August 2007 – Page 10

August 13, 2007

American Athlete Taking Finasteride Fails Drug Test in Japan – Hair Loss Information by Dr. William Rassman

From the Associated Press:

A former Triple-A pitcher from California has become the first player in Japanese baseball history to flunk a drug test.

Rick Guttormson, who played in the San Diego and Seattle minor league systems, was suspended for 20 days Friday after testing positive for a banned substance. His team, the Fukuoka SoftBank Hawks, was fined $63,000.

Japanese baseball officials said a postgame test July 13 showed Finasteride in Guttormson’s system. Finasteride was in a hair-growing agent the 30-year-old Guttormson had been taking for two years. It’s banned because it can be used as a masking agent.

Read the full article here — American pitcher becomes first player to fail drug test in Japan

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August 10, 2007

Follow-Up: Are Doctors Promising More Grafts Than Can Possibly Be Delivered? – Hair Loss Information – Balding Blog

Re: Are Doctors Promising More Grafts Than Can Possibly Be Delivered?

Hi Dr. Rassman, I appreciate you addressing this very important issue. However, I think you missed the questions on this post. It seems to me the poster is asking if there is really 10,000-15,000 grafts available for transplant in the average male rathar than how many can be transplanted in a single session. I have noticed an increasing number of doctors who are saying this and using it as a basis for giving young men very aggressive hairlines. Can you expound on the issue of how many grafts are typically available?

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The available number of hair follicles for a hair transplant is different in each person. Some of the factors that affect the number of hair grafts are:

Density of hair in donor area. Average density is 2.0 hairs per square millimeter. It could vary significantly from person to person and between different ethnic groups. The actual donor area may represent 30% of your original hair (the rim around the head) of which half are possibly harvestable (in theory). This would reflect about half of the 30% of the original or 15,000 hairs (reflecting about 8000 grafts).
The size of the head also affects the size of donor area. Bigger heads with similar hair density have larger numbers of donor hair. Unfortunately, bigger heads have larger baldikng areas.
The average number of hair in each follicular unit is also important. People with higher density will have less single hairs and more groups of three and four hairs. In those who may have densities of 3 hairs per mm2 (150,000 hairs on such a head) the harvestable hair will be higher and may run as high as 45,000 hairs or 22,000 grafts (theory of what can be harvested). Actually harvesting these high numbers is more the exception than the rule.

Considering all these above factors, you can calculate the possible number of grafts and add to it the effectiveness of those hairs in producing appearance of fullness. It is true that in an average man with an average sized head, with average hair density (2.0 per mm2), and an average number of hairs per each follicular unit (~2), you can remove about 10,000 grafts safely, but this number can vary significantly and other factors should be considered in this equation.

This number is driven from a simple calculation that needs to be done for every patient when planning a hair transplant. Obviously since there are a lot of variables involved, this number can vary significantly, but is still easily assessable.

You asked about using such numbers for justifying an aggressive hairline. I occasionally have to create a thinner hairline due to scarcity of donor hair considering all of the above factors. I strongly believe that normal placement of a hairline in the ‘mature position’ is the correct location for a hairline. The Master Plan I keep talking about determines the distribution of harvestable hair in a worst case scenario, so that no matter what happens to the patient, no matter how much hair loss occurs with age, the patient will ALWAYS look normal. The quality of the donor hair is also very crucial for making the decisions in the Master Plan. I will, once again, list the factors that make up the elements for calculating transplant grafts in a solid Master Plan:

Hair thickness (the thicker the hair, the more volume it will produce, so less hair is needed for a given result).
Hair curliness (the curlier hair generally appears fuller and less hair is needed to produce the same appearance).
Contrast of the hair color and skin tone (the higher the contrast the more hair is needed to produce the appearance of fullness).
Donor density and scalp laxity will determine the ‘number of grafts’ that are available at any one point in time.

As you see, decision making is complex and many factors are involved. So available hair follicles are only part of this and other factors, including hair quality, should be taken into account. I also have to mention the importance of patients having a real expectation and is involved in making decisions on how aggressive we should design the Master Plan. See Medical Publications on the NHI site for more.

August 10, 2007

Testicular Pain 2 Days After Finasteride Use – Hair Loss Information by Dr. William Rassman

Hi Dr.Rassman
i’m 27 yr old and have been taking finasteride for a week now, i have been prescribed finepecia as propecia is not available in india, my doc says that both of em are same, anyways my concern is that i have been having testicular pain after the 2nd day of use, its mild but remains, will it subside? also i am very much concern about the sexual side effects. i have recently quit smoking and in college i have had my fair share of marijuana…will these things aggravate the side effects. what do u suggest should i stop it or continue ?

Smoking cigarettes and using marijuana can have negative sexual side effects independent of Propecia use. With respect to testicular pain after starting Propecia, I have occasionally heard reports of this as a relatively rare side effect. Usually the pain is not significant and will subside. However, it is more important to check with your doctor and notify him/her of this problem since the testicular pain may signify other serious medical problems unrelated to the Propecia use.

August 10, 2007

Taking Placebos and Using Your Mind to Regrow Hair – Hair Loss Information by Dr. William Rassman

This question is for William Rassman. I understand that in the studies of both rogaine and propecia, some men on placebos in the control group had actually slowed their hair loss down and even some regrew their hair. I would like an understanding of this. If a man assumes he will grow hair, can the mind trick the body into growing growing hair? If nothing is blocking the DHT and there are no other medications used I find this puzzling.

