I tested positive for AGA then she would prescribe Propecia as a hair loss treatment. Is this the right solution for a 33 year old female? I heard that it isn’t use in women. I thought the better course of action would be the combination of Yasmin and Spiro.

Also, I would like to know how safe is Rogaine for the long run (decades). I am very hesitant about taking anything orally that would play around with my hormones (Yasmine, Spiro., or Propecia). Thanks for your time. Much appreciated!

There is no really great, proven treatment for a typical female hair loss. Rogaine (minoxidil) is FDA approved to treat hair loss in women, but it doesn’t get to the root of the problem (no pun intended). Even if your hair loss is found to be androgenic alopecia, there are no studies to validate that any treatment really works for women. In other words, there really isn’t a better course of action.

In theory Yasmin (drospirenone and ethinyl estradiol) and spironolactone should work for treating hair loss in women, but that is not always the case. Yasmin and spironolactone are not FDA approved treatments for androgenic alopecia, and I would be particularly cautious about starting Propecia (finasteride), as it is not FDA approved for women due to a risk of pregnancy complications (birth defects) and other unknown hormonal issues. While many doctors do use these medications for certain women with some benefit, they are not for everyone. The best advice is to be closely followed by a physician or get a second opinion (this does not count as a second opinion — I am not your doctor).

It is safe to use Rogaine for a long period of time, but follow the instructions. It is a topical medication and many patients have been using it for decades.

Tags: rogaine, minoxidil, propecia, finasteride, spironolactone, yasmin, hairloss, hair loss, female hair loss

My 3 Year Old Has a Scar on Her Scalp with Hair Loss

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

Dear Sir,

I have read responses on your most helpful website. I hope you can help me.

My 3 year old daughter had a laceration to the back of her head 4 weeks ago. The cut was closed at hospital casualty with medical glue. The scar is about 4cm in length. The area around the scar is bald (say 2cm to 3cm either side).

Please could you advise if you think the hair will grow back on the area not scarred? I note with interest that you were in Vietnam. From what I have read the medical glues were first used there. Do you know if they led to such cases of baldness? If so, was it just short term? Also what can be done for hair restoration on the scar itself e.g. will hair grow back? Is it best left? can a transplant be done if necessary?.

This is really worrying me. Kind regards

Some hairs should grow back, but there may be an area where hair will not regrow. Medical glue does not cause scarring, but the lacerations will.

Hair transplantation can be done if necessary, but you should wait at least one year to allow hair to regrow to see what happens. Having a hair transplant at 4 years old is generally not advisable for fixing the scar, so perhaps you should wait until your daughter is older until she has a maturity level to undergo such a procedure. The best age will be determined between you and her doctor. Most girls under 8 years old do not really focus on small scars.

Tags: scar, hairloss, hair loss, injury, wound, laceration, child

Could My Diabetes Be Causing My Neck Hair to Thin?

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

Dear Dr. Rassman,
I’m a 55 year old male in good health with the exception of being a type 1 diabetic. I have been using propecia and rogaine for 10 years with very good results and have maintained almost all of what I started with.

Here’s my question. My hair is thin at the nape of my neck. I can pull on it and 5 or 10 hairs will come out each time. I don’t think I have DUPA because I cannot see any change in my crown,vertex or hairline. I have read on your site that this type of loss is genetic. I know you prefer not to diagnose online but could the diabetes have anything to do with it? my A1c is 7.5 to 8.0 which I know is an the high side – Thanks

I doubt that the diabetes is causing your neck hair loss. I have seen men over the years (in airports, on the streets, in shopping centers, etc) who have lost just their neck hair and not their scalp hair, so I believe that this is a genetic trait in these men. I suspect that the number of hair cycles your neck hair has is limited and those hairs develop apoptosis (meaning that they have reached the end of their lifetime); if this is the case, there’s not much you can do. Perhaps applying minoxidil to the area will cause new hair growth? Also, I agree with you — it doesn’t sound like it is DUPA if it is limited to the nape.

