Spironolactone for Treating MPB?

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

Hi Dr.Rassman, what are your opinions regarding the safety and effectiveness of topical spironolactone? Is it a safe alternative to proprecia or does it pose harmful side effects?

It does work for the treatment of balding, but the side effects are significant and far more common than Propecia, including the scope of side effects.

Spironolactone causes an increased risk of bleeding from the stomach and duodenum, gynecomastia, and testicular atrophy (kills off the testicles or makes them smaller and less effective). Erectile dysfunction would be common and it can cause a serious rise in potassium in the body (hyperkalemia). The side effects and complications go on and on.

It should never be used to treat the benign condition of male pattern hair loss.

Tags: spironolactone, hairloss, hair loss

Micro Extensions?

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

Is there anything else other than finasteride I should consider to help with my hairloss?

What is your thought on micro extensions?

Finasteride and minoxidil (Rogaine) are the two drug treatments I will recommend, as they are FDA approved to treat hair loss.

Micro ring hair extensions do not use glues or sewing, but while I haven’t had it done myself (I prefer my hair short), the photos I’ve seen show me that it will probably run the risk of causing traction alopecia (more hair loss) due to the tight pulling on the scalp.

Tags: micro extensions, hairloss, hair loss

2006 Study Says Saw Palmetto Doesn’t Improve BPH Symptoms

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

Dear Dr.

Link: Study Shows Saw Palmetto Extract Does Not Improve BPH Symptoms

It says: There is no different between Saw Palmetto and Placebo. if it’s correct, then maybe there is absolutely no benefit for inhibiting 5-alpha-r/DHT? Please tell us your comment. thank you.

I believe if you search BaldingBlog over the years, we have always maintained that saw palmetto is just an herb and there is no scientific proof of its efficacy (for MPB or BPH). Informal studies, differing dosages, and duration of use have all been issues with clearing up once and for all if saw palmetto does anything to treat hair loss.

Regardless, as I have said too many times here, “Buyer beware”.

Tags: saw palmetto, hairloss, hair loss

When All Else Fails, What Can a Young Man With Hair Loss Do Besides Give Up?

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

Hey, I just want to take a second to thank Dr. Rassman for all of the time that he puts into this blog in helping young men as myself in looking for solutions to hair loss. I just want to explain something for a second.

First of all im 20 years old, have been losing my hair for some time. For all the time I put looking for answers to stop my receding pattern, people like me seem to be just wasting their time. I have been on finasteride for two years, and from the looks of my head, it seems as if I have no more options. I come to this blog out of desperation to hopefully find a “miracle cure” that will hopefully one day regrow the little fibers of youth that have slowly destroyed any bit of self confidence I once had. Im afraid that I have put countless hours a week researching baldness and still can find no answer in how to stop this.

How do people like me… when all fails…deal with this situation?…because it seems to me like the answer that makes the most sense is to just give up. It is most certainly wrong that young men, barely out of high school, will not face judgement and humiliation from this. In my case, I am embarrased to say that this little problem has turned into one big life crisis. A couple of years ago I was a pretty good looking kid. Now I cant jump into a pool without my scalp showing for everyone to point fun at. Two years ago I was happy…now im just depressed

If I’m going on a little rant here im sorry, but im just desperate I’m afraid. In reality, is there any hope for the guys like us, who seem to see thier youth crumbling, and confidence fading?

You’re not alone in feeling this way. Unfortunately, we don’t have all the answers and there is no cure for hair loss. It’s possible that a hair transplant could be in your future… but you need to find a caring doctor who can work with you on a Master Plan addressing hair loss possibilities.

Tags: depression, hairloss, hair loss

I’m Noticing an Increase in Chest Fat with Finasteride Use

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

Dear Dr. Rassman,

Several months into using Finasteride, I seem to be developing a case of pseudo-gynecomastia. I do not have any swelling, tenderness or fibrous tissue growth, just a noticeable increase of fat in my chest. I have decided to halve my dose of Finasteride to see if there is any improvement; however, is this safe?

In other words, am I now at greater risk for permanent glandular changes and, as infinitesimal as the rates are, breast cancer? It is my hope that a lower dose and increased aerobic exercise will get rid of most or all of the fat. How might I proceed? Many thanks.

Gynecomastia is a documented side effect of Propecia (finasteride), but how it relates to breast cancer and its risks are unclear. Gynecomastia is also an issue in it of itself for a minority of men who are not taking any medication. It could be coincidental timing. Have you changed any eating or exercise habits? Either way, BaldingBlog is not a place for diagnosis or treatment.

If you have gynecomastia you need to speak with or be examined by your doctor and discuss your options. Each and every case is different. While a lower dose might decrease side effects, you should also be discussing your dosage change with your prescribing doctor.

