Author: Dr. William Rassman

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Hair Loss InformationShampooing with Nizoral – Hair Loss Information – Balding Blog

Doc

This might be a fairly prudish question (more hygienic implications than medical) but I will ask it anyway. How often do you recommend washing hair (for people with copious hair loss) with Nizoral.

secondly, I have been on 1mg generic finasteride for the past 6 months (although I started experiencing hair loss 7 years back, but did not pay heed to the thinning hair until recently). Do you think there will be any effect of the drug?

Thanks

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NizoralI would think there should be usage instructions on the Nizoral bottle, and how often it is used depends on the strength of the shampoo. I’ve read that 1% can be used daily and 2% should be used twice a week, but you should double check what strength you’re using and look for instructions on the packaging just in case I’m mistaken. Nizoral contains ketoconazole, which some people believe has some hair growth abilities; I don’t believe that to be the case. I don’t recommend any particular shampoo for general hygiene, but Nizoral could work well if you’re experiencing dandruff.

I don’t know enough about your hair loss to be able to assume if you’ll have any effect from Propecia. I cannot say if it will work for you because I really do not know what you are treating. Get a good examination. Document what you are starting with and follow up with your doctor in one year to see if there was some benefit. Lets be scientific!

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Hair Loss InformationStopping Propecia After 30 Years? – Hair Loss Information – Balding Blog

Say one starts taking propecia once minor thinning is first noticed in a young male the age of 19-20. Say propecia reveres the minor thinning and maintain the hair until your 50s. Is it possible to get off of propecia at 50 since Androgen levels are at their highest in our 20s-30s? I’m a 20 year old male with my juvenile hairline but with very minor crown (literally unnoticeable only to me it is) thinning…I’m hoping that could be the case for me and others in my situation. Also…is it likely propecia will work very well in my case?

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Since the medication hasn’t been available for 30 years, it’s easy to see why there is no 30 year study available on Propecia (finasteride 1mg) to answer your question with any certainty. If I had to guess though, I would say:

  1. Propecia will not usually stop the balding process over a 10 year time frame (let alone a 30 year timeline)
  2. If it did stop the hair loss for 30 years and the genetic pattern was substantially more than you have now, then stopping the Propecia (even after 30 years) would cause accelerated hair loss

As to whether the medication will work “very well” for you, I couldn’t say for sure, but if you start taking it when the loss is early you have a great shot at seeing benefits, particularly since your loss is in the crown. Propecia tends to work best in the crown and for young men with early loss.

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Hair Loss InformationI Haven’t Consistently Used Minoxidil – Is It OK to Just Stop Completely? – Hair Loss Information – Balding Blog

I’ve been using minoxidil on and off for about 8 months now. I apply it once a day and quite often miss days or a few days. At one point I missed two weeks. I don’t think it has done much for my hair and have recently started propecia. With regards to stopping minoxidil (if you think I should), should I come off it gradually or will stopping it suddenly have no serious effects i.e. instant/prolonged shedding? If it helps, i’m 19 and in the early stages of hair loss.

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It seems like you’re asking me for permission to stop minoxidil, and that’s really a decision you’ll need to make on your own. I cannot guarantee anything, but as I have said many times here, you may potentially lose whatever you gained from minoxidil. Stopping it cold turkey or limiting use over time will ultimately result in the same thing if you saw benefits from the drug. You’ve used the medication irregularly for only 8 months, so I’m not sure that you’ve given it a fair chance. Starting Propecia is a good idea for someone with early genetic hair loss, but it unfortunately won’t retain any benefits you got from the minoxidil.

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Hair Loss InformationTaking Melatonin with Propecia – Hair Loss Information – Balding Blog

is it okay 2 take melatonine supplements as a sleep aid while on propecia?

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Here’s a list of Propecia drug interactions (which does not include melatonin). I am not familiar with any connection between the two, but best speak with your doctor about the use of a double dose of melatonin. I have tried melatonin once for a couple of nights to help me sleep and my immune system went nuts, activating my psoriasis into a painful breakout of body sores.

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Hair Loss InformationSwitching to a Different Brand of Generic Minoxidil? – Hair Loss Information – Balding Blog

Hi Doc,

I have a question I am from India and have been using Dr Reddys Minox 5% but right now I am in United states is it ok if I change into any Local brands out here in the market? Would there be an effect on my hair? I know it sounds crazy but I dont want to take my chance.

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It doesn’t sound crazy! There should be no difference between the brands of minoxidil, as long as the % is the same. So if you switch to a 5% minoxidil from your local pharmacy, it should produce the same results as the Dr Reddy’s brand you were using.

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Hair Loss InformationHair Transplant Doctors That Charge By the Session vs By the Graft – Hair Loss Information – Balding Blog

Can you please translate this.

I always thought that most hair loss surgeons charged by the graft. However, I noticed the following on a certain surgeon’s website. The surgeon is very well known and highly respected, so I don’t believe he is playing a pricing game, but I have no idea of what is meant by “charging by the session and NOT by the graft.”

Also, how could charging by the graft be misleading, like the wording claims? Please explain what he is trying to say and clarify how you charge.

