I’m a Medical Student Taking Propecia — Can I Just Prescribe It to Myself?

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

Dr. Rassman-
This question can be answered by you or any other M.D. working on the site, I do not mind. I am a 25 year old 4th year medical student who has been on propecia for 4 years and have had great results with no side effects. Stopped my hair loss completely at a Norwood 2 and have maintained since starting.

My problem is that the Dr. that prescribes to me, a prominent hair guy in New Jersey, has recently been unavailable for reasons that I can not figure out. I recently had to get an family doc that I did not know from my school to write me a temporary 90 day script, but with my future move to residency and the time constraints on a surgical resident (which I will be), makes me worry I will be left in the lurch if this keeps happening.

My question is basically this: can I write myself scripts for propecia every 90 days when I get my prescription pad this July? Is their anything ethically/legally wrong that will prevent me from doing this?

All the best

MedicalI understand that dealing with doctors can be difficult, but in your generation of medical students I am sure you are ingrained in the medical ethics of medicine.

In addition, the American Medical Association suggests, “Physicians should generally not treat themselves or members of their immediate family“.

So as harmless it may seem, you should not be prescribing medications to yourself. If you are so motivated, I suppose you can ask a colleague or another physician if they would mind (or feel comfortable) prescribing you the medication.

Tags: propecia, finasteride, prescription, doctor

Can Hair Continue to Regrow If You Take Propecia and Then Stop?

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

Hi, I has some questions about Propecia.

1. From what I understand, if you take Propecia it might not last (meaning after anywhere from 5 to 12 years, you go start balding again) is this ture?

2. I read someones post saying that he took Propecia for one year, stopped, started to bald and then his hair grew back again. Can this really happen? Is this possible?

I’ve had some patients on Propecia for over a decade with continued benefits, and I’ve had some on Propecia that saw their hair loss slowly start again after a few years. Each person is different, so I have no way to know how you’ll respond.

Your hair may not be dependent upon Propecia so if you stop it, depending upon the value you got from the drug, your hair may continue to grow. Once you lose your hair from genetic balding, it is usually a permanent effect. Propecia may just slow the process down.

Tags: propecia, finasteride, hairloss, hair loss

My Hairline is Great But My Doctor Sees Thinning on Top

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

Hello, doctor. My hairline is only a Norwood 1.5. But I have recently found out that the top of my head is thinning. It isn’t that noticeable. Meaning only the doctor could see it. Not my friends, family etc. The only one I know in my family who was bald was my great-grandfather. All my other male relatives have a great head of hair. Does my thinning on top mean i will eventually go totally bald or could this be as worse as it gets? Should I start rogaine?

If your thinning isn’t noticeable, what is your doctor doing differently to see it? Is he/she using miniaturization mapping or measuring your hair bulk?

I have no way to know if your loss will get worse and eventually lead to you being totally bald. It’s not quite as simple as that. Similarly, I have no way to know if you should be on Rogaine or any other treatment.

Tags: hairloss, hair loss

Patient Results – Growth at Only Four Months After 1622 Grafts (with Photos)

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

This is a patient only a few months following surgery of 1622 grafts. He had grafts transplanted to the hairline and sideburns, and while it is unusual to have this much growth at only 4 months, I expect it will get even fuller over the next 4 months. I’m often asked what a hair transplant will look like at various monthly intervals until it is fully grown in, so I wanted to show a unique case.

After only 4 months (1 procedure of 1622 grafts):

 

Before:

 

Tags: hair transplant, hair restoration, surgery, hairloss, hair loss

I Just Turned 17, My Hairline Isn’t Straight — When Will I Go Bald?

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

Hi all,i have just turned 17 and recently realized that my hairline is not straight and is set back at the temples and i am wondering at what age i will go bald. However i did notice that my brother who is 11 has a very similar hairline. Help would be great

There’s no way to tell. From what you are telling me about your 11 year old brother, the hairlines sounds like a family trait. If and when your hairline rises to the mature position, then you will be different from your brother. Even if you develop a mature hairline, it is normal and does not necessarily mean you’re going to go bald.

Tags: hairloss, hair loss, hairline, mature hairline

Using Smaller Needles in FUE?

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

Hi Dr. Rassman.
Why doesn’t the surgeons use a small needle? I have seen needles reported down to 0.4-0.6 mm. This should be good for less scarring in the donor area.

One doctor proclaims that he does hair multiplication and he also claims that he uses less invasive surgical instruments.

Thanks

Be careful not to believe everything you read. A 0.4mm punch for follicular unit extraction (FUE) is very difficult and I would doubt repetitive in each grafts. I would like to see the results he gets and examine the grafts before I believe what I am told. I have done this on a number of occasions, and you would be amazed at what I found.

