Month: January 2023

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Why Are BPH Patients Prescribed 5mg Finasteride if 1mg Suppresses the Same Amount of DHT?

I’m considering upping my dose of finasteride. When I began taking it 18 years ago I took the full 5mg daily. About 6 years ago I started taking 1mg Propecia, and I feel it has not maintained my hair as well.

Now, I’ve read the argument, and seen the graph explaining that finasteride suppresses DHT at a rate that platoes at about ~70% DHT for 1mg to 5mg. So the suppression rate of DHT is no better for 5mg of finasteride than for 1 mg. My question is this, if the amount of DHT suppressed by 1mg – 5mg finasterde is virtually the same, why BPH patients proscribed 5mg instead of 1 mg? If purpose of the medication is to reduce the amount of DHT wouldn’t 1 mg be as effective in the treatment of BPH, if dosages of 1mg – 5mg produce the same effect on DHT concentration?

For this reason I’m skeptical of doctors who say that increasing my dose of finasteride won’t produce better results (as I believe I’ve had before). Can you tell me where my reasoning is wrong?

Thanks a lot.

When drug doses are assessed, they are tested against large, statistically valid populations who have symptoms. The effectiveness of a drug is determined by balancing the safety of the drug.

In the case of finasteride, huge populations of balding men were given graded doses from as small as 0.25mg to as large as 5mg, and the researchers looked for what dose produced the best response with the least side effects.

For balding, although the drug worked well in ranges of 1-5mg, the 1mg dose produced essentially the same results as the 5mg dose with the least side effect. The same approach was done for those with benign prostatic hyperplasia (BPH) and the conclusions were that the 5mg dose was the most effective dose for that disease.


2013-06-17 10:16:53Why Are BPH Patients Prescribed 5mg Finasteride if 1mg Suppresses the Same Amount of DHT?

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Why Are Bald Spots Appearing Randomly In My Beard?

I want t know why I have random bald spots on my face. I always had a healthy beard, and for the past two or three months the areas have increased not dereased. What is possibly causing this, and how can I fix the problem? I miss my beard.

There are many things that can cause hair loss like you describe, including ringworm (a fungus), alopecia areata (an autoimmune disease), etc. See a good dermatologist for a diagnosis.


2008-12-22 12:23:17Why Are Bald Spots Appearing Randomly In My Beard?

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Why am I still balding with a low Testosterone?

When you have genetic balding, the genetically impacted hairs respond to DHT, is a byproduct of testosterone metabolism. Even a low Testosterone will still be converted by the liver into systemic DHT and working in combination with your genetics, you get the hair loss effect.
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Why am I shedding 7 months into Treatment?

So I’m 6 months into my finasteride 1mg a day and minoxidil 5% twice daily treatment. The first few months were good, I had an initial shedding period that I expected and then the shedding stopped. However now it’s starting to shed more and it’s begun to have me concerned

Hair loss is a progressive process and just because you are now treating it and it worked for 6 months, it doesn’t mean that the hair loss just will not accelerate while you are on treatment. Speak with your hair doctor about it.

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Why Am I Losing My Eyebrows and Eyelashes?

Hello,
Can Androgenic Miniaturization occur in the eyebrows and eyelashes. I hear many reports that hair loss in these areas must be something else. I have exhausted all other possibilities; hormone checks, diet, fitness training, you name it. The hairs fell out in unison and the ones that grew back grew in thin and fragile. Could you tell me if Telogen Effluvium can present with the loss if thick hairs being replaced with thin (shaft diameter) slow growing hairs

I don’t know much about you and I obviously cannot diagnose your condition, but telogen effluvium can causes eyebrow loss in some cases. Some people just lose the outer 1/3 of their eyebrows as they age. If you have exhausted all possibilities and ruled out all medical issues, eyebrow hair transplantation may be an option. Have you seen a doctor?

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Why Am I Losing My Eyebrow Hair?

Dear Doctor,
I am losing my eyebrows hair (23-male).

  1. Can dandruff be a reason for it?
  2. Do you always recommend scalp hair for translpanting to eyebrows? Can chest hair be used? Or armpit hair?
  3. I have always heard about scarring at donor site. Are there scars or marks at recipient site ever?

Thank You very much indeed.

There are many reasons for eyebrow hair loss, including hypothyroidism, plucking, trichotillomania, psoriasis with scratching, dermatitis, infection, any inflammation process, and a series of autoimmune problems including alopecia areata/totalis. Using hair at the occipital area to transplant by single strands to the eyebrow areas is the best way to do it.

  1. Dandruff is not the cause for it.
  2. Experience with other body hair (armpit, chest hair, leg hair) is not well documented and must be looked at as experimental at this stage.
  3. I have never seen scars in the recipient area.


2006-03-14 14:33:26Why Am I Losing My Eyebrow Hair?

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Why Am I Losing Hair At Only 17?

