March 2010 – Page 9 – Balding Blog

March 8, 2010

Rogaine Usage Instructions – Balding Blog

I purchased rogaine for women to begin the regimen but misplaced the pamphlet which provides detailed instruction for usage, especially as it relates to chemically treated hair. Can I obtain this detailed information online and if so, where? Thanks

This should be the same information that is included with the Rogaine (liquid and foam) packaging –

For men: How to apply and Important drug facts
For women: How to apply and Important drug facts

Here’s what it specifically says about using Rogaine on chemically treated hair: “Rogaine can be used on color-treated hair. You may blow-dry your hair, but it’s best to use medium heat or lower. On the same day that your hair is colored or treated with chemicals, don’t use Rogaine if you’re concerned about scalp irritation.”

March 8, 2010

Patient Result — 8 Months After Hair Transplant (with Photos) – Balding Blog

This patient is in his mid 20s and showed a Norwood class 3 pattern with additional recession in the temple area. The results posted below are after one procedure of 1733 grafts, with the photos taken only 8 months after surgery. I fully expect additional growth in the transplanted area with more time, but the patient is very excited with the way things have turned out so far. I hope to have updated photos to post in a few months when we get to the 1 year mark.

It’s worth noting that the patient styled his hair forward in the corners of the hairline, and the “after” photo is not a straight line as it may appear to some. Click the photos to enlarge:

After (1733 grafts):

Before:

March 8, 2010

Doctors That Don’t Do Miniaturization Mapping – Hair Loss Information by Dr. William Rassman

When attempting to find a good HT Doctor, should one that doesn’t do a Miniaturization test be a strong factor in determining whether to use them?

There are many doctors that do not map the scalp for miniaturization. It is a relatively easy procedure, and in my hands it is basic to using medications like Propecia, in determining the health of the donor area, and in developing a long term Master Plan for the patient. If they do not use a high-powered video device to examine the hair, they will miss things like diffuse unpatterned alopecia (DUPA) on many patients who have it. And to continue that example, I am sure that if they end up performing surgery on a person with DUPA, they will absolutely harm them.

I am not a fan of doctors that do not do a complete examination of the scalp before they go forward with hair transplantation surgery. Of course, you should make your own determination of that issue.

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March 5, 2010

Hair Loss InformationThe Majority of Women Are Not Hair Transplant Candidates! – Hair Loss Information – Balding Blog

Megaphone As regular readers might know since I’ve mentioned it in the past, I’m part of an email group of hair transplant doctors. We share clinical stories, exchange ideas, etc. There was an article in O Magazine about female hair loss and we were asked about percentages of female patients that are candidates for surgery. Dr. Robert Bernstein had said around 20%, but one physician in the group disagreed with him and stated that close to 80% of his female patients are surgical candidates! From my own personal observations, some doctors will perform surgery on the majority of female patients that come through their door, but in my opinion, that would just be taking advantage of these women. Ask the doctor you selected what percentage of the hair transplant practice is women. If the number is high (over 20%) then I would seek another doctor.

Every once in a while a doctor will say something completely outrageous, and without mentioning who the doctor is, I wanted to share my reply to the group of doctors with you all. It will likely ruffle some feathers, but it needed to be said:

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I really don’t understand the answer from Dr. [name removed]. Dr. Bernstein and I have routinely performed miniaturization analysis of the entire ‘donor area’ of all women, quantifying the good hair and the poor hair. I feel that if a doctor does not do this, it would reflect poor medical judgment in diagnosis and possibly a lack of concern for the patient.

The miniaturization pattern is almost always the same when female hair loss impacts the donor area. Fully 80% of female hair loss patients have greater than 30% of their hair miniaturized in the donor area, and if it is 30% in the center of the donor area, miniaturization analysis as one moves laterally might rise (possibly 50% miniaturization in that same patient). The drop in donor density, particularly on the sides of the donor area, is a cardinal sign that the balding process has taken its toll on the donor area. If the surgeon harvests this hair, then the surgeon is moving ‘bad’ or impacted hair from the donor area. If, for example, the normal donor density is 2 hairs per square mm and the impacted hair in women is 30%, then the effective donor density is only 1.4 hairs per follicular unit, but this hair probably has a tendency to miniaturize further and that will only reduce the effective donor hair over time and with 30% miniaturization, the average hairs per follicular unit will be low. We see the same phenomenon in men with diffuse unpatterned alopecia (DUPA) and too many of these men have been transplanted only to face disaster not only in the recipient area with very poor yields, but the development of progressive see-through donor areas which are clearly surgically induced.

