Author: Dr. William Rassman

Posted on

Doctor Believes DHT Is Produced by Estrogen? – Hair Loss Information – Balding Blog

Dr. Rassman & associates,
What is your professional, unbiased, opinion and/or facts, as to the use of a DIM product, such as Myomin from Dr. Chi, which definitely is a known estrogen metabolizer in addition to a known aromatase inhibitor.

Dr. Wong had stated that he believes DHT is produced by excess estrogens, most notably the bad ones, as in Estradiol, in males, and further that DHT is not directly produced by testosterone but by these bad excess estrogens? Myomin and/or DIM is said to metabolize these bad estrogens and act as an aromatase inhibitor?

thanks

Block Quote

One wayTo put it politely, I think this Dr. Wong needs to go back and review college biochemistry if he really believes DHT is produced by excess estrogen. There are no such thing as bad estrogens, etc. DHT is NOT a byproduct of estogen or estrodiol. DHT is a byproduct of testosterone as it is metabolized. If you do not have your testicles, you will not produce enough DHT to cause balding.

It is a much more complicated process (see this chart), but here is an analogy that hopefully won’t make things too confusing:

Think of it as a one way street with a fork in the road. If you start with testosterone, you have the option of (a) going down the path of DHT or (b) going down the path of estradiol. Now it is a one way street, so you can not backtrack and go back from estradiol to testosterone to DHT. However, if there is a block in the road to estradiol, you can theoretically get a back-up in traffic and have a slight increase in testosterone, thus traffic is forced to go down the DHT pathway. Similarly, if you block the road to DHT (with finasteride) you can get a back-up and have more testosterone go down the estradiol pathway. There are other pathways, but we can ignore them for now for the sake of simplicity (if you’re not lost yet… keep up with me just a bit longer).


Now, aromatase inhibitors will do just that and block testosterone from forming into estradiol, the way finasteride blocks testosterone from forming into DHT. Thus in effect aromatase inhibitors will (theoretically) back-up traffic to divert more testosterone to go down the path of producing more DHT. In short, aromatase inhibitors can cause more DHT production (again, theoretically), which can cause more hair loss! In fact, I saw a female patient in my office not too long ago who was taking an aromatase inhibitor for her breast cancer treatment and she had what appeared to be androgenic alopecia.

Biochemistry is more complicated than this, especially when it is related to actual human beings. Theoretical things do not always work out in real clinical scenarios, but I believe that aromatase inhibitors can in theory make your androgenic alopecia worse! As for Myomin and DIM, both are herbal supplements that I’m honestly not too familiar with and don’t know enough about the claims attributed to each… but for those curious, this page has a lot of info.

Posted on

Does Finasteride Make Things Worse If I Stop It? – Hair Loss Information – Balding Blog

Dear Drs,

I’m concerned about the rebound effect of stopping finasteride.

I was having a look at some website, I should stop searching about hair loss as I’ve become so lost, but one website had a comment which gave me some concerns. This is what they had to say about finasteride. Basically it means that whoever takes it and then stops it, will be in a worse situation than if he never took finasteride in the first place. Is that true? If I take it for a year or few years, then decide to stop, would hair shed as it would have naturally or is there be a rebound effect where I would go balder than if I never used finasteride?

Thanks a lot

Block Quote

The internet is a great resource, but it does not always mean it has accurate information… and as you have found out, it can be very confusing.

What you are describing is “catch-up” hair loss from stopping Propecia. In brief, if you stop taking Propecia after months or years of use, you will lose any benefits you saw and go back to what your hair loss “would have been” if you never took it in the first place. So if you never took the medication and were destined to be a Norwood Class 5, then you’ll see a Class 5 hair loss pattern emerge. This does not mean you will be worse off than if you never took it.

Posted on

Reader Warning About Switching from Propecia to Avodart – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

This is a story, not a question, but I thought you might want to put it on your site because you often talk about the unproven effects of Avodart and why you don’t prescribe it. I had a very bad experience with Avodart and wanted to put it out there where people would be able to read about it.

I took Propecia for 3 years, then switched to Avodart (at my doctor’s suggestion) because I was still experiencing some hair loss (possibly due to stress at the time). I took Avodart for about 6 months, but I developed almost total impotence during that period. I told my doctor that I wanted to go off Avodart entirely, but instead he prescribed Viagra and told me to just switch to a 1/2 dosage as “I would lose a lot of hair if I switched back to Propecia from Avodart.” However, I was still experiencing impotence after 4 months on a 1/2 dose of Avodart, though, so at this time I became so frustrated that I ignored my doctor’s advice, stopped seeing that doctor, and switched to Propecia.

