Month: March 2008

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I’ve Seen 3 Different Dermatologists with 3 Different Views on My Hair Loss – Hair Loss Information by Dr. William Rassman

I have seen 3 dermatologists with 3 different views.

The first derm i go to does the pull test and says the ease of hair coming out might make it seem like a non genetic thing. The second derm wants to give me corti shots…which i received, we were to meet for 2 more sessions, but he suddenly quit the office. The 3rd derm , in replacement of the 2nd, says it is genetic and prescribes me Propecia. I feel like these docs aren’t taking the time to study things case by case so I come to YOU for some experiences advice.

HISTORY:
Started to notice hair loss in senior year of college. It has been many months since start of serious hair loss. Mother’s side all good…father’s side, hair loss beginning in 40’s and 50’s.

MY CONDITION:
Itchy scalp, most noticeable when in contact with a brush. Flaking, now very few, prob due to few uses of Nizorol. Oily…in fact, my pillow smells and in the morning it is oily and a mess. Back, side and front very good condition, the hair loss is diffused amongst the top portion of my scalp.

HAIR CONDITION:
When examining the fallen hairs, they usually have a bulb but it is small and dark. Sometimes there is a oily/flaky substance attached to it. Also, some hair I notice have a wave to them and the tip is very thin and pointed.

I have thought the possibility of a seborrhea condition, is my case something a scalp biopsy can figure out? A blood test has already revealed normal ranges in all except some hard to decipher words in the hermatology report which my physician did not deem notable.

Thank you very much in advance.

I do not agree with cortisone shots in the scalp for treating genetic hair loss. Seborrhea should be treated by any good dermatologist or family doctor. The use of topical steroids are often overkill. Pull tests are part of the work-up of a patient with hair loss. Mapping out your hair for miniaturization gives me a great deal of knowledge on what is going on in the hair of a person with balding or thinning.

Doctors don’t all agree and that is a fact of life. When you are caught up in the middle between doctor’s advice, make a judgment on who you like, who treats you with respect and who has a caring manner, then stick to that doctor. A good doctor/patient relationship is important, and trust in your doctor is significant. I can be the 4th doctor to look at you, but I’m in Los Angeles and you indicated you’re in New York — so if you don’t mind the travel, I’d certainly invite you to my office for a consultation. Or more convenient for you, my colleague Dr Robert Bernstein has an office in New York.

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Dr Rassman Quoted in Boston Globe – Hair Loss Information by Dr. William Rassman

Boston GlobeMy initial thought was that a quote by yours truly in the Boston Globe would be a really great thing. Then I realized that the writer of the article only found three words of mine (relating to DHT) to be worth quoting. Check it out:

Am I the “shrivels hair follicles” guy now? Is that going to be my claim to fame? Wow, I hope not! But hey, at least it gave me something funny to mention on the blog.

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Hair Loss InformationTreating White Scars From Hair Transplant – Hair Loss Information – Balding Blog

Hair Transplant – What is the best treatment for white scars which left after transplant surgery?

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Today’s hair transplants do not produce a white scar if follicular unit transplants are performed. The old plugs done 20+ years ago, had white skin within the plugs and many of the older plugs never grew, so these poor souls had white scars (depigmented from the damage of transferred grafts). If this is what you are talking about, you should review our articles on repair that were published in Dermatologic Surgery in 2002:

If I missed something or misunderstood your question, please write me again to clarify.

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Hair Loss InformationStress Related Scalp Build-Up and Bleeding Scalp – Hair Loss Information – Balding Blog

I had supposed stress related scalp problems. it used to bleed and sometimes get really dry. when i put scalp grease on it it would get too greasy and buildup some nasty thing i would peel off. it itched so bad and bled when i scratched it. the dermatologist did cultures and found nothing so i guess its from stress. the problem went away on its own but i have spots on my scalp that wont grow hair. i wonder if the scalp is covering the follicles. can my hair grow back?

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A bleeding scalp is not normal. Without an examination, I can not tell what is happening to you. As you already have seen a dermatologist, I suggest you ask him/her what is wrong with you. If your doctor can’t determine the problem, see another doctor. You need to get an opinion from a physician who can examine you in person.

