What If Merck Took Propecia Off the Market?

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

doctor rassman what are your thoughts on merck pulling propecias website down? there are articles all over the web.

is there a chance that propecia will be off the market? that sucks. so many of us use it with good results and no side affects

PropeciaI’ve been sent links to articles about the Propecia site being pulled down, but the few I’ve seen were actually just cleverly disguised advertisements for a class action lawyer. We posted about that site being down a couple weeks ago.

Now I don’t know Merck’s intention (as I am not part of their inner circle), but I would be really surprised if Propecia is pulled from the market. I know there are some people beating a drum about it, but consider this — the 5mg dose of finasteride (Proscar) will always be available as a prostate treatment, so even if Propecia (1mg dose) went off the market, one could switch to 1/4 of a Proscar pill daily. Proscar has many generics in the marketplace and it is used in benign prostatic hypertrophy.

When Propecia goes off its patent protection, many manufacturers will produce the drug at the 1mg level. I realize there are already generic 1mg producers for some markets, but those pills aren’t legally sold in the US yet. When that patent expires late next year, I can’t say that Merck will continue to produce Propecia as the prices come down due to competition from the generics. But either way, finasteride will still be available.

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

In the News – Doctors Not Always Honest with Patients

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

Snippet from the article:

Trust your doctor? A survey finds that some doctors aren’t always completely honest with their patients.

More than half admitted describing someone’s prognosis in a way they knew was too rosy. Nearly 20 percent said they hadn’t fully disclosed a medical mistake for fear of being sued. And 1 in 10 of those surveyed said they’d told a patient something that wasn’t true in the past year.

The survey, by Massachusetts researchers and published in this month’s Health Affairs, doesn’t explain why, or what wasn’t true.

Read the rest — Study finds MDs not always honest with patients

The results are based on a survey of over 1800 doctors across the US from 2009, “to see if they agree with and follow certain standards medical professionalism issued in 2002”. In another study, doctors suggested that they color the truth with presenting issues on the seriousness of illnesses more positive than it is.

In a recent symposium I (Rassman) attended, the doctors in the audience were asked how many of them would not discuss dying with their patients. More than half raised their hands. When probed why, the doctors cited issues like (a) the time it takes to manage a dying patient is significantly more than they can allot, and (b) they are uncomfortable in dealing with death and dying.

Tags: doctors, physicians, honesty

What Kind of Doctor Specializes in Hair Loss?

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

I know you are primarily a hair transplant specialist, but who would you recommend as someone who only specializes in hair loss? It seems most doctors a visit are more knowledable about transplants than they are with hairloss.

Some people see a dermatologist, but hair transplant doctors are generally the most knowledgeable when it comes to hair loss, because they specialize in hair. Just don’t get pushed into surgery, but use their expertise to help determine a treatment plan (or rather, a Master Plan).

Tags: hairloss, hair loss, doctor

I’m Intrigued By Your Attitude on Shock Loss

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

Dear Balding Blog Contributors, I mean no offense by this post-I am genuinely just intrigued.

After reading 32 pages of baldingblog.com blog posts which mentioned shock loss, I was intrigued by the attitude that was expressed, which seemed to be ‘shock loss happens, deal with it-propecia may help’.

What intrigues me is that this attitude seems to be contrary to your role as pioneering doctors in this field. After seeing shock loss affect and no doubt traumatize patients paying large sums of money to GAIN hair, should you not be investigating treatments which may help to reduce it? I’m no expert, but off the top of my head I can think of drugs to reduce the immune system’s rejection of hairs, drugs to calm inflammation or stress in the body, topical drugs for the same end, dietary supplements etc.

Am I missing something, or is the attitude I have interpreted you as expressing a little negligent of the well being of hair transplant patients?

Maybe you are missing the point. We (at least here at NHI) do not recommend hair transplants to patients who are at risk for significant shock loss, but some hair loss will occur that is inevitable with or without any medication. There will also be some form of nerve damage with surgery (both strip and FUE) in the small cutaneous nerves that are all over the scalp. This will make the scalp feel numb for several weeks to months, more in some areas than others. There will also be some pain while we’re at it, which may persist after the procedure (minor pain to some and rarely severe to others). These are just a few of the risks associated with surgery. We do not take this lightly. It is an educational and informed process that all surgery candidates go through. You don’t just show up to have surgery and get great hair. There are always these risks that need to be considered for the benefit of looking better (more hair). If any of the risks are unacceptable to both the patient and the surgeon we do not go ahead with the surgery.

Some patients are rightfully concerned about shock loss with hair transplant surgery, but they should not be obsessed with it. Reality is that even without surgery, hair loss will happen if you have the balding gene (pattern). That is the reason why people have surgery, right? And the timing of surgery is highly variable for each individual who comes for a consultation. If the risk of shock hair loss is too great then we will hold off on surgery with medication until the benefits will outweigh the risks. An example of this would be someone in their early 20’s who is rapidly losing hair and is not on medications (like finasteride), but still has a decent amount of existing hair to cover their thinning. These are things that cannot be conveyed completely on a blog, as each case is different.

