I Take a Cut Proscar Tablet 6 Times a Week

/by William Rassman, M.D./5 /

Hi i’ve currently been taking Proscar 5mg tablets cut into quarters I take it 6 times a week and have a 1 day break (so im intaking 7.5mg per week) I’ve been on the drug for close to 4 months. firstly is this acceptable or should I be looking to take it every single day?

Also my main question, I have alot of vellus like hairs some grow to a centimetre or so some are eternally lingering around 1mm, small and blonde my plan with finasteride is to revert these hairs back to the terminal stage, I’ve noticed my remaining terminal hairs look stronger right now but im wondering the rough timescale of when I should see my vellus hairs growing in stronger, I know everybody responds differently but if you could ball park the average for me and maybe explain what I should see process wise (does anything change to let me know etc) if the medication is working for me. Many thanks!

This should be discussed with the doctor that prescribed you the medication. In general, the recommended treatment for male pattern baldness is 1mg finasteride per day. Many patients break up the 5mg finasteride pill into four pieces and take 1.25 mg per day with no issues. The half life of finasteride (Propecia) is about 4 hours, so after 24 hours almost all of the medication is out of your blood stream (even if you took a 5mg dose or 1mg dose or 1.25mg dose). Thus, the medication is meant to be taken daily (without skipping) so that you maintain a consistent level in your blood stream. It is not a cumulative dose over a week. You cannot take a 7mg pill once every seven days and expect it to work the same as taking 1mg daily for 7 days.

Finally, without an examination I really do not have any way to know if the medication is working for you. Ideally, one would have a measurement done before you started the medication (such as a photograph, miniaturization study, or bulk measurements) and compare this with a follow-up measurement. Otherwise it is just a subjective guess.

The Propecia timeline for results can be found here.

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

My Plugs from the 1980s Look Ugly and I Don’t Want to Wear a Hairpiece Anymore to Hide Them

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

Iam 64 yrs old. I had transplants done in the early 80’s. Donor hairs from the back of my head to the front. In time the rest of my hair from the top fell out. The transplanted plugs looked ugly and I resorted to wearing a hair piece. I recently started to shave my head and I like it except for the scarring on the back of my head and the in front of my head where the plugs were inserted and hair grows. What can be done? The shaved look is really in style and I don’t want to go back to using a hair piece.

Your options are very limited, unfortunately. The plugs can possibly be removed, but you’ll still be left with scarring in that area and in the donor area at the back of your head.

Scalp Micropigmentation could be an option for covering the scars from old plugs. Many men with bad plugs and bad hair transplants have opted to shave their head and cover the scar with SMP, giving them the appearance of a closely cropped hairstyle. Each case is unique, but I doubt you’d be able to completely remove scalp scarring.

Tags: smp, pigment, hair plugs, repair

In the News – Hair Loss Myths (Slideshow)

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

Hey doctors,

I found this slideshow of popular hair loss myths that Dr. Bernstein wrote that I thought you’d like.

Link: CBS News – Hey, Baldy: 10 Things You Need to Know about Hair Loss

We’ve covered practically every hair loss myth I can think of (most of which I’ve never heard before I started this site), but the slideshow mentions a few of my favorites — Genes for hair loss come from mom, hats make you go bald, and clogged pores cause hair loss.

There’s not much substance beyond 1 liners and stock photos, but CBS has the myths on their site at the link above.

Tags: hair loss, hairloss, myths, genetics

Could 20 Laser Treatments Cause Complete Regrowth?

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

What’s your take on this woman that had 1 laser treatment each week for 5 months and got all of her hair back? It’s very remarkable!!

Link: Health Watch: Hair Growing Treatments

I don’t believe it for a moment. I suspect that this lady had chemotherapy and lost her hair, then after a time, it grew back. I also suspect that doctor (?) or clinic involved in the process took the credit for what would have happened anyway.

Tags: hairloss, hair loss, laser

Balding in the US Congress

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

CongressHi,

I just wanted to share with you our latest infographic: Bald Power

Feel free to give me a shout if you need an alternative sized version for you blog. Hope you like it!

Feedback appreciated.

I meant to post this a little while ago, but it slipped through the cracks. The graphic is quite large, so click the image at right to see the full size.

I haven’t looked at photos of Congress members for myself, but does your graphic account for thinning hair or strictly those that are bald? The infographic is nice if your numbers are right, but you spelled “United” wrong twice.

The presence of balding in the 5-8% range amongst members of the legislators (more men than women) is much less than the general population. In men, the balding rate (some degree of hair loss) is about 50% in men over 45, the age of most of our legislators. Except for Eisenhower, there has not been a bald president since before World War II.

I have written before that men with hair on the head have a better chance at getting elected than balding men. There is considerable prejudice against balding men in the population, and I’ve written about that here and here.

Tags: politics, congress, house, hair loss, hairloss, balding

Sex and Hair Loss?

/by William Rassman, M.D./7 /

Will having sex cause an increased rate of hair loss on men? And if so, is it better to have sex without ejaculating?

