Should I Bother with Medication If I’m Only Experiencing Corner Recession?

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

Dr. Rassmann:

My corners appear to be receding, but I don’t seem to have hair loss anywhere else.

I know you’ve said that Propecia and Rogaine’s effectiveness is limited to the crown and the top area of the scalp. But I don’t seem have any miniaturization in those areas.

Should I even bother exploring treatment with Rogaine or Propecia if I’m experiencing only corner recession?

The best results from these medications are seen in the crown / top, but there are definitely cases with visible regrowth in the hairline. I wouldn’t suggest that it is likely for most men to see that type of result, though. In other words, it’s rare for decent hairline regrowth to be seen… but not impossible.

Tags: hairline, hairloss, hair loss, propecia, finateride, rogaine, minoxidil

Do Actors Get Their Hairlines Transplanted Back to Juvenile Levels?

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

Is it common for actors coming to you and your contemporaries to ask to have their juvenile hairline back? Do you do agree with this procedure and can it be made to look natural? (I’m assuming a movie star would need a completely natural look).

Thanks!

Many men want their juvenile hairlines back. They do not have to be actors. The relevant point is whether they are mentally and psychologically prepared to have a juvenile hairline for the rest of their lives. There have been actors that requested this, but so do some men of many different professions.

If you are 21 years old with early balding, you would not know where your hair loss will end up, but I understand that such a young man would remember very well where his hairline may have been just a few years before. For this and other reasons, most of the time I advise against putting back the juvenile hairline. But there are patients that insist and are fully accepting to the permanence of a juvenile hairline.

If I am comfortable that the patient will not develop an advanced hair loss pattern (higher than a Norwood Class 5) and I’ve estimated that the donor supply is adequate to follow the worst case pattern that the patient might develop (my opinion), I would consider creating a juvenile hairline on the patient. It’s really a case by case scenario, though.

Tags: hairloss, hair loss, hairline, juvenile hairline, hair transplant

I’m 17 Years Old And Wonder If My Hairline Will Get Worse (with Photo)

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

Hi Doc,

I am 17 and I have been very anxious recently about a receding hairline and I am wondering if it will get any worse.

I have what appears to be a NW2 hairline with very fine thin hairs around the corners of the hairline which have receded. My hair is already very thin and fine and when I was younger the corner of my hairline where blonde as opposed to my dark brown hair which I’m unsure if that has any significance. Thanks.

Is there a chance I am not balding or will I see more hair loss in the future?

Link: Photo

It is clear from the picture, your age, and your concern that you need to see a good doctor to help you. At 17 years old with what appears to be a Norwood Class 3 balding pattern, it is a concern to me as well. It’s possible you won’t lose more hair, but there’s no way for me to know that just based on a hairline photo. You need to have an examination.

Since you indicated you’re in the UK, Dr. Bessam Farjo has offices in London and Manchester and I would suggest that you contact him, as he is local. You should also get a parent involved.

Tags: hairloss, hair loss, hairline, teenager

Does Early Success with Propecia Give Any Indication on the Future?

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

Doc,

Thanks for the great blog.

I started taking Propecia about 7 months ago at age 21 and have had great results. I’ve had some regrowth even at my hairline.

Is early success any indication of future effectiveness/longevity? I’m trying to gauge how much time I can expect Propecia to hold off baldness. Have you found any sort of correlation with your patients?

Thank you.

It appears that people who had a good response to finasteride early do get better long term results. Like I’ve said before, I’ve had patients on this medication for over a decade with continued great results. I won’t be able to know what kind of time frame of success you’ll have, though.

If you’ve had regrowth at the hairline, that is fairly rare, but exciting!

Tags: hairloss, hair loss, finasteride, propecia

Would a Doctor Prescribe Finasteride to Maintain a NW1 Hairline?

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

Dr. Rassman,

It seems there are a lot of young men frequenting your site, myself included, that are concerned about hair loss.

My questions is how much recession from a juvenile hair line must occur before hair loss can be diagnosed and a treatment can be issued.

Would a responsible doctor issue finasteride to maintain a Norwood 1 hairline?

Finasteride does not usually bring back frontal hairlines and I do not prescribe it to men who are not balding. Norwood 1 or 2 patterns are not considered balding.

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

In the News – Baldness Cure is 2 Years Away?

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

Snippet from the article:

They are already talking with pharmaceutical firms about making the product, which would work by stopping the effects of a single guilty enzyme.

US-based dermatologists announced earlier this year that they had found that an enzyme, called prostaglandin D2 (PGD2), instructed follicles to stop producing hair. They identified it by screening 250 genes implicated in hair loss.

George Cotsarelis, head of dermatology at Pennsylvania University, said the one responsible for levels of PGD2 played “the major role”. He said he was now talking with several drugs firms about creating the anti-baldness product.

