November 2006 – Page 3

November 28, 2006

Male Pattern Baldness Skipping Generations – Hair Loss Information – Balding Blog

Hello Doctor,
I’m a 28 y/o male, and I have a question reagarding genetic balding. I understand that MPB can skip generations, but based on your experience from treating many patients, how often have you seen cases of MPB on patients, whom claim to have no family history of balding? Is it very rare, like 1%? Or is it more common, like 20-30%? In my case, my father, and all uncles and both grandfathers has no balding. I appreciate your response.

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I would be guessing that something in the order of 20% of men coming to my office report their inability to match the balding pattern they have in their family line. This may or may not be generation skipping. Sometimes, the actual balding pattern that is inherited is less or more than the worst in either side of the family. The other side of that coin is to respond by saying that more than half of balding men will recognize that their pattern existed in some male member of their family (father, grandfathers, uncle or brother).

November 28, 2006

Falling Hairs Do Not Contain Bulb At the End – Hair Loss Information by Dr. William Rassman

I am a 26 year old male who has been mapped for miniaturization and on Propecia for a little over 3 months. I have noticed that most of the hair I shed does not contain the little white bulb at the end and appears to be thick terminal hair with a slightly tapered tip. Some of the hair shed is real short (about the width and length of an eyelash). Could this be some form of anagen effluvium or loose anagen syndrome? Thanks for your advice.

I am in the dark here, because I do not have you in front of me to see what you’re talking about. Speak with the doctor who mapped your hair for miniaturization and ask him/her how what you’ve observed relates to the mapping results. Do you have genetic hair loss?

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November 28, 2006

Decreased Libido After 3 Days of Propecia Use – Hair Loss Information by Dr. William Rassman

“There are three general potential threats with Propecia: decreased libido or sex drive, erectile dysfunction and ejaculation disorders. Clinical tests showed that 1.8% of all men treated with Propecia experienced decreased libido, 1.2% – erectile dysfunction and 0.8% – decreased volume of ejaculated sperm.

Interesting to note that after 5 years of Propecia treatment, the above mentioned side effects disappear and only 0.3% of all patients still have them.”

Quote from site.

I am facing a decrease in libido during my first 3 days of propecia. What should i do, should i carry on taking it? it seems that the side effect dissapear, or should i stop it.

Stay the course for a month or so and see if the problem goes away. If not, I generally advise my patients to stop the drug for a week (everything should be back to normal) and then try taking a half a pill a day and see if that makes a difference. I would see the doctor who prescribed the Propecia to you and alert him/her of these problems.

November 27, 2006

When Is a Good Time for a Hair Transplant? – Hair Loss Information – Balding Blog

I was just wondering when you can get a hair transplant. I’m 20 years old, male. My hair is falling and I’ve already started the propecia. I know that the propecia isn’t going to get me to where I am before so I just want to get a transplant. I don’t want to stick with where I’m at. There are no bald spots….just the scalp is visible all over when my hair is wet. My question is this…..can I get a hair transplant already or do i have to have a bald spot? Thanks a whole bunch.

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You should be on Propecia (finasteride 1mg) for at least a year. You need to get your hair mapped out for miniaturization and follow the benefits or lack of benefits of the drug. Either you will:

Get better with less miniaturization after a year
Slow or stop the hair loss
Get worse

Based upon the response to the miniaturization mapping, you need to develop a Master Plan with your doctor which will define the various paths open to you, including the timing of things you can do. Some men of your age will slow, stop, or reverse the hair loss on Propecia, while others may continue to bald at their own accelerated rate indicative of strong genetic and hormonal influences. There is no magic about hair transplants and if you are going to get really bald, then great care in how transplants are used is critical to being sure that you will always look normal, never trading short term benefits for your long term appearance. The Master Plan will lay out the transplant option and put it into perspective with projections on your hair loss which might be easy for a doctor with a great deal of experience in doing such predictions. 20 year old men are often less objective and less able to stand back and look at the long term hair loss process when they have short term needs (girls, self confidence), but some doctors see the money in it and may be willing to take your money to allow you to focus on short term agenda issues. That is in no man’s best interest. If you are unfortunate and have a very rapid hair loss process going on that is not benefited from Propecia, hair transplants could be the worst thing you could do right now. Please remember the following philosophy: A Good Decision Today is a Good Decision Tomorrow. Get a caring doctor who works with you on that Master Plan I discussed. I have done a few hair transplants in very young men (early 20s) but I am careful that I know what is happening to them and I learn a great deal about them as fellow human being before embarking on such a path.

November 27, 2006

My Friend and I Both Have Missing Patches of Hair – Hair Loss Information – Balding Blog

yesterday afternoon my mom noticed that i had a patch of hair missing from the back of my head. i dont know if its a disease because my friend had the same problem but he had patches missing everywhere in his head and i dont know if im heading in that same direction. i hope not but it scared me when i found out i had a patch of hair missing. could you tell me what i could do to regain that hair back or what i should do to cure it? thank you for your time. have a nice day

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I would like to have more information about your situation. A bald spot in two people who are friends could have environmental or infection causes. What is the age of you and your friend, do you share the same living space (apartment or house), how long have the patches been there? Are they progressive (getting larger) or are they stable and getting better? Are the patches punch like with sharp edges or irregular patches along their rim? Is there any hair inside the patches? I would like to see some photos of these patches. I might be able to give a better indication after seeing the photos, but it might be easier and better to see a good dermatologist in your area and get to the root of the problem. As you can see from my questions, making a diagnosis over the internet can be a problem and a visit ‘one on one’, with a good doctor is the best way to go.

