In the News – Finasteride and Dutasteride Raise Prostate Cancer Risk

/by William Rassman, M.D./9 /

Snippet from the article:

A class of drugs meant to improve symptoms of an enlarged prostate gland actually increase the chance of getting a more serious form of prostate cancer, health officials said on Thursday. However, they also said the drugs’ benefits outweigh the risks.

The drugs in this group include Merck & Co’s Proscar and GlaxoSmithKline’s Avodar and Jalyn, as well as Merck’s Propecia, which is approved to treat male pattern hair loss.

The Food and Drug Administration said it revised the labels on all such drugs, called 5-alpha reductase inhibitors (5-ARI), to include the risk after reviewing two large studies.

Read the rest — Prostate drugs raise risk of prostate cancer: FDA

Today comes news that the FDA is warning that drugs like Avodart and Proscar may increase the risks of some forms of prostate cancer.

In the original studies, the overall incidence of prostate cancer in the thousands of individuals enrolled in a double blind FDA sponsored activity showed that overall risks of cancer in those men treated with 5mg finasteride (Proscar) saw a 25% decrease in risk of developing prostate cancer. After the study was published, pathologists looked at the types of cancer that they saw, and reported that of those fewer men that did develop prostate cancer, the presence of more aggressive cancers was greater in that group.

These risks are very small and the overall reduction of prostate cancer standing at 25% in the 7 year trial should offset the other risks of a more aggressive cancer, but the statistics on this are dubious at best. For those men who are taking finasteride (at any dose), they must recognize that there is a risk of a more aggressive prostate cancer, no matter how small that risk is.

The information about cancer reflects the experience with finasteride 5mg (Proscar), not 1mg for treating hair loss (Propecia). What we do not know is the threat of the 1mg dose, if any. There have been no reports that separate the 5mg and the 1mg dose in the cancer risk scenario.

Tags: finasteride, dutasteride, propecia, proscar, avodart, prostate, cancer, fda

Is Medication Even Worth Using to Treat My Temple Region?

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

I’m 19 years old and I am already losing the hair of my temple region. Am I too young to take medicine to regrow hair? And, I have also read that most of the medicines don’t work as well in the temple region. So, would it be worth it to even try?

I assume that you are talking about the hair on the sides of your head — temple peaks — not the corners of the hairline (which many people mistakenly called the “temples”).

Medications such a Propecia and Rogaine do not usually work nor are they recommended for treating hair loss in the temple region. I cannot say if it is “worth” it for you to try. Talk to your doctor, get a diagnosis, and find out what you are really trying to treat so you and your doctor can come up with a Master Plan.

Tags: hairloss, hair loss, temples

I Self-Prescribed Finasteride and Now I’m Wondering If I Should Stop

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

Taking Finasteride Without Needing It

Hello doctors at Balding Blog. Thanks a lot for such a wonderful site. It has truly answered a lot of concerns I have had. I write because I have a concern. Im a male that just turned 19 2 days ago, but have been shedding hair for about 9 months. I made the mistake of “self prescribing” so I have been on Finpecia for about 3 weeks now. The shedding is the same but I am wondering what I should do at this point. Should I stop taking the drug and see a doctor. Or should I continue taking it while I get the appointment. If you could please give me some advice I would be truly grateful.

Obviously, you should never self-prescribe medications. I can’t in good conscience tell you what to do here in regards to stopping or continuing the treatment. Keep in mind that after only a few weeks, you’re not likely going to notice a change in your hair loss. Here’s what you should do:

  1. You should go see a doctor.
  2. Get a diagnosis of what you are treating.
  3. Discuss the issue of taking any medication, if warranted, with your doctor.
Tags: finasteride, finpecia, hairloss, hair loss, propecia

How Much is SMP?

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

Hello Dr!

Could you give us a ballpark figure on the costs of SMP? I think it’s a very cool procedure .

Thanks and as always your blog extremely helpful and I very much appreciate the efforts you and your colleagues put into it .

The cost of Scalp MicroPigmentation varies, but in general it ranges from $2000 to $6000 depending on each case. This includes all touch-ups and follow ups, plus anesthesia for a pain free experience.

Tags: scalp micropigmentation, scalp micro-pigmentation, smp, tattoo, pigment, hairloss, hair loss

If I Don’t Take Propecia, Will My Transplanted Hair Fall Out?

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

Hello Dr. Rassman,
I have done a hair transplant surgery about 6 months ago and I am using Rogaine twice a day along with Hairman comb for maintaining my hair. I am not using Propecia as it is having sexual side effects. My question is that since I am not using propecia which stops DHT which causes hairloss, are my new hair follicles in danger of falling out? I am 26 years old.

