Hair grows everywhere on my body on Minoxidil

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

Minoxidil is causing vellus hairs to grow around my eyebrows and cheekbones, but doesn’t seem to be doing much for my head.  It’s given me more hair growing out my nose, on my toes, armpits and chest. I’ve got 1000 hairs in my tush. But where I want the it the most, on my head, it’s packing its bags. Mother nature has a dark sense of humour and she’s pranking us boys.

When minoxidil gets absorbed, some people end up with a lot of hair almost everywhere. That is why, when minoxidil was introduced in the 1960s as an anti-hypertensive agent, we saw a lot of hairy women from the drug which was not very effective consistent high blood pressure.

Responses from ‘Finasteride is a risk in pregnancy’ post

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

This is my original post:  https://baldingblog.com/finasteride-is-a-risk-in-pregnancy-with-unprotected-sex/

In this study (https://www.ncbi.nlm.nih.gov/pubmed/29855987), the women, aged 39, was taking 2.5mg of finasteride daily alongside her partner during the entire gestation period. The male baby was healthy with no deformities of the genitals.

I can’t put it together but I did note the article. The report from the patient indicated that the scrotum and its support structures develop in the male fetus at the end of the first term or beginning of the second term of pregnancy. In this study, the woman only took the finasteride for the first 5 weeks of her pregnancy but her partner appears to have continued using it. Cause an effect is difficult to impossible to pin down in this troubled man.

What about wanting to have a child while on finasteride, should we stop medication? And for how long?

I have to think about this. The half life of finasteride in the blood stream and extracellular fluids is about 6 hours which means it should be out of your fluids in a day or two at most. I also know that it stays in some tissues, possibly everywhere, so I really don’t know any science that informs me how to answer your question. When your partner gets pregnant, you can resume protected sex with no problems and that is absolutely safe.

Well that’s rather concerning. Along with your conclusion, I’m assuming this also means that if you are trying to conceive you should not be on finasteride/dutasteride. Would you agree with that, Dr. Rassman?

I would leave that to you. As I said above: “The half life of finasteride in the blood stream and extracellular fluids is about 6 hours which means it should be out of your fluids in a day or two at most. I also know that it stays in some tissues, possibly everywhere, so I really don’t know any science that informs me how to answer your question.” I am no longer able to think through this problem at this moment.

Isn’t it kind of far fetched to link such statistical ‘tail event’ to the use of finastride in this scenario? The causal link imposed could very well be due to total randomness.

Could be!

I didn’t know this, and my wife is currently 25 weeks pregnant… we used a condom for the most part but I’m still terrified.

Statistically, the odds are in your favor and you should be fine. There are very few reports like the one brought forward by the man I referenced, but for all the men who read this going forward, they should engage in protected sex if they are on finasteride.

Finasteride is a risk in pregnancy with unprotected sex

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

A man wrote to me about this problem with his baby who developed a problem unique to 5 alpha reductase inhibitors

This is what Merck wrote:

Although the above comments reference 2 studies using a 5?mg dose, Merck (2007) also measured semen levels of finasteride in patients taking a 1?mg dose. The men were treated with 1 mg for 6 weeks. The highest level measured was 1.52 ng/mL, and the mean level was 0.26 ng/mL. Using the highest measured level (1.52 ng/mL), women exposed to a 5?mL ejaculate per day would be exposed to 7.6 ng/d (assuming 100% vaginal absorption). Merck (2007) found this level to be 750 times lower than the “no effect” level for developmental abnormalities in rhesus monkeys.

