I am writing this post from the ISHRS annual meeting in Chicago. I have just heard a wonderful and informative discussion on the use of of the drug finasteride. As we know, the hormone DHT is 40 times as powerful an androgen as testosterone. The treatment of genetic hair loss is to address blocking the DHT hormone. One of the worlds experts, Dr. Mohit Khera from the Baylor College of Medicine, told me privately that when DHT levels are in the low normal range, the use of DHT blockers such as finasteride will have little value and may not be effective in the treatment of genetic hair loss. With this as a suggestion, we will now optionaly offer DHT blood tests for any person who wishes to have this test prior to going on finasteride (Propecia). If the blood levels are low, we may not advise the use of this drug as the goal of using this drug is to drop DHT levels, which may already be low. This lecture is based on considerable research both in animals and human studies but it is not absolutely definitive as there was much controversy at the meeting that the doctor may have had a conflict of interest in the opinions he drew.


I have a question regarding exclamation point hair. Or more specifically thinned proximal shafts (Picture linked at the end). Age:18,Gender:Male

Online sources say that exclamation point happens when you lose hair in patches or in non traditional MPB ways but I am suffering diffuse style MPB (pattern) and the hair that falls off is really thin at the root with a white bulb thick at the top. I also have seborrheic dermatitis. I was prescribed 2% nizoral which then caused me to lose almost 50% of my hair in the span of one year (or maybe it was meant to happen?). Could nizoral cause scalp inflammation that leads to MPB?


The online source of “exclamation point” hair shaft from Am Fam Physician. 2009 Aug 15;80(4):356-362 is describing Alopecia Areata which is a disease process where your body’s immune system “attacks” your own hair causing hair loss.
Male Pattern Balding is a genetically inherited condition where men lose hair in a typical “pattern”.
Seborrheic dermatitis is an inflammatory condition which causes scaly patches on the scalp/skin which may cause hair loss from the inflammatory process.
Nizoral is a shampoo with antifungal properties that is used to TREAT Seborrheic Dermatitis. Some people may have an allergic reaction to this and a rare side effect is hair loss.

All of the above are separate and unrelated causes for hair loss and it is understandable you are searching for a unifying answer.

The simple answer is that Male Pattern Balding is genetic and unrelated to Nizoral, Seborrheic Dermatitis, or Alopecia Areata.

For a more complete answer you need to follow up with your doctor to find out the cause of your hair loss especially if you are having side effects with the medication you were prescribed.

just to share something and also post an enquiry. January this year, after seeking advice from a dermatologist, I decided to take the plunge and switch from propecia to avodart. It has got to be the worst mistake I ever committed. since the time I stopped propecia, hair shedding started about close to a month after switching. In a matter of 5 months, my hairloss progressed drmatically and I have now a very noticeable receded hairline. I should have stayed on propecia, although it didnt regrow a lot of hair I have expected, but It did regrow decent amount and most importantly, maintained what I had. Looking back, I could only blame myself for all reports that supported Dutasteride were either small scale, or short-term. I have since switched back to propecia a week ago after seeking a 2nd medical opinion.

My question would be that, is my shedded hair all lost and not returning? Notice I am not like the typical propercia user who quit due to side effects, I switched to a more powerful anti-dht and am not switching back propecia. Bearing in thought that all the while I had decreased DHT in my body, and during that 5 months, decrease up to 90%.


Thank you for sharing your experience with Propecia (finasteride) and Avodart (dutasteride).

To answer your question in perspective, there is no magic pill or drug to cure or reverse hair loss. If you are genetically predisposed to hair loss, Propecia will only postpone it as long as possible. For some men this may be many years. For other unlucky men this may be a few months or a few years. This does not matter how much DHT you block. Most men who do this also get a drop in their sex drive as Avodart has a higher sex drive suppression than Propecia.

Tags: avodart, finasteride, switch back to propecia, hair shedding, decreased dht

I posted this one in another forum to no avail. I am a 5 year user of Finasteride 1.25mg ED. I have never noticed any sides but in the past 6 months I have had a downward spiral of anxiety, mood changes, depression and negative thoughts. I know that it may not be the finasteride but something is not adding up. I’ve tried everything (except anti depressants), my life is great minimal stress, financially sound, supportive family etc. but the feelings and thoughts are overwhelming even at the best of times. I have read a but recently about the effect of fin on allopregnanolones and it made sense to my situation. Problem is that in order to test whether finasteride is the cause I have to undo all it’s hard work which could leave me feeling worse than before – that is unless there is another way of testing whether finasteride is the cause. Is there a way of testing progesterone, allopregnanolones, DHT etc. to find if fin is causing this imbalance before I give up fin? Are there alternatives to fin which I can try if I was going to give it up? Thanks!

