I along with hundreds of thousands of men suffer from PFS

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

I and hundreds of thousands of young men like me got PFS from a single pill, doctor – from the first pill. How would your self-rationalization deal with that inconveninient truth? Oh, I know how:

Denial.

If that is true, I can’t understand the physiology of it. If there were hundreds of thousands of men suffering from PFS from a single pill, I would have seen it in my practice. A single pill? What is the mechanism for it? I am a clinical scientist and I look to science for answers to questions.

A physician wrote: “I have personally been taking finasteride for 14 years and will be taking it for the rest of my life.  I have never had a patient in my practice have long term side effects from finasteride [he has prescribed it to thousands of men].  I have only seen a positive psychological influence on my patients’ lives since they realize they are slowing a progressive aging process. I would bet my retirement that there is a lowering depression/suicide rate for patients on finasteride compared to their peer group not on finasteride with similar Norwood pattern hair loss (if this study could ever be performed since there are so many confounding variables).”

All the doctors in my field are struggling with the PFS problem as you told us here.  In my practice I have not seen PFS in my patients except one man who reported impotence within 2 hours of taking the first dose and I told him to stop it.  Like the doctor I quoted above, I too have been taking finasteride for years with no ED or libido problems. What is in it for me to prescribe it if it didn’t help my patient?

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Is SMP risky for people with hair?

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

Looking to get the opinion of Males or Females that have gotten it. I find SMP to be riskier than a transplant, half the People who are bald and get it regret it. There aren’t a lot of stories of people with hair that get it.

We have done quite a few men and women with thinning hair applying tattoo pigments with great responses and happy patients, see here: https://scalpmicropigmentation.com/gallery/thinning-hair/ . It is a great adjunct for people with thinning hair especially for women who have no other options when they are post-menopausal.

Possible DUPA

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

This man wanted a hair transplant and came to a colleague asking for one.  If his donor area was examined under a hand microscope, it would show either very low density or DUPA. In either case, he would be an unlikely candidate for a hair transplant.

Losing hair, no satisfaction with clinic

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

So I’ve been losing a ton of hair for around the last year. My hair has thinned out dramatically, and receded in the front a little but I have no balding areas just diffuse thinning. I have been using Rogaine and Finesteride and have seen some thickening at the crown but no benefit everywhere else. I have had a CMP done to check for any deficiencies and it was negative. I went to a hair loss clinic yesterday and they scoped my scalp and told me I had a normal amount of follicles and no miniaturization (the hallmark of male pattern baldness). When I asked why I was losing so much hair they couldn’t really help me. One person told me that I should rinse and shampoo my hair everyday because accumulated rogaine can cause hair to become brittle but other than that they just said they couldn’t help me. Does anyone have any ideas? I’m worried the finesteride won’t help either because it specifically inhibits DHT.

If you went to a clinic, you should have seen a doctor skilled in this field. I would have examined you, performed a HAIRCHECK, a miniaturization analysis and quantified your donor supply. I would have told you what to expect short and long term.

Is Transplanted hair DhT sensitive when moved?

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

May I take the opportunity to ask you: once a hair is transplanted from the donor area to the crown/top of the head, does its follicle become a “crown/top” follicle in its identity and sensitivity to DHT? Because I know for sure that the post-transplant therapy includes in most cases (if not always) finasteride and minoxidil. Thank you.

No, the hair that is transplants from the donor area keeps its genetic identify so it is not DHT responsive

Vitamin D saved my hair

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

So a few years ago I started to lose my hair and develop dark circles and facial wrinkles. I tried minoxidil for a while with limited results, then gave that up. Then on a hunch I read up on vitamin D deficiency, and found out that one of the symptoms was hair loss.

I started taking 4000 IU of D3 every day, and 6 months later my hair is almost completely restored – like nothing happened. Also my dark circles are getting much better, and my energy and mood have improved.

What can I say that you didn’t say! It is worth sharing here. Be careful at that dose as it may eventually cause overdosing.

If you take Saw Palmetto with no sexual side effects, does that mean Finasteride is safer?

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

My doctor prescribed me saw palmetto before all the exams hormonal sperm ecc before starting fin …I started saw palmetto which lowers dht by 35%  What i feel Is improved erection quality, my Dick Is hard as steel, more libido, and i experience getting hard during the day …  Does this mean that if i use fin, probably i will feel the same ? Or even better?

Saw Palmetto is a weak DHT blocker while finasteride is a stronger one. I would expect that some people taking Saw Palmetto without sexual side effects might be better on finasteride.

