Should I Abandon Propecia for the New PGD2 Hair Loss Treatment?

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

Hi doctor Rassman, I just read the update on the new pdg2 thing for hairloss. I emailed you the article yesturday by the way. I just want to know soemthing, what about DHT? does this mean DHT is not the cause and we don’t have to take propecia anymore? I would really appreciata a reply, becuase I have no clue on this.

There is no other identified effective replacement drug yet available, so it would be advisable to stay on your doctor’s prescribed finasteride. Of course, talk to your doctor about stopping or changing any prescription medication if you really are concerned.

We’re all still learning about this new PGD2 research, so I can’t comment further on it. I know everyone is excited about it, but we need to wait and see beyond these initial reports what the reality is.

Tags: propecia, finasteride, hairloss, hair loss

Finasteride Stopped My Hair Loss, But Should I Use Minoxidil For Regrowth?

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

I’m a 29 year-old male who’s been taking finasteride for about a year and a half. I had been experiencing mild to moderate thinning on my crown and hair line, which seems to have mostly halted, although there has been no regrowth of lost hair.

I’ve avoided minoxidil due to concerns about the shedding it can cause, and the fact that I’m relatively content about where the finasteride seems to have halted my hair loss. My question is, am I losing any potential for regrowth by holding off on minoxidil? Is the expected benefit greater in using minoxidil when hair loss has been relatively minor, compared to beginning its use only when hair loss starts to accelerate?

Finasteride and minoxidil work in different ways, so many patients try both. There is no risk for using these medications together. I have no way to know if minoxidil will regrow hair for you though, so I couldn’t say if you’re missing out on anything by not starting it.

Tags: finasteride, minoxidil, hairloss, hair loss

In the News – A Possible Cure for Balding Appears Credibly Close

/by William Rassman, M.D./23 /

A lot of press coverage recently about the latest protein (prostaglandin D2 or PGD2) identified that may hopefully bring a cure for male pattern baldness, based on a study published in Science Translational Medicine. We will have to wait out the FDA process and see where this is all going to take us.

The suggestion is that this may be a cure to prevent the balding process, but it does not imply that this can reverse the damage from hair loss in the past. The team of researchers was lead by dermatologist Luis Garza (then of the University of Pennsylvania, now at Johns Hopkins University) and by Penn dermatologist George Cotsarelis. Here are some quotes from articles around the web:

From Bloomberg News —

“Male-pattern baldness may be caused by a protein in the scalp, according to research that raises the possibility drugs being tested by Merck & Co. (MRK) and Actelion Ltd. (ATLN) for other uses might prevent hair loss. Bald spots had an excessive amount of a protein called prostaglandin D2 or PGD2, according to a study in Science Translational Medicine. Merck’s experimental treatment for facial flushing and Actelion’s allergy compound, both in late- stage studies, block the protein.“

From The Los Angeles Times —

“The discovery that prostaglandins might be the catalyst that sets baldness in motion, was a surprise to the researchers, who ‘hadn’t thought about prostaglandins in relation to hair loss,’ said Cotsarelis. From there, researchers were able to identify the receptor — the cellular landing dock — for D2, called GPR44. Find a way to block that receptor, or somehow thwart PGD2’s path to it, and, voila! —baldness doesn’t happen. That, say the researchers, will be their next effort — to try topical treatments that block the GPR44 receptor. They hope the same approach might help find treatments that prevent hair thinning in women.“

From MedPage Today —

“To explore the possible mechanisms, Cotsarelis and colleagues examined scalp tissue from 22 white men ages 40 to 65 who underwent hair transplantation for male pattern baldness. None of the men were taking either of the two approved medications for baldness — minoxidil and finasteride. Through genetic analysis of bald scalp tissue and hair-covered scalp tissue within the same individuals, the researchers discovered that levels of prostaglandin D2 were about three times higher in the bald scalp tissue.“

From HealthDay —

“Several companies have compounds in development that block the receptor for PGD2. Those compounds are being studied to treat asthma. We think using these compounds topically… could slow down and possibly reverse baldness.“

Tags: hairloss, hair loss, cure, balding, baldness, protein, prostaglandin

Can a Skin Irritation Trigger Alopecia Areata?

