Author: Dr. William Rassman

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Hair Loss InformationHow Successful Are Transplants for African American Women? – Hair Loss Information – Balding Blog

I am an african american woman with traction alopecia. I have about an inch to inch and a half of traction above my forehead and temples. No traction any where else. I have ample donor supply. My hair is very thick and coily. I recently saw a hair transplant surgeon in San Francisco, that told me i have the donor supply but may not have a successful transplant because of the texture of my hair. The surgeon has showed me pictures of his past work but I was not impressed.

They were pics of african amer men but i saw little improvement. I see pictures and comments on the web that it is possibly for women of my hair texture to have successful transplants. I am not prone to keloids, however, I experience ingrown hairs in my pelvic region. Is there a specialist our Dr or technique that can help me?

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Success of a hair transplant surgery is highly variable with each medical group. It’s not like going to a mechanic, where you can have a tire changed or your oil changed and the end result is pretty much the same. Unfortunately, I don’t have any specialist referral to provide.

Surgery in African American men and women is technically challenging, because each hair (underneath) the skin is curly. In other words, the grafts are curly. That means it is difficult for the technicians to cut and place the grafts. If threading a needle is hard enough, imagine threading a tightly coiled thread through a needle. Many doctors and medical groups for this reason shy away from performing surgery on African American hair or even curly hair. Add this to the fact African American men and women have a greater tendency to develop scarring and keloids. If you’re not prone to keloids, you’re lucky!

Another point to make is that hair transplantation surgery in women generally is not as straight forward as surgery in men, as the results may not be permanent. Men have a permanent donor area, whereas women’s hair loss is more diffuse. You should also know that to fix the balding from traction alopecia, the patient will often need more than one surgery, as the density of transplanted hair may not match the density of the natural hair behind it.

Alas, I am not your surgeon and I am not here to give you a personalize opinion. This information is generalized and you need to understand what is and is not possible. Weigh out the pros and cons of what you are trying to achieve and make an informed and educated decision.

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Hair Loss InformationLactic Acid in the Scalp – Hair Loss Information – Balding Blog

I read the item about hair foliclle damage because of lactic acid secretions on the scalp. Well, I was told the same thing, and given a lotion to neutralize the acid. I can confirm this situation does occur when subject to unpresidented levels of stress. When i say stress, stress at such a level I was physically ill with it, for a long period of time. Halucinations etc

One day I notice that my incredibly thick hair was going fine and curly. Finasteride made no difference, and I was shown hairs from my head, that had no outer sheath on them. Also prior to seeking advice the affected area became hot, itchy and greasy- when i was stressed, and this is where the hair follicles have died.

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Lactic acid is not a cause of hair loss. Whatever you read about lactic acid secretions on the scalp causing hair loss is false. I found some message board that talked about it, but I don’t think it went beyond speculation. It wasn’t mentioned in any medical journal that I could find.

Without knowing what dose or how long you took finasteride, I don’t know that I could agree that it “made no difference”. I don’t know enough information to give you anything beyond generalities, but if you’re balding in a pattern, it’s not stress. Stress could be exacerbating the loss, but it’s ultimately your genetics. I wouldn’t expect a “hot, itchy, and greasy” scalp to be normal from stress, and it’s certainly not normal to have hallucinations, no matter how much the stress. You need to seriously see a doctor.

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Hair Loss InformationIn the News – Canadian Class Action Suit Against Merck – Hair Loss Information – Balding Blog

Snippet from the article:

A class action was filed today in the Supreme Court of British Columbia by Vancouver resident, Michael Miller, against Merck Frosst Canada and its affiliated companies. The lawsuit has been brought on behalf of Canadian men who used Propecia or Proscar and suffered continuing sexual dysfunction.

Propecia and Proscar are prescribed as a cosmetic treatment for male pattern hair loss also known as androgenic alopecia. The product monograph discloses that some men may experience sexual dysfunction but states that the symptoms disappear after cessation of the drug.

Mr. Miller, who is in his early 20s, was concerned when his hair started to thin in some areas. He was prescribed Proscar which he hoped would stop his hair from thinning.

