Month: April 2008

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3 Years of BaldingBlog – Hair Loss Information by Dr. William Rassman

Whew! I was just reminded of a huge milestone that I wanted to point out — BaldingBlog launched 3 years ago yesterday, on April 6, 2005!

Judging by the amount of growth this site has seen in recent times, not to mention the HUGE amount of emails we receive each day, I’d say we’ve got a good thing going here. This site started as an experiment of sorts, and the response has truly been overwhelming in just three short years. Although we simply can’t post every single question received, I do hope we’ve been able to provide some help and possible comfort to many of you.

Thanks to everyone for the continued support!

William R. Rassman, MD

Medical Director and Founder, New Hair Institute
Senior Editor, BaldingBlog

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Hair Loss InformationClarifying Finasteride Dosage – Taking More than 1mg to Treat Hair Loss – Hair Loss Information – Balding Blog

Hello Dr. Rasman,

First I would like to thank you for such a wonderful site. I have been an avid reader of this blog for some time now and find your dedication to this field quite remarkable. I have a question that I would like clarification on regarding finasteride dosage. It seems you that you frequently state dosages higher then 1mg have no increased effectiveness in treating MPB. Most recently quoted here: What If I Take 5mg of Finasteride to Treat Hair Loss?

“Taking finasteride 5mg (Proscar) daily will not have any benefit over the finasteride 1mg (Propecia) in the treatment of androgenic alopecia (AGA).”

But I have come across some blogs in the past were you seem to state that there “may” be an increased effectiveness in higher doses. I have quickly searched your site and here are two examples:

1: Propecia and Dosage
The dosage of Propecia was arrived at because when Merck went through the FDA the 1mg dose was found to be lowest effective dose to get the desired result based on the clinical trial program that was done.

“That may suggest that a higher than 1 mg dose may be more effective, but that was not studied for treating hair loss.”

We do know that higher doses of finasteride will increase the known side effects. A decreased ejaculate is one of those side effects. With regard to brain fog, there is nothing that I know of that will support this as a known side effect of finasteride. Be careful that you are not setting yourself up for this and obsessing too much.

“If you want to play around with the dosage, wait a few weeks between changes as it takes that long to change the tissue levels of the drug.”

2: 1mg vs 5mg Finasteride for Hair Growth
I am not familiar with any study that directly compares the 5mg dose to the 1mg dose, but I would suspect that like any bell curve, the 1mg recommendation applies to those individuals in the center of the bell curve and that “some people most certainly would be better with a higher dose,” possibly worth trying if the 1mg dose is not adequate to meet the needs of the patient’s problem.

Even your colleague Dr. Bernstein makes refrence to this on his own site, which is linked here: BernsteinMedical.com

So then is their truth to the statement, that though unproven, a higher dose of finasteride may be more effective in treating MPB?

I thank you again for your time and this wonderful site.

Best Regards

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Propecia (finasteride)When I discuss finasteride dosing, I’m referring to the dose that the studies show is effective and safe. There is never one dose for every person, because we all have different body weights, different metabolisms, different hair loss (possibly from sensitivity to DHT that may vary by time, where you are on your hair loss cycle, your genetics, etc.). You can pick and choose and interpret all that has been said about the dosages of finasteride, but in the end 1mg finasteride works and in a large population it is the dose that worked most effectively.

Looking at the big picture, a higher dose is probably not going to make a huge difference. All drugs have limitations and a higher dose is not going to give you dramatic gains. Case in point: think of all the bald men who are taking 5mg finasteride for their prostate issues. I believe that the men on 5mg finasteride are not much better off than men taking 1mg finasteride when it comes to their hair loss.

I am afraid we are beating this issue to death, but I appreciate the time you took to find out about my consistency and respect you for it.

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Taking Propecia for My DUPA – Hair Loss Information – Balding Blog

Hi Doctor,
I began noticing my DUPA a year ago. Since then i have been on propecia (almost 8 months now). I have made the decision to finish atleast a the full year of treatment. My DUPA has definitely been getting worse over time. My entire scalp is getting thinner. Do you suggest that i stop propecia if it continues to progress after a year? Does this mean that i am just one of the people that propecia does not help? I ask because it is a large financial investment… Please advise.

