Hi Dr. Rassman, I just have a few questions. Basically, I’m 24 years old and I have had (from what I can tell) diffuse pattern thinning on the top of my head. This has progressed for the past 3-4 years now as the hairs are becoming gradually more and more miniaturized. However, it wasn’t particularly noticeable until about a year ago. At this point (as it began to bother me) I went to my doctor and upon his recommendation I obtained some Propecia.

Anyways, after the first week I had some side effects (erectile ones) and it was recommended to me that I should take a half dose. I did this for about 10 months, and from what I can tell, the half dose didn’t seem to have much effect on slowing down the miniaturization (although, who knows it may have). Finally, about a month a half ago I got up the nerve to try the full dose everyday. The great news is I am not having any side effects. However, a friend of mine told me about a study (which I also looked up online) in which it was shown that there really isn’t much of a different in potency between the 1mg and .5mg dose. This makes me apprehensive about whether the full dose will make a difference.

1. So my first question is, do you think I should take Propecia for another year on the full dose before I make conclusions?
2. As for my second question, does Propecia have a propensity to work less/more/the same on people with a patterned diffuse hair loss in your experience?
3. My third question is related to my family genetics. I have two uncles who are bald. Both of them thinned out around their mid-30s and had the typical norwood-scale baldness pattern with a bald spot in the back that gradually got bigger until they finally started fully balding on the front and crown around 40. I don’t have this. Does that mean anything of significance, other than the fact that I probably have this issue from their genetics?
4. My final question is, I met soccer star David Beckham at a dinner a little over a year ago and he had what appeared to be the same kind of diffuse hair loss I have now at the time. Since I watch a lot of soccer, I couldn’t help but notice recently that his hair is significantly better than it was when I met him. I took another look at some pictures on the internet and its almost like he completely grew his hair back. How is this possible? Have you heard anything about what he did? I know you have been asked this before, but I figured I would ask again since I know for a fact that he was thinning at the time.

Sorry for such a long email. Any comments you can make would be greatly appreciated! Cheers

1. From what I recall, the difference is not that big between half dose (0.5mg finasteride) and full dose (1mg finasteride) of Propecia. I believe half dose is about 70 to 80% as effective as the full dose. In your particular case, I cannot really say if the problem is dose related, but as you do not have side effects from the drug now at full dose, I do not see any reason for you to cut back to half a dose. I’m not your prescribing physician, so discuss this with him/her. Remember, Propecia is not a cure for balding. Some patients will have some hair growth in the first year or two. Some patients will have no further hair loss. Some patients will continue to have hair loss. In the end, all of these patients taking the drug will continue to lose hair to some degree, albeit at a SLOWER rate than if you were not taking Propecia. You see it may not be a cure, but it slows the hair loss down.
2. Propecia works for angrogenic alopecia (genetic male pattern balding). You self-describe your hair loss as “diffuse”, but I have a hard time believing you actually have diffuse hair loss. Diffuse hair loss would mean the back of your head is thinning as well. If you actually have diffuse hair loss (even in the donor area), then Propecia would likely not work for you. I would see a doctor for a diagnosis and a miniaturization study to document what you are treating.
3. Male pattern hair loss is genetic, but if you have it, you have it. It doesn’t really matter if your uncle, cousin, grandfather, father, or brother is bald because it is very difficult to associate a predictive inheritance pattern.
4. I didn’t think David Beckman was thinning or balding from the many pictures I reviewed of him asked by various readers. It is possible that there is a difference in lighting or hair products or perhaps even medication. I really have no way to know. Your definition of diffuse hair loss is peculiar to me though, and perhaps we are not on the same page here. I would love to examine you if that is possible.

i was wondering is rogaine safe. i hear that rogaine causes heart attacks but you know how people are. i just had a hair transplant and wanted to see if it was safe. thank you doctor

High doses of Rogaine (minoxidil) can drop your blood pressure and may not be a good idea if you have existing heart disease. I can imagine some case where a person uses minoxidil and has one of a variety of existing heart conditions, and the medication causes a drop in blood pressure leading to a heart attack… but that is theoretical and I have not actually heard that such a case exists.

So to answer your question, Rogaine does not cause heart attacks.

dear sir,thanks a lot for your kindness and great care about answering my questions. dr, can ketoconazole be taken systemically to treat seborrehic dermatitis?

There is a ketoconazole oral, but it has huge warnings about liver problems that can sometimes be fatal. That being said, ketoconazole is an antifungal medication… and to treat seborrheic dermatitis (dandruff), you would probably be better off with a shampoo.

This isn’t hair-related, but it is quite interesting and may have applicability to many of you. After you review it, you might want to talk with your doctor about this subject.

Abstract from the study:

The use of statins is widespread and many patients presenting for surgery are regularly taking them. There is evidence that statins have beneficial effects beyond those of lipid lowering, including reducing the perioperative risk of cardiac complications and sepsis. This review addresses the cellular mechanisms by which statins may produce these effects. Statins appear to have actions on vascular nitric oxide through the balance of inducible and endothelial nitric oxide synthase. The clinical evidence for these benefits is also briefly reviewed with the objective of clarifying the current status of statin use in the perioperative period. There is reasonably strong evidence that patients already taking statins should continue on them perioperatively. However, the evidence for the prophylactic use of statins perioperatively is weak and lacks prospective controlled studies.

Read the full text — Statins for All: The New Premed?

For years, I have been taking statins even with a normal cholesterol level. Many people who die of heart disease have normal cholesterol. Today’s regular Western diet may not be good for your health and as my father died from heart disease, the genes are there in my family line. Unfortunately, sudden death is often the first sign of heart disease (in 70% of those who have a heart attack). Although this article points to the risks associated with anesthetic risks and ways of mitigating them, my feeling is that there is a great value to taking a statin drugs routinely.