I Ordered Propecia Online, Now I’m Losing Hair!

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

Hi there, in the past 2 months I have noticed my hair thinning in my crown area. I am Caucasian male, 23 years old. Since then I ordered Propecia online (it’s not the generic kind) and have been using it for 3 weeks now. I did not go and see a doctor in person to get a prescription.

Now I am getting a little paranoid that my hair is falling out even more since I have been using Propecia. I feel like my hair is thinning all over. Could this just be a placebo effect and me just being overly anxious and paranoid? I mean is it safe to use Propecia or does it make your hair fall out if it is not needed or prescribed by the doctor? I do not have any of the side effects that are listed on their website. Could you please advise as to what to do? I just want to know that what I am taking is not harmful to my existing hair as I might have not needed Propecia in the first place but became paranoid that i was loosing hair in the crown area. Thank you.

The first question you should ask yourself is, “Am I sure I got real Propecia?” If you just bought a prescription medication from an online vendor without a doctor’s prescription or any verification, I wouldn’t necessarily put a whole lot of trust in it.

What I really want to know is, why are you treating yourself? You should never take a medication if it is not needed, and you should’ve been under a doctor’s care before treating yourself with prescription drugs. A doctor can tell you if the medication is right for you. You couldn’t really expect me to encourage or even condone your actions, could you? That being said, Propecia shedding is reported by some people.

Follow the many posts here on the drug Propecia (use the search), get the diagnosis of hair loss, find the presence of miniaturization, and on and on. I can not practice medicine on you over the internet and it sounds like you need to see a doctor.

Tags: propecia, finasteride, online pharmacy, hairloss, hair loss, medication, prescription

Does a Maturing Hairline Also Decrease the Total Volume of Scalp Hair?

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

hi doc

i’ve got a general question about maturing hairline. while a hairline is maturing, can the total volume of scalp hair diminish? is that possible?

If the hairline and the hair that disappears reflects 2% of your total hair count, then the reduction will be 2% of your hair (total volume measurement). While it is maturing, the impact (if you do not have genetic balding) will not affect you anywhere other than the first 1/2 inch of hairline. In other words, if you’re losing hair beyond the hairline it isn’t just a mature hairline.

Tags: hairline, mature hairline, hair loss, hairloss, genetic, mpb

How Soon After FUE Can I Wear a Baseball Cap Without Being Careful?

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

CapHello Dr.

First of all thank you for having such an informative and helpful site. I wish other doctors would spend the time to have a site like this rather than having their sites full of promotional and marketing tricks. My questions is very simply.

I recently had ( 3 weeks ago ) a FUE procedure of 2600 fues to the zone 1 and zone 2. My question is… how soon can I start wearing a baseball cap/hat WITHOUT being extra careful with it. Meaning that the hat can touch the recipient area and also be a bit tight. My doctor say to wait a YEAR before I do this but it seems to be a bit too much. He said I can wear a hat after 30 days but making sure it is very loose and that it doesn’t touch the scalp. I find this very difficult to do given the locations where I received grafts.

I would like very much to know your opinion on this. Thank you!

Once the scabs are off, you can wear a hat or do anything that is reasonable. The donor area should be healed by this time. I’m not your doctor and I don’t know how your procedure was done, but that is the instructions I give my patients. You should double check with your surgeon, of course.

Tags: fue, hair transplant, aftercare, hat, cap, hairloss, hair loss, hair restoration

Prostaglandins to Treat Hair Loss?

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

Are there any new developments in the study of prostaglandins as a treatment for hairloss?

Dr. Farjo (one of our editors) feels that this drug group may have value in the future development of medications for treating hair loss. I don’t have any information about specific new developments, though.

For everyone else, see this article from 2003 and this article from 1996 for information on this subject.

Tags: prostaglandin, hair loss, hairloss, treatment

Did Intercytex Fail?

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

For Dr. Farjo please: Are you still working with Intercytex on trials or have you lost confidence in the project? Based on what Dr. Rassman said (he doesn’t see a breakthrough in cloning/multiplication for at least 10 years) whereas intercytex predicted a product in 2010… Do you think it’s worth putting off a hair transplant for about 2 years if not urgent for something to come out of Intercytex? Or did they fail? I am confused about this because you had said the results were good at some stage… please let me know if something changed your mind.