I cannot help you here. You need to see a doctor in person for your problem.

I will try to be more clear with facts:

1) You are having anxiety, mood changes, and negative thoughts.
2) Internet is not the right source for self diagnosing psychological or medical issues. There are abundance of information on the Internet but they can be overwhelming and confusing with misinformation or misinterpretation.
3) You are trying to make a correlation between a drug you have been taking for 5 years with a mood change you’ve been experiencing in the last 6 months. If you look hard enough on forums and Internet sites, it may seem to justify your case, but that does not mean it is correct.
4) There have been rare reports of mood changes with finasteride, so talk with your doctor (not look on the Internet) for a possible solution.

The best solution is see your primary care doctor or a psychologist in person.

Tags: propecia depression, propecia anxiety, finasteride depression, finasteride anxiety, hair loss drugs mood change

According to the indictment below, a named doctor has been using the Internet to sell non-approved doses of Minoxidil with claims that are not proper. Read the document below for details

SALT LAKE CITY ‹ Four men, including two Utah’s, face federal charges for allegedly selling hair replacement drugs over the Internet without U.S. Food and Drug Administration approval. Dr. Richard Lee, 72, and James Dorius, 69, both of Whittier, Calif., owned Regrowth, LLC, a business that made and sold hair treatment drugs online. Alexander Ahn, 32, and Min Kim, 32, both of Provo, ran a Utah company called Minoxidil Solutions that sold the drugs after Regrowth had agreed with the FDA to pull them from the market, according to the indictment.

The indictment alleges that the FDA discovered that Regrowth was selling drugs Lee made using his own formulas and recipes dating back to 1996. Some of the products contained active pharmaceutical ingredients. The company was not registered with the FDA and did not seek or obtain approval to sell its hair growth drugs, according to the indictment. As apart of an agreement with the FDA in February 2011, Lee stopped selling the products and sent customers an ³urgent drug recall² notice informing them of potential health hazards. Two months later, Lee and Dorius delivered Regrowth¹s remaining drug
>ingredients and manufacturing equipment to Kim and Ahn in Utah. According to the indictment, Kim agreed to pay Lee and Dorius half of what Minoxidil Solutions earned on the sale of hair growth drugs made using Lee¹s ingredients and formulas. “These kinds of cases are important because in many instances individuals are advised by FDA that they cannot lawfully manufacture and sell unapproved and misbranded drugs, yet even after warning, they continue to manufacture and sell these prohibited drugs,” said Patrick J. Holland, special agent in charge of the FDA criminal investigations office in Kansas City. Lee, Dorius, Ahn and Kim are charged with conspiracy to introduce misbranded drugs into interstate commerce, which carries a penalty of five years in prison and a $250,000 fine. All four men are scheduled for an initial appearance in U.S. District Court on Oct. 23.

Tags: inappropriate claims, hair growth


I took Norlevo (morning after pill) 15 days ago and now I have noticed that my hair is falling out. How long will this last? Is there anyway to stop it?

Thank you.

The morning after pill is a hormone similar to what you find in a birth control pill. Birth control pills could possibly cause hair loss in rare instances. I can not tell you if that if your hair loss is related to the pill (Norlevo). It may be due to stress in general as well. You need to follow up with your doctor for an exam.

Tags: norlevo, morning after, gene, hairloss

Hi docs,
Because of an erectile dysfunction, an urologist (seen in early 2008) gave me pantestone (40 mg) orange pills without any blood analysis. I didn’t need these pills!

So, I’ve been taking pantestone pills for a week, once a day since 2008. But one day, i took about 10 or 15 pills at a time because i thought i could get a better result. Since that day, i’m losing my hair on the temples and now, 6 years later, i’m at least at the second stage of Norwood Hamilton. My testosterone level is normal now. i would like to know if is it because of these pills that i’m losing hair and having a similar evolution as my fathers’.

Thank you for reading. Hope you could answer me because i’m getting anxious about these pills and i have got a lot of remorse of having taking it.

Pantestone is apparently a testosterone pill sold in some European countries. Taking testosterone will cause hair loss in individuals who are carrying the genes for balding.

You mentioned that you are now a Norwood class 2 pattern, which suggests to me that you might have a maturing hairline rather than balding. Some people confuse the evolving maturing male hairline with genetic MPB, and without seeing your photos, I can not tell the difference.

Tags: testosterone, pantestone, hairloss, hair loss

EffexorI am currently taking venlafaxine for depression and finsateride for hair loss. I have noticed my hair is starting to thin a bit more. Can venlafaxine cause hair loss?

Yes, hair loss is a known rare side effect of venlafaxine (also known as Effexor). While finasteride does protect you from the progression of your genetic hair loss pattern, it isn’t likely to protect you from hair loss due to medication.

