Doc,
Do you find older men may need more that 1 mg of Propecia. I’m in my 50’s.
Not usually. The dose is fairly standard and effective for treating hair loss at the 1mg level. More won’t hurt (possibly more side effects), but the impact just might be stronger in a slightly higher dose. Also remember that Proscar (finasteride 5mg) is commonly used for treating the prostate, something that older men should be concerned with.
Hey Doc,
I have been on proscar split into 5 for 19 weeks. At about week 14 I noticed a lot of hair loss at the back of my head in the permanent area. The hairs that fall out are full thickness/growth and have a ‘bulb’ of skin from where it was joined to my scalp. I now lose more hair from here than anywhere else on my head and running my fingers through my hair just above my neck results in 5-10 hairs to come out at once.
Would you think this is TE? And if so would you recommend me to let it run its course? It doesn’t worry me because it is the permanent area I am just curious.
Regards
For those that aren’t familiar with the “permanent zone” of hair — it is the sides and back, as seen in the remaining hair of a Norwood Class 7 balding person (see image at right). We call it the permanent zone (or “donor area”) because the hair is not effected by male pattern baldness.
I cannot say if you have telogen effluvium (TE) just from your description. It is quite unusual for finasteride to cause thinning in the permanent area… and in fact, I’ve never heard of it happening. I would go back to the doctor you received the medication from and have him/her reassess your permanent area that you are concerned about. Your description of seeing 5 to 10 hairs fall out when you run your fingers through your hair is subjective not scientific… and it will not give you the answers you need.
You should have gotten a donor hair density measurement, which shows how many hairs you have in a given area. You also should have gotten a miniaturization study evaluation to see if there were hairs that were thinning. Of course, this may be an ideal case scenario for some, but that is the standard way I run my medical practice.
Scalpure, this has to be a con right?
This is a new one to me. I enjoy when readers bring products to my attention, and it seems like a new unproven hair loss product is available every day. And just like many of these unproven products, Scalpure claims to be a “natural” and “breakthrough” treatment. The ingredients listed do not seem to be anything breakthrough: various oils and apple cider vinegar, none of which are likely to do anything for treating genetic hair loss. The makers claim that it pulls DHT out of the scalp like a magnet, but offers no proof of this. I don’t want to call it a “con”, but here is what it seems to be offering — buzzwords. What does it lack? Science and proof.
If you want to use this, it’ll set you back about $55 for 2 months of Scalpure, including shipping. The price isn’t terrible, but how much is your patience, your time, and your hair worth to you?
hey im really concerned because i noticed the corners of my hairline has went back a little. im only 17 and im african american and i heard its not just a maturing hairline because that only happens to caucasians. please help
The hairlines of different races do vary and the mature hairline of an African American is different than a Caucasian. You need to see a good dermatologist to determine if you are now balding or if this is a maturing hairline you’re seeing. I would be happy to evaluate you if you’d like to send photos to the address on the Contact page. Otherwise, you can find a hair transplant doctor in your area by checking the physician search at ISHRS.org (I’m not suggesting you have surgery, but these doctors will know a lot about hair).
I’m 61 years old and have been using Rogaine for about 3 years. I have had positive results, but they recently have been leveling off as I still have some bare spots where my hair simply won’t grow. Could this be because the hair follicles have miniturized to the point where they have simply vanished?
I would need to map out your scalp for miniaturization to determine an answer to your question, but it is not unusual for minoxidil to level off on its value over time.
How can you tell the difference between course hair and fine hair. Does course hair have a kind of messy, split end type of look, whereas fine hair feels very smooth and silky? Also, does course hair have more volume than fine hair?
Yes, coarse hair has more volume than fine hair. Split ends occur when you abuse your hair with straighteners, hot blow drying, and too much junk on your hair. Your overall treatment of your hair should include a good shampoo with a conditioner added. Letting your hair dry by itself is always best.
Hi. I just came home from seeing a new dermatologist. She said if I tested positive for AGA then she would prescribe Propecia as a hair loss treatment. Is this the right solution for a 33 year old female? I heard that it isn’t use in women. I thought the better course of action would be the combination of Yasmin and Spiro.
Also, I would like to know how safe is Rogaine for the long run (decades). I am very hesitant about taking anything orally that would play around with my hormones (Yasmine, Spiro., or Propecia). Thanks for your time. Much appreciated!
