Dear Doctor,
Are any parasites/worms connected with hair loss? If so, which ones?
Not that I know of, but the association of malnutrition with worms and parasites could cause hair loss or accelerate genetic balding.
I have just started balding and I’ve just found out about DHT and hormones affecting hair loss. What can I do to remove DHT in my scalp without shampoos specifically for hair loss? Will Pine Tar shampoo work?
The cause of hair loss in men is almost always due to genetic causes, and it is known as male pattern baldness (MPB) or androgenic alopecia (AGA). Scientists have discovered that genetic balding is linked to a hormone called dihydrotestosterone (DHT), a byproduct of testosterone. While everybody (men and women, balding and non-balding) has DHT, it is the men who have the genetic trait of balding that will lose hair in a specific “male pattern”… and DHT must be present. The hair follicle makes DHT. It may have nothing to do with DHT blood levels, but you must have the genetic predisposition for hair loss.
There are medications, such as Propecia, which block the impact of DHT on the hair follicle and it may stop or reverse the balding process, but it is not a cure. To date, there is no cure for hair loss. Pine tar shampoo won’t stop, slow down, or reverse genetic hair loss.
Hey doc, just finsihing my 10th month on propecia, pretty sure hair isnt any better maybe alittle worse in front. However I think propecia is working to at least slow down my loss. So my question is, after 1 year of treatment what is the state of the typical propecia users hair. Also what is their own opinion of their hair, before you look at it, do they think that their hair is better, worse, or the same? Finally I have heard that best results (thickening of hair) do not happen until 24 months, how true is that for most of your patients? Thanks!
It takes about 2 years to maximize the benefits of Propecia (finasteride 1mg), but in one year you will kind-of know what you are going to get. Reversal of frontal hair loss is not common, but stopping or slowing the hair loss is common. Response to this drug is often age dependent with the younger men getting more benefits, provided that they are not heading to a Norwood Class 7 (extreme case) by the age of 23.
The hair that reverses in the crown is just like it was before it went away, but you really can not tell one hair from the other. The degree of miniaturization is a better indicator for benefits if you want a metric on this process.
Hi Dr. Rass. I am a every day visitor of this web site. You already mentioned about Viviscal in your site. But please go thru this site. Viviscal MAN
They have mentioned about something called “flax seed” which is a DHT blocker. Is it true?
Flax seed has not been proven to be a DHT blocker. There was a very small pilot study I read about from a few years back that consisted of 10 men that took 250mg of flax lignan extract in Thailand over the course of half a year, and that seems to be what people are basing this assumption on. Any hint of success, no matter how small, seems to be get blown out of proportion and becomes the next “ingredient of the day” in these hair products.
Sorry, but watching the hair of ten men over six months is not enough for me to be convinced. If there are more recent studies (preferably peer-reviewed), I’d love to see them.
Hello. I’ve been trying to get pregnant with my second child and it’s taking a long time – went to fertility doc last year and all tests came back fine for me and husband – he put me on Femara to help me ovulate more efficiently – I was on it for 4 cycles but after the second cycle I started shedding hair like crazy and my face broke out awful – I’ve been off of it since last Dec but my hair and skin have not gotten back to normal – my ob/gyn ran bloodwork for hormones, thyroid, etc and all came back normal – do you have any idea why my hair is still shedding and not growing back normally – I never had a problem with my hair until I took the Femara – I’m just nervous that it did some permanent damage to me – I’m sure stress is not helping because of course now I’m stressing about the hair loss – please help if you can!! Thanks so much!
Alopecia (hair loss) is listed as an uncommon side effect with Femara, so it is known to some degree. In general, hormone manipulation can cause hair loss, particularly if there is some genetic trait that makes you vulnerable. It can take up to a year to wait to determine if the hair will return (just like hair loss with or after pregnancy). Good luck, but be patient.
Great web site. I’ve looked on from time to time but never saw this question asked. Can a dap of olive oil be used to condition hair before or after blow drying? It wound seem like a inexpensive and natural way to condition ones hair rather than using something like Neutrogener triple moisture. Any thoughts?
Olive oil has been used as a hair conditioner and while I’ve got no personal experience with it, I see no danger in trying it. Here’s a site that has a recipe (though I just found it via Google and make no claims as to how well it works) — Care2.com.
