In the News – Anxious People Are Twice as Likely to Have Heart Disease?

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

In non-hair-loss news:

Dr Annelieke M Roest (Tilburg University, the Netherlands) and colleagues performed the first-ever meta-analysis on the association of anxiety with the incidence of CHD in initially healthy people, using data from the US, Europe, and Asia. Even after multivariate adjustment, anxious people had around a 25% greater risk of CHD and an almost 50% higher risk of cardiac death over a mean follow-up period of 11.2 years.

In the second study, almost 50 000 Swedish men who were medically examined for military service and followed for an average of 37 years were assessed by Dr Imre Janszky (Karolinska Institute, Stockholm, Sweden) and coworkers. Depression was not a predictor for subsequent coronary disease, but those with anxiety disorders—as diagnosed by a psychiatrist—were twice as likely to suffer CHD or acute MI, even after adjustment for baseline confounders.

Read the full article — Anxiety predicts heart disease years later

The meta-analysis combined the results of 20 different studies with nearly a quarter of a million people (it mentions that in the article, but I wanted to highlight it here). It remains to be seen if treating anxiety will also treat heart disease, but I’m sure studies about that will be taking place soon enough.

Tags: heart disease, coronary heart disease, chd, anxiety, depression, medical

I’m Worried About Initial Shedding from Finasteride

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

Hi there,

Thanks for this blog it really is so helpful to many of us! I am 24 and definitely going bald, all the men in my family on both sides have MPB. Although I am going bald, at the moment I am hiding it pretty well with what I have but it’s getting to the point where I can’t hide it any longer, so I plan on going on Finasteride in the hope I can conserve what I have.

My only concern is that I have heard some awful stories about Finasteride actually causing an initial shed, or at least worsening the hair loss before it makes it better. In your experience have you encountered this with patients? Although I am determined to put a stop to it I would be devastated if taking Finasteride made my problem rapidly worse even if it would help in the long run.

Thanks for your time.

I have not seen patients in my practice who shed hair after starting Propecia (finasteride), though I have seen patients who shed initially after starting Rogaine (minoxidil). I’ve also seen patients who continue to lose hair while on Propecia, but it may just be regular genetic balding that is outpacing the medication itself. I really haven’t seen a case where someone has accelerated hair loss after starting Propecia. Either way, both medications do help most men in treating their hair loss.

If you are worried about these issues, please discuss them to your prescribing doctor. When you take ANY medication or partake in ANY medical treatment, you need to consider the risks and benefits and understand why and what you are treating. Just being scared will not solve any problem without a good solid assessment of what you are trying to do.

Here are some recent past replies about finasteride shedding, if you’re curious:

Tags: propecia, finasteride, minoxidil, rogaine, hairloss, hair loss, shedding

In the News – FDA Warns That Unapproved Autism Drug OSR#1 Causes Hair Loss

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

Snippet from the article:

A product promoted to parents of children with autism is not a harmless dietary supplement, as claimed, but a toxic unapproved drug that lacks adequate warnings about potential side effects, including hair loss and abnormalities of the pancreas, the U.S. Food and Drug Administration has warned in a letter to its maker.

The FDA’s June 17 letter to Boyd Haley, a retired Kentucky chemist and hero to the autism recovery movement, details five violations of the Federal Food, Drug and Cosmetic Act related to his product, OSR#1. Failing to correct such violations can result in fines, seizure of products and even criminal prosecution.

The Tribune in January reported that the compound, sold as OSR#1, had been developed to treat mining wastewater, and that it had not undergone rigorous testing to ensure it is safe and effective. The report was part of an investigation into unproven autism therapies offered by health providers who say they can reverse the disorder.

OSR1Read the full article at the Chicago Tribune — FDA warns maker of product used as alternative autism treatment

Wastewater treatment turned unproven autism therapy? Wow. Just wow.

When the Tribune first broke the story about this industrial chemical (sold as OSR#1) being fed to autistic children, the maker of this “supplement” stated that it was tested on 10 people before being sold to the public, yet provided no proof of even that much. You can find that earlier report here.