To be clear, there have been no medications that completely stop genetic hair loss or shock hair loss. At best what we have seen in our 20+ years in practice is that Propecia helps with shock loss. If you can point out the drugs you are referring to which “reduce the immune systems rejection of hairs”, please let us know. Immune suppression is a dangerous process. Take note, however, anti-rejection types of drugs you may be referring to have many unfavorable and sometimes dangerous or deadly side effects. One minor side side effect is… hair loss. Not so simple, eh?

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

Understanding Catch-up Hair Loss After Stopping Finateride

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

My question is to do with ‘catch-up hairloss’ after quitting finasteride.

If DHT gradually destroys the hair follicle and finasteride protects the follicle by reducing DHT, then why would there be such a fast ‘catch-up’ hairloss after quitting finasteride?

My thinking is, say your follicles have 3 yrs left before DHT finally destroys them. Then you go on finasteride for 5 yrs before quitting, surely your follicles would then still have 3yrs left, much like weather proofing a wooden fence?

Good thought, but finasteride does not block 100% of DHT… and DHT may not be the only factor here. More importantly, as much as your logic may seem true or make sense, in the real world catch-up hair loss from cessation of finasteride does not work that way based on many patients we have observed. We all have an internal clock, and your follicles are still on that clock (call it the apoptosis clock) so that the clock’s time advances regardless of whether you are on finasteride.

We’re just observers to a body process we barely understand.

Tags: propecia, finasteride, catch-up hair loss, hairloss, hair loss

Calculating Baldness?

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

Dr Pak/ Dr Rassman,

I asked you about your baldness calculator over a year ago in this post. That post referenced the original post from 2007.

Any further progress on that baldness calculator? Sorry if I am persistent but you Doctors seem to be the only ones out there challenging the status quo and giving us new options for hair loss. One can’t help but be a little curious.

By the way, have a great New Year!

The US Patent was just awarded (but not published by the USPTO yet) a couple of months ago. Now Dr. Pak and I have the challenge to think through the design and engineering issues, which is not an easy process.

Don’t hold your breath for us to complete this process quickly, as it isn’t a high priority right now. But I do appreciate your continued interest!

Tags: calculator, baldness, hairloss, hair loss, patent

In the News – Men with ED Should Check Their Eye Pressure

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

Snippet from the article:

Men with erectile dysfunction (ED) have a nearly 3-fold greater risk for also having open-angle glaucoma (OAG) than men with normal erectile function, report researchers from Taiwan in an article published in the January issue of Ophthalmology.

A case–control study matching 4605 men with ED with 5 control patients each showed that after controlling for potential confounding factors, men with ED had an odds ratio (OR) for a prior diagnosis of OAG of 2.85 (95% confidence interval [CI], 2.10 – 4.07), write Shiu-Dong Chung, MD, from the Division of Urology at the Far Eastern Memorial Hospital in Taipei, Taiwan, and colleagues.

“Our findings suggest that prospective studies should be undertaken to develop the appropriate clinical guidelines for evaluating concurrent or subsequent ED in OAG patients,” they write.

Read the rest at Medscape — Do Glaucoma, Erectile Dysfunction Have a Common Cause?

This isn’t hair loss related, but I’m sure there is a percentage of this site’s readers that are interested in ED-related studies.

Tags: erectile dysfunction, ophthalmology, glaucoma

Lycopene and Treating Hair Loss?

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

I’ve read online that Lycopene is A 5 Alpha Reductase Inhibitor. Can it be used to halt hair loss or even help. If so could it interfere with finasteride and would it cause an initial shed?

I have little doubt that there are many 5-alpha-reductase inhibitors in the various foods we eat, or in herbs and plants (examples here). The issues that I believe should be the focus is the effectiveness of these substances and their side effects. With Propecia, the drug has been extensively studied for these two issues and the recommended dose is the most effective with the least side effects of anything that I know of. As shown in the paper referenced below, the inability to scientifically document the effective dose is critical.

Do you want to take lycopene? If so what does does it require? Will it really work as well as Propecia? Are you willing to put your hair loss at risk to gamble on the dose or in experimenting on yourself? If hair loss is what you’re wanting to treat, then stick to what we know works.

See: Serum lycopene concentration and prostate cancer risk: results from the Prostate Cancer Prevention Trial

Tags: lycopene, hairloss, hair loss

What Size FUE Punch Was Used?

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

Dr Rassman.

I was just browsing through your SMP site. Great work!

This particular client caught my eye: scalpmicropigmentation.com

What sized mm punch was used to extract his grafts? He wasn’t an NHI client, correct? Thanks for your time!

Actually, he wasn’t our surgical patient. I believe 1mm to 1.5mm punch was used, though I would guess more on the 1mm side.

