Hello Doc,

I’ve wrote once before. I appreciate your reply. My question is I now have been using propecia for 1 1/2 months now. Sincerely, my hair thickness has degraded significantly. It has shed to a point where my scalp is visable in many areas. Maybe I am one of the small % of the crowd, but definate loss is more since AFTER initiation of treatment. Also, with reading in many different sites and encyclopedias, prostate cancer % is decreased in men, but tumors or certain cancers are more agressive. Also toying with testosterone and estrogen levels is not recommended. There are tons of products out there, I think most are scams fishing for suckers. I found this product called Procerin. It sounds safer to me. I value your professional feedback. If you don’t recommend this product, and I feel propecia isn’t the answer for me, please tell me the best product to use without scary sounding side effects? Thank you for helping…

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I originally commented on Procerin a few months ago (found here).

I have read various articles about Procerin on the web, and there is an unsubstantiated claim that it is a DHT blocker. It might be right, but I can’t say for sure, as it is not FDA approved for that claim and good science for Procerin is just not there to give me comfort that claims can be substantiated. Your problems may not be related to Propecia, but you can always stop the drug and see what happens. I suggest that you take (whatever you do), one step at a time. Stop the Propecia if you want to see what happens. I would hope that any ill effects will be reversible in a month or two if you go back on it. Do not bind yourself to a medication you are not comfortable with. If you believe in Procerin, then try it after being off Propecia 6 weeks or so. Then see what happens. There may be competitive inhibitors to the DHT production sites that Procerin might impact (if it is a DHT blocker, that is), competing with the likes of saw palmetto and other DHT blockers at the actual active site in the body. I have written much about Propecia in this blog, so you can find out other things I have said about it by clicking here. I frankly do not know and do not know how to find out the answers to your questions, however.

Good luck.

Transplanting Someone Else’s Hair to Your Head

If one can transplant the face of another person, why can’t we transplant the hair from another person? Please read US plans first face transplant on BBC News for details about the face transplant.

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You are referring to the face transplants that have been recently approved by the FDA. The answer is that a face transplant is like a cadaver kidney transplant. Some genetic matching helps, but anti-rejection drugs are essential. The issue is best exemplified by the old adage “Does the punishment fit the crime?” One can easily transplant most people’s own hair (an autotransplant) so that rejection of the hair is never an issue. If you transplant someone else’s hair, then you would have to use anti-rejection drugs to stop the body from rejecting the hair organs from the other person. These drugs are dangerous and in themselves have great risks associated with them. In the very deformed people, the benefits outweigh the risk. As your own hair is easier to use, there is little need or demand for transplanting someone else’s hair to your head. The few that are very, very bald, or those who have run out of donor hair after receiving far too many old type hair transplant procedures, are left without a solution for today’s focused world.

Recipient Area Scarring

I had two hair transplant procedures performed on me. The first was in 96 and the second in 98. I was only 21 at the time of my first procedure. I recieved a total of about 900 graphs between both sessions. I am very unhappy with the results. I’d like to know if my transplant can be reversed. What could be done about scarring in the recipient area? Any info would be greatly appreciated.

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You may be able to have the grafts removed with FUE. This may remove the grafts, but the skin may still not be normal and it would shows scars. Alternatively, you can fix it and complete the process if the hair supply is good. You first need to be examined by a first rate doctor. For more info, please see the following links:

Does Azelaic Acid Stop Hair Loss?

Does Azelaic acid in Xandrox block DHT? Will it will inhibit virtually all synthesis of DHT in the scalp at the follicle level as claimed by some [people? It has been said that it will not bind with the 5 alpha reductase enzymes (Propecia binds with type 2, 5-alpha reductase.), but it will inhibit the synthesis of all of the hormones in the 17-hydroxy group, which would include testosterone, DHT and androstenediol, the most potent of the androgens. Can you clarify this for me?

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I reached out to my colleagues and Drs. Shaprio and Cooley responded with one of the better answers given to me. The focus of the quoted study was on in-vitro (in the laboratory) studies and there are no invivo (in patients) studies. The finding in the laboratory is interesting, but it is a big jump to answering it for people like you who seem to research things in great depth. I would warn most of my readers that there is a long stretch to findings in the laboratory and responses in patients. we have seen cancers killed in the laboratory and no impact on patients. Certainly safety issues are pre-eminent and drive much of what I recommend for my patients.

“I think Dr Lee is referring to this old in vitro data. I’m skeptical azelaic acid is a good in vivo topical 5AR inhibitor and even if it is”, as Dr. Shapiro said, “there’s still the systemic DHT that must be addressed. I doubt that azelaic acid does much for hair growth. ”

Read the citation summarized below from British Journal of Dermatology, 1988 Nov;119(5):627-32.

Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid, by Stamatiadis D, Bulteau-Portois MC, Mowszowicz I., Laboratoire de Biochimie B, Hopital Necker-Enfants-Malades, Paris, France.

The effects of zinc sulphate and azelaic acid on 5 alpha-reductase activity in human skin were studied using an in vitro assay with 1,2[3H]-testosterone as substrate. When added at concentrations of 3 or 9 mmol/l, zinc was a potent inhibitor of 5 alpha-reductase activity. At high concentrations, zinc could completely inhibit the enzyme activity. Azelaic acid was also a potent inhibitor of 5 alpha-reductase; inhibition was detectable at concentrations as low as 0.2 mmol/l and was complete at 3 mmol/l. An additive effect of the two inhibitors was observed. Vitamin B6 potentiated the inhibitory effect of zinc, but not of azelaic acid, suggesting that two different mechanisms are involved. When the three substances were added together at very low concentrations which had been shown to be ineffective alone, 90% inhibition of 5 alpha-reductase activity was obtained. If this inhibition is confirmed in vivo, zinc sulphate combined with azelaic acid could be an effective agent in the treatment of androgen related pathology of human skin.

Desperate for Hair that Looks Real

I’ve been losing my hair since i was 19 and now i’m 23. I’m pretty much at a strong norwood 3. I tried alot of things, but nothing has helped. My mom’s dad was bald and the rest of his family too. Basically don’t know what to do. I’ve read that i’m too young to get a transplant and have not made a move on it. Im also afraid to get one cause of the scars. I really don’t know what to do. It has pretty much ruined my life. I use to have girlfriends all the time now have not had one since 20. Pretty much so desperate i would sell my mustang just to pay for a transplant but i don’t know if i should if results don’t look real and if there is scars involved.

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First, be careful with statements like “I would sell my mustang just to pay for a transplant,” because many unscrupulous people will take your money and sell you hair. Realistic expectations, reasonable predictions based upon a good solid examination of your hair and hair loss distribution with good microscopic examination of the scalp, a good doctor with great integrity and lots of good experience, and some comparative shopping will tell you much about what you can do. Read my book, available online in PDF format here, or get one sent to you free. Visit my offices if you are in California. Natural results with a hair transplant are not difficult to obtain, but first you must know where you stand and what your long term ‘Master Plan’ should be before you jump to a hair transplant.

I know that if you do not feel good about yourself, if you do not have the self-esteem you want, then having a normal life becomes more difficult. A hair transplant may or may not solve these problems. The main reason we generally discourage men of your age in getting a hair transplant is that (1) you may not be able to determine when the hair loss will stop, (2) you may not be mature enough to understand both the financial and social remifications of the transplant process, and (3) you may not be able to get the realistic expectations that fit with your hair metrics (hair density, contrast in colors, character of the hair, laxity of the scalp, etc..). In effect, will you have enough hair supply to follow your hair loss to meet your expectations? Get a good doctor and develop a Master Plan with him/her. Then and only then, can you deal with the decision of “Should I or shouldn’t I?”

Taking Multiple Hair Loss Drugs at the Same Time

I’m am a 22 year old male and have been balding since i was 17. I have been taking Proscar, saw palmetto and applying minoxidol for about one year now and there is definite improvement in the crown of my head but not alot in the front. I have just ordered dutasteride over the net but i still have some proscar left. I was wondering could i take them at the same time, not take the proscar and just take the dutasteride, or maybe take the dutasteride and not take the proscar?

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When you play doctor, you sometimes undo what you are trying to do. I know it’s been mentioned on this blog many times before, but for the readers that aren’t familiar with the various hair loss drugs, Proscar (5mg) is the same medication as Propecia (1mg). Propecia is FDA approved for treating hair loss, and Proscar is a prostate drug. Many people will cut Proscar into quarters to achieve the benefits of Propecia, but for a reduced price.

Dutasteride and Propecia are both very good DHT blockers, with Dutasteride probably stronger. There is no point to take Propecia if you are taking Dutasteride, but I have warned the young men out there that there is no FDA clearance for Dutasteride in young men for hair loss use.

Saw Palmetto may be a competitive inhibitor to Propecia and/or Dutasteride. That means that when Saw Palmetto hooks on to the DHT receptor instead of Dutasteride or Propecia, it will compete with these drugs. Saw Palmetto is a weak DHT competitor, making the stronger drugs less effective. You may be undoing what you want to do.

