Month: June 2012

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Hair Loss InformationDoes Finasteride Eventually Stop Working Completely? – Hair Loss Information – Balding Blog

What happens when a drug like finasteride loses its effect?

I read somewhere that when finasteride loses its effect, you will actually advance to the stage you would be at if the drug was never used in the first place. Does this apply only for the hair that was regrown, or for the hair that was maintained as well.. so that if you started using the drug at a nw2, you could rapidly become a nw4 when it loses effect?

I also read that the reason it loses effect is because the body starts producing more dht, if this theory and the above is true, wouldn’t you be even worse off than if you didn’t take anything at all, in other words completely bald before you should’ve been? I realize this might just be a crazy theory, but I would appreciate you giving a shot at it anyway.

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I feel like I answer this type of question on a regular basis. The questions have little twists in them and are asked in different ways, but the answer remains the same. Male pattern baldness (MPB) or androgenic alopecia (AGA) is due to genetic causes. Men who are born with the gene will be susceptible to dihydrotestosterone (DHT). Controlling the DHT levels will not stop the balding forever, since genetics will have the final say.

In the grand scheme of things your genes win out over any drug; however, I have seen some men on finasteride for 13 years and have had complete reversal of the balding in the crown without any loss of effectiveness of the drug over this period of time. If you are going to lose your hair, it will happen. Drugs such as Propecia (finasteride 1mg) will prolong the inevitable, but as we don’t always know the timeline (as in the cases where a 13 year history is available), there’s no way we can really know how long you’ll see cessation of the hair loss. So it isn’t really about finasteride that stops working, but more about you aging and the gene(s) expressing its fate. Also note that everybody responds differently to drugs.

People also ask if the body produces more or less DHT to counteract the finasteride. In an article published in the Journal of the American Academy of Dermatology in 1999, they studied this very question and found that DHT levels went down under finasteride treatment at varying doses.

One of the interesting findings of this study is that the lower doses of finasteride (lower than the recommended hair loss treatment 1mg dose) shows significant reductions of DHT at the skin and blood level. This lends credence to our approach of reducing the dose (but continuing on the finasteride) when sexual or other side effects occur. The drug seems to continue to be effective at lower doses.

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Doctor Recommended Vitamin D to Cure My Son’s Alopecia Areata – Hair Loss Information – Balding Blog

My seven year old son is suffering from Alopecia areata since december 2010 (first appearance: 7 spots of different sizes, stopped in june 2011, regrowth till mid-end september 2011, then hair loss starts again on other places, stopped in november 2011 and normal growth till february, new hairloss with 7 spots, actually regrowth…). A lack of vitamin D(25-OH vitamine D2-D3 is 10,7 ng/ml) has been diagnosed by a physician (who has some experience with AA patients) and he prescribed a vitamin D cure (choleciferol 25000 UI twice a week for one month, than once a week for two more months). But the dermatologist that is treating the AA thinks that this treatment is useless and that it could be harmful (he said that he would not administer vitamine D to his own kids…).

So my question: is there a risk for my son? can it help to cure the AA (or at least have less hairloss, longer periods without hairloss…)

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I am not your doctor, nor your son’s doctor, and I am not an expert in vitamin D deficiency, so I couldn’t give you a personalized answer. If you’re concerned about one doctor’s recommendation, consider getting a second opinion.

I do know that alopecia areata is a self limiting condition that will resolve without any treatment in some people. A good resource for alopecia areata information is the National Alopecia Areata Foundation. I don’t know that they would consider vitamin D as a “cure” though.

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Hair Loss InformationDoes Toppik Work On My African Hair? – Hair Loss Information – Balding Blog

I am a African American woman and i was chemical burn by relaxer about 7 yeas ago. I do not know how and if you can help me with me living in the Caribbean. I was thinking of getting toppik but will that work on my African hair? please help

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Yes. I know many African American men who came into our office to get a consult with us and when they are using Toppik, it seems to work well. I don’t see why it wouldn’t work in the same way for women. Give it a try!

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Can My First Hair Transplant Be a Megasession? – Hair Loss Information – Balding Blog

Hi, I’ve got a “virgin” scalp, ie. no previous hair transplants.

Although, I’m not there yet, my hairloss looks like it will eventually end up in a Norwood 5-6 pattern.