I should point out that even while he wasn’t our FUE patient, he could have had the same punch scars produced if we did the surgery. What I mean is, FUE is NOT a scar-less surgery that many clinics claim it to be. Even 1mm punch will leave a scar. Even 0.8mm punch will leave a scar. Not everyone will develop scars to this degree, but as you can see in the photo, it’s a possibility.

Tags: follicular unit extraction, fue, scarring

Workplace Stress Caused My Alopecia Areata

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

Hi Doctors

A while ago I wrote in with this question – Pea-Sized Bald Spot on Crown with Small Hairs in the Center

After visiting my doctor it turned out to be alopecia areata that was triggered by workplace stress I was going through at the time. The stress was relieved and the area grew back within a month.

My next question is unrelated though – when you look at a hair that has been shed, is there any difference between a white hair bulb and a dark hair bulb?

Thank you

In my humble opinion, alopecia areata is an auto-immune issue where your body attacks its own hair follicles (to put it simply) and it has been occasionally linked to stress as a precipitating factor. It may have been a triggering factor. Hair loss from alopecia areata often will grow back with time (with or without any intervention), but it may come unexpectedly at any time in the future.

Finally, there is no difference between white and black hair bulbs.

Tags: alopecia areata, stress, hairloss, hair loss

Traction Alopecia from Pushing Down on Hair?

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

Hair bandCould a head band cause hair loss? I know the answer will probably be “if it pulls on the hair it may cause traction loss” which I understand, but I honestly don’t know if something like this has potential to pull on the hair.

Here is a photo of the item in question, it would be good to hear your thoughts on the possibility of traction loss: Photo

I guess another question is, since something like this pushes down on the hair, is traction possible from something pushing down on your head like this would? Thanks.

The band you are using does not appear tight. If that is correct, I would doubt that this would be a problem.

Tags: hairloss, hair loss, traction alopecia, hair band

Is Minoxidil Only for Men?

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

I am a 58yr old woman. My hair is falling. A hair doctor has put me on to MINOXIDIL TOPICAL SOLUTION USP 2% HAIROUSE-MX. 1ML 2 X DAILY along with multivitamin tablets. I have been on it since 45 days. But to know more about this solution i googled it. To my surprise i found out that this solution should only be used by men, not women. Secondly,when stopped hair falls again.

What should i do? i am worried. I dont want to use it for the rest of my life. How do i stop it and being a female using this, am i harming myself? Please help.

2% minoxidil is sold as Women’s Rogaine, 5% minoxidil is sold as Rogaine (for Men). It is the only medication that is FDA approved for treating female hair loss. Some doctors may prescribe the stronger minoxidil (5%) for women, but that is on an individual case by case basis. Besides, it looks like your doctor put you on the 2% anyway.

You do need to use it for life if you want to continue seeing the benefits, and stopping it will result in a disappearance of any benefits you saw from it. In 45 days, you probably didn’t notice too much of a difference, if any. You should talk to your doctor about your concerns.

Propecia (finasteride) is only for men, so perhaps you’re confusing the two medications.

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

Why Would Celebrities Wear Toupees?

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

Why would Elton John and William Shatner wear toupees when hair restoration is easily available?

Elton JohnSurgery is a personal decision, so I can’t speak for everyone… but I can make an educated guess. Hair restoration or hair transplant surgery is in essence about moving your existing hairs around. If you don’t have lots to move around you cannot cover a huge area of balding or achieve the look of a 16 year old fullness.

Moreover, many older celebrities with their financial success have had a hair transplant surgery 10, 20, 30 years ago when hair transplant surgery results were not the best. So with their fortune they depleted their donor hair supply and do not have enough donor to fix the problem. As a result, their only option is a wig and or toupee.

Tags: celebrities, hairloss, hair loss, wigs, toupee, hollywood

I’m 18 and Finasteride Stopped My Hair Loss

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

Hey
I’ve been taking finesteride since september of 2011 and my hair loss has seemed to either slowed down or stopped and i don’t seem be having sexual problems really. I’m only 18 so is this a good sign?

Did you need me to answer this? I must be missing something here…

Your hair loss slowed down (possibly stopped) and you have no side effects after taking finasteride for 5 months… and you’re asking if that is a good sign? Um, yeah. I’d say that’s a good thing. The medication you’re taking to treat hair loss is working and as long as you stay on it, it will probably keep working.

Tags: finasteride, hairloss, hair loss

My Mom Has Hair Loss After a Triple Bypass

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

My Mother had triple bypass in August 22, 2011. She has had alot of hair loss. She has done well from the surgery but this bothering her. Can this be from the meds that she was given to put to sleep?

I’m not sure which medications she’s taking, but stressful surgeries can certainly cause hair loss. Most of the time this will reverse in a year or so. Just wait it out.

Tags: hairloss, hair loss, surgery, triple bypass, stress