In summary, a 1?mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

This is what is really the issue:

Mohan et al states which clearly shows that even a small amount of finasteride that comes through the semen, the risk is real:
“Congenital scrotal agenesis is a rare anomaly that, to our knowledge, has only been reported in the literature on four previous occasions.. Scrotal development is initiated in the 7th embryonic week with the formation of labioscrotal folds on either side of the urogenital folds. Foetal testosterone is converted into more potent dihydro-testosterone by the action of the enzyme 5a-reductase type 2 which is expressed in these tissues. The scrotum is then formed as a result of enlargement and midline fusion of the labio-scrotal folds in response to the androgens…
Sinnecker et al. have shown that that 5a-reductase type 2 deficiency can result in a spectrum of phenotypes  with varying degrees of virilization spanning from completely female to almost normal male. The phenotypes reported in our cases could be explained by a localised deficiency of 5a-reductase type 2, limited to the labioscrotal folds. This could possibly result in partial virilization of labioscrotal folds where in there is absence of development of normal scrotum but at the same time labioscrotal folds are prevented from developing into the complete female phenotype, i.e. labia majora. Later during topical therapy, the incompletely virilized labio- scrotal folds could have developed into normal scrotal tissue under the influence high concentration of testosterone. This is akin to the development of normal male external genitalia in children with 5a-reductase type 2 deficiency during pubertal testosterone surge.”
This condition is directly linked to 5a-reductase type 2 deficiency. I will get him all of the best medical treatment possible but I don’t believe the guilt will ever leave me. This is still a happy time with a baby but also the most traumatic. Thank you for your offer, I appreciate it. Please publicise these risks as much as possible as well. I look forward to hearing from you more in future.

I Am Going to Get My First Hair Transplant in Turkey and Believes a Lot of Promotion ‘Bull’

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

Hello fellow baldies. I’ve finally decided to take the leap and go get a hair transplant. I’ve been quoted on the price and scheduled an appointment in Istanbul. The clinic is Esteliv if anyone’s wondering or if anyone has underwent a procedure there I’d love to hear how it went.  About the procedure: *Extraction of follicles with micro motor using stemcell technique and Sapphire FUE.  They will be extracting between 3000 and 4000 grafts.  Hopefully this’ll be game changing for me. Wish me luck!

Do you need 3000-4000 grafts? You have a donor bank that only has withdrawals and the typical Caucasian has between 6000-7000 grafts, only half of which can be safely harvested from the donor area without getting over-harvesting. If you are Asian, Middle Eastern, or family from Southern Asia (India, Thailand or Vietnam) then usually limits are substantially less than Caucasians.  Do you actually believe this Stemcell and Sapphire FUE stuff?  You should realize it is all promotional stuff.

20 Years Old and Thinking About a Hair Transplant.

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

I’m basically at Norwood 3 and I don’t want to lose my f***ing youth. Going isn’t an option like for many here since I have moles on my head and can’t grow a beard anyway.  I also got depression because of my hairloss, and it’s literally the only thing that bothers me in terms of my body.

However, most information online says you have to be at least 25 to do one. I can’t really wait 25 years and suffer like this. Is it really a bad idea to do it now, and is it even possible? I’ve got around 14k€ saved up, so money shouldn’t be an issue.

It is never a good idea to do a hair transplant at 20 years of age because you don’t know where your balding pattern will end up, and you can use up all of your donor hair before you get to the final pattern. Some bad doctors are unfortunately motivated to make a lot of money by doing more and more grafts on each patient, and that leaves you with possibly nothing left for future hair loss. Send me photos to wrassman@newhair.com

Lockdown! Should one take Vitamin D?

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

It looks like a lot of us are going to be going into lockdown for the foreseeable future, which means a lot of us aren’t going to be getting enough Vitamin D. Now, Vitamin D does have a proven link to hair growth. It’s not going to stop AGA but it’ll help keep some of the thickness and generally just make us feel healthier in these times. Stay safe

If you live in cold climates, have to stay indoors for a long time, don’t have a tan, then taking daily Vitamin D supplements may be a good idea for your hair. Vitamin D only works in the presence of a Vitamin D deficiency.

A Personalized Master Plan for a second hair transplant?

