I Used Both Finasteride and Minoxidil with Great Results, But I Want to Stop One

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

Hi! About 1 year ago I noticed a bald spot on the crown of my head, typical for Male Pattern Baldness. After reading up on the issue I decided to try the double approach of finisteride tablets (Proscar) and Minoxidil spray. My doctor told me that it was unecessary to use both, but I read a few postings on chat groups about success stories taking this double approach, so I decided on that route. Now, a year later, the results are absolutely fantastic! The untrained eye would probably not notice anything. So now I am considering stopping either the minoxidil or the finisteride tablets. If I did stop either of these, and notice a regression, would resuming the treatment again bring back my now great hair? Which of the two would you recommend stopping as a test? Thanks for your help!

I don’t know your age or the degree of balding you had. That would make my impression inadequate to help you, based on the scant information you supplied me. If you are young (under 29 years old), then Propecia should be more important than minoxidil. I would get miniaturization studies and map out your scalp accordingly so that if and when you stop minoxidil first, you can follow the results with scientific measurements.

Tags: finasteride, minoxidil, hair loss, hairloss

Does Dying Gray Hair Lead to Faster Graying?

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

How true is it that when you color your grey hair, you will grow more grey hair faster than not coloring. I have been getting different answers from the web. I need your opinion. Thank you.

DyeIt’s not true at all.

Hair color is the result of pigmentation due to naturally occurring chemicals (primarily melanin). These chemicals are present at different levels, thus giving hair its distinctive color. The more melanin present, the darker the hair; the less melanin, the lighter the hair. Hair color changes as we age, going from their natural color to gray and then white. The color change occurs when melanin is no longer produced in the hair root and new hair grows without pigment. Coloring the hair has no effect on the rate of graying and on the deposition of melanin in the hair shaft — it just affects the hair above the skin.

Tags: gray, grey, hair color, dye, greying, graying, aging

How Do So Many Older Rock Stars Still Have Such Great Hair?

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

I always find it amazing how rock and roll stars in their 50’s and 60’s still have hair like 20 year olds. Could there be something they are doing or is it just the lack of stress of being a rock star has enabled them to keep their youthful look. Just some examples would be Sammy Hagar,Mick Jagger, Robert Plant and Steven Tyler.

Thanks

Rock and rollI can not comment specifically on any of these men, but I am personally aware of a few musicians that use either hair extensions or hair systems to give the appearance of a full head of hair. Long hair seems to be for musicians like hair was to Samson and I have been told over and over again, that without the appearance of hair, they can not perform well. Perhaps it is a confidence issue, perhaps it is something else entirely.

Tags: musician, rock star, rock and roll, celebrity, hairloss, hair loss

Will My Urologist Tell Me to Stop Finasteride?

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

Going to see a Urologist next week, will he tell me to stop finasteride?

Hi Doctor. I have been on 1/4 proscar for over a year now with great success, no side effects, and great reqrowth and maintenance. I’m a 26 year old male and went to my hair loss doctor for my yearly check up a few weeks back and he and I were very happy with the way things are going. In the last 3 months however i have had 3 cases of hematospermia, passing blood in the semen accompanied with some minor pelvic pain. I however, have no other problems urinating so it’s clearly something to do with the prostate. My family GP gave me some antibiotics, which seemed to clear one episode and he referred me a urologist to get it checked out further. He mentioned that the fact i was on finasteride would have to be seriously looked at when I visit the urologist. I mentioned all of this to my hair loss doctor during my yearly consultation, now this guy is very ethical and has over 20 years in micro surgery and over 2000 patients my age on the drug. He told me that the finasteride had nothing to do with it.

In fairness to finasteride, I was on it for 10 months without a hitch before I started getting episodes of hematospermia. I’m just worried that the urologist may ask me to stop it as he clearly will not be concerned about male pattern baldness…and effectively lose the wonderful gains the drug has provided me.