It is probably true that there is a relationship between testosterone and sexual appetite. There is also a relationship with testosterone and hair loss and if, for example, a man (who has the genes for androgenic alopecia) applied testosterone creams, he would increase his testosterone blood levels and probably have more hair loss due to the increased DHT. That is where this conversation ends.

Ejaculation (present or not) should not increase testosterone levels. There is no connection between ejaculation and hair loss. If you want to have sex without ejaculating… good luck!

Tags: sex, hairloss, hair loss

I’m Concerned That Stopping Propecia Will Give Me Post-Finasteride Syndrome

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

I’m 24, been on Propecia for a year, and really haven’t seen much of a change. I’m balding from my hairline but I feel (but can’t really see) thinning in the big horseshoe, Norwood 6 or so.

Over the last year, my hairline’s continued receding at about the same level it was before, and recession is definitely much more noticeable than it was before I started. I also haven’t seen any side effects except maybe anxiety or depression, but that could also be related to external factors since I’ve had experience with both of those in the past.

Since it’s been a year, and I don’t think it’s worth spending $1000 a year on my salary for what seems to be negligible results, I was thinking about stopping. But with all the “panic” around Propecia over the last couple of weeks, I’m concerned that stopping might bring on new side effects, even though I haven’t had any on the drug. What are your thoughts on that whole alleged “Post-Finasteride Syndrome” and, as someone who has been very minimally effected by the drug, do you think it’s worth me even being concerned about? I know the internet’s full of hyperbole and all, but I just want to make sure I cover all of my bases before I stop taking the drug.

It feels like I’ve written about this dozens of times on the blog. Side effect incidence is rare and the recent hysteria is from a published article about 54 men that were interviewed (men that joined the study after being recruited from a forum created to complain about the drug). I think the power of suggestion is likely at play.

If you’re concerned about the price — you can ask your doctor for a prescription to the 5mg pill (a generic is available which makes it incredibly cheap), and then just cut the pill. That saves significant costs.

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

In the News – NFL Star Wes Welker Got a Hair Transplant

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

Snippet from the article:

New England Patriots wide receiver Wes Welker has had a hair transplant and will appear in ads for the Rhode Island doctor who performed it.

Welker had the procedure done in Cranston this month during a five-hour session. It involved transplanting follicles to the parts of Welker’s scalp where his hair had begun thinning.

Read the rest — Patriots wide receiver Welker has hair transplant

This was sent to me by a reader, but there’s nothing I can really add. There are no after photos yet, since the surgery just happened… but if you want to see what he looked like before the surgery, check it out here.

Tags: wes welker, patriots, nfl, football, hairloss, hair loss, hair transplant

How Does a Surgeon Fill In a Hairline Without Causing Shock Loss?

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

How does a HT doctor, not recreate, but fill in an existing hairline without causing trauma to nearby follicles. Is shock loss inevitable because of close proximity to existing follicles?

Thanks

We do not recommend surgery if we believe there is a greater risk of shock loss over the benefits of a hair transplant procedure. In other words, we do not blindly advise surgery to everyone.

If surgery is recommended, we use the smallest instruments and take great care to avoid trauma to adjacent existing hairs. There will be some trauma to the hairs, but the overall goal is to minimize this and make the hair transplant surgery worthwhile to be of a cosmetic benefit for the patient. This is one of the many reasons you must pick a doctor and the medical clinic with a good reputation and history of doing quality work.

The causes of shock hair loss after a hair transplant relate mainly to the age of the patient and the degree of miniaturization present at the time of the transplant. A patient with active hair loss who is under 28 years old has a higher risk of shock loss than a man over 40 who does not have active hair loss. The use of finasteride tends to protect the patient against shock loss, even in the patient under 28 years old.

Tags: shock loss, hair transplant, finasteride, propecia, hairloss, hairloss

Finasteride Was Eaten by Pseudohermaphrodites?

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

doctor,
in this article back in 2005 you mention that the pseudohermaphrodites had a diet high in finasteride? I am kinda confused here. so pseudohermaphrodites ate finasteride due to them having low DHT?

here is the article

I think you misread the post. A diet that was high in a finasteride-like substance caused pseudohermaphrodite characteristics in children of a mountain village in the Dominican Republic. These people did not know of finasteride. It was just a part of their diet. In the end, this was how finasteride was discovered. That is why finasteride is not to be taken by women who are pregnant and especially in the first trimester of pregnancy when the sex of the fetus establishes the gonads.

Please note the taking finasteride itself does NOT cause pseudohermaphrodites. These tidbits of information can sometimes be misconstrued into a wild tangent and taken out of context.

Tags: finasteride, propecia, aboriginal

Using Minoxidil After My Eyebrow Transplant

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

Dear Dr Rassman,

I had an eyebrow transplant 10 months ago. There was a fair bit of shock-loss and I was recommended by a really kind doctor (not actually my operating surgeon) to try latisse and minoxidil. The latisse has I think helped. I have for the last two weeks been trying topical minoxidil 5%. I have noticed shedding of hairs and also increased flaking (I already have moderate dermatitis).

In such an instance, what would you typically recommend?- continue with the minxodil but at a lower dosage, switch to a different formulation, or altogether stop using it. At what point do you know if the minoxidil is doing more harm than good? Is a little bit of flaking ok? Is it best for someone with dermatitis not to use minoxidil? I would be grateful for any thoughts.

