August 2008 – Page 4 – Balding Blog

August 25, 2008

Testicle Pressure from Finasteride – Hair Loss Information by Dr. William Rassman

I have been taking Fincar (generic finasteride) for a little over a week. I noticed two things…a slight pressure feeling on both of my testicles, and a sudden shedding that happened today (there were like 20 hairs at once on my hand when I shampooed.) I’m kind of thinking about stopping, and I wanted to know what I should expect. I’ve read that once people stop, you can have a massive shed. Did taking the drug for 10 days even do anything? Am I going to have another shed on top of the one I just had?

Finasteride is a great drug for treating genetically induced hair loss, but if you were on it for just one week and stopped, there is no risk of loss. Twenty hairs is not a big deal (for example, you could’ve had some product in your hair that kept hairs from falling out through the day — totally normal) and you are probably overreacting.

Testicular symptoms do occur in a very small number of patients, and you should see your doctor if you’re experiencing pressure in your groin.

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August 25, 2008

Propecia Raised My Testosterone, So I Switched to Avodart – Hair Loss Information by Dr. William Rassman

since taking propecia for 6 months my testosterone had been raised quite high, so i decided to switch over to avodart as i heard it is better. my testosterone is still high. my question is, is it worth me taking these medications for my hair loss as its raising my testosterone in turn producing higher amounts of DHT and higher amounts of DHT will cause more hair loss. in a sense im taking a drug to stop DHT but at the same time the drugs making higher amounts of DHT so im in a confusing paradox. should i continue with either one of these medications if all there doing is creating more DHT, even though there getting rid of it. please help Dr. Rassman and NHI team. thanks

It sounds like you are buying these drugs on your own without being followed by a doctor. There is a reason why these medications require a prescription from a doctor. In general, Propecia should not raise your testosterone levels to a significant amount over the long term, but testosterone levels have been found to be higher in those men on Propecia. There may be other issues special to your particular case. If Propecia raises your testosterone levels, Avodart will also increase the levels (certainly not decrease). If you’re indeed under the care of a physician, you need to ask these questions to him/her.

Without going into the biochemical aspects, there is no paradox that you are referring to. The real paradox is taking Avodart (dutasteride), because Propecia (finasteride) raised your testosterone level.

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August 25, 2008

My Right Eyebrow Is Normal, My Left Eyebrow Is Going Bald – Hair Loss Information by Dr. William Rassman

It occured about half a year ago almost un-self concious of the problem my left eyebrow started losing hair. As I thought it would just grow back, I ignored the problem but as now its still left unsolved. My left eyebrow has kept the same appearance over the months. The eyebrow isnt completely bald, rather a majority of it is composed of short one millimetre length hairs which doesnt seem to grow at all. There are two small areas of the eyebrow that are have still normal length hairs. My right eyebrow isnt as affected but the right end of the eyebrow does show signs of hair loss.

I am planning to see a dermatologist about this problem but the appointment date duration is almost a month of wait so if you can provide me any advice that would be great. Thank You.

It seems you are doing the right thing by seeing a dermatologist. I don’t know what I can offer you in the month you have to wait to see the dermatologist that will change your outlook or regrow your eyebrow. I don’t know why you lost only one side of your eyebrow. It sounds strange. There may be many reasons why you are experiencing such a problem, but I will only be guessing and my guesses may just give you more anxiety and undue worries without solving the real underlying issue. My best advice is to be patient and address these issues with your doctor. Good luck!

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August 22, 2008

Does Dr Rassman Think He Is One of the Best Hair Transplant Surgeons in the World? – Hair Loss Information – Balding Blog

Dr.Rassman, this question may sound ridiculous and from looking at your replies to many questions on this blog it seems you are a very modest person. My question is, would you say you are the best hair transplant surgeon in the world. you have the most extensive collection of before and after photos which i must say have not failed to impress. also i have looked on hundreds of other sites and they dont have even half the amount of photos you have., or (evidence) as i say. John lennon once said ‘we are the greatest band in the world and the greatest songwriters, we have had more number ones than any other artist’, what i think he is saying isnt arrogant he is simply saying that they have more number ones than any other act. as you have the best results and more results than any one else would you say for arguments sake you are at least one of the best hair transplant surgeons.

