Hi Dr. Rassman,
My pharmacy (CVS) gave me a different type of finasteride (actavis), after a year of using the same one (mylan). Do you think this matters ? Or should I go back, and ask for the originally generic they have been giving me for the past year.
Thanks
I wouldn’t think it would make a difference, so long as the active ingredient (finasteride) is the same in both. Do what works for you. Speak with your pharmacist if you have concerns.
I was wondering what a good alternative would be to Minoxidil or Rogaine foam as they contain alcohol and resulted in redness of the scalp. I have tried Propecia but there were side effects so I stopped. I recently started using Tricomin shampoo but from what I heard it generally won’t result in regrowth, only in retaining what you have left.
Androgenic alopecia is a genetic trait and there are no drugs or potions that will stop it. Propecia and Rogaine seem to slow it down or sometimes reverse it for a few years (it buys you time), but you will continue to lose hair. In other words, there’s no cure. In your case, it is unfortunate that you cannot take the two medications that actually work and are FDA approved to treat hair loss.
There might be an alcohol-free minoxidil out there, but I couldn’t name any off the top of my head (no pun intended), nor do I know if the lack of alcohol would make it more difficult to apply evenly. I’m not sure which Rogaine you tried, but the 5% has less alcohol and more propylene glycol; the 2% has more alcohol.
As for Tricomin, I’ve written about it before here. A key ingredient in that shampoo is apparently copper peptide, and you can learn more about that here.
Hi Dr. Rassman,
I’m 22 and I’ve begun the early stages of balding, no doubt about it. Nobody in my known family has begun balding as young as I have.
In the past 5 years, I have been through severe emotional trauma; watching my dad wither away and die from a rare form of cancer, dealing with my mom’s substance abuse problems and a suicide attempt from her, and struggling to live on my own. I have had severe depression and suicidal thoughts recurring.
My question to you is: is there any way this stress could have brought about the expression of my balding pattern younger than I would have if I had a healthier mental health record, or would bad luck in genetics be more likely to blame? Thank you in advance.
Stress related balding is different than genetic balding. Stress related balding is likely reversible. For genetic balding, there is no cure… but there are adjuncts such as medicine and surgery.
There is one catch: stress can precipitate genetic balding earlier on. BUT you have to have the genetic trait to bring this about.
Finally, while genetic balding is considered hereditary, it does not have to mean your immediate or distant family must have balding. In simpler words, the gene may have been ‘silent’ until it came to you.
Here’s a hilarious video from CNN about conspiracy theories and President Obama’s mysterious scalp scar that I thought you all might enjoy…
Hello Doctor
Do you believe that with the advent of scalp micro-pigmentation, it is now feasible for transplants in younger patients / more aggressive transplants in general?
A patient could have a transplant to frame the face with a NW2 or so look, and if they cannot keep up with hair loss via meds + additional transplants, they may have the SMP procedure, (with the option of some hair transplanted to the regions), in order to obtain the close-cut stubble look.
Additionally, has there been any attempts to fill in the “white dot” scarring from FUE procedures?
The answer is yes on all accounts. Scalp MicroPigmentation (SMP) works wonderfully in filling in the white dots from FUE harvesting. Combining SMP and transplants must be made individually by a person skilled in the art.
1) Would someone who is 46 and starting to thin on top benefit from finasteride? I have read, possibly on this site, that it works better on individuals under 35.
2) I have read that DHT aids with libido and regulating estrogen. That seems to explain why Gyno and sexual dysfunction are side effects. However, I noticed in one of your responses you mentioned “You do not wipe out 70% of DHT, you just block 70% at the hair follicle level”. If finasteride does not reduce DHT but simply block’s it at the hair follicle level, then why is testosterone and estrogen raised when on finasteride? Also, why would Gyno and sexual dysfunction be side effects at all?
3) Since estrogen can rise on finasteride, would it make since to use with an estrogen blocker or at least monitor estrogen levels on a regular basis to ensure they are not raised significantly?
Three questions for the price of one.
I don’t see a problem with starting finasteride at 45 years or older, but the impact on hair that is not fragile isn’t as great. That is why it works so well in young men as the hair loss process is most active below the age of 30.
I do not see a value of using an estrogen blocker. There are feedback loops in the body that I do not understand. Competitive inhibition (blocking) DHT function occurs all over the body, but I only know of the hair effects. There are strong suggestions that DHT blockage could have many other undocumented side effects and people who report not feeling normal (mental brain function) could be impacted by this DHT blocking effect as well.
