Government Study Comparing Finasteride, Dutasteride, and Placebo

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

https://clinicaltrials.gov/ct2/show/results/NCT01231607?show_locs=Y&sect=X430125&view=results#othr

 

ClinicalTrials.gov Identifier: NCT01231607

Recruitment Status : Completed

First Posted : November 1, 2010
Results First Posted : October 4, 2012
Last Update Posted : August 10, 2018

Sponsor: GlaxoSmithKline

Dr. Rassman’s Comment:  I want to call your attention to the chart below, which discusses sexual side-effects between these medications and the placebo. To find out the real incidence of the Libido and Erectile Dysfunction problems from this study, you must subtract the placebo numbers. If this is true, the incidence is relatively low.
Government Study Comparing Finasteride, Dutasteride, and Placebo
Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement, lead to unreliable or uninterpretable data.

 

 

Early Balding in Black Men Under 30 Show an Increase Risk of Prostate Cancer as They Get Older

/by William Rassman, M.D./0 /
This year, the American Cancer Society predicts that about 238,000 new cases of prostate cancer will be diagnosed and more than 29,000 men will die of the disease. Besides race, known risk factors for prostate cancer include older age and a family history of the disease. This study of more than 500 black men found that those “who have baldness by age 30 are more likely to develop prostate cancer,” said researcher Charnita Zeigler-Johnson, a research assistant professor at the University of Pennsylvania’s Center for Clinical Epidemiology and Biostatistics, in Philadelphia.

I have also read that men who develop crown balding (back of the head balding) have a higher risk of heart disease. I found this to be true in my patient population.

Statistics are always interesting!

Accutane and Hair Transplants

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

Can you receive or do you recommend getting a hair transplant while on Accutane (isotretinoin)? My understanding is that the drug disrupts cell division and skin regeneration. Will this delay healing?

Yes, having a hair transplant while you are on Accutane it is not a good idea. You should wait a year without the drug ensure that the transplants will work and grow well.  There is no point in spending money and your donor hair if you are not going to have good results.

Body Dysmorphic or Just Needing Hair, That Is the Question? (From Reddit)

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

I did two hair transplants on a very bald psychologist who was age 52. After he got his hair back, he felt like a hairy person, not a bald man with low self-esteem. He told me that he underwent 18 years or psychoanalysis for his self-esteem problem and was angry that he thought he could have had a hair transplant 18 years earlier and solved his problem.  I have performed hair transplants on many celebrities. Many of them felt that they could not be themselves without hair and once they got their hair, the never focused on hair but their careers.  They each told me, regardless of their age, that the hair made them feel like themselves and freed up their creative side. Thanks for the nice write-up.

Body image issues and why getting your hair back isn’t going to change your problems. from tressless

Where Can I Meet Someone Who Had Hair Transplants and Achieved a Full Looking Head of Hair?

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

It is important for me to not only see some men who have had a full head of hair created by hair transplants, but to talk to them so that I can understand their decision process and what the experience was like. Looking at pictures is a sterile, non-personal process. 

The appearance of a thick head of hair is achievable with hair transplants. To manage people who have your needs, we have a series of men who regularly attend our monthly Open House events who have achieved this goal and can be met at my office.  We have been doing this for 27 years.  Spontaneous visits by many of my other patients repay their experience in such meeting by dropping into our monthly Open House events, unannounced.  We have an office in West Los Angeles and Irvine, California. We hold these events once a month in Los Angeles, and once every other month in Irvine.  In addition to meeting patients, you can see a surgery in process, speak with patients who are in the process of having it done, see a Scalp Micropigmentation procedure being done.

Beard Pimples (Photo)

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

I had a beard transplant in Turkey, and I can’t go back to my doctor as I am in England. What is wrong with me and what can I do?

You should find a local doctor who will diagnose and treat you. You most likely have an infection (folliculitis) which needs to be drained by a doctor, cultured and then treated with appropriate antibiotics.