Taking that info for face value I have the following question. Assuming a patient will need at least two to three procedures, is it better for someone with a virgin scalp to have their initial transplant be a large “mega-session?”

In other words, is it harder to have a larger subsequent done down the road because of laxity issues caused by a previous smaller surgery?

Basically, is it better to knock-out a mega-session first while the scalp has its best scalp laxity?

Thanks

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Generally, we do not preemptively transplant hair to non-balding areas and prefer to treat the impending balding area with medications like Propecia. How do you know you will end up as a Norwood 5 or 6?

We pioneered the “megasession”, but just because we can do it does not mean we recommend it to everyone. Every case is different, and both the long term and short term goals must be discussed with each patient. For example, one patient may choose to have several smaller sessions over their lifetime as they are balding. Or another patient may wait until they are bald and have one big megasession.

Having a good scalp laxity works at making a megasession on the first surgery easier to do. Scar laxity usually returns to preoperative status after a surgery. If you have an FUE procedure instead of a strip surgery, the surgeon will take out what you need… and take out more and more of what you need as your balding progresses. No recurrent scars with FUE is clearly an advantage, but without seeing you, I am not sure how what I said applies to you.

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Hair Loss InformationStrip Scar Length and Graft Numbers – Hair Loss Information – Balding Blog

If I don’t require to have a lot of grafts placed on my scalp, and I want a strip surgery, can the doctor cut a small strip of hair, lets say, 3-4 inches in length so the linear scar is not big and doesn’t go from ear to ear?

My other question, if a person doesn’t require to many grafts placed on the scalp, why do the surgeons still cut a long strip that is from ear to ear?

Thank you

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This is one of the things the doctor should go over with you during a consultation. There are many patients who do this! Requiring a small number of grafts will give you a shorter scar. Some patients wait a year after their first small surgery for another small surgery, and they end up with a single short scar (replaced from the old). Many patients are not informed about this opportunity prior to coming to see me, but learn of the option during the first consultation. This is a part of the Master Plan we create with every patient.

On the flip side… if you want to have as many grafts as possible in one surgery, a larger scar is necessary to obtain the grafts needed.

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Finasteride Causes an Upregulation of Androgen Receptors? – Hair Loss Information – Balding Blog

hello doctor rassman
there was a study done where finasteride upregulates adrogen receptors in the prostate. here is the link- PubMed

is it possible that a user who takes finasteride for hairloss can have an upregulation of androgen receptors at scalp level? therefore causing more hairloss while on propecia? or propecia not working at all?

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I am not a biochemist to give you a clear answer on how this study relates to hair loss. Of note, this was a very limited study in 47 cases in a cell line study.

The big picture here is that people take Propecia for the treatment of hair loss, and the studies of this drug have shown effectiveness for this. The research does not show that it produces hair loss.

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Hair Loss InformationReCell Spray-On Skin in Hair Transplant Surgery? – Hair Loss Information – Balding Blog

Dr.Rassman/Dr.Pak,
Thought you might be interested in the following – ReCell Spray-On Skin

This technology was recently used to great effect here in the UK on a young child suffering from second-degree burns – Second Degree Burns Are Healed With ReCell Skin Spray

Do you think ReCell could be adapted for use in hair transplant surgery?

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Interesting find, but scarring from hair transplant surgery has more to do with the tension created by the cut on the scalp (not a burn on the tissue or tissue damage). So I don’t think the product would have a great effect on hair transplant scars.

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Why Do Scalp Pimples Occur After a Hair Transplant? – Hair Loss Information – Balding Blog

I had a hair transplant 2 months ago and have now developed pimples where they put the grafts. The doctor prescribed an antibiotic, but never explained the cause of the problem.

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If you look at the anatomy of the hair follicle, you will see that this is a complex structure that contains skin, a hair shaft with a bulb, dermal papillae, outer root sheath, dermal fat, arteries and veins, nerves, muscles that hook up to the hair that makes it erect when you are cold or stimulated… and with regard to your question, the sebaceous gland.

Above: Schematic drawing of a two hair graft with all elements of the anatomy labeled (on left). The photo on the right shows an actual mirror image of this schematic drawing. Note the similarity between the diagram and the photograph.

