Have Studies Shown That 0.1mg Finasteride Reduces Almost as Much DHT as 1mg?

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

You say that 0.25mg is about 50% effective as 1mg. Any idea why this would be when studies seem to show that even 0.1mg seems to reduce almost as much DHT as 1mg?

If 0.25mg would only reduce DHT levels by half the amount of the 1mg then I’d be quite inclined to try it just to have some benefit to my hair. I have reasons for not wanting to reduce the DHT in my body as low as 1mg would.

Thanks.

I don’t know which study you’re referring to that says 0.1mg is as effective as 1mg, but I am sure the 0.1mg finasteride dose should have some benefit. The recommended standard dose for treating hair loss is 1mg, and I’m sure this wasn’t chosen arbitrarily. Good luck with splitting the small pill into 10 pieces.

Tags: finateride, hairloss, hair loss, dht

Propecia, Erections, and Low Sperm Count

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

I am 30. I had very little hair loss when I came in but you told me the side effects were a non-issue so it would be worth it to take finasteride. I’ve had no major side effects and no hair loss since. However, I find that with a woman atop me (as in, no gravity helping blood flow), it is, for the first time in my life, difficult to remain erect. Also, I had my sperm count tested and it is very low. I no longer wake up with erections. Otherwise I feel fine and my sex life functions well minus that one position.

I just read about this new admission by Merck that more people get side effects than was thought and that side effects can be permanent and worse after discontinuing finasteride. I am down to half the dose you prescribed these days. I felt like I was taking too much after the sperm count test.

My question is: if I go off finasteride entirely, what percentage of men suffer this horrible post finasteride syndrome? The drug seems too dangerous to continue. But is it dangerous to discontinue? Very alarming.

There may be a connection with your loss of libido and the drug finasteride. The real life incidence of sexual side effects associated with Propecia is about 1 to 2 percent. These side effects are reversible once you stop the medication, and despite what you may read on the Internet, I have yet to see a patient with permanent issues. The lack of erections in the morning may reflect the side effect or other unrelated ED causes which may need to be addressed by your primary care doctor or an ED specialist.

The easiest way to address your issue is to consider stopping the medication for 1 to 2 weeks and see what happens with your sexual issues. If you saw me at my office, please give me a call or set up an appointment so we can discuss your issue in detail. Two weeks off the medication should not hurt much with regard to hair loss. The low sperm count also bothers me and it should you as well. The confounding factor in this is that we do not know your sperm count before you started Propecia (finasteride). After stopping the medication, you may repeat the sperm count and see what happens.

Finally, having a woman on top of you has nothing to do with maintaining a stronger erection.

Tags: sperm count, hairloss, hair loss, finasteride, propecia

In the News – Alaska Airlines Flight Attendants’ Uniforms Causing Hair Loss?

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

Snippet from the article:

Hundreds of Alaska Airlines flight attendants say their uniform is making them ill. The Association of Flight Attendants – which represents roughly 2,800 Alaska employees – says the company’s recent uniform makeover has prompted itching, hair loss, and other adverse health reactions.

In a letter to the company’s president last month, the union says 280 – or about 1 in 10 flight attendants – developed issues after Alaska made the switch in 2011. It believes a contaminant, possibly Tributyl phosphate, may be embedded in some uniforms and is causing the problem. The union is asking the airline to make a change.

Read the rest — Alaska Airlines uniforms sicken attendants

The employee union believes a chemical in the uniforms has caused the sickness, but multiple labs have tested the uniforms and were unable to make a determination of the cause.

In any case, it sounds like the hair loss has subsided in most of those that were affected… so hopefully this was just a temporary issue.

Tags: hairloss, hair loss, airline, sickness, chemical

I Haven’t Used Shampoo In Days and My Hair Feels Fuller

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

I have the same type of hair loss as my father. My father suggested not using shampoo, saying that his hair loss was better after not using it. I haven’t been shampooing for two days, and my hair FEELS thicker and fuller, but I’m not sure if that’s just a placebo effect.

Will NOT using shampoo cause more hair loss, because of sebum build-up etc?