The problem with traveling to Turkey is that when complications arise, where do you go? Who is responsible for you? I guess the answer is that you are responsible for yourself and you must take charge of your complications by finding a doctor who is willing to step up and treat you as a human being who requires medical attention.

beard pimples

I Had About 5000 Grafts Almost a Year Ago, What Can I Do? (Photos)

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

You have classic donor site depletion resulting from over-harvesting the grafts considering your donor density. The surgeon did not know what he/she was doing and clearly pushed your donor area well beyond what the blood supply could support and probably what your original density was. From what I see, this looks like you had too many grafts removed from your donor area.  The absolute number of grafts is relevant with regard to your original donor density, although few men’s donor area can support 5000 FUE grafts.  We perform Scalp Micropigmentation (https://scalpmicropigmentation.com/scar-covering/) on people like you but you will have to commit to keeping your hair shaved in the back for the rest of your life. The good news is that you will look normal after what must have been over a year of hell. Make sure that you do not have alopecia areata which could look like this? To make a diagnosis, you would need a biopsy.

depleted donor 15 delpeted donor 14 depleted donor 13

Failed Female Hair Transplant and It Also Produced Brillo Hair

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

I had an FUT procedure, and my hair looks and feels like a Brillo pad. It is a very unnatural hairline shape for a woman and hair is not growing in line with my natural hair or when it is parted. It looks sparse like I’m balding and it is quite masculine. What can I do?

I recommend having a second opinion by an expert. You can find them through the https://www.ISHRS.org society which recommends doctors who specialize in the hair transplantation field.

Scars from FUE (Photo)

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

Scarring from FUE is common. If it bothers you, the best treatment is Scalp Micropigmentation.  I don’t know how many grafts you received, but if it exceeded 3,500 FUE grafts, it is likely that you were over-harvested.  We have performed SMP on many people with all types of donor scars including for FUE, see here: https://scalpmicropigmentation.com/scar-covering/

fue scarring

 

Prostate Cancer Treatment Associated with Higher Risk of Heart Failure

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

Men with early-stage prostate cancer who receive androgen deprivation therapy are at significantly higher risk for heart failure, according to a study published in the British Journal of Cancer.  After following a cohort of 7,637 men diagnosed with localized prostate cancer between 1998 and 2008, researchers found androgen deprivation therapy was associated with an 81 percent increased risk of heart failure in men without pre-existing cardiovascular disease (CVD). 

SOURCE:  https://www.cardiovascularbusiness.com/topics/heart-failure/prostate-cancer-treatment-associated-higher-risk-heart-failure?utm_source=CVNW&utm_medium=6c47c50623&utm_content=article&utm_campaign=newsletter_referral

I Want a Very Dense Hairline. How Dense Should I Tell My Surgeon to Make It?

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

The question of density by itself makes sense as the size of the balding area dictates the planning. However, density is only one of the considerations. Your donor density relates to the size of your balding area, so a skilled doctor needs to plan the reconstruction of these parameters as well as other factors such as hair thickness, the waviness of your hair, and the color contrast between your hair color and your skin color.

Topical Finasteride Caused Sexual Side-Effects, Pain in My Testicles, and Water Semen, Even When I Lowered the Dose

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

We have seen that topical finasteride is not the magic bullet we had hoped, and in some men, the side-effects still persist.

Hasson & Wong Topical Finasteride (what I’ve noticed) from tressless

Hair Transplant Failure? (from Reddit)

/by William Rassman, M.D./0 /
You have a persistent frontal forelock which goes down to the highest crease on your furrowed brow. I feel strongly that when people have these forelocks or remnants of a low hairline that abuts the highest crease on your furrowed brow, then the transplant should incorporate these elements of the old hairline. If not, you may be stuck looking “not normal” and with a hairline that is seen as a hair transplant, regardless of its quality.
I sat on a jury, and the judge had a terrific hair transplant. I knew it was a hair transplant because it was placed too high and high receding hairlines are never tight. This is wrong for both the patient and the surgeon who performed it. Hairline location is critical on the first pass of any hair transplant process.
From the video, I am assuming that your hairline was placed too high and that is your complaint. If the grafts failed to grow, 99% of such failures are technical failures of the surgical team.
See Video here:  https://www.reddit.com/r/tressless/comments/98clof/was_it_a_failure_7_month_hair_transplant_update/

I Have Notice This Patch Behind My Head. Is This the Beginning of Balding for Me. I Am 21 Years Old.

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

No, this appears to look like a disease called Alopecia areata. You need to see a doctor and have a biopsy followed by treatment if the diagnosis is confirmed.

alopecia areata 2

What Is the Best Way to Use Minoxidil?

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

The best way to use Minoxidil is to apply it at night after a hot shower, so the pores of your scalp can absorb the drug. Then, wash it off in the morning, so you can style your hair normally.  It will take up to a year to see the value of this drug.