Read the rest – Baldness cure could be on shelves in two years

Two years seems like a bit of a stretch, considering there is no actual product yet… but the media is easily excited about hair loss “cures” as anyone that has been waiting for new treatments has surely seen. Apparently this new hype is based on a study of 17 people, but I don’t know where this idea came from about a proven safe and effective product being available by 2014. Whether or not PGD2 will be the next great hair loss treatment, there’s a lot of work that needs to be done first.

Just to sum this article up — apparently we went from a small study on PGD2, all the way to the miracle hair loss “cure” being on the shelves in a couple years even though there is no product just yet. I’ll believe it when I see it.

Tags: hairloss, hair loss, cure, PGD2

I’m Shedding Hair Months After Taking an Oral Corticosteroid for Breathing Problems

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

Hello Dr,

I was prescribed an 8 day cycle of an oral corticosteroid containing 20mg of prednisolone to treat a mild breathing problem. 2 or 3 days after the treatment ended, a massive hair shed started along with acne and seborrheic dermatitis all over face and back. I used to loose around 10 strands of hair when showering and this number raised to more than 80 after the treatment.

3 months have passed and my hair hair is still shedding. My hairline receded more in these 3 months than the whole last year (I have been diagnosed with MPB 1 and a half years ago and been taking finasteride for a couple of months now).

What happened after I took the corticosteroid, will this shed ever stop? I’ve been to several doctors and no one believes me or gives me a reasonable explanation, I am kind of lost. What can I do to regulate my body back to normal and stop the shedding? The hair I lost is gone for good?

I have a hard time believing that you can’t get straight answers from doctors, particularly the doctor that prescribed you the corticosteroid. There is a well known connection between exogenous steroids and hair loss where the drug triggers genetic predispositions to balding. I can not tell you how long this might go on, as this is an individual genetic issue in each case.

Tags: hairloss, hair loss, corticosteroid

Cyberchondriacs Trust Online Forums More Than Medical Professionals

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

In a recent comment on the blog, a reader brought up a term I wasn’t familiar with — cyberchondria — which is when a person will escalate their concerns about symptoms based on what they’ve read online. It seems like half the questions this blog gets are from cyberchondriacs, or rather, people who tend to play armchair doctor or fantasy biochemist when it comes to medicine and disease.

Have you noticed an increase in know-it-alls coming into your practice in recent years? It’s always good to educate yourself, but are we starting to get to a point where a doctor is just someone we need to see in order to get a prescription for something that we’ve already diagnosed ourselves with?

That is a good point. “Cyberchondria” is not only limited to BaldingBlog. With the rise of the Internet, doctors battle with patients that diagnose themselves on a day to day basis. Of course it is good to educate yourself, but I would think hypochondriacs and/or cyberchondriacs make for a formidable nightmare for a lot of doctors.

Tags: hypochondriac, cyberchondriac, hair loss, hairloss

Can It Take 6 Years Before Propecia Side Effects Show Up?

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

I started using Propecia when I was 27 and I am now 43. I didn’t really notice any side effects until I was 33. I started having erectile difficulties then which are offset by daily Cialis use. The difficulties were loss of erection during sex and reduced ejaculate. Is it possible that it took 6 years for the sexual side effects to kick in from Propecia?

The drug has definitely helped me prevent hair loss and I would like to keep taking it but I have also dealt with some anxiety and depression issues over the last few years.

The basic question is: Can it take that long( 6 years) for side effects to show up?

You need to see a medical doctor and have a physical exam. Many men in their 40s or even 30s have erectile dysfunction (ED) without ever taking Propecia. It’s just that they do not openly talk about it. You might also have undiagnosed medical conditions (diabetes, high blood pressure, high cholesterol, obesity, etc) that can cause ED. Or you can be taking other medications (blood pressure, anti-depressants) or drugs (marijuana, cocaine, etc) that may be causing the ED. Maybe you smoke cigarettes or you drink alcohol. I don’t know enough about you and since you’re not my patient, I’m just taking wild guesses here as to possible causes.

I suppose it is possible that after 6 years in a healthy man with none of the things discussed above, some sexual side effects may develop over time. That being said, it is more likely that if you were going to have side effects from Propecia, they would appear within the first few weeks.

I’ve written about this before here.

Tags: erectile dysfunction, hairloss, hair loss, propecia, finasteride

Can You Get More Grafts from Strip or FUE Over a Lifetime?

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

Many thanks doctors for providing help to all of us!! Your blog is very interesting.

How many grafts it is possible to extract from a caucasian male with an average donor supply over the course of his life? Does it make a difference whether it is a FUE or strip? 9,000?

This is a debate among many hair transplant doctors themselves. In my opinion, you would get the most number of grafts and hairs with the strip procedure over a lifetime to make an overall cosmetic difference. FUE (follicular unit extraction) grafts can sometimes have less hairs per graft than those harvested using the strip method. So over a lifetime FUE grafts may produce less coverage.

For maximum harvest in a theoretical scenario, you would maximize the grafts with the strip then use the FUE method when the donor area is more limited.

Tags: hair transplant, techniques, fue, strip surgery

Xanax and Propecia Drug Interaction?

