Month: January 2023

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Does Stress Aggravate Hair Loss by Elevating DHT?

Doctor,
I am turning 23 years old in May. I have noticed that I have been thinning on the back of my head around the vertex. The thinning seemed to have started this summer. After slightly noticing it, I asked my barber if he had noticed anything. He said that it has been relatively the same for the past 5 years that he has been cutting my hair. I have been monitoring the situation and noticed that it has thinned out a little bit more. Today when I got my hair cut, my barber said it seems to be thinning now. It is visible to me that I am most definitely thinning at the vertex especially after cutting it a bit shorter around that area. I have just entered pharmacy school and I am afraid that with stress elevated levels of DHT can affect my hair.

My question to you is, first, does stress aggravate hair loss by elevating DHT? Second, I would like to take Finisteride 5mg and cut it up into 4 pieces. That extra bit of Finisteride, is that ok? Lastly, should I use Minoxidil? My beef with that medication is that it is a vasodilator and I am afraid that I would have to use it forever, I would rather take Finisteride forever (or until I decide I just do not care). My hair loss is not noticeable; it looks like it is simply the separation of my hair. However, I know my own hair density. I believe Finisteride should be enough to at best stop any further thinning. Also, I can provide you with pictures if that would help. Thank you for your time and have a wonderful weekend.

I would doubt that stress is elevating DHT levels. Men with hair loss and thinning at the top/crown are mostly likely to have genetic male pattern baldness. Yes, DHT is one of the factors, but your genes are ultimately to blame. Chances are, the loss you’re seeing is coincidental to your entering pharmacy school.

If you cut a 5mg finasteride tablet into 4 pieces, that’s 1.25mg per day (if you get the pill cut perfectly)… and that’s ok. Ideally, cutting the 5mg pill into 5 pieces would be best, but getting 5 equal pieces would be extremely difficult. Using minoxidil with the finasteride is up to you. Some patients like both medications, but it could feel like a daily chore that you need to keep up with.


2010-05-06 11:33:45Does Stress Aggravate Hair Loss by Elevating DHT?

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Does Spironolactone Cause More Hair Loss?

Hello Doctor Rassman,
Does spironolactone cause more hair loss? I seen a lot of people on the internet that claims propecia make their hair worse and others says that this is reflex hyperandrogeincity and their argument was “when DHT lessened testosterone increased alot and cause more hair loss!” but what about Sprio? I heard it decreased testosterone itself and also block androgen receptor, so how it could cause more hair loss?

I’ve always said the Internet is a great source for information, but not everything you read on the web is factual and true. If you want to treat your hair loss with a medication, you need to speak with a doctor. Anecdotal statements or claims found online will mostly mislead or confuse people.

Spironolactone does have theoretical anti-androgen factors, but clinically I have not seen or found credible evidence that it helps with androgenic alopecia. But I do understand that there are patients and doctors who use it as a treatment option. I do not.

Propecia (finasteride) does treat androgenic alopecia. It is not meant to cause hair loss. It is meant to grow hair. I understand there may be controversy on the Internet of Propecia’s side effects and some patients have strong feelings regarding those side effects. My opinion is that each and every individual talk with their doctor and discuss the side effects and understand the risks and benefits. In my practice, many patients use Propecia… and have been using it for over 10 years with no issues.

We can all sit on our ivory tower and debate the biochemical relevance of drugs and mechanisms, but in the end the results (hair growth) is what matters.

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Does smoking increase complications of hair transplants?

In a 2009 article written by Dr. David Perez-Meza reflecting upon Dr. Tony Mangubat’s two cases of problems following a hair transplant, the connection between smoking and complications from a hair transplant or any plastic surgery to the face, is significant (see attached article below).

Still a other article mirrors these claims: J Surg Res. 2009 Apr;152(2):224-30. doi: 10.1016/j.jss.2008.02.066. Epub 2008 Mar 31 concluding that: “Nicotine has a limited vasoactive effect in the skin and subcutis unlikely to be explained by smoking, which distinctly decreases tissue blood flow, oxygen tension, and aerobe metabolism independent of smoking status“.

This does not negate the effects of smoking just the direct connection between the causes seen and the presence of nicotine suggesting other causes in the cigarette smoke produce problems in wound healing.


2019-10-11 13:15:08Does smoking increase complications of hair transplants?

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Does Sleeping On Your Side Make a Difference to Your Hair Loss?

Dr. Rassman,

Does running your hand through your hair have any effect on the rate of hair loss? I have a habit of running my hand through my hair frequently (possibly 50 times) each day, and being a 20 year old male with my genetics against me, I am beginning to wonder if this may be encouraging hair loss to occur (although no loss, other than slight recessions, is visible yet).

Also, when sleeping, does it matter whether I sleep on the crown of my head verses the side of my head? Specifically, does sleeping on the crown help to encourage hair loss in the crown area (eg. the bald spot), and should I attempt to sleep on my side more often, or does it not matter whatsoever? Once again, no hair loss is visible in my crown as of yet, other than the small spot I was born with.

