Any News of the Avodart Clinical Trials?

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

doctor rassman
whatever happened to the fda trials with avodart? we all know avodart is more effective but when will it be cleared by the fda for hair loss? are their trials still going?

We know that dutasteride (Avodart) works when used to treating genetic hair loss. Some reports suggest that it may work even better, but the safety issues in young men, the sexual side effects and other side effects, and the long term issues related to sterility are not known.

The last I remember, there was a Korean study being done… so I looked up the ClinicalTrials.gov site and found this post about recruiting 900 Korean men for a dutasteride post-marketing study by GlaxoSmithKline (makers of Avodart). It was updated just a couple of weeks ago, though I’m not sure which part was updated, and appears to be concluding in July 2013 — AVODART Alopecia Post-marketing Surveillance (PMS).

The FDA will weigh out the safety issues before any application for use in hair loss is approved. So at this point, we’re still in wait-and-see mode.

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

My Daughter Has Alopecia Areata and High Fever

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

My daughter was diagnosed with Alopecia areata 2 months ago just recently the bold spots that looked like the size of a quarter are becoming bigger and bigger and its only in the back . I took her into the emergency room 4 days ago due to her high fever at 105 104 and she’s been having a recurrent fever every other day our the whole day just observing her.

I’ve been with 3 different pediatricians and none if them can answer me why? Where do I have to go to get answers? ; Who do I have go with? Is it an internal capability? Why the fever? Why the Vomiting? I just need to have some kind of answer

thank you.

I understand that you have a sick daughter who needs medical attention, but I am a hair transplant surgeon. Alopecia areata is not likely related to your daughter’s overall problem, which sounds serious. Vomiting is related to possible treatments that she might’ve been given for the alopecia areata, but I have no idea if she was treated with anything.

A good internist or pediatrician (if she is under 16 years old) is the doctor you might consider consulting. The doctors you have seen may not have a definitive diagnosis, but they should be able to assess and treat your daughter and answer your immediate questions.

Tags: alopecia areata, hairloss, hair loss, illness

Will I Eventually Have My Father’s Pattern If I See Some Hair Loss?

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

Hello Dr.

Question: When hair loss is hereditary, is it always the same type of hair loss pattern? I believe my father suffered a Type V hair loss, and my hair loss has been at a Type 3A for about 4 years now. Will my loss eventually become a Type V over time?

-Thanks!

I do not know your age, I have not examined you for miniaturization or bulk analysis, and I essentially know nothing about you other than a connection to hair loss by one side of your family (father). As you know, there is a 50/50% chance of getting his pattern if we blindly guess using available statistics.

Tags: hairloss, hair loss, genetics

I’m 39 Years Old and Norwood 1 — Could I Still Develop Hair Loss?

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

Dr. Rassman:

I am 39-years-old, and while there’s no advanced balding in my family tree, the Norwood 3v pattern is very common, slightly more so on my mother’s side. As a result, I’ve been very vigilant through the years for even the slightest signs of hair loss.

Even still, I recently visited a hair loss specialist who told me that I am still a Norwood 1. She took pictures of my scalp and analyzed the hair follicles, and informed me that the hairs seem uniformly thick and there’s no significant miniaturization.

What are the chances that I could still develop a Norwood 3v pattern showing at this point?

It would be highly unlikely that you inherited any balding if it has not shown at your present age, your hair is thick without miniaturization, and there is no frontal recession.

Tags: hairloss, hair loss

Why Would Prince William Be a Surgical Candidate?

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

Thank you for running a great site. I’ve found it immensely helpful in learning about this condition.

My question is – earlier last summer, you mentioned that Prince William would likely be a good candidate for a hair restoration procedure. I am curious though why that is the case. I had always been under the assumption that a young man with an aggressive pattern like the Prince would not be a candidate. Am I mistaken? If so, what particularly sets someone like Prince William apart? Is it the fact that he is a diffuse thinner rather than a receder?

Prince WilliamIn general if a person has male pattern baldness (like Prince William) and has good donor hair and scalp laxity, they WANT and DESIRE a change, and they have REALISTIC expectations of what is possible, they can be a candidate for a hair transplant surgery.

I have never met Prince William and my answers were just based on the reader’s hypothetical questions. Perhaps Prince William does not want a hair transplant surgery and is fine with his hair and the possibilities of eventually going completely bald in the Norwood class 6 pattern. I do not know if he has (a) fine, medium, or coarse hair, or (b) what his donor supply looks like or how it would measures out if I checked his hair density in the donor area.

From his overall pattern, I would suspect that he might benefit from Propecia (finasteride) based upon his age and overall pattern. Many class 6 patterned individuals who are young and go on this drug, may notice increased coverage, reflecting the thickening of the existing hair shafts or even new hair growth.

Finally based on pictures alone, I do not think he has a disease like DUPA, as it appears that he has good hair on the sides and back of his head.

Tags: hairloss, hair loss, royal family, prince william

Am I Losing Grafts 4 Months After My Transplant?

