Doc
Bad reaction to Rogaine foam.. 5% PG formulas cause irritation. If I mixed 2% and 5% together in the same bottle would that be a problem?
The goal would be to get something a little stronger than 2% but less irritating that full 5%.Thanks
Mixing the two liquid formulas of different strengths should not produce problems. Hopefully it will provide you with some results and less irritation. Good luck and let us know how it works out.
Hi Doc,
I had a FUE done with 3000 grafts exactly 8 days ago (photo attached).
My concern is that there seems to have been a lot of scabbing or crusting (what is the difference between the two anyway?).
The scabbing/crusting started coming off in places near the restored hairline and it now looks like a river delta (i.e. lines where there is no hair/crusting/scabbing with pockets of crust/scab/hair).
Is this normal? Or is it due to trauma (e.g. scratching) or bad surgery? I know when I am awake, I do not touch the area (I have worn a bandana lightly from the day after the surgery, but only for a few days and first 2 nights). Sometimes at night, I inadvertently brush my hand against the recipient area and wake up.
My doctor advised me to start washing once a day from Day 2 onwards with a spray bottle with a mixture of baby shampoo and water (and rinsing with plain water from the spray bottle) which I have done.
Should I be trying to get rid of the scabs/crusts with light finger pressure when shampooing or should I wait for the 10th day before trying any of this? It is difficult to see the hair due to the black scabs/crusts, but the transplanted hair is there.
Thanks!
The crusting is very bad, which means that your management of your scabs was not good. We rarely, if ever, see this degree of crusting. How is the scabbing in the donor area at the back of your scalp?
Be very careful not to rush to take these crusts off. Use a shampoo and leave it on for 10 minutes and then gently, very gently rub in the shampoo. The crusts will slowly loosen and eventually they will come off. Give it another 10 days and hopefully the problem will be gone.
The scabbing/crusting (interchangeable words) is pretty intense, but hopefully there is no problem with the grafts because of it. Of course, follow up with your surgeon if you are concerned.
Hi Dr. Rassman,
I am a 21-year-old that has been on finasteride (1 mg) for almost four months now. The good news is that I have noticed that my hairline is now actually proceeding – a phenomenon that is supposedly rare. However, I have not been able to detect (and it may be because I have not given it a close-enough assessment) any re-growth on my crown – something that is irritating me, considering that this drug is supposed to be most effective on the crown.
Anyways, my question is: When exactly is the best time to take my 1 mg tablet of finasteride? Someone asked this question in the past. Your response was something along the lines of: “early in the morning†or “in the morningâ€. For the past few months, I’ve been taking my tablet every single day between 5:30 pm and 7:15 pm. Because testosterone levels are at their highest in the morning, should I be taking my tablet sometime right after midnight or when I get up in the morning at around 8:30 or so?
Thanks a lot! I love your blog!
Your result are rare. Propecia is mainly effective on the top and the crown (not the front hairline). But if it works, then stay on it. The crown may respond within a year on the drug.
There is no right time or optimal time to take Propecia. The goal is to take it everyday at about the same time. It has more to do with remembering to take the medication. We can theorize about when would be the best time to take Propecia based on your hormone levels, but I do not find this to be of a realistic or clinical significance.
im using minoxidil 5% but i want to also use prothik concealer,can i use both at the same time and does prothik clog the pores and cause further hair loss. thanks
Be sure to apply minoxidil right after a good shampoo and wait at least 15 minutes before using the concealer products. Clearly, you should apply the minoxidil to the scalp, not on top of the concealer.
ProThik (or any other similar products like Couvre, DermMatch, and Toppik) doesn’t cause hair loss.
Snippet from the non-hair-loss article —
Protection against skin cancer can be added to the list of health benefits that come with drinking coffee, a new study says.
Women who drank more than three cups of coffee daily were 21 percent less likely to develop basal cell carcinoma (BCC), compared with women who drank less than one cup of caffeinated coffee per month, the study showed. For men, this risk reduction was 10 percent.
“Most likely, the protective effect is due to caffeine,” said lead author Jiali Han, an associate professor at Harvard Medical School and Harvard School of Public Health in Boston. People in the study who drank decaffeinated coffee did not appear to have a lower risk of developing the skin cancer.
Read the rest at Scientific Amerian – Coffee May Help Protect against Skin Cancer
Caffeine intake is possibly linked to skin cancer prevention. Interesting stuff.
doctor Rassman/Pak I have a question.
I read that there are castrated men, who stop losing hair once they get castrated. There are castrated men who had mild thinning before castration(just like the some of the people who have mild thinning before taking propecia), and they never regrow some of the lost hair once they get castrated. all it does it just stop further balding.