Hi doctor,
Twice you have answered my question. Thanks a lot for that.Now I would like to know Whether provillus is effective for thinning hair. The topical contains minoxidil 5% but the supplement contains 1500 mg of saw palmetto plus some vitamins and minerals. Since there is know proven results for saw palmetto’s efficiency on hair growth, Is it an effective way of combining it with minoxidil? as with provillus or what alternate supplement you suggest that can be taken with minoxidil which faster the hair regrowth process other than finasteride?And I have tremendous amount of itching on my scalp if I apply minoxidil (even 2%) now what shall I do? Do I take some anti-allergic pills and continue application of minoxidil?
Allergy to minoxidil is a common side effect and other than stopping the medication completely, lowering the dosage is reasonable to try. I don’t think an over-the-counter anti-itch cream (with benzocaine or something similar) would be of much help. When you develop an allergy to minoxidil, topical steroids may be the only thing that will help, but it could do more harm than good and I don’t advise that.
Combining the saw palmetto with minoxidil in a topical medication as Provillus does suggests that the company is tossing everything but the kitchen sink into their product line. I’m not convinced of saw palmetto’s use as a hair loss treatment (especially as a topical), and the only suggestions I feel comfortable giving for hair growth are the FDA approved ones that are proven to actually do what they claim: minoxidil and finasteride.
My question is for Dr Rassman: I have a 15 year old son who seems to be losing his hair (from the crown only – mpb in the family). I understand that Propecia is not suitable until he is 18. Is it worth using Rogaine until then and at what strength? Based on your experience how successful do you think it would be in retaining the hair he has until he is old enough to try the Propecia?
I know you have to deal with many questions but I would be so very grateful for your reply.
A worried mum.
I am reluctant to recommend Propecia (finasteride) for someone that young, but I and many other doctors have done this provided that your family doctor goes along with it. I have allowed my young patients to use Rogaine (minoxidil), starting off with 2% and moving up to 5% in the crown, if his family doctor does not want to use Propecia.
One thing to keep in mind — benefits from minoxidil are not kept by finasteride and vice versa. In other words, if he sees positive results from Rogaine and then decides years later that he wants to take just Propecia, it won’t maintain what Rogaine has kept.
Here is an article which gives the latest update of Restoration Robotics. It predicts that the device will come out in 2012.
Article: I, robot: Prototype harvests follicular units for transplant
The article states, “The Restoration Robotics prototype system is a state-of-the-art, interactive, image-guided robotic system that is designed to conduct automated harvesting of follicular units in hair transplant surgery.”
For those doctors who have not mastered FUE through a manual approach, this will become a tool that will aid new doctors in the field. It will probably be slower than the manual technique in expert hands. The cost of the robot will add some costs to the process. I’m interested to see how this materializes. See past posts I’ve written about Restoration Robotics.
Snippet from the press release:
“Up to 85 per cent of people with SLE develop skin involvement at some point,” explains Dr. Pineau. “Our study shows that the risk of skin damage such as permanent hair loss and scarring from skin inflammation is significantly increased in smokers. So is the rate of active lupus rash.”
Read the full text: Smokers With Common Autoimmune Disorder At Higher Risk For Skin Damage
The information comes from a study published in the Journal of Rheumatology, and “has clearly linked skin damage and rashes to smoking in people with systemic lupus erythematosus (SLE).” The great majority of those with SLE are women, and could be something else doctors consider when looking into a cause for female hair loss.
Hi Dr Rassman
I had a hair transplant done 5 months ago by a board certified doctor with lots of experience. I recieved 1750 grafts (aprox 4300 hairs estimated). After 5 months it looks like maybe 43 new hairs have shown. The only difference between now and before the procedure, is that now I have a donor scar on the back of my head keeping me from shaving it all. I am very discouraged/upset by this.In your experience, or to your knowledge, do some people not respond to hair transplants (the new hairs don’t ever grow)? If this is not reported as so, then does the length of time before ANY new hair shows ever take longer than 5 months? I realize it generally takes 9 months or so for the hair transplant to be fully realized, but I was told (and read) that by month 5 significant new growth should be visible. Your answers and info is much appreciated.
