I’ve Had Great Success with Finasteride, But Could Side Effects Suddenly Happen Over Time?

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

Hi Doc,

Had a question about finasteride…after all the scary stories, decided to take the plunge either way as hair transplants are not in my budget and am fairly young…been on it for 1.5 years now with great success (no regrowth but have seemed to stop at a norwood 3, and I was going pretty fast lol).

Anyways my question is this, do the drugs side effects increase with time, I mean by the looks of it until something better comes out, ppl have to be on this drug indefinitely ..if they want to maintain…and there are ppl like spencer kobren whose been on it for 20 years with great success…my question for you is do you personally have any patients who have been on the drug for such a long period of time, and if so how was their continued success/side effect profile

At the moment I am happy, stopped the hairloss and I decided to go with the science and not the crazy over blown stories on the net..but then again i’m paranoid too ,, you hear about people who had been on it for 6 years…great success no side effects and then boom after 6 years they are claiming ED, pain in the groin, shrinkage god knows what not…what are your thoughts?

Side effects from any drugs (including Propecia) usually are seen in the beginning and not after 20 years, but it is possible. I have seen many patients over the years and I do not recall anyone off hand who suddenly had a side effect after years of use.

If you don’t have side effect with a medication then leave it alone. If you think you have a side effect, speak with your doctor to make sure it is indeed a side effect and not an unrelated medical condition. In your case, I would just continue to enjoy the benefits of your halted hair loss.

Tags: propecia, finasteride, hairloss, hair loss

Not Hair Loss News – Type of Anesthesia Might Influence Prostate Cancer’s Return

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

Snippet from the article:

For men having prostate cancer surgery, the type of anesthesia doctors use might make a difference in the odds of the cancer returning, a new study suggests.

Researchers found that of nearly 3,300 men who underwent prostate cancer surgery, those who were given both general and regional anesthesia had a lower risk of seeing their cancer progress than men who received only general anesthesia.

Over a period of 15 years, about 5 percent of men given only general anesthesia had their cancer recur in their bones or other sites, the researchers said. That compared with 3 percent of men who also received regional anesthesia, which typically meant a spinal injection of the painkiller morphine, plus a numbing agent.

Read the rest — Type of Surgical Anesthesia Might Influence Prostate Cancer’s Return

Correlation does not imply causation, but the research is interesting.

Tags: prostate cancer, cancer, surgery, anesthesia

I’ve Seen Hair Loss Since Starting Birth Control!

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

Dear Doctor,

I am a 22 year old female who just started birth control four months ago. For the past month or so, I’ve been noticing hair loss, which I think I’ve identified as telogen effluvium. At first I didn’t worry too much about it, but I’ve become increasingly worried as I see more and more of my hair fall out and more and more of my scalp. The shedding seems to be diffuse, and I’m starting to see a few short hairs come in along my scalpline, but I’m still worried because I’m not sure the shedding is completely going away. I’ve been continuing with the same birth control pill, but I’m wondering if I should discontinue the pill. I don’t want to do any more damage to my hair than the pill has already done, and although I know this might be a long process, I’d like to do all I can to help it.

I saw my gynocologist, and she didn’t seem concerned at all about the hair loss. Do you think I should see a dermatologist or will this clear up by itself with time? Most of all I want to know if I should go off the medication or not. At 22 I want to make sure I get my hair back!

Thank you very much

The decision to go off or even start any medication should be made by you and your doctor (not over the internet). I have not examined you, but I will take your word that you are losing hair. While it is possible that your birth control is causing or contributing to the loss, you don’t know for sure if it is actually related. It seems that you have self-diagnosed telogen effluvium, but it would be in your best interest to establish or confirm this diagnosis before considering a treatment plan.

In general, telogen effluvium can cause hair loss for several weeks to months before it stops and there is no medication or products you can use to speed this along. If it is telogen effluvium, your hair will grow back and it can take well over a year for this to happen. But at this point you are speculating, so I would suggest meeting with another doctor to have a diagnosis confirmed.

Tags: telogen effluvium, birth control, hairloss, hair loss, female hair loss

Do You Think I Should Add Rogaine to My Propecia Regimen?

