Month: November 2014

(Since these topic tend to be hot debates, the following was taken from a comment section from a recent post) The statistics posted in this blog entry are not correct. The frequency of ED in men in the 20s is much lower than 20% and it does not increase linearly by 10% every decade. It would be nice because the numbers are convenient, but it just simply isn’t empirically observed.

If you look at the Propecia clinical trials which included men under the age of 40, only about 1% in the placebo had sexual problems of any kind. A lot of hair transplants make the argument that sexual dysfunction is common to minimize the likelihood that sexual problems are caused by Propecia, but this is never backed up by fact mainly because it isn’t true.

It is true that it has not been studied in detail how PDE5 inhibitors will affect men suffering from finasteride related side effects, but many men who develop irreversible side effects also report limited benefit from erectile dysfunction medications. These drugs work for certain types of ED, psychogenic ED included, but it is commonly observed that they are not very helpful for men with post-finasteride-syndrome.

The exact number or statistics on erectile dysfunction (ED) may be of debate since most of these studies are based on self assessment and honestly reporting that they actually have ED. For example, if you wear women’s lingerie, have a small penis, or cheated on your spouse, etc would you honestly answer such personal or embarrassing questions? The answers and its accuracy can vary widely depending on the setting of how the question was asked and even who administered the questions. You can lie just as easily based on the person’s agenda. I use the prevalence of ED numbers more as a generality. You can find evidence on the Internet that may affirm the statistics or disprove it.

As to the persistent side effects of Propecia and post-finasteride syndrome discussed around the web I think it is difficult to confirm. Most of it is “speculation” as noted even by the scientific community that supposedly study the phenomenon. It’s based on self reporting and never clearly back up. You’re basically trusting someone’s word that they cannot have an erection or orgasm.

If you really look into the websites that report these persistent side effects of Propecia/ finasteride, the hidden agenda is a legally motivated.

There are so many other medications (that is used to treat depression and anxiety, such as Zoloft, Lexapro, Xanax, even good old fashion alcohol and marijuana use) that can have a much more profound effect in orgasm, sexual desire, and erections. These are never discussed in the context of Propecia and ED.

I am not dismissing the idea that there may be long term issues with Propecia. It just seem strange that I have not come across someone with these long term side effects in my 23 years of practice.

Can I Go To My Local Hair Transplant Doc for SMP?

Hair transplant doctors do not perform Scalp MicroPigmentation. They usually hire local cosmetic tattoo or tattoo specialist to work for them. As far as I know, only Dr. Pak performs SMP personally using our developed pigment and technique. Several prominent hair transplant doctors have come to have SMP on themselves by Dr. Pak which we take as a great compliment and acknowledgement of our expertise.

SMP is not standardized and everyone use different inks (pigments) and some (bad quality pigments) turn color. The machines and needles used are different. SMP is a simple concept but a difficult skill to perfect and few people learn it well. We see a lot of problems in the community and there is no real place to learn it.

I have invited one of our SMP patients to come to the ISHRS medical meeting two years ago, with 450 hair transplant doctors present. The world expert in the various alopecias was the guest lecturer and when she looked at him, she didn’t believe it until she touched his smooth, bald head with SMP. Her eyes and her fingers told her brain something entirely different (no stubble and only SMP). Over 400 doctors at the meeting did the same thing. My point is that if the person in your community can SHOW you their results in 6 or more patients, then seeing is believing. I would not go to anyone who can not show patients who had it done.

1. Is initial shedding experienced with minoxidil the same as loss due to trauma? That is, does the initial shedding often experienced from a topical solution represent permanent loss (like loss from surgery or medications), or is it simply the start of a new hair cycle, with potentially thicker hairs growing back. Or is this the same as traumatized hair that, once it falls out, regrows weaker and smaller? I ask because I began adding liquid Rogaine on weekends in addition to the foam during the week (it is just too greasy otherwise), and I am hoping that maybe some of the most recent loss might have been caused by the liquid formulation.

Minoxidil is known to cause shedding in the initial use. It is not comparable to trauma. The hair should come back and start reversing from the short term loss within 2 or so months.

2. We discussed formula 82M. So, in addition to 5% minoxidil, it contains retinoic acid, tretinoin, 0.01% topical steroid fluocinolone, and oleanolic acid. I am just curious if you would expect to see any real difference in response to treatment between 82M as opposed to Rogaine. I have not felt any irritation from the 82M upon application, but my scalp has become extremely dry with a tremendous amount of skin flaking (when I wake up in the morning, my pillow looks like it has been sprinkled with confectioner’s sugar). I never had a problem with scalp irritation from either liquid or foam Rogaine. If there is no reason to expect different results from 82M versus regular minoxidil, I do not know that it will be worth using in the long run.

The various acids in the 82M or other similar medications generally cause the scalp irritation, dryness and flaking. The basic theory behind the extra ingredients is to irritate the skin to absorb the minoxidil better.

3. Many doctors promote PRP treatment, and I know you remain fairly skeptical without good clinical evidence, but have you actually seen positive results in any patients anywhere? Is it a hit-or-miss type of treatment, where some people respond and some do not, or is it purely nonsense?

PRP has not shown any value. This came up at the recent international meeting for hair restoration surgeons and after review, it was my conclusion from that meeting (as well as many of the respected doctors who where there) that PRP has little value, if any in the various balding or hair transplant scenarios.

I have not seen positive results or met anyone who claimed positive results.

