Month: May 2015

I was reading about minoxidil and finasteride as I am wanting to start one or the other but am curious about something.

According to the wikipedia article for minoxidil, the reason minoxidil gains are lost when treatment is stopped is that DHT is then able to re-shrink the follicles unimpeded. But if finasteride inhibits or blocks DHT, shouldn’t one be able to keep minoxidil gains longer if they switch to finasteride with a, say, 6 month overlap of the two? Everything I’ve read indicates you lose everything from minoxidil if you ever stop it no matter what.

Despite how many seek information in the Internet, Wikipedia is not always a definitive or correct source of information.
Propecia (finasteride 1mg) and Rogain (topical minoxdil) does not have the same mechanism of action on hair growth. They work in different ways. Both medications will lose effectiveness once you stop using the medication. In other words, you will lose the hairs you gained when you stop the medication. Overlapping the medication or switching from one medication to another does not mean it will sustain the effects of the former medication.

Doctor. I appreciate that you always advise patients to try one product at a time so they know what’s working. And you always advise men to try Propecia first and minoxidil later. Propecia is obviously more effective. But couldn’t it be less effective if minoxidil was started before propecia?
I’m just guessing here but if minoxidil is used first you now have susceptible mph hairs addicted to a less effective medication. The suggestion is minoxidil dependent hairs aren’t protected by Propecia. So you now have a lot of hairs that could been Propecia dependent giving greater and longer protection dependent on much less effective minoxidil and more susceptible to loss. Adding Propecia after affords no protection to those minoxidil dependent hairs. I’ve seen nothing that says hair can be dependent on both. So I would think its always best to getting hairs dependent on Propecia first then starting minoxidil 6 months to a year later. Is my reasoning off here?

You ask an interesting question. The simple answer is that there is no right answer. What medication you choose (Propecia vs Rogaine) is up to the individual and its results may not be a significant issue because the two medication work in different ways (different mechanism of action). The hairs you gained from Rogain may not be the hairs you would have gained from Propecia. I generally suggest that our patients do both, to get the big-bang right up front.

A new meta-study finds the following:

“Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic under detection…”

From Wiki definition: A meta-analysis comprises statistical methods for contrasting and combining results from different studies in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.[1] Meta-analysis can be thought of as “conducting research about previous research.”

The report is interesting but a Meta Analysis is only as good as the clinical trials it is analyzing. All studies have its advantages and pitfalls. If adverse or sexual side effects were being examined, I question why other (much larger and comprehensive clinical trials) of finasteride 5mg was excluded.

During period of two months October – December 2014 I lost 35 pounds, cca 15% of my total weight. I ate mainly vegetables, basically it was starvation and gym. At end of december noticed diffuse hair loss. Immediately normallized my eating pattern, went to dermatologist. Dermatologist ask for hair loss genetics and looked thru microscope. No signs of miniutarization, no vellus hairs and my hair genetics is perfect, no balding in my familly, I am 39 years old. 5 months after, there is no significant hair regrowth, and no further hair loss. What to expect, what will be real time frame for possible hair recovery? After hair loss I lost good amount of chest hair, could easily pull 70-80% of picked chest hairs, now it is ok..

Starvation like a crash diet and extreme work outs do not sound very healthy. It isn’t such a surprise you suffered some unintended consequence such as loss of your hair. I can’t tell you if your hair will grow back. Only time will tell.

A patient who had a surgery yesterday, told me about his experience as he was walking the two blocks to his hotel. His surgery was finished at about 4:00 pm and he was wearing a surgical cap (to cover his FUE and hair transplant surgery) and a doctor’s scrub top (given to all of our patients for surgery). He was approached by two beautiful women who seem to be tourist with Russian accents. They flirted with him and struck up a conversation eventually asking him what type of doctor he was. While he loved the attention and as a single eligible man on the dating scene, he just had a hair transplant procedure and it was not the time to flirt back. He thought “what would be the chance of meeting women like that after his hair grew out wearing a surgical garb?”. We both had a real good laugh.

I am 21 year old male suffering from moderate hair loss. The males from my mothers family are all bald and I share the same blood group hence the problem may be genetic. I have been prescribed anti DHT drugs by my doctor. The dosage will be 4mg per month for 6 months initially. Will the hairfall start again or even increase if I stop the medication after 6 months? Also what dosage causes side effects like difficulty in getting an erection and libido loss? My doctor said my dosage is very mild and wont cause any side effects.