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

My Temples Are Lighter In Color Than The Rest of My Hair

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

I am 28 and my temples are alot lighter in color and feel thinner than the rest of my hair. Does this indicate miniaturization and will I eventually lose this hair without treatment? Also, I feel like the corners of my hairlines are way further back than they should be. I have tried propecia and rogaine for the past 2 years and nothing has seemed to work. Bernstein hair told me that I wasnt a candidate for hair transplant yet but I am really self conscious about my hair. Any ideas on how to proceed? Thank you!

Lighter color doesn’t necessarily mean you’re going to lose that hair. Propecia and Rogaine aren’t likely going to help to regrow the temple peaks, as you’ve found out.

Without seeing you, I can not tell you what to do… but Dr. Bernstein is a good doctor and his opinion often mirrors mine. That being said, you can always get a second opinion. I just don’t know enough about you or your particular case to offer any real direction.

Tags: hair color, hairloss, hair loss, temples

Do You Perform a FUT Test Before Surgery?

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

Dr.Rassman/Dr.Pak,
I understand that you conduct tests (FOX test) on potential FUE patients to determine their suitability, but do you offer similar tests to FUT patients (e.g. 3 cm x 1 cm excision / ~300 graft mini-HT to ascertain healing quality of recipient and donor areas, donor-strip scar assessment, health of grafts, growth/take of transplants, etc.)?

Thank you.

Unless there is an issue with the patient who has a history of poor wound healing or poor growth, we do not test patients for FUT (follicular unit transplant — also known as “strip method”) surgery. If someone would like a mini hair transplant, that would be another issue.

The FOX Test (for follicular unit extraction / FUE) is only testing 1 to 5 extractions. We do not transplant the grafts unless there is a strong desire expressed by the patient. Thus the FOX test is a very simple 5 to 10 min test which we offer at no cost.

Tags: fox, fue, follicular unit extraction, hair transplant

I Had a Chemical Burn at the Hairline 5 Years Ago — What Can I Do?

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

Hi, Im a 20 year old black male and my problem is when I was younger around 15 yrs old or so I used to have braids and I would relax my hair every so often. I got a chemical burn one time right on the front of my hairline in the middle and a little on the side. It scabbed up and I scratch the scabs off and the hair never really grew back so it makes my hairline look like its receding. I have long hair now and I was just wondering is there ANYTHING I can use or do to grow or fill in these spots so I can get my confidence back!?

If there was trauma to the hair follicles and it has not grown back in 5 years I highly doubt you can do anything to have it regrow on the area with any medication alone. Hair transplant surgery may be an option, but you would need to consult with a doctor if you would be a candidate.

Tags: hairloss, hair loss, chemical burn, hair transplant

Hair Length for Bulk Analysis

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

I came in and asked for a bulk hair analysis but you said I did not have enough hair on the side for the device to grab. What is the minimum length you would need?

Also when I do a pull test on the sides of my hair (DHT resistant region) no matter how hard and how many times, I fail to get any hairs to come loose. But when I do it to my thinning areas hairs come off freely. Does that mean the cycling is accelerated in those areas? And that those areas will eventually become bald?

Thanks in advance.

Bulk measurement is done by grasping hairs that are in an area about one square inch of your scalp. So if you can pick a region and mark off about one square inch and you are able to grab the hairs freely with about two fingerbreadths, that should be enough of a length. I’d say that about 3 inches long would be sufficient.

Also, you should not have any styling product (gel, pomade, hair spray) in your hair, as that would artificially increase your bulk. Remember that no test is perfect and these are all just our way of trying to standardize and quantify the hair loss progress.

If you are a patient who came to see us at NHI you should have gotten a follow up consultation letter with your likely Norwood diagnosis. Also, stop pulling on your hair.

Tags: hairloss, hair loss, hair bulk, bulk analysis

In the News – Women of All Ages Can Have Hair Loss

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

Snippet from the article:

Women make up about 40 percent of Americans experiencing hair loss, according to data from the American Hair Loss Association, a California-based organization dedicated to educating and improving the lives of those affected by hair loss. Despite growing concern among women, hair loss is still often considered a male issue, but there are signs that women are no longer willing to suffer in silence.

Read the rest — Hair loss common in women of all ages

The article talks about female hair loss treatments, and acknowledges that the options are unfortunately more limited for women than they are for men.

We’ve written before about the many possible causes of female hair loss and the tests one may undergo to help determine the cause.

Tags: female hair loss, hair loss in women, hairloss, hair loss

Scratching My Head At Night After a Hair Transplant

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

It’s been 2.5 month after my hair transplant but i got the habit of scratching my scalp during the night and i have bought a hand glove just to prevent it, however sometimes it still happen, i got blood in the morning

is it possible for me to lost the graft at 2.5 month with scratching? i have encounter this at least 8 times and i really scare i will ruined all the transplanted graft starting 1 month post op

please advice

In general, I doubt you would lose grafts after 2.5 months (or even 1 month). In fact, it’s rather strange to hear you have bleeding that far out from surgery! Follow up with your surgeon for an examination if you are concerned.