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Canadian lawsuitRead the full story — Class action filed against manufacturer of Propecia & Proscar

If this young man was in his early 20s and prescribed Proscar without being told to cut the pill into a smaller daily dose to treat hair loss, his chances for side effects would’ve increased. Proscar is 5mg finasteride used to treat prostate issues. Propecia is 1mg finasteride used to treat hair loss. So if you’re taking 5x the recommended dose, what would you expect?

We’ll see how this class action suit plays out…

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Hair Loss InformationSide Effects Occur with Many Medications – Hair Loss Information – Balding Blog

Just a quick note about Propecia. I have been on it for 15 years. Never had a single side effect. Well not that I’ve really noticed anyway.

Any time you take a medication you have to realize that there are side effects. One of the side effects to Proscar for instance is that it can STOP YOUR HAIR FROM FALLING OUT!!! Get the idea? Birth control pills also has a ton of side effects but almost every girl I know is on the pill… hmmm…

I’m not saying to run out and buy Proscar but if you do, it’s your choice. There’s nothing wrong with educating yourself before taking something but understand that “side effects” are the reason you’re taking it. This is your hair on drugs… Any questions?

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Good advice. I think if one actually read all the side effect possibilities in common medications that they think are 100% safe, they’d be surprised.

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Hair Loss InformationPropecia and the 15% Risk of Side Effects Myth – Hair Loss Information – Balding Blog

NOTE: The following comes to us from a longtime reader that wishes to remain anonymous. He’s gifted us with some insightful posts in the past about the FDA, LLLT, and clinical trial regulations. His email is as follows:

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The Journal of Sexual Medicine recently published an article that has been the source of several Balding Blog posts, including one that answered a reader who wondered if, “the study suggests up to 15% of men taking the drug might experience some form of sexual dysfunction” in context of “the warning label on Propecia (that) … only 2 percent of men might experience erectile dysfunction while using the drug…”.

As a fan of the Balding Blog and a clinical trialist (someone who interprets clinical trial data), and one who has no relationship to Merck or financial interest in finasteride use, I have reviewed the article:

  • Dr. Rassman has correctly pointed out that this article is not a study per se, but a review of data in the literature from completed and published finasteride studies that included placebo groups.
  • The review included 3 studies of men using finasteride (1 mg daily) for alopecia, 15 studies of men using finasteride (mainly 5 mg daily) for benign prostatic hyperplasia, and 2 for “none” listed as the condition.
  • The 3 studies of men using finasteride for alopecia included a combined total of 1196 men receiving finasteride, and 1035 men receiving placebo.
  • As Dr Rassman has nicely emphasized before, the “true” incidence of an adverse event (attributable to a drug) is the percentage of men who experience a side effect receiving an active drug minus the percentage of men who experience a side effect via placebo. It is important to emphasize that this equation implies no causality (i.e., if a man receiving a drug gets a side effect, it is attributable to his active drug or placebo regardless of other factors – such as diabetes – that may be causally involved).
  • The largest incidence of sexual side effects among the 3 studies involving men with androgenic alopecia is from the smallest study involving only 286 men who received finasteride and were a considerably higher age (41-60 years) than men in the 2 other studies (ages 18-40 years). In older men, factors that contribute to sexual side effects (diabetes, coronary artery disease, and aging) are considerably more frequent. In this small study of 286 men, changes in sex drive were observed (over a period of 1 year of treatment and 1-year of follow-up) in 4.9% receiving finasteride and 4.4% receiving placebo (treatment effect of 0.5%). In the same study, erectile dysfunction was observed in 3.8% of men receiving finasteride and 0.7% of men receiving placebo (treatment effect of 3.1%). In the two larger studies – involving younger men – the incidence of erectile dysfunction was 0.5% (1.4 minus 0.9) in one study, and 0.75% (0.75% minus 0) in the other study.
  • Taken together, these results are consistent with the incidence of sexual side effects noted in the finasteride (Propecia) US product label: decreased sex drive (1.8% finasteride vs. 1.3% placebo) and erectile dysfunction (1.3% vs. 0.7%).
  • The “15%” figure contained in the Balding Blog post by a reader was based in part on the cited (and misleading) newspaper commentary from a business reporter that stated ”…up to 15% of men taking (Propecia) might experience some sort of sexual dysfunction.” Indeed, The Journal of Sexual Medicine article cites a study of 613 men aged 45-80 taking 5 mg finasteride daily for benign prostatic hypertrophy for 2 years. In this study, 15.8% of men receiving finasteride (compared with 6.3% of men receiving placebo) reported erectile dysfunction. This is 5 times the recommended dose for treating hair loss, though. The largest study, involving 2315 men aged 45 years or older (with prostate hypertrophy), showed the next largest effect on erectile dysfunction: 8.1% (finasteride) vs. 3.8% placebo. This latter figure is almost identical to the incidence of erectile dysfunction noted in the finasteride (Proscar) US label.