Many thanks

We do not typically recommend minoxidil or Latisse (bimatoprost) following an eyebrow transplant. There is no good clinical evidence behind this, but I do realize many doctors recommend this approach.

If there is eyebrow loss and flaking I would definitely discuss these issues with your doctor or a dermatologist.

Tags: bimatoprost, latisse, minoxidil, rogaine, eyebrow transplant, hairloss, hair loss

Transplanted Female Hairline (with Photos)

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

Some women develop changes in their hairlines as they age that make them look more masculine due to receding corners. These defects are very evident in women with very dark hair and light skin (like the Asian patient below), more so than in women with blonde hair and white skin or brown hair with olive skin tones.

These changes occur with many women who undergo plastic surgery, as their hairlines are often negatively impacted by face lifts and brow lifts. The changes tend to become noticeable rapidly after their plastic surgery is done, while others who did not have any such cosmetic procedure will barely notice the changes as they occur very slowly over the years. There are many women who show miniaturization in the corners of the hairline that may eventually lead to the type of changes shown here.

We love doing these surgeries as the patients are most grateful.

The before photo is below on the left, the after photo is on the right. This was done in a single procedure of 1800 grafts, mostly in the corners with some work in the frontal hairline. The after photo was taken about 18 months after her surgery. Click to enlarge.

 

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

My Surgeon Said Some Grafts Can Be Dormant a Year After My Hair Transplant

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

A year after a successful transplant I can still feel some grafts on my head that never shed a year later.

Hello doctor, it is about 12 months since my FUT procedure of 2350 grafts. I and all concerned are very pleased with the results. As expected by this stage, almost all of the grafts are grown out and have matured for quite some time now. However, I find it strange that in one or two areas of my head I can still feel some of the short shaved implanted hairs that never shed or started to grow in the whole 12 month period. Now this number is very small, im talking maybe only 10 to 15 hairs over my entire scalp, most of which are in the hairline region.

I discussed this with the transplant surgeon at my 12 month review, and he told me that it was acceptable that even after 12 months there may still be very small number of grafts still in the dormant phase, and that these would eventually grow out in time.

I was just wondering if you had ever come across this before and if it was normal? Perhaps my growth is just a little slower than average as I noticed my real thickening happened around month 9/10 as opposed to the normal month 6 that one usually reads about. I also have been on finasteride for the past 5 years.

Thank you and I appreciate any response you may have for me on this.

Kind regards

You may also have the hair from the original transplant that just never shed and is just stuck in there (without shedding or growing). You can test this hypothesis by finding this “stubble” and gently tugging on it. If it slides right out, it may have been the original hair in the grafts from a year ago. Imagine a splinter stuck in your scalp. In this case, the splinter would be your inert hair.

Otherwise, your guess and your surgeon’s guess is as good as mine. I have no idea what you may actually be experiencing without an examination.

Tags: hair transplant, hair growth, hair grafts

I’m 16 Years Old and My Hair Is Falling Out At the Top of My Head!

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

I’ll try and make this as short as possible. I am 16 and will be 17 on halloween and for about the past 2.5-3 months i’ve been noticing hair falling out somewhat alot… mainly on the top of my head. The hair falling out is becomes thinner as you get closer to the root and also the root has that white bulb at the end of it, and some of the hairs look as if they are sort of whitish around the root but that may be because it just looks like that since they are getting thinner towards the root.

My father is 52 and is baldish sort of on top but has hair and the same for my mothers side of the family. And i’ve noticed that the top of my head, where the hairs are coming out, is kind of itchy and its not dandruff or lice…also my diet is kind of bad…

PLEASE HELP!!!!

I am not sure how I can help, but if you are male, post-puberty, and experiencing rapid hair loss, the chances are it may be genetic (androgenic alopecia). It may be worthwhile to see your primary care doctor or a hair transplant doctor for a good diagnosis. Without knowing what you have, you cannot treat it.

At 16 years old, I’m not suggesting a hair transplant, but to simply consider meeting with a doctor that specializes in hair loss so that you can get a better idea of what is going on.

Tags: hair loss, hairloss, teenager

Rogaine Foam Ruined My Hairline Within a Month — Should I Wait for It to Regrow?

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

Doctor..

Had slow diffuse thinning for years. Just turned 60 with what many thought was a full head of hair. Though i knew it was thinning. Thought I was years away from needing a transplant until switched to Rogaine foam which devastated my hairline within a month. Lost years in days. The company told me to stop using it. So the question is, should I consider a transplant now or wait to see if the hairline grows back? Read a lot about minoxidil shed hair grows back (though all I did was switch brands) and am on another brand now, but grow back at the hairline? I highly doubt it. What do you think?

Without an exam, this is a highly subjective question to answer. Moreover, we do not give medical recommendations on BaldingBlog.

Rogaine (minoxidil) can sometime cause initial shedding, but it should generally reverse over time (should wait at least 1 year). You may see the reversal in as early as 3 months.

Tags: rogaine, minoxidil, hairloss, hair loss, shedding