Tags: neck, hairloss, hair loss, diabetes, diabetic, propecia, rogaine, minoxidil

Keloid Folliculitis

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

I have been battling hair loss for the past 10 years. I am a 32 year old african american female. I was first diagnosed with Keloid Folliculitis in 1999. I have received continuous treatment from various dermatologists and specialists. The folliculitis issue appeared to have cleared up by 2002 with no reoccurrences. My hair loss began in 2000. I have had a series of blood tests and a scalp biopsy. The biopsy showed my scalp had scarring. The blood work showed that I had high levels of testosterone, low performing follicle hormone, and low iron. (this occurred 3yrs ago.) Since then, I am taking 65mg of iron 2x each day and on birth control. I am also insulin resistant and taking metformin. I have tried various over-the-counter solutions for hair growth, but I am still losing hair.

Bosely will not grant me hair restoration; Duke’s Hair Clinic has temporarily closed. Currently, my primary care physician is injecting cortisone shots to see if this will trigger any hair growth. I am bald on both sides of my hair, and thin on the top and back. Wigs are my only savior at this point. My hair is natural. Please help me with my next step. I am tired of finding hair everywhere but on my head. Thanks!!!

I have never seen a person with keloid folliculitis and have no experience with it. Regardless, your situation is clearly complex and giving you any opinion without at least an examination would not be in your best interest. There are some doctors who specialize in such conditions and do hair transplants. Since you’re near Duke University, I’d be happy to recommend Dr. Jerry Cooley in Charlotte.

Tags: keloid folliculitis, duke, keloid, hairloss, hair loss

Using Baby Oil on Recent Hair Transplant?

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

Dear Sir,
I had recently done a hairtransplant surgery and starting from day one i started spraying the grafted area with johnson baby oil at night before going to bed and washing my hair with johnson baby shampoo every other morning and evening.

Do you think that gohnson baby oil might cause a problem to the grafts if the grafts are washed regularily.

your quick response will be appreciated
Best Regards

I don’t know why you need this routine, but I can not find a problem with it, provided that the daily wash is done properly. I hope you received aftercare instructions from your doctor.

Tags: baby oil, baby shampoo, hairloss, hair loss, hair transplant, aftercare

What Keeps Dr. Rassman Busy These Days?

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

Dr. Rassman, I am a patient of yours from years past and remember you were involved in many things over and above your hair transplant practice. Can you tell me what you are doing now and how you keep everything in balance. There are only so many hours in every day, so how do you cope?

I am very well organized, depend heavily on computers and software to keep my non-surgical work efficient, and I have a wonderful supportive staff that keeps me prepared. My thirst for information is helped by reading journals and magazines which cover the entire field of science and scientific discovery (such as Scientific American and The New Scientist), and each day I get an email from LBN E-Lert to keep me informed of the latest worldwide news. I must constantly stay in contact with the world around me.

MavenAlong with writing for the blog almost every day, I’m a surgeon, business owner, and inventor. I need diversity in my life, so I have invested time and money into a biotech company with their focus on rapid disease diagnosis and screening — Maven Biotechnologies. The best way to explain the vision of Maven is to imagine a disposable bio-chip (like a microchip on a small piece of glass or plastic) that can precisely test a drop of your blood for hundreds of diseases, along with your reaction to available drugs for the treatment of these diseases in just minutes! Now imagine visiting your doctor, who inserts the chip into a small desktop device for processing, then presents the results to you in the very same visit. This animation will give you an idea on how Maven’s unique technology will eventually facilitate the development of personalized medicine, a rapidly evolving change in the future of clinical medicine.

One recent invention of mine that I’ve worked on with one of my patients, is the newly patented Ski Brake, which will make it much easier for adults to learn how to ski. One prototype has been developed and you can view a simple animation of how it works.

I live and feel every minute I am alive and am fortunate to have the health and the associates to make these dreams turn into a reality. This is no different than what Dr. Bob Bernstein and I did in the 1990s to change the way hair transplantation is done.

