Month: November 2009

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Traction Alopecia – How Tight is Too Tight? – Hair Loss Information – Balding Blog

Dr. Rassman,

We are repeatedly warned that traction alopecia results from pulling hair too tightly. What exactly constitutes “too tight?”

I have thick, long hair (to just above mid-back) and I use a hair-tie at about neck-level to keep it in a ponytail. With a hair tie, only the outer portion of the ponytail hair contacts the actual tie and thus supports the weight of the entire ponytail. For example, the hair at the front of my head and base of my neck often feel the brunt of the weight. Could this be this too much weight? I wonder how much of my thinning is due to years of wearing my hair like this in professional settings.

I assume that “too tight” refers to only to VERY tight hairstyles such as braids, dreadlocks and cornrows. Should I have reason to worry?

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Are you losing hair along the outer rim of the pony tail area? If not, then don’t worry. It’s all a matter of perspective. I can’t put a number to it. If you feel excessive pulling, then don’t keep the hair that tightly pulled.

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Hair Loss InformationWhich Future Hair Loss Treatment Do You Think is Most Likely to Happen? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

I was fielding some of the questions about future hair loss treatments, and I’ve noticed all things considered, there are a few (supposedly) options in the pipeline.

My question is out of the prospective treatments (cloning, more effective medication, genetic treatment), which do you think is the most likely to materialize? Or put another way, given your experience, which do you think has the highest probability of reaching the consumer level?

Thanks

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FutureYou are correct in stating that there really are only a few treatment options available. Medically there is Propecia and Rogaine. Surgically there is a hair transplant procedure. These treatments are not a complete solution in itself, but it does work with its own limitations.

For the future, your guess is probably as good as mine. We all know genetic cloning research is being carried out, yet there is no definite light at the end of the tunnel, so to speak. In my opinion, for something revolutionary to reach the consumer level, I would say it could take another 10+ years (and I only say 10+ years because that’s a time frame that is pretty far for me to think about). Maybe we will see new drugs in less than 10 years. I certainly hope so.

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Hair Loss Drugs Designed for What They Treat? – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

It seems funny how all the effective hair loss meds (propecia, minoxidil, dutasteride) were discovered for hair loss by accident and were meant to treat something else. Is the next step in hair loss treatments a drug designed for hair loss from its inception? Just curious what you think the future holds here.

Thank you again

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In medicine and in science, many things were discovered by accident. Of note, Viagra was originally intended to treat high blood pressure, not impotence. Botox, a poison made by bacteria, was not intended for cosmetic purposes, and I am sure their marketing team worked overtime to keep the word “poison” out of its literature.

The future of drugs for hair restoration is unclear, but one drug I am somewhat excited about is a glaucoma medicine that seems to grow eyelashes, bimatoprost. That relation was found accidentally as well. It is still unclear if it grows scalp hair, though.

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I Want to Up My Propecia Dosage After 9 Years But My Doctors Don’t Agree – Hair Loss Information – Balding Blog

I’ve been on propecia for 9 years now. My hair has held up pretty well but in the last year I fell it’s gotten thinner. I’d like to up my dosage of propecia to 2mgs a day or 1.5mg’s a day in hopes that I’ll get better results. Unfortunately, my doctor nor dermatologist believes in upping the dose.

What can I do? After 9 years would increasing my dose help to prolong the benefits? Any help would be appreciated.

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If I was your doctor and you had no side effects from the 1mg (which I’d assume not, since you’ve taken it for 9 years), I would go along with a higher dose provided that you do not develop side effects. The studies on the 1mg dose is an idealized study (middle of the bell curve) so there may be benefit of a higher dose in some people.

Did you ask your doctors why they won’t consider increasing the dosage? You always have the option of pleading your case to another doctor.

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Probiotics and Propecia? – Hair Loss Information – Balding Blog

Can someone still take probiotics supplements and omega 369 oil while taking propecia as well? or do they interfere with propecia ability to work?

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I don’t believe that these products will have any effect on your body, and taking Propecia at the same time is OK. As far as I’m aware, probiotics are only harmful in those critically ill patients or those with low immune systems. Taking Omega 3-6-9 and Propecia should also be fine.

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Should I Continue Using Rogaine After 10 Years? – Hair Loss Information – Balding Blog

Dr Rassman, I have been using both rogaine and propecia for the past ten years. I think they have worked fairly well but I have read that rogaine becomes less effective over time. My question is it still worth using, does it have any negative effect if you continue to use it even if it does not seem to be growing as much hair as when it was first started. I don’t have any shedding due to its use and have always read that using them together is a good approach to fighting hair loss.

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If it is working now and you’ve had success for a decade, I’d keep up with your daily routine. Why take chances? Do what you know best. If you discontinue its use now, you’ll lose any benefits you’ve had for all this time. Remember, new hair that has grown from minoxidil is dependent upon the drug and if it is withdrawn, it is highly likely that these dependent hairs will fall out.