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Horn I don’t mean to toot my own horn, but the International Society of Hair Restoration Surgery (ISHRS) awarded me with the 2004 Golden Follicle Award, which reflects what the doctors around the world may think about me. Only about 14 physicians have ever received this award in the history of the society. Our hair transplant organization has outpatient surgery facilities which are certified by the Accreditation Association for Ambulatory Health Care (AAAHC), which is a national accrediting agency for outpatient surgery facilities and holds these facilities accountable to a known standard of care. In the field of hair transplantation, there is no requirement to build a certified facility, but I have been adhering to this standard for the past 10 years and every three years or so, we get a physician reviewer who comes in to judge the standard of care, the outcome of our work, the infection incidence, the accident status, and the things that go wrong. If we have not met some minimum standard, we do not get the accreditation. AAAHC Few hair transplant centers in the United States undergo this process, because it is a difficult standard to meet and the cost to adhere to their requirements on quality cost us well over $100,000/year. Even with this high cost, the comments of the reviewers guarantees that we are constantly observed and criticized to help us improve our quality of care. I generally tell those patients who are considering us to be their doctors, to check out any doctor that they are considering for such national certification. Our facility and our standards are the best and it is backed up by the accreditation of the AAAHC. What I’m getting at is that we strive for the best, and if people see us as the best, then we’re doing our jobs.

I thank you for your direct question, but although I like a pat on the back as much as the next guy, what I see, read, and hear from patients at our monthly Open House events (which we have been holding for over 15 years) says it all for me. I love the people side of this field… the doctor/patient interaction from the patients I meet. The diversity of my patients is what stimulates me to work, to listen, and to help them, and that is what makes me what I am, whatever it is.

August 22, 2008

Propecia Effectiveness Statistics? – Hair Loss Information – Balding Blog

Hi Dr.,
I’m a 19 year old with a head full of thick hair. However, I have a slight recession that is following the pattern of my grandfathers. His hair receded into his early thirties and then stopped suddenly. I believe this is called a mature hairline, but it didn’t look like a mature hairline, it looked much worse. I really would prefer my hair not get like that. I think a hair transplant would be unwise this early, and getting one after the recession is finalized would kind of defeat the purpose of having one. Do you have any statistics on the effectiveness of Propecia, and would you recommend me taking this.

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Merck If it is a mature hairline, there isn’t much you can do. Medications may help, but I can’t say to what degree (each person is different and will react different to these drugs). At 19 years old and with very little (if any) male pattern baldness, you are definitely not a candidate for hair transplantation and any doctor that would do any surgery like that on you is taking you for a ride.

For Propecia stats, I’d say one of the the best places would be this page at the official site — Propecia.com – See the Proof — which is setup by the manufacturer, Merck. Although you may think that would be a terrible place for unbiased info, I should point out that Merck is heavily scrutinized by the FDA to make sure any claims, statistics, or other information provided is accurate.

August 22, 2008

Dr Rassman’s Opinion About the Latest in Body Hair Transplantation? – Hair Loss Information – Balding Blog

Good day Dr. Rassman,
First, I want to thank you for having this blog. I find it very useful; I visit this blog regularly.

My question: From some of your previous answers, it seems that you are not a proponent of body hair transplants, and you have given good reasons why. However, if it would be all right, may I ask your opinion of some of the latest works, with body hair transplants?

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I am familiar with the body transplants that are being done. I am softening my position on them in very special situations. I met a man yesterday who does not have enough donor hair for the crown, but has gorilla hair on his back. He is aware of the limitation in telogen hairs and nevertheless wants to have his back hair moved to the crown. He is realistic and reasonable and I will therefore do this for him. So you see, I am open minded on the subject and as always, will do what my patient needs if the requests are reasonable.