Tags: fda, autism, hair loss, hairloss, drug warning, osr 1, osr

Finasteride Prevents a Quarter of Prostate Cancers from Developing?

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

Greetings Dr. Rassman,

I am a very happy patient of yours. (Background: I’ve had two procedures and am taking Propecia.)

I wanted to pass along the information below. Perhaps it would be useful for your blog. I was flying the other day, and in the airline magazine, there was an article on preventing cancer that mentioned finasteride: “Dr. Peter Greenwald, director of the Division of Cancer Prevention at the National Cancer Institute in Bethesda, Md., notes that the drug finasteride could prevent about a quarter of prostate cancers from ever developing.”

Full Article: Pursuing Prevention

Best regards

Thanks for sending this. The information about finasteride reducing the incidence of certain prostate cancers is correct, but that study is based on taking 5mg of finasteride daily (Proscar, a prostate treatment). I’ve actually been writing about this for years. Propecia is 1mg finasteride and you cannot establish an exact parallel, but the inference is there.

Many experts, however, feel that the 1mg dose may have the same impact as the 5mg dose, but without proof, one can not state this as a fact. The reference to Dr. Peter Greenwald is correctly stated, but the dose was not in the quote offered.

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

I Upped My Finasteride Dosage and My Hair Loss Stopped Drastically

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

Dear Dr. Rassman,

I understand the debate regarding the appropriate dosage of finasteride to be taken seems to have no end. I am currently taking 2.5mg (half proscar since 3 years ago where Propecia stopped working as well), so far so good. I would not say propecia stopped responding, but more of my genetics are catching up. Anyway, by upping to 2.5mg , hairloss has stopped drastically but still very gradually.

My conclusion is that, any amount of finasteride is better than none when it comes to fighting hair loss. And according to scientific results, 1mg vs 5mg has similar effects on hair loss prevention. Therefore 2.5mg should be a safe and worth-trying dosage provided no major side-effects are present. Hence, I think its ok to recommend to people who has stopped responding well to propecia to try 2.5mg (half proscar), even though there is no guarantee that it might work better – ultimately, any finasteride is better than none?

Thank you for your thoughts. In general, more does not necessarily mean better and the recommended dose of finasteride for the treatment of male pattern balding is 1mg a day. As always, please discuss your treatment options with your prescribing physician.

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

DHT Is Converted from Cholesterol?

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

Hello Doctor,

Alright so, I don’t believe vitamins, and a change of diet or saw palmetto is gonna stop hair loss, lets make that clear, if it was no one would be bald face the facts people.

But with that said, DHT gets converted from cholesterol (assuming my sources are right) so wouldnt lowering your cholesterol assist in the slowing process a little? And Stress is also a contributing factor so wouldn’t vitamin D (or something to that affect, creating a calm and stable mood) also assist in slowing the process. And if coffee increases your cortisol levels, wouldnt not drinking it also help?. And if Biotin or “what ever” vitamin helps to improve the quality of your hair wouldnt that also assist in some what of a stronger hair shaft?

And again im not saying its the cure, because obviously it just isnt!! but in theory wouldnt it help to slow down the speed of your hair loss by even just a little?

Everyones body is different and even a big fat gross out of shape dirty slob can have a big beautiful thick head of hair due to good genetics. but wouldnt these things ive suggested provide some what of a healthy environment for a poor little miniaturizing hair, assuming the cost is with in a balding mans budget.

A person balding should obviously try propecia or minoxidil and if it works great!! but these suggestions i’ve made must have some affect in the assistance of the slowing process? A healthier body must fight better against hair loss then a not so healthy one?

I know my suggestions are not ‘FDA’ approved but lets get real, if its not “the cure” itself no companies gonna drop the large amount of funds for testing if it only helps a little bit.

Just trying to keep a open mind thats all. thanks.

Ps, love the site.

CholesterolA little information can be dangerous. In this case, you are somewhat correct that cholesterol is related to DHT as a precursor step in the process; however, lowering cholesterol does not and will not lower DHT. Our bodies are not that simplistic and your body generally controls the DHT levels.

