SMP for a Severely Thinning Crown

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

Can people crop their hair, get this procedure and grow out their hair again? How would a severely thinning crown with hair grown out look if SMP has been performed on it?

There is a line where the SMP (Scalp MicroPigmentation) process can not substitute for a hair transplant. We have tried it on one severely thinning head of hair and it didn’t work well, even with low contrast between hair and skin color.

There must be enough hair to work with SMP. This can be imagined well if you think about using the camouflaging agent Toppik on a slick bald head. Toppik alone will not accomplish what it can do with real hair present. In the determination of this, you need to get a real expert to assess your goals and what can be achieved with SMP in combination with a hair transplant.

Tags: smp, pigmentation, pigment, hairloss, hair loss, crown

Taking Finasteride and Multivitamin Together

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

Dr Rassman,

I take a 1 quarter proscar pill in the mornings at around 7:30am, then later on in the day either in mid morning or afternoon i will take a multivitamin tablet and vitamin E capsule, is that ok? And would there be any DDI if i take proscar and the multivitamins at the same time?
Thank you.

You can take vitamins and finasteride together. Known drug interactions with finasteride can be found here.

Remember, if you have concerns about what you’re taking or questions about taking supplements and medication together, talk to your prescribing doctor or pharmacist.

Tags: finateride, proscar, propecia, interaction, medication

Can My FUE Procedure Be Done Over 2 Days?

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

Hello,
After consulting with a doctor, I need 2500 units for my hair transplant. It can be by FUE, because I have a good donor area. Considering the two-day visit of a clinic in Turkey. I’m worried that so many units is called a megasession. Can it be done in a one-day procedure, or two day procedure, or would you recommend to do the first year approx. 1500 units and the following year 1000 for density?

By this letters you are one of the most experienced, so I appeal to you,because in Europe and my country is not many information about FUE procedure. thanks for the reply, with respect

FUE can be done over two days. For the larger sessions, some doctors do it this way. I’d follow-up with your surgeon about his/her recommendations.

Tags: follicular unit extraction, fue, hair transplant

I’ve Had DUPA Since My Teen Years

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

I have been experiencing DUPA-patterned thinning since puberty, if you can believe it. I had my thyroid checked at 15 (20 now) and apparently everything was in order. Classic MPB runs in both sides of my family but I haven’t seen any instances of DUPA, and both my brothers seem to have been spared this condition. I took propecia for a year and it did nothing.

Are there any leads on possible underlying causes of DUPA, since it has become rather apparent that it is not [entirely] related to DHT levels/sensitivity? Could I possibly benefit from a visit to an endocrinologist or other specialist?

I do not know if you will benefit from an endocrinologist or other specialist unless you have actually been diagnosed with diffuse unpatterned alopecia (DUPA) by a physician. Are you diagnosing yourself with DUPA because you have thinning of your hair? Some people do have thin hair, but that is not DUPA. There’s no underlying cause of DUPA that is known at this time, so nothing you can really be on the lookout for. We simply don’t understand the condition all that well.

I also do not understand why you would be taking Propecia without a diagnosis of androgenic alopecia. Are you self treating? At the least you need a good examination and a diagnosis.

Tags: hairloss, hair loss, dupa

Multiple Failed Transplant Procedures?

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

Have you performed multiple Hair Transplants on one person only to discover that the person might somehow not be suitable for further Hair Transplants because the grafts didn’t grow in from either operation.

No. I have seen men that lost hair following transplants (shock loss), but it was likely their native hair that fell out. This is a real problem in young men, especially if they did not take Propecia before surgery.

I have also seen men with DUPA (diffuse unpatterned alopecia) who have had failed transplants as well. Patients with DUPA are not candidates for hair transplant surgery. Hair transplant failures are most often the result of poor techniques and quality control of the process by the doctor and his staff.

Tags: dupa, hair transplant, failure

Is Prince Harry Starting to Bald, Too?

/by William Rassman, M.D./3 /

Is Prince Harry balding too? After watching the royal wedding, I couldn’t help to notice that Prince Harry had a balding spot too. Do you think he’s balding too, just like his brother?

If you look closely, you can see it in this video at 1m34. But is also mentioned by some people on Twitter.

