July 2006 – Page 6 – Balding Blog

July 21, 2006

Should I Be Using 2% or 5% Minoxidil with Propecia? – Balding Blog

Hi Doc, what a wealth of information this blog is so many thanks. I have recently started propecia for vertex thinning and am thinking that i should also probably use minox in conjunction with it. Do you have any thoughts on wether it should be the 2% or 5% dosage or if i should use it at all. Im 7 months into my propecia regime. thanks

In my practice, I generally recommend one change at a time. Wait out the full 8-12 months on Propecia before you add minoxidil. You should be using a good metric on this treatment (mapping out your hair for miniaturization) so that you know what is really happening and what you really need.

Higher concentrations of minoxidil have a greater risk of potential side effects such as dizziness and fainting from low blood pressure. Minoxidil and Propecia have different mechanisms of action and do not have any significant interactions.

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July 21, 2006

Shaving Head After FUE Procedure – Hair Loss Information by Dr. William Rassman

How long after FUE is it safe to shave the head short? Is there danger of pulling out grafts.
Many thanks for your time.

I clip the patient’s hair short on the day an FUE is performed and you can keep it that way. Shaving the head can be safe at about 1 week. Be careful not to cut the new skin in the donor area, though.

These photos are from 11 days after one FUE procedure of 1,901 grafts. Click the photos to enlarge.

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July 21, 2006

Doctor Won’t Transplant Me Until I’ve Taken Propecia for a Year – Hair Loss Information by Dr. William Rassman

I met with a doctor in Madison Wisconsin, Dr. Gencheff.

I am 21 years old, soon to be 22. He advised me to start taking Propecia first to “stabilize” because he said young men can have an “shock loss” if transplantation is performed without it. This was in December 2005. It’s been 6 months roughtly since I started the drug. I actually take “Finpecia” which is a generic finasteride. I think it is working to slow down the process, but I can’t tell the full results yet. I will continue to take it as long as i need. He mentioned that transplanting in the crown area is not a good idea. I am not exactly sure why, i think he said its because you don’t know how far its going to progress. All in all, he said I had good hair to transplant with, but he said he wouldnt operate on me until I had taken Finasteride for at least a year. Is it possible to transplant in the crown area? By the way, i think he diagnosed me as a future 5a. The mid scalp is thicker as well as the front hairline. Thank you for your help, I may be seeing you soon.

From your brief description, I agree with your doctor that you should be on Propecia for a reasonable amount of time before resorting to a hair transplant surgery — especially at the age of 21. Your doctor seems to be looking out more for your interest than his own bank account, which is definitely a good thing. I often write on BaldingBlog about the “Master Plan” of a life long goal of maintaining a desirable head of hair, rather than just achieving a quick fix. If you are indeed a future Norwood 5A (assuming you are a Norwood 3A now) then it would be wise to see how much Propecia can slow, stop, or even reverse the hair loss process. Maybe you will be lucky and reverse some of the process you are now experiencing. I look forward to seeing you in San Jose and would be happy to map out your scalp for miniaturization, trying to outline where you may be going with the balding process.

July 21, 2006

DHT and Transplanted Hair – Hair Loss Information by Dr. William Rassman

I would like to know how a hair follicle falls off. I was told that as DHT accmulates at the bottom of hair follicles hair falls off. This DHT is produmed by male harmones. Is this true? If this is the case even after hair transplantation DHT will be accumulating and it will cause the transplanted follicle to fall off. Then how is hair transplantation a permanent solution?

DHT is created when your body metabolizes testosterone. It is mostly made by your liver. For people who have the gene for genetic balding, when the hair is at the point in time when it is susceptible to the effects of DHT, it usually starts to get thin (we call that miniaturized) and as it thins out more and more, eventually the hair will permanently fall out. Sometimes the hair just falls out rather than going the route of miniaturization.

Transplanted hair does not have the faulty genetic code, because hair from the sides and back of the head (for reasons not clearly understood) have normal genetic code. These hairs are not vulnerable to the effects of DHT. Look at the people who are genetically bald. They always have hair around the side and back of the head, always. I can not tell you why that is the case, but I know for certain that these hairs around the side and back of the head are programmed to grow for life, so when they are moved in a hair transplant (to a new home in the front), they keep growing as they did at their old ‘home’ in the side and back of the head.

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July 21, 2006

Birth Control Pills and Hair Loss – Hair Loss Information by Dr. William Rassman

Hello Dr. Rassman,

I am a 29 year old female and have been slowly losing my hair for several years. It’s gotten to the point where it is noticible and I am very concerned. I have been to my pcp and determitologist. I have had the standard thyroid tests, etc. and everything is normal. I also have mild vitiligo which I have heard can cause hair thinning as well. I am currently taking spironolactone and am using minoxil. They don’t seem to be helping but I know those can take time.

