This is a review of a 20 year old patient who started to bald after he hit puberty. He was so devastated he actually skipped going to school for over a year. He shaved his head and tried to accept his genetic fate when he found out about Scalp Micropigmentation. After his transformation, he came back and gave all the staff a big hug.

I am about to undergo Chemotherapy for breast cancer and I have been told that I will lose my hair. Is there anything I can do to prevent this?

We have written about a device called the Cold Cap before HERE

Many patients over the years have written to us about the successful use of the Cold Cap at preventing hair loss from Chemotherapy. You can review our previous posts on the subject. For reasons unclear to me, I have been told that many cancer oncologists resist this approach under the analysis that if there is metastasis in the tumor, the reduction of blood flow to the scalp limits the amount of chemo-drugs to the scalp skin. The value of not loosing ones hair seems far more advantageous to a remote risks that were brought up by some opposing doctors.

I am a medical student and was wondering how finasteride works to give people a fuller appearance of hair.

In the Journal of the American Academy of Dermatology July 2006, Volume 55, Dr. Vera Price summarized the action of finasteride as follows:

“Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

This is important, because what she implies is that the miniaturized hairs reverse. That is why it is so important to map out the scalp for miniaturization and to perform bulk measurements with the HAIRCHECK instrument. These two approaches used prior to starting finasteride (Propecia) gives us a baseline metric to determine the value of the treatment. I have seen people with miniaturization in the 80% range, reduce substantially to almost normal levels (under 20%). This is why everyone taking finasteride should be evaluated prior to starting the treatment by a doctor who understands this process clearly.

Doctor can this happen on propecia. Ive been on it for 2 and half years with good results, maintained and thickened a bit, but my hair is weird. the first year on propecia it looked like it was getting worse, then into the second it started getting better over all. then again half way through the secong it looked bad again, and then a few months later it thickened again. I take pics, and that’s how I can tell. also there is a single hair that I excluded from the other hairs to follow and look at to see how it progresses, and to give me an overall picture on how the other hairs might be responding and growing. the last month or so that specific hair thinned and looked like it was gone, and then a few days a go I see It growing and thickening again. I know this is a weird email lol, but from you experiences does hair go through diff stages?

To be exact I started propecia in june 2013. from june 2013 to june 2014, it looked like I lost ground a bit, so I still stuck it with propecia. then around January 2013 my hair started looking good, and was thicker and the pics I took started to show a difference from the baseline. around april of 2013 my hair looked thin again and looked like I was reverting back to baseline. around august till about now my hair has looked its best. I started noticing new hairs sprout from the hairline that were not there before, and the looked so much thicker, and way different from baseline. its basically at its best. my question is why does it go through these stages? bad, good, bad, good, etc? is that normal?

Our hair will cycle and grow in different stages, so some hairs fall out while others grow from a stem cell that regenerates the hair follicle. You may be noticing some changes, but you cannot really say with scientific objective certainty what is really happening with just subjective observations or pictures. For example, dry frizzy hair in dry fall weather can make your hair seem voluminous, where oily damp hair in the humid summer days can make your hair seem flat and thin. Even different shampoos or hair products can affect how your hair may look and feel. For a more accurate analysis, we try to quantify it with measurements such as a miniaturization study and hair bulk measurements and compare the values on a yearly basis.

Finally, you need to understand that being on Propecia does not mean your hair loss will stop. Based on your genetic predisposition you will continue to lose your hair to the predestined hair loss pattern. Taking the medication (Propecia) means it will probably slow the process of hair loss down but each individual’s response to the drug is different. There may be some variations where you may notice less hair loss and more hair loss over the many months to years. We generally lose about 100 hairs a day (on the average), but this number is also highly variable with time for the individual. So I think what you are experiencing is likely normal.

Simply put, what you see may not reflect what is really happening. That is why we measure hair bulk with the HAIRCHECK instrument and also a microscope for a Miniaturization Study. The metric (numbers) what they instrument tells us, will allow us to compare a year ago to today and determine if you are really losing hair or not.

Dr. Rassman,

I have been a patient of yours for over three years now and I recently visited your office back in August. After seeing you again it was established that my hair loss had not progressed from last year and had possibly even improved. Unfortunately, over the past month, I have been experiencing non characteristic loss. When I am in the shower, I have never ending clumps of hair coming of my head and clogging the drain. Also, when brushing my hair there is even more loss. Dr. Rassman, this has never happened before and I have no idea what to do. Is it possible that the Propecia that I have been taking since November of 2005 has stopped working for me and my genes are taking over?

All of the loss has been occurring since I have been out of town on a job. I seem to even have some kind of infection on the corners of my lips. I am sure the two things are not related, but I figured I would tell you.

Anyway, is this a normal experience for someone on the drug as long as I have been? Should I take more of it? Is it possible for a person to lose all of his hair immediately? Could this be a possible hair cycle or allergy? Again, I have no idea what to do and what to expect. I appreciate you taking the time to read this and your advice/help would be greatly appreciated.

Thank you and looking forward to hearing from you soon!

Hair loss can increase from stress amongst many other things, such as the normal progression of hair loss that occurs in some men (even those on Propecia). As one of my patients, please come see me and let me see if your miniaturization has increased. We can get a baseline on the HAIRCHECK instrument by measuring your hair bulk now and then repeat it in a year to see, for future purposes, if you are continuing to lose your hair.

QUESTION FROM THE PAST
I have been taking Propecia for just under a year with really no ill effects, and some good results. But in early November 2006 about 5 weeks ago I noticed discomfort and some swelling in my right nipple. I had a sonogram and was put on two different antibiotics for one week, each to no avail. The doctor thought it was mastitis or a staph infection. I had blood work done and all appears normal. I spoke with a surgeon today and he said I had Gynomastia and needed surgery next week. I want another opinion.

Can I simply stop using propecia and substitute with another treatment? Must I have the surgery? Please help thanks