In summary, one can’t properly mix “apples and oranges” involving clinical trial data involving different doses of drugs with different patient populations and for different indications. The journal article offered no major insights to me but is a nice review of currently published work. To me, a significant issue of side effects is reversibility. Even a minor headache is devastating if due to an active drug and is not reversible.

Despite anecdotes from blogs, I have seen no case histories published in the medical literature of men using finasteride for androgenic alopecia who have developed irreversible erectile dysfunction that has been attributed to use of finasteride. I am not saying that such a phenomenon does not exist; I just have not read any well-documented case history. A newspaper commentary from a business writer that references a blog where a 32-year old man developed erectile dysfunction (“had pretty lousy quality erections otherwise”) of unknown duration 12 years after starting finasteride and who cites “(recent) experiences with a new sexual partner” is not compelling (to me).

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Hair Loss InformationHair Loss Can Be a Positive Thing? – Hair Loss Information – Balding Blog

Dear Dr Rassman
Your blog is a true beacon in the foggy world that is hair loss treatments and remedies. I am a 24 year old man that is currently being treated by a fantastic dermatologist and together we have been able to hold onto my slightly receded hairline using only FDA approved generic drugs (fin and min).

However I would like to tell a story of two important people in my life, both doctors, My father a surgeon and his best friend (my godfather) a general practitioner. In the final year of studying medicine my father worked incredibly hard and was able to secure numerous surgery placements at some top hospitals, his best friend unfortunately feel ill in final year, performed badly and missed many opportunities for work experience and specialist placements. At the same time whilst sick, his wife fell pregnant and by the end of his medical study he was without work, with a child on the way and incredibly concerned about his future well being.

With a great amount of thought and a huge amount of courage he secured a loan and started up his own general practice at the tender age of 25. At the start business was slow as many patients where not comfortable being treated by such a young inexperienced doctor. This situation created a huge amount of stress for my godfather and the high levels of stress paired with poor hair genes lead to rapid hair loss, his hairline and mid-scalp was literally washed down the sink.

However as his hair fell his demeanor and appearance was altered creating the illusion of a much more experienced doctor and it became far easier to market himself and his clinic. Business soon picked up and his financial problems where alleviated. In contrast, my father who has a full had of hair (I get my hair from my mum) struggled for years starting his surgical practice because his full hairline created the illusion of inexperience, which turned off many patients initially.

My point is that hairloss has its positive externalities and as I go into the world of business I am glad that I have a receding hairline as it gives the impression that I actually know what im talking about, even if I don’t. Although I certainly do not want to be bald!

Thanks again Dr Rassman

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Thanks for sharing the story with us. I agree with you on one level, but there is a counter argument to your story. It just depends on how you spin it…

In our society, while we associate bald men with wisdom and age, we tend to favor and look up to men with hair in our choices of leaders. Look at politics and leading men in Hollywood cinema as examples. Of the US Presidents of the past half century, only Eisenhower was bald. It’s rare to see a major movie star with heavy male pattern baldness. There’s always exceptions, but if you consider that balding men reflect 50% of the male population, that should tell you something. And without even looking it up, I’m sure a majority of male CEOs for Fortune 500 companies have decent hairlines, as well. I’m not suggesting it’s right or wrong, but it’s society.

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Hair Loss InformationAfter 3 Months on Propecia, My Hair is Oily – Hair Loss Information – Balding Blog

I am a 24 year old male, and have experienced mild hair loss for the past 2 years or so, mostly in the temple region. However, the rate of hair loss has significantly increased in the last 8 or 9 months, and has expanded to the entire top of the head. The front is now very thin, and my scalp is plainly visible all over when the hair is wet. I began taking Propecia 3 months ago, and have not noticed any slowdown in the rate of hairloss. What I have noticed recently, is that my hair has become very oily (it has never been very oily before), and mild acne is beginning to form at the hairline.