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

Hi Doctor thank you for your help. Can skin irritations trigger Alopecia Areata? I have read many different articles about the triggers of AA but it is still confusing. I see certain chemicals and allergies might trigger another spot. It is hard for me to understand if skin irritations or skin allergies are really enough to do this. Also are there irregular shaped spots or are the spots always round. Thank you for your time.

Alopecia areata can often be spontaneous, but some have tried to connect allergic reactions to it. I really don’t know though, to be honest. The spots can appear singular or at multiple locations, regular or irregular and they can change in size and grow larger.

For more info on alopecia areata, I recommend visiting the National Alopecia Areata Foundation site.

Tags: skin irritation, allergy, alopecia areata, hairloss, hair loss

Woman Took Dutasteride and Got Acne

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

(female)

Hi Dr. Rassman! I have a quick question for you. While I found a combination of Rogaine, Diane 35 birth control, and 200 mg spironolactone just about completely reversed my AGA hair loss, I was stupid enough to begin taking Dutasteride (Avodart) which I ordered from the internet at a dose of 0.5mg/ every other day. The predictable shed started recently as is common, but what really got me was my skin started getting filled with pimples (I take pride in having good skin) and I decided it wasn’t worth it, since my hair had already become pretty good before I started it, and who knows if the acne would be temporary, or even get worse. I stopped it about 5 days ago.

Now I am wondering if you have any idea, even a vague one, as to when my hair will return to how it would have been pre-Dutasteride use, since I stopped using it during a hair shedding phase which was induced by the drug. (weeks/months/ever?)

Any ideas would be so helpful in helping me feel reassured. Thanks so much for your time.

I hate to use you as an example, but this is exactly why you should not treat yourself with prescription drugs bought via the Internet. I can’t say this enough — you should not be self-treating your medical issues and you certainly should not be purchasing prescription medication without a physician’s prescription.

Unfortunately, I do not know anything about you to even begin assessing your medical issues. Sorry. You really need to see a doctor for an in-person examination. I realize the Internet is an easy way to try to diagnose and treat yourself, but you could be doing more harm than good.

Dutasteride (Avodart) is not recommended for women and it may have unforeseen long term side effects. I was able to find a forum where a woman took dutasteride and had a similar side effect that you had (acne breakout)… but beyond that, I really don’t know what it would do for treating female hair loss.

Tags: dutasteride, avodart, hairloss, hair loss, female hair loss

When Propecia Starts Working, Is It Sudden or Gradual?

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

I am a 21 year old who has begun taking generic propecia for about a month now. However, I have yet to see any progress so far. I am shedding hair at the same rate as before, and the frontal hair line recedes at a very rapid pace that I can notice the difference daily. I understand from reading some of the answers on this blog that the effects of propecia become apparent after about four months of usage on the average. Does that mean the hair loss will suddenly come to a stop (assuming propecia works for me) after a few months of taking the drug? or Would my hair show a series of gradual signs such as thickening of hair and losing less and less hair that will eventually lead to a stop in hair loss? Thank you very much.

I generally tell patients it takes 6 to 12 months to see the effects of Propecia. You will definitely not see any effects in one month other than (in some people) the cessation of rapid hair loss, if they happen to have it. These things take time and it does not magically happen overnight, as the hair grows out 1/2 inch a month if it is healthy. Remember that seeing less hair falling out may be a positive sign. People do NOT always get more hair growth.

Tags: propecia, finasteride, hairloss, hair loss

Gas-X and Propecia?

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

hello dr rassman

can i take bloating pills(gas x) with propecia or that will affect the effectiveness of propecia?

Gas or no gas should not have any effect on Propecia, nor will pills taken to relieve pressure or bloating from gas.