You can learn more about the side effects of venlafaxine here. If the side effects are concerning, you should talk to your prescribing doctor.

Tags: antidepressant, depression, effexor, venlafaxine, hairloss, hair loss, finasteride, propecia

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

Due to chronic sinus inflammation and infections, as well as mild asthma, I have been on Steroids (Prednisone and Advair 500/50) for about 5 years now. In that time I have experienced many minor side effects. One thing that has happened is hair loss. Not rapidly or in large quantities but progressively each day. Going way back in my family (both sides), we have been blessed with thick healthy hair and I carried that trait until I started getting sick and jumping on these drugs. I did some initial research online and discovered others who have either made the connection or question the connection to steroid use. Is this a path I should pursue? If I saw a hair loss specialist, would they be able to help determine cause?

Thank you for your advise.

Corticosteroids in general can cause many systemic problems (not only hair loss), but hair loss from steroid use is not uncommon in those with the genetic hair loss gene. In general, hair loss in men is mainly from genetic androgenic alopecia without steroids.

You may want to note if your hair loss is diffuse or limited to certain areas. If you want a clear diagnosis, see a doctor.

Tags: steroid, hairloss, hair loss, corticosteroid

Hello Doctor, My question is that i have been using minoxidil liquid for the past 2 month and it has really damaged my hairline. Is there is chance that the lost hair will grow back. My hairline was receding before i started minoxidil liquid but i was losing hair very slowly. Also should i continue using minoxidil if i don’t see any results in 6 months time.

Some patients have occasionally mentioned that they’ve seen shedding from the use of minoxidil and if it does, it usually stops 2-3 months later. The choice to continue with it is your choice to make and of course, you must consider the risk of the problem getting worse.

Minoxidil works best in the crown/top of the head, and I wouldn’t expect too much regrowth at the hairline from that medication.

Tags: minoxidil, rogaine, hairloss, hair loss, hairline


I am a 22-year-old male, and last year I took small dosage of isotretinoin for around 6 months. My hairline seems to have receded some, but I am wondering whether I should go out of my way to go see a doctor about taking propecia as of right now. My father began balding in his late twenties, so I am worried I am following in his path.

I took a look at the few photos you sent, and while they were poor quality photos, I didn’t see any hair loss. A maturing hairline could be what you’re worried about, but that is not considered treatable balding.

Isotretinoin (Accutane) is known to cause hair loss in some, but having your hairline mature is a normal occurrence for many men as they get older.

If you are concerned, see a doctor — but based on the photos, I don’t know that you have anything worth treating. Of course, a doctor will be able to examine you in person, map your scalp for miniaturization, and provide hair bulk analysis to give you a better sense of your hair loss (or lack thereof).

Tags: accutane, isotretinoin, hairloss, hair loss, mature hairline

I am a 45 yr old female and have been diagnosed with hereditary loss. I started rogaine 5% about 10 days ago, I immediately developed a rash and started to shed more than 200 hairs a day and worse when I washed it? My hair was already diffused on top and now it is ten times worse.

I want to stop use because i cannot afford to continue to shed like this. Will the hair I lost grow back without use of rogaine, or is it gone forever?

There is no way to predict if the hair will grow back, but I suspect it will once the allergic reaction passes. It will take months to see the positive impact on regrowth.

Tags: rogaine, minoxidil, female hair loss, hairloss, rash

I’m 17 years old female. I have been taking tetracycline for about 2 months for acne and have recently noticed a fair amount of hair falling out of my head when i wash/dry/brush it. This has been happening for about 3/4 weeks. I just wanted to know if there’s a link to it and if i stop taking it will my hair be okay? I’m really worried. I haven’t noticed that its going very thin, or any bald patches.

The relationship between tetracycline and hair loss is known, though rare. If the only change in your medication schedule over the two months was tetracycline and the hair loss started with this drug, then there may be an association between the two. Speak to your doctor about this problem and possible alternatives to tetracycline.

Tags: tetracycline, female hair loss, hairloss, hair loss

My mom’s hair was thinning a little. She went to see a dermatologist. The doctor prescribed Clobetasol ointment & Clobex shampoo. She was using these for 6 months straight. Her hair was falling out in clumps & getting a lot worse. The doctor kept telling her it takes time. Everything that I read about Clobetasol states not to use it more than 2 weeks. Would Clobetasol and/or Clobex make her hair loss worse? Please help.


Heavy doses of Clobetasol (a corticosteroid) can cause hair loss, among other systemic side effects. If you are concerned about this treatment, I would ask your mother to seek another opinion by a physician you see face to face, not over the Internet. I do not know the diagnosis here, so I can not comment on the treatment plan.

Tags: corticosteroid, clobetasol, female hair loss, hairloss, hair loss