Month: May 2010

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Graying Body Hair – Hair Loss Information – Balding Blog

Hello Rassman – I have been following your site for sometime and I have a question about my hair loss. My hair(Asian) has been graying since I was 17 years old and I started using some hair colors as a result of which I believe I lost a lot of my hair. Now I am NW Class 5. I believe you always attribute hair loss to genetic reasons. Now I am 33 yrs old and I see that the hair on chest also started greying since 4-5 months. Isn’t it too early that I see the grey hair on my chest. Is that also related to genes. Is there any diet that I can follow to avoid this early graying on the body.

As always thanks for your attention to my question and I hope you can answer my question.

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Graying scalp, body, pubic hairs are all due to genetics. Some people go gray in the 30s, some don’t gray until much later. There are no foods or medications proven to stop the graying process at this time, though there are products that claim to do this (like this one).

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Breast Cancer, Hair Loss, and Dismissive Doctors – Hair Loss Information – Balding Blog

I am among the many young victims of breast cancer (37 y.o. with estrogen+ progesterone+ Stage III breast cancer) who has undergone 16 rounds of chemo, 6 surgeries (including oophorectomy), and 35+ radiation tx, plus am currently on aromatase inhibitors. I am treated at one of the top 10 facilities for cancer in the US, yet trying to get help for my slow growing Ludwig Type II hair while on aromatase inhibitors, esp. 2 years after chemo is proving more daunting. First, my oncologist revers me to dermatology, then dermatology refers me to endrocrinology, then endocrinology suggests I see a hair specialist doctor….but now I read in your archives to defer to the oncologist. It frustrates me that I am being punted around between medical specialties who don’t want to have any liability or necessarily want to work together to come up with a treatment plan for this pervasive side effect which many women in my position are experiencing. No one wants to touch this hair loss issue with breast cancer survivors.

I researched all the medical literature, and although there is plenty of information on observations of hair loss, there is nothing about the treatment of hair loss for those of us who are on either tamoxifen or aromatase inhibitors after breast cancer. I already started 12.5% Rogaine with Retin-A along with 5% minoxidil foam, Aminexil with Madecassoside, and washing with alternating 1-2% Nizoral. Propecia isn’t even an option. Also, I feel I’m relegated to wigs which you deem may accelerate hair loss (although if it not bonded or clipped to hair, I don’t know how that would be the case). Is there anyone in the San Francisco Bay Area that even has the breadth to tackle this problem?

Please tell me there at least some proprietary research out there that is addressing this issue on the horizon, because then I won’t be such a cynic about medicine. Clearly quality of life after cancer involves helping to alleviate hair loss as a result of aromatase inhibitors.

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Pink ribbonI am truly sorry to learn of your frustration (we’ve all been in situations where we’re referred back and forth and feel like we’re getting nowhere), but the hair loss issue really isn’t specific to breast cancer survivors. Hair loss in all women is a very difficult issue to treat. There are many potential causes, and especially with your medical history, it can be hard to pinpoint the cause. The only FDA-approved medication available to women to treat hair loss is minoxidil (Rogaine), but you should be careful with taking 12.5% and 5% minoxidil foam at the same time so that you do not overdose yourself. Some women have had minor success with Propecia, but that would be taking the medication off-label and there are potential serious risks for women that use this medication (so just to be clear, I do not recommend that approach).

Unfortunately, there are very few options available to women that are losing their hair. For men, Propecia slows the process down, could reverse it, or even completely stabilizes it for years; hair transplantation just rearranges permanent hair from the back to the front. For women, the hair loss may be so diffuse that there is not much to rearrange and there is no specific area of permanent hair like is the case with men. Approximately 20% of women may be helped with hair transplantation, so each patient must be individually evaluated. With regard to your specific situation, I would be willing to see you since you are somewhat local (I do have an office in San Jose) and maybe I can add something to help you, such as the possible use of concealers like DermMatch or Toppik. Wigs might work in your case, but one must be careful that there isn’t traction on the existing weak hair or that’s when you might run into problems with further loss.

I don’t know of any proprietary research, and I wish I had a specialist in mind that I could point you to… but I’m posting your message in hopes that it reaches a wider audience that might be able to provide more insight or assistance. As much as I might want to have all the answers, I fully admit that’s not the case.

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In the News – Viagra and Hearing Loss – Hair Loss Information – Balding Blog

In non-hair loss news:

Sure, Pfizer’s wonder pill has side effects such as headaches, facial flushing, upset stomach, erections lasting more than four hours, bluish or sudden loss of vision. There’s one more risk to the pill that grants erections: Hearing loss.

Research published this week in Archives of Otolaryngology-Head and Neck Surgery showed an association between long-term hearing loss and Viagra.

This side effect is already acknowledged by Viagra – especially after the U.S. Food and Drug Administration forced this labeling changes for oral erectile dysfunction medicines known as PDE5 inhibitors in 2007.

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DeafRead the rest of the article — Viagra associated with hearing loss

Interesting. All medications carry some side effect risks, regardless of rarity… but there are some medications, like Viagra, where many of the side effects are well known. It got me to think about how many millions of people still take Viagra despite those side effect warnings, including sudden loss of vision and now apparently hearing loss. Yet the pills still sell incredibly well and men (even those without erectile dysfunction) are eager to take it!