The following response is by UK-based physician Dr. Bessam Farjo:


Response by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

Back in 2007 and early 2008, Intercytex genuinely believed that good news was around the corner. This was based on the very promising results of the laboratory work. What happened was that the positive results of clinical trials were not as efficient as the lab ones. In other words although promising and exciting, not quite good enough to justify applying for a therapeutic product for the public. Since then three things have happened. Firstly the credit crunch hit the biotech sector hard in that major investors pulled out. Secondly, an unrelated Intercytex product did not come up with the goods, which meant negatively affecting the company share price. Thirdly, money aside, Intercytex agreed that the future probably lies in their ongoing lab research of making fully formed hairs from the cloned cells before taking them back to the donor. At this point, I dont know when this work will result in a clinical trial.

At the moment you could say I am in between contracts with Intercytex as there no trials taking place. I was never employed as such by Intercytex.

If your donor hair is good enough for now and the future then I would encourage you to go ahead with transplants if you are a suitable candidate. Hair cloning, when it becomes available, is more relevant where donor hair is a problem. Another point depending on your age, you are probably more concerned about your loss now than you will be in 10 years time. The top doctors in the field will be able to advise you of your suitability and potential future hair loss.

—

Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

Tags: intercytex, hair cloning, farjo, hairloss, hair loss, hair transplant, biotechnology

If I’m Not Seeing Results from Propecia After 7 Months, Is It Not Working?

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

I am 32 male, and have been losing hair slowly for 12 years. It has started increasing in the last couple of years. I started propecia about 7 months ago. I don’t believe I have seen results, hair still coming out slowly. I also have had dandruff, mostly because I don’t wash my scalp that well because do not want to force my hair out!! My question is after 7 months should I assume it will not work for me?? And if so what should I try?

I have answered this question many times. I believe Propecia (1mg finasteride) always works on balding men, but by “working” I mean reversing, slowing, or stopping hair loss… not necessarily regrowth. In other words, you may not see the true value of the action of the drug unless you take it for a few years and then stop it. Stopping it will show catch-up hair loss, and then you will know for sure that it was working before you stopped it. Of course, I wouldn’t recommend going this route, but it would be one way of proving the medication’s effectiveness.

If you make regular miniaturization analyses of the hair, you would have an objective metric to determine its value. There are some people who do not get great benefits after 2 years of finasteride use, and there are tests that can determine if you are going to be sensitive to this medication (see HairDX Genetic Test for Finasteride Response).

Tags: finasteride, propecia, hairloss, hair loss, hairdx, benefits

If The Gene Was Passed from My Father, Will I Have the Same Degree of Loss?

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

Hi Dr. Rassman,
here’s my question is it possible to have the same genetics for hair loss as say your father but not have it to the same degree. For example thinning in the crown but not as much, or recession but not as far back. I have this in families where it is obvious that brothers have the same genes but seem to have less progression of hair loss. I have even seen this where the older brother has more hair then a sibling two to three years younger.

The one-to-one relationship you are looking for does not exist. It is possible that you inherited the gene from your dad, but the expression of the gene might keep you from ever balding. That gene could be passed to your son and he might have your father’s hair loss pattern.

We do note that if you are balding like your father, then the gene may be similar and the pattern of balding you inherit may be the same as his.

Tags: genetic, gene, hairloss, hair loss, family

Is My Female Hair Loss Due to Flat Iron Use?

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

I am 23 female. I was using flat iron to straight my hair for about one and half year. Now it’s been almost six months I have totally stop using it because I was loosing hairs. I have been noticing that my hair is getting thinner. When I split my hair into sections. Is it because of flat iron? Will they grow back? What am I suppose to do? Does flat iron make us go bald? I am very much worry. No one in my family has been through any hair problem and/or baldness. I don’t even have any diseases and/or not taking any medications. Please help! Thank you!