In your experience have you ever encountered cases of hematospermia any more in patients on finasteride in my age group? Do you think it may have anything to do with it, what about prostate shrinkage?

Thank you so much and i hope you can help me on this, i really hold your opinion i this area in high regard.

Regards

People who are not on finasteride do develop hematospermia, so I would expect that people on the drug will be at the same risks. I doubt that the drug is contributing to the problem and would agree that finasteride should be continued. I would doubt that a urologist would ask you to stop this, considering the benefit you have achieved.

Tags: hematospermia, finasteride, proscar, propecia, prostate, urologist, urology, hair loss, hairloss

Will There Be A Better Medication for Regrowth by 2010?

/by William Rassman, M.D./3 /, ,

Hi Dr. Rassman i recently wrote you about the 19 year old who thought he was a good canidate for a hair transplant. It’s not that I am going to plunge into it i was just wanting more advice. Furthermore i know you have probably had to answer this a million times and your sick of it but like do you think by 2010 that there will be atleast a better medication for regrowth? I honestly can’t go through my life being bald its affecting me so much man. all my confidence is gone. if you could , could you just respond to me in email ? im honestly so bummed out about this ordeal ive went from being so happy to depressed.

I don’t know what advice I can give. I don’t see the average 19 year old as a hair transplant candidate. If the hair loss has advanced to a place where it is stable and further loss isn’t likely to occur, a hair transplant may be a viable option, but without an exam I couldn’t begin to make that determination. Please note that very few 19 year olds would fall into this category.

There is a medication that is in FDA trials for treating hair loss, dutasteride (Avodart), and it has been shown to work better than Propecia (finasteride) in some cases at high doses, but with that comes much greater risk of sexual side effects and possible permanent sterility. It is still in the testing phase, however. You can learn more about dutasteride here — Update on Dutasteride. Note that there is no cure for hair loss.

I understand your confidence issues, and suggest that you may want to seek some help for any depression you may be experiencing.

Tags: hairloss, hair loss, dutasteride, avodart, finasteride, propecia, medication

You Told Me I Wasn’t Balding, But I’m Obviously Losing Hair!

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

A couple months ago I went to your offices for a consultation and was told that I had a healthy amount of miniturization and wasn’t balding. However, everyday more of my scalp, especially on the crown, is showing and I’m obviously losing hair. when I tug strands come out everytime. I have been using minocycline and tazorac for acne. Would this cause significant hairloss and if I stop using these products after the 6 month period to get rid of the acne should the hair grow back (don’t want to stop unless I need to)? Are there any acne meds that don’t cause hairloss? I hear that it’s the vitamin A in the meds that do this.

also my scalp and hair has becoming increasingly dryer from the medication. can a dry scalp and hair cause hairloss at the roots and be potentially damaging. would rogaine help the situation or make it worse due to drying out the scalp more?

Thanks a lot for your time doctor. I really appreciate all the time you put into this blog!

If you are a patient of NHI, please call our office at 800-NEW-HAIR for a private discussion of your problems/progress or lack of it.

That being said, hair loss is a dynamic process and things may have changed. If you are noticing increased thinning at such a short interval, you may be a candidate for medications such as Propecia. Mapping your hair again for miniaturization will show if you have genetic balding that is progressing or not. You didn’t provide your name, so I really am just blindly guessing as to what the situation is/was. Acne medication can cause hair loss with or without miniaturization. Clearly, you have some complex issues that need to be explored.

Tags: balding, hairloss, hair loss, nhi, miniaturization, acne

Is Alopecia Areata Like Cancer?