If you don’t wash your hair, you will build up grease and grime from the environment, as well as wax from the glands located in each hair follicle which secrets sebum. Your hair may appear thicker as the grime builds up, but this will not impact hair growth one way or the other.

Tags: shampoo, hairloss, hair loss

Permanent Hair Destroyed By Accutane

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

Hi doc
I want to know if there is medication that can cause hair transplants to fall out. I know you’ve said that transplanted hair is permenent but is there any cases where medication can result in that not being the case?

I recently performed a hair transplant procedure on a patient that I had initially transplanted 17 years ago. He had good results at that time, but slowly over the years, the 2500 grafts he had transplanted in 1995 had died off. When hair transplant surgeons say that transplanted hair never falls out, one is reminded of the old saying, “Never say never”.

The permanent hair I transplanted for him 17 years ago was slowly destroyed by the drug Accutane (isotretinoin), which he has been using for years. Of interest, his donor area is also damaged with much less density than I measured 17 years ago and the Accutane clearly impacted those hairs as well. I suspect that the transplant will be possibly more successful this time around, as the hairs that he had in the donor area survived against the Accutane attack.

So while it is true that in most cases the grafts taken from the donor area for transplantation aren’t susceptible to hair loss, it’s possible that some medications could cause continued loss. It’s not very common though, and in the majority of cases the transplanted hair is permanent.

Tags: hair transplant, accutane, hairloss, hair loss

Has GSK Abandoned Plans to Market Avodart for Hair Loss?

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

Doctor Rassman/Pak

I recently contacted Glaxosmithkline regarding avodart and hair loss, and this is what they said.

    “Thank you for contacting GlaxoSmithKline about AVODART® (dutasteride).

    GSK will not be pursuing further studies on the use of dutasteride for AGA (alopecia – male pattern hair loss). This decision is based on market research analyses and not for any safety or efficacy reasons.

    A copy of the prescribing information for this product is available at https://us.gsk.com/products/assets/us_avodart.pdf for review and discussion with an appropriate healthcare provider.

    We appreciate the opportunity to serve you. If you have further questions concerning GlaxoSmithKline or our products, please contact our Response Center at 1-888-825-5249 during our normal business hours, Monday through Friday 8:00 A.M. to 6:00 P.M. (Eastern Time).

    This is a send only email address. Please do not reply to this email.”

–

what does it mean that they won’t pursue further studies because of market research analysis?

Some doctors in the know have told me for some time that GlaxoSmithKline (GSK) had no real intention to get into the hair business with Avodart, but their recent study may have reflected their playing the options for the future. According to the ClinicalTrials.gov site, GSK is still recruiting participants in a study of Korean patients to be concluded in July 2013… so I really don’t know what they’re doing.

As I am not an insider, I really can only speculate like everyone else.

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

Can I Shave My Gray Hair and Just Get SMP So It’s Always Dark?

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

Hello Doctor Rassman, thanks firstly for you great blog.

My question relates to SMP. I know you have mentioned about use of pigment colours depending on hair colour.

But what about someone like me who is gray on the sides and balding on the top…and who wants to conceal not just the balding but also the graying on the sides. Can I completely shave off my head and have black pigments on the sides where there is gray hair growing currently?

Will that hide the graying?

You can certainly shave your head and not worry about the gray hair. While having Scalp Micropigmentation (SMP) done on a shaved head is a common approach for many men who wish to maintain the closely cropped look, having this done to the sides of your head just to offset the graying is not a reasonable approach.

Tags: smp, scalp micropigmentation, pigment, gray hair, grey hair

Can You Predict If I Will Bald Like My Father?

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

I have been asked over and over again if I can you predict a balding future for the young man with a family history of balding. I have also been asked to explain how I would go about such a prediction. I have two tools: miniaturization analysis and bulk measurements. Below, I’ll discuss the difference between the miniaturization studies we have been preaching about in the past and the bulk measurements we are now also doing in our patient assessments.