What you are referring to is known as the “placebo effect”. The placebo effect is the measurable, observable, or felt improvement in health that is NOT attributable to treatment. Read more about the placebo effect at The Skeptic’s Dictionary.

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August 10, 2007

Hydrocele and Crown Hair Loss? – Balding Blog

Hi, I am experiencing thinning on the top of my head, a bald patch shaped like a number ‘8′ on my crown. I also have a hydrocele which i have had for eight years, could this be a possible reason for the balding, considering that it might affect testosterone? cheers

I doubt that a hydrocele is the cause of hair loss or that it has an affect on your testosterone level. You may have male pattern hair loss. If you are concerned about hair loss, you should see a hair specialist (transplant doctor or dermatologist) to explore medical or surgical options.

August 10, 2007

Gamma Linolenic Acid – Balding Blog

Hello Dr. Rassman,

On wikipedia I read that gamma linolenic can inhibit 5 alpha-reductase. I was wondering how effective taking gla would be and if you have observed its affect on anyone. Thank you ahead of time.

Gamma-linolenic acid (GLA) is an essential fatty acid (EFA) in the omega-6 family that is found primarily in plant-based oils. You likely eat GLA every day if you eat food prepared with plant-based oils. The internet is a wonderful resource and sites such as Wikipedia have lots of information, but sometimes too much information can be confusing and misleading. GLA to my knowledge has not been observed to grow hair.

There are many oral vitamins and minerals which have suggestive evidence for preventing hair loss. This site may have interest for our readers, but I can not take a position on the recommendations it contains.

August 9, 2007

Taking Medication with Grapefruit Juice – Hair Loss Information – Balding Blog

A study published a few weeks ago indicated that the blood serum level of certain cancer medications, when ingested along with a meal and washed down by a cup of grapefruit juice, can be enhanced by up to nine times. This enabled patients who had been prescribed pills 5x daily on an empty stomach to cut their intake to 1x daily, as well as making their regimens much more affordable to them.

Can grapefruit juice be used to enhance the absorption of eiether finasteride or dutasteride? What about when taken along with a meal?

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Grapefruits I have read that grapefruit juice impacts drugs. Unfortunately, I don’t know any particulars about enhancing absorption of hair loss drugs. Read the following references:

August 9, 2007

Stopping Propecia While Trying to Conceive a Child – Hair Loss Information by Dr. William Rassman

I am trying to conceive with my wife and the doctor advises that I stop taking propecia during this period. If I do so, I have 2 questions:

How long after I stop taking it will I start to see hair loss – been on it for 7 years.

How long after I stop taking it will my body not have any its system to impact this conception process?

Thanks

Officially, you can continue taking Propecia while trying to conceive a child. From the official Propecia.com’s Possible Side Effects page: “Contact with the semen from a man being treated with PROPECIA is not a risk to the unborn child of a pregnant woman.”

However, some doctors and patients are still cautious about using Propecia when trying to conceive. Because of this, some doctors recommend you temporarily stop taking the medication during the fertile period when you are trying to conceive with your partner and best to stop for only a week when your wife is fertile. You can also stop taking Propecia for two weeks and I doubt it will have any significant negative impact on hair. I’ve written about Propecia and pregnancy before:

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August 9, 2007

Lipodrene and Hair Loss – Hair Loss Information by Dr. William Rassman

I was taking lipodrene for like 5months to lose some extra body weight. I decide to stop taking it, and when I did I realized that my hair was starting to fall out. It has been 7 months since taking the lipodrene pill and my hair is thinning and I have loss about almost half my hair. It is really noticeable that I have lost my hair. Why is my hair falling out and when is it going to stop and finally grow back. What hair growing shampoo should I use to help it grow back?

I am going to assume that you are a female and that what you are telling me about is not genetic hair loss. I do not know why your hair is falling out. There may be reasons other than the use of lipodrene, such as anemia, thyroid problems or iron deficiency. You need a physical examination and a good medical history. You may be noticing something coincidental.

I do not know of any hair growing shampoos in existence. It is a buyer beware market.

August 9, 2007

How Can MPB Catch Up If You Take Dutasteride, Which Blocks Up to 90% of DHT? – Hair Loss Information by Dr. William Rassman

Doc,

You have stated in previous answers that no matter what treatment a male is on, Male pattern baldness will eventually catch up. I do not see how this is possible since drugs such as Dutasteride can block up to 90% DHT when taken on 0.5mg form. Lets say it is approved in five years time for MPB by the FDA and taken along with minoxidil twice a day, how would MPB be able to catch up since the main factor; DHT is blocked?

Are then any studies that actually back up your opinion/theory?

If this is the case then surely every male suffereing from MPB including myself is throwing their money down the drain?

I suspect MPB is not singularly dependent on the concentration of DHT alone. Small amounts of DHT (the 10-20% that still is produced, even with taking dutasteride) can still trigger hair loss. Case in point, there are a few of my patients who have chosen to take dutasteride, but they still lose hair. I do not believe taking medications such as finasteride or dutasteride is “throwing their money down the drain,” because I have seen clear evidence on many of my patients that it does work! All medications have limitations — yes, including dutasteride and finasteride. For example, you can take the most potent anti-oxidant anti-aging medication, but you will still grow old and look your age.