Month: February 2010

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Guaranteed Graft Growth? – Hair Loss Information – Balding Blog

How can clinics like Bosley and M.H.R. guarranty that every graft will grow or they will replace it and you and Dr. Berstein make you sign a disclaimer stating that a hair transplane is not guaranteed to grow at all. Thanks for a great blog.

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There are no guarantees on workmanship. You could imagine that someone with cancer wants the doctor to guarantee that he can cure them. Ridiculous, yes? So the most that a doctor can guarantee (under the law) is to replace what did not work at no charge to you.

The signing of a legal document on the day of surgery is a legal requirement that says both you and your doctor agree that you’ve been fully informed of all of the risks, including the possibility of death from an anesthetic agent. It also forces the doctor to reveal everything that is risky to you. That is why it is called an informed consent document.

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Hair Loss InformationCan I Strengthen My Hair to Prevent Hair Loss from Relaxer Chemicals? – Hair Loss Information – Balding Blog

I am an African American female and experiencing hair loss. I currently use home relaxers on my hair because it’s easier to manage. What can I do to strengthen my hair to help prevent the hair loss? Thanks

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Keep in mind that I am a hair transplant doctor. With that said, from my point of view there is not much you can do to strengthen hair. Despite all the hype, there really is no secret formula. Use what works for you. Eat a healthy diet. Minimize chemical exposure to your hair. I generally will not name supplements and shampoos to give credibility on how to make one’s hair stronger. If this isn’t satisfactory, a hair stylist might be able to recommend some products he/she is likely ready to sell you.

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Scabbing 20 Days After a Hair Transplant – Hair Loss Information – Balding Blog

I underwent a mega session of 2884 grafts and was worried on the 20th day as my scabs didnt fall off. So I contacted my doctor who told me to do a gentle massage. I did it but during this massage what I noticed was that there were some scabs that had hair attached to it. Does it mean I have pulled the graft even after 20 days!?

I would like to clear that i massaged with my fingers ( not nails ) in a slow circular motion.

Waiting anxiously for a quick response.

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I’m confused. You called your doctor who performed your surgery to ask about scabs, but you’re asking me if the grafts were pulled out? The problem is that you should not have waited until 3 weeks after surgery to do a proper washing of your recipient sites!

Some of the hairs should be falling out on their own with or without scabs, but the roots of the grafts will still be in place, as seen in the article we published in 2006 — Graft Anchoring in Hair Transplantation [PDF file].

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Finasteride and the Swedish Medical Products Agency – Hair Loss Information – Balding Blog

This is continued from my response an hour ago about finasteride and the Swedish Medical Products Agency (MPA). The question was:

What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?

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MPAAs I said in my earlier response, “If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious.”

What that boils down to is that I’m not going to try to convince people to use a medication if they’re already so convinced it’ll do them harm. I’m not a sales rep and it isn’t my job to make guarantees about medications or provide incentives for you to take it. It’s an elective medication. You don’t have to take it if you don’t want to. If you’d rather believe message boards than published reports in medical journals, then by all means that is your choice to make.

But I’ll elaborate more with some interesting tidbits from the Swedish Medical Products Agency (sources: here and here). Some key points I found:

  1. In clinical studies, single doses of finasteride up to 400 mg and multiple doses of finasteride up to 80 mg/day for three months (n=71) did not result in dose-related undesirable effects.
  2. Drug-related sexual undesirable effects were more common in the finasteride-treated men than the placebo-treated men, with frequencies during the first 12 months of 3.8% vs 2.1%, respectively. This means 3.8% of men taking Propecia had undesirable sexual effects and 2.1% men taking a fake sugar pill had undesirable sexual effects. The incidence of these effects decreased to 0.6% in finasteride-treated men over the following four years. Approximately 1% of men in each treatment group discontinued due to drug related sexual adverse experiences in the first 12 months, and the incidence declined thereafter.
  3. People that are up in arms about the Agency listing “persistent difficulty having an erection after discontinuation of treatment” as a possible side effect should also realize this is listed under the “frequency unknown” section. In other words, they received complaints about it (how many hasn’t been established), but it is not a proven effect.