I have maintained, as has my student Dr. Bernstein, that moving bad hair from an impacted donor area in typical female hair loss patients produces poor yields. I have further maintained that doctors who do surgery on these women are confusing the principles we defined in our published articles and talks on follicular unit transplantation in men (not women), with their need for the doctor to pay their rent. I have no doubt that a solution to our marketing problem in this recession is to transplant more and more women, even if their donor area is inadequate. Women are often desperate for hair and they are easily talked into a transplant option, in fact they often push for it. Not doing a hair transplant, at times, takes great restraint on the part of the doctor, but the principles of our Hippocratic Oath should always be central in our thinking (I’m preaching to the choir of good doctors out there I am sure).

March 5, 2010

Transplanting From the Armpit to the Scalp? – Hair Loss Information – Balding Blog

i wanna know that can armpit hairs be the donor for scalp hair transplantation???? plz reply me soon

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Armpit I suppose anything is possible, but I doubt you’d really want to do this if you knew what the end result would look like. I have seen everything from transplanting armpit hair, pubic hair, and even beard hair to the scalp (I’ve not done these procedures, but have seen patients with them done).

Not only is the hair quality and texture just not the same as scalp hair, but more importantly, the growth rate and success of body hair transplantation is not as high as scalp hair transplantation (despite what the doctor may tell you). Plus, underarm hair will carry its glands with it so you may have to use deodorant on that hair. In my humble opinion, it is an experimental surgery with a potential for problem results.

March 5, 2010

Hair Loss InformationNew Finasteride for Women Study – Hair Loss Information – Balding Blog

Snippet from the article:

Molecular dermatology research and development innovator HairDX today announced the results of a six month pilot study that presents, for the first time, evidence that genetic mechanisms may predict treatment response to Finasteride for postmenopausal female Androgenetic Alopecia (female hair loss).

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Read the full article: Study indicates Finasteride therapy may benefit women suffering from hair loss

This is a very positive early study from HairDX and the first I’ve seen which targets the post-menopausal women who have a high sensitivity to the effects of Propecia (finasteride). With that type of information, I would be willing to treat post-menopausal women with Propecia after they get the testing which predicts response.

March 5, 2010

If Dutasteride is Safe for Prostate Patients, Why Not Hair Loss Patients? – Balding Blog

Hello,
I am turning 40 and have been on propecia for over 14 years. In the last year I have really noticed a decline in its effectiveness, and I uped the dose with no real results. I am seriously looking at switching to dustasteride and was wondering why there are a lot of safety concerns about the drug. It is prescribed for prostate patients with no real problems. At my age, would it really be a problem switching over to it? Do you think we will ever see it as a prescribed treatment for mpb?

Avodart Doctors, when prescribing medications, stay with medications that are FDA approved for the particular condition they are treating. That is because the FDA gives its stamp of approval that the drug is safe and effective for the condition that it is being prescribed for. The doctors have some restrictions in the way they use their medical license when prescribing drugs and their insurance carriers will not cover them for drug use outside the FDA approved drugs, so if something went wrong, they are bare for insurance coverage.

Let’s say that you are 21 years old, are prescribed Avodart (dutasteride) to treat your hair loss, and after 10 years of taking it you become sterile. That would not be good for you and you could take legal action against the doctor who prescribed it, which would not be covered under his malpractice insurance policy. For Avodart, there is no evidence that long term use is safe for young men and as such, it is not presently FDA approved for the treatment of hair loss. For the prostate, on the other hand, this drug is used in men usually over 60 years old who are statistically unlikely to be having children, so Avodart is approved for men with prostate problems.