Thank you for the great site doctor.

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Diffuse unpatterned alopecia (DUPA) has an unknown cause and as such, we are just using medications that may help. It may reflect a variety of diseases, including diffuse alopecia areata or chronic telogen effluvium, because it has similarities to both in the way DUPA looks when you see it with the naked eye. But microscopically, it is different. I would suggest that after a year without any benefit, you should speak with your doctor about the possibility of stopping the Propecia (finasteride 1mg). If it gets worse, then you could start it again. My heart goes out to you and I know what I said here may just add to the confusion, but frankly we really do not know enough about DUPA to be more scientific in its treatment.

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Will ScalpMed Make Me Go Blind? – Hair Loss Information by Dr. William Rassman

Doctor, I have a question to make you, I’m wondering if a comment from one user of Scalp Med it’s true, I doubt it honestly, the commentary says, ‘I have using Scalp Med since 3 months and im started to lose a little vision in my eyes since this three months’. I honestly don’t believe that, but I wanna be sure that Scalp Med doesn’t have these side effects.

So I would really like if you know from this side effects of Scalp Med, cause I’m thinking seriously in use this product.

Thanks in Advance.

ScalpMed contains minoxidil, which is known to cause blurred vision as a rare side effect in some people. For more info, see:

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Why Not Just Wash Your Hands After Applying Rogaine Foam? – Hair Loss Information by Dr. William Rassman

This is a follow-up question I received from Should I Be Applying Rogaine with a Rubber Glove?

once you apply Rogaine foam can’t you simply wash your hands with anti-bacterial liquid soap instead of wearing a glove?

The minoxidil absorption is probably fast, but I do not know how fast. If you are absorbing it with more hand hair, then a glove is the only guarantee to stop it getting through the skin and into your hands and body.

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Saini Herbal Conditioner Smells Like Urine – Hair Loss Information by Dr. William Rassman

I started losing my hair towards at the hairline when I was about 18 yrs old. I would say the whole process take close to 20 – 25 years for the horse-shoe look to occur. My Question. There is a product on the market that was developed in India now selling in Houston Tx. The product name is SAINI HERBAL scalp and hair conditioner. The ingredients are : BHRINGARAJ,AMLA,EXTRACT OF NEEM OIL. WHITE PETROLEUM JELLY.SHIKAKAI,CAMPHOR,RESAUT,DHT BLOCKERS,DHT REMOVER (PULP) they say it is 100% natural and safe. The company is called Positive Trends. To me the product has a slight urine like smell and I stopped using it after a week because I was afraid of any side effects. Is this product safe ? I cannot find any negative comments or any U.S. studies done on this product to prove to me that the product is safe, yet alone grows any hair. Although they do make a honest claim that it may not work for everyone one if you do not have active hair roots. Thank You Doctors !

Herbal products are not regulated by the FDA and your guess on its effectiveness is just as good as mine. It is a buyer beware market. I really cannot tell you if the product is safe or effective as I have no experience with the product. The reason you are having difficulty finding studies on this product being safe and effective is probably because none exist. The Saini Herbals website mentions a study conducted in India, but provides no source of the study, no author of the study, and no actual scientific information. They do, however, display a tiny, meaningless bar graph and a lot of proclamations about unproven supplements.

I personally would not use any product that smells like urine… or any other bodily fluid. Perhaps I’m alone in taking that position.

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Lost Chin Hair from Stress, Then It Regrew White – Hair Loss Information by Dr. William Rassman

Dr. Rassman, I read your blog daily and appreciate all the information you provide to hairloss sufferers.

ok, so 3 years ago I lost a large patch of hair from my chin, over the next 2 months it grew back stark white. I had to dye it with “justformen” for a year, finally it has began to grow in black. I feel this occurred form stress. is there a name for a condition such as this?

This is the first time I’ve heard of a case like this, so unfortunately I don’t have any experience to base any conclusions. Discuss this with your dermatologist.

