Author: Dr. William Rassman

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Hair Loss InformationReader Reports Propecia Stopped His Hairline from Receding – Hair Loss Information – Balding Blog

I been taking Propecia for frontal hair loss for almost 2 years & it stopped it completely from receding. I did catch it early so everything is there except some mild thinning on the corners and in the middle too bad that didn’t thicken up as I hoped. DHT causes MPB so Propecia can stop and thicken hair loss anywhere on the scalp not just the crown.

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Thanks for the comment. Not many people write to report about good results to us (as I’ve said before, those with complaints are often the loudest). Propecia is generally used for thinning in the top/crown area, but rarely it does seem to work for the front as well.

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High Grade Cancers, Propecia, and Avodart – Hair Loss Information – Balding Blog

Hi, I was reading an article yesterday that mentions Propecia and Avodart and tumor growth. I’ll put the link below. I’m currently taking Propecia and I want to know if I have anything to be concerned about? Thanks!

Article: Avodart may promote some tumor growth

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AvodartSometimes its hard to decipher research and its conclusions especially when there is controversy. The news you are referring to is from a recently published study in the April 2010 New England Journal of Medicine (a respected medical journal). Its conclusion was, “Over the course of the 4-year study period, dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia.” This is good.

The confusion is in the news article spin-off you found of other doctors giving their opinions and commentaries. The significance of this article is that now Avodart (dutasteride) has been shown to reduce the risk of incident prostate cancer similar to what was shown in the Proscar (finasteride 5mg) study, which was published in the New England Journal of Medicine in 2003.

Despite the apparent positive findings, there were controversies due to interpretation of the studies where some thought Proscar may be delaying aggressive prostate cancer from being detected. To address this, the National Cancer Institute published a bulletin in 2006 which stated, “We’ve now shown that the cancers prevented by finasteride are often clinically significant, the same kind of cancers that lead to surgery. In addition, we showed a 28 percent reduction of high-grade cancer with finasteride.”

Remember, these are positive findings for Proscar and now Avodart. Also note that these studies are not about Propecia (finasteride 1mg), and while the inference is there, you cannot make a claim that taking the 1mg dose will have the same impact on the reduction of prostate cancer risk.

So to answer your question more simply — no, I do not think you have anything to be concerned about based on this information.

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Hair Loss InformationIn the News – Total Face Transplant – Hair Loss Information – Balding Blog

This isn’t hair loss related, but fascinating all the same. Snippet from the article:

A team of 30 Spanish doctors say they have successfully performed the world’s first full face transplant. A man injured in a shooting accident received the entire facial skin and muscles – including cheekbones, nose, lips and teeth – of a donor. The man is recovering well after the 22-hour operation, said a spokesperson from Vall d’Hebron University Hospital.

Another 10 face transplants have been carried out around the world, but this is believed to be the most complex.

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Face OffRead the full article at BBC News- Full face transplant ‘a success’

Face transplants are most difficult technically, and this is believed to be the first total face transplant. There are many problems that include blood supply to each part of the face, as the blood vessels have to be connected and they are very small. Nerve connections are also a challenge. The overall face transplant is like any other organ transplant with regard to rejection issues and the patient must be on anti-rejection medication for life, provided that the short term success of the face “taking hold” works.

I have seen the work presented at a medical meeting at the Cleveland Clinic by Dr. Maria Siemionow who documented the entire process with Rat experimentation first over many years (see here for more on that).

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Hair Loss InformationIs it Safe to Assume Taking More Avodart Each Day Will Have Better Results? – Hair Loss Information – Balding Blog

Why did testing on Avodart not include 1mg/1.5mg/2mg? I have gathered that the drug is dose dependent so it puzzles me as to why each 0.5 interval has not been explored. My hair loss affects me greatly and I am also a model so it is terrifying me with regards to my job-is it safe to assume that taking 1mg of Avodart per day is better than taking .5mg a day? I would take 2.5mg a day but the cost would be too much.

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No, you should not just assume that by taking more of any medication you will have better results. For starters, Avodart (dutasteride) has not been approved for treating hair loss. It is an FDA approved prostate medication, and although early studies show it does work to treat hair loss, it has a much longer half-life than finasteride (meaning it stays in your system for a while). Side effect risks haven’t been fully established for younger men and optimal dosing for treating hair loss hasn’t been established. I don’t know why various dosing intervals haven’t been explored, as I am not affiliated with the maker of the medication, GSK.

It is worth noting that the dose for treating the prostate is 0.5mg of dutasteride daily… and you are willing to take up to 5 times that much to treat your hair loss?

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Hair Loss InformationHair Transplant After Radiation – Hair Loss Information – Balding Blog

RadiationAs you’ve just stated, finasteride is not effective if a person has lost some hair due to radiation. But would a transplant be effective in that case?

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The type of radiation that you got and the extent of skin damage will dictate how well the scalp will do with a hair transplant. If you or your doctor have doubts about survival of a hair transplant, we often do a test hair transplant of 20-50 grafts taken out FUE style and then wait 6-8 months and see the yield. If the yield is good, then a full transplant will do just fine. Finasteride may or may not have value in the radiated area if the radiation killed off the hair.