Miniaturization mapping:
I use miniaturization measurements to get a general idea if there is genetic balding present. It can not give us (without special software) a metric on what is going on. From a practical point of view, checking for miniaturization over the course of months could never truly be in the exact same areas unless we place a tiny dot tattoo as a reference point. Then months after the first exam, we could examine the exact area again by finding the tattoo and measuring the degree of miniaturization at a point anterior, posterior, or lateral to the dot. In those people with a measurement of miniaturization, it varies from place to place even within a defined area (without a tattoo). The area observed is often just over a square mm. In other words, it’s using educated guesses.

Hair bulk analysis:
On the other hand, bulk measurement using a tool like HairCheck can cover a relatively large area (square inch) and finding anything in that area as measured by distance from the nose is replicable. So from a value point of view, it can give the doctor an assessment of bulk comparison to a person’s normal hair bulk when compared with the donor area in the back of the scalp. If the measurement changes over time, it will allow the doctor to produce a metric (number) which reflects the status of our hair bulk. In everyone with genetic balding, some part of the scalp hair will lose bulk.

Read more

Shaved My Head After a Transplant and I’ve Got Pits at the Recipient Area

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

Ive shaved my head, have scar from hair transplant, that’s ok but how can I conceal the pits on top of my head, I can’t explain away that besides saying fell into cactus

The pits you are seeing, assuming that you had true follicular unit transplants, are probably the result of too much skin left at the surface of the graft. I make a point to cut off as much of the skin as possible without damaging the hair grafts at the time of surgery. When follicular unit extraction (FUE) is done, most surgeons do not trim the skin edge, leaving more skin present in the graft. These bits of skin in the graft can cause the type of pitting you are referring to.

Unfortunately, it can not reasonably be fixed. Some doctors suggest dermabrasion (filling down the skin with a rasp), but this just produces other types of deformities, often worse than the pitting you are referring to.

Tags: hair transplant, pitting, scarring

Hair Loss and Brittle Nails After Back Surgery

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

I had a hip procedure in Oct then Back surgery in Dec. Since then, my beautiful THICK LONG hair has gone.Also, my finger nails are really brittle. Nothing in my diet or my life has changed except that I am taking vicodin. My PCP and pT have told that vicodin is causing this. Is there anyway to fix this. I can’t come off the meds because the PT is terrible.

It is not unusual to develop hair loss after a traumatic event like what you went through. This is called telogen effluvium and it usually passes, unless you are male and have invoked the genetic balding process.

A telogen effluvium usually reverses in time, and a doctor can make this diagnosis with a simple pull test.

Tags: hairloss, hair loss, telogen effluvium, surgery

Styling Product Buildup on the Scalp?

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

Hello Doctor

I was wandering whether chronic buildup on the scalp (of shampoo and styling products) due to poor hair washing (rare washes, low shower pressure, no thorough washing) could eventually lead to permanent hair loss

Thank you

No. Styling products, shampoo, sebum, regular washing, or irregular washing do not cause permanent hair loss. Genetic inheritance causes hair loss in men for the majority of cases.

Tags: shampoo, sebum, hairloss, hair loss

Experience with Using Cold Cap Therapy to Prevent Hair Loss from Chemo

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

Thank you for baldingblog, a wonderful source of information on hair issues. My wife just started on chemotherapy for colon cancer with a drug known to cause hair loss. She wrote this to a friend about her chemotherapy and the Cold Cap experience and with her permission, allowed me to send it to you to post on your site.
—

    “The chemo was on Tuesday – and I slept through the entire event. I thought to call Dr. Rassman and thank him for the reference to this cold cap therapy. He is among the most caring people I know.

    They loaded me up with lots of anti-nausea meds and some Benadryl which really made me sleepy. Now you might wonder how one can sleep with a turban at -24 degrees Fahrenheit on your head – well I did. In part to counteract the cold, you wrap yourself in an electric blanket set to sizzle – and that put me right to sleep. My husband had to wake me every 30 minutes or so to trade the cold cap for a newly chilled one. You keep up the cold caps till 4 hours after chemo is done so I didn’t really wake up till about 6:15 PM on Tuesday – that included the drive home. We were quite the spectacle at the clinic and had many doctors and nurses coming in and out to see the changing procedure. I actually think my husband was enjoying the attention. Almost everyone at the clinic knew about cold cap but none had direct experience with it and all were very interested to see if they work. Needless to say I am too.