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Motorcycle Helmets, Finasteride, and Guarantees in Life – Hair Loss Information – Balding Blog

Hi, I have a few questions regarding hair loss and finasteride.

  1. Does tight motorcycle helmet causes hair loss.I’ve notice increased hair loss since i regularly started wearing full face helmet which is a bit tight on my hairline and genera crown area.
  2. Could it be possible to experience hair loss due to lack of iron mineral?
  3. Propecia is being advocated very often but how is it logical not considering the loss of 70% of your DHT as a serious issue which is in essence the maleness hormone from a young age of 23?
  4. What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?
  5. I am prone to depression and sexual problems due to antidepressants from time to time, do you still recommend finasteride in my case?
  6. Can you guarantee from your expertise that side effects subside even if you quit the drug after e.g 3 years or more of continued use?

Thanks

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Helmet

  1. There is one patient I have seen that had traction alopecia from wearing a very tight fitting helmet everyday for a year. The hair loss did not look like genetic male pattern balding, but the balding area was where the helmet was rubbing on the side of the head. So it is possible, but not common.
  2. A lack of iron in your diet can cause anemia (low red blood cells). Your mucosal membranes (under the eyelids and gums) will be pale, you will feel weak, and you will have other serious medical issues before hair starts to fall out. Hair should be the last of your worries.
  3. Men in their early 20’s take Propecia without adverse effects associated with lowering of their DHT levels.
  4. If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious. I’ll point out some interesting tidbits about this in my next post…
  5. This is something you’ll need to discuss with your doctor. Assuming you would be a good candidate for Propecia based on your hair loss, your doctor will need to make the decision if you’re a candidate based on your history of depression. There shouldn’t be a problem with taking the medications together though.
  6. There really is no guarantees in medicine (or in life). Actually, the only two guarantees in life are death and taxes. I do not give reassurances to someone who is afraid to use a medication. This is something you need discuss with your doctor.

#4 continued here

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Can I Empty Dutasteride Capsule into Water? – Hair Loss Information – Balding Blog

Hi,

Like a previous case, I’m a vegetarian who takes Dutasteride (Dr Reddy’s) 0.5 mg one dose daily for hair loss. I have seen better results with this medication than with finasteride (no results at all). The trouble is I’m unhappy with the fact that the capsule itself has gelatin contents.

I understand that it’s advised to have the capsule swallowed whole because of some sort of risk of irritation. However, would it be permissable to empty the contents into a full glass of water and take the medicine like this?

Any help and advise would be most appreciated.

Kindest regards.

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Gel capsulesYou are asking about using a different method for taking a medication that is intended to be swallowed. I suppose you can try it, but I don’t know if that would compromise the efficacy of the medication. You can try contacting the Dr Reddy’s Laboratories here, but I’d assume they’d tell you that the capsule should be swallowed whole.

I’m not an expert on generic dutasteride and its variations, but there might be another company out there that makes a pill that isn’t a soft gel capsule.

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Female Teenager with White Bulb on Falling Hairs – Hair Loss Information – Balding Blog

(female) I’m a teen experiencing hair loss with a thick white bulb at the end. What can be the causes of this? I do NOT pull my hair. It comes off by itself. So why is it that the bulb is present on EVERY piece of fallen hair? Will it grow back? How long will it take for it to grow back? I’ve been losing hair when I comb it, in the shower. It’s an all around hair loss and I’ve noticed that my hair has thinned a lot. Any advice, something I should tell my doctor other than “I’m losing hair?”. Should I mention this hair bulb thing?

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I don’t know if it’ll grow back, but the white bulb isn’t anything to worry about. It is likely sebum. See this post for a similar question.