Another question that I have came across a clinic in London and they are offering Minoxidil 12.5% which stronger then the normal 5% Minoxidil. Minoxidil 12.5% have to be used only once a day. Switching to Minoxidil is a safe idea, please advise.

Your prompt response will be appreciated. Regards

Transplanted hair is from the donor area (back of the head), so it should not fall out from genetic causes. If you didn’t experience shock loss after your surgery, particularly since you’re a young man, you are quite lucky. There is a chance your loss could still progress, but there is no laser or topical treatment that will prevent that. Actually, there’s nothing that will 100% prevent all future hair loss (that would be called a “cure”, which doesn’t exist).

Propecia helps slow the progression of genetic male pattern baldness (MPB), but if that isn’t an option for you, I’m not sure what to tell you. Did you experience side effects yourself or are just frightened by what you’ve read on the internet?

Minoxidil has been proven safe and effective at 5%. If clinics are offering stronger medication, that doesn’t necessarily mean it will work better. You do run a higher risk of irritation and other side effects from minoxidil as the concentration is increased. Have you tried the 5% without success? I’m confused as to why you’d want to try a very high strength right off the bat.

Tags: minoxidil, propecia, hairloss, hair loss, hair transplant

Retrograde Alopecia

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

I’ve searched your site over, but haven’t been able to find anything about Retrograde Alopecia, where the hair directly above the ears and neckline thins. Can you tell us something about this? Does Finasteride or Minoxidil help? In what percentage of patients do you see this? Thanks for taking the time each day to contribute to your blog! I thoroughly enjoy it!

I have seen hair loss above the ears and neckline over the years in my practice, but it is not very common. I wish someone could quantify this. I tend to see this more when I travel, particularly in airports where a lot of men are walking around. The problem for me is that my eye only catches the ones with the hair loss in these areas. There is no history with these drugs in this type of hair loss.

I’d think hair transplantation could work well as long as the donor hair isn’t affected, however, I have not performed surgery on any patients with neck hair loss. I believe “retrograde alopecia” may be a correct term, but it is not mentioned or popularized on web searches because it isn’t a common occurrence.

Tags: retrograde alopecia, hairloss, hair loss

Allergan Rep Told Me Latisse Will Be Out Soon for the Scalp

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

Dear Dr. Rassman,

I was in a plastic surgeons office with my wife last week. I just happened to meet the Allergan rep. He told me that Latisse was going to be released soon for hairlines. The thinking is that if hair is present that Latisse could make the hair shaft grow thicker.

He told me that the company believed that there was a huge market for the product for people experiencing hair loss.

Just wanted to give you a heads up that this is in the pipeline.

A reader pointed out that Latisse (bimatoprost) is currently in a clinical trial for use on the scalp — see here.

I’m not sure how far away they are from submitting for approval, but if the FDA approves it, I’m sure they’d be as quick to get it to market as possible. There’s money to be made on hair loss treatments, and FDA approval of hair loss treatments are few and far between.

Tags: latisse, allergan, fda, hairloss, hair loss

24 Hours After My Transplant, I Found a Loose Graft

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

After shampooing gently using the cup method 24 hours later, I noticed a hair graft with skin still attached laying on top of my hair just as I was starting to comb my hair. I didn’t see any blood anywhere when I checked. Could this be a lost graft or could the follicle still be intact under the skin?

-Thanks.

It’s probably a lost graft. Have your doctor examine the area. At 24 hours after surgery, the grafts haven’t taken root yet. If the loose grafts are caught early enough and in the right circumstance, your doctor can usually push it back in and save it. Otherwise, it is expected you will lose a few grafts no matter how careful you are.

Tags: hair transplant, grafts

Donor Area Yield After Multiple Transplants?

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

How does the recipient area change after 1 or 2 hair transplants? If 1 mm punches are used to place the grafts, does it result in less yield from future hts due to scarring or does the tissue return to normal? How would this effect something like acell if it does turn out to be the solution for the limited donor supply problem?

I think you are referring to the donor area. No surgeon should be creating recipient sites with a punch in modern day hair transplant surgery.

If you mean the donor area (back of the head) that has been harvested with 1mm FUE punch, then the logical answer is that the donor area would be depleted of however many grafts/hairs were harvested. The donor area, depending upon your donor density, can supply 4000-9000 grafts in your lifetime. As the number of grafts come out, the remaining supply will obviously decrease by that same amount. The resultant scarring of the donor area may (or may not) impact any future FUE surgery. Each and every patient is different.

Finally, I do not know how ACell will impact hair transplant surgery in general. It is anybody’s guess at this point.

Tags: donor area, hair transplant, hair loss, hairloss

Can You Prevent SMP From Turning Into a Blurry Mess?