Predicting Hair Loss

Hey Doc,
I got a question for you. Im 26 years old with no definitive loss yet although i do have the mature hairline. My question is has do with genetics. What is the likelyhood that a male will either take after their father or mothers father in terms of Male Baldness, is it almost 100% that you will take after one or both of them or could you concievably not follow either one’s baldness pattern and instead follow inherit MPB pattern as that to your cousins, uncles, great uncles, grandfathers.

This is the reason i ask my father started to bald by the time he hit age 25 and was completely bald by around 35, my mothers father started balding in his late teens and was completely bald by 30 yet here i am at 26 with no apparent loss. With this family history i always figured i had no chance to keep my hair because both my father and mothers father have excessive MPB, so i assumed by the time i graduated High School, i would have some sort of loss.

Also the reason i ask is because generally many of the male family members on both sides (father and mother’s side) namely uncles and cousins have fairly good hair, is it possible i was fortunate enough to escape the MPB gene from 2 of the closest male members (dad, mothers father) and somehow instead inherited the hair of the more distant male relatives?

IN you encounters as a derm, do you think most males take after either their father or mothers father, or is it common for a male to not follow either one of their patterns and instead have a hairloss pattern that of a more distant relative.

Thanks for your response

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Basically, we can take after either parent or neither parent. We can inherit genes and not have them expressed, yet pass the balding genes to our children or future grandchildren. I tell all of my patients that the best way to know, is to have a good microscopic examination of your scalp periodically. By the age of 27, you should have an idea of what your possible hair loss pattern is. In your particular situation, the appearance of a mature hair line has no significance for your balding pattern. It is possible that your pattern may have skipped generations or was inherited from others in the family that do not express the gene.

The Woods Technique

Is the Woods technique a viable option to consider for hair transplantation?

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This technique is undocumented and has never been explained. This doctor has kept his process secret, including the yield and growth rate of the transplants. Woods has chosen to do his technique without any peer review and not publish it in recognized journals. By making his technique secret, he has succeeded in creating a mystique (a cult) that he has promoted on the internet to create hype.

I have had the opportunity to see a couple of his patients and the recipient sites are not as clean or as natural as ours (I believe he creates larger recipient site wounds). In addition, the scarring in the donor area is evident on his videos and on his patients. Doctors in Australia tell me of significant failures in his hands based upon patients that have come to them. Although bashing doctors is at times fashionable for competing doctors to try to gain a competitive edge, Woods has failed to fulfill his basic responsibilities with the Oath that doctors take when they are given their diploma to practice medicine and surgery. That failed responsibility (to share knowledge and educate patients and colleagues to improve the quality of medical care) increases my skepticism about his work. Creating secrecy does little more than to make a sect that confuses the public and people who may get sucked into marketing hype and then ask obvious questions, wanting to know facts. I have tried to find out what he does, if only for curiosity. For now, however, Woods chooses to do his thing under the cover of secrecy.

For more info on the New Hair Institute’s published FUE technique:

Experiencing Pain from Propecia Use

Hi Dr.Rassman
I am a 20 years old guy. I have a bad family history with hair loss. The same thing happend to me 1 year ago. I decided to take propecia 2 weeks ago. The problem is that in the first 5 days i had testicular pain.Than it was better and better and now i dont have it anymore. I asked my doctor,but he didn’t tell me why it was happening.Can you tell me why did it happen to me?
Thank you for your time.

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I am not familiar with testicular pain from Propecia. It is not a known side effect and I have had no patients report such a problem to me, despite the many patients who I have prescribed this drug to.

The Magic Bullet for Hair Loss?

HI I would like to tell you a little story about me… I am 39 and I started losing my hair in 2000 and I took the advice of tricoligist a person who studies hairloss. THIS person told me all the wrong things like saw would stop my hairloss..!!!! it did not!!!!! I am so mad because if I started on propecia I would not have this thin spot on my vertex. I would like you to go this web site and look at these products and tell me what you think of these products and services. I would like you honest opinion..PLEASE!!!! LET ME KNOW

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I’ve removed the link you provided as to not give free advertising to that site.

I have looked over the site you asked about, and I have read your email carefully. The only DHT blocker that is FDA approved is Propecia. The drug Avodart has been reported from reliable sources to be more effective than Propecia, but it is not FDA approved for hair loss (it is FDA approved for prostate problems, however). Many of the other substances listed on this site are not proven, yet there are claims appearing all over that say these products are good at preventing or reversing hair loss. The site appears to sell everything they review, and that puts out an alarm for me. I do not cash in on FADS, but rather use my knowledge and extensive education to help my patients use what works.

You made a mistake years ago; do not make it now. If you have genetic hair loss yould should be on Propecia. Using other approaches may not hurt, but I would question the value of them.