The general public sees cholesterol as a bad thing, but cholesterol is a very essential part of our physiology. It would take a year long course in biology and biochemistry to explain this and it may lead to someone simplifying and misunderstanding the human body and its physiology.

Alas, let me try (with a warning that it is not as simple as it sounds). Cholesterol is the building block to hormones such as testosterone, estrogen, progesterone, DHT, etc, etc. Our bodies are smart. Just because you have a high cholesterol level does not mean you will have excess of these hormones.

To illustrate my point here is a “simplified” pathway that shows how cholesterol is the building block of some hormones — cholesterol flow diagram.

Tags: dht, cholesterol, hairloss, hair loss, hormones

I’m 18 Years Old and I Wonder If My Hairline is Maturing

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

Dear DR,
I’m a 18 year old Caucasian male. A few months ago I noticed that my hairline looks like its receding although I’m not totally sure if its just a maturing hairline or balding hairline. I have always had quite a high hairline and my right side is slightly higher than the left side. My father has class 6 balding at 45 but didn’t start balding until around 30, my uncle on my mothers side is 65 and he has little or no balding at all.

I have a included a image of my hairline with several measurements on the image. I also give permission for the image to be shown on the site. Thanks

 

Thank you for allowing me to publish your photos. Just based on the photographs alone, it does not look like you are balding. What the photos show to me is a maturing hairline.

You should get a miniaturization study to see how your hairs look under a microscope at your front and behind your hairline. There is no guarantee and no one can predict your future, but a miniaturization study is your next best thing along with an examination by an expert.

Tags: hairline, hair loss, hairloss, mature hairline

Could Diet Lower DHT and Stop Hair Loss?

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

Hi, the mechanism of medications such as Finasteride in stopping hair loss is well known; that of inhibition of the 5-alpha reductase enzyme; which in turn means that far less free testoserone is converted into DHT.

I was therefore wondering, if a complete change in diet to foods that lower DHT would theoretically have a similar effect? The end result would after all be the same; less DHT in the body to bind with the hair follicles. What food should be included into such a diet; just ones that have a direct effect on DHT? What about foods that relate to lowering or raising testosterone levels? How do testosterone levels relate to free testosterone levels? What about foods that increase production of Estrogen? Would that mean that there would be less free testosterone for the body to convert to DHT?

BroccoliI do not know of a diet that would lower DHT. I’ve read many theories and ideas about stopping hair loss just by changing your diet, but I’ve yet to see or read about anything that truly works. If it was as simple as eating more broccoli or root vegetables (as some theories suggest), there would be far less balding people in the world.

I like your creative reasoning, but keep in mind that ultimately it is your genes that cause hair loss… not DHT, testosterone, estrogen, etc. Lowering DHT will slow things down, but it does not completely stop hair loss.

Tags: hairloss, hair loss, diet, dht, testosterone

What is This Balding Bump on My Head?

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

I am currently having a lump/hump(elevated)on my head it’s circle in shape and around that bump is a bald area but inside that circle shaped hump has hair. What should I do sir? Is this some kind of a disease? Should I do something or wait for it to go away. I had this for nearly a year now and I’m still 15 years old. This was small at first but then it became bigger. I fear this can do something bad to my health. Please reply. I really need help. I went to the doctor but the medicine and lotion i received isn’t working. I think she had a wrong diagnosis. :)

thanks!

I really couldn’t begin to guess at what the lump is without an examination. It could be a variety of things, but there’s nothing that stands out to me by your description. If you’re not satisfied with your doctor’s diagnosis you should get a 2nd opinion from another doctor. It never hurts to double check!

Tags: hairloss, hair loss, bump

Using Body Hair With Scalp Hair for Transplanting?

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

Hi
I have read about Body Hair Transplants and I do see that it is not recommended. I was wondering though, would it be a feasible thing to have it used in conjunction with scalp transplants, kind of a topping it up for density?

As you’re familiar with my issues with body hair transplants (BHT) due to differences in growth cycle, length, and character, I won’t get into it again here. For those unfamiliar with my stance, you can read about it here, here, and here.