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

I have a fairly aggressive form of androgenic alopecia. By 26 most of the hair top of my head was gone. So decided to get an initial FUE transplant for at least the front of my head. It was roughly 1500 grafts. Result was moderate, while a huge improvement to what it was, I could not get that thick hair look but was pleased nevertheless. Since then the alopecia has impacted the crown of my head as well as the sides and the back as well( above the donor areas).

Now it’s left me wondering on what to do. Because of the widespread thinning. I keep my hair short now. Clip size 2 on the sides and back and clip size 6 at the top( wahl clippers). I feel like I look better with a clip size 1 cut on the sides and back but this gives that odd look in the doner area and you can make out some sort of procedure could have been done because of scarring.

My surgeon at the time said that doner area could support another 1500 or so grafts but that would leave the back heavily reduced and would probably have to be kept short permanently as the deplemention would be noticeable.

I guess what I need is some advice as I’m not sure at all!

  1. Get 2nd FUE to cover crown. Sides and back permanently short( Wayne rooney style). Noticeable scarring at the back though.

  2. Leave as it is. Back and sides and thinning anyway. Keep hair short and work with what’s left.

  3. Accept baldness!

A Personalized Master Plan would be on the hair transplant side of the plan and would address your donor supply for hair from the back and sides of your head for your life-time. These are measurement based tests. These numbers should be discussed with your doctor prior to starting the hair transplant process. Assuming that you have an ‘Average’ donor density for a Caucasian and you have a ‘Medium’ hair thickness, your doctor should first ascertain your worst case balding pattern which will cover the entire life-time hair transplant process (worst case) . Everyone is different and to judge your worst case pattern the doctor would (1) measure your balding area, (2) do a HAIRCHECK test on the parts of your scalp where the loss needs to be measured to predict future balding patterns and do a miniaturization analysis when appropriate, (3) budget your hair needs now (the area you want to cover and the grafts you need to cover it), (4) subtract the grafts you use now from the total donor hair grafts you have for hair transplants over your lifetime, (5) know your worst case balding situation and see to it that your hair graft reserves and the surgeon’s plans can accommodate all of your needs so that you not only always have hair, but that you always look normal. Sometimes the Personalized Master Plan will include Scalp Micropigmentation when the original donor density is low or if the Hair Mass Index is low reflecting fine hair.

Finasteride & Dutasteride may cause Type 2 Diabetes

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

The article shown here published in a respected medical journal discusses the influence of Finasteride and Dutasteride in the appearance of diabetes in men with enlarged prostates treated with these drugs

CCBY Open access

Research

Incidence of type 2 diabetes mellitus in men receiving steroid 5 alpha-reductase inhibitors: population based cohort study

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1204 (Published 10 April 2019)Cite this as: BMJ 2019;365:l1204

Authors:  Li Wei, associate professor in epidemiology and medical statistics1,, Edward Chia-Cheng Lai, assistant professor2,  Yea-Huei Kao-Yang, professor2,  Brian R Walker, pro vice chancellor (research strategy & resources), Thomas M MacDonald, professor of clinical pharmacology and pharmacoepidemiology5, Ruth Andrew, professor of pharmaceutical endocrinology3

Author affiliations  Correspondence to: R Andrew ruth.andrew@ed.ac.uk (or @RuthAndrewMSEd on Twitter)

  • Accepted 11 March 2019

Abstract

Objective To investigate the incidence of new onset type 2 diabetes mellitus in men receiving steroid 5?-reductase inhibitors (dutasteride or finasteride) for long term treatment of benign prostatic hyperplasia.

Design Population based cohort study.

Setting UK Clinical Practice Research Datalink (CPRD; 2003-14) and Taiwanese National Health Insurance Research Database (NHIRD; 2002-12).

Participants Men in the CPRD who received dutasteride (n=8231), finasteride (n=30?774), or tamsulosin (n=16?270) were evaluated. Propensity score matching (2:1; dutasteride to finasteride or tamsulosin) produced cohorts of 2090, 3445, and 4018, respectively. In the NHIRD, initial numbers were 1251 (dutasteride), 4194 (finasteride), and 86?263 (tamsulosin), reducing to 1251, 2445, and 2502, respectively, after propensity score matching.