Over the next 8 months I lost a *lot* of hair — substantially more than I’d ever lost before. I don’t know for sure, but I assume that it was because of the increased testosterone flowing in my body in reaction to the Avodart, and the Propecia being unable to counteract it. My sexual function has been restored, though.

Obviously I probably acted rashly and made a mistake ignoring my doctor’s advice about quitting Avodart, but I feel that Avodart put me in an unbearable Catch-22 situation: either endure partial impotence for the rest of my life (or pay for Viagra, which I felt I shouldn’t be taking as a 32-year-old man), or switch off Avodart and lose a lot of hair. I realize that many people take Avodart without any side effects, but it was a really depressing situation to be “one of the 5%.” I’d advise anyone out there who is considering Avodart to think twice and be ready for potentially devastating side effects.

Block Quote

Thank you for sharing your story. Sex vs hair… it’s a tough choice for some men!

Granted, many men that take Avodart (dutasteride) likely won’t see the severe effects like you saw, but until the medication and its risks are fully studied I can do not advocate the use of Avodart in my practice. It’s hard enough the dispel the distrust of Propecia’s side effects, and that is a medication with known side effect risks.

Posted on

Minoxidil 7% Irritated Me After 10 Months of Use – Hair Loss Information – Balding Blog

I have used minoxidil7% (2mL/day)and finasteride for 13 months with good results, including a period of shedding 10 months in. Then, suddenly, I felt burning on my scalp so discontinued minoxidil. I returned to the minoxidil after 2 months but can tolerate only 0.5mL/day). I have been back on for 3 weeks. In that time I have noticed a loss of density.

My questions are:

1. might 5% minoxidil be right for me?
2. is 0.5mL minox 7% likely to be ineffective?
3. could this recent loss of density be due to resuming the minoxidil, albeit at a reduced level of application?

Many and sincere thanks for your time and expertise.

Block Quote

Really, the only way you can know if 5% minoxidil is right for you is by trying it. Generally, I do recommend the 5% minoxidil if you want to use a topical. Higher percentage is not necessarily better, as you’ve found with the irritated scalp. Are you applying it twice daily, as recommended? As for the hair loss you’re seeing, it could be due to using only 1/4 of what you previously used, but there’s really no way for me to tell.

Posted on

Hair Loss InformationAvoid the Scam – Hair Transplants That Do Not Grow – Hair Loss Information – Balding Blog

Scam AlertI’m often outspoken about the problems with ethics in our industry, and I know I just wrote about transplant failures a couple months ago… but I continue to see a large number of patients who are unsatisfied with the growth after their hair transplants. Part of me really hates writing these types of posts, because I just know I am turning some people off to the idea of surgery altogether. But really, these posts should serve as a way to educate yourselves. Transplant failure is a problem that can not be denied and an increasing number who received surgery from various doctors all over the world are visiting my office to ask for help as to why they aren’t seeing the growth they were promised. I’ve even received emails about the same issue. Although there are a number of reasons why a transplant could fail, it seems that these failures are mostly technical in nature and related to the hair transplant staff. In other words, the problem is avoidable.

So how does one avoid losing donor hair or paying for grafts that aren’t going to grow? Finding a surgeon with a staff that knows what they’re doing is a good start. An experienced staff is hard to hire, and I have been training my own technicians for years. The drop-out rate from training is high, but for those that we retained, the high quality of our work reflects the quality of our staff. I know what I am about to say is self-serving, but I do very limited promotion here and wanted to point out that we have a travel reimbursement program which offsets the cost of travel and hotel for those patients coming from out-of town. With our standby rates, it is hard to compete with the value NHI offers and in 8 months, few worry about what actually grew out.

Posted on

My Hair Falls Out with Skin Attached! – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

I’ve noticed that sometimes, when my hair falls off, it’s not just simply the hairs. Sometimes I see dry bits of skin that look sort of like the image you have on your website showing the FUE method (only instead of looking fresh and fleshy, it looks dried up): Photo

I’ve actually had this happening for a while now, and I am balding, so I was wondering whether this has anything to do with it. That I can see, most of my hairs are fairly thick (they don’t look like they’re literally thinning), but there’s just a lot of space in between the hairs.