It is technically possible to do what you’re asking, but whether it adds real value is another story. For the patient who had a depleted donor supply in their scalp from many hair transplant procedures, body hair may have value.

First, you need to be evaluated by a GOOD doctor who cares about you and your results, not just the money he would make. I realize finding a “good” doctor is easier said than done, but do your due diligence. Research this procedure and the surgeons who perform it to form a short list of doctors you want to meet with to hopefully find someone you trust with the patient results you’re looking for. Then get an assessment of your need, and your donor supply will be matched to your goals by that doctor. Only after you have a good education on the matter, should you make decisions like what you are asking me here.

You might detect that I am neutral on the value of body hair transplants when mixed with donor hair, but I would be open to do them if I felt that it had value to you and you were well informed.

Tags: body hair transplants, bht, hairloss, hair loss, hair transplant

My Hair Was Transplanted with Micrografts Lower than My Juvenile Hairline!

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

Hello Dr. Rassman,

I had a couple of HT procedures in the late 90’s that placed several hundred “micrografts” and “minigrafts” into my hairline. While the result is not as bad as some of the super-pluggy transplants I’ve seen, I now know that an FUE procedure could produce much better results. The issue is that the surgeon placed my hairline too low – it was lower than my juvenile hairline, but still along the forehead muscle. Due to this, I have no room to have a “transition zone” transplanted in front of it.

Would it be possible to have my hairline taken back a centimeter or so over a few sessions by individual graft excision and then have some refinement with FUE? I have spoken to one doctor who wants to bring my hairline down further, but I am completely opposed to this (I would like it to be a little higher at the end of any repairs).

Without examining you, I wouldn’t be able to define your options (particularly based on your unique case, which might be very difficult to correct). Generally, a brow lift may essentially bring the hairline up to a level that can be worked with, but it’s really not a sure thing. There will always be some risk of scarring when you take out old grafts in the front, but with a brow lift and a surgery to bring up the hairline you might be able to have follicular unit extraction (FUE) to thin it out some. People have entertained using laser hair removal which may expose the micrograft scarring (I personally have not seen a successful one yet) and even with FUE there are issues of scarring and a risk of an unnatural appearance.

You need to find a surgeon that will work with you, and assess the risks and benefits. You have limited options, but you need an expert to analyze your problem.

Tags: hairloss, hair loss, hair transplant, hairline, hair restoration, repair

I’ve Developed a Habit of Pulling My Hair Out

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

Hi. I am a male thirteen years of age. I developed a recent habit of plucking my hair from the top of my head scalp. I now regret it as it is very hard to cover up. Is there anyway that it will grow back again? Previously answered questions say that it will if the hair was healthy. I have no idea if my hair was healthy. At a closer look, the bald area only has a few hairs starting to grow back up; and this is after a month. The rest of the bald area remains…bald. Please help me.

What should I do? How can i encourage a speedy hair growth and when will it have grown until it is nt visible anymore? Thank you!

If you’ve only recently been pulling your hair out it will likely regrow, but repeating this over and over will result in permanent loss. You’ll just need to have patience to see regrowth.

At 13 years old, I would get your parents involved and see a psychologist or psychiatrist, as what you’re describing is an obsessive compulsive disorder called trichotillomania. You need to get this under control. I’ve written about this before here.

Tags: hairloss, hair loss, pulling, plucking, trichotillomania, ocd

Hypohidrotic Ectodermal Dysplasia and Hair Loss

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

I have a condition called Hypohidrotic Ectodermal Dysplasia and it affects the hair. I was wondering if you know anything about this condition? the hair loss is affecting my confidence. I am 21 and I live in Australia. I have asked the ozed support group and NFED and they weren’t much help. So can you please email me back and if you need any more info just ask.

I know of the condition, but there’s not much that can be done to treat the thin hair associated with it. People with hypohidrotic ectodermal dysplasia often have a low number of hairs on the head and this produces a see-through appearance. This thin look can be helped with the use of concealers like Toppik or DermMatch, as this is a good, inexpensive way to produce the cover you need.