But how come some of the people who take propecia regerow some of the lost hair. I have seen alot of before and after pictures from hair transplant websites and even the propecia trials showing what propecia can do, and alot of people regrew hair on propecia. since castration is 100 times better than propecia, why don’t castrated reverse the thinning like people on finasteride do?
Basically, castration stops further hair loss because the castrated man can’t make testosterone and therefore can’t make the DHT that his body normally produces. Propecia may slow or stop the hair loss in many cases, but there is still production of DHT by the metabolism of testosterone, as it is only about 70% effective at stopping DHT production. It is the testosterone production which takes its toll on men who still have testicles.
We have no experience with castration in men who are in the balding process, but I would suspect that if the hair had not died out, that castration would produce more hair regrowth than finasteride or dutasteride, because since these two drugs are not 100% effective at blocking DHT, castration would produce no significant systemic DHT and be close to 100% effective. That being said, I don’t know of any cases where castration caused regrowth of hair.
With that said, we know that some testosterone is produced in other parts of the body (e.g. adrenal glands), but probably not enough to produce hair loss. So yes, castration is more effective than Propecia, but I would not choose to have my testicles cut off to prevent balding The sexual side effects are very predictable with castration and I don’t know any men that want to give up sex for life.
hey doc, I found this and thought I’d send it just for laughs
Link: Man Magically Cured Of Erectile Dysfunction After Drinking Wife’s Breast Milk
Here’s the video clip from TLC’s show Strange Sex about a man that “claims that drinking his wife Michelle’s breast milk straight from the source has cured his erectile dysfunction”. The video shows enough to restrain me from making a joke of the benefit and its cause.
I will be moving to a different country and I need to carry my year’s supply of finasteride with me. I have two questions:
1-Does Finasteride get ruined by the ionized radiation?2-Any device on carrying it safely in carry on luggage?
I do not know how ionizing radiation can affect Propecia (finasteride). I would be more worried about my own body being affected by ionizing radiation. If you are worried about ionizing radiation affecting Propecia, invest in a lead box.
I do not know of any special device to carry Propecia aside from the medication bottle it comes in. I would think that is sufficient for travel.
Hi, I am 19 years old. I noticed my hairline receding at the corners about one year ago. I have met my doctor and was prescribed Finasteride and he also suggested that I take Minoxidil and Nizorol shampoo. I am about to start my treatment in the next week.
I am planning to have a hair transplant on the corner recession next year but I am worried that the effects of the medical treatment might wear off in a couple of years. Therefore I would lose the hair on the top of my head, leaving two horns of hair where I will have had transplanted.
Do you think that the medical treatment will lose it’s effectiveness within ten years? And if so do you predict that we will have other treatments by then? What do you suggest I do? Leave the temples as they are? Or go ahead and have the transplant and deal with the next problem when and if it comes.
Thank you for your help.
About 7 years ago, I saw a 21 year old man from the UK who had a hair transplant when he was 17 years old to his frontal hairline corners (when he only had hair loss in those areas), and eventually became completely bald to a Norwood class 6 pattern. He was left with 2 triangles of hair at the front of his head. It was terrible looking, and his transplant surgeon never addressed a Master Plan or recognized that this 17 year old had early signs of a Norwood 6 pattern loss. I always stress lifelong planning and goals, so you need a good diagnosis by an honest doctor to assess your future hair loss pattern and plan your treatment options so that you’re not left with a couple of “hair horns”.
Everyone is different and if you are losing hair at 19 years old you should find a good hair transplant surgeon to discuss medication as well as surgical options… or a combination of both. The medication might work well for over a decade, but I really have no way to know for sure.
You need to know where the earliest signs of balding are appearing with good bulk measurements made throughout the scalp for predictive purposes. Then you can follow that yearly and see a trend. Only then can you build a Master Plan that will hopefully carry you through the entire process as you age.
Hello,
I’ve been reading your blog for a long time and really appreciate the time you take to help inform people about hair loss. I’m 22 years old and have some extensive MPB-caused hair loss (started balding around age 18). I have seen numerous dermatologists and have been prescribed Propecia for the hair loss. However, I always have negative side effects when I take Propecia (pain in testicles and frequent urination), and have been unable to take the medication for more than a week before having to stop. I have even tried lower does (.5mg and .25mg) and still had the side effects, so I know that I cannot use PropeciaHowever, my question is related to Dutasteride – especially because of the new report you recently put on the blog. While I understand that the proper/safe dosage for taking Dutasteride is unclear at this point, I was wondering if you think that someone (like myself) who has had negative side effects from Propecia, would be likely to have negative side effects from Dutasteride?
Does having negative side effects from Propecia make it likely to have similar negative side effects from Dutasteride, or do the medications work differently and create different responses in patients? I would like to try a small dosage of dutasteride, and that is why I am writing to you with this question.
