Ever Since I Moved to a Place with Hard Water, My Hair is Getting Damaged!

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

I’m 31 years old. For the past year I’ve been in an area with hard water. It’s damaged my hair. i’ve got 50% of hair loss, lost shine, itchy scalp weak roots with white bulb at the end, and my hair comes out easily as i put my fingers or comb. Also from the front my hair breaks. New hair have started to grow which looks really bad. Please tell me something to mix in water and to use!

There are water softeners you can buy, which will soften the water. Hard water can make washing and styling very difficult. Hard water likely didn’t cause 50% of your hair to fall out, though. Have you seen a doctor about your hair loss or are you just speculating on the cause?

I did note that the internet seems to have many shampoo offerings for those with hard water, however, I have little experience in this area. You might try washing your hair with bottled water that is not hard and comes from a reliable source.

Tags: hard water, hairloss, hair loss

Can I Take My Thyroid Meds and Propecia At the Same Time?

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

Is it safe to take my prescribed thyroid medication (desiccated) and carbamazapine (seizures) at the same time I take propecia?

Would two hormone affecting drugs (thyroid & propecia) taken together interact. Or carbamazapine interact?

Thanks for the website.

I don’t know of any interactions between desiccated thyroid, carbamazepine, and finasteride. You can probably take them at the same time, but you should discuss it with the doctors that prescribed the medications to play it safe.

Tags: thyroid, carbamazepine, finasteride, hairloss, hair loss, propecia

Can I Shave My Head Right After a Hair Transplant While I Wait for Growth?

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

Would a patient be able to achieve a shaved head look straight after a transplant? By this I mean, once the scalp heals do the transplanted follicles look like shaved hairs until they start growing properly or are they invisible? I wouldn’t mind having a shaved head until they started growing if this is the case- as long as it looks full!

You can shave your head after a hair transplant, but you have to be careful until all of the scabs fall off and the donor scar is healed. If you wait until the scalp heals, the scabs will be gone by then.

There will likely be redness in the recipient area, which may make a very short hairstyle something you won’t want to do, but each person is different and the redness could subside quickly if you’re not histamine positive.

Transplanted hair may appear thinner when first growing, but after 9-12 months or so, it should look just like the hair in your donor area.

Tags: hair transplant, shaved head, hairloss, hair loss

My Last Hair Transplant Was Over 2 Years Ago and the Scar is Still Pink

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

Hi,
I have had 2 successful transplants, the last being about 28 months ago. My scar is still a light pink colour. My scars usually take a long time to fade, so I think this is probably normal for me. Is it possible to use lasers get the scar to fade as I would like to get SMP into the scar. Or alternatively, can you get SMP and then reduce the scar redness with lasers, or would this likely cause the SMP dots to fade too?

Thanks!

If you let your hair grow out to a reasonable length, the pink color of the scar will be covered. That’s the easiest solution, really. Was your scar pink for a long while after your first hair transplant?

You may just have to wait it out. You can try topical hydrocortisone (a small dab spread over the scar) for up to to 7 consecutive days, then pull back for two weeks and try it again. This might work to lessen the pinkness.

Tags: scarring, hair transplant, hairloss, hair loss

Can I Liquify the Rogaine Foam?

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

Can you tell me if this could prevent minoxidil from working? Liquify the foam so you can apply it with a dropper. Fill the cap with foam. Hold the cap in a glass that’s filled with hot water. The foam will melt. Then apply with a dropper.

I do this because I get irritated by liquid Rogaine and I find that the foam doesn’t reach properly the scalp.

I haven’t heard of this being done before, but I’d think that this is a reasonable solution to your problem.

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

Does Spironolactone Lotion Treat Hair Loss By Reducing Scalp DHT?

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

Hi Dr.Rassman,
I am 27 years old suffering from male pattern baldness for over two years. I want to know whether spironolactone lotion (used on the scalp) really works as some of such brands said:

(1). Spironolactone significantly reduces the amount of DHT in the scalp by inhibiting the conversion of precursor steroids to DHT.
(2). Spironolactone reduces DHT in the scalp by converting localized testosterone into estrogen, which is thought to be protective of the
hair follicles.
(3). Spironolactone blocks the follicular androgen receptor sites, thereby rendering any residual or circulating DHT harmless to the hair follicles, and it doesn’t have such side effects as Propecia; and whether it is widely used in treating with male patten baldness.

Thanks for the your answer!

Spironolactone is generally used for treating high blood pressure. While I realize there is a theoretical anti-androgen property associated with spironolactone, there is no conclusive evidence that it really works to re-grow hair. I also realize that many doctors may prescribe spironolactone for hair loss as an “off-label” use, but I personally do not see (or have seen) any benefits from it.