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Dr. Proctor’s Proxiphen – Hair Loss Information by Dr. William Rassman

I started using Dr. Proctor’s proxiphen – his combo topical and shampoo in September. After a month he had told me to ween off of minoxidil application as it was included. While he offers this “prescription” without a visit, the follow up is a little difficult. By December/January the shedding was so incredible and hasn’t stopped – now shedding long thick hairs, not just weaker ones, that after seven months, I decided to stop. Going back on minoxidil foam, three weeks later, yet another shed, making my head begin to look like a mess. The front third of the scalp is a disaster area (all things considered in the world, there are many worse things, but alas, this isn’t all that good…) And after the “almost” guarantee of correcting a thinning problem, not only is the hair much thinner, but a couple of thousand dollars later, the response becomes “well maybe it is the balding process continuing…” Indeed. No sh*t, sherlock.

As far as Proctor, I think there is a REAL problem there. He promotes his meds but refuses to tell anyone what exactly is in it. Some of the so called aficionados swear by his product, but I can tell you. I lost more hair using that crap (at a hundred bucks a tiny vile, mind you, now about eight viles) than with any form of MPB. Worse, it is a script med (god knows what’s in it) and then he asks you to forward a script for Propecia which then allows him to script his stuff, and does no follow through, and sort of sells and well, you know. And then he says to ween yourself off of Minoxidil. At any rate – the long and short of the story is, that my guess is I lost tons of hair on this – and stopped. I wonder though if it will recover now that I have started the minoxidil again, but I rarely think so – I wonder if I have really depleted the supply to amount to really diffuse thinning which is likely what I did… I can use a little topic and still look like I have great hair, but alas, no…

So, back to tradition, rogaine foam, continued use of propecia (which I have been religious about) and feel free to post.

One wonders – could this be a “having left minox” shed, followed by a “return to minox” shed. God only knows.

Although I wrote briefly about Dr. Peter Proctor’s Proxiphen a couple of years ago, I wanted to share the above email from a friend/patient of mine who experimented with this treatment. I have no personal knowledge of this approach, but felt this email was worth sharing for those curious readers.

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Hair Loss InformationHad 3 Transplants 20 Years Ago, Now I Am Losing Temple Hair – Hair Loss Information – Balding Blog

Dr. Rassman,

Great website. I am a 50 year old man who had 3 sessions of transplantation in my early 30s. I now am in need of another procedure as my lateral hairlines have become bare, ie temple areas. I still have a good deal of donor supply in back but am not looking to use Propecia, in the past it did cause sexual side effects I was not willing to put up with. What are my chances of success and how common is it to need an additional procedure or 2 as we age? Thanks

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I can not tell you how much hair you have left to transplant in the areas that are thinning, as I do not know the following about your case:

  • what procedures you had done in the past
  • how much area of donor supply was moved
  • what your donor density is
  • what your scalp laxity is
  • what your Norwood classification is
  • what your residual donor supply looks like

It sounds like you had your surgeries prior to the advent of the megasession and follicular unit transplantation. It is not unreasonable to have more surgeries as one ages and one continues to progress in the balding process provided that you have a Master Plan which deals with change and hair loss over time. The supply of donor hair is critical in the formulae. If you want to send me some photos I would be glad to look at them and give you better advice (please reference this post when sending).

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Is Women’s Rogaine Making My Hair Loss Worse? – Hair Loss Information – Balding Blog

ive been using women’s rogaine for about 2.5 months, my hair was just thinning when i started, then in the last few weeks it started to just fall out in my brush, the shower, etc. my hair seems to be very thin, and very easily pulled out, like it’s not holding on to its roots. now my hair is so short I can barely make a pony tail! what’s going on, is this normal from taking the rogaine, and how long before i start seeing real growth, and when will the shedding stop!

thanks

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Women's RogaineWe have heard of people who initially lose hair when they start Rogaine (minoxidil), the theory in this process is that Rogaine resets the hair cycle and hair that is falling out is actually the hair follicles going into a dormant stage (telogen and catagen). Have you seen your primary care physician or a physician about your hair loss? I want to make sure that there is not another reason for your thinning hair that may be related to a medical condition or medications.

Generally people do not see the results of Rogaine for 6-12 months. You need a diagnosis for what is causing your hair loss, and this is not something I can offer to you without an examination.