I have also been taking Levora for about 8 years. I hadn’t thought about that as being a possible cause, but then I noticed that it is listed as a possible side effect. And one of your posts mentions that hair loss is a side effect of birth control pills in 1-5% of women.

Any suggestions? Are there better pills to be on or should I try to go off the pill?

Thanks for your time

It is true that birth control pills can cause hair loss. I realize hair loss is a very sensitive topic, especially for women, but so is an unplanned pregnancy. You should definitely discuss any medication changes with your regular doctor. Some birth control pills may have more hair loss than others, so ask your doctor to experiment with a few of them to determine which one has the least impact on your hair problems.

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July 20, 2006

Weaved Extensions Caused Hair Loss – Hair Loss Information by Dr. William Rassman

I have recently taken out weaved extensions (conrows) that I have worn for over 3 years. I have lost almost all my hair in the back where the braids were. Do you think this will be a permanent loss and it’s too late now?

I also just started using rogaine extra strength (5%) for men, even though I am female (since like I said I have a ton of hair loss), is this okay to do, and do you think it will help in my case of all traction loss?

It sounds as though you indeed have traction alopecia from your braids. Given that you recently took the braids out, your hair may grow back. It is too early to tell as it could take several months to see new growth. I do think minoxidil is a reasonable choice in the meantime. However, the male version of rogaine 5% is oil based and makes hair styling more difficult. The female version is alcohol based and tends to hair styling a little easier.

July 20, 2006

Taking Propecia for Telogen Effluvium – Hair Loss Information by Dr. William Rassman

If a male is suffering from a bout of Telogen Effluvium rather than MPB, would taking Propecia be either harmful or is it just totally benign, outside of the possible latent benefits for his prostate.

I doubt that taking Propecia (for men) would be harmful. However, I have many questions that were raised by your question, such as — How did you make the diagnosis of TE?

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July 20, 2006

Restarting Minoxidil Months After Transplant – Hair Loss Information by Dr. William Rassman

I had a transplant procedure (approximately 1600 grafts) 4 1/2 months ago mainly to the thinning crown of my head but some to reinforce the frontal hairline. The frontal grafts are beginning to show evidence of growth. The crown graft areas are causing some problems with redness and some sore spots that have been addressed elsewhere in this blog. The itchy red patches have made it impossible for me to continue using Minoxidil. As the patches eventually resolve am I likely to experience benefit from restarting Minoxidil even 5+ months post surgery? I am female and had one transplant 10+ years ago which was very effective at the time and from which I did not experience the same degree of problems with an itchy red scalp. It should be noted that I am 56 years old, with very fair skin and have had fine texture hair throughout my life. I was carefully evaluated prior to this procedure and determined to be a viable candidate for the procedure again. I did find a reputable transplant surgeon.

Thanks for your help.

If you have confidence in your tranplant surgeon, these are issues that the surgeon should address. You need to be examined to make sure there is no chronic infection (folliculitis) or other problems. It is always important to achieve a good patient to doctor relationship and these problems and concerns should be mentioned during your meeting.

With regard to restarting minoxidil, that is not a problem as long as the itching and active inflammation are gone.

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July 20, 2006

Propecia Half-Life and Morning Testosterone Levels – Hair Loss Information by Dr. William Rassman

If the half-life of Propecia is only 8 hours (or whatever it is…less than 24 hours anyway) I’m just wondering shouldn’t it be taken at least 2-3 times a day? I know it wouldn’t be viable given the cost, but technically speaking, is this a reasonable assumption?

Also you speculated a while back that it may be better to take Propecia in the mornings as testosterone levels are highest at that point. Even though it was pure speculation, I was wondering: are testosterone levels highest in the morning or when you wake up (which may not necessarily be in the morning).

Your assumptions are reasonable. However, Merck (the makers of Propecia) has determined through extensive human clinical testing that once a day dosing of Propecia (finasteride 1mg) had the best effect on male pattern hair loss.

Male testosterone levels are generally higher in the morning if your body is in a regular circadian rhythm following a normal wake/sleep cycle. If you are a night-shift worker or sleep at different times, your testosterone levels may peak at different times.

July 20, 2006

Nothing Would Benefit Society More than Curing Baldness – Hair Loss Information by Dr. William Rassman

I feel that nothing would benefit society more than curing baldness. The men that would be cured from this would then give society more gains, because of their newfound confidence, than could ever be imagined otherwise. I would absolutely guarantee this beyond a shadow of a doubt. Ciao

Confidence is important in any person for it frees that person from the constraints that limit human creativity. Some people measure value with dollars, some with euros. Some people measure man’s contribution with patents, some with Nobel prizes, and some with hair. I know where you are coming from.