In conclusion, it is still a “buyer beware” mantra that I maintain. It’s also worth noting that Spironolactone has its own list of side effects.

Tags: spiro, spironolactone, aldactone, hairloss, hair loss

If I’m Starting to Lose Hair, Could Coloring or Straightening It Cause More Loss?

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

I’ve been slightly balding in front of my head. is it ok to straight and color my hair?? would it cause more hair to fall out?

Coloring and/or straightening the already weakened hair can cause significant hair loss. I recall a patient that bleached his hair for years when he started seeing hair loss (less contrast between his hair and skin), but the bleach wasn’t doing him any favors.

If you’re at the early stages of hair loss, you should see a doctor about a prescription for Propecia to try to keep your loss from advancing and strengthen the miniaturizing hairs.

Tags: hairloss, hair loss, color, chemical

How Should I Store Cut Finasteride Pills?

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

I know that with regard to cut up 5 mg finasteride pills, you recommend that pills are only cut up one at a time, to avoid excess hydration of the pill fragments with vapour in the air.

I have a question about the storage of the three pill fragments each time a pill is cut (assuming it is cut into quarters). Right now, I just leave the pill fragments inside the pill cutter, but would it be more effective to store them in an airtight container for three days? Or does it not make a considerable difference, given the short timeframe of storage?

Thanks.

It might not make that much of a difference if you’re cutting one pill at a time (which is what you should do), but I would err on the side of caution and store the fragments in an airtight pill bottle.

Tags: finasteride, pills, storage, propecia, proscar

Walgreens Sent Me Generic Propecia!

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

Hello Doctor,

I’ve always enjoyed reading your blog. Thanks for sharing your knowledge.

I’ve been getting my Propecia delivered in the mail via Walgreens for quite some time. I’ve always taken the Merck brand, but was surprised to see my refill was something called “Dr. Reddy’s Finasteride” made by an Indian company. The cost for 90 tablets was $183, which seems a bit high for generic.

Walgreen’s never notified me that they were changing my prescription from Merck to Dr. Reddy. Also, I’m concerned with the shipping of this product overseas and the possible very hot climate in transit. If the temperature in transit were to get into the 90’s or higher, it could be problematic for the medication.

I’d love to hear your opinion on this new generic brand that seems to be out on the market and what we should expect as a cost for a generic version. Thank you!

We previously wrote about the generic Propecia finally being sold in the US in a couple of posts —

The cost will remain on the higher side for at least 6 months, because Dr. Reddy’s has an exclusive window to sell the generic 1mg finasteride. Once other manufacturers are able to sell their generics, I would expect the price to come down.

Dr. Reddy’s is an Indian pharmaceutical company, but they do have manufacturing facilities in the US (I’m not sure which facility their finasteride is made in, though). I would think safeguards are in place during shipping of medication to maintain proper temperatures in transit, and everything that they do is over-viewed by the FDA.

Tags: finateride, generic, propecia, dr reddys, hairloss, hair loss

Propecia Maintained My Hairline for Years, But I Noticed More Side Effects Over Time

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

I’m a male in my late 20s. I’ve been using Propecia successfully for almost 5 years now to maintain almost a teenage hairline. I had noticed the very beginnings of temple hairloss at age 24 and started the regimen. Over time i’ve noticed more and more side effects (whether directly attributable or not, who knows). They are enough of an issue that i’ve decided to go off the drug.

I assumed i would be able to get 2 or 3 hair transplants from a reputable surgeon over next 5 years to ensure that my hair will still look decent. However i’m now reading that hair transplants don’t work in my situation because it causes more hair loss than it fixes. Is this true? Any guidance would be appreciated. Thanks.

The best guidance I can provide is that you seek a consultation with a hair transplant surgeon for a better personalized assessment and a Master Plan.

Having a hair transplant does not mean you need to be on Propecia. Many patients undergo a hair transplant without taking Propecia. You do run the risk of shock loss without the medication, but your surgeon will be able to explain the pros and cons of a hair transplant (and determine your candidacy).

Tags: hair transplant, hairloss, hair loss, propecia

Could Low Testosterone Be The Cause of My Hair Loss?

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

Hello doctor! It’s more or less been five years that I’m having some different negatives psychosomatic symptoms: tiredness, spine ache, depression and reduced sexual pleasure. I’m thinking that they could be caused by low testosterone. The problem is that at the same time, I’m having moderate hair loss. The question is: could a lack of testosterone cause my hair loss? Thanks.

Low testosterone could lead to hair loss (because androgenic hair loss in men is due to the genetic predisposition not the hormone level), but I couldn’t say if that is the cause of your loss. Stress could also cause hair loss (if it is in a non pattern/ diffuse), and the stress could be brought on by your psychosomatic issues.