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

Dear Drs Rassman & Pak,

I’m 34 years old, white male with dark brown hair. I have been on propecia since age 29 for a thinning crown. My current results are in the photos attached. Results have been excellent, substantial reversal and the hair fall when I touched or washed. My hair ceased. I would like to know if you think adding rogaine would give even some minimal improvement in thickness and/or crown coverage, or if adding minoxidil could be harmful and damage my Finasteride results. I am aware of the compliance issues.

Thank you very much, any advice greatly appreciated. You may post these photos.

 

The photos you sent were basically the same, so I opted to just post one of them. The photo doesn’t really show me much, since I don’t know what I’m comparing it to. Lighting and hair style could play a role in what I’m seeing.

As I’m sure you know, Rogaine is an over-the-counter medication for treating hair loss. While some people have noted an initial shedding they experience, I would think if Rogaine harms the hair it would not last or be sold in the free market. If you want to add it to your regimen to treat hair loss, it is your prerogative. You can also discuss this options with your doctor. Many patients use both Propecia and Rogaine, and there should be no problem with using both if you have the time and commitment to each for a lifetime.

It would be ideal if you can have some baseline measurements such as a bulk measurement value or even a miniaturization study to document what you are treating or how effective the treatment is.

Tags: rogaine, minoxidil, hairloss, hair loss

Hair Transplant Rejection?

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

Hello doctor

Is is possible for transplanted grafts to be rejected months or years after a successful HT? If so how often and to what extent does that happen?

For men, the hair on the back of the scalp is considered permanent. It may thin a bit with aging, but even old men in their 80s, 90s, 100s will have hair at the back of their heads. So if you harvest the hairs from this permanent area, the transplanted hairs will act like the hairs on the back of the head and will have the same life span. This concept is called “donor dominance”. This is why hair transplants work for men. For women, it may be different and there is a small risk the transplanted hairs may not be as permanent as men.

Theoretically it is not possible for successfully transplanted hairs to be “rejected” years or months after it has grown, but I have seen a handful of patients over the last 20 years who have had transplanted hairs fall out. This may be due to a diagnosed condition such as DUPA (diffuse unpatterned alopecia) or other esoteric medical conditions.

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

I Have a History of Heart Palpitations — Can I Still Use Rogaine?

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

Hello, I am looking to use rogaine to regrow my hair. But before i use this product i have a history of heart palpitations and have had two episodes of atrial fib. I am 30 years old and am otherwise very healthy. the doctors never found anything wrong with my body to be causing atrial fib. my question is, can i use rogaine? and if not what can i use otherwise to stop my hair loss and regrow my hair

Thank you

Minoxidil (Rogaine) can cause heart palpitations on rare occasions, but with your history of cardiac issues, I suspect that your doctor can better advise you about whether it’ll be safe for you to use it. Please ask this question to your doctor.

I think you would be better off asking your doctor about Propecia (finasteride) to treat your hair loss. It is a prescription medication, and it doesn’t have the heart-related side effect risks.

Tags: rogaine, minoxidil, cardiac, heart palpitations

In the News – Australian Hair Transplant Clinic May Have Given Patients HIV

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

Snippet from the article:

Health authorities in Sydney are investigating whether patients of a hair replacement clinic have contracted hepatitis or HIV.

The Health Department says there’s evidence the clinic wasn’t properly sterilising equipment. But they haven’t been able to contact former patients because the department believes records have been stolen.

The Health Department says the risk of infection is low but numbers involved could be in the hundreds.

Read the rest — Hair replacement clinic may have given patients hepatitis or HIV

They are issuing alerts to patients of Dr Angela Campbell’s clinic that would have had a hair transplant between December 2010 and February 2013. The patient records went missing, so they don’t have any way of finding the patients to inform them.

Tags: australia, sterilization, hair transplant, surgery, surgeon

I Just Had a Transplant to the Front and Temples — Can I Use Minoxidil On the Crown?

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

I had a hair transplant five days ago, at the frontal area and the temples. But even though the problem there is -in theory- solved for now, my vertex area is starting to thin as well, but it wasnt so bad as to need an HT yet. So Im asking you can I use minoxidil at the crown, given that the new grafts on the front & temples are still healing? Is it going to affect them at all? I don’t want to let the vertex thing turn big while Im waiting for the transplanted hairs to grow.