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


Dr. Rassman,

The SMP procedure looks very promising and I’m sure you are getting tons of questions regarding it. Here is another one. On the HTN forums, a representative for Dr. Rahal said he had been impressed with SMP but did in fact see a patient whose pigment turned into a blurry grey mass. He didn’t know which clinic did the pigmentation. I was wondering if you have come across this at all and what NHI does to prevent this kind of outcome.

Much thanks!

The key to preventing the blending of the pigment dots into a blurry mess relates to:

  1. The depth the pigment is placed
  2. The size of the pigment dots
  3. The angle used in the placement of the pigment
  4. The instrument used

I hope that NHI has all of this well controlled, as we recognized this early in beginning the business.

Tags: smp, scalp micro-pigmentation, micropigmentation

Scalp MicroPigmentation (SMP) and Color Options

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

I had a few procedures to the front and temple areas. I wear my hair about 1″ 1/2 – 2″ long. Do you do S.M.P.in areas between hairs to give an illusion of more density. If the answer is yes with dark brown hair would you use different color inks.

We would have to evaluate you to determine the best approach to your desire to thicken your hair… but yes, we have used Scalp MicroPigmentation in between existing hairs to create a denser look.

Varying shades of brown can be achieved, though your candidacy is an individualized decision between you and us. We have very successfully used SMP in patients who wanted more fullness and in those who had previous hair transplants.

Tags: smp, scalp micro-pigmentation, micropigmentation

In the News – There’s an Average of 70 Side Effects Per Prescription Drug

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

Snippet from the article:

Lists of the side effects for prescription medications on drug labels, packaging and advertisements have mushroomed up to an average of 70 per medication, a new study reports.

Cautions about side effects were designed to inform doctors and consumers of potential hazards, but this expansion may have more to do with worries about litigation rather than actual health concerns, say the study authors, who argue the information could be presented much more efficiently.

“Having a high number of side effects on a drug’s label should not suggest that the drug is unsafe. In fact, much of this labeling has less to do with true toxicity than with protecting manufacturers from potential lawsuits,” the study’s lead author Dr. Jon Duke, Regenstrief Institute investigator and assistant professor of medicine at the Indiana University School of Medicine, said in a university news release.

Read the full text — Lists of Prescription Meds’ Side Effects Keep Growing

Although the article isn’t about hair loss, in light of the recent hubbub about Merck, finasteride, and side effects, I thought this was an interesting study worth sharing.

Tags: prescription medication, drugs

RepliCel

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

Greetings from a loyal reader! I did a quick search, and saw that this topic hasn’t been covered on your blog. I was wondering if you’ve ever heard of Replicel? I would love to hear your thoughts.

Thanks!

I haven’t heard about it before, but I’ve looked into it since your email. RepliCel recently completed the acquisition of TrichoScience, a company that worked with hair multiplication. This sounds like more of the same. From the FAQ: “With RepliCel’s treatment a very small punch biopsy is taken and new hair cells are replicated eliminating the need for a large hair donor site to be moved to the bald area.”

Their site says that they’re currently conducting a clinical trial with data expected to become available in the first quarter of 2012. So there’s really not much to know yet, as they’re still testing things and have months of work yet to go.

I would want to know if the investigators obtained an approval from an Institutional Review Board for the research on humans. That might make them credible as these boards are very tight giving approvals on anything less than solid evidence.

Tags: replicel, trichoscience, hair multiplication, hair cloning, hairloss, hair loss

Can SMP Be Recolored?

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

Hi,
In regards to SMP, can this be re-done or re-coloured in the future? If someone was to get black or brown SMP then as they aged their hair turned grey/white, can the original SMP work be ‘re-coloured’ or is it a one off, permanent solution?

For all realistic purposes, Scalp MicroPigmentation (SMP) is permanent. You can’t change the color of it, but you can have a touch up to enhance areas which may fade over the years. If your hair turns grey/white, SMP color will remain the same… but if you shave your hair or dye your hair after a SMP procedure is done, this should not make a difference.

Tags: smp, scalp micro-pigmentation, tattoo, hairloss, hair loss, color

Could Steroids Trigger Extreme Hair Loss?

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

Is it possible that supplementation of androgens (steroids) can trigger and miniaturize all your DHT sensitive follicles at once?

I am currently in my 30s. Lets say I were to be destined a Norwood 7 at 80 years of age, but after steroids, all of my follicles “switched” on at the same time (did not follow the Norwood progression).

Is it safe to say within a year or two it would be possible to jump right to a Norwood 7? Have you seen patients with this kind of radical hair loss?

Thanks

Anabolic steroids can accelerate androgenic alopecia (AGA). Most people who are Norwood 7 will start to lose their hair in while in their 20s and 30s (not in their 80s).

I have seen rapid hair loss from anabolic steroid use, but I have also seen rapid hair loss without anabolic steroid use.

Tags: steroids, hairloss, hair loss