If flat iron use damaged the hair above the scalp, then the hair that grows from below the scalp will eventually replace it with healthier hair. It just takes time. Flat irons do not make people go bald — damaging your hair will result in loss, though. There are safer ways to iron your hair, as described in my book. Sorry, I can’t re-write the book here.

Tags: flat iron, hairloss, hair loss, female hair loss, damage

African American Female Hairline Lowering in NY?

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

Hi Dr. Rassman

I am an African American female with a congenital high hair line. I have always hated the vastness of my forehead and am limited to hairstyles with bangs. I would like to have have my hairline lowered. Because of keloid risks I would probably opt for transplants instead of surgery.

My questions are; do you know of any good or great surgeons in NYC or surrounding area who have experience in this type of surgery? Everything I see is in Beverly Hills or Oakland Ca. And also, if I choose to have implants do I have to go to a surgeon who does implants or can I go to a hair restoration institute? Thanks for your time.

I can’t say for sure either way about the keloids or whether you’re a candidate for surgery, but I do know that Dr. Robert Bernstein in Manhattan would be the person to see in New York. I have worked with him for more than 10 years and we co-authored Hair Loss and Replacement for Dummies.

Tags: hairline lowering, nyc, ny, new york, bernstein, hairline, hairloss, hair loss

I Read That DHT is Important for Brain Function, So Why Block It?

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

Hi,
About 7 months ago I visited Dr. Pak in San Jose, and was prescribed Propecia. I took it for a month or two, however after reading many stories on the internet about its unwanted and possibly permanent side effects, I decided to stop. I have been taking minoxidil for about 5 months now, however my hair loss has continued very rapidly, and Ive also been drinking heavily (daily) during this period. I am wondering if the drinking could be a cause or contributing factor??

At this point I am very unsure about what to do, I really do not want to go bald at only 21 years old however I also am apprehensive about taking Propecia because Ive read also that dht is important in brain functioning and has other functions, so it seems that blocking it could be harmful. Would you recommend taking propecia and minoxidil together?? Also, I was wondering if you would recommend continuing minoxidil after 5 months of no effects and rapid shedding, and what the odds are that if I start propecia again that it will work?? Sorry for the long message but this hair loss quandary is really bothering me and I am really uncertain about what to do… Thanks.

If you are concerned enough about brain function, you might want to stop drinking heavily, as alcohol has many temporary and permanent effects on brain function. The scientific articles here and here discuss the way steroids work on brain and body function. I am linking to them for your overall education. We know that Propecia (finasteride 1mg) has minimal effects on brain function and is deemed safe and effective by the FDA. You have clear choices, and taking a safe medication that appears to have no significant brain side effects in most men at the 1mg dose is the alternative to taking no action to treat your balding.

Starting or stopping minoxidil is your call to make. I’d stick with it for a few more months, but it is ultimately up to you. I couldn’t tell you if Propecia will work, as each person is different.

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

I Want Scar Revision and Then FUE to Eliminate My Scar Completely

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

Hi,

First of all I want to thank you for this informative blog. I have searched this wonderful blog and have found numerous postings relating scars and hair transplant. Here’s my case: I have what “they” call a coronal scar that runs from ear to ear. What I want is to completely cover the scar through a FUE procedure, but I want my scalp to be like how it first was, normal. My research has been conclusive and I first want to have a scar revision surgery to reduce the width of the scar, once that is done i want to follow some type of scar treatment to make the scar less obvious in color (seems like the scar gets pink/red after a scar revision surgery). Afterward get the FUE procedure and go from there. Is there any treatments that you would suggest?

I want the scar to be inconspicuous to the point to be able to cut the hair in the military/short hair style, because ultimatley i want to join the military as an officer.

Best Regards

Your plan is good, but it may not be realistic to have the scar completely hidden. Even if the hair in the scar is brought up to near normal density (which may take a few FUE procedures), there is often a color difference in the remaining scar, though of course it will be hidden with FUE grafts.

As you are local to my Los Angeles office, please arrange to see me so that I can ascertain a plan that matches yours. Any preparatory treatments can be assessed and recommended when you see me. You can call 800-NEW-HAIR (or 310-553-9113) to schedule a free consultation with myself or Dr Pak.