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

Hello
i had a FUE transplant last december, everything seems ok, but sometimes i feel a little itchy spot and when i scratch it, a hair (seems like it is one of the transplanted ones) comes out of the scalp attached to a bit of something looking like hard sebum, almost looking like when cleaning a black head blemish or an ingrowing hair. Is that normal? is that the follicle coming out? if so does this mean that i’ve lost one of the transplanted hairs?

thanks

These are really questions for your doctor. If you pick (or vigorously scratch) at your hair, you run the risk of losing the hair. Picking causes hair loss, infection and associated skin problems. For hair transplant patients, they should always have their doctor check out what is going on with their head.

I would doubt that you’re losing grafts at four months after your surgery, but I couldn’t tell you what is causing the itch. Maybe it is an infection, but this is clearly not something for an Internet-based diagnosis. Please call your doctor for a follow-up exam.

Tags: hair transplant, hairloss, hair loss

Switching From Propecia to Finpecia

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

Dear Dr. Rassman,

Thank you for your very informative blog. I have been on Propecia for nearly three years with good results. For cost reasons I am thinking of getting Finpecia when I am next in India. Do you believe switching from Propecia to Finpecia would have any effects for a good responder like me? I will only do it if the transition can be seamless.

Many Thanks

Assuming Finpecia is 1mg finasteride, I do not expect there to be an issue. Propecia is just the brand name for 1mg finasteride, and the generic form is sold by a variety of different names outside of the US (where it is not legally available until late 2013 due to patent laws).

There might be some differences in the manufacturing process, but chemically Finpecia (made by Cipla) is the same as Propecia (made by Merck).

Tags: finpecia, propecia, generic, hairloss, hair loss

Taking Propecia with Liquid?

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

doctor rassman, this question might sound stupid, but does taking propecia with a glass of water make it less effective? or should it be take wuthout liquid at all?

I’d assume most people take Propecia with water or some other kind of liquid. Water doesn’t change the efficacy. Just avoid taking it with grapefruit juice.

Tags: propecia, finasteride, water

My Donor Area is Thin, So Can I Have My Entire Beard Transplanted to the Scalp?

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

Hello,

I’m a 25-year-old male and I’ve been thinning since the age of 20, and I believe I might have stabilized the hair loss process as I’m taking medication and substances to stop the hair loss.

I’d like however to undergo a hair transplant, especially at the front of the scalp. The bad news in my case though is that my donor area is also thinning out, which means that perhaps 1500 grafts can be harvested.

My question to you is if it’s possible to harvest grafts from other parts of the body, say like the beard, arm pit hair and pubic hair, also the hair between the buttocks? Let’s throw in arm, chest and leg hair while we’re at it. Is it possible to transplant hairs from these areas to the scalp?

I wouldn’t mind if my ENTIRE beard was to be transplanted, because I have sebhorroeic dermatitis and my beard is just aggravating that condition. Is it possible to transplant the ENTIRE beard?

Grateful for a reply

I really can not answer your question properly. First, I have not examined you so I can not confirm what you are reporting.

Second, if you are losing your donor hair, then you probably have some condition that is not genetic patterned balding. Do you have diffuse unpatterned alopecia (DUPA)? It’s not usual to have the entire scalp thinning like you described.

Third, a hodgepodge of hair transplants from different parts of the body may give you a freaky, unnatural look and therefore, I wouldn’t be interested in doing a surgery like that. The hair from the beard is different than the underarms, the chest, the leg and so on. Body hair in general is different from scalp hair, as I’ve written about before (see here). Hypothetically speaking, transplanting the entire beard would leave facial scarring that wouldn’t be in your best interest.

Anything is possible and any hair can be moved from one area to another, but how it will look in the end is another entirely different matter.

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

In the News – Merck Updates Propecia Side Effect Warnings

/by William Rassman, M.D./8 /

Snippet from the article:

Warning labels for Merck & Co’s drugs for baldness and enlarged prostate will add notices of sexual side effects that continued after use of the medicines was stopped, U.S. health regulators said.

Labels will be revised for Proscar, which treats symptoms of enlarged prostate, and hair-loss treatment Propecia, the Food and Drug Administration said. The active ingredient in both drugs is finasteride.

The Propecia label will now include notification of problems with libido, ejaculation and orgasms that continued after use of the drug was ended. Proscar’s label will include notification of decreased libido.

Read the rest — Sexual side effect warnings added to Merck drugs

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

Clobetasol and Female Hair Loss

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

(female)
I have used clobetasol off and on for years. I have never been advised that this med can thin the skin or cause hair loss. Just about 1 yr ago my scalp psoriasis became quite aggressive and I spent every evening slathering my scalp with the med. My hair thinned to about 1/2 of its normal thickness. Is it possible to somehow regrow the hair that I have lost?

Clobetasol is a powerful topical steroid that can thin the skin, thin the hair, and produce a variety of systemic problems from steroid overdose. Withdrawal from this medication can be a problem and you may need to be managed by a good doctor for the withdrawal process.