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

my son has alopecia. i was woundering if that has a risk on life and is it dangerous. he is barely 9 years old and has extreme bald spots and lots of hair loss. i want to know if its like cancer and what the difference

Without seeing photos of your son or knowing anything about his medical history, it is difficult to tell, but from the brief description you gave, it does sound like he has alopecia areata. This is a condition that affects about 1-2% of the population with initial presentation in the teenage years. It is not contagious and is thought to be an autoimmune disorder, and not cancer. It is an inherited process. Since the exact mechanism of hair loss is not known completely known, there is no known cure to date, but in the hands of some specialists who focus on this disease, there are some effective treatments. In 90% of cases the hair will ultimately regrow. It would be wise to have your son seen by his primary care doctor to determine if there are any potential underlying causes of his hair loss and a dermatologist for possible biopsy.

Tags: alopecia, areata, alopecia areata, child, son, hairloss, hair loss, disease

I’m Going In for Knee Surgery — Do I Need to Tell My Doctor I’m Taking Finasteride?

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

Hi,
Thanks for offering such an objective viewpoint on the subject of hairloss where many others seem to offer empty promises and such skewed opinion. I may require surgery on an ACL injury in about 6 months as that is most convenient time for me to have the surgery. I am 22 and started taking propecia about 3 months ago, but I did not go through my doctor and just did my own research and bought off a reputable website. I don’t want to damage the relationship between my doctor and tell him that I did not even consult him before starting with propecia, but I was concerned that I might have to tell him I was taking this medication for my own safety given the ACL operation. Is it necessary he knows this information if I have surgery. Also, you talk alot about young men obtaining better results with propecia, but I couldn’t find any statistics apart from the study for men between 18-41. What is the exact benefit for under 25 compared to 30 year plus.

Thanks for your help

PropeciaThank you for your kind words.

I would recommend that you come clean with your doctor and tell him everything about your health and medications that you are taking. After all, if you are trusting your doctor to perform surgery on you, I am sure you would want your doctor to trust you. It makes for a good doctor-patient relationship.

With respect to Propecia statistics, the scientific data comparing one age man with another is not available. From the extensive experience by many physicians in the field, Propecia works best when hair loss is more recent and that implies younger men. The practical answer is that it is never too late and I have seen it work in men from 18 years old to 70 years old. And all the research and statistics go out the window when YOU are the one taking the medication, because if it works… it works! You should only worry about statistics if you have a wager on how well it will work on you, because even if the statistics are low, I am sure you will take it since you have nothing to lose (but hair).

Tags: acl, knee, surgery, finasteride, propecia, surgery, doctor, hairloss, hair loss, age

24 Year Old Using Propecia and Minoxidil for Years is Still Balding!

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

Hi doc! I’ve been on propecia for about 4 and a half years now and i’ve also been using minoxidil 5% for about 3 years but I’m still balding! I’m only 24 and I’ve been balding since the age of maybe 16-17. I always see you answering to young people that they should try Propecia or Rogaine, but that stuff doesn’t work for me. What should I do?

I would love to have a hair transplant so that I can at least enjoy a “normal” haircut for the next 5 years, instead of waiting for my hair loss to stabilize (going completely bald) and THEN have a transplant and still look pretty bald.

While Propecia and topical minoxidil are great medications for male pattern baldness, they have their limitations. Your genetic predisposition will always win. Nevertheless, while you are still losing hair, I am sure the rate of your hair loss is slower than if you are not taking the medication at all. In short, these medications are likely working for you, but your genetic fate is winning the battle.

If you were to stop taking these medications, I am fairly certain you will accelerate your hair loss.

It seems your next step might be a hair transplant surgery. Of course, I couldn’t say for sure as I haven’t examined you, but options are limited if your loss isn’t stopping with medications. If you would like a private consultation with me either directly or by phone, please call our office at (800) NEW-HAIR (800-639-4247) and my staff will be happy to arrange it.

Tags: hairloss, hair loss, minoxidil, rogaine, propecia, finasteride, hair transplant, hairtransplant

I Think I’d Be a Good Candidate for Hair Transplantation at Age 19!