As I mentioned in yesterday’s post about dutasteride, if you already had children / had no desire for children and had a vasectomy, and you’d already tried Propecia for a year or so and it was not working well, I would consider prescribing Avodart for you for off-label use. Other doctors might be more willing without qualms about it, but that is on them. There would be qualifiers that it has not been proven safe for a 40 year old man and it is not FDA approved for treating hair loss, so I would be at risk. You could also be at risk if you end up taking it for 20+ years. Usually, 60+ year old men who start Avodart to treat their prostate issues have a life expectancy of less than 20 years, so they may not even live long enough to develop problems that may not have been defined as of yet.

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March 4, 2010

Why Do Some Men Have Increased Libido from Propecia? – Hair Loss Information by Dr. William Rassman

Dear sir,

When I started on finasteride I noticed a very strange but rather pleasant side-effect: an increased libido. This makes sense since finasteride raises the levels of total testosterone; it is, however, contrary to the science literature, which commonly reports DECREASED libido as a potential side-effect.

Why do some men suffer a decreased libido when finasteride actually gives them more testosterone? Thank you and best regards

We really do not know the reasons for the increase or decrease in libido that some rarely observe after taking finasteride. The decrease is seen in 1-2% of men, and the increase is even more rare… so congratulations!

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March 4, 2010

Is Hair Regrowth from Propecia Just a Bonus? – Hair Loss Information by Dr. William Rassman

hey doctor, it seems everywhere (mainly hair loss forums) i read it’s saying that propecia is meant to just maintain hair and that any regrowth is an added bonus. But propecia’s website says in their 2 year study that 66% of men had visible regrowth. 2/3 sounds like the majority of people should regrow hair. furthermore the 5 year study says that almost 50% regrew hair. could u shed some light on this as nearly every forum i visit states that hair regrowth with propecia should not be expected.

I have seen substantial growth from Propecia, and even a complete regrowth in the frontal area once or twice in my years in practice. Regrowth in the crown is much more common and expected in men under 30 years old.

As for forums vs scientific data, well… let’s put it this way. If you got great growth, are you going to spend time on a message board letting everyone know? Probably not. But if you didn’t get the results you expected, you’ll be more likely willing to spend the time to warn people. So when it seems like a lot of posts say the same thing, its because it can be easily skewed.

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March 4, 2010

Criteria for Prescribing Dutasteride? – Balding Blog

Good day Dr. Rassman, Great forum with lots of useful info. What is your position on prescribing Dutasteride? I believe in the past you’ve stated you wouldn’t, but I also thought I remembered reading a post where you said you might under certain circumstances. I’m 45 years old and have been on Finasteride for 7 years and have noticed the diminishing returns over the last year or so. I would like to try Duasteride but not without talking with a professional such as yourself first. I guess what I’m asking is, provided I meet your criteria, are you open to prescribing Duasteride? I would like to schedule an office visit with you so I could get your analysis of my particular situation. Great excuse to go to a Laker game.

Avodart Under the following circumstances, I would consider prescribing dutasteride before it is FDA approved to treat hair loss, but see the qualifier below:

It is a man over 40 years old and has had all of the children he expects to have.
Even better for me is if the patient had a vasectomy done to ensure that there will be no more children.
At least a year on finasteride with poor results or slipping backwards.

The qualifier is — realistic expectations, such that we develop a good doctor/patient relationship. It is important to note that your question itself is a problem, as I do not create rules for prescribing something that the FDA has not approved of. I created this above list under stimulus of this question. Some of you might think I’m crazy for the 2nd item in the list (vasectomy), but honestly, it is just a way to highlight to the patient that we’re not fully aware of all risks when it comes to this medication. The drug was FDA approved to treat the prostate, and while it may treat hair loss, the dosing and age criteria haven’t been established for prescribing it off-label. This is a powerful medication and it has been shown that the half-life of dutasteride is far greater than the current hair loss treatment of choice, finasteride (Propecia), thus the side effect risk is possibly also greater.

I’ll go into a little greater detail about this tomorrow… so please check back.