So my two questions are:
1) Is the increased rate of hair loss, and sudden expanded hair loss region normal?
2) Is the oily hair and/or acne side effect of Propecia? Normal symptoms of hair loss? Or something else?

Thanks a lot for your great blog!

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These are questions for your doctor. Remember, you’re asking about a prescription medication. You should pose questions about this sort of thing with your prescribing doctor.

In my experience, what you are reporting for the first three months with regard to seeing a benefit on Propecia is usual as it takes almost a year to see value. With regard to the oily nature that you are reporting, I have not seen this reported by my patients.

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Hair Loss InformationDoctors Sharing Information About ACell – Hair Loss Information – Balding Blog

Hi Dr.,

I applaud your participation in the ACell study. I do wish to quickly ask why you have not contacted either Dr. Cooley or Dr. Hitzig about the specifics of ACell? Dr. Hitzig is adamant upon the fact that if Dr’s do not contact him about how to use this, then each Dr.’s study will most assuredly fail. As a result, Dr’s will prematurely claim the study a failure and disregard it as a major achievement in the fight against hair loss. I am pleading with you to contact either of the Dr’s to understand the specifics of this study. Please don’t let this opportunity pass you by.

Please check this thread out where Dr. Hitzig specifically talks about this: BaldTruth.com

All my best

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We had extensive discussions with Dr. Cooley. I like sharing, and doctors who share information are ethical doctors. I do not mean to ignore Dr. Hitzig, but Dr. Cooley answered our questions to our satisfaction.

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Hair Loss InformationIncreasing Propecia Dose – Should I Take Half Early and Half Late in the Day? – Hair Loss Information – Balding Blog

Great information given by you and your staff. I know sometimes patients have been put on a higher dosage of propecia after years of being on the medication due to loss of effectiveness. If you were to go from a quarter pill to half a pill would it be better to take two quaters at different times throughout the day due to propecia’s short half life.

thanks

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First of all, I’m assuming when you say you take a quarter pill, you’re talking about the 5mg Proscar… not a quarter of the 1mg Propecia.

Secondly, you must understand Propecia doesn’t actually lose effectiveness over the years, but rather you’re losing the battle as your genetic predisposition is showing through. It’s the classic game of tug-of-war. You cannot cheat genes. Now there are a few patients who do elect to take an increased dose of finasteride, but I often find that this is hit and miss as for additional benefits.

As for your question on dividing the dose to twice a day, I would think it would make better scientific sense to take it all at once, especially since you would want (in theory) a higher concentration in your body. If you break it down to twice a day, you will lose the advantage of the higher potency (all assuming this is going to work). If you take it in the morning, your testosterone level is highest, so it just might be more effective.

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Hair Loss InformationMy Beard Hairs Fuse Together – Hair Loss Information – Balding Blog

Hello,

Some of the individual hairs on my beard get really thick and seem to fuse together with other hairs. These hairs are clearly visible upon close examination of my stubble, at least to me … I hunt these bizarre hairs like wild game then extract the bounty, mercilessly, with a shiny pair of unforgiving tweezers. If I rub the follicular carcass between my powerful digits, individual hairs separate from the seemingly single, thick, shaft. Moreover, when I pluck these wild beasts, there is no pain, whatsoever – they submit to my attack and exit the follicle, without fight or protest. If I pull a regular beard hair out, it screams in protest and fights ’till the bitter, painful end.

Are you familiar with the hairs I’m describing? If so, what’s going on?

I’m a 32 year-old male and I’ve been on Finasteride for almost three years. I break a 5mg pill into four pieces. I take one piece in the morning and one piece at night so I always have some in my system.

Thank you very much.

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You’re taking 2.5mg of finasteride daily after only 3 years? That’s higher than the recommended dose for treating hair loss, but hey, if it works for you and your prescribing physician is fine with it, more power to you.

Some hairs grow out in 2’s or 3’s. It can be normal to see those on your beard, chest, or pubic area. You’re probably not seeing your facial hairs become symbiotic, attacking each other in a fight to death. Give your hairs some “mercy”.

By the sound of what you describe, you seem like someone who battles not only with hair loss, but perhaps an obsessive compulsive disorder. I will give you points for a highly creative email, though.