I don’t quite understand why you didn’t ask your surgeon when you had face-to-face access just days ago. Even after the surgery, he/she is still your doctor and will be able to provide you with a better (personalized) answer. Don’t be afraid to contact your surgeon for questions about aftercare!

In general, we advise surgical patients not to use any products, including minoxidil, for a few days or weeks (it depends on the surgery). Even if your surgery was limited to the front, you run the risk of accidentally getting the minoxidil in the transplanted area. Your surgeon might have specific directions, so I would follow-up with them to find your answer.

Tags: minoxidil, rogaine, hair transplant

Questions About NHI’s Surgical Technicians

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

Dr Rassman

Do all NHI’s surgical technicians have valid, unrevoked, or unsuspended certificates/licenses?

Do they place the grafts in the receptor sites during HT surgery? And if they do, is the surgeon in the room all the time with his HT patient, supervising that process of grafts transplant?

Yes, NHI surgical technicians are highly trained and operate under the license of Drs. Pak and Rassman. There is no certificate or license in this field other than general medical assistance training.

The technicians do place the grafts. More importantly, all of our technicians receive specialized training at NHI and are supervised.

Tags: surgical technician, hair transplant, surgery

I’ve Been Losing Hair After I Bumped My Head

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

About 6 months ago, I was leaving my fiance’s house and hit the left side of my head really hard on the low overhang of her front door. I didnt think anything of it at the time because there was no redness, swelling or cuts, bruises, etc. A few weeks later, I was taking a shower at work and when I got out I looked in the mirror and my hair appeared dented in on that side of my head, almost a lopsided look.

As time went on, I started to get a burning, tingling sensation on that side of my head that spread to the back of my head as well. My hair started thinning on the whole left side of my head, even in the very back of my head. I still experience burning sensations on that side to this day and my hair hasnt gone back to the way it was.

Just last week, I was folding clothes in my spare bedroom and hit the middle right side of my head on a low light fixture and now I am experiencing the same sensations on that side and it really scares me! I am gonna lose all of my hair because I barely bumped my head on something?? I mean, really? Im very frustrated and have been online looking for answers. The only thing I can find is that it is maybe Telogen Effluvium, Scarring Alopecia, or Burning scalp Syndrome. I really dont know. I have an appt with a dermatologist in 2 weeks but would like an opinion from someone on here if possible. Thanks.

Some people might see some hair loss after a local trauma to the scalp, but I can’t explain how bumping your head would cause hair loss weeks or even months later, nor can I guess as to why you’re experiencing burning and tingling that is spreading. I am curious to know what your dermatologist comes up with.

Tags: hairloss, hair loss

My FUE Grafts Were Placed at a Weird Angle — Can This Be Corrected?

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

Hi doctor.

I have had two sessions of FUE hair transplant to my hairline and frontal with two different doctors in Europe, the first one of 1000 grafts in 2003, and last year additional 1000 grafts, total of 2000 grafts.

As I was still losing my hair, I wanted more density to my hairline and beyond it and close the angles which was left open. This procedure and doctor completely ruined my appearance by adding many large grafts in the hairline and just filling in the already straight hairline instead of making it irregular with single grafts. The two other main things that went wrong was the angle the grafts was set in, on one side of the hairline he inserted the grafts to follow the existing hair and this side I am happy with today. On the other side he did something that I still today dont understand, he must had a total blackout of some kind, he placed the new grafts pointing to my temple crossing my existing hair from the first procedure growing slightly back.

That makes my hair on this side problematic to shape as it is like a nest where the hairs are growing in all different angles, which leaves the hairline look unnatural and this side very strange in all.

My questions are:

– Is this a lack of skill from the doctor to place the insertions in this wrong and unnatural angle on this side?
– How to correct this in the best and easiest way?
– How to correct the multiple grafts in and the beyond the hairline?
– Should he do the repair for free or pay my money back so i can go to a professional doctor to correct me?

My doctor is only thinking about money and not his reputation by telling me that the result is natural and that I should be happy with my results. In my opinion he doesnt have the skills for this kind of work because its so big mistakes done by him.