From the very brief view of Prince Harry, it does look like he has crown balding. It’s so quick, it’s hard to really tell in that video. But if he does have some balding up top, then wearing a royal crown would provide him adequate coverage for now. The photos I’ve seen using a Google image search don’t really show any loss, but certainly hair loss runs in his family.

Tags: prince harry, royal, hairloss, hair loss

Safest Hair Dye?

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

Hello Doctor Rassman,
I am quite bald (confortable with that part) and keep my hair very much cropped. However, the sidelocks have now started turning quite gray (say 50%). I was told my someone to use a dye which is PPD free. Which brand do you think is safer?

thanks in aniticipation.

I am not a hair stylist and I have no skills or special knowledge in the various brands of dyes. Probably best to ask your stylist.

Tags: hair dye, hair color, safety

Dark Circles Under My Eyes After Rogaine Use?

/by William Rassman, M.D./3 /

I noticed severe dark circles after using rogaine 5 perc i was only using it once a day and i noticed my veins under my eyes became more pronounced. I dont know if its related to minoxidil or the seasonal allergy that attacked me this season around. Could you please tell me if its possible for minoxidil to cause this symptoms.

Thank you so much !

RogaineCould you have stayed out too late or haven’t slept well lately? I realize those are the obvious questions to ask, but they’re probably the more common causes of dark circles under the eyes. Did you rub your eyes after applying the medication? How long were you using the medication before you saw these circles start?

I just don’t know how dark circles under your eyes can be related to the Rogaine (minoxidil) you use on your scalp. Perhaps it’s blood circulation related, but if this is a side effect it’s not well documented. It seems like a stretch to think that your veins under your eyes can be dilated to produce dark circles because of Rogaine. I haven’t heard about this from any of my patients, though I have seen a few posts about it on the web and have even had people mention it to me via email. Nothing conclusive, though. Maybe it is just coincidence. If there’s real information about this phenomenon, I haven’t seen it.

Tags: minoxidil, rogaine, dark circles, hairloss, hair loss, side effects

Another Positive Propecia Experience

/by William Rassman, M.D./29 /,

After reading this blog for over 3 years I just wanted to share a positive experience with propecia.

I noticed my hair was receding when I was 19. It came as no shock as my father and all his brothers were completely bald by the time they were 40. After reading many different online forums and websites and deliberating over it for 3 years! I decided to get a prescription for propecia.

My doctor stated that I was about a norwood 2.5 and just starting to bald in the crown when I started. I have been on propecia for 4 years now with amazing results. My doctor now thinks I’m a norwood 2 and have held that ever since.

I have also experienced ZERO side effects of propecia. It really works!

Now sure, the anti-Propecia squad will be quick to post comments about how this is some shill post (just like last time), but get real. The medication works, so it’s unsurprising that some people would want to write in about it. Besides, the amount of negative Propecia posts far outweigh those about positive results, and I appreciate when the readers let us know about what has worked in their battle against hair loss.

To the reader that wrote in — thanks for telling us about your Propecia experience! I hope you have continued success.

Tags: propecia, finasteride, hairloss, hair loss

My Brother Has DUPA

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

My brother is 25 and was just diagnosed with DUPA. He has been prescribed Propecia. Are there any other things he can do or any clinical trials he can participate in? I read about Neosil, but not sure what has happened to that.

DUPA (diffuse unpatterned alopecia) is not the same as MPB (male pattern baldness). That being said, Propecia is a medication for the treatment of MPB, which means it will most likely not be of help in treating your brother’s DUPA.

There are no treatments, clinical trials, or medications for the treatment of DUPA that I’m aware of.

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

Whey Protein Isolate Causes Hair Loss?

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

Dr. Rassman,
I read where one dermatologist (who specializes in hairloss) claims that whey isolate protein causes hair loss but whey concentrate (cheaper, less refined) does not. How could that be? To my knowledge, protein supplements do not affect hormonal levels at all. Do you know of any reputable studies to that effect? I take a whey isolate protein that agrees well with my stomach and I do not want to give it up unless there is some truth to that. Thanks for this blog.

I would also agree and ask “how could it be?” I don’t know of studies that backup those claims. Perhaps astute BaldingBlog readers can point us in the right direction.

Did your specialist offer an explanation?

Tags: whey protein, hairloss, hair loss, protein, whey

Do I Still Need Propecia at 58 Years Old?