And then think about all the men who worry about Propecia’s sexual side effects, which occur in 1 to 2% of men (which are reversible) and are afraid to even try it. I guess it is all about perspective. I suppose we’d rather be bald, blind, and deaf than to not have sex!

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Digoxin and Hair Loss? – Hair Loss Information – Balding Blog

I have been taking digoxin for a short while and have noticed clumps of my hair in the bath drain plug, on my pillows and basically everywhere. I am extremely worried about this and would like to know if this is reversable? kind regards.

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LanoxinDigoxin (also known by its brand name, Lanoxin) is a heart medication that shouldn’t cause hair loss as a side effect, but if adding this medication to your routine was the only thing that has changed prior to clumps of hair coming out, there might be something to it. That being said, I would discuss your hair loss issues with your prescribing doctor and explore the possibility of other undiagnosed conditions.

I couldn’t say if the loss is reversible without knowing why you’re losing hair. For men in general, hair loss occurs in specific “male patterns” and this is due to genetic balding.

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In the News – Processed Meat Linked to Coronary Heart Disease – Hair Loss Information – Balding Blog

Not hair loss news, but interesting health stuff…

The first study to systematically separate out the effects of red unprocessed meat from processed-meat products has shown that eating the former is not associated with an increased risk of coronary heart disease or diabetes.

But eating 50 g of processed meat per day—the equivalent of one typical hot dog in the US, or two slices of deli meat—was associated with a 42% higher risk of CHD and a 19% increased risk of diabetes, say Dr Renata Micha (Harvard School of Public Health, Boston, MA) and colleagues in their paper published online May 17, 2010 in Circulation.

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Hot dogRead more of the article at Processed meat, not red meat per se, linked to CHD, diabetes

This is good news for those of you who are meat eaters, but not permission to go overboard. The researchers believe that the increased salt and other preservatives in the processed meat could explain the added risks. So while sausages, salamis, and hot dogs are the foods to avoid, all meats do lead to higher incidences of some cancers (especially colorectal).

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Doctor Believes DHT Is Produced by Estrogen? – Hair Loss Information – Balding Blog

Dr. Rassman & associates,
What is your professional, unbiased, opinion and/or facts, as to the use of a DIM product, such as Myomin from Dr. Chi, which definitely is a known estrogen metabolizer in addition to a known aromatase inhibitor.

Dr. Wong had stated that he believes DHT is produced by excess estrogens, most notably the bad ones, as in Estradiol, in males, and further that DHT is not directly produced by testosterone but by these bad excess estrogens? Myomin and/or DIM is said to metabolize these bad estrogens and act as an aromatase inhibitor?

thanks

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One wayTo put it politely, I think this Dr. Wong needs to go back and review college biochemistry if he really believes DHT is produced by excess estrogen. There are no such thing as bad estrogens, etc. DHT is NOT a byproduct of estogen or estrodiol. DHT is a byproduct of testosterone as it is metabolized. If you do not have your testicles, you will not produce enough DHT to cause balding.

It is a much more complicated process (see this chart), but here is an analogy that hopefully won’t make things too confusing:

Think of it as a one way street with a fork in the road. If you start with testosterone, you have the option of (a) going down the path of DHT or (b) going down the path of estradiol. Now it is a one way street, so you can not backtrack and go back from estradiol to testosterone to DHT. However, if there is a block in the road to estradiol, you can theoretically get a back-up in traffic and have a slight increase in testosterone, thus traffic is forced to go down the DHT pathway. Similarly, if you block the road to DHT (with finasteride) you can get a back-up and have more testosterone go down the estradiol pathway. There are other pathways, but we can ignore them for now for the sake of simplicity (if you’re not lost yet… keep up with me just a bit longer).


Now, aromatase inhibitors will do just that and block testosterone from forming into estradiol, the way finasteride blocks testosterone from forming into DHT. Thus in effect aromatase inhibitors will (theoretically) back-up traffic to divert more testosterone to go down the path of producing more DHT. In short, aromatase inhibitors can cause more DHT production (again, theoretically), which can cause more hair loss! In fact, I saw a female patient in my office not too long ago who was taking an aromatase inhibitor for her breast cancer treatment and she had what appeared to be androgenic alopecia.

Biochemistry is more complicated than this, especially when it is related to actual human beings. Theoretical things do not always work out in real clinical scenarios, but I believe that aromatase inhibitors can in theory make your androgenic alopecia worse! As for Myomin and DIM, both are herbal supplements that I’m honestly not too familiar with and don’t know enough about the claims attributed to each… but for those curious, this page has a lot of info.

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Does Finasteride Make Things Worse If I Stop It? – Hair Loss Information – Balding Blog

Dear Drs,

I’m concerned about the rebound effect of stopping finasteride.

I was having a look at some website, I should stop searching about hair loss as I’ve become so lost, but one website had a comment which gave me some concerns. This is what they had to say about finasteride. Basically it means that whoever takes it and then stops it, will be in a worse situation than if he never took finasteride in the first place. Is that true? If I take it for a year or few years, then decide to stop, would hair shed as it would have naturally or is there be a rebound effect where I would go balder than if I never used finasteride?