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Using a Sauna While On Propecia – Hair Loss Information by Dr. William Rassman

I understand that using a sauna can remove drug residues from the body. In view of this, my question is can you use a sauna while on propecia? or will it limit the effectiveness of propecia itself?

thanks

No, a sauna will not cause you to expel or remove Propecia from your body or limit its effectiveness.

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The FDA is Corrupt and Mismanaged – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,

Check out this article on the Wall Street Journal: FDA Chief Is in Budget Bind.

With all due respect, why do you put so much stock in the FDA? It is clearly a horribly mismanaged government agency. President Bush and Congress have declined the FDA’s request for a budget increase due to the system being “badly broken” and even though it is still considered the “gold standard” (as the article states), it is obvious that there is much corruption. So why can you so easily disregard every product that hasn’t made FDA approvals and even some that the FDA have cleared (like the hair lasers)? I get that you’re hesitant to recommend anything beyond the FDA approved drugs because you are a physician and you do not wish to do any harm, but I’m open to new ideas and you seem to be coming from this old school mentality of just believing what the government tells you and disregarding everything else.

I love your site and I know you’re writing by far the most honest hair loss site on the web, but this is just something I have a problem with and I hope I can shake your tree a little bit to find out your thoughts on the FDA as a regulatory agency and their actual ability to act in the best interest of the public or in the best interest of the drug companies.

FDAIf I had to judge safety and effectiveness, I am afraid that I would be doing only one thing with my life and that thing would be to become an expert in possibly only one drug. It would take years and a massive effort to perform the same types of studies that the FDA requires. Every civilized country has their own FDA or equivalent with the same mission — to judge safety and effectiveness of various products before they come to market.

Governments build bureaucracies and much like the Katrina disaster in Louisiana, our government did not do a competent job. I am not a fan of bureaucracy or incompetence, and upon reading your referenced Wall Street Journal article, I know it speaks clearly about the problem. I am afraid, however, that I must use whatever sources are available to determine safety and effectiveness and other than the FDA, there are not any other substitutes.

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Shouldn’t I See Significant Growth at 5 Months Post-Op? – Hair Loss Information by Dr. William Rassman

I got a hair transplant myself almost 5 months ago- on October 10,2007. The hair on the front of my top scalp is still pretty thin,.I can’t tell if I lost more hair than before I had the transplant or if there is little growth from the transplants. AT 5 months, shouldn’t I be able to see significant growth- and if there isn;t should I ask my doctor at 11 months do consider doing it over again?- because they will probably say they did everything right despite the results being poor???

At just 5 months post-surgery, you can not tell how successful a hair transplant was. You shouldn’t be in such a rush to expect failure. Usually the growth just starts at 4-5 months, so I would expect that by the 6-8th month you should see 80+ percent of the hair grown.

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Injecting Finasteride and Minoxidil Into the Scalp? – Hair Loss Information by Dr. William Rassman

Hi Doctor,

I came across a doctors site which supposedly has a procedure for balding in which they actually inject a small amount of fines. and minox. along with vitamins and trace elements via computerized mesogun into the mesoderm of bald areas. The site is www.msi-medspa.com, under hair restoration tab, in the “Is there any other solution for hair loss other then surgery”.

Does this technique seem feasible? I have been on propecia for a month now. My question is, would using the above technique assist in preserving the current stage of my hair until the propecia begins working (assumingly in 3 months now)? Could it be used in conjunction, and would injecting fines. directly in bald areas prevent side effect?

Thanks for your help.

Guinea pigOral Propecia (finasteride 1mg) starts working immediately, but it takes months to see the effects of it (a good 8 months to see the impact on hair growth). I can not imagine injecting either minoxidil (which will drop your blood pressure, as that what it was designed to do) or finasteride (not shown to be effective here).

The site you referenced says: “Tiny amount of active ingredients of minoxidil, finesteride together with all vitamins and trace elements are injected via computerized mesogun into the mesoderm of bald areas It gives an excellent results in both Androgenic and pseudo androgenic alopecia.”

I would like to see the proof that this procedure provides “excellent results”, for it sounds like you’d be experimenting with yourself as the guinea pig.