Main outcomes measure Incident type 2 diabetes using a Cox proportional hazard model.

Results In the CPRD, 2081 new onset type 2 diabetes events (368 dutasteride, 1207 finasteride, and 506 tamsulosin) were recorded during a mean follow-up time of 5.2 years (SD 3.1 years). The event rate per 10?000 person years was 76.2 (95% confidence interval 68.4 to 84.0) for dutasteride, 76.6 (72.3 to 80.9) for finasteride, and 60.3 (55.1 to 65.5) for tamsulosin. There was a modest increased risk of type 2 diabetes for dutasteride (adjusted hazard ratio 1.32, 95% confidence interval 1.08 to 1.61) and finasteride (1.26, 1.10 to 1.45) compared with tamsulosin. Results for the NHIRD were consistent with the findings for the CPRD (adjusted hazard ratio 1.34, 95% confidence interval 1.17 to 1.54 for dutasteride, and 1.49, 1.38 to 1.61 for finasteride compared with tamsulosin). Propensity score matched analyses showed similar results.

Conclusions The risk of developing new onset type 2 diabetes appears to be higher in men with benign prostatic hyperplasia exposed to 5?-reductase inhibitors than in men receiving tamsulosin, but did not differ between men receiving dutasteride and those receiving finasteride. Additional monitoring might be required for men starting these drugs, particularly in those with other risk factors for type 2 diabetes.

Transplant Hair Is Growing in Curly….But I’ve Never Had Curly Hair Before?

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

6 months post transplant. Hair has been growing in for 2 months now. Got transplanted hair put on both temples and lowered hairline slightly. Left side temples and lowered hairline hair is coming in as expected. However, on the right side, the hair is growing in curly and is off-putting. I had a follow up with my surgeon last month and she couldnt explain it. The barber who has been cutting my hair says the hair needs to grow longer for it to straighten itself out. His thinking is that the hair is at a weird/short length which makes it curly. But I have never seen my hair be curly like this. There have been times in my younger yrs where I buzzed my hair, and my hair was never curly at a short-length, it was always straight still.

Is this just part of the “growing-pains” of the transplant hair? Will it eventually sort itself out over next couple hair cycles to be my normal straight hair? Or perhaps the technician screwed up during the procedure and angled the hair wrong?

This happens with some (rare) transplant patients. I have seen this consistently in the same patients who had more than one hair transplant, but I would say that the common change is more wavy hair, less curly and very rarely kinky.

MPB Progression

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

Can rates of mpb change time to time in a person. From 2017 – 2018, my hair line went to Norwood 1 from Norwood 0. The texture of my hair changed and density decreased. From July 2018 to now, there was no change in hairline or density, remains the same. Essentially does mpb progress in a linear, exponential, or sine wave like fashion? Or is there no idea.

Moving from a Norwood 0 to a Norwood 1 is just moving from a juvenile to a mature hairline, and it is NOT balding. To be sure, I would have to see what you are referencing with some good photos.

Man follows his hair transplant progress over a year (video) from Reddit

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

It is wonderful when someone allows us to watch the progress of

their hair transplant and take the time to do it with such intention to detail.

The hair transplant changed his look!

I took a picture every day after my Hair Transplant last year, I compiled the footage in a time lapse video. If someone wishes to see how my transplanted hair grew in a year. Here’s my head :) from tressless

How Rare Are Permanent Side Effects from Propecia/Finasteride?

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

The science papers suggest that the sexual side effect (the focus of most men on this site) are less than 2% and are reversible if stopped early. The nocebo effect is much higher as young men bring on their sexual side effects by obsessing over taking the drug, and reading forums that suggest that this is a common occurrence. The greatest concern of most young men is the condition called Post Finasteride Syndrome which if real, may reflect a 1% risk at most. There is controversy over the existence of this condition within the medical community, but it is nevertheless important for any man considering this drug