We’re off today to pay respect to the men and women who gave their lives for their country… also known as the unofficial start of summer, Memorial Day. We’ll be back tomorrow!

USA

Hi Dr. Rassman,

I want to start off by thanking you for acknowledging and attempting to help people in what can be such a stressful and consuming problem for people.

My question is in regards to the possible mental side effects of finasteride. I understand that you have touched on this in the past, but I was wondering if you could say based on your experience if you believe these claims have any merit. I took finasteride for about a month a few months ago, and thought that I noticed these symptoms(stuttering, etc) upon quitting. I really believe in the drug in the battle against hairloss and want to start again, but these claims and my possible experience with it prevent me. I am 32 years old, but I believe that my hairloss(mostly crown area) is in its early stages and I could benefit greatly from this drug.

P.S. I would try minoxidil, but am afraid of the experiences that I read online(bloated face, wrinkles, shedding, etc)

When a formal drug study is done it is carried out on thousands of people and the side effects are reported. When the drug is actually used by millions of people, I am sure there are rare side effects that were never reported that will come to light.

I do not mean to dismiss or invalidate the unusual reports such as yours. In my practice since Propecia has been introduced into the marketplace, I have seen this complaint once (while the patient was on the medication, not after he stopped it), but I generally do not see or hear of these issues other than on Internet forums. The one experience a patient had does not prove anything statistically. It is also very difficult to pinpoint if there really is a direct cause and effect relationship, as there may be other factors.

For example, it is conceivable that men who take Propecia are also taking other medications with other medical issues (such a blood pressure or depression). Certain blood pressure lowering and anti-depressant medications are well know to cause decreased erections and libido. Certain anti-depressants can even cause stuttering (Ritalin, Prozac, as an example). Certain medical conditions which you may not be aware of can also cause stuttering. So I really cannot even begin to say what your particular cause of stuttering may be. I would discuss your issues with your doctor and see if there are other issues at hand as well.

I find it rather interesting that you were more scared of minoxidil’s side effects than Propecia’s side effects based on what you read on the Internet. The web can be a scary place when researching medical issues, as most users with positive results won’t spend their time telling people about it, but those that feel slighted will try their best to alert everyone. Again, go see a doctor for medical questions and get your answers in person, where a doctor can evaluate your case better without the back and forth delay of emails.

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

My husband and my 8 year old daughter and myself have been losing our hair. It was really bad there for awhile. We have lost half our hair. No one seems to know why..We went to the Derm, A toxocl, and our family dr. Whats even more upsetting is no one is taking this serious. How can be like that? It hurts when your 8 year old asks “mommy why am I losing my hair” and you cant give her a reason.

do you know what it might be? We have also had blisters on our arms and back..and I had a rash that looked like a sunburn on my chest and back..and my head was on fire! Do you think it could be a chemical we may have came in contact with..and if so will out hair grow back? We have always had thick , thick hair now its real thin and fine…so confused and upset..please help..

Question markThis is quite the mystery. I wish I could provide some insight, but there’s really no way I can seriously help when even the doctors you have seen face-to-face cannot come up with the answer. I’m at the great disadvantage of not having met you to learn more about your history. There’s just so many possibilities… anything from disease to infection to chemical, etc, etc. The blisters and rash are interesting, but I wouldn’t even know where to start with that. Are they coincidence? They could be related, but again, I’m at a total loss.

All I can suggest is to keep looking for that doctor who will listen to you and take you seriously. That should be your first step. Until you find out what is going on, there’s no way you can figure out how to resolve it. I do wish you good luck and hope you to hear from you when you finally get to the bottom of whatever is going on.

Tags: hairloss, hair loss, mystery, rash, infection, family

Do you believe there is a link between lack of sunlight and the speed of mpb? I’m not talking about synthetic vitamin d supplements here. I’ve noticed people who tan do not bald and people in southern sunnier climates do not bald as much as those in the northeast united states and northern europe. I know age, lifestyles, and ethnicity are factors but could sunlight reduce the speed people lose hair?? I truly believe there is a link.

ModelI don’t believe male pattern baldness is associated with sunlight, vitamin D, or geographic/climate variations. Perhaps people in sunny climates (particularly what I see here in Southern California) pay more attention to their physical appearance/ Maybe what you are noticing are good hair transplants or wigs on these people? I really cannot say for sure and I’m struggling to find statistics that show a breakdown of balding population by location/region. I’d be curious to see if what you’re noticing has any merit.

By the way, have you tried to correlate female breast sizes with climate and geographic locations? I’d guess women in sunny climates have a higher incidence of breast augmentation than women in colder climates where there is more skin cover.