August 22, 2008

Macular Degeneration from Propecia? – Hair Loss Information – Balding Blog

Dear Doctor,
I have a question about possible serious side effect of using Propecia. I am 23 years old male and I have started using Propecia one month ago. After already two pills I noticed some small defect in my vision which becomming worse in time (I was seeing crookedly by one eye). The diagnosis is macular degeneration. My ocularist thought it was caused by Propecia though there were no information about this side effect in the label. I was said that if macular degeneration appears by youth it is in most cases caused by using steroids and its interference to hormones. I have never taken steroids and so doctor thinks it is a result of Propecia’s hormones changes. I would like to ask you have you ever seen similar case of Propecia side effect? Could Propecia theoretically caused it (already after two pills)? And do you recommend me to continue with finasteride in the future? (I stopped after 15 pills and now I am much more worried about my vision than my hair).

Thank you very much.

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Eye This is a question you need to ask of your ophthalmologist. A short course of Propecia should not cause any problem and macular degeneration from Propecia is not defined as a known complication of the disease that I could find. I’ve certainly not had any patient mention anything like this to me over the years.

For more about macular degeneration, see Wikipedia.

August 22, 2008

Scalp Severely Tender 11 Days After Hair Transplant – Hair Loss Information – Balding Blog

Hi! Thank you for providing so much helpful information! I had a hair transplant eleven days ago with a very reputable surgeon. I had 3700 grafts placed in my temples and frontal hairline via strip method. I have been having severe scalp tenderness in my crown where no hair was transplanted. The tenderness does not seem to be improving at all. The crown is much more tender than my donor sites. I don’t have any tenderness in the recipient areas. I contacted my doctor who said this was normal and should improve over the next few weeks. However, I have not read about any other patients having a similar experience. So I would greatly appreciate your thoughts. Do you think this is a typical problem after surgery? Do you think that it will completely resolve? If so, about how long do you think it will take to improve? Thanks in advance!

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I do not know how to answer your question without examining you. At 11 days post-operative, the differential diagnosis could be infection, too tight a closure with ischemia to the scalp (restriction in blood supply), nerve injury, and on and on. Your doctor needs to examine you and let you know.

August 22, 2008

Is It Too Late to Add Rogaine to My Daily Procedure? – Hair Loss Information – Balding Blog

I am 37 years old and have fine thin hair. I have been using propecia for seven years and have been happy with how it has helped me retain my hair. However, lately I have noticed some thining of my hair. Should I start using rogaine along with propecia to stop any further thining or loss of hair, or is too late for me at age 37 to start using rogaine with propecia ?? Thanks.

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Adding minoxidil may be worth a try. It isn’t too late, but it will take a full year to know if the second medication is working.

August 22, 2008

Eating Dairy Makes My Scalp Ooze – Hair Loss Information by Dr. William Rassman

Anytime I consume dairy products especially milk and butter and sometimes ice cream,(yogurt and cheese do not bother me), I start getting a secretion on my scalp within a day or so and it hardens while trapping the hairs on the scalp. It is almost like putting gum or glue on the scalp. I wash my hair every day and sometimes I can dig my fingernails into this stuff to try to get it off my scalp but then tons of hair come off with it. Polysorbate 80 works great for eliminating this stuff but I have avoided consuming milk and butter for well over 10 years and that works better. I also notice that by just being overweight(even without consuming milk or butter), I am afflicted with this problem so I have slimmed down. I would like to know what is this stuff that forms on my scalp and why does it do that in the first place?

Dairy Maybe you should not consume dairy products at all. Perhaps switching to soy will be a solution. I couldn’t tell you why the sebum output on your skin/scalp seems to be stimulated by the dairy you consume. With regard to polysorbate, Wikipedia says:

“Polysorbate 80 (commercially also known as Tween 80, a registered trademark of ICI Americas, Inc.) is a nonionic surfactant and emulsifier derived from polyethoxylated sorbitan and oleic acid, and is often used in foods. Polysorbate 80 is a viscous, water-soluble yellow liquid.” … “Polysorbate 80 is often used in ice cream to prevent milk proteins from completely coating the fat droplets. This allows them to join together in chains and nets, to hold air in the mixture, and provide a firmer texture, holding its shape as the ice cream melts.”

Thanks for the interesting question.

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