Why Am I Getting Chest Pains and Difficulty Breathing from Minoxidil?

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

Dear Dr. Rassman,

For 2 years I’ve take minoxidil 5% and experienced chest pain and difficulty in breathing twice previously. Both times it happened when I mixed minoxidil with retinoic or azelaic acid and used a little bit too much acid. The first time it lasted like 3-4 days. I had chest pain, difficulty breathing, rapid heart etc.

And today, when I came home I was a little bit tired, I hesitated applying minoxidil (I use rogaine foam in the morning, kirkland in the evening). Firstly I applied azelaic acid (drug name Azelderm, %20 azelaic acid) and then the daily dosage of minoxidil to the crown area. After 20 minutes I had side effects. This is rare, only the 3rd time in 2 years. I urgently washed my hair in order to send away the minoxidil and dried it and then I went to the hospital. My blood pressure was 12/7. It was ok and the heartbeats were ok. 4 hours after applying it I feel better, but still some heart pain.

Why does this drug causes chest pain and difficulties in breathing even though my blood pressure is ok? If you have an opinion I’ll appreciate it, thank you for everything.

Minoxidil applied topically shouldn’t cause chest pain in most cases, though if you are experiencing it, I suspect your body is absorbing too much of the medication. Your chest pain sounds more like a heart attack / unstable angina type of pain. I would take this seriously and go see your doctor or go to your local ER to get your heart checked out.

Even if you still believe your chest pain is related to your minoxidil use, you cannot afford to not rule out that your chest pain can be an underlying serious condition.

Tags: minoxidil, rogaine, chest pain, hairloss, hair loss

If My Father is a Class 5, Will I Have at Least That Same Pattern?

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

hello doctor

is it likely for young balding men to have a more severe pattern of baldness or does it depend on their genetics? i’m 24 male started to lose my hair at 21. my father and my uncle are norwood class 5. Am i likely to follow their pattern or have more severe pattern? thank you

You could follow a similar pattern, or you could have a more severe pattern, or you could have a lesser pattern. There’s just no way for me to know what your end balding pattern will be just based on what your father and uncle have shown.

Tags: hairloss, hair loss, genetics

Since My Hair is Short, Would My Propecia Regrowth Results Come in Faster?

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

Hello Doctor,

I have a question that I don’t think you’ve gotten before, it has to do with when I should expect to see results with Propecia.

I understand it takes about 6+ Months to start to see results, I assume time line is meant for people with average length hair. However; I have very very short hair, I crop it pretty close. Since my hair is short enough that mere buds would be noticeable…when do you think I should start to see new hairs?

How long would it take for the budding hair to just start to show itself on an almost bald head?

LawnFirst, hair length won’t make the hair regrow faster or slower.

Propecia doesn’t always grow new hair, though it can thicken existing miniaturized hair. If your hair is short, I suppose you will be able to see new hairs (if there are new hairs that grow)… but I doubt you are that observant to see a few hairs out of thousands of existing ones. It’s like trying to see new grass grow from an existing field of grass. Long or short, it would be pretty hard.

If Propecia is really working, you will see it overall in your appearance, not at the individual hair level.

Tags: propecia, finateride, hairloss, hair loss, hair length

Facial Surgery Required Me to Take Steroids, But I’m Worried About Hair Loss

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

Six ago I had follicular hair transplant surgery for female pattern baldness. The procedure worked really well. Two days ago, I had orthagnatic surgery to correct an extreme under bite on my lower jaw. While I was at the hospital, they started me on a short term dose of heavy steroids, to combat facial swelling. I didn’t want to take them, but was sort of out of it and couldn’t remember that steroids have always caused hair loss for me in the past. Should I stop the steroids immediately? I’m panicked. I also have a laser comb. Do you think the laser comb can couteract the effects of the steroids? I’d appreciate any advice you have.

I would follow the advice of your doctor. I am not your doctor. In general, steroids can cause hair loss, though they don’t always cause hair loss. Your doctor will explain this to you and give you a better balance of your personal risks as well as benefits. The internet is a horrible place to find personalized medical advice, as you will likely end up more confused with general information that may not fit your own personal issues.

As for the LaserComb, I wouldn’t put too much hope into that achieving anything.