From a certain surgeon’s website: “At (name removed), we try to keep hair surgery affordable. We charge by the session, not by the graft or hair, which can be misleading and overly expensive.“

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CountingMost hair transplant clinics do charge by the graft. I think the surgeon who made the above statement clearly believes session charges are less misleading and have a greater value than graft charges. At one time, I entertained the idea of doing a session charge rather than a per graft charge, but I ran into a problem working through the details of the charging mechanism. For example, if a person had a session charge for 400-800 grafts and then another charge for 801-1200 grafts, would the person who paid for 801 grafts feel cheated when he knew that someone else paid a lesser price for 799 grafts? I think that a patient would want to know just what they are getting and per graft charges really reflect, in my opinion, the amount of work done and the value in transplanted hair to the outcome. Iin this example, there is almost no difference between a charge by the graft for 799 vs 801 grafts, compared with a big step up in pricing for a session charge.

Charging by the graft is like a lawyer charging by the hour. If the lawyer is honest in his hourly billing, the client actually pays for what he gets; likewise, if the surgeon actually delivers the grafts that he says he transplanted, the same question of honesty is raised by the patient who should ask, “How do I know what I purchased in number of grafts were actually delivered?”. Here’s a few posts about ethics in graft counting that may interest you:

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Hair Loss Information24 Year Old Has Hair Loss After Losing Weight (with Photos) – Hair Loss Information – Balding Blog

Hello Dr.Rassman. Your site is really informative and I really thank you for the work you do.

I’m a 24 year old male and over the past couple months the front (and to some degree various spots behind it) of my hairline have fallen out at a rapid pace. Now I’m not sure if this is due to stresses on my body (lost 50 pounds in 4 months) or just MPB (limited history of it in my family, or even a maturing hairline its hard for me to tell. I’ve already been to a dermatologist and she wasn’t sure and doesn’t check for miniaturization so while i search for one that does i would greatly appreciate your opinion.

I’ve included a couple pictures of the front and side. You may use these on your site if you wish, i don’t mind.

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First of all, I appreciate allowing me to publish these photos. Click each photo to enlarge.

 

The thinning can be related to stressed induced by the rapid weight loss, a known cause of hair loss in both men and women. The short term loss may be reversible in your case if the miniaturization is extensive and the hairs are still there, just miniaturized. Stabilizing the weight situation (work that out with a good nutritionist) and taking Propecia (finasteride) might help. You won’t know for a good year or so, but you might see a slow reversal towards normal. It is worth a try. Get your hair and scalp mapped out for miniaturization so that you have a basic number for comparison a year from now.

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Hair Loss InformationDoes Transplanted Crown Hair Grow Slower Than Other Scalp Areas? – Hair Loss Information – Balding Blog

Hello Dr. Rassman. I got a ht done just under 6 months ago and i’ve noticed that the crown has shown little to no growth while the top front half of my head has shown a significant amount of growth. Could it possibly be the crown is the last place that sees the new hair growth?? the difference between the front and crown is very drastic and looks as if no hair was even transplanted in the crown. Im on week 25 so should the new hair in the crown have grown by now or is still too early? also, i still have those little red dots on my crown area but nowhere else on my scalp.

thanks in advance

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Little red dots on your recipient area may reflect folliculitis and this can, on occasion, kill the transplants if not treated in a timely manner. You need to discuss this with your surgeon as he/she has a vested interest in your outcome.

I have often seen differences in the rate of growth from front to back or right to left. I would not worry a great deal if this is a rate dependent variable, unless you do not see the results you expect by the 8th month. I would expect some growth in most patients by now, but again, see your surgeon and discuss your concerns.

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Hair Loss InformationCan You Honestly Tell Me Side Effects Are in My Head? – Hair Loss Information – Balding Blog

I see you often dismiss permanent side effects from Propecia on here. You rationalize them away, usually blaming them on psychological conditions or naturally occurring ED. Care to rationalize my situation. Pre-fin I was a healthy 21 y/o male with a raging sex drive and no difficulty with erections. I took 1mg daily for 12 days when I began to notice sexual side effects. I’ve been off for 3 months now and can count on one hand the number of erections I’ve had in that time period and my libido is non-existent. Can you honestly tell me its all in my head? Or that the fact that it happened during and after my time on propecia is merely coincidental?

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I feel for you. I have no explanation to your complaint as I have not seen patients with this complaint. I am not minimizing your problem. I do not and never underestimate what a patient tells me and I always try to help to the best of my ability. Your anger at me seems misplaced. I would honestly try to help you if I knew what to do.

Finasteride is a prescription drug, and I hope you’ve discussed these side effect issues with your prescribing physician.

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Hair Loss InformationReceding Hairline Without Miniaturization? – Hair Loss Information – Balding Blog

Hello Doctor,

I have an important question about miniaturization. Is it possible to have a hairline that keeps receding pass NW2 and still show no miniaturization? Also, NW3 is considered early balding but is that only when miniaturization is present? If someone is at NW3 or NW4 with no miniaturization would Propecia be recommended or not? Also, why is it that some young adults start losing hair early?

Thanks

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Miniaturization sometimes is not the forerunner for balding at the Norwood Class 3 or 4 stage, but it usually is present if looked for. The change for a Class 2 to an early 3 pattern may not have miniaturization, but the further back the pattern becomes evident, the more miniaturization will be seen.