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

Hi Drs. Rassman and Pak:

I take 2.5mgs of Xanax once per day, in the morning, prescribed by my psychiatrist for anxiety and panic attacks. Is there any drug interaction between Xanax and Propecia? Also, would the sexual side effects risk be increased by taking Xanax? I have no side effects with Xanax, by the way.

Propecia (finasteride) does not interact with Xanax (alprazolam).

In general, I do not know of ANY drug that has a truly bad interaction with Propecia. Interactions can be found here, but there’s nothing all that common and nothing I can see that is alarming. As always, ask your prescribing doctor and be sure to inform your doctor about what medications you are on.

Tags: propecia, finasteride, xanax, alprazolam, hairloss, hair loss, interaction

What Percent of Your Propecia Patients Find Lumps in their Chests?

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

Dear Dr Rassman, thanks again for the great blog and thoughtful responses.

Afraid I have yet another propecia related inquiry! I noticed in a recent post you informed another reader that there have been cases of your patients on propecia developing lumps in the breast region and that your are now working with another Dr to treat this side effect.

While I’m aware these are not necessarily related to their propecia course I was wondering if you could give an approximate indication of what percent of your patients have suffered this side effect?

Many many thanks again

I believe what you are referring to is gynecomastia (enlargement of breast tissue). They are not necessarily “lumps”. I believe the reported incidence is about 1 in 300 to 1 in 700 or so. In my clinical practice I think the incidence is lower.

Tags: gynecomastia, breast enlargement, gyno, propecia, finasteride

Announcing Mini-FUE (with Video)

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

For those that didn’t see our announcement last week, check it out here — Breakthrough FUE Announcement by the New Hair Institute.

Below is a one minute video of our new technique for doing follicular unit extraction (FUE) that allows you to keep the donor hair long. We are averaging about 300 grafts per hour. Some patients are more difficult than others, so our hourly extraction ranges from 200-500 grafts per hour, depending upon the patient. With a traditional FUE when we do not have to deal with the long hair, our speed goes up considerably.

We use a specialized instrument that we have created for all of our FUE procedures and it has worked well for us for quite some time. So you might ask, “What is the difference between the standard FUE and the mini-FUE?” Simply put… we will not have to shave your donor area, as no haircut is required to get to the donor grafts. You can go back to work the very next day without the potential of anyone seeing a shaved area at the back of the head. What is mini about this procedure? It is smaller than our usual FUE so we call it a ‘mini’ procedure (mini-FUE).

All of the benefits of FUE without the downside of the social disruption. As you look at the video, note that the grafts are coming out with a long hair, so you see that no shave was done. Contact us at NewHair.com to schedule a consultation.

Watch the clip below (caution – surgical content):

Tags: fue, follicular unit extraction, hair transplant, hairloss, hair loss

I Have Scars from Where My Plugs Were Removed — Can I Do Anything to Smooth Them Out?

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

Is it possible to smooth out just a small area where old hairline used to be that was damaged from surgically removing old plugs? I am a 45 year old male who had a hair transplant in 1984. I had one session (47 plugs, about 8-10 hairs each plug) around the frontal-hairline part. I did not like it as the result was not what I had expected so did not go back for another one.

In 1988 I had all of the plugs surgically removed. For the most part it looks ok except for the right side above the right temple but close to the forehead. In certain lighting you can see the scarring and tell that it was where the old transplant hairline was as they fall in or pitted is the word used to describe it (where 5 plugs were removed on this side). So instead of having cobblestones I now have the opposite.

I would be interested in seeing if just this area can be improved by either laser therapy to smooth it out or to do a surgical scar repair and pull the skin tighter on these 5 only or any other recommendation? If it improved just 50% it would be a great improvement. I would not be interested in another hair transplant. I keep my hair long enough so the donor area is ok as is.

Also, would massaging this area help smooth it out or make it worse? Thank you and your site is amazing and very much appreciated.

In general, scalp scars (or any scars really) are very difficult to treat. If there is something that can be done, it would involve understanding that the outcome will not be perfect.

You are asking a very specific question for a case that is likely quite unique. You would need to visit a doctor one-on-one and have him/her examine you for their assessment and recommendations. Since you indicated that you’re in New York, you could check with Dr. Robert Bernstein.

Tags: scarring, hair plugs, repair, hairloss, hair loss, hair transplant

How Many Days of Forgetting to Take Propecia Will It Take Before I See Catch-Up Hair Loss?

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

I have been on propecia about 6 years. Over the past 5 months I have probably missed 7-10 days a month. The past month I have noticed alot of shedding and am concerned I am experiencing catch up hairloss. Have I missed enough days that this could be the case? If this is the case, will I recede the point of never having started propecia or to the point of when I first began treatment. If the former is the case, should I quit treatment and accept my fate? Thanks.

I wouldn’t worry about missing a few days of the medication. It generally takes weeks or months of consistently not taking Propecia for catch-up hair loss to be evident. There is tissue fixation at least for a week, if not more. Talk with you doctor regarding your medication and clinical decisions.

Tags: propecia, finasteride, hairloss, hair loss