Tags: head scratching, hairloss, hair loss, hair transplant, graft

Propecia, the FDA, and High Grade Prostate Cancer

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

Dear Dr. Rassman:

I am a bit concerned about continuing with Propecia in light of the recent finding on the risk of high grade prostate cancer. At the FDA hearing in June of last year, the FDA statistician estimated that the risk of getting high grade prostate cancer using 5mg of Finasteride over a 7 year period was 1 in 200. I realize that Propecia is one fifth that, but even a 1 in 1,000 risk when it comes to an aggressive cancer seems, well, risky. If you told me that there was a 1 in 200 or 1 in 1,000 chance the plane I was about to board would crash, I would not board. So, my question is this: is there anything in the study you see that makes you think it’s safe to keep going with this drug?

I believe you are reading things out of context. The FDA site states:

“The labels of all 5-alpha reductase inhibitors (5-ARIs) are being revised based on FDA’s review of two large studies examining whether these drug products (Proscar, Avodart) reduce the risk of prostate cancer. The studies did find an overall reduction in the risk of lower-grade forms of prostate cancer, but both studies also showed an increased risk of high-grade prostate cancer.

As a result of these two studies, the labels of all FDA-approved 5-ARIs will be revised to include new information that these drug products may increase the risk of high-grade prostate cancer. The product labeling will also state that 5-ARIs are not approved for the prevention of prostate cancer.” [Source]

I did a quick Google search and found prostate cancer statistics, unrelated to finasteride use. “Based on rates from 2006-2008, 16.48% of men born today will be diagnosed with cancer of the prostate at some time during their lifetime.” That is about 16 in a 100 or 1 in 6 men.

My point is: Propecia does not cause cancer. The studies that the FDA quotes and the media has latched on to point to how those men who ended up with prostate cancer while on finasteride had a higher grade prostate cancer than men who did not take finasteride… but the controversy of why this is, was not clear from the studies.

A final point is that if you are concerned about the medication, you do not have to take it. It is an option I give to all my patients. This is one of the many reasons why a doctor should prescribe you the medication, because each and every patient is different and the prescribing doctor should be there to address all of these issues one on one with the patient.

Tags: finasteride, propecia, cancer, prostate cancer, hairloss, hair loss

Teenage Girl Wants a Lower Forehead

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

I am a girl, 15 years old. I have had an awkwardly shaped forehead all of my life and it has made me extremely self conscience over the years. I’ve always wanted to put my hair back with a cute headband, but my hair line has made me too self conscience to feel comfortable with it. I start with a widow’s peak (which is already far back), then it goes back to a few centimeters away from the center of my head above the outside of my eyes. What would you suggest doing about this? I just want it fixed, and I don’t know what my parents would say to surgery or anything like that, but it’s my dream to have my forehead fixed to a normal size.

Thank you so much !

There are procedures to move your hairline forward which work very well, such as forehead reduction or hairline lowering. There are doctors who specialize in these procedures, but at 15 years old, you need to get the support of your parents on such a decision.

There are photos at Dr Aharonov’s site if you’re curious about results.

Tags: forehead lowering, hairline

Dutasteride Dosing and Steady State

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

Hello all. I have not been on the blog for some time, but I wanted to take an opportunity to answer a recurring question that I see (with the Doctor’s kind permission, of course) Many are asking about Avodart (5-6 weeks)and it’s superior half-life over Propecia (24 hours). Many are under the impression that you just pop the Avodart and magically, 90% of the circulating DHT is eliminated. This is not the case. In order for there to be a 90% DHT serum decrease, the patient must be on the drug, every day, for a minimum of 90 days. Probably more like 120 days.

There is a thing called “steady state”. This refers to blood levels of a drug. You must ingest the drug, on a regular basis, and for a predetermined period of time, in order to reach “steady state”. All steady state means, essentially, is saturation. This means that the blood is saturated with as much of the drug (in this case, Dutasteride) as it can hold. Dutasteride is bound to a blood protein called albumin very, very tightly. This is the reason for its half life. It doesn’t want to let go!

Now, after 90-120 days you should be able to get away with megadosing once or twice a week, however, there is this little concern regarding the law of “Diminished Returns”. Plus, if .5mg every day for 90 is sufficient at blocking 90% of type II 5ar, I personally don’t see how juicing it to 94 or 95 percent would have that much more clinical benefit.

Thank you for your opinion. I haven’t seen any information about the appropriate Avodart (dutasteride) dose for treating hair loss. More importantly, it has never been clearly shown that Avodart is necessarily better than Propecia (finasteride), particularly since it has a higher side effect potential.

Tags: dutateride, avodart, dosing, hairloss, hair loss