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Hair Loss InformationDiffuse Hair Loss All Over My Scalp! – Hair Loss Information – Balding Blog

Hi, for the last ten months I’ve been having diffuse hair loss all over my scalp. Both top and sides of my head. My hair line has not receded. Within these ten months, I would say that I’ve lost about 60% or more of my total hair. All of the hairs have the small white bulb at the end. I’ve gone to a dermatologist and he suggested that it might be TE or MPB. I then went to an endocrinologist and had some blood work done. I came out having slight hyperthyroidism and I show many of the symptoms.

It seems that my hair loss has continued the same. I have slight hair regrowth but it tends to fall and my hairs still have the white bulb at the end. this problem began in june ’09 and I had been under a great stress two months prior. I am now 19. I have been on methimazole for about a month now and I am really anxious to try propecia. Do you believe this to be TE or MPB? Thank You.

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I really don’t know what you’re seeing, so I can not recommend anything without checking out the hair loss for myself. I need to make a diagnosis and to see the distribution of your hair loss.

Since you’re not too far from my Los Angeles office, I’d like to suggest coming in for a free consultation. You can call my office at 310-553-9113 (or 800-NEW-HAIR) to set up the appointment.

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Avoid the Scam – Hair Transplant Bait and Switch – Hair Loss Information – Balding Blog

Scam AlertI saw a patient last week who had a hair transplant surgery from a local doctor. He went in for a 400 graft procedure and during the middle of the procedure (while under sedation), he was told that the doctor was able to remove about 1000 grafts more than he paid for. He was asked if he wanted to pay for the extra grafts for a special “deal”, because the alternative was to throw them away. What would you do? He was sedated, but he wasn’t crazy to let the hairs go to waste. So he reluctantly agreed to pay more for the hair.

As a surgeon, I understand that the harvested grafts cannot be an exact number that was planned. While it does happen on occasion, the actual harvested grafts are either over or under the estimate. We (NHI) do not throw away any grafts (even if the patient cannot pay) and we clearly inform all our patients well before the surgery, before they are sedated. We account for every single graft and if the actual number of grafts is short by even one, we give the appropriate refund. I have always made this point clear to my patients and for those who are on a tight budget, I try to keep the estimated harvest amount slightly under. But if the actual number of grafts is over the estimate, then it is my issue and I do not let the patient worry about the fate of those extra hairs while they are still under sedation. I transplant the extra grafts for them. The point I am trying to make is that it should never come to this, and the patient and doctor should know what to expect and the range of payment before the surgery is even considered.

Shady business practices are unfortunately a hurdle in our everyday lives. Physicians are generally held to a higher standard and are more trusted by the general public than most professionals, so it is disappointing to hear stories like that. Even hair transplant surgery is a buyer beware market.

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Enlarged Vein After Hair Transplant – Hair Loss Information – Balding Blog

I am a 45 years old male who has underwent over the years several HT procedure. Since my last procedure April 2010 I noticed en enlarged vein in the left temporal area which I believed is an av fistula. I have two questions. Will this resolve over time? If not what corrective procedures can be taken to fix it?

Thank you

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This is a very important point: If you had surgery with a doctor, you absolutely need to discuss any concern and issues with that doctor (especially if you had the procedure just recently). It is not because I do not want to help or I am trying to pass it along, but your surgeon knows your case and your issues the best. Baldingblog is not a place to get second opinions or get medical diagnosis.

With that being said, if you really do have a AV fistula it will not resolve on its own. Complications can include bleeding, an aneurysm followed by rupture, and internal bleeding below the skin. This can be a complication of any surgical procedure. For more information, please see:

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Rogaine Worked Well at First, Then Stopped Working After 6 Months! – Hair Loss Information – Balding Blog

H I’ve been using rogaine for 6 months now, at first it worked very very well. A little time to get use to a routine but I stuck to it. I did shed at first in the first month but it grew back and it was great however in the last month I’ve started to shed again quite rapidly badly and I don’t understand why. I apply it exactly the same as I did before but I’m becoming very concerned about this. I’m not stressed at all all and live a healthy lifestyle

I’m coming to a conclusion that body is finally rejecting and genetics is winning, and I feel I should just stop (and save what I got left) but on the hand I’ve read numerous and numerous of horror stories that when stopped it gets even worse which I know is a fact – but then again I don’t know if it can get worse. I’m a 24 year old male, with everyone in the family having a health head of hair except my dad.

Thanks for taking time to read this!

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Rogaine (minoxidil) typically does not work so fast, but it often stops working and it is not a truly reliable drug for treating hair loss, as the typical response is quite variable between different people. It usually takes about 6 to 12 months before you see some benefit. It seems you are having a different experience than most, but I doubt that the medication just “stopped” working. I would continue for at least one year.

Rogaine, however, is not the ideal treatment for hair loss in a young genetically balding male (your age). Finasteride (Propecia) addresses the balding problem directly and is the treatment of choice for your problem.

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Kidney Disorder, Propecia and Rogaine? – Hair Loss Information – Balding Blog

Hi Doc
Can a person with Kidney disorder take Propecia or can he apply Rogaine.

Thanks

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Finasteride (Propecia) is metabolized in the liver so the presence of kidney disease is usually not a problem for taking this medication. For liver disease, finasteride could be a problem and you must check that out with your doctor.

In the case of minoxidil, the presence of kidney disease will cause more retention of the drug in your body, so there could be a greater impact if you take regular doses of minoxidil as the blood levels may rise.