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

Hi Dr. Rassman, Im a 19 year old male who has been losing his hair quite quickly since the age of 18. I honestly had VERY thick curly hair all through my life honestly had a huge curly afro like the guy from american idol when i was about 16. And now my hair on the top of my head and my crown has thinned and a bald spot is coming in. my question is, even at 19, could you get a successful hair transplant? You honestly can plainly see the balding pattern that im getting by visual and its the same pattern as my grandpas who im almost positive had more hair than me still at 30 but he is now completely bald. I was just wondering if at 19, it is virtually impossible to rethicken the hair. My hair loss is not insane but you can see the Horseshoe balding pattern and easily notice my thin crown spot. Please any positive advice, this is really really depressing me in such a horrible way. i would think since you can so easily see my balding pattern id be a good candidate for HT. always my back and side hair is still extremely thick and in good condition

If you have genetic male pattern balding as you describe, you may be a great candidate for Propecia (finasteride 1mg), but hair transplantation would likely accelerate further balding. I realize that in your urgency to regrow your hair, you’re wanting to do whatever it takes. But unless you are completely bald already, I would generally advise against a hair transplant for someone your age. This is a decision that will stick with you for the rest of your life, and is not something you should be rushing into. You need to see a doctor and have a good physical exam and educate yourself on hair loss options and then develop a good Master Plan for your hair loss management. Hair transplants can be part of a Master Plan if indicated and done at the appropriate time.

Tags: hairloss, hair loss, propecia, finasteride, hairtransplant, hair transplant, teen

20 Year Old with Early Hair Loss

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

Hi, a dermatologist told me that I am definitely losing my hair. I come by it naturally as my father is bald. I am only 20 and wonder if I started now with the transplants it would be less noticable to people. I am already getting comments from people concerning my hair loss. It is really beginning to affect my life. Can you help? Thanks,

In a young man just starting to lose his hair, the best treatment is not hair transplants, but rather medications. Propecia (finasteride 1mg) is the best way to approach the problem. Transplanting you at this age would be not only unethical, but wrong. I tell young men that see me to treat their hair loss that they need to get their hair mapped out for miniaturization prior to starting the drug so that you can understand the impact of the drug on hair measurements. The drug can stop and possibly reverse the hair loss if it is early.

Tags: propecia, hairloss, hair loss

Late Onset of MPB? (with Photos)

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

Hi Dr. Rassman,

Consider this permission to use the photos if you use my question.

51 years old, full, thick head of hair until recently. I have been thinning for about 2 years I guess, it has been a few hairs here and a few there. Didn’t think too much of it until this last 6-8 months when it really seemed to accelerate. My brother is 59 and has no balding in the crown/vertex. I started on Propecia in December of this year and have been tolerating it well. So far no side effects. Have a very stressful life ( I’m in Healthcare ! ) and this Year has been the worse.

My question is ? I would like to try the propecia for a full year to see if it can help. Given my age and late onset of what I think is MPB do you think this is a good course of action ? At what point would I be a candidate for a hair transplant ?

Thanking you in advance, maybe one day we will meet !

 

It is unusual for a man of your age to start genetic hair loss, but I have seen it before. You want to make sure that you do not have a medical illness that is causing it. Propecia is most effective with recent hair loss of 2-3 years duration. Thank you for giving me permission to post your photos (click them to enlarge).

You have some options. You can try taking Propecia for 8-12 months. As a general rule, the older you are, the less likely will be the response, but with your gray hair, any response will add value and with the 2-3 year history of hair loss, you may break the ‘rules’. If you still have no response after that period of time and wish something done about it, then a hair transplant may have value. Alternatively, you can have a transplant and take Propecia. There is no doubt that the hair restoration will be good with the transplants alone, and any gain you have from the Propecia is a bonus. The more the grafts, the better the fullness if you go forward to transplants. I’d estimate between 1000-1500 grafts might give you reasonable coverage.