Is this a normal MPB thing, or do I have something else going on?

Block Quote

The photo you referenced (at right) are dissected follicular units of 1, 2, 3, and 4-hair grafts used in transplantation. I highly doubt you are able to see a follicular unit fall out naturally from your scalp.

Now I don’t know exactly what you’re seeing, but if I had to guess, I think you’re noticing a small white material that is attached to the ends of the hair. This is sometimes referred to as sebum or a waxy substance that your hair naturally produces (see here for more on that). That isn’t skin with the hair and it isn’t anything to worry about, but if you’re still concerned about this condition please see your doctor.

Posted on

Hair Loss from Stress and Lack of Sleep? – Hair Loss Information – Balding Blog

SleepIf you have lost hair due to a prolonged periode of lack of sleep and stress, can you regrow some if not all of the hair you lost if you can manage to correct your sleeping patterns. Thanks

Block Quote

I’d assume you would be able to regrow some hair if you knew for sure that the loss was stress/sleep related, but it can take up to one year. If the timing of your hair loss was coincidental (meaning you had genetic hair loss, but you had a period of stress at the same time) that genetic loss won’t regrow on its own. In the meantime, get some sleep!

Posted on

Susceptibility to Traction Alopecia? – Hair Loss Information – Balding Blog

My question is: If you already have a predisposition for balding, would you be more susceptible to other balding factors as well? i.e; traction alopecia, or something else that may lead to hair loss?

Thank you

Block Quote

I think you are confused about balding issues. Male pattern baldness (MPB) is genetic to that particular trait.

Traction alopecia is hair loss from pulling on your hair. It has nothing to do with MPB and many people (usually with a tight braids hairstyle) will see traction loss without any other patterned genetic balding. In other words, you are not susceptible to traction alopecia if you have male pattern baldness. So the short answer to your question is “no”.

Posted on

Acid Reflux, Diet, and Propecia – Hair Loss Information – Balding Blog

Dear doc, i have been using Propecia since one month. I have not experienced any sides yet. I would appreciate if you could clarify my following doubts.

  1. If a person has acidity, does it make Propecia ineffective?
  2. During my first week of Propecia use, my hair loss completely stopped, but on my third week, i started noticing a mild hair fall. Is it common?
  3. Is there any particular diet i should follow on Propecia use?
  4. I take egg whites and whey protein (optimum nutrition 100% whey protein) as i heard that these foods could raise testosterone levels, should i discontinue taking these foods?

Please reply me.

Block Quote

Eggs

  1. I will assume your meaning of “acidity” is referring to acid reflux, because a normal live human being is not acidic. In any case, it has nothing to do with Propecia.
  2. While you might be enthusiastic about Propecia stopping hair loss in one week, I highly doubt the medication worked that fast. It takes a few months before you see any results.
  3. There is no particular diet you should follow with Propecia. Just stick with a healthy, balanced diet as you should have regardless of the hair medication you take.
  4. I assume you’re taking these because you’re trying to gain muscle mass, as these aren’t usual food items. That said, I do not believe egg whites or whey protein has anything to do with testosterone. There’s one study I can find that suggests whey protein could raise testosterone levels, but I don’t believe this is conclusive. I haven’t found anything about egg whites raising testosterone levels, but they are eaten by bodybuilders for the protein. I’d say you’re fine continuing with that regimen.

I am always very surprised at the diversity of questions I receive and answer about just ONE drug (Propecia)… a drug that is considered very safe. I mean in the grand scheme of things, millions of people take thousands of other drugs for hundreds of ailments which have far more severe and even life threatening consequence and side effects. I wonder where those people go for their questions.

Posted on

I’ve Taken Propecia for Days and Now My Beard Grows Slowly – Hair Loss Information – Balding Blog

I have just started taking Propecia on Tuesday (5/11/10) and almost instantly my beard has been growing slowly. Usually I shave on Monday mornings and Wednesday mornings… Instead I have the amount of stubble on my face that would amount to 2 days of growth except it has been nearly 4 days..

Block Quote

What you’re describing is highly improbable after taking Propecia for just a day or two. While there’s been no identified link, some people do report slower facial hair growth after taking Propecia in very rare cases, but this would take weeks or months. And even then, I haven’t seen any proof that this occurs.

Look on the bright side, if Propecia does indeed slow your beard hair growth you will save 50% on your shaving supply and needs!