About 2 years ago I began to thin around the front of my head and being a female this freaked me out. I tried some rogaine, but I lost a lot more hair in the front and stopped when I noticed my hairline got weird. During the last 1.5 years it has gotten even worse and now I am see thru thin on the top and I have 2 or 3 bald spots.
I went today for a “hair restoration” consultation and it was a complete waste of time. They wanted to give me hair plugs. I am 35 years old and I think what prompted my hair loss was a bad set of braided in hair extensions. Is there anything I can do or take – like steroid shots to the scalp to get this hair to grow? I get married next April and I dont want to be the bald bride. No one in my family is or was bald – maybe thin, but please – any advice?
If you had hair extensions and developed traction alopecia from the tight constant pulling, nothing short of a hair transplant will fix it. Most women do not go completely bald unless that have specific conditions like alopecia totalis.
Rogaine can cause hair loss when you first start using it, but it is not a permanent type of balding. Alopecia areata can also lead to balding. All of these opinions point to the need to get a consultation by a good doctor who will care about you. Your primary care doctor should first clear you from any medical issues relating to your hair loss.
I’ve been using Rogaine for about a year now with good success on my hairline, and recently started using it for my crown. I’m adding Nizoral 1% to my routine every third day-what should I expect? Further stabilization? Nothing?
Although it is a good shampoo, Nizoral (ketoconazole) isn’t proven to regrow hair. Some people suggest it has benefits for hair growth, but I’ve written about that before.
But as for expectations, I’d expect Rogaine to help in the crown now that you’ve started using it there (particularly if you had success in the hairline, which is rare). I suppose it depends on how you define success.
hello doctors,
im 21 yo this year and had my hair transplant 3 days ago. when i was sleeping last night, i accidentally scratched the area where it was transplanted and soon it started to bleed, i went to check in the mirror, and noticed significant blood and a single hair was dislodged on my forehead. i just want to know if there were more then just one hair graft dislodged? as i have checked and seems that theres only 1 hair graft that is missing. will it affect other hair graft too?
I remember a patient who had 3 transplants and seemed to love to scratch his head while he was sleeping. He lost some grafts (as did you). I told him to wear a boxing glove, which seemed to stop the late night scratching as he fought with himself at night.
Snippet from the article:
Medical device company Restoration Robotics Inc. said Thursday the Food & Drug Administration approved its system for treating hair loss.
Mountain View-based Restoration Robotics, which is privately held, said the system harvests hair follicles from the scalp in men diagnosed with male pattern hair loss with black or brown straight hair.
Read the full story — FDA approves Restoration Robotics system for treating hair loss
This product has limited use, as it only performs the FUE (follicular unit extraction) harvesting, not the implantation of the grafts, which is by far the most challenging technical aspect of the hair transplant process. The learning curve for manual FUE takes a few months, but the learning curve for placing the grafts easily approaches one year. For the novice surgeon who never learned the manual FUE technique, it allows that person (with minimal training) to produce a high quality FUE process.
In our original article which introduced FUE to the hair transplant community a decade ago, we categorized patients in 5 categories to determine which were the best and the worst patients for FUE (Fox class 1 was the best and Fox class 5 was the worst). In that article, we reported the worst Fox class 5 patients reflected about 20% of the population. It remains to be seen whether the robot can produce the high quality grafts with minimal damage in the Fox class 5 patient. Today, I believe that only about 10% of patients would be classed by me as a Fox class 5.
The cost of the robot, I believe, will be very high (significantly more than $100,000)… so the market will be small. There are many alternative approaches to the FUE technology, as there must be more than a dozen extraction devices produced. Some work, but many do not. Despite the automation of the extraction process, I doubt that this robot will become today’s ‘Standard of Care’. There is no doubt that the FUE technique has been well defined and proven today with the various techniques, but there are still a number of doctors who perform the technique very poorly. I have unfortunately seen too many of their failures in my office. At least with the robot, I would expect that the patient will be confident that what he is paying for and what he is going to get is what he expects he will get, and that alone should help the patient make a decision about their surgeon (if there are any doubts as to their chosen surgeon’s competency).
I must reveal here that we have a vested interest in the success of this particular robot, as we licensed the core optical technology for the robotic FUE technique many years ago. Seeing that the product finally has come to the market is very satisfying to us. We have also developed comparable hardware technology for placing grafts and obtained US patents in this arena, so when and if Restoration Robotics moves into graft placing, we can finally say that the automation process is complete.