I’ve written more about these camouflaging agents in my book, Hair Loss and Replacement for Dummies (see chapter 8), and there might be more assistance you can find at the Ectodermal Dysplasia Society.

Tags: hypohidrotic ectodermal dysplasia, ectodermal dysplasia, hairloss, hair loss, thin hair

Shouldn’t Finasteride Have Made a Dramatic Difference in 6 Months?

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

Hi Dr. Rassman,

I first noticed a thinning of my frontal hair around April of last year. I am 26 years old Asian male. Hair growth slowed down and the front half of my scalp started to feel thinner than the rear.

In January this year, my dermatologist confirmed presence of early MBP and prescribed me finasteride (Proscar quartered daily). At that time I also started to use Minoxidil 5% nightly. It is now mid-June and I feel like I am still thinning rapidly. The frontal thinning is becoming visible now and I feel all the hairs on the top of my head have gotten much softer than the sides and back, which I suspect is because of miniaturization and the hairs growing thinner.

Its been almost six months. Shouldn’t finasteride have made a dramatic difference by now? Is there no hope? At this rate, I will be bald before I’m 30 and it’s a very, very, very saddening and scary prospect.

How long does finasteride take to show its effects visibly in the hair? I would be happy just to see this hair thinning halt and stabilize.

Here’s a graphic I grabbed directly from Propecia.com that might help —

Propecia timeline

 

So really, the value of finasteride takes at least a year to see, and I’d say the full benefits may take 2 years to see. Some people might see less hair loss around the 6 month mark, but hair grows out at 1/2 inch per month… so after 6 months the hair that is 3 inches long will have just started to be exposed to the drug when it was formed.

Please understand these facts:

  1. There is no cure for genetic male pattern hair loss. Medications such as Propecia (finasteride) and Rogaine (minoxidil) help, but neither will stop hair loss completely or forever. For some men the medications can dramatically slow the progress, but eventually your genetic predispositions will win out.
  2. The front hairline is very difficult to treat with medication alone, as Propecia and Rogaine are not officially recommended for that area since it really doesn’t seem to help in clinical studies. Many patients still use these medications in hopes they’ll help that area a bit, and in some patients it may actually help to some degree.
Tags: finasteride, propecia, hairloss, hair loss, minoxidil, medication

Hair Loss from Combat Stress, Heavy Equipment, and Wearing a Helmet for 5 Years?

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

Dear Doc Rassman

How are you doing doc rassman? i have an interesting question for you. and from reading your bio im sure you already have seen and know the answer for this. im 23 years old and have been in the army 5 years as an airborne infantryman, deployed to baghdad iraq for 15 months and am current back in iraq. been here a year. ive always had great hair, my buddies nicknamed me Jewfro hah. its thick, and slighty wavy. i did notice tho during my last deployment the hair on my temples was going, quick.

i was injured, put in combat stress and have worn heavy equipment and a helmet for 5 years straight, it seemed like when i came home the areas regrew. now that im back its happening again, worse, almost into a widows peak. again i am under constant combat fatigue and stress. its got me worried. im young, about to be a civilian and in college and id like to…well not look like an old beat up war horse. ive wondered if this was common or am i just balding? i know my current situation is almost more stress inducing and extreme than others who are and im sure its got alot to do with it.. just wanted to double tap. and see what i have to look forward to.. hoping to have a full head of healthy hair in my near future

Thank you

HelmetAny stress could potentially cause hair loss (called telogen effluvium), and certainly the emotional and physical toll of war is among those stressors. I couldn’t say with any degree of certainty that your hair will regrow again, but if you saw regrowth the last time you were home, I’d hope you’d see the same regrowth the next time you’re home.

When you get back to the US, you should see someone who specializes in hair loss and can judge what has happened to you. In the examination will be a process I call mapping the degree of miniaturization of the hair in different parts of the scalp (learn more about that here). This will show if the hair loss is in a pattern consistent with genetic hair loss or not. If you have miniaturization present, the use of finasteride (Propecia) may be warranted. Helmets should not cause hair loss unless the helmet is tugging on the hair, creating traction alopecia.

Tags: combat, stress, war, hairloss, hair loss, army, military