 

After a hair transplant, everything you see here disappears, and when the new hairs finally grow, these structures are rebuilt by the body to complete the newly growing hair organ. The sebaceous gland may not die and often survives after the hair transplant. When that happens, it is still a functioning gland — and what do glands do? They put out sebum. If the gland survives the initial transplant, it will still be functioning, pumping out the sebum that normally came out through the pore in the skin that the hair exited from.

With the pore gone (because there is not hair to maintain it open), the glands secreting sebum has no where to go. It will be attacked by the body as a foreign body, and in this attack, it may be walled off from the surrounding fat, forming a cyst. Most often these cysts contain sterile sebum, but this is very irritating stuff and the scalp often does not like it. If the walling off is successful, you may never know it ever happened and the body will remove the sebum as it would remove any foreign body, but sometimes it can not wall it off successfully and instead propels it out of the body, breaking through the skin on occasion (forming what we often refer to as a zit or pimple).

With proper warm soaks, the body is encouraged to get a cyst near the surface of the skin to expel it and then when it breaks through, it often appears yellow and thick (occasionally tinged with blood). If you saw me in the office, I would probably drain it with a needle under sterile conditions and if there were many of them, I might put you on an antibiotic. When we culture the ones that look “mean” to my medical eye, the culture is often done, but rarely do they show any bacteria when the culture reports are returned to us from the laboratory.

There are other causes of this condition to include: People who pick on the hair graft area and cause folliculitis (common), remnants of the hair shaft from the transplant (common), autoimmune reaction short term (probably common), autoimmune reaction long term (rare), etc…

If they persist, you should see the doctor who did your hair transplant and let that doctor determine what is causing it, and this is especially important if the problem continues.

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I’m Taking Iron Supplements, But After 3 Months My Hair Has Gotten Worse – Hair Loss Information – Balding Blog

(female)
I’m really hoping someone will be able to help me out. I am 24 years old. Over the past 8 months or so I have had a few medical problems ranging from headaches, joint pain and severe hair loss. I have seen my primary, who then referred me to a rheumatologist. She was concerned about my ANA but ruled out Lupus. She referred me to a dermatologist. He informed me that my iron absorption level was low, and put me on an iron supplement, which I have been taking for three months.

My hair has gotten worse. I use to have thick curly hair. I have such thin hair now that you can see my scalp no matter what I do. It is extremely depressing. I’m only 24 years old and I fear I am going to lose all my hair. I am married and have a 5 year old son and a full time job, so like any other person I have stress, but I am not so overcome with it that I feel that is the reason this is happening to me. I do not have a family history of hair loss. I don’t know what to do. I’m 24; I can’t believe I am going through this. Please help me.

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The best help I can offer is to tell you to consider seeing a doctor for your issues, including your depression and stress.

With respect to your hair loss issues, I cannot diagnose you or even offer a treatment (since I have not examined you or know exactly what is going on). Iron deficiency is known to cause hair loss, but I couldn’t say if that’s the cause of your loss. Continue the iron supplements for a good year or so, as it does take time to reverse any deficiency.

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Hair Loss InformationWill Finasteride Prevent Hair Loss from Accutane? – Hair Loss Information – Balding Blog

Two years ago I took accutane to deal with bad acne. During such time I ended up receding a lot around the temples – to the point of NW1.5ish – which certainly wouldn’t have normally happened – considering I was only 17 then.

To deal with the hair loss I’ve recently gone on Finasteride. However, my acne has also returned in a moderate form that like before, doesn’t respond to any creams. I know this second round will fix my skin once and for all, but I don’t want to lose any more hair.

Do you know if my taking Finasteride will somehow prevent hair loss from Accutane? The hair loss I suffered whilst on Accutane appeared to be TE as I was losing a lot more eyebrow, eyelash, and normal hair than normal – all with a white bulb at the end. I just want clear skin, and to maintain my hair. But my skin is so sensitive to acne creams thanks to Accutane, that I’m unable to treat it. It’s a real catch-22 and I’m afraid to go on Accutane again in case I go bald or something.

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Propecia (finasteride) is used for the treatment of genetic hair loss, not for loss caused by other medications. I doubt that it will protect against possible hair loss caused by Accutane (isotretinoin).