Tags: fue, needle, surgery, hair transplant, follicular unit extraction

I Use 3 Hair Growth Treatments and They’re Working — How Often Should I Wash My Hair?

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

Hi, I have a family history of androgenetic alopecia; both of my grandfathers experienced severe baldness early in life and my brother has lost nearly all his hair. Until a year ago, I had a receding hairline and suffered moderately severe vertex baldness. Propecia/minoxidil/nizoral (2%) have significantly and remarkably filled in all balding areas! Many people have commented that I now have thicker hair than when I was a teenager.

My question is how often I should wash my hair for optimum hair growth/restoration? Using minoxidil 2-3 times daily does make my scalp oily, but this does not concern me as I often wear a cap. So much contradictory evidence makes this topic confusing. Your help would be much appreciated.

It’s reasonable to wash your hair once a day. Washing your hair isn’t going to cause more to regrow, but as long as your treatments are working, you should keep up what you’re doing.

Tags: hair washing, shampoo, hairloss, hair loss

Female Pattern Hair Loss Overview Published in Medical Journal

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

Snippet from the article:

Androgenetic alopecia affects both men and women. In men it produces male pattern hair loss with bitemporal recession and vertex baldness. In women it produces female pattern hair loss (FPHL) with diffuse alopecia over the mid-frontal scalp. FPHL occurs as a result of nonuniform hair follicle miniaturization within follicular units. Diffuse alopecia is produced by a reduction in the number of terminal fibres per follicular unit. Baldness occurs only when all hairs within the follicular units are miniaturized and is a relatively late event in women.

The concepts of follicular units and primary and secondary hair follicles within follicular units are well established in comparative mammalian studies, particularly in sheep. However, discovery of these structures in the human scalp hair and investigation of the changes in follicular unit anatomy during the development of androgenetic alopecia have provided a clearer understanding of the early stages of androgenetic alopecia and how the male and female patterns of hair loss are related.

Read the full abstract — Hair loss in women: medical and cosmetic approaches to increase scalp hair fullness

This is an interesting article published in the British Journal of Dermatology (December 2011) which covers the subject of hair loss in women. The recommendations in treatment suggest early medical intervention with drugs like spironolactone, minoxidil, and finasteride. When the hair loss becomes advanced, hair transplants work well if the hair in the occipital area (donor area) remains relatively unaffected by the process found in the balding area. The article also suggests women should use camouflaging agents to help give the appearance of thicker hair. There’s nothing particularly groundbreaking in here, but it’s a good overview.

Based on our experience at NHI though, unfortunately the donor area is often not spared in the woman with advanced balding so that the number of good candidates are limited. We have found that if the donor area has significant miniaturization, transplanting this hair to the thinning area often fails to give full benefits. Many women aren’t surgical candidates for this reason.

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

In the News – Online Campaign for Bald Barbie

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

Snippet from the article:

Mattel is being urged to mass produce a bald Barbie in order to make girls suffering from hair loss feel more attractive and to help children cope with hair loss among friends and relatives.

A Facebook campaign designed to encourage Mattel to produce the bald version of the popular doll now has about 6,000 “likes” on its page. The page states that such a Barbie would benefit girls suffering from hair loss due to cancer treatments, alopecia (an autoimmune disease causing hair loss) or trichotillomania (hair loss from pulling or twisting), as well as those who know a female experiencing hair loss.

Bald BarbieRead the rest — Campaign for Mattel to produce bald Barbie growing

Mattel did produce a one of a kind bald Barbie for 4 year old going through chemotherapy (see image), but they haven’t announced any intention to do a limited run, let alone a wide production run like these online petitions are asking for.

The article states that there’s also an online petition for a bald GI Joe action figure for boys experiencing hair loss.

Tags: barbie, toy, doll, bald, hairloss, hair loss

Close FUE Scars With Sutures?

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

Dr.Rassman/Dr.Pak,

Would FUE donor-area wounds closed by suture allow for relatively scar-free surgery, or would the procedure be simply too impractical and/or prohibitively expensive to carry out?
Thank you.

It would be prohibitively expensive and time consuming. Many people with densities of 2 hair/mm square or better will not scar significantly if the punch that the surgeon uses is 1mm or less. Some surgeons use larger punches and if the person has a low donor density, the scars will be evident as these two things are combined.

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

Mountain Climbing After a Hair Transplant?

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

How long after a HT do you think i would have to wait before i could climb 14,000 feet mountains again?

