I have been taking Pradaxa for over a year-I also take metoporol & digoxin. I always had plenty of hair & my eyebrows were almost perfect naturally.about 6 months ago my eyebrows have disappeared almost completely & my hairline is receeding–could these meds be causing this??? Thank you! I am a 68 year old female & would like my eyebrows & hair!

Women lose hair just like men, but in different patterns and stages. Women don’t go bald like men, but they thin out later in life. This can also be genetic as well. For women, there may be other medical issues such as thyroid conditions. There’s a list of possible causes here.

In general, medications can be the cause of hair loss. Pradaxa (dabigatran) and Lanoxin (digoxin) aren’t known to cause hair loss as far as I can find, but metoprolol (marketed as Toprol or Lopressor) does have hair loss listed as a rare side effect. More importantly, these medications are taken for serious health issues, so they should not be stopped or changed without a serious discussion with the doctor.

Many women lose their eyebrows and this can be genetic as well (as do men). A hair transplant procedure is a good option for those who want eyebrow restoration.

Snippet from the article:

It sounds more like an explanation that would be used by nursery children than respected scientists, but researchers have found that rather than losing their hair altogether, people who are going bald are suffering from “sleeping” hair follicles.

Trichologists have discovered that hair follicles on the scalp can become trapped in a resting state where they do not grow new hair, leading to thinning.

They now claim to have identified a way of waking the follicles up again to help restore a fuller head of hair to people who are going bald.

Read the rest — Balding men offered hope of waking their ‘sleeping’ hair

We have long believed that the stem cells that eventually grow into hair are probably still present in many people. Are they really dead in the balding man or can they be restarted by finding some defect in the pathway to the creation of an anagen hair? We really do not know this, so is it reasonable to call this sleeping hair?

L’Oreal in Paris carried out the research, and they’re reportedly working on a shampoo or cream to be a used as a new hair loss treatment. No time frame has been announced so far on this treatment, though.

A comment received from the recent post about Propecia and free testosterone levels –

doctor…as an athlete, this is something about propecia which interests me greatly – but there just doesn’t seem to be enough information available about it.

Would there be anything to stop doctors like yourself taking bloodwork of patients before and during finasteride use so that you (as someone in a position who sees finasteride users daily) could report back to us – so we could make informed decisions taking into account not only our hair, but other matters also of interest to us like hormone levels?

Would really appreciate a response. Thanks.

This can be done, but insurance may not cover these tests. If someone wants to pay for the tests out of pocket, it would be in the hundreds or even thousands of dollars. And even if these tests were free, what would we do with the results? What significance or interpretations would come from the tests?

If you look in the literature, I am sure there have been similar studies done before Propecia or finasteride was approved by the FDA. You need to know what you’re looking for before searching for data points.

First off thank you very much for such an informative and helpful website.

I am 25 year old male who is concerned with my hairline. I have always had a high or mature hairline since my teens along with really thick hair, but I am worried about miniaturization starting and progressing in my temple and frontal areas. My family does have a history of mild to moderate hair loss. However nobody in my immediate family is completely bald including both grandfathers.

I am interested in taking propecia. I understand that at my age and my stage of hair loss, I am a good candidate for the drug. I live in Denver and have scheduled an appointment with Dr. James Harris who appears to be one of Colorado’s top Doctors in hair restoration. However, the earliest I can see him is in a month and a half. Would waiting this 45 or so day period be detrimental to the goal of maintaining my current hairline? How quickly can miniaturization advance?

I don’t want to miss out on my window of opportunity but at the same time I want to talk to an expert who can examine me to see if I even need the drug, and if I do, discuss the side effects of Propecia before recommending an appropriate course of action.

Thank you so much for your time and advice.

Best wishes

I do not think 45 days would be a cause for alarm. At least you are getting in to see a reputable doctor in Dr Harris and he can give you a good assessment and recommendations. You need a diagnosis, then a plan. You cannot go about it backwards and blindly go on a medication.

There have obviously been lots of inquiries on the forum about ACell’s ability to multiply hair, but I’m curious about a different use. I had a consultation with a doctor that advocated using ACell in the donor region to aid wound healing (which you’ve discussed), but also injecting into the graft areas–not for hair multiplication, but to thicken miniaturizing hairs in the grafted areas and promote growth of the grafted follicles; sort of a nourishing property, if you will.

This is a completely different use from the “plucking” application yes? Any thoughts about this use?

ACell does not multiply hair. Some doctors, including myself, were involved in a year long study and the multiplication/plucking claims by the original doctors involved were false and unable to be replicated (see here and here). Otherwise, the entire hair transplant industry would have been changed by now (almost 2 years later).