4. There are no solid studies regarding the effectiveness of LLLT on hair growth. Despite the question of efficacy of LLLT, I wonder if it is still possible to determine which device may be the best choice for the end user. I was considering trying a new laser, if only for better coverage and convenience of use, but is there any reason to think that the hair cap, for example, is any better than other laser products?

I have tried LLLT on patients over the years and I never saw any value and that is my belief. One doctor I respect, told the meeting that of the various devices, the Laser Hair Comb might be the best. I ask the best of what?

Some variation of this question has been posted on this blog before but I would like to ask:

Can hard water indirectly cause hair loss? I am not asking about the effects of hard water on genetic baldness but whether hard water can aggravate scalp conditions in sensitive subjects, thereby accelerating hair loss. I suffer from seborrheic dermatitis and I am noticing more aggressive hair loss when washing with hard water compared to soft (my parents have a water softener).

If so, what do you recommend doing? Is there any benefit to washing with soft water or distilled water? Is this hair loss permanent?

Hard water just means it has higher mineral content in general. It does not cause or accelerate hair loss as far a I am concerned. If you think it is affecting your hair, you can always try soft water. But I personally do not see its benefit with respect to genetic hair loss, more of a washing issue

I read about a compounded minoxidil solution called Formula 82M.

I have been using Minoxidil 5% for more than six years and I think I am losing the battle against baldness. Can the above solution give me much needed reinforcements?

Can you also please suggest any additives to minoxidil that can help in better hair growth?

Genetic hair loss has no cure. Topical minoxidil can help but there no scientific evidence that any additives or reformulations will help. Many compounding pharmacies and entrepreneurs will re-brand and add extra ingredients to promote a product. It works to generate interest and sales but it really has no clinical significance in overall improvement of growing hair. I always have states it is a buyer beware market. They may be no harm in trying different products other than the financial drain.

Reported From Medscape, September 10, 2014: Scientists contradict WHO criticism of e-cigarettes

The benefits that E-cigarettes don’t have the tar and poisons from burning tobacco is the point of the article. E-cigarette-do not pose a “significant health risk”, say the scientists. The risks of nicotine addition is still present and there is legitimate concern that this is a ‘gateway’ drug that might lead to smoking tobacco, especially in children

I am a 30 years old man, I have found that my left widow peak is thinner than my right one, is it normal? Have you ever seen guys with uneven/imbalanced widow peaks of both side?

Second, does thinning on widow peak indicate that the loss of temple hair?

The widow’s peak may disappear as one ages. I wrote a paper on this and published it in a medical journal. The area we call a widow’s peak is centrally located and usually its point touches the highest wrinkle of the furrowed brow. It is never present in very young children, but appears as the frontal hairline migrates to a more mature position as early as 5 years old. It is common in women. One doctor reported that 83% of women over 40, have a windows peak.

The temple peaks seem to have its own genetic pattern that is independent of the classic Norwood balding patterns that impact the frontal area and the top and crown of the head. I have looked at advanced balding patients who retain their temple peak even as all of the hair in the front, top and crown of the head is lost. I do not know if drugs like finasteride can stop the loss of temple or widow’s peaks. Ronald Reagan lost his temple peaks even though he maintained a full head of hair until he died.

No one’s hair is perfectly symmetric, especially when a person is in the process of losing hair from genetic balding. One side’s hair loss might be ahead of the other side, but it will eventually catch up over time.
Widows Peak is not related to temple hair loss.

This is an excellent discussion of how to apply a traditional body tattoo. Posted by Destin at SmarterEveryDay

This is an excellent discussion of how to remove a traditional body tattoo Worth a viewing. Posted by Destin at SmarterEveryDay

Scalp Micropigmentation (SMP) is essentially a specially applied tattoo where a pigment is deposited under your skin. I think that everyone who is going to undergo any tattoo, like Scalp Micropigmentation (SMP) view these videos. The traditional tattoo moves the ink deeper than SMP does so colors can be blended with each other as an illustration is made. With SMP, every “dot” is controlled with regard to depth, time in the wound that is made and the angle of placement. The goal with SMP is to make every dot look like a follicular unit. With the limited volumes used in SMP, the migration of the pigments should be significantly less than with traditional tattoos.

Medscape Medical News, Reducing Sedentary Time May Protect DNA, Laird Harrison, September 04, 2014

“Less time spent sitting may lengthen telomeres and protect DNA from age-related damage” The Telomeres are found at the ends of the chromosomes and as they shorten, it could precipitate “age related damage”. The authors of the study believe that exercise itself, can not offset the negative telomere impact from the long exposure to sitting but it might slow down the shortening. It is normal for telomeres to shorten with age. Ref: September 3 in the British Journal of Sports Medicine. Some naive scientists believe that finding a way to lengthen the telomeres, may be the fountain of youth.

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted. I am curious how you would mange his follow-up care if he was 30, 40, 50, 60 or 70?. Is balding in this particular pattern common in younger or older men? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

 

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old but we commonly see this pattern in men in their 20s and 30s,. The older they are, the more stable is their hair loss. As he is 50, I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants particularly if the balding pattern was really much worse. Many men like this develop crown balding (a Norwood Class 3V pattern) which may require another procedure. For men with only frontal hair loss like this patient (age 50+), I would probably not use Propecia (finasteride) but in men 20-40, that would probably not be my position. By taking Propecia (finasteride 1mg) the hair loss pattern may not progress very fast and is more likely in younger men. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.