Be open with your doctor and tell him/her anything that you think could contribute. He’ll likely have questions of his own and should run tests. Female hair loss is different from male hair loss. Most men experience hair loss from genetics — with women, it could be genetics, hormonal imbalance, low iron, etc, etc. Learn more about that here.

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Would Using Minoxidil Only Periodically Make Hair Loss Worse? – Hair Loss Information – Balding Blog

Hello, i know that minoxidil is supposed to be used every night before bed. My question is, due to my extremely busy lifestyle and lack of routine i sometimes go a week without using minoxidil. If i use it for three days then dont use it again for a week then use it again for three days in a cycle, besides it not working well enough as it needs to be everyday is it actually making my hairloss worse in the sense that if its causing shedding (which is a sign its working) then not using the treatment again for a week, is it basically just shedding my hair and because im then not using it again for a week the hairs that ‘would have been’ stronger and healthy because of the minoxidil are just the thinning hairs that are not being protected by minoxidil. Am i just basically shedding my hair faster?

thank you

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To my knowledge, minoxidil will not work on an irregular schedule, particularly one that fits into your lifestyle. Either use it regularly or forget about using it. If you’re seeing continued hair loss, it’s more likely that its just your genetics continuing the process (which was the reason you were using minoxidil in the first place).

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How Long Can a Single Dose of Propecia Stay in the Body? – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

I’ve read here that a single dose of Finasteride can stay in one’s body for up to 7 days or more: regrowhair.com

Do you think it’s true?

Thank you! Best Regards

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PropeciaThere are many resources for information as well as misinformation. Some sources say finasteride half life is 4-5 hours. Some say it is 8 hours. My Epocrates drug database says it is 6 hours. Half life is the time it takes for 50% of the drug to be out of your bloodstream. So if you assume that the half life is 6 hours, then most of the medication should be out of your bloodstream and excreted out of your body in a day or so (it is excreted in your feces and urine). But being out of the bloodstream does not always correlate with it being out of your body per se, because some form of the medication is left in your tissue. In general, this minute amount is not enough to affect the physiologic goal that was intended, so we have to take the medication at the corresponding interval to keep a consistent level in your body. Propecia (finasteride 1mg) has a recommended dosing of one pill, once a day. This makes sense, because most of the drug is out of the bloodstream in one day.

For the conspiracy theorists…

Now, the confusing part to those who scour the Internet for conspiracy theories and mistrust in the medical and scientific world is that it has been shown that after stopping Propecia there seems to be a suppression of the DHT levels even after one day (when Propecia is out of your bloodstream). There is no clear explanation of why this is. You can also theorize that maybe it takes a while for the DHT to return back to its normal levels in a few days after stopping Propecia. There is no clear answer that I can find, but I suppose some may advocate taking Propecia every other day. I personally would follow the recommended dosing and discuss any changes with your doctor.

For those that still don’t believe…

You want more science? Let’s use the finasteride packaging study as the source: Following an oral dose of 14C-finasteride (radioactive dose) in men, approximately 39% (32-46%) of the dose was excreted in the urine in the form of metabolites. Virtually no unchanged drug was excreted in the urine and 57% (51-64%) of the total dose was excreted in the feces. The elimination rate of finasteride decreases somewhat with age. Mean terminal plasma half-life is approximately 5-6 hours (3-14 hours) and in men more than 70 years of age the half life rises on average to 8 hours (6-15 hours range). These findings are of no clinical significance and hence, a reduction in dosage in the elderly is NOT warranted.

To conclude…

To all who are utterly confused by now, I say this: Propecia is a medication to help men who have androgenic alopecia. Propecia does not cure androgenic alopecia, but it does slow it down. Propecia has its side effects, but as with all drugs you have to consider the risks as well as benefits and after discussing all the options with your physician you have a choice! Finally, the recommended dose of Propecia is once a day. If you want to take it any other way, that’s between you and your doctor. This is not rocket science and there should not be confusion in this matter. It is a simple drug to take with clear instructions. The rest are just mental masturbation, hypotheticals, and Internet hype.