Tags: gas-x, propecia, finasteride

A Year After My Transplant, It Looks Like Most Are Just Single Hairs

/by William Rassman, M.D./4 /,

Hello Dr. Rassman,

I’m 29 years old and had a transplant exactly one year ago in Thailand. I had roughly 1000 grafts transplanted to my hairline and temples using the FUE method. After waiting the full year, I’ve got to say I’m somewhat disappointed in the results.

I purchased a digital microscope after reading many of your blogs. I’ve taken a good look at the recipient area and it appears that 90% of my grafts are just single hairs, as if the follicular units were transected during the operation. I’ve also noticed many colorless, short, thin hairs in that area. Are these the remnants of my native hairs that have miniturized? Would you say I can expect any more development in the transplant? Or is 12 months pretty much it? If I was a norwood 2 at 27, how far would you guess my balding will progress? My crown looks thin to the naked eye, but I believe it’s because of the cowlick and that I’m a blonde and the light penetrates through. With the microscope, I see no miniturized hairs in the crown. Thank you for your time

If you have 2-hair grafts placed and only a single hair grew from each, that could mean one of three things:

  1. Close to half of what grew in each follicular unit died from the process you had done. Or…
  2. You are Asian and have typical Asian hair densities, which means that there are equal one and two-hair follicular units growing in your native hair. Or…
  3. The doctors just divided the 2-hair grafts to make singles to increase the graft count.

Even if you are Asian, you should have 50% one-hair grafts and 50% two-hair grafts (on average). Strict quality control is critical for all of the hairs in the follicular units to grow and if you had all two hair grafts (typical of Caucasians) the growth of only one-hair grafts reflect some damage. You should also count the grafts, as well as the hairs. Was it a bargain deal? Take a look at our recent post about cheap hair transplants.

The doctor could have separated all the grafts into single hair grafts (if the doctor was not honest and tried to push up the graft count if he charges by the graft). In any event, 1000 two-hair grafts should have yielded 2000 hairs (in a Caucasian) and 1500 hairs (50% each of one and two hairs in each graft). That is the bottom line. I always measure the density of the patients prior to surgery so I know what I expect to achieve in the harvested grafts as well as how many hairs are transplanted, the count of each graft with regard to the number of hairs they contain. Some clinics charge per HAIR and not per graft, so look at how the billing was made. Maybe you were charged for 1000 hairs and not 1000 grafts (not uncommon to find).

Tags: hair transplant, grafts, hair growth

Proving or Disproving MPB?

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

I stubbled across this website and have one question. Does NHI provide a service that proves or disproves mpb for men? Reason I ask is because I have noticed hair loss or thinning for about a year and a half now and there are really only two areas that I notice a problem. Around my cowlick back left around the crown and front left which is noticeably thinner than the right. Wondering what can be done as I am already using finasteride, minoxidil, hair club EXT treatment and laser comb. Thanks

We are not in the business of proving or disproving MPB. We are physicians who examine, diagnose, and treat patients. We developed a concept of establishing a Master Plan for every patient who visits us. It sounds like you have tried everything (and the kitchen sink) and have not established a baseline to determine where you started and where you are going.

Tags: hairloss, hair loss

When I Stopped Smoking and Was in the Sun, My Hair Regrew

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

can you figure out how hair that i had lost and hadnt grown back in years, all of a sudden came back over 2-3 months of giving up smoking and jogging everyday in the scorching sun ?.

I ask as the moment i got it back i stupidly started smoking and stopped excercising and it all diffusely thinned again.

Im guessing my hairloss wasnt male patterned and whatever type it was reacted to the constant sunlight ?

thanks

I don’t know how these things are related to your hair regrowing, but thanks for sharing your story with us. Sunlight doesn’t make hair regrow, for those curious. If your hair is falling out and regrowing on its own, there’s probably something other than MPB going on.

Tags: hairloss, hair loss, sunlight, smoking

Has Merck Accepted That Propecia Has Prolonged Side Effects?

/by William Rassman, M.D./6 /

Dr. Rassman,

Thank you for your dedication to this blog site, it has been a source of great comfort on an issue that is often brushed under the table. Please respond at the very least by private message because I would really like to have a better understanding of what is happening.