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Clarification – Propecia and the Hairline – Hair Loss Information – Balding Blog

I’m pretty confused about the whole “propecia working on the frontal area/hairline” debate. It seems your various posts about the topic vary greatly in opinion of its efficacy. Let’s say I’m a 21 year-old male, Norwood 1.5 moving toward a 2 and my hair loss is undetectable to outsiders at this point. Would propecia be good to stop the hair loss at my hairline/front or could it reverse the thinner hairs? Or would I just absolutely be wasting my time with the drug? I also heard that frontal hair loss is caused by testosterone and propecia will have absolutely zero effect on it?

I’m quite confused and am getting tired of all the conflicts of interests/information. I’d say the miniaturization at my hairline is pretty mild at this point; the hairs almost look the same as the rest of the hairs on my head but I can just tell they are getting thinner. You say that if caught early enough, propecia works equally all over the head, but then you’ll say that it isn’t known to work on the hairline. For instance:

Why Is the Hairline Immune to Medication?
Could Propecia Shedding Be Cosmetically Significant?

What’s the deal??

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I don’t know what conflict of interest you see, but I do see why you’re confused. In one post I said, “Propecia is not known to work on the hairline or reverse hair loss on the hairline (it happens in extremely rare cases).” In an older post I said, “Medication does work in the hairline, but I believe the hair loss has to be treated earlier.” It seems consistent to me, although perhaps a little ambiguous. Allow me to explain. Propecia (finasteride 1mg) isn’t reported in the literature to work at the juvenile hairline, which is the part that begins at the highest crease in the wrinkled brow and extends 2/3rds of an inch toward the back of the head. But I have seen rare cases of reversal of the leading edge of the mature hairline, which starts about 2/3rds of an inch above the highest crease in the wrinkled brow. One problem is that by the time the hair loss is noticed, it is too late for Propecia to do much good in the hairline. This is why I recommend mapping your scalp for miniaturization to be able to watch for this early loss. Hair loss has to be treated with finasteride just as it starts miniaturizing at the mature hairline if you want to try to halt the hairline from moving further back.

So what is the deal? This is the deal! I believe a Norwood Class 2 frontal loss reflects in most men, the loss of a juvenile hairline. I do not consider losing the juvenile hairline as balding. It is unknown if Propecia can impact the migration from a juvenile hairline to a mature hairline.

Norwood 7If you have miniaturization behind the juvenile hairline location, I would think that a DHT blocker like Propecia could reverse that balding, but I’d be more confident that it would slow down or halt the loss in most cases for a 21 year old. I say “most cases”, because I haven’t examined your scalp and I just don’t know if you are heading to a Class 7 pattern (see diagram at right), where taking Propecia when you’ve got massive miniaturization may not help much. I wouldn’t think you’re wasting your time with the drug, but it could end up being the case.

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NBA Player Manu Ginobili’s Bald Spot – Hair Loss Information – Balding Blog

Hey Doc,

Since you live and work in Los Angeles, I’m pretty sure that you’re familar with the local sports scene. Having said that, I was wondering if you could comment on how many grafts it might take to fix Laker nemesis Manu Ginobili’s bald spot. He has balding in his crown area.

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Manu Ginobili

Above is a photo of NBA star and Olympic gold medalist Manu Ginobili playing his game for the San Antonio Spurs, and on the right is a shot of the crown area that you mentioned. If he is willing to use Propecia and his hair density is at least average, he may be a candidate for a hair transplant with 1000-1300 or so follicular units. It’s tough to give a better estimate since I’ve never met the man and the larger photos I’ve found don’t exactly zoom in on his hair. Considering that he keeps his hair shorter these days, FUE may be a good option for him.

I guess you weren’t alone in noticing his thinning crown, as I found this site.

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Using Clobetasol Topical Steroid for Scalp Itch – Hair Loss Information – Balding Blog

DR.
Recently you suggested that a patient sufferring from scalp itch caused by minoxidil should be cautious about using topical steroids to relieve the itching sensation. I have been prescribed the topical steroid clobetesol to relieve itching I have suffered from the same symptoms, what are the potetial negative side effects that I should be concerned about? Thanks.

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Chronic use of steroids can cause hair loss and if the steroids are in high enough quantity and taken long enough, it can, of course, impact the adrenal glands. This is why potent corticosteroids like clobetasol should not be used for extended periods of time (no longer than 2 weeks is recommended in most cases).

Interestingly, excessive hair growth is reported as a possible rare side effect from clobetasol (depending on the variation used), but itchy and dry skin seems to be common. The list can be found here.

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Hair Loss InformationThe FDA Has Been Wrong in the Past – Hair Loss Information – Balding Blog

I hear you say any Propecia side effects are gone within a few days or weeks at most. But what about other drugs that the FDA has recalled because of permanent side effects? Those drugs presumably had half lives, and the literature indicated that side effects would go away soon after stopping those drugs. Maybe the same scenario goes for Propecia.

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You have an agenda in your question. God does not reside at the FDA, which means that their activities are less than perfect, and yes, they’ve made mistakes in the past. We can only tell you what we believe we know. Finasteride has been on the market for over a dozen years now. If you can’t find the research and proof to be credible by now, I don’t know what more I can do to help.