Tags: hairloss, hair loss, propecia, finasteride, hairtransplant, hair transplant

Advice for a 16 Year Old with Bald Spot?

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

Okay, Well I’m not quite sure how this works but I’ll try it out anyway. I’m a 16 year old male living in the state of Washington. I constantly get crude remarks on how I have a bald spot. Self confidence and the inability to function without a hat is very depressing. I the thing that gets me is how young I am. If you could provide any advice it’d be very much appreciated.

Thank You.

Without seeing you, I do not know what you mean by a bald spot. Are you balding? Did you suffer from some trauma on your head, which produced a bald spot? You need to be examined by an expert doctor. If you are balding, then you will show miniaturization of your hair in the balding area. Even at your age, when balding occurs, the drug Propecia usually works very, very well to reverse it.

Tags: age, teen, hairloss, hair loss, trauma, balding

I’m 18 Years Old with Norwood Class 2 and I Want a Hair Transplant

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

Dr.Rassman, I am an 18 Y/O male Suffering from MPB which started at 15 and I Am wondering if there are any Hair transplant options For me, I Realize the problems that can arise when getting a HT at this age which is why a surgeon like you who maps out future progression hair loss plans Is a must, I understand you prefer not to Perform HT on people below the age of 25 And 18 is clearly well below that margin, however I have been on propecia for over a year now And have been using rogaine for the past 7 months, alas Neither have stopped the progression of my MPB Although propecia has slowed it down and Rogaine has improved my temples. I have moderate expectations And do not expect the hairline I had at 13 but any improvement would be a blessing.

I’m a nw2.5 and my hairloss is very zig zaggy along the frontal hairline with the classic M shape above the temples then another M shape at the widows peak, I can send pics If that could assist you. I have bad miniturization along the frontal hairline, Moderate behind that and then healthy hair behind that giving me a less then acceptable hairline to say the least but overall decent coverage.

My father is a nw5 at 50 as well as all his brothers so I believe that is the direction I am heading in currently(although none of them ever tried propecia or rogaine so I do not know how mine will develop on my current regimen.

Thank you for your time any help and advice would be greatly appreciated.

Norwood Class 2While the real rule might be “never say never”, I need to know about my patients before undertaking any surgery on them. One might ask, with being a Norwood Class 2 and wanting a hair transplant, could you possibly be body dysmorphic? That is something I will understand when we meet. A Norwood Class 2 patient having a hair transplant may be doing more damage to the patient than they suspect. I’ve posted similar commentary in the past on this subject:

Tags: hairtransplant, hair transplant, norwood, class, hairloss, hair loss

My 18 Year Old Daughter Is Losing Hair — What Should I Do For Her?

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

Could you please tell me what type of doctor you should take your 18 yro daughter to if they are experiencing considerable hairloss. Her hair is thinning all over her head, and especially on top in the front. Our general practitioner sent us to a derminatologist. We went to the dermatologist for around 6 months without any progress. He tried to tell us it was hereditary hairloss, yet no women in the family on either side has thin hair.

They finally ordered blood work that I got a copy of. They never even called us with the results. It showed her MPV was low, 6.4 fL and her Ferritin was only 12ng/ml. Not sure what MPV is, but I know ferritin is iron. I’m having her take a multivitamin in the morning and an iron supplement at night. I would like to get her into a good doctor who gives a darn and could help her out. She is very athletic and does a lot of working out and sports. Any reccomendations would be greatly appreciated.

Also, should I have her give Mens 5% Rogaine foam a try to see if we can accelerate the progress?

Ferritin of 12 is in the low side of the normal range. The best thing you can do is to see a good internist to treat iron deficiency if present and also to check for other medical conditions that can cause hair loss in women, including thyroid disorders, immune diseases, and PCOS. If there is a genetic component, then having her hair mapped out for miniaturization will show the classic signs of the genetic process in women.

Tags: hairloss, hair loss, female, women, woman, ferritin, iron, teen