Month: January 2006

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Will Avodart Lose Effectiveness After 5 Years, Like Propecia Does? – Balding Blog

Hi Dr,
We know that the study on Propecia shows that after five years, users typically lose most of their regrown hair, and that propecia continues to deter hairloss but that hairloss does continue over time.

My question is…why? Is it that Propecia no longer effectively inhibits DHT after 5 years (body develops an immunity, DHT serum/scalp levels therefore increase.) Or, more likely, is it that there are still undetermined factors which contribute to hairloss, even though the type 2 DHT inhibition rate remains constant?

The question links to avodart. If avodart is just a *much* stronger DHT blocker, and if DHT-inhibition is not the cure-all to hairloss, can’t we expect that Avodart too is equally limited in its scope?

I don’t see how type 1 inhibition and long half life can help in the overall process if there’s more ground to cover than DHT inhibition.

Actually, Propecia users keep more hair than non-Propecia users even after 5 years (ie they do not lose most of their retained hair), and Propecia continues to stop or slow hair loss at the very least in the crown area for as long as you take it. I have patients who have been on it since it came out and their hair loss (if any) is undetectable.

As for those who only experience dramatically slowed loss (still a big improvement), no one knows why hair loss continues at low levels. You are correct to point out that we do not have all the answers with hair loss, the fact that Propecia works mainly in the crown for returning hair and not the front (and only in men) is proof of this. But Propecia will slow loss in the front if you catch it early enough in some people. Pattern baldness is progressive by its very nature.

You are also correct to point out that Avodart is far from being a panacea. We do not even have studies proving it’s efficacy in hair retention (although I myself believe it possible), so it cannot be the final answer or the magic pill we all hope for. Before starting more medications, you should get a metric (measurement) by having your scalp mapped out for miniaturization to determine if you have premature genetic balding.

There are still many unknown factors in hair loss, the future will bring many advances and surprises, I am sure. Until then, Propecia, Rogaine, and hair transplantation are the only means of hair loss help that have scientific evidence to prove and quantify their effectiveness.




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Proscar Prescription – Balding Blog

Hi Dr. Rassman,

I was wondering if it would be possible for you to write me a prescription for Proscar which I can cut into 4 pieces. If not, do you know a physician who will? Also, is there a good method for cutting it evenly? Thank you.

Yes, I can write a Proscar precription for you, but you will have to come into the office for a check-up and diagnosis. Since you indicated you are in the Orange County area, you’re not too far from my Los Angeles office. You can use a pill cutter to cut the pill into 4 or 5 parts. These are sold in every pharmacy for a dollar or two.




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MesoHair / Mesotherapy – Hair Loss Information by Dr. William Rassman

Can you give me your opinion about MesoHair (or mesotherapy)? Just from reading this article, it sounds like it is INJECTIONS in the scalp. Is this better than taking a pill?!?! It says “virtually painless” but I can’t see how injecting stuff into my head can be without pain. The article is at http://www.clickpress.com/releases/Detailed/6646005cp.shtml

Thanks

I can not answer this with any authority. I read the page referenced above and am not convinced that problems of vitamin deficiency are a cause of the hair loss in many normal healthy people who have a good diet. There is a suggestion on that website that this therapy “delivers long-acting neutralizing effects on the DHT hormone” and I have a hard time understanding how this is done. If there was proof, I would love to see it, but as it exists, these appear to be just claims. I suggest that you use Google, as I have, to search out the history and science behind this approach and read the above reference carefully. “Let the buyer beware” is an axiom that still applies.

Just to be clear, the above linked “article” is actually just a press release rather than an independent news story.