With respect to hair growth, if it does not regrow within one year, it will probably never grow back.

Tags: clobetasol, female hair loss, hairloss, hair loss, steroid

I Was Told I Didn’t Need to Take Propecia, But I’ve Already Been Taking It

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

I am 25 years old, and weeks ago i had my first appointment with Dr Pak at your office.

He was very helpful and professional and gave me very good news, we took a look for miniaturization and bulk loss and everything was fine and there was no point for my to worry about.

Dr Pak told me that it wasn’t even necessary for me to take propecia (which i been taken for two years and 6 months), i havent stopped propecia so far, because even though Dr Pak didn’t classify me on the norwood scale, what worries me is the hairline, now i believe i am between norwood 2.5 and 3.

My question is, is it safe to stop propecia when the norwood scale is more advanced that 2?

Perhaps my pictures taken by dr Pak two weeks ago are available in the data, and perhaps you could classify my in the norwood scale.( i’m not ok with having them posted)

Anyway i want to thank you and Dr Pak, I plan to have an apointment once a year if everything stays the same without changes, and i also plan the possibility to have a hair transplant with nhi on the hairline when i hit 30.

Thank you Dr Rassman

I did review your file and it seems your hair loss issue started when you had a long hospitalization stay from your illness (considered stress-related hair loss). You noted hair loss after being discharged from the hospital and since then it has grown back.

There is little harm taking Propecia if there are no side effects; however, if after bulk analysis, miniaturization mapping, and observing your frontal hairline, it still indicates that you are not balding, then taking the drug is unnecessary.

Many men worry that they have frontal balding and often classify themselves as having a Norwood class 2 or 3 balding pattern, but they are really just seeing the appearance of a mature hairline. We often do not agree with their classification, but the final decision about taking Propecia is obviously yours and I can justify the drug in your particular case.

Tags: propecia, finasteride, hairloss, hair loss

How Long Will My Testicular Pain Last from Propecia?

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

I’m a 24 year old male. I’ve been using Propecia for about 40 days and just started getting testicular pain. Everything functions as normal, but I have pains and my libido seems down about 30%, although it could just be from the pain. I can deal with some libido loss as I really want to keep my hair. It’s unlikely to be caused by anything else. Will symptoms likely fade and how long should I wait before discontinuing treatment? Also, I take the generic, Finpecia 1mg.

Testicular pain can be a serious medical emergency. Before dismissing it on a side effect of a medication please contact your doctor or get yourself to the nearest emergency department. This is not a place to get a diagnosis for your testicular pain issue or self treat a potentially serious medical issue.

In the last 10+ years I remember only two of my patients who had testicular discomfort (not pain) reported as a possible side effect from Propecia, and both of them found that their symptom was gone (best of my memory) in less than a month.

Tags: testicle pain, propecia, finasteride, hairloss, hair loss

Tell Me What Prescription Medication to Use!

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

Hi, I’m 22-years-old (111 lbs) and started to diffused thin when I was 17. At the time, I was under severe prolonged stress and eating turkey with wheat bread for every meal for 7 months due to digestion problems, and using Nizoral to treat dandruff.

Since then, for the past 5 years, I have kept most of my hairline, excluding the receding area around my right-temple.

Most of the thinning is near the crown and on top of the scalp. The left-temple still has its shape but the hair quality is noticeably thinner than the rest of the hair on the sides.

I have been on-and-off Minox 5% for the past 3 years; Finasteride 1 mg for 16 months; miconazole nitrate cream for 6 months; and Folligen since the last month.

Overall, I have been trying to convert my vellus hairs into terminal ones, but so far I have not been successful. Should I drop Finasteride and go for either Dutasteride (? mg) or RU58841?

Thanks and looking forward to your response.

Sorry, I am not your prescribing doctor and can’t tell you what medication you should take. Dutasteride’s proper dosage is still undetermined, it isn’t FDA approved for treating hair loss, and as it is a much stronger medication, the side effect risk is likely greater (and longer lasting). As for RU58841, the last I remember it was some experimental lotion that was tested on macaques years ago.

You sound desperate to try anything, but with severe stress and malnutrition, your hair loss should be one of the last concerns you have.

Tags: dutasteride, hairloss, hair loss, finasteride

Why Is It OK For Women To Talk About a Man’s Balding?

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

Dr. Rassman / Dr. Pak,

Oops… faux pas! Why is it considered socially acceptable for women to openly discuss a man’s balding pate, often at some length and in excruciating detail, but should a man happen to discreetly mention to a woman, ‘Your butt looks a bit big in that dress’, he can confidently expect to be crucified?!

Good humour might not be the panacea but surely it’s a constituent.

Happy Easter!

Redesigned NHI website is excellent!

I’m not going to claim to completely comprehend why some topics are more socially acceptable to talk about than others. Perhaps men are expected to be less sensitive and able to take criticism of their appearance. Any sociology majors out there have a theory to add?

Your observation about men and women is noted. And thanks for your kind words about our redesigned site.

Tags: hairloss, hair loss