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Any Particular Post-Op Shampoo for Long Term Use? – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I am in the process of researching surgeons for a possible transplant. I have learned from your website that post-op care is just as important as the care you receive on the day of surgery. It seems that many doctors have different post-op washing strategies.

What shampoo and conditioner do you recommend to your patients for long-term use after a person has had a transplant. In addition, what is your opinion on using NANO Shampoo and Conditioner or Dr. x’s Regrowth Shampoo (containing Nizoral 2%/Salicyclic Acid 1%) after a transplant? Would either of these selections be harmful? I use both on alternate days and want to make sure that these formulas would be okay after surgery, since I feel they are beneficial to my current progress.

Lastly, do you have any events in Texas planned for 2008?

Thanks in advance.

The value of the shampoo is in the mechanical cleansing of the scalp. Our practice has been to wash the hair thoroughly on the day after the transplant surgery to clean up any scabs that are present. Most people who do this and maintain almost any shampoo that is gentle, will see fast healing on the surface. What happens below the surface should not be impacted by the shampoo you use. Daily or twice daily washing is critical to an undetectable post operative course and most of our patient are so clean within a few days, that the transplant visibility is practically insignificant.

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Experiencing Anxiety, Increased Libido, Shedding and I’m Scared to Discontinue Using Propecia – Hair Loss Information – Balding Blog

Hello Doctor,

I’d like to first thank you for such an informative blog, it has answered many of my questions. I am a 24 year old male and first started noticing hair loss exactly a year ago after moving from California to Maryland (Not sure if the climate change has anything to do with it). I have always had a lot (almost too much) hair, and other than my dad, all the men in my family have a lot of hair including both grandfathers that are well into their eighties. So I never considered hair loss as a possiblity and have been in denial for the past year. I finally felt like too much hair was falling out in the shower, and wanted to make sure if it was normal or due to mpb.

I visited a doctor, who to my disappointment merely glanced at my hair, and said that it is mpb (Which I found hard to believe as I didn’t think my hair loss was something noticable to the naked eye). He prescribed propecia, and told me to use it with rogaine or alone. Either way, I figured he was my Doctor, a dermotologist, and probably new better than me. It has now been 6 weeks that I am on propecia, and have been experiencing anxiety, aggitation, increased libido, and a great deal of shedding all over my head. The shedding is bothering me a great deal as I feel I am losing more hair than I ever was before, and as a result my hair density is becoming greatly reduced with my scalp slowly becoming visible. More importantly, now that I have been reading through your blogs about all the preliminary tests, mapping, and precautions you take before prescribing propecia to your patients, i’m wondering if I ever should have been put on propecia, or if I was just going through natural hair cycles.

I now have no idea what to do, i’m worried about continued use of the propecia if I don’t really need it and due to the side effects i’m feeling. And i’m scared to discontinue, not knowing if the hair i’ve shed will come back or not, and I really don’t want to cause anymore hair loss by stopping it’s use. At this point I would really appreciate any advice you might have for me as to what to do with the propecia. Also, if you recommend any doctors in the maryland area that I could see i’d appreciate it. Thank you very much for your time.

Kindest regards.

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You really need to discuss these issues with your doctor, as there may be other medical problems unrelated to Propecia (finasteride 1mg) or balding. Generally speaking, increased libido is a very real side effect of Propecia (some people think that there is about 10% of men taking Propecia who report this, but I don’t have great statistics available). In contrast, 1% of men may experience a decrease in libido. I can’t tell you whether you should be stopping any medication that I didn’t prescribe to you.

It is true that you should start off taking any medication with a full understanding of what you are treating and what your realistic goals are. A miniaturization study is what I recommend at NHI before I’ll start a patient on Propecia. I do realize most doctors do not perform miniaturization studies, but I would advocate it. At the least you should have good photographs of your head with a short hair cut or wet hair so that the degree of hair loss is more visible.

Some reports available today indicate that even a quarter of a pill of Propecia (0.25 mg rather than 1mg) may have value for hair loss without libido problems. This approach works for those few patients who have experienced a negative impact on their libido. I generally feel that some finasteride is better than none, but that is my opinion and is nessarily not backed by others in the field.

I don’t recommend doctors as a rule, but you can use the physician search at ISHRS to find a doctor in your area and this list is narrowed to the doctors who do this ‘almost’ full time.