Tags: low testosterone, low t, hairloss, hair loss

I’m 59 and When I Comb My Hair Back My Hairline is Uneven

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


Doctor

I’m 59 and If I part my hair you wouldn’t notice thinning, however I like to comb my hair back and recently you can see the uneven hairline you see with thinning in addition to seeing the thinning which actually makes a broken nose look bigger. I can see how something like 300 grafts would solve it. Am I just being too vain?

I guess solve isn’t the right word ’cause i assume thinning will continue. And more procedures may be needed every couple years. Is that a correct assessment?

In a man of your age, I would expect that the progressive hair loss has already stopped and a hair transplant could solve the problem. I am not sure that 300 grafts would do the job, but I suppose it depends on how uneven your hairline is and what you want changed.

To determine what you need and balance it against what you want, you need to meet with a doctor to determine what your goals are. What I generally do is draw a line for the proposed hairline, estimate the ‘gap’ between this drawn hairline (we decide together where this line is). Then I figure out how much hair it would take to fill in the area behind the drawn hairline to where your existing hairline is.

You are not vain. Everyone has an image of what they would like to look like and you are no different than most men. I had a hair transplant last year (age 70) to fill in a balding crown with great results. You can see photos from that here.

Tags: hair transplant, hairloss, hair loss, hairline

Proactive Hair Transplants

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

My question is perhaps unusual but I feel it is a valid one. I am 33 and I have been experiencing slow diffused thinning over about 7ish years. My thinning started to show in the top of my crown and slowly moved towards the mid and front. I have had no hairline depletion or recession at all.

So I have been on finasteride for about 4 months now. I also had a procedure at another clinic and had a 1.25cm*33cm strip taken and I have high density especially in the back. Anyway, grafting was done basically over the class 6 sort of layout with a back up hairline behind my current one. My total hair count was approx 7,500 hairs. I do have coarse black hair that becomes wavy when long.

Here’s my concern, though I am no where near my final result, what is the merit to doing another say more proactive procedure? That was my original plan but I mean almost in anticipation of the class 6 coming to full reality in my lifetime. Proactive grafting. Thank you in advance, you advice is greatly appreciated.

Finasteride is the best approach to your future concerns. At only 4 months on the medication, you’re not likely to see much results-wise from it, but stay the course. You could avoid surgery by taking a pill.

I am not an advocate for proactive or preventive hair transplants. My 9 months old granddaughter has a relatively large bald spot on the back of her head. I tease my son about transplanting it, but that is only a joke in a hair transplant family.

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

I’m 30 Years Old and Not Much of a Beard — Could Finasteride Slow My Facial Hair Development?

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

Dear doctor, I am 30 years old and development of my secondary sex characteristics was always far behind persons of same age. My beard is still not fully developed, I have hairs around my chin and under nose, but almost nothing on cheeks and around ears. I have first noticed starting hairloss about the age of 28 and I started with finasteride treatment. Could this drug affect my beard developing and slow down this process yet more?

Finasteride does not affect beard hair. I wouldn’t expect you to finally start growing a beard at 30 years old (with or without finasteride). Some men just have patchy facial hair, and that is your genetics.

You can consider doing a hair transplant to your face where the beard is not present if it’s bothering you that much.

Tags: finasteride, propecia, beard, facial hair

Predicting a Final Hair Loss Pattern?

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

Hi Doctor,

I was wondering about predicting final patterns. You’ve explained how this is done by using the densitometer to check for miniaturization in areas where thinning might not be visible to the naked eye. You’ve also said that final patterns usually cannot be predicted with certainty in young men (say, a 21-year-old) because miniaturization could subsequently appear in new areas.

So, I was wondering, is there a particular age at which one’s genetically-programmed final pattern can be ascertained with reasonable confidence? (I realize that people don’t necessarily reach their final patterns.)

Also, do people who are Norwood 3V’s at young ages usually turn into Norwood 6’s? (I was told this.) Or is their hope that Norwood 3V/4/5 could be a final pattern for such a person?

Thank you for all of the amazing information.

Norwood 3VI don’t believe you can predict your final pattern with absolute certainty, especially in your 20’s. In general, we will say that as you get older into your late 30’s to 40’s, the pattern should manifest. There’s no exact age I can pinpoint.

If you have a Norwood class 3V pattern (see diagram at right) as a 21 year old, these may enlarge with time and could end up as a class 4 pattern. I don’t know that a young man showing a 3V at the present time will usually advance to a class 6.

We try to better assess this with bulk measurements and miniaturization studies.

Tags: hairloss, hair loss, patterns