The only oral medication for treatment of male pattern hair loss is Propecia which is finasteride 1mg. I do not know what DHT medication you were prescribed but you should ask your doctor and ask him these questions (directly to your doctor). The only other DHT reducing medication is Avodart (dutasteride) but 4mg is not a standard dose. Too many people think that they are getting a DHT treatment medication with something advertised on the internet or given by unethical doctors. This is a classic story of “Buyer Beware”!

As a physician (who reads medical journal articles regularly) and someone who received scalp micropigmentation (SMP) at your office, I thought your recently published article on SMP in the March issue of The Journal of Clinical and Aesthetic Dermatology was outstanding and very educational. As this article is freely available to the public (without cost) on either the journal web site or (below) through the National Library of Medicine, I thought it would be valuable to mention.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Rassman+pak+2015

After clicking this link, one should go to the button that says “Free PMC Full Text” on the right upper corner to access the full article.

Thank you for the mention. We have other medical journal publications HERE.

LeBron James is probably one of the most well-known athletes in the world. Articles have been written that he is perhaps self-conscious about his hair loss and wears a headband very high on his head in an atypical way to cover his receding temporal hairline. I was watching an NBA playoff game last week and even from my couch (via TV) I could plainly see a bald linear area on the back (right side) of his scalp. I looked at his postgame interview and he clearly has had some hair transplants to his temple areas. My question is: LeBron has worn his
hair in near crewcut fashion since high school. He makes millions of $ yearly and can go to the best surgeons in the world. Why would a strip FUE (as opposed to non-strip FUE) be desirable in someone like him who now has a very visible scar?

It does seem LeBron James had a hair transplant surgery looking at the photos. I cannot say why he would choose a Strip surgery over the FUE surgery. FUE surgery certainly would have spared him of the scar. I do know that curly African American hair is also very difficult for most doctors to perform FUE. Only a select few doctors can successfully perform FUE on curly hair. Even the ARTAS robot cannot predictably perform FUE on kinky hair. For whatever reason why LeBron had the strip surgery, only his doctor can tell you for certain.

Finally, I have found over the years, many celebrities often don’t do their own research or due diligence when choosing a cosmetic procedure. Often times, they are referred to a doctor from a close friend or find doctors via professional/ social connections. This does not mean the doctors are less qualified or not at the top of their profession. It is sometimes “who you know”, not “who is the best” in the decision making process. I find that in most cases the average “Joe” salary man does the best research when choosing the right doctor for their surgery and they have a better sense of the “value” the doctors provide. I am not saying LeBron’s surgeon was not the best, but it is one observation I had from past celebrities and other patients where money was not a factor.

Now, if LeBron ever wants to address his hair transplant scar, Scalp MicroPigmentation would be a great option for him.

I was reading about minoxidil and finasteride as I am wanting to start one or the other but am curious about something.

According to the wikipedia article for minoxidil, the reason minoxidil gains are lost when treatment is stopped is that DHT is then able to re-shrink the follicles unimpeded. But if finasteride inhibits or blocks DHT, shouldn’t one be able to keep minoxidil gains longer if they switch to finasteride with a, say, 6 month overlap of the two? Everything I’ve read indicates you lose everything from minoxidil if you ever stop it no matter what.

Wikipedia is not a substitute for a doctor or definitive information – especially when it comes to personal medical related topics that can impact your health. It is not a substitute for seeing a doctor.

Minoxidile does not have an impact on DHT. We really don’t know the exact mechanism why it works but did observe that new hair was grown on people who used the drug (1960s) when it was used as a treatment for high blood pressure. Once you stop using the medication, what you gained will be lost (despite being on Propecia) because the hair grown on the drug is directly from the drug effects on the skin. Propecia works by blocking the DHT at the hair level and unlike minoxidil will not grow new hair. Propecia may reverse the effect of miniaturization, the start of the balding process in men. If you stop using Propecia once you have been on the drug for awhile, what you gained will be most likely lost. These two medication work in different ways and it doesn’t always have the same efficacy or same effect on the hair. The best of both worlds would be to use both medications and stay on both medications for as long as you are concerned about your hair loss continuing.

Men who use muscle-building supplements (MBSs) that contain creatine or androstenedione may have up to 65% increased risk of developing testicular cancer, according to a case-control study published online March 31 in the British Journal of Cancer. So many of our readers are focus on body building and use these supplements as a way to enhance the benefits of working out. This is a disease that hits many who are just too young.