Tags: hairloss, hair loss, sun, sunlight, geography, climate

One of the doctors in this article says that hair cloning will be on the market in 2-3 years. Thoughts?

Link: Huge Breakthroughs In The War On Baldness

I always find the prediction of when hair cloning will be available to be interesting. For the past 19 years since I entered this field, the predictions on cloning have always been 2-3 years out. I am hopeful as all of you, but any breakthrough will take years to work its way through the FDA.

Tags: hair cloning, hair loss, hairloss

Hello Doctor, I am 46, I’ve been on Proscar (cut in quarters, every second day) for 3 yrs now with good results in halting further loss & slight only thickening in the crown. The usual side effects I experience such as no morning erections anymore & only occasional unpredictable ED.I also use generic 5% Minoxidil every night. In Sept 08 I had 3,476 grafts which have grown pretty good with decent coverage as I have only very fine hair. Because of my fine hair I still use Couvre & Toppik with excellent results.

My question is prior to taking Finasteride I took a herbal over the counter tablet called Trinovin (containing Isoflavines) with good results for my since age 35 ish weak urine flow & in later yrs symptoms of BPH. I stopped Trinovin when I started Proscar as I wasn’t sure of the combo use but would like to try it again for the previous stronger results it gave me for urine flow. Will the Trinovin work in sync with the Finasteride or work against it causing bad results all around? Trinovin’s has a comprehensive website & it’s info seems to give the same sort of explanations in it’s workings as Finasteride, but I wanted to ask your opinion first before I try it as a combo. Thanks.

TrinovinI hadn’t heard of Trinovin before (it’s made and promoted primarily in Australia), but upon looking at the product’s website it almost looks like it could be a medication in the way that it is marketed. As you point out, it’s actually an herbal product (red clover) that is said to treat prostate issues. Regular readers of this site know how I feel about most herbal treatments, and while in general there is nothing wrong with herbals, my motto has always been “buyer beware”. If it works for you, that’s great. I am not here to promote or discredit anything.

The US FDA lists red clover as “generally recognized as safe” but with that being said, I also cannot give you medical advice. I don’t think it would be an issue to take Trinovin with finasteride, but again, I’m really not familiar with this herb and I don’t want to guide you in the wrong direction. If you’re taking prescription finasteride and have had a history of prostate issues, you should be under the care of a doctor already. You need to tell your physician about your desire to get back on the Trinovin and see what he/she says. As an aside, I am a bit worried that you have been having these prostate problems since 35 years old, and even now you are still too young to be having these types of issues.

Tags: bph, prostate, hairloss, hair loss, finasteride, trinovin, herbal

Hi Doctor, thanks for your site

I am keen on getting a hair transplant, but i am a little bit worried about the scaring that will occur.

I was just wondering, say i only want a small amount of grafts done, is it possible to get a procedure which will only produce a small scar in length, say one 5cm long on the back of the head rather than one from ear to ear?

Thanks in advance for your reply.

You need to talk with your surgeon, and ask these specific questions and convey your wishes. You do NOT have to have an ear to ear scar. There are options for hair transplantation, such as the FUE procedure, which produces no linear scar.

A shorter length linear scar (5cm long) is possible though, and would obviously yield less grafts than a longer strip. It all depends on how many grafts you are expecting or require. A 5cm length strip might yield anywhere from 300 to 600 grafts (depending upon height of the strip and the density of your donor hair), but this is a VERY general estimate and will vary with each individual.

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

Hello!

Congratulations for the great insight that you give with your blog.

I’m probably hopping on the Propecia bandwagon and would like to know your clinical experience with it concerning side effects. Do many patients discontinue it after some time? I know the whole debate about Propecia’s safeness, for me it’s probably more of a psychological issue, becoming dependent of a drug is not high on my list, but I’d like to keep my hair hoping that some effective topical or surgical treatment comes out in the meantime.

Thanks!

Propecia does not completely stop hair loss forever, nor does it cure hair loss. It slows the process down, usually for many years. If you stop taking it after a period of use, the hairs that you gained or kept from falling our will disappear. Your hair loss will catch up to where you would’ve been had you not taken the medication in the first place, which is why I refer to it as “catch-up” hair loss.

There is no dependency issue. Like all medication if you stop taking it, the benefits are gone. Propecia is meant to be taken for life, much like cholesterol medicine, blood pressure medicine, etc. Most of my patients do not stop taking the medication.