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15 Year Old Female with Hair Loss – Hair Loss Information by Dr. William Rassman

Your information on female hair loss was helpful, but the information on teenage female hair loss was not as informative. I’m fifteen, and I feel I need more information. When I was a child, I had thick hair. When I was around seven, I cut it short. It was still thick then. Around seventh grade I decided to grow it back out, but still, it was thick then. When I started my freshman year in high school, though, mid-year, it began to thin. It has shown no sign of stopping, and it does worry me. My ponytail has significantly gone down in size. I can’t wear my hair down without having loose strands cover my back – which is not popular at school. Plus, I lose an extreme amount of hair each time I shower – at least fifty strands. My hair is also lackluster in shine, and crooked and crinkled when it falls out. My mother took me to a doctor, who told me it was not my thyroid level. A week or two ago, my father told me to start taking vitamins and trying to eat better – the latter of which is hard, when you go to high school. Personally, though, I’m not sure that I believe this is a diet issue. If it was, why wouldn’t it affect more teenage girls at my school? I wish to know if there are medical conditions that I might have that give a symptom of hair loss, and possibly also slight depression – I have noticed that my mood seems to be getting worse and worse. I am also on birth control, which I noticed you said might cause problems… but it shouldn’t, because I have been having hair loss much longer than I’ve been on birth control. I just want to know what I could have, and how I can get this to stop.

You need to have a good doctor do a thorough work-up on you. There is no way I can help you without getting a full opportunity to get a good history (including detailed dietary history) and a full examination of your scalp and hair for miniaturization. This will determine the health of your hair and your overall health. There are no shortcuts and no internet site that can get you what you want, because what you need is a good doctor (one who is interested in this field) first. Also, look through the Female Hair Loss category, as there are many posts that discuss the various conditions and tests that are part of what a good doctor will be able to perform on you.

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Female Hairline Restoration After Brow Lift (with Photos) – Hair Loss Information – Balding Blog

I have had a higher hairline since I was a teenager. I always hated it. When I had a face and brow lift at the age of 49, the high hairline became even higher. Is there a simple way of lowering it? Is transplanting the only solution?

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The photos below are of a 45 year old woman who, like you, had a high hairline compounded by a brow lift as well.

These first 3 photos are surgical pictures because they show what was missing, the deformities that were there and the problem that was tackled before (the middle and right photos were from immediately after surgery):




This next set of photos were taken after this lady’s 2nd procedure had grown in. The black hair and light skin are the most challenging contrast for hair transplant surgeons, explaining why it took two procedures to get the results you see here. She had a total of 3,508 grafts (in two procedures). Note that the side hair and temples were brought forward. In normal female hairlines the temple prominences often extend closer to the eyes than in men, narrowing the amount of forehead shown. Women’s hairlines, because they are rounded, not recessed, and the temples are important for accentuating femininity, make the work more difficult from an artistic vantage point.




The high hairline bothered her greatly after the brow lift and became unacceptable. The brow lift produced a wide scar behind the hairline (compounding the problem). In this situation, a hair transplant is the correct decision because lowering the hairline and filling in the scar behind the hairline can be accomplished with a single procedure in a person with blonde or white hair, and two procedures with someone with dark hair and light skin. The hairline was lowered by 3/4 inch and filling in the brow lift scar was also accomplished in the same procedure. A brow lift usually takes away the possibility of a hairline lowering procedure.

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Plug Repair Cost – Hair Loss Information – Balding Blog

Hi Doc,

I’m a one time hair transplant patient of Dr XXX in Rhode Island and very displeased with the results. I had it done back in 1993 at 24 years old. At first it seemed okay, but now my hairline has receded more and the graft are way too pluggy and I’m forced to pluck them, but the pitted scars still show! I shaved my head once and the donor scar is way too obvious. It looks like I’ve been in a car wreck or something. Anyway, it appears my only logical options are to:

1) remove the plugs
2) wear a piece to hide the plugs
3) repair the hairline with a competent doctor

My current hairline has been the same for about 7 years now. It’s about the same as the actor’s Matthew McConaughey at TheSmokingGun.com.

Any idea on the cost to help thicken the hairline again. I know I’ll never get back my old hairline I had in my early 20’s. Just want it to look normal.

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We have written articles for scientific journals on the repair options. Those options have become better than since the articles were written and now we can often be more aggressive when needed with far less risks. In addition, we can take follicular unit grafts from the old plugs, softening them in a more distributed way.

The costs vary per patient. At the least, I would need to see pictures to make that estimate. You can send photos to the email address on the Contact page.