Tags: lasercomb, steroids, hairloss, hair loss

My Child Had Hair Pulled Out By a Toy 6 Months Ago

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

My 2 1/2 year old son had his hair pulled out by a toy. He has now turned 3 and his hair has not grown back. The scalp appears to have extremely fine hair that is growing and a maybe five strains of normal hair. Does this mean his follicles are damaged and the hair will never return?

I do not know. Your son may have had a traumatic traction hair loss and it may never return, but you really cannot tell if the hairs will grow back until one full year has passed. Give it a bit more time to regrow.

Tags: hairloss, hair loss, child

What Is Hair Pitting?

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

What exactly does hair pitting mean and how is it caused and is there any way to fix it?

I believe what you may be asking is the possible scarring that occurs after a hair transplant. It should not happen with modern day hair transplantation, but I still see it on occasion when patients come in for a consultation.

The “pitting” you are referring to is just what it sounds like: an inward indent into the scalp – a pockmark on your head about 1/8 inch in diameter (or more). This happens when the surgeon or the staff is inexperienced. It can also happen if the patient does not heal very well. Or even a combination of both.

You really cannot fix it completely. Some have tried steroid injections, dermal fillers, or even micro-abrasion, but in my experience it never really works the way you intended and patients are left dissatisfied. The best advice is not to get yourself into a situation where you may end up with pitting. To start, you should research whichever surgeon you decide to go with. Don’t go bargain hunting for cheap surgery, because like a bad nose job, it will stand out and you’ll end up spending years and spending thousands of dollars trying to fix it.

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

I Wore a Hat After My Transplant and Some Grafts Fell Out

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

hello doc, I have two questions

I had a hair transplant 5 days ago, and in that time I have been wearing a hat. I just realized that my hat was breaking off a few transplanted grafts. When I look closely the stub of transplanted hair is still in my scalp but the rest of it has broken off. Do you think I killed my grafts this way?

Also, I washed my hair the day after my HT procedure but then i read somewhere that I wasn’t supposed to wash it for 3 days. Could washing my grafts with a sponge and water next day after HT damage the grafts completely?

Thank you for your time

Please follow up with your doctor on aftercare instructions. Every doctor is different with the post-surgical care. I do not now what you really did or if the grafts were actually lost. I’m not sure what you should be doing after your surgery, as I was not your surgeon and don’t know anything about your procedure or case.

In general, most patients (at least here at NHI) wash their hair the next day and wear loose hats without an issue.

Tags: hair transplant, hat, hairloss, hair loss

In the News – Brazil Senate President Used Air Force Jet for Hair Transplant Travel

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

Snippet from the article:

Renan CalheirosThe president of Brazil’s senate, Renan Calheiros, will repay the cost of using an air force jet for a trip during which he reportedly had a hair transplant, his spokesman said Tuesday.

“The president is to repay the costs of this flight. He is waiting for the air force to calculate the bill before doing so,” he said. “I don’t know if the president has had a hair transplant.”

The Folha de Sao Paulo newspaper had reported that Calheiros had flown 1,980 kilometers (1,230 miles) from Brasilia to Recife to have 10,000 hairs implanted while purportedly on a business trip.

Read the rest — Brazil senate chief to repay ‘hair transplant’ flight

Corruption in politics? Unheard of!

Tags: calheiros, hair transplant, corruption, politics, politician, brazil

I Appear to Be a Norwood 6 or 7 at Just 21 Years Old

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

I have been losing my hair since age 15, I am 21 now. My hair loss pattern appears to be NW 6/7 and I have lost significant density on sides and back as well. I have three older brothers and none of them has any visible hair loss. My dad lost his hair only in his 40s. I am thinking about getting my blood checked. My question is that the deficiency of what elements in blood cause hair loss?

I am going to ask the clinic to include the details about the potential hair loss causing elements in blood. So, Please provide the list of all those hair loss related elements in blood. Thanks

Norwood 7The diagnosis of male pattern baldness is made with a physical exam, not a blood test. Blood tests are used to test for other illness that can cause diffuse hair loss (not patterned hair loss).

Male pattern hair loss can start as early as puberty, and in general, the men who go completely bald to a Norwood 6 or 7 pattern will notice their balding by their early twenties. While possible, it is rare for men to go bald all of a sudden in their 50s.

The “element” that causes male pattern (Norwood 6/7) balding was sealed when you were created 21 years ago in your genetic make up. It is genetic.