Thanks
Take a look at this patient and watch his hair grow over time. At 5 months after his single hair transplant procedure, he had some short hair growing… and by the 7th month it was styling length. Some people grow faster or slower (by about 2 months). Ask your doctor in another 2 months to judge if your hair growth met his expectations and match it to yours.
Hi Doc
Any thoughts on MDF Advanced (site), seems like it’s a mega all in one treatment – but i thought duta wasn’t allowed to be used for hair loss?
keep up the good work
MDF Advanced contains a very high level of minoxidil (15%), dutasteride (a prescription medication), and flutamide (I’ve yet to see a study that proves it does anything to treat hair loss topically). I don’t see how this is safe or why a doctor would sign off on this. The way they sell the topical treatment is interesting — you order it and supply your doctor’s info, they fax something to your doctor asking for him/her to approve prescribing this medication, then they have their own pharmacy send you this formula containing a prescription medication. Is that even legal? It might be a gray area.
There’s a couple of red flags that I need to point out:
- Dutasteride is yet to be FDA approved as a hair loss treatment (it is a prostate medication), so the doctor would be signing off on something for off-label use. Doctors have to consider their liability when prescribing off-label medication. Also, the FDA controls all claims on lotions, potions, drugs, and any variation left open for misinterpretation can be actionable. Many doctors won’t do what this company wants them to do. I certainly would not!
- It contains dutasteride in a topical form (the limited studies I’ve seen have been for oral dutasteride). You’re risking a lot to use an expensive treatment that hasn’t been proven safe or effective.
I started taking propecia when i began noticing my hairline receding and hair becoming thin in the crown. About 1 year later i decided to give dutasteride ago. Throughout both medications my testosterone increased quite alot, causing increased libido to such a degree that i was getting an erection almost 3 times a day compared to almost never (unless needed) when i wasnt on the medication. i have been taking these medications now for 3 years and my testosterone shows no sign of of decreasing back to normal.
My question is, if i am taking medications to reduce as much DHT as i can and my medications are actually increasing my testosterone which inturn is creating more DHT as its a by product isnt it a paradox and useless. I have however heard that this increased testosterone isnt almost a momentary thing that may last a while because my bodys thinking ‘we need to make more testosterone’ due to the decrease caused by the medication.
Thanks NHI Team
Few men will complain of an increased libido or an increase in the frequency of erections. As you noted that the increase in erection function has been now two years since you started it, I would imagine that it will continue. How do you know your testosterone levels increased? Did you have them measured before and after you are taking Propecia and/or dutasteride? These blood levels need to be compared to the normal values established by the lab testing you.
The connection with your sex drive and the DHT block from the drugs you are taking, and possible increased levels of testosterone are unclear. Without knowing testosterone levels before and after you started taking the DHT, I can not tell you much. I personally think that you are going overboard with analysis here, and should just enjoy the moments as long as everything is working well.
There was a wallstreet journal article talking about the efficacy of the laser comb. It said that it works. Do you think there’s any evidence to support this? Here is the link.
By the way your site has been a big help. I’ve been balding since senior year in high school and am now twenty years old. Your site is the only site I have found that doesn’t seem to be pushing or selling anything, thank you.
The Wall Street Journal really didn’t conduct any research on their own to determine efficacy, but just quotes the study provided by Lexington (makers of the LaserComb). I guess if you took a vote from experts in the field, you could count my vote as thumbs down towards these hair lasers. I conducted a study on some of my patients for over a year when I had the large hair laser machines in my office (and offered their use free of charge to my surgical patients). I did not see any value on those using the hair laser, and honestly, it seemed like a waste of time for patients that don’t have time to waste.
Thanks for your kind words about this site. We work hard to make it what it is.
Dr. Rassman
I have started using scalpmed. It requires daily twice application. I cannot go to office with greasy head. I either have to take bath after applying or have another minoxidil based solution that needs daily once only application. So
- What should be the minimum time between application of minoxidil and shower?
- Is there any minoxidil based treatment that requires once nightly application?
The minoxidil will have been absorbed by the skin within an hour or so, so that should be the time in between applying and showering.
Using Rogaine Foam might solve the greasy head problem for you. Since both the foam and ScalpMed are minoxidil based, you wouldn’t lose benefits by switching between the two. Most minoxidil products recommend twice daily use, but some people do apply just once a day.