Tags: fue, scarring, scar, repair, hair transplant, hairloss, hair loss

How Can I Test DHT Levels?

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

Dear Dr Rassman,

I searched the blog, but did not find answers to two specific questions.

1.)Is there a blood test one can have to determine the level of DHT in the body? What level of DHT would be considered above normal? If I want my DHT levels tested, what do I ask for? (I have an appointment with a dermatologist next month)

2.) Is Androgenic Alopecia the ONLY thing that causes miniaturization of the hair follicles? For example, could seborrheic dermatitis, or some other scalp or systemic illness, cause the follicles to shrink in a similar fashion?

Thanks so much for sharing your knowledge!
(male, 28)

The best way to get your DHT blood levels is to have your doctor send your blood to a lab that can do this test. Testosterone is broken down to DHT by an enzyme called 5-alpha-reductase type 2.

Miniaturization can be caused not only from genetic hair loss, but also it can be found in an unhealthy person and by certain medications you may be taking, such as tranquilizers. People who go through telogen effluvium can have miniaturization as well and the process can be reversed. More about miniaturization can be found here.

Tags: hairloss, hair loss, miniaturization, dht

Does Loniten Help Treat Hair Loss?

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

What if you need treatment for high blood pressure can using oral loniten help lower pb and also help a little with hair loss.

Thanks

You are very creative, but Loniten (oral minoxidil tablet) is not a reliable blood pressure medication and that is why it is not recommended for blood pressure management today. Topical minoxidil is more consistent in producing hair regrowth in the areas where it is applied, not everywhere on the body as Loniten did on occasion.

Tags: loniten, hbp, blood pressure, tablet, pill, medication, minoxidil, hairloss, hair loss

Stress and Hair Loss

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

hello
is there a link between stress (psychological not physical) and hair loss? if yes, what is the mechanism of it?
thanks

There is clearly a link between hair loss and stress. We see it all of the time in people with hereditary hair loss. The hair loss can be brought on during the stress of the college student (for example) or during illness. I do not believe we understand the mechanism of it, though.

Tags: stress, hair loss, hairloss, illness

FUE Affordability and Restoration Robotics

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

Hi Dr. Rassman. I’m 25 and have been following your site for a few years now since my hair started thinning at 22. I’ve been taking finasteride though and it’s kept it at bay…

I have a couple of questions for you if you please:

1) Any chance that FUE can become more affordable soon? Am I right in thinking that a FUE procedure of 2000 grafts would cost over $15,000 nowadays? Any chance it could drop to $10,000 soon?

2) This question is sort of related to the one above – Do you have any updates on the Restoration Robotics FUE procedures? All I know is that there are trials being carried out here. You mentioned before you had granted them use of your license… Have you enquired as to whether they’re seeing any success? Any chance the robotic technique will result in cheaper FUE procedures?

That’s all. I really hope you can answer these questions which have been on my mind (and many others I’m sure) for a while now.

Best Regards

RobotCosts for follicular unit extraction (FUE) will follow a supply/demand formula. Although many physicians perform FUE procedures, the failure rate is very high, so buying 2000 FUE grafts may mean that you purchase the delivery of these grafts, but survival may not follow the delivery because of damage done at the time of extraction. There are many groups working on mechanisms to deliver quality FUE grafts that will not be damaged so that they grow. Many groups have devised better tools and have announced them at the various ISHRS conferences and elsewhere (Drs. Feller, Harris, Boudjema, Cole, and myself).

Restoration Robotics will require FDA clearance before their product can be released for commercial application. The other devices are what the FDA calls Class 1 devices, which do not require FDA approval. I’m not sure of their progress at the present time, nor do I know of any costs, though doctors will still likely set their own pricing. My guess (and I am not privy to any info, so this is entirely speculative) is that the equipment start-up costs will be substantial and like any other product or service, costs will come down at some point in the future when it becomes available to a wider market. How near of a future, I couldn’t tell you. One step at a time.

Note: The image is of a violin-playing robot developed by Toyota. It won’t do hair transplants, but it might play you a song.

Tags: robot, restoration robotics, fda, fue, hair transplant, hairloss, hair loss