Tags: hairloss, hair loss, genetics

Any Info About Spironolactone Cream for Treating Hair Loss?

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

What do you know about the spiro cream being touted all over the Internet as a DHT inhibitor for men and women?

I have stated in past posts that topical spironolactone probably does not work for treating hair loss. Spironolactone in (real world) practice does not solve the hair loss problem from its touted anti-androgen property, which is more theoretical in my opinion. There’s no conclusive evidence that I’m aware of.

I realize some doctors and commercial websites will market this as an anti-hair loss medication, but I personally have not used it in my practice.

Tags: spiro, spironolactone, hairloss, hair loss

Not Hair Loss News – New Tool to Determine Risk of Prostate Cancer Overdiagnosis

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

Snippet from the article:

Studies have found that prostate cancer is over-diagnosed in up to 42 percent of cases, prompting men to receive unnecessary treatment that can cause devastating side effects, including impotence and incontinence.

Now, researchers at Fred Hutchinson Cancer Research Center and the University of Washington have developed a personalized tool that can predict the likelihood of prostate cancer over-diagnosis. They announced their findings this week in the online issue of the Journal of the National Cancer Institute.

An over-diagnosed cancer is defined as one that would never cause symptoms or pose a risk to the patient, therefore not require treatment. Treatment of such cancers provides no benefit and can only cause harm. The researchers created a nomogram, a graphical calculating device, that incorporates a patient’s age, prostate-specific antigen (PSA) level and Gleason score — which grades prostate cancer tissue based on how it looks under a microscope — to determine the likelihood that screening-detected prostate cancer has been over-diagnosed.

Read the rest — Researchers Develop Tool to Determine Individual Risk of Prostate Cancer Overdiagnosis

Tags: prostate cancer, cancer, diagnosis

Measuring Density with HairCheck

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

Dr. Rassman

Thanks for all the information on your blog. Im 29 years old male with thick head of hair but was wondering about the Haircheck device. My dermatologist that I see every year looks and examines my hair and says its good with no signs of male pattern baldness or thinning. He told me that everyone has different hair patterns. Sometimes your hair transition from the front different which I have a frontal hair whorl which makes my hair go different directions.

You are always talking about the Haircheck device to get your bulk test done. I was wondering what is considered normal hair density for your hair not to be considered hair loss or thinning (male pattern baldness)? Is it 5% or 8% or below that? I now that you have to measure the back donor hair to get a good reading for the rest of the hair. Every video I’ve also seen of the Haircheck device they tell you to measure in the middle of the hair and the video shows it too. If you measure it from the hairline would your hair density be a little different than back even without male pattern baldness? If you do have 10% percent difference in the front or hairline than the donor hair in the back does that mean you’ll definitely be bald there or thin out there or could it stay like that the rest of your life possibly?

Thanks for your time and hope to hear back from you soon! Sorry if too long! Have a good Holiday!

Hair loss can be a very subjective thing. Measuring how much you are losing or gaining over a period time can be an issue if you do not have an objective metric. Using pictures with constant lighting may be good, but even with the same haircut and same hair style, subtle changes in angle and light can make your hair look better or worse. Thus using photos are a very subjective assessment.

We try our best to be objective by putting a value / number to things we can measure. We use miniaturization studies to give a general understanding of what is going on visually at the microscopic level, as the more miniaturized hairs you have, the more active your balding process is. Perhaps one day there will be a machine to count every single hair on your scalp with an analysis of the miniaturized hairs to good, healthy hairs

We also use the bulk measurement studies to estimate the bulk of hair at different parts of the head in a given fixed area. But all these tests have their issues and limitations. Bulk measurements can be inaccurate if you have gel or other products in your hair, giving a false high value. They also cannot be done if your hair is too short, as we can’t “grab” a portion of your hairs to fit in the caliper.

We do not measure the hairline necessarily, because we use microscopic assessment in the leading edge of a hairline. The HairCheck instrument usually measures an area behind the hairline. If you really want to measure the receding hairline, just get a tape measure and mark out the relative distance from a fixed point (such as your eyebrow or tip of your nose). Bulk tests are mainly used to compare the donor (back) hair against areas on the top and front of your scalp.
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What Do You Mean By Finasteride Slowing Hair Loss Down?