Tags: propecia, finasteride, hairloss, hair loss

Hi Dr Rassman,

I am thinking of having a hair transplant FUE approx 2000 grafts in 2 months time.

My concern is I have just recently had multiple surgeries to fix a broken jaw, rhinoplasty (broken nose) and scars suffered in a recent accident. I was told I would be able to resume normal activities in a few weeks and exercise in 6 weeks. Just wanted to know if the success of the transplant (2 months after the multiple surgeries) would be hindered at all.

ps: the surgeon who performed the multiple surgeries said it should be fine but to consult with a transplant specialist.

The ultimate answer will be from your hair transplant physician, who can examine you and determine if they feel comfortable going ahead with the surgery. In general though, it should be fine.

Tags: hair transplant, surgery, surgeon, accident

Dear Dr. Rassman,

I’m a fairly young hair loss sufferer (23), and I’m currently evaluating my options. Finasteride gave me side effects, despite two trials (one low dose). As you’re no doubt aware, the remaining topical and internal treatments are either even more side-effect prone (dutasteride) or simply not very effective (almost everything else). I’m too young for transplants, and if my loss does progress to NW6/7 – which is fairly likely having started losing at 19 – I would be a poor candidate anyway. I have tried the shaved look, and it doesn’t work for me.

By process of elimination, I’m coming round to the idea of trying wigs. I’ve done a fair amount of research on them, and I have to say I’m fairly dismayed by your reports on the topic. You present the costs as astronomical, which they don’t have to be. Many use them for approx. $1000 a year very easily. You also critique them because of the shadiness of the industry. There’s no denying that it’s a dodgy business, but that’s precisely why you have to do research and shop around.

I’d contend that most of the criticisms you lay at the door of the wig solution could also be leveled at HTs. They are both only good options when you go to GOOD providers. Your posts are akin to someone posting about HTs saying that they’re overpriced, operated by con-artists, leave people butchered, and give poor results. These are true for bad HTs, but it’s not a legitimate reason to criticize the industry. I’d say the same of wigs.

I only write this email because, had I come to you before I’d done all this research, I might not have looked any further into them. I’m concerned that some for whom it might be a legitimate solution will be similar put off, given the exposure of your blog.

No big deal really, I’d just prefer it if you qualified your criticisms with the fact that while the wig route CAN be bad, it isn’t always like that.

MoneyI am not against wigs / hair pieces. My point has been that it can be relatively expensive in the long run when comparing it to a hair transplant. In your case, if you pay $1000 a year, after 20 years you would have spent $20,000… which is much more than most people would spend for a hair transplant that lasts a lifetime without all the maintenance that wigs/hairpieces would require. Let’s say your hair transplant only costs $4000. That’s 4 years of wigs vs a lifetime of transplanted hair. To me, it seems like a waste of money. Of course you may not get the same density and fullness as a wig with a hair transplant, but that is one’s choice.

There are many people who live with a wig and there is nothing wrong with that. If you want to go that route, try it! In the worst case scenario, if you do not like it, you have other options. Some however get stuck on the wig system and find it hard to stop wearing it, as it becomes a drastic change in appearance. Some even do a combination of both wig and a hair transplant. They have a hair transplant in the front to achieve a natural looking frontal hairline and wear a wig to cover the top/back area. You also need to be aware of the traction alopecia risks, depending on how the hair system is attached.

At 23 years old, you may not be too young for a hair transplant. Each case is unique so I can’t say 100% without seeing you, I’m just pointing out that you’re not automatically disqualified based on your age alone. I don’t know what your pattern looks like at this point, but just because your loss started at 19 years old doesn’t mean you’re for sure heading towards a Norwood 6 or 7.

Tags: wig, hairpiece, hair system, hairloss, hair loss, hair transplant

Hi Dr. Rassman,

I am 24 and I know I have MPB. However, I’ve been having a poor diet over the last 4-5 months, which I already stopped and started getting a proper diet. However, during those months I noticed my hair getting thinner.

My question is simple: with a proper diet will I have my hair as thick as it was before the poor diet began? I do not expect an exact answer of course but just an idea based on your experience.

Thanks

Poor dietWill your hair get as thick as it was before your bad food habits? Likely not. If you are sure you have genetic male pattern baldness (diagnosed by a doctor?), the poor diet might’ve exacerbated the hair loss. It could regrow somewhat, but I don’t know enough about your hair loss pattern or history to really speculate too much more.

You need to be seen by an expert, and you should consider getting on Propecia to slow down the loss if you are indeed experiencing MPB.