The hair transplant surgeon has full control on the angle and direction of transplanted hair. If it was placed in an odd angle or direction (that does not look natural), it was due to the surgeon’s mistake. Unfortunately, you cannot correct the wrong angle or direction of hair after it has been transplanted. You can possibly have some repair work, but it will never solve your problem 100% and it will likely be very costly.

If you believe you had bad work and do not trust your doctor, why would you go back to the same surgeon?

Before you do anything, you should consider seeing another doctor for a second opinion to confirm if what you are describing is actually true. I do not know you or your doctor and I really cannot judge if your transplant was a failure. I am just going by your word.

Finally, this type of situation is the very reason why you need to choose a competent and skilled doctor. Not all hair transplant surgery is the same.

Tags: hair transplant, hair direction, surgery

Copper Peptides For My Itchy Transplant Scar?

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

I used minoxidil with no alcohol. Have had 3 transplants with a scar revision. My scalp periodically itches with dry skin flaking off. The scar line also itches at times. I typically use copper peptide solutions. You briefly commented once they can reduce redness after a surgery, but I do get a soothing effect if I apply the product to help the itching

1. Have your thoughts changed at all on copper peptides?
2. Do you they promote hair growth versus some soothing scalp effect?

Thanks Doc

1. In my practice, I use a copper peptide shampoo for the first week as an option for hair transplant patients. My practice and thoughts on copper peptides is not new or different.

2. It does not promote hair growth nor does it provide much soothing effect on itchy scalp. I do know that minoxidil can cause scalp irritation (even without any alcohol).

Tags: copper peptide, hair loss, hairloss, hair transplant

I Have Rheumatoid Arthritis and Lupis — And They’re Taking Their Toll on My Hair

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

I have always had very thick and long hair. However 15 years ago I was diagnosed with Rheumatoid Arthritis and 4 years ago with Lupus. The medications, rashes and the progression of the diseases has taken their toll on my body and my hair. Each time I comb my hair it sheds heavily. I try to limit the amount of heat I put into my hair, and my beautician deep conditions it every two weeks as well as lengthening the time between relaxers. Last visit, we discussed a small amount of weave to thicken it up because you can now see scalp.

I already see a Dermatologist for Lupus related skin problems. It seems when she corrects a skin problem, my hair benefits. However, when the skin problems reoccur so do the hair problems. Do you have any suggestions to help make my hair stronger?

I really can’t offer much help here. In general, if you treat the cause of hair loss, such as your lupis and RA, the hair will grow back. Treating the underlying condition will treat the hair loss.

Tags: lupus, arthritis, hairloss, hair loss

Inflamed Follicles?

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

Hello
I have a receding hairline with some pitted scarring and mild redness. My derm did a scalp biopsy. He said I have inflamed follicles and put me on antibiotics (minocycline). He said my hair loss isnt age related but I’m not so sure as I have what appears to be classic MPB. Have you heard of inflamed follicles causing a receding hairline and if so am I right to rely on the antibiotics and not use propecia?

Thank you for your help

If you want a second opinion, you need to see another doctor. This site is not a place for a second opinion.

If you were diagnosed with a infection, then an antibiotic seem to be a logical treatment. If you were diagnosed with genetic male pattern baldness (MPB), then it is a different story. Your doctor would be able to make that determination upon an examination of your scalp and hair.

Had you been diagnosed with MPB, then Propecia would be a good treatment to have a prescription for… but if you don’t have MPB, then Propecia isn’t going to help you. I don’t know enough information about you to provide much more. It is worth noting that genetic MPB is not an infectious process that causes inflamed follicles or scarring.

Tags: hairloss, hair loss, infection, antibiotic

Should I Apply Minoxidil After a Hot Shower?

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

1- is it good to use minoxidil after my scalp pores are opened by steam (should I use it after I take a hot shower)?

2- what is the best thing I could do to make minoxidil work faster and more effective?

thanks

1. In my opinion, hot showers or steam do not matter as long as you use the minoxidil as directed (twice a day).

2. The best thing to make a medication work is to use it as directed. One small study suggested that using a microneedling instrument before applying minoxidil did help some men see greater results, but I don’t have much direct experience with this method. You can read more about that study here.

Tags: minoxidil, rogaine, hairloss, hair loss