Thanks a lot

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The internet is a great resource, but it does not always mean it has accurate information… and as you have found out, it can be very confusing.

What you are describing is “catch-up” hair loss from stopping Propecia. In brief, if you stop taking Propecia after months or years of use, you will lose any benefits you saw and go back to what your hair loss “would have been” if you never took it in the first place. So if you never took the medication and were destined to be a Norwood Class 5, then you’ll see a Class 5 hair loss pattern emerge. This does not mean you will be worse off than if you never took it.

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Reader Warning About Switching from Propecia to Avodart – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

This is a story, not a question, but I thought you might want to put it on your site because you often talk about the unproven effects of Avodart and why you don’t prescribe it. I had a very bad experience with Avodart and wanted to put it out there where people would be able to read about it.

I took Propecia for 3 years, then switched to Avodart (at my doctor’s suggestion) because I was still experiencing some hair loss (possibly due to stress at the time). I took Avodart for about 6 months, but I developed almost total impotence during that period. I told my doctor that I wanted to go off Avodart entirely, but instead he prescribed Viagra and told me to just switch to a 1/2 dosage as “I would lose a lot of hair if I switched back to Propecia from Avodart.” However, I was still experiencing impotence after 4 months on a 1/2 dose of Avodart, though, so at this time I became so frustrated that I ignored my doctor’s advice, stopped seeing that doctor, and switched to Propecia.

Over the next 8 months I lost a *lot* of hair — substantially more than I’d ever lost before. I don’t know for sure, but I assume that it was because of the increased testosterone flowing in my body in reaction to the Avodart, and the Propecia being unable to counteract it. My sexual function has been restored, though.

Obviously I probably acted rashly and made a mistake ignoring my doctor’s advice about quitting Avodart, but I feel that Avodart put me in an unbearable Catch-22 situation: either endure partial impotence for the rest of my life (or pay for Viagra, which I felt I shouldn’t be taking as a 32-year-old man), or switch off Avodart and lose a lot of hair. I realize that many people take Avodart without any side effects, but it was a really depressing situation to be “one of the 5%.” I’d advise anyone out there who is considering Avodart to think twice and be ready for potentially devastating side effects.

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Thank you for sharing your story. Sex vs hair… it’s a tough choice for some men!

Granted, many men that take Avodart (dutasteride) likely won’t see the severe effects like you saw, but until the medication and its risks are fully studied I can do not advocate the use of Avodart in my practice. It’s hard enough the dispel the distrust of Propecia’s side effects, and that is a medication with known side effect risks.

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Minoxidil 7% Irritated Me After 10 Months of Use – Hair Loss Information – Balding Blog

I have used minoxidil7% (2mL/day)and finasteride for 13 months with good results, including a period of shedding 10 months in. Then, suddenly, I felt burning on my scalp so discontinued minoxidil. I returned to the minoxidil after 2 months but can tolerate only 0.5mL/day). I have been back on for 3 weeks. In that time I have noticed a loss of density.

My questions are:

1. might 5% minoxidil be right for me?
2. is 0.5mL minox 7% likely to be ineffective?
3. could this recent loss of density be due to resuming the minoxidil, albeit at a reduced level of application?

Many and sincere thanks for your time and expertise.

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Really, the only way you can know if 5% minoxidil is right for you is by trying it. Generally, I do recommend the 5% minoxidil if you want to use a topical. Higher percentage is not necessarily better, as you’ve found with the irritated scalp. Are you applying it twice daily, as recommended? As for the hair loss you’re seeing, it could be due to using only 1/4 of what you previously used, but there’s really no way for me to tell.

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Hair Loss InformationAvoid the Scam – Hair Transplants That Do Not Grow – Hair Loss Information – Balding Blog

Scam AlertI’m often outspoken about the problems with ethics in our industry, and I know I just wrote about transplant failures a couple months ago… but I continue to see a large number of patients who are unsatisfied with the growth after their hair transplants. Part of me really hates writing these types of posts, because I just know I am turning some people off to the idea of surgery altogether. But really, these posts should serve as a way to educate yourselves. Transplant failure is a problem that can not be denied and an increasing number who received surgery from various doctors all over the world are visiting my office to ask for help as to why they aren’t seeing the growth they were promised. I’ve even received emails about the same issue. Although there are a number of reasons why a transplant could fail, it seems that these failures are mostly technical in nature and related to the hair transplant staff. In other words, the problem is avoidable.

So how does one avoid losing donor hair or paying for grafts that aren’t going to grow? Finding a surgeon with a staff that knows what they’re doing is a good start. An experienced staff is hard to hire, and I have been training my own technicians for years. The drop-out rate from training is high, but for those that we retained, the high quality of our work reflects the quality of our staff. I know what I am about to say is self-serving, but I do very limited promotion here and wanted to point out that we have a travel reimbursement program which offsets the cost of travel and hotel for those patients coming from out-of town. With our standby rates, it is hard to compete with the value NHI offers and in 8 months, few worry about what actually grew out.