Thanks so much for your help!
Dutasteride is similar to Propecia (finasteride) in its mechanism of action, so if you have side effects from one you would likely have the same side effects from the other.
Of note, dutasteride has a HIGHER percentage of side effects than Propecia. How that translates between one person taking the two medications and its side effect profile is not clear. It would be an assumption that you would have more side effects if you switch from Propecia to dutasteride.
I have noticed immediate thinning after hair transplant, however I have not noticed any shock loss of even an increased number of hairs falling out in the shower/pillow – How is the recipient area thinner, if there is no signs of shedding?
Will the hair, thicken and grow back as before and what will be the length of time in this case? You reply would be very much appreciated. best reagrds.
You almost certainly lost native hair with the transplant if you notice a thinner look. Not all men will regrow the hair if they lose it from shock loss following a hair transplant. If you were on finasteride (Propecia) before the surgery, the chance would be that the drug would protect you from such loss, but this is not an absolute rule.
If your hair is thinner, it’s not disappearing into thin air. You’re losing the hair somewhere, probably shedding it throughout the day.
hello doctor, i am currently undergoing MTF hormone replacement therapy. i have been taking both spironoactone and estridol for about six months. not only this but i have recently had an orchiectomy. before i began i was at around a norwood 2 or 3 and am currently 24 years old. i was wondering if i can expect that my hair loss to permanently halt after such an experience.
at the moment i am also curious as to if the spiro is still needed after an orchiectomy or if it will still halt without the further use of the spiro. i ask this on account of the many myths associated with this and was hoping you could speak from any experience you may have had with similar individuals.
Thank you for you time
I have never seen or treated a balding patient with an orchiectomy (removal of the testicles). In theory, it should help with respect to male pattern androgenic alopecia. Time will tell.
Hi doctor I’ve seen some pictures of balding men with persistent juvenile hair line in baldingblog. I’m 25 year old and balding exactly the same way
Did they get benefit from finasteride or this type of baldness is not different at all? Thank you
Finasteride (Propecia) mainly works on the top/crown areas of your scalp. It doesn’t really help the front corners or juvenile hairlines. This being said, there are a few men who rarely respond to Propecia. If you choose to take Propecia for a juvenile hairline, it should be discussed with your doctor so your goals and a baseline can be established.
You reported a persistent juvenile hairline, as shown in this post. Take a look at the examples in that link. If you are saying that the blue area is holding up and not balding, but the balding is occurring in the red area, then this is an unusual pattern that I have seen on a number of patients. In those patients with their frontal juvenile hairline holding, I have seen it last decades (men over the age of 50). Balding behind such a juvenile hairline makes the transplant easier and taking finasteride should slow it down or stop it in men of your age.
dr. rassman,
can general anesthesia be used for SMP procedure?
Does the pigment ever stretch as the patient ages, like how a tattoo on a 70 year old looks?
can the hairline be made to look natural, i have seen “his hair” procedures in which it looks like a line is drawn on the forhead instead of a natural shaved head look.
i can send you a couple photos of my balding, im 26 and have beeen since i was 18 but the past 2 years it seems to have slowed a lot. i do not take propecia, and do not want to.
i want a good smp procedure to give me back a symetrical face. Can smp go with a “number 1” buzz cut or is it used with a “no guard” buzz cut.
thanks
We offer local anesthesia for a pain free experience. We also offer light sedation, but we do not offer general anesthesia (where you are completely out).
The pigment, like all cosmetic pigment or tattoos, fade and spread over time. We have techniques to minimize this as much as possible. The length of hair you need for SMP varies from number 1 guard to a shave.
If you would like a photo consultation, you would need to email photos and call (800) NEW-HAIR to speak to me or Dr. Pak.
Hi Dr.Rassman,
Thank you for this great blog. I have found it to be very honest and informative. My question is regarding Propecia. I hear everyone talk about how it is wearing off or losing its effectiveness, etc. It is possible that Propecia works better for some over time? I have been on the drug for 8 years and i notice from pictures my crown looks better than it did 3-4 years ago. Keep in mind, I never did an actual hair count, but I take pictures in identical settings (same spot, lighting, no flash) every year to keep track of my hair loss.
Even in that small 10 year study, there was a significant portion of people who actually looked better than the 5 year mark. They’re reasoning that MPB is a slow progressive process, reversing it can be a slow process also. Or something along those lines. I’m 38 years old and I know that MPB starts to slow down at this age. I was just also wondering if Propecia would have more impact as the person gets older?
Thank you so much.
We actually do not know the answer. People respond in different ways. Some people remain sensitive to the drug for years and they are the ones that probably get the best results. If it is working, just stay on the plan to keep taking it. When and if it should reduce its effectiveness, certainly go back to your doctor and get his/her advice.