November 27, 2006

Can Excess Cortisol and Hypothyroid Cause Texture Changes in My Hair? – Hair Loss Information – Balding Blog

I was recently diagnosed with excess cortisol (adrenal fatigue) and hypo-thyroidism due to the production of excess cortisol in my body. Can this combo of excess cortisol and hypothyroidism cause color and texture changes to my hair, reduce facial growth and thin/miniaturize my whole scalp hair in a uniformed global fashion?

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Adrenal fatigue syndrome is a condition with diverse manifestation. In this condition, hair tends to get thin, wispy and dry. You may also experience some hair loss. In low thyroid function, hair tends to get more coarse and sparse and may become wavy or the hair color may change. You can find a nice table of information here.

For more information, you should see an endocrinologist.

November 27, 2006

Blood Pressure Medication and Hair Loss – Hair Loss Information – Balding Blog

Which other BP medications don’t cause hair loss and coughs like Lisinopril does?

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Any medication can potentially cause hair loss as one of the side effects. However, the most common cause of hair loss is not due to medications. If you are losing hair you should have doctor who specializes in hair to examine it for signs of miniaturization in specific pattern or distribution. To answer your question more specifically, there are no studies to compare the hair loss effects of a particular blood pressure medicine against another. That is the type of research I would love to see, but a research project that is unlikely to happen. More importantly, you should always consult with your doctor before stopping or changing any medications.

November 27, 2006

Shedding From Minoxidil and Propecia – Hair Loss Information – Balding Blog

Dr Rassman:
I started using Monixidil 5% two times a day combined with Nizoral shampoo 3xweek about two and a half months ago. I also added Propecia to my thinning hair treatment about a month ago. I started experiencing shedding about a month and a half ago and still I am shedding; my dermatolgist did not see anything wrong with my scalp by the time she Rx propecia. Is shedding normal under treatment for this long? The Monoxidil has irritaded my scalp which also seems to be part of treatment but I decided to take a 10 day brake which ends today (11/18/06) so I started using it again. The irritation has ended…so far and the Nizoral definetly helps.

I started the treatment as prevention, I am 43 and thinning but now I am questioning my decision because of the excessive shedding.
May you please offer some advice? When should I expect improvement on the shedding? Are those follicles still intact? My biggest fear is that I have caused more damage than good. Thanks for your help.

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Shedding is occasionally reported when starting minoxidil or Propecia (finasteride 1mg). You must wait out the period until the shedding stops (about 3-4 months). This appears to be an acceleration of the hair cycle before the better growth kicks in. Your reaction to minoxidil indicates that you may not be able to take it. Some people get considerable irritation from it.

November 27, 2006

New Study – Dutasteride vs Finasteride – Hair Loss Information by Dr. William Rassman

In a recent article in Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2006 Dec;55(6):1014-1023), dutasteride and finasteride were compared over a limited 12 week and 24 week study in 500 men in a study which had also compared placebo effects. The authors of the article are Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, Wilson T, Rittmaster RS; for the Dutasteride Alopecia Research Team.

Based upon photographs taken, dutasteride was superior to finasteride in this time frame. Dutasteride blocks both Type one and Type two receptors and the suggestion of the authors was that the combined block of these two receptors may be better than a block of one receptor in reversing the process. Clearly, the study needs to be extended well beyond 24 weeks.

The long term safety of Type 1 clocking for DHT production is safe and there is a natural model both genetically and through eating finasteride, but no comparable model exists for the DHT block of both receptors for safety, as the study above just discusses limited views of efficacy. The FDA’s position is still that dutasteride is not an approved drug for treating hair loss.

November 27, 2006

Finasteride and Depression – Hair Loss Information by Dr. William Rassman

For some time now, some studies show a possible link between finasteride and depression. A recent article, titled “Finasteride induced depression: a prospective study”, discussed this connection and was published in BMC Clinical Pharmacology and appeared online in early October.

Some of the relevant points from the article are:

5alpha-reductase is a critical enzyme in the conversion of several steroids such as testosterone, progesterone, aldosterone and corticosterone in the brain. This enzyme converts testosterone to the most natural potent androgen DHT, and also it acts an important role in conversion of progesterone to dihhydroprogesterone (DHP)…..A decline in serum DHT level occurs after finasteride administration. This may contribute to finasteride induced depression. We [the authors] couldn’t find any significant change in the anxiety scores before and after the treatment

The authors conclude: This preliminary study suggests that finasteride might induce depressive symptoms; therefore this medication should be prescribed cautiously for patients with high risk of depression. It seems that further studies would be necessary to determine behavioral effects of this medication in higher doses and in more susceptible patients.

For the complete article, see BioMed Central.

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