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

I understand that finasteride can stop hair loss or slow it down. When you mean slow it down, does that mean instead of permanently losing 10 hairs a year you only lose 5 for example. How slow does the hair loss really become on finasteride in terms of numbers and actual hairs lost? Thank you.

There is no absolute cure for genetic balding. Taking a medication like finasteride (Propecia) slows down the hair loss. Perhaps it is best explained with the graph where you see a group of men who never took Propecia (the placebo group) to another group who did take the medication. The group that took Propecia collectively have less hair loss.

Unfortunately, I don’t have the actual data, but the visual graph should be helpful. Click to see the larger size:

Propecia

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

Do Propecia and Minoxidil Operate in Cycles?

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

Hello Dr Rassman, thank you for this amazing blog of stable information.

I am a 23 year old male, thinning in a NW 3V pattern with diffuse hair loss on top of scalp with a NW 6 final pattern (had my miniaturization check). However, I look like I have dense NW 2 hair with proper styling (caught it very early). I have been using minoxidil and propecia for 7 and 9 months respectively, and had fantastic results since then. My shedding had almost completely stopped and I had a significant increase in density and regrowth.

However, since the beginning of last month, I have been experiencing a horrific process of shedding, almost more than 300 hairs everyday. Obviously this upset me after seeing such good results during the previous months, but I did notice the hairs I shed are very small (both in length and width) and miniaturized, and the general appearance of my hair has not altered so much during this intense period of shedding (have photographed my hair during the process, derived this result from comparisons; unfortunately bulk measurement is not available in where I reside).

So my question is as follows; does medicine like propecia and minoxidil (medicine with the potential of regrowing hair) operate in cycles? Are my small hairs shedding in order to make way to healthier, thicker hairs? Can some of the miniaturized hairs be effected after 8-9 months into the treatment? Or the first shedding period effects all the miniaturized hairs at the same time and the process of regrowing hair is a smooth transition which does not include a secondary shedding phase? This is the second shed that I am experiencing since beginning the medication, and I have been unable to find any other credible information similar to the matter.

I have been to my dermatologist (who specializes in hair loss), but he has only told me that shedding waves with types of medicines occur sometimes and I should not worry about it. Don’t get me wrong, I do understand that medical solutions are almost always temporary, and I accept the fact that I will go bald eventually. I am only curious about what I am experiencing, as these drugs are supposedly most effective after the 1 year mark. I wonder whether you have seen something similar in your practice throughout the years?

Thank you very much in advance.

I’ll break your questions out to make it easier to answer —

1- Does medicine like propecia and minoxidil (medicine with the potential of regrowing hair) operate in cycles?

    ANSWER: Probably not

2- Are my small hairs shedding in order to make way to healthier, thicker hairs?

    ANSWER: I doubt that is the case

3- Can some of the miniaturized hairs be effected after 8-9 months into the treatment? Or the first shedding period effects all the miniaturized hairs at the same time and the process of regrowing hair is a smooth transition which does not include a secondary shedding phase? This is the second shed that I am experiencing since beginning the medication, and I have been unable to find any other credible information similar to the matter.

    ANSWER: I rarely see shedding with either minoxidil or Propecia. Shedding this far into treatment might mean that your hair loss is now into a more aggressive phase, or you are developing a refractory state when it comes to one of these medications.

You will have to wait it out. Sorry, I can not help you.

Tags: hair loss, hairloss, propecia, finasteride

Proteins, Vitamins, and Minerals That May Help to Prevent Hair Loss?

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

Dear Dr Rassman,

I just finished reading the “Hair Loss & Replacement for Dummies” which was very informative and interesting reading. In chapter 9, there are references to suggested intakes of daily proteins, vitamins and minerals that may aid in hair loss prevention. Can you recommend some over the counter supplements that would contain the daily recommended dosages without having to use several brands at the same time?

Secondly, if there is no one type brand that supplies all the recommended proteins, vitamins and minerals, which ones and what dosages would you recommend to take on a daily basis?

Thank you in advance

Vitamins and minerals may be good for the hair, but it will not reverse or regrow hair for those with genetic balding. I do not have a specific brand of supplements I recommend; however, I found that many patients seem to take prenatal vitamins since they’re a good source of vitamins and minerals and a low cost alternative than the branded “hair vitamins” (and they are OK for men).

Despite what is advertised, there is no specific vitamin or mineral that is targeted for hair.

Tags: vitamins, minerals, supplements, hair