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

[/bq]I have had 2 sessions of hair transplants 7 years ago and have taken propecia for past 7 years. Now I am 58 years old. Is it still neccessary to continue the propecia or is the risk of future balding minimal at my age?[/bq]

I don’t know. Only your doctor can say if you “need” or “should” take Propecia (finasteride). In general no one “needs” to take Propecia. But many men take Propecia to slow down the genetic hair loss. If you still have native hair that are at risk of thinning then Propecia may help. A good miniaturization study will show if your native hair is vulnerable (miniaturized) and that could be used as an indicator to help you decide if you want to take the drug. I also point out that the long term impact of finasteride at reducing the incidence of prostate cancer by 25% is a good reason to be taking the drug.

One patient (who is my attorney) is in his 70’s and he took Propecia and it actually grew back his crown area without the need for surgery.

Isn’t a Maturing Hairline Still Considered Hair Loss?

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

Hello, Dr. Rassman. Why don’t you consider the small recession into the “mature hairline” to be hair loss? DHT causes this change, just like it causes the balding process. And intriguingly, the Dominican Republic pseudo-hermaphrodites did not show any amount of hairline recession into what you consider a “mature hairline.”

I would think if you are losing hair it could be considered “hair loss”, but the key is the cause of the hair loss, such as:

  1. androgenic (also known as genetic)
  2. mature hairline
  3. stress related
  4. infection related

I don’t think labeling something is that important. The important thing is looking at the big picture and understanding what is going on. The label “mature hairline” is qualified for a physiologic hair loss that is present in a substantial number of men who do not show any patterned balding.

Tags: hairloss, hair loss, mature hairline

Is There a Connection Between Finasteride and Tight Foreskin?

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

Thanks for the great site. I have a new one for you. I’m 26 yo male taking the standard finasteride dose for hair loss under doctor supervision for about 18 months. None of the typical complaints.

About 6 months ago the distal tip of my foreskin began tightening with a white ring of inflexible tissue. This was recently diagnosed as ‘balanitis xerotica obliterans’ or BXO. A simple analogy is thinking of your soft eyelid skin losing its elasticity. Hardly comfortable.

I’m no hypochondriac looking to blame my condition on finasteride. I’m aware any connection is unlikely. I ask your opinion based on the following tidbit I stumbled across: “…[patients] have been found to have decreased serum levels of free testosterone, androstenedione, and dihydrotestosterone compared with control subjects. The underlying defect may be a problem with the function of the enzyme 5-alpha reductase.”

Perhaps you could take a look at the medical literature on my behalf? I will be seeing my regular doctor for this matter, but I thought you might be intrigued enough to add your educated thoughts. Thanks.

Thank you for the information. It is intriguing, but I’ve not had this complaint from any of my prescribing patients. I realize not all patients might be quick to tell me about all possible issues they have, but that’s all I have to go on.

I did search PubMed, but I couldn’t find a correlation between DHT reduction and penile foreskin. The penile issues involving DHT are mainly from when you were in your mother’s womb. For example, if your mother was taking high doses of finasteride or had a genetic defect in DHT production.

Tags: finasteride, penis, foreskin, propecia

Tretinoin Is Causing Me to Grow a Unibrow

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

Hello Dr. Rassman and contributors,

I am almost positive that tretinoin increases hair growth, at least on the face. I have never had unibrow in my life but i can grow one in a week by applying tretinoin there, and it stops growing if i stop applying. My eyebrows can also grow higher and further along the temples when applied. I have done this many many times. I was thinking since tretinoin in part possibly works by preventing hyperkeritinization that hyperkeritinization could be synergetic in balding by allowing to DHT to “stay” longer in the follicle. Also I am very certain for me that it increases eyebrow growth, however I would be very skeptical, and would not try it on my head, are their different factors that influence hair growth on eyebrows vs scalp?

Thank You

UnibrowI will assume that you are not experimenting on yourself because you are trying to grow a unibrow, but if you noticed that hair grew between your eyebrows when you used the medication, it makes sense that this could be a side effect. What else can I say?

Tretinoin (also known as Retin-A) has been said to cause hair loss for some people and grow hair for others.

Tags: tretinoin, hair growth, unibrow, eyebrow