Tags: diet, hairloss, hair loss, food

I work in a small hotel where we have many Asian guests. Without a doubt, both Asian men & women shed far more hair on a daily basis than any other group. Is there a reason for this?

SheetsThere is no ethnic variation in hair loss, except in a select minority of American Indians who generally do not lose any hair. For more on that, see Racial Differences in Hair Loss.

If I had to guess why you’re seeing more hair shed from Asians, it’s probably because you see the black hair a lot easier on the white bed sheets that are common in hotels, rather than blonde or light brown hair.

Tags: asian, hotel, hairloss, hair loss, shedding

Article on Propecia and the author’s excellent response to it within 6 months of using (with photos)

Link: Unveiling the bare facts of hair-growth treatment

A 44 year old journalist for The Mainichi Daily News took finasteride and his before/after photos are at the link above. It’s great to see some positive things posted on the internet once in awhile. The results look good, and may even get better if he continues the medication beyond his 6 month test.

Thanks for sending!

Tags: japan, propecia, finasteride, hairloss, hair loss, news

Hello Doctor! I am an eighteen year old suffering from hair loss. I guess my story started 3 years ago, back when I was 15. I took accutane, 10MG in the morning, 20at night, for about I would say, eight-ten months. During this time I lost a lot of hair, according to my mother, who had the chore of changing my bed sheets and thus, obviously noticed the hair left behind on the pillow.

So I guess its safe to say that I started going bald since I was 16. Both my mother’s brothers are bald, and ALL FIVE of my father’s brothers are bald, hence I know, the probability of me going down the route is ,I dare say, inevitable. But,I am ONLY eighteen! I KNOW it can happen at such a young age, but I am hoping that at this age, I can reverse it.

I dont want to take propecia due to the sexual side effects, and the fact it is permanent in some patients, so I guess my only choice is rogaine,(or is it?) My question is, in your opinion and experience, is it helpful for someone my age and situation?

oh btw, I am norwood scale 2. hope that helps, thank you very much!

We generally do not consider a Norwood Class 2 pattern to be balding, just a maturing hairline in its early stage. However, if your mother saw the results of your heavy hair loss for 3 years I’d expect your pattern to be greater than NW2. Maybe what she saw was the normal loss from hair cycling we all see each and every day? If you used a product like styling gel in your hair, it’s possible that those hairs that would’ve normally fallen out throughout the day became trapped, only to be loosened when you slept on your pillow. I’m just guessing here, as there are just way too many variables to consider, and since I haven’t seen any photos nor have I examined you, I’m totally grasping at straws.

It doesn’t even sound like you have seen a doctor or obtained a diagnosis from a professional, which I’d recommend before starting any treatments. You’re 18 years old with what you describe as early hair loss, which means you could potentially be a good candidate for Propecia (finasteride). Besides Propecia, the only other FDA-approved hair loss medication is Rogaine (minoxidil). Propecia works much better than Rogaine in cases of early hair loss, but if you’re afraid of a safe and effective medication like Propecia, I’m not going to waste my time trying to convince you otherwise. There’s enough scientific proof available if you’re interested in seeking it out. Every medication has some level of risks (we’re all different), but the Propecia side effects are not permanent and are incredibly rare. Perhaps you’re also scared of drugs like Advil (ibuprofen) too, because the side effects list that you can cough up blood and have seizures.

Your Accutane (isotretinoin) history coupled with your family hair loss history does make it seem likely that you’re going to follow the family loss pattern at some point, if it hasn’t started already. My recommendation is to see a doctor, get a diagnosis, and evaluate all your options.

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

Dear Doctor,

You hear all the facts on putting egg in your hair, and by now it is obvious that cracking a egg and letting it sit on your scalp isn’t “the cure” for hair loss. But my question is simply, can your hair actually absorb the high protein in egg and effect hair whatsoever? it has proved itself as a conditioner, but is that all its doing, is making your hair silky smooth? is hair becoming “stronger” or “Healthier” after it sits there for the recommended 15 minutes?

Thanks so much for your time

Scrambled eggsYou’re right in that eggs do not cure hair loss… nor does it treat hair loss in any way. Eggs are used as a natural hair conditioner by some people (though for me, I like the bottled stuff). It’s supposed to make your hair smoother and appear healthier, and I’ve read that egg might make hair stronger because of the proteins. I honestly don’t know for sure, but perhaps a cosmetologist might have more experience with using various foods as conditioners. Just don’t use hot water with the egg in your hair unless you want to scrape scrambled eggs off of your scalp!

You can learn more about the various foods people use in their hair, here.

Tags: egg, hair conditioner, breakfast, hair