Some doctors use ACell in the donor area to promote faster wound healing. It does not grow new hair there nor does it make the scar smaller. It just promotes healing faster. We have been using ACell at NHI for a couple years for this purpose and based upon our experience, I can say that there is no evidence presented anywhere that miniaturized hairs can be reversed with ACell.

Okay, so let’s face it, hair loss sucks, hair loss does make a man less attractive by a noticiable amount. There’s no avoiding it. Propecia is an effective medication at stopping hair loss and regrowing hair. Is it really safe though? I have my doubts. One could say that anti propecia blogs are full of men who had problems in the first place and that most normal men wouldn’t be on these blogs in the first place. But the other day, I stumbled upon this article written by none other then Men’s Health magazine. Here is the link.

The full article is not available online but the first page does a good job of describing what the article will talk about. Now Men’s Health is no subtle underground publication it is read by millions of men. I’m no doctor but when you block DHT by using Finasteride which also happens to alter how your endocrine system functions, things probably won’t go well, hormones are emotional regulators and DHT is a powerful male androgen. Obviously hair loss is slighty devestating at worse and dissapointing at best but is it worth sucking out the life of an increasing number of men just for hair? Men want hair to appear as if they are full of life and virility so isn’t it ironic that propecia kills that motivation for many men?

The basis for the article in Men’s Health seems to be the tale of a guy with side effects from Propecia. Then it references a study that says sexual side effects occurred in men 45 to 78 years old when taking 5mg of finasteride (to treat their prostate problems). That is 5 times the dose for treating hair loss, and the prostate problems themselves can lead to libido issues without any medication involved. The article fails to mention that.

The rest of the article is a story about a man named “Charles K”. There isn’t much science here, but rather, a story about an unknown man.

I am scheduled to go in for a consultation in two weeks for getting a procedure done. What I wanted to know, I have wavy hair but when it is short its not wavy. However, the wavy hair starts to come out on the top and front of my head first then the donor area follows a few week after. Wouldn’t that be a problem if I get a transplant b/c I will have straight hair in certain areas and then wavy hair?

Are most clinics required to develop a long term plan for future hair loss for a patient, and are they required to use devices to measure miniturization on the scalp for a patient?

You should always start off with a Master Plan, created by you and your doctor based upon his findings during your examination. If you have wavy hair in the donor area it will grow out as wavy hair in the transplanted area.

There are no requirements to measure miniaturization. It is something I stress in my practice and on this site, but many doctors do not do this, nor do they measure bulk of the hair in the various parts of the scalp in the initial examination.

Hello Doc,
I have recently been diagnosed with low testosterone levels and my doctor recommended that I start testosterone replacement therapy. Is it possible that once my testosterone levels reach “normal” or average levels that I will experience hair loss?

This is something you need to discuss with your doctor and express your concern to him/her. If you carry the genes for genetic androgenic alopecia (AGA) then testosterone replacement therapy can potentially cause hair loss.

I am 40 years old. I have bald areas corresponding to Norwood 3 Vertex but thin (but stable) hair corresponding to NW6 according to two doctors. I am not taking Propecia for 18 months.

1. Can I still progress to a NW6?
2. If you (Dr. Rassman) were to transplant me, would you fix the NW3 regions or the NW6 regions or both?

Generally, when doctors assess patients with a Norwood scale, it is meant to categorize your eventual balding pattern. You may not look like a Norwood class 6 right now, but it seems two doctors that have examined you think you are going to eventually be a Norwood 6. This likely means you are not a Norwood 3V, but you have a pattern leading to a class 6.

Many men on finasteride may never lose all of the hair in the end pattern, but no one really knows. Best to get good baselines with bulk measurements along with some good pictures, and then repeat them serially year after year to know where you are actually going.

So a good doctor should recognize this and transplant the hair with both a short term focus to address your immediate needs and a long term focus leaving enough donor hair available to address the evolving situation as it unfolds. In short, this is what I always stress about on this blog and in my private practice. This must be a Master Plan for each patient before going forward with the first hair transplant in what may become a course you will follow over your lifetime.

doctor,
since we know DHT is a cause of hairloss, why do some people start showing sings of male pattern baldness later in life? I know a few family friends pople who have had extremely thick beautiful hair norwood 1, with no signs of balding in their 40’s and late 40’s. then in their 50’s they started get thin and crown balding. if dht is the cause then i’m sure these guys had dht in their body in there 20’s, 30’s, and 40’s. why all of a sudden in there 50’s the dht decided to choke the follicles?

Dihydrotestosterone (DHT) is the cause of hair loss when it is associated with the genetic disposition of male pattern baldness. The genes that cause hair loss are preprogrammed and often express themselves at different ages.

For example, some men and women get grey hair in their 20’s, whereas some never do. Most men with the balding gene will go bald in their 20’s and 30’s, but there are always exceptions to the rule as you pointed out.