    I did hook up a small group of patients in a support group, a couple have used the cold caps successfully for their chemo. It is more involved than just the turbans – there is a lot of extra hair care but all say that it is worth it. So we are “all in”. We did look like we were moving in to clinic for a week wielding our two coolers on a rolling dolly, a rolling suitcase filled with the blankets and extra needed accoutrements (including welders gloves to handle the dry-ice), and an extra bag of layering clothing.

    I am feeling ok – I wear out easily and then crash hard. I am still not sleeping well – what they have given me is helping a bit but I don’t get more than 5 hours of solid sleep and then doze as best I can. Today is the last day on the heavier anti-nausea meds and when the steroids will wear off – they say that tomorrow is the trail day.”

I try to get involved in the lives of my patients and have developed many close friends from this group of wonderful people. I’m glad I could offer some help to this patient and his wife, and I wanted to post this so people considering using Cold Cap Therapy during chemotherapy might know what to expect. There’s a good article about this treatment here.

This reminds me of another time that I wanted to share, when a hair transplant patient got a routine heart scan on my recommendation and found that he had an aortic aneurism. This is a time bomb that kills almost everyone when the aorta (the main blood vessel that exits the heart) leaks and bursts. I helped him find a great doctor who brought his body temperature very low at the time of surgery, stopped his heart, and replaced the blood vessel with a cloth one while everyone hoped that his brain would function after they restarted his heart. He lucked out and survived, brain fully intact.

Right place, right time.

Tags: hairloss, hair loss, cold cap, chemotherapy

Any Treatment Suggestions Now That I’ve Stopped Pulling My Hair Out?

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

Thanks for taking my question. I am a 23 year-old who had the OCD scalp-picking issue you mentioned in a previous post. I managed to completely quit the behavior approximately a year ago after doing it for about 2 years at varying levels of severity. As a result of the disorder, I have hair pulling back on one side of my head much more aggressively than the other. I also have hair that is thinning all over, but the thinning is not yet visible when dry. I also have a very dry scalp, which I have read may cause hair to grow thinner. I wear my hair at a medium to medium-long length.

Could you please provide suggestions? Suggestions in all aspects of hair care are welcome. (Shampoo, hair regrowth treatment, etc.) Thank you very much for your time.

Best Regards

Many people who reported to me that they stopped pulling their hair out, were not being honest with themselves. The good news is that if I examine you, I can tell you if you have pulled hair out in the past 3 months. Minoxidil might help — try it for a full year before considering it a success or failure. There’s no shampoo that will regrow your hair. Even with medication in a best case scenario, you’re not going to get back to where you were before your picking or pulling began.

Hair transplants are a known and proven option, but this requires you to visit a specialist in this field as it can not be done by just anyone.

Tags: trichotillomania, dermatillomania, hair loss, hairloss, pulling

Why Has There Been So Little Progress on Hair Loss Treatments in 2 Decades?

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

I find it hard to believe that the only two FDA approved medications for balding were both approved over 20 years ago. How come there has been such little real progress since then? Is balding considered a “solved problem” due to the current status quo (surgery + finasteride/minoxidil)?

Why can’t we routinely exceed the sound barrier when we fly, since after all, the airplane was invented 110 years ago? If you answer this question, you might better understand that it does take time to find a cure for balding. Many groups from around the world are working hard on a cure or a better treatment, and I suspect that it will arrive when it is ready. The FDA process for such treatments may take years to obtain the approvals needed for human use.

Tags: hair loss, hairloss, treatments

Would Gynecomastia Surgery Be Nullified By Propecia or Avodart?

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

Dr. Rassman, you alluded to a simple cure for gynecomastia. For those of us who are plagued by this condition, & are financially tight, would you please share what this cure is, & will the continuance of Propecia or Avodart nullify the surgical benefits? Thanks so much for a great Forum!!!

There are different surgeries that can successfully treat gynecomastia from a cosmetic point of view (removal of breast tissue or liposuction). The drugs Propecia or Avodart will not reverse or cure this problem and in very rare situations can produce it. I don’t know that these medications would nullify the surgery completely or at all.

Tags: propecia, avodart, dutasteride, finasteride, gynecomastia