Propecia, Liver Deposits, and the Harshness of Winter

Thank you Dr. Rassman for maintaining a wonderful blog and for being a generally nice guy. My history is a bit checkered:

Seven Years ago I was told by Dr. Bernstein (another really nice guy by the way) that based on family history I might have diffuse pattern alopecia although only the vertex was thinning. He put me on Propecia and refused to operate till some time passed. The Propecia worked well but I had elevated liver enzymes from fatty liver deposits and stopped it after a year. After six years I have lost a lot of hair on the crown but the rest of my hairline did not vanish as I expected. In fact the crown is noticeable precisely because the rest of my hair is present. So basically from a thinning vertex I now have a bald vertex but the rest is intact. I don’t know about miniaturization though.

1. Question 1. My liver readings are the same. What are my options?
2. Unrelated question 1. I have always wondered whether i have mild trichitillomania. I ask because I never pull my hair hard but I used to (and still sometimes do) very very gently test my vertex hairs and they always slip out readily. The test is so mild that on my permanent zone I can barely feel the tug and yet on the vertex two out of three hairs slip out. Have I harmed myself with this “strength test or were these weaklings doomed anyway?” Incidentally the hairs would not come out when I took Propecia.
3. Unrelated question 2. My biggest discomfort from my bald spot is the dampness from sweating on the bald crown. In New York my scalp sweats profusely from the heating indoors and once outdoors it feels colder than the rest of my head even with a hat. In fact the hat in contact with the bald spot feels awful.

1. People with liver disease just need to take a smaller dose of Propecia and they can be on that medication. Without seeing you I can not make judgments. I’d see Dr. Bernstein again.
2. I don’t know if you have a mild case of trichotillomania, but if you’re just gently pulling on the hair to see if it comes out, it may just produce traction alopecia. Trichotillomania is an obsessive compulsive disorder, and it doesn’t seem like that’s what you’ve got going on… but I really couldn’t diagnose trichotillomania over the internet like this.
3. Bald heads do sweat in hot weather and lose body heat in cold weather. Hair allows air to move through it in hot weather acting like a radiator effect. In the winter it acts like a blanket as it insulates the scalp where the blood supply is quite high (in the winter) so the body does not lose heat. When Napoleon’s French troops invaded Russia in the early part of the 19th century, the first soldiers to die from the harsh cold temperatures were those who had balding.