Facebook Response from a Nurse in Vietnam

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

My son Ian, posted my photo when I was in Vietnam on facebook for Veteran’s Day and a nurse, Carol, responded with this very nice post which I wanted to share with you:

Wow. I knew that guy!!!
I watched your dad work tirelessly to heal and help US troops and then when others might rest during off time, he went off to do the same down at the Vietnamese hospital where he shared his skills and knowledge with local practitioners. He was also always trying to find ways to keep our spirits up. He managed to find a popcorn machine and had it helicoptered in for our little club. Something so simple to give us pleasure. He knew that caregivers also needed care and respite from the emotional strain of death and trauma and illness. He heard some nurses talking about how they missed soaking in a bath tub and the next week one appeared in the sky being lowered down from a chopper. He’s a guy I’m proud to know!
I remember that I also found a piano 300 miles away and flew the piano to our hospital hanging off of the bottom of a helicopter to entertain the troops.  I was fortunate as I was the officer in charge of the Officers Club which was a night-time job for me.  That gave me access is huge amounts of beer and liquor which was worth gold in trading for things. I traded palates of beer for air conditioners and airconditioned the entire hospital patient facilities (the club was very profitable).  I remember Carol very well, a great caring nurse who the patients all fell in love with.

Aspirin reduces the effectiveness of minoxidil

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

https://pubmed.ncbi.nlm.nih.gov/30226287/

Low-dose daily aspirin reduces topical minoxidil efficacy in androgenetic alopecia patients

A Goren 1, A Sharma 2, R Dhurat 2, J Shapiro 3, R Sinclair 4, M Situm 5, M Kovacevic 5, V Lukinovic Skudar 6, M Goldust 7, T Lotti 8, J McCoy 1
Affiliations 

Abstract

Topical minoxidil is the only US FDA approved OTC drug for the treatment of androgenetic alopecia (AGA). Minoxidil is a pro-drug converted into its active form, minoxidil sulfate, by the sulfotransferase enzymes in the outer root sheath of hair follicles. Previously, we demonstrated that sulfotransferase activity in hair follicles predicts response to topical minoxidil in the treatment of AGA. In the human liver, sulfotransferase activity is significantly inhibited by salicylic acid. Low-dose OTC aspirin (75-81 mg), a derivative of salicylic acid, is used by millions of people daily for the prevention of coronary heart disease and cancer. It is not known whether oral aspirin inhibits sulfotransferase activity in hair follicles, potentially affecting minoxidil response in AGA patients. In the present study, we determined the follicular sulfotransferase enzymatic activity following 14 days of oral aspirin administration. In our cohort of 24 subjects, 50% were initially predicted to be responders to minoxidil. However, following 14 days of aspirin administration, only 27% of the subjects were predicted to respond to topical minoxidil. To the best of our knowledge, this is the first study to report the effect of low-dose daily aspirin use on the efficacy of topical minoxidil.

Keywords: alopecia; aspirin; minoxidil.

Finasteride and suicide

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

A recent article here: https://jamanetwork.com/journals/jamadermatology/article-abstract/2772818 suggests that men under 45 who take finasteride, have a higher risk of suicide than control groups.

We have known that there are some complaints of Central Nervous System problems in a few young me who take finasteride.  We need a lot more information than is supplied in this article but I have no doubt that if a man is suicidal, then should stop taking finasteride if they are on the drug. It is interesting to note that suicide is the second most common cause of death in men under 45 and that does not include finasteride.  How does this information alter the finding in this paper?

Can a hair line mature unevenly?

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

Can a hairline mature unevenly? My hairline hasn’t been totally straight since I was about 14. Every man in my family is sort of Norwood 1.5 or 2, my dad is 60 with Norwood 2 but he is thinning a bit. Nobody except my maternal grandfather has ever gone bald. I’ve really freaked out about my hairline since I noticed it at the beginning of this year. It’s changed very slightly since I was about 14, however it has remained unchanged for about a year. It’s about a norwood 1.5. My forelock is still where it’s always been, which makes my temples look far more receded than they are. One temple seems to be a bit higher than the other, just slightly. Is it possible that the front of my hairline will mature too, making it look less dramatic? Or will this stay the same? I don’t really think it’s MPB, but I’ve had a lot of grief over it. I’d love not to worry about it anymore. I’m 18 by the way!

Yes, hairline maturation can be asymmetrical but eventually it evens out if you give it time.