Now that merck admits to prolonged site effects, do you at all feel betrayed? as looking back at most of the content on this website, you are rather adamant that any side effects will go away when propecia is discontinued…

as a propecia user myself, the idea of myself, or another young male in their 20’s losing normal bodily function permanently seems devastating to say the very least! even if the drug works well on 99%, and one out of 100 take it have a permanent reaction, then is that even really worth it? lives being ruined?

What is your whole hearted suggestion in light of recent developments, ie. class action suit, website removal etc. for someone like me. Do we stop taking the medicine? common sense says it takes a hell of a lot for a pharma giant like merck to take down their website. and it takes a hell of a lot of evidence to form a class action suit.

and at this point mercks acceptance of prolonged side effects almost negates the original clinical studies all together…no?

No. Every drug has its risks. I don’t believe that Merck knowingly withheld information from the public. The FDA and the drug companies work together to control safety and effectiveness, but they are never 100% certain that everything is covered.

One of my three sons is still on Propecia and I endorse his decision. He looked at his mother’s side of the family and saw Norwood class 6 balding patterns. Now he has all of his hair. I don’t know what his pattern would have been like had he not taken the drug when he was 29 and an early class 3 pattern, certainly not his mother’s family line. My son has had no side effects (same as most of my patients).

I always tell my patients of the risks, and they then make their own decisions as consenting, educated, knowledgeable adults. Pulling down a website and seeing advertisements for law firms trying to collect enough people to sue them isn’t enough for me to believe Merck is admitting guilt.

Tags: propecia, finateride, merck, hairloss, hair loss

Rosacea and Hair Loss?

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

Hello, doctors.
Can rosacea on scalp cause hair loss or hair thinning? or do rosacea sufferers have thinner hair?

The diagnosis of rosacea has many forms of severity and symptoms (see here), but it is generally limited to the face, not scalp. Hair loss isn’t a usual side effect of rosacea as far as I’m aware.

I found a post on the National Rosacea Society forum that discusses having scalp inflammation in addition to the facial rosacea, which might be of some help. You should talk to your dermatologist to determine the cause of your hair loss.

Tags: rosacea, redness, hairloss, hair loss

Prince Harry Has a Thinning Crown?

/by William Rassman, M.D./6 /

Dr. Rassman

I know you’ve commented before on Prince Harry, but I noticed some better pictures found here, including close up from above: link

Do you think this is balding and if so, what norwood would he be at and possibly progress to?

Thanks

That is one great collection of royalty. He clearly has vertex balding, but his frontal hairline can not be seen clearly, so I can not guess what his final pattern is. I also do not know if he is using any medication, which makes sense to arrest the hair loss, thereby modifying his final pattern.

Tags: prince harry, royalty, british royalty, hairloss, hair loss

Why Is a Cure for Hair Loss Taking Forever?!?!

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

Flat out doc….
when is there going to be a cure for hair loss? I mean come on, our scientist have done some seemingly impossible things, yet we can’t figure out hair loss? I don’t believe it. There has to be a way. They seemed to have been able to reverse it in mice at a %100 effectiveness rate what about humans??? Our bodies can do amazing things there is no way you can tell me it can’t regrow hair. I believe it’s possible…….

The fountain of youth has also failed to materialize. I would like to think that one day there will be a true hair loss cure, but I have no way to know if or when it will happen.

Tags: hairloss, hair loss, cure

Recoverup Stem Cell Treatment?

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

Hi doctors,
I saw this video of a stem cell treatment that says you have “noticeable” results in a couple weeks. What do you think about this?

Here’s the link on Youtube.

When any stem cell treatment is advertised and promoted as producing hair within 2 weeks, I’d think that this is another stem cell fraud, just as the TV program 60 Minutes recently covered. It’s interesting that this video just shows computer animations and not photo results, but regardless, to my knowledge there is no proven effective stem cell treatment for hair loss on the market today… particularly one that grows hair in a couple of weeks.

I’ve embedded their video here, but I don’t believe their claims for a second:

Tags: recoverup, recover up, stem cell, hair loss, hairloss