Month: February 2009

Dr. Rassman,

I have relatively dense brown hair. I am using minoxidil to restore a hairline that is visibly receeding. However, whenever I lightly scratch my scalp after having used product containing minoxidil, I notice little hairs attached to my fingernail. They are normally about a half inch in lenghth, fine, and clear.

I thought, perhaps, that it was an anomaly. However, with repeated runs of my fingernails over my scalp, I continually pick up one or two of these strange, small hairs. This has been occurring as long as I have been using minoxidil (a year or two.)

Are these vellus hairs that are falling out? Is this a sign of an unhealthy scalp?

I don’t know what these little hairs are. If I looked at them under the microscope, I might know, but in the meantime you should just stop scratching them. Leave them alone! Let’s see what happens when they grow out.

Hello Doctor,

I wanted to share something. I’m sure you are familiar with the product called Procede. I believe you have even written about it before and thought it was some sort of coloring agent. Information on the product is very sketchy and nobody seems to know how it is even supposed to work. Until recently, the ingredients were never even posted on their website and the company has always been extremely vague about its mode of supposed action.

I just discovered the ingredients are now posted. I have pasted them below. The product seems really weird and the list of ingredients seems alarming. One of the main ingredients is actually a depilatory agent and the other is used for shrinking varicose veins. Obviously, the product does not seem to be a coloring agent as suspected.

Can you please look at the ingredients and tell us what you think the makers had in mind in formulating this product. What route do you think they were going for to achieve the claimed results? By what action do you think this product is supposed to work by and what do you see it actually doing?

A Formula #1 Ingredients:
Deionized Water, Thioglycolic Acid, Monoethanolamine, Cetyl Alcohol, Stearyl Alcohol, Mineral Oil, Polyquaternium-6, Ethyl Alcohol 1.4%, Ceteareth-12, Methyl Salicylate, Salicylic Acid, Sodium Lauryl Sulfate, Hydroxyethylcellulose, Lactic Acid, Glycolic Acid, Propylene Glycol, Diazolidinyl Urea, Methylparaben, Propylparaben, Papain, Citric Acid, Tartaric Acid.

Formula #2 Ingredients:
Deionized Water, Sodium Bromate, Cetyl Alcohol, Mineral Oil, Cetearyl Alcohol, Ceteareth-20, Urea, Sodium Lauryl Sulfate, Propylene Glycol, Diazolidinyl Urea, Methylparaben, Propylparaben.

I am not a chemist, and I really cannot comment on if those ingredients will grow hair. I’m not seeing anything proven to grow hair in there, though. I can tell you there is no cure for hair loss. Even the best medications we have (Propecia and Rogaine) still have limitations. As the ingredients you listed as being in Procede are not controlled by the FDA, you are at the mercy of the manufacturer unless you decide not to use is (which is still in your power).

Hello,

I’m a 30 year old male, and about 10-12 months ago started going through some various minor illness problems that lasted around 2-3 months total – things like a sinus infection, fatigue, aches, abdominal pains, nausea, etc. I’ve previously never really been ill, and always had (overly) thick hair.

I was finally diagnosed with Gilbert’s Syndrome – though whether this was related to my problems (or even accurate) I don’t know. Then, around 6 months ago, I noticed hairs falling out, say around 5-10 and up to 15-20 each time I washed or styled my hair. At first it didn’t worry me, but I’ve recently noticed that my hair is now a lot thinner, especially from the centre of my head to the front hairline. My scalp also seems to itch a fair amount in roughly the same area.

Am I just getting old and hitting a standard balding pattern, or could the increased bilirubin in my blood be a contributory factor? Either way, is there anything that can help (preferably avoiding prescription drugs, but I’m open to all suggestions)?

If there is any liver disease associated with Gilbert’s syndrome, then you will metabolize many hormones slowly (like DHT) which could cause them to have a higher blood level. I did see one report of someone with this syndrome getting a great response to finasteride. Finasteride is a prescription drug, though.

Dear Doctor
I’ve been taking propecia for a few months now and have just recently started taking green tea capsules I heard it worked as a DHT blocker, but I saw in your book that natural DHT blockers such a saw palmetto can counteract propecia. could Green tea have the same effect.

It is possible, but probably not at reasonable doses of green tea.

Can a potential natural supplement not be a DHT blocker in vitro (in a petri dish) but be a DHT blocker in vivo (in the body)?

Also, if Propecia only blocks about 70% of type II 5 alpha reductase, why doesn’t it block the rest if finasteride is meant to block 5ARII?

Is MPB only about blocking DHT or is there more to the story? For example, if we could block 100% of DHT, would our hair loss be blocked?

The things we see in petri dishes and live animal subjects do differ, however, I would want to know specifically what you are asking (a directed question of course).

There is more to balding than DHT alone, but the more of the receptor that is blocked, the better the drug will work. That is why many people like dutasteride as the block gets up to 85% or more, but as I’ve pointed out — at what price? If you became sterile from a high DHT block (I am not saying that it will happen, but lets say hypothetically) the outcome is priceless (negatively speaking).

Doctor,

When quiting minoxidil do the dependent hairs fall out all around the same time,say within the same few weeks? Or do they fall out a little at a time over months? And when would it be safe to assume all dependent hairs are out? After 3 months?

If you restart minoxidil after 3 or 4 months what are the odds of salvaging any lost hairs, going by what you’ve seen in your practice?

You say that minoxidil and propecia work differently, but if DHT eventually overtakes minoxidil as you say then why wouldn’t Propecia protect minoxidil dependent hairs if you stopped minoxidil. Since it’s really DHT that’s causing the hair to fall out?

Thanks..

BTW, I appreciate that a transplant surgeon advocate 2 drugs that could be considered your competition.

I practice good medicine and always give the best, safest, and least invasive solutions for hair loss. If medication can solve the problem, I’d rather a patient go that route. Surgery should never be the first resort.

There is no rule with regard to hair loss from withdrawal of either finasteride or minoxidil. Generally the hair is lost slowly over 3-4 months, and not all at once. Restarting the medication never gets you exactly back to where you were, but if you realize you made a mistake and want to get back on the drug, you should see benefits from that point on. The action of minoxidil (Rogaine) and finasteride (Propecia) is different so when you withdraw either, the other medication will not prevent the hair loss that can occur. Minoxidil is a drug that grows hair as a side effect, while Propecia blocks the effect of DHT. A person on minoxidil can still lose hair from DHT influences, and that is not blocked by minoxidil. Stopping minoxidil will result in the loss of those hairs grown from it — but that is due to stopping the medication, not DHT.