Tags: maven, biotech, biotechnologies, ski brake, hair transplant, science, rassman, doctor, invention, inventor

Heavy Drinking Blocks Finasteride Effectiveness

/by William Rassman, M.D./4 /

New study showing heavy alcohol usage blocked effects of finasteride (half way down page): Prostate cancer and alcohol

BeersThe link has quick paragraphs about a variety of topics, but here’s the relevant info from the page (the bold emphasis added was mine) —

    “This study analyzed data on 10,920 men. In a seven-year span, prostate cancer was detected in 2,129 of them, including 564 men with high-grade tumors, which grow and spread quickly. Those who consumed, on average, four or more drinks a day (totaling roughly two ounces or more of pure alcohol) five days a week in the year before diagnosis were more than twice as likely to have developed high-grade prostate cancer as were those who did not drink. No link was found between prostate cancer and more-moderate drinking. Also, among men who had been randomly assigned to take finasteride (Proscar, Propecia) as part of other research to test the drug’s ability to prevent prostate cancer, heavy drinking blocked the effectiveness of the drug.“

This is interesting, but it doesn’t necessarily prove that heavy drinking blocks finasteride effectiveness. Heavy drinking (4+ drinks a day) in itself can cause higher grade cancer. It should go without saying, but heavy drinking is not good in any case. If there is indeed an association with finasteride not working when you drink heavily, I would say it is a good idea to limit your alcohol intake!

Tags: propecia, proscar, finasteride, alcohol, drinking, hair loss, hairloss, prostate, cancer

Must Hair Be Miniaturized Before Falling Out?

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

Hi Doc, I have a buring question, I am a 29 year old Asian made with very thick black and have very good hair coverage, my question is when i comb my hair I see thick black hair that come out approx 10-15 not what you would describe as minutrized hair. Must hairs be minutrized when they fall out as mine seem very strange becase they appear to be very health ‘normal’ hair?

Thanks doc

Norwood 4AI do not believe that hair must be miniaturized to be lost hairs in the balding patterns. Miniaturization does point to a problem, though, for as the DHT attacks the hair, the impact suppresses the hair growth to normal circumference (hence “miniaturized”). As the balding process probably reflects the number of cycles of a hair in any given location, a hair will only live out the number of cycles it is destined to live (for example, hair in the front might have 10 cycles in your lifetime of 3 years each). The hairs around the head usually will outlive you, while the hairs in the front for a Norwood Class 4A (see image at right) balder may last only 7-12 cycles, on average.

Tags: hair cycle, hairloss, hair loss, miniaturized

Shedding After Increasing Propecia Dose?

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

Hi,
Can someone have shedding after increasing the dose of propecia? I’m 22 years old started losing hair 2.5 years ago, a year ago I started taking proscar pills cut in quarters, hair loss continued but it may have slowed down a little bit, about 3 months ago I started taking proscar pills cut in half, and since then my hair loss increased a lot and I lost hair much faster than before, so could it be shedding from increasing propecia dose?

thank you

When finasteride is taken and is effective, it can accelerate the hair cycle and can give you temporary hair loss. We have seen this rarely in people who start the drug and it often disappears in 2-3 months. I would guess (although I have not seen it) that the same phenomenon can be observed if the increased dose was working on you. It should abate in 2-3 months.

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

Testing Fertility While on Dutasteride?

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

Doctor,

I’m a 29 male in good health who has been taking avodart daily for ~5 years and took propecia for four years before that. I recently had a sperm analysis done along with my physical as I was concerned about potential risks associated with avodart. The results that came back were positive in the sense that my sperm count was in a normal range. My question is can you recommend any other tests that I could take to monitor my fertility while on avodart?

SpermI do not specialize in male fertility, but if the sperm have a normal count and a normal motility, I would expect that there is no problem with it. I would pose this question to your primary doctor or better yet, a fertility specialist. This is beyond my scope of knowledge.

Tags: fertility, hairloss, hair loss, dutasteride, avodart, sperm