Thank you!

There is no real risk to running your fingers through your hair, unless you are pulling on your hair. Running your fingers through your hair is not causing your hairline to recede, I can tell you that much. Sleeping positions do not impact hair loss.


2008-11-17 09:09:50Does Sleeping On Your Side Make a Difference to Your Hair Loss?

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Does shampoo cause hair loss?

“Normally, between 40 and 100 hairs are shed daily on a non- shampoo day; twice as many are shed on days when the hair is shampooed.” Does that mean we shouldn’t shampoo?

Hair that is shed is not coming out because you shampoo your hair, it comes out because it is either going through its normal telogen cycle or you are losing it from miniaturization or genetic factors. Not shampooing your hair will make no difference in your overall hair volume or hair density across the scalp. Brushing it roughly will pull out miniaturized hairs so I generally tell men with hair loss to use a wide toothed comb

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Does Sexual Arousal Increase DHT?

This isn’t another “does mastrubation cause baldness?” question but it is related. Many people seem to think that mastrubation increases testosterone which increases dht levels but does simple sexual arousion cause a rise in testosterone levels too? If I am sexually aroused, and find myself with an erection, is that enough to influence dht levels or is it ejaculation of semen that is the prime testosterone booster?

I guess this is another way to answer the same issue. Masturbation, erections, sexual arousal, ejaculation, etc do not cause hair loss. Your genetics are the cause of male pattern balding.

I’m not trying to be rude here, but I get this question many times a week and have answered it dozens of times already. And every time I write about it, I get emails from guys that disagree and tell me tales of going celibate with all of their hair regrowing on their previously balding scalp. I don’t buy it. If that was the cure to balding, I think the world would look very different.

If you believe masturbating or sexual arousal can lead to hair loss, then feel free to leave your genitals alone and stay away from anything or anyone that might sexually excite you. If you see your balding continue, you could probably find something else to blame it on.


2012-05-10 11:19:12Does Sexual Arousal Increase DHT?

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Does Sex Cause the Body To Produce More DHT?

Hello, i know that finasteride avoids the productions of dht by methods i cant explain with my bad english. The fact is that the DHT is needed for the erectile functions of the penis. How can i think that sex/masturbation dont make the body to produce more DHT to have reserves?

If that logic holds true, then all the bald men of the world must be sex addicts or rampant masturbators. Please excuse my humor, but your assumptions are erroneous. Increased DHT does not lead to erectile dysfunction. And increased sex or masturbation does not cause hair loss. Have fun!

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Does Sebum Cause Hair Loss In Any Case?

what do you make of this theory? is it possible that there could be any truth (or even half truth) to it?

www.againstalopeciaandbaldness.com

The site you linked to doesn’t offer much besides unproven theories presented by an unknown author. It doesn’t look like the site has even been updated in almost a decade.

There has always been talk that sebum is the cause of hair loss, but sebum is the normal exudate from the glands on the hair follicle and when produced, it is completely normal. Now with that said, we see many people who are concerned about hair loss or just poor hair and when looking for something to blame, sebum always seems to come up. Sorry, folks — sebum does not cause hair loss.

Also, to perpetuate this old wives’ tale, you will always find some business that makes money helping you clean your hair better so that the “evil” sebum does not do its damage. Everyone needs to make a living, so I guess the sebum cleaners have been around for as long as people have focused on their hair problems and are willing to give up their hard earned money.


2012-05-13 11:54:10Does Sebum Cause Hair Loss In Any Case?

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Does Seborrheic Dermatitis Rule Out a Hair Transplant?

I have been on propecia due to MPB for about 2 1/2 months. In addition, I also have seborrheic dermatitis. I believe I am going through a shed however I can’t be sure as my seborrheic dermatitis has flaired up over the last month so I cannot totally tell which my accelerated hair loss is from. My questions are:

  1. When you shed from propecia, does shedding also occur in the hairline? If so, does this hair grow back?
  2. Hair lost due to the seborrheic dermatitis, does it regrow? I haven’t been scratching or picking at it, but hair has fallen out of parts of my scalp affected by it.
  3. Does having this condition make you a bad candidate for a hair transplant?

Thank you very much

  1. When you lose hair at the hairline, the hairs rarely grow back (even if you take Propecia). Propecia mainly slows down the shedding process.
  2. Seborrheic dermatitis is a skin condition, not a hair condition, so it shouldn’t cause hair loss. However, it might accelerate underlying MPB or you could be seeing loss if you are picking at your hair. Picking at seborrhea can produce traction alopecia, which can be permanent.
  3. I have performed hair transplant surgery on many patients with seborrheic dermatitis and there is no issue. Sometimes if it is severe, I will use a short course of topical steroids to calm it down.