For examples of plug repair, please see:

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Hair Loss InformationDoes a Hair Transplant Increase the Forehead? – Hair Loss Information – Balding Blog

Your site is very helpful and is a great service to the community. I applaud your selflessness. I was motivated to check your site because I saw the Procede ads – thanks for setting us straight on that one.

I am curious, however, about Regenix and wonder if anything new in the way of clinical evidence has come your way to suggest how it works vs. something like Rogaine?

Also, is it true that hair transplant surgery, by borrowing from the back of the scalp, also serves to increase the forehead space? If so, is it advisable to have the transplants along the frontal hairline to lower the hairline and reduce this space?

Thanks for your help.

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I have no information on Regenix in the way of clinical evidence (Tier 1 evidence) at the level of proven FDA approved treatments such as Minoxidil (Rogaine) or Finasteride (Propecia), nor are there any head-to-head trials comparing these sorts of treatments (who would pay for possibly proving someone else has a better treatment?). If someone tells me a certain treatment works for them, GREAT! Keep using it. However, I will not recommend treatments for which I do not have rigorous and incontrovertible scientific evidence.

As for the oft-asked question about a forehead lift from removing skin from the back of the head, I am happy to tell you that your forehead does not move, but your butt raises up two inches… I’m just kidding, you actually don’t have any change except for a little less excess skin at the back of your head because of the way the skin is attached to the skull it is loose. We have redundant tissue at the back of your head because your neck is actually a joint, like your elbow or your knee, so you need a little extra skin to allow for flexion. Thankfully for the hair surgeons, nature has provided a bit more skin there than is necessary, which is why we can take some out and not affect anything around it. Sorry for those of you who wanted a combination facelift/hair surgery!

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Hair Loss InformationDoctor Recommendation in Philadelphia? – Hair Loss Information – Balding Blog

Hello Dr. Rassman, I am a 51 year old white female who has had thinning hair for past 4 yrs when I went through menopause. All blood work is normal, even low testerone. I take Bio identical hormones (only bi-est and progesterone) and spironolactone. I would like to find a good hair loss doctor in the Philadelphia area. I know you have mentioned one in Fort Lee NJ but that is quite a distance. And do you find that propecia works for women? Thank you so much for your time.

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I can not tell you the name of a particular Philadelphia based doctor, but a visit to Dr. Robert Bernstein in Fort Lee NJ or Manhattan NY via Amtrak would be a good bet. Dr. Bernstein is a real expert, and worthy of your consideration and with regard to female hair loss, you need a doctor with special expertise in knowing what to do and when (or if) to do it.

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Thinning Hair Since High School – Hair Loss Information – Balding Blog

Hi, Im 21 and I have had thin hair since atleast 9th grade. It has gotten progressively thinner since high school, but my hair line is not moving. Rather, I experience a general thinning all over like you see in old women. I know i get it from my mothers side because she also has really thin hair while my father has a healthy head of hair. What is my best option to stop this gradual thinning?? My dad is a doctor so he prescribed me Propecia which i used for 5 months with pretty much no results. I feel that most of the products on the market are aimed at male pattern baldness while there is nothing for men like me. Could you please recommend a course of action. Thanks alot.

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You need to get a proper diagnosis. Get your head mapped out for miniaturization and determine if you have Diffuse Unpatterned Alopecia (DUPA). This is a condition that is similar to female genetic hair loss, except that it occurs in men of all ages. Rather than write a book on your management, I suggest that you get your doctor (father) to connect with us. Have him start by reading the article I wrote titled Follicular Transplantation: Patient Evaluation and Surgical Planning?” and find DUPAwithin the text of the article.

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Hair Loss Information » Female Hair Loss from Prozac? – Balding Blog

I have been on Prozac 20+ years. Current dosage of 40 mg. per day. I am experiencing hair loss which is increasing. About half the hair on top is gone, there is stubble. Have been to dermatologist who don’t know why.Could Prozac be the reason for the hair loss? I am a caucasian female.

Prozac is known to cause hair loss, although it is rare.

Please read the other posts I’ve made in the Female Hair Loss, and consider having your scalp mapped for miniaturization, so that you have a better understanding of what you are dealing with.