Dear Dr. Rassman,

I am a 17-year-old male that is experiencing moderate hairloss. I’ve had this problem since I was a pre-teen have gone throughout highschool with this embarrassing feature, as it has increasingly gotten more and more noticeable. The problem is I don’t know why or how this happen as the hair loss take on no typical male pattern hair loss pattern and is thin throughout my entire scalp. I’ve been to a doctor and a dermatologist and all they did was prescribe rogaine and propecia. I’ve tried rogaine for a series of months with no results and propecia’s outside of my budget. Can you please give any clue as to why this is happening to me at such a young age and how i can treat it. I have no medical conditions.

thankyou for your time.

There are many causes of thinning. These can include changes in your hair character itself, something that happens as a person matures. I have seen young men with a coarse hair character change to a finer hair. If this is your situation, then this is the new you. Of course, the first thing you must do is get a diagnosis. Genetic balding, the most common cause of hair loss in men, can easily be diagnosed with a process I call mapping our your hair for miniaturization (which most regular readers know that I mention quite a bit). Even without patterns of hair loss, miniaturization does occur in a variety of medical conditions. I never tell people to go at this blindly. Get your diagnosis first, then go from there figuring out how you might deal with the problem, that is, if there is really a problem there.


2006-07-12 22:57:10Why Am I Losing Hair At Only 17?

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Why Am I Losing Hair Around My Belly?

ive had steady hair loss around my belly button hair area for about 2 years now, it just keeps getting thinner & continues on a steady pace. i dont care all that much about losing hair in that area, but my concern is the reason for it & will it spread to other areas? is this normal? thank you

Often the belly is an area that is rubbed by belts or articles of clothing. These can cause traction alopecia. Have you gained weight and increased your belly size?


2010-01-19 09:37:33Why Am I Losing Hair Around My Belly?

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Why All the Negative Doctor Posts Without Stating Their Names?

Dr. Rassman. I have noticed that you have a fair amount of threads about bad transplant surgeons such as this one here, but you never say the doctor’s name. What is the point in posting this unless you mention the Doctor’s name so patients in the future will stay clear of this doctor and others? Without mentioning the doctor’s name, other patients will be subject to his horrible results.

CrookI would love to mention the doctors’ names, but that would almost certainly bring me into court, something that I do not wish to spend my life doing (it might bring me to the brink of financial ruin with large lawyer fees just to prove what I said). I get angry when I see the mess created by many of these doctors, but alas, you must use the information in ways to become a knowledgeable buyer, so I use this blog to call people’s attention to what they need to look for when engaging a doctor’s service for a hair transplant.

In 1994, at a medical meeting that easily had 400 physician in the audience, I rose to the microphone and openly referred to the sleaze in this business, with doctors low balling patients and deforming them without telling them the risks to hair transplantation (giving them proper informed consent). The surgical results before 1994 were often deforming and pluggy. These, in hindsight, were very substandard when compared to today’s artfully performed hair transplants. Many doctors would not enter the business to perform hair transplants because of the deforming nature of the surgery at that time. One doctor, in particular, was my target and when I exemplified this sleazy, dishonest doctor without mentioning his name (I called him a “crook” in the true sense of the word), the audience responded with a standing ovation for my being so outspoken, echoing my message. At the end of the session, I was surrounded by many doctors congratulating me on my outspoken comment. One doctor (the one whose name was never mentioned) waited for the crowd to clear and approached me with great anger, saying that he did not appreciate my calling him a crook. As I never mentioned his name, I said “If the shoe fits, wear it” and walked away.

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Why All The Fuss About the LaserComb?

Why all the fuss on your site about the Hairmax Lasercomb? You constantly remind your readers that it’s a buyers beware market, and with all the garbage cures out there, I assumed you would be supportive of a company that went to the trouble of getting FDA approval (no easy task)for their treatment, and offers a money back guarantee after using their product for 5 months.

Why do you approve of Merck’s FDA approval for Propecia but not Lexington International’s for the Lasercomb? Was Merck’s research better or more independent? And if yes, how so??

As a side not, you said you offer laser treatment in your office free of charge to your patients. Why do you do this if you dont believe in the treatment?

As I understand it, the LaserComb was not approved for effectiveness, but was approved based on a predicate device which they showed was similar. The Merck studies are extensive drug studies, which show statistical value in hair growth and hair retention. You can review the Merck data, which is all over the internet.

You are right, the only thing you can lose is the few hundred dollars you pay for the laser comb and assuming that the company will be around to refund your money, there appears to be no down side other than to delay proper diagnosis and treatment in some patients. All of the fuss you are talking about reflects:

  1. Many doctors feel it is a scam
  2. Many doctors wish they had a piece of the pie, as it may make many millions for those who put the product together — so it is $$$ envy behind the fuss

I, for one, have my integrity and will not put it up for sale, so I am free to express my opinions when I feel that the product offering may be misleading the public.