There is no really great, proven treatment for a typical female hair loss. Rogaine (minoxidil) is FDA approved to treat hair loss in women, but it doesn’t get to the root of the problem (no pun intended). Even if your hair loss is found to be androgenic alopecia, there are no studies to validate that any treatment really works for women. In other words, there really isn’t a better course of action.
In theory Yasmin (drospirenone and ethinyl estradiol) and spironolactone should work for treating hair loss in women, but that is not always the case. Yasmin and spironolactone are not FDA approved treatments for androgenic alopecia, and I would be particularly cautious about starting Propecia (finasteride), as it is not FDA approved for women due to a risk of pregnancy complications (birth defects) and other unknown hormonal issues. While many doctors do use these medications for certain women with some benefit, they are not for everyone. The best advice is to be closely followed by a physician or get a second opinion (this does not count as a second opinion — I am not your doctor).
It is safe to use Rogaine for a long period of time, but follow the instructions. It is a topical medication and many patients have been using it for decades.
Dear Sir,
I have read responses on your most helpful website. I hope you can help me.
My 3 year old daughter had a laceration to the back of her head 4 weeks ago. The cut was closed at hospital casualty with medical glue. The scar is about 4cm in length. The area around the scar is bald (say 2cm to 3cm either side).
Please could you advise if you think the hair will grow back on the area not scarred? I note with interest that you were in Vietnam. From what I have read the medical glues were first used there. Do you know if they led to such cases of baldness? If so, was it just short term? Also what can be done for hair restoration on the scar itself e.g. will hair grow back? Is it best left? can a transplant be done if necessary?.
This is really worrying me. Kind regards
Some hairs should grow back, but there may be an area where hair will not regrow. Medical glue does not cause scarring, but the lacerations will.
Hair transplantation can be done if necessary, but you should wait at least one year to allow hair to regrow to see what happens. Having a hair transplant at 4 years old is generally not advisable for fixing the scar, so perhaps you should wait until your daughter is older until she has a maturity level to undergo such a procedure. The best age will be determined between you and her doctor. Most girls under 8 years old do not really focus on small scars.
Dear Dr. Rassman,
I’m a 55 year old male in good health with the exception of being a type 1 diabetic. I have been using propecia and rogaine for 10 years with very good results and have maintained almost all of what I started with.Here’s my question. My hair is thin at the nape of my neck. I can pull on it and 5 or 10 hairs will come out each time. I don’t think I have DUPA because I cannot see any change in my crown,vertex or hairline. I have read on your site that this type of loss is genetic. I know you prefer not to diagnose online but could the diabetes have anything to do with it? my A1c is 7.5 to 8.0 which I know is an the high side – Thanks
I doubt that the diabetes is causing your neck hair loss. I have seen men over the years (in airports, on the streets, in shopping centers, etc) who have lost just their neck hair and not their scalp hair, so I believe that this is a genetic trait in these men. I suspect that the number of hair cycles your neck hair has is limited and those hairs develop apoptosis (meaning that they have reached the end of their lifetime); if this is the case, there’s not much you can do. Perhaps applying minoxidil to the area will cause new hair growth? Also, I agree with you — it doesn’t sound like it is DUPA if it is limited to the nape.
I have been battling hair loss for the past 10 years. I am a 32 year old african american female. I was first diagnosed with Keloid Folliculitis in 1999. I have received continuous treatment from various dermatologists and specialists. The folliculitis issue appeared to have cleared up by 2002 with no reoccurrences. My hair loss began in 2000. I have had a series of blood tests and a scalp biopsy. The biopsy showed my scalp had scarring. The blood work showed that I had high levels of testosterone, low performing follicle hormone, and low iron. (this occurred 3yrs ago.) Since then, I am taking 65mg of iron 2x each day and on birth control. I am also insulin resistant and taking metformin. I have tried various over-the-counter solutions for hair growth, but I am still losing hair.
Bosely will not grant me hair restoration; Duke’s Hair Clinic has temporarily closed. Currently, my primary care physician is injecting cortisone shots to see if this will trigger any hair growth. I am bald on both sides of my hair, and thin on the top and back. Wigs are my only savior at this point. My hair is natural. Please help me with my next step. I am tired of finding hair everywhere but on my head. Thanks!!!
I have never seen a person with keloid folliculitis and have no experience with it. Regardless, your situation is clearly complex and giving you any opinion without at least an examination would not be in your best interest. There are some doctors who specialize in such conditions and do hair transplants. Since you’re near Duke University, I’d be happy to recommend Dr. Jerry Cooley in Charlotte.