Give it a week or so, then whenever you feel ready after that should be fine! I generally tell people that they could even run a marathon a week after a hair transplant. One man thought that was great, because he never was able to run a marathon before he had a hair transplant.

Tags: hair transplant, mountain climbing, hairloss, hair loss

I Think I’m Evolving Into a Norwood 7 — Can I Get a Transplant to a NW3?

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

This site is great, and I’ve learned a lot from it.

My question is – I am a young man (mid 20s) thinning in what appears to be evolving into a NW 7 pattern, given a family history of NW7’s, and I am taking finasteride.

Is it possible/advisable to get a conservative hair transplant with a Norwood Class 3 hairline? I have accepted the fact that I will lose my hair someday, but I would like some hair in the front/top to frame the face, would such a course of action be advisable?

I’m glad that you’ve found the site to be a useful resource.

You might be able to get to that Norwood 3 hairline through surgery, but what you need is a Master Plan that takes the following into consideration:

  1. Your hair density
  2. The thickness of the hair shaft
  3. The present color of your hair
  4. The character of your hair
  5. Your response to the drug finasteride

With that information and a great doctor, the question can be refined with an appropriate answer catered to your needs.

Tags: hairloss, hair loss, hair transplant

My Hair Is Thin, Falling Out, and My Scalp Burns

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

My hair has been falling out in handfuls for over two years now. Not only is my hair falling out, but each strand is SO thin, it’s almost invisible. And my scalp burns as if it’s been rubbed with jalapeño peppers. I’ve been to three different dermatologists. All said it’s hereditary, even though no one in my family was bald or had hair loss problems. Two dermos put me on minoxidil (Rogaine). My scalp screamed in pain, so I stopped. Each attempt with minoxidil made my hair come out in handfuls.

Since tripping on this site, I’ve realized that my hair first started falling out when I began taking cod liver oil for my general health. Then I added Omega 3/6 supplements, salmon oil… and, most recently my naturopath suggested I take flax seed oil! My scalp pain is so bad, I’ve tried everything to calm the pain. Never did I consider that it might be the supplements. I also take high doses of D3, having recently switched to the gel caps, instead of tablets. I will stop everything and see if things improve.

Here’s the question: those who’ve had success growing their hair back, do you recommend taking biotin? Or should I stop that, too?

I’ve seen a few references to Nizoral. Is it better than Denorex or Selsun Blue, and if so, why? How long did it take for your hair to grow back after you quit taking the oil supplments? I’m desperate not only to stop the hairloss, but to end this agony with my burning scalp.

You may be asking the impossible from me. Short of a visit and a full hour consultation, I doubt that I can help you with a text reply. Actually, I’m not even sure that I could help after a full hour consultation. I don’t know enough about your medical history (or you) to have any idea what could be causing your scalp sensitivity/pain and subsequent hair loss.

The first step is to find a diagnosis for your hair loss and scalp pain. If you’ve been to two dermatologists and neither has been able to find a solution, keep trying until you can find a dermatologist with a solution. I wish I could offer more, but I’m at a loss.

Tags: hairloss, hair loss, scalp pain

My Hair on My Comb and in the Sink Seems to Be Miniaturized

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

I believe you have mentioned before that, at any given time, roughly 10% of the hairs on your head are in the miniaturized/resting state. For some time now, however, I’ve noticed that many, if not most, of the hairs gathering on my comb and around my sink appear to be miniaturized to some degree. Is this normal, or should I really start to be concerned? I’m currently 19 with no noticeable signs of balding.

Thinner hair shafts represent about 20% or less than the rest of the hair in most people. These hairs may reflect vellus hairs, not miniaturized hair. What you see on the comb and in the shower drain is probably miniaturized hairs reflecting the balding condition. You can find out for sure by getting a set of bulk measurements comparing the donor hair with hair elsewhere on your head. Why guess?

Tags: hair loss, hairloss

In the News – Baldness is Like Animal Shedding

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

Snippet from the article:

An animal shedding its coat at certain points of the year may involve the same science behind male-pattern baldness.

New research out of the University of Southern California found that not only is hair loss caused by the hormones in the hair follicles themselves, but also in the tissue surrounding the follicles. That is similar to animals that shed their coats, a routine occurrence triggered by the animals’ bodies.

“The hair-follicle stem cell is not only listening to the voice in the stem cell, but also from the outside,” Cheng-Ming Chuong of University of Southern California and lead author of the study told MyHealthNewsDaily Wednesday at the meeting of the American Society for Cell Biology in Denver.

The research suggests that new treatment should focus on the tissue around the hair follicles instead of just the follicles themselves.

Read the full text — Baldness Similar to Animal Shedding Coat

Tags: research, usc, hairloss, hair loss