Dr. William Rassman – Page 1324

April 14, 2009

What to Do for a 21 Year Old Non-Responder to Propecia? – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman, thanks again for your work here. I was wondering if you have ever encountered a young patient say, 21 years old, that did not respond to propecia. I have been on propecia for 8 months now and my thinning is becoming more evident. From my impression, you’ve held that propecia is most effective for the early stages I’m experiencing. Should I expect to see any difference between 8 months and a year (the full potential marker)?

I’m just really concerned propecia hasn’t slowed the process for me. Thanks for the help

I’ve been mentioning it a lot lately, but there is a genetic test that will determine just how good Propecia will be for you (see here). You can find a doctor in your area that carries the HairDX tests here.

I believe Propecia always works, but it could be a matter of degree. It should slow down the balding process, but the balding process could be aggressive. Generally you see the results in 1-2 years, but some indication of the benefits should be evident at this time. I would recommend getting baseline measurements for miniaturization and then get the genetic test. This combination of things should give you more insights with a good doctor at your side.

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April 14, 2009

Would Switching from Propecia to Cut Proscar Tablets Induce Hair Loss? – Hair Loss Information by Dr. William Rassman

Could switching Finasteride products possibly be dangerous on my hair? I’m currently on 1mg Propecia, but when my prescription runs out I may to switch to 5mg Finasteride tablets and cut them into 1/4ths. I’ve read that switching medications like this, despite having the same ingredients, can bring on a sudden and serious shed. Is there any truth to that and should I perhaps get another renewed prescription for Propecia instead?

No, I don’t believe you’ll see a shed from switching. Most people who switch from Propecia to Proscar do it for economic reasons, as the 5mg pill is substantially less expensive (particularly the generic 5mg, since there is no generic 1mg legally available in the U.S.). I wish the drug company, Merck, would get that message… and maybe they will, as this blog is frequent reading by their sales force.

Propecia is a brand name for a drug called finasteride in 1mg strength and Proscar is the same drug in a 5mg strength. Splitting the pill into 4 or 5 pieces is a cost saver, but as long as you are taking 1mg finasteride daily it is the same thing for treating hair loss.

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April 13, 2009

Can Propecia Interfere with My 18 Year Old Son’s Genitalia Growth? – Balding Blog

I’d like to know if finasteride is safe for an 18 year old boy. Can it interfere with a possible genitalia growth spurt that I’ve been told can occur even after complete bone growth up to age 20 or 21? My son appears to have male pattern baldness, so his Dermatologist has put him on the drug, but his Endocrinologist advises against it. My son doesn’t want to lose his hair so he’s taking Propecia, but doesn’t know about the other possible problem. It’s not something I want him worrying about unless the drug can really interfere with genitalia growth, in which case he should know so he can decide for himself whether or not to take the drug. Please advise.

Propecia (finasteride 1mg) is safe for 18 year olds and this medication is not known to retard genitalia development in young men. The 5-year effectiveness and safety study submitted to the FDA included men aged 18 to 41 years old. He is correct that to hold on to his hair, this is the best approach.

April 13, 2009

Can Shampoo Harm Hair? – Hair Loss Information by Dr. William Rassman

You’ve said that daily shampooing of hair won’t cause hair loss unless we wash too rigorously. Disregard the physical aspects of washing. Can the chemicals in shampoo be affecting our hair follicles? I know that hair is “dead” when it grows out of the skin, but I’m concerned our hair follicles are shallow enough that the shampoo may be affecting them. Although if this were the case, perhaps a lot more women would have the same type of hair loss as men.

Sorry, but you’re completely off base with this. Shampoo itself has nothing to do with hair loss… absolutely nothing if it is a good commercial shampoo.

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April 13, 2009

Does Dr Farjo Perform Miniaturization Mapping? – Hair Loss Information by Dr. William Rassman

dear dr farjo,
i live in the UK and have consulted a few transplant drs up to this point- but neither of them could give me a conclusive answer as to whether the hairloss i have experienced is the development of a mature hairline or early stage MPB. (I have minor recession at the corners of my hairline, and am 24 yr old male)

I would be interested to know how you would assess this and do you perform the miniaturization study like dr rassman? as the drs i have consulted so far did not.

thank you

The following response is by UK-based physician Dr. Bessam Farjo:

Response by:

Dr Bessam Farjo
United Kingdom

Well, I start by asking you about your own hair loss history and its progression. I then obtain a thorough family history to assess the likelihood of progressive hair loss. Unfortunately the younger you are the harder it is to be accurate. An examination of your entire scalp follows to see if you are losing it in a genetic pattern. I may even suggest a genetic test to help predict your future loss but that is not definitive either.

I can certainly assess your miniaturisation like Dr Rassman. One of the other video microscopes I have is also capable of measuring hair calibre and has the software to compile such data.

A genetic test to assess responsiveness to finasteride is in development and I will be able to provide that when ready.

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April 13, 2009

I Ordered Propecia via the Internet at the First Sign of Hair Loss – Hair Loss Information by Dr. William Rassman

Dear doctors, keep up the super work. This is my story below.

I worked crazy 12-14 hour days for the past 2 years, and I practically skipped my meals, or had them very irregularly. I lost a lot of weight, and looked good in clothes. Essentially I was malnutritioned. But 1 day I woke up, and noticed easily 20-30 strands of hair on my pillow. I dismissed it as normal, and over the next few weeks, it was the same scenario everyday. It still failed to sink into me.. because I was always healthy. I had a friend who laughed at me, and said that I had a receding hairline. But I ignored him, because I have had a very high forehead / high hairline since birth. One day I looked in the mirror and realised to my horror, that YES I was losing my hair. I immediately ordered Propecia thru the internet.

I have been on Propecia for the past 9-10 months, and I have seen a slowing in the loss of hair. However I’m not really sure if there has been any significant re-growth. There are definitely side effects for me. I no longer get ANY morning wood.. and I need to be significantly aroused before I can have any sex. In the past, it wasn’t the case. (Easier to be aroused). Currently I’m a Norwood 2 – 3. (Can see my widows peaks easily.) By doing the frown test, I can see my hairline has receded half an inch, while my sides have receded 1 inch.

Now for the question:
I can see tiny vellus hairs at the part where my hair has receded. Should I attempt to apply Rogaine just along that 1/2 inch area of tiny vellus hair? Or should I continue my Propecia treatment and hope for the best? It’s really quite sad to see my hair go this way.

I thank you for all the help you have rendered all the brothers here. I feel happy that we can find support in your blog. I wish you and your team all the best always.

You can apply Rogaine at the hairline, but I’m not sure it’ll do much good there. Worth a shot, I suppose. Vellus hair does not turn into normal adult terminal hairs.

I really hope you didn’t just order a prescription drug via the Internet without a doctor’s prescription, because that is what it sounds like you did with Propecia. Regardless, regrowth from Propecia doesn’t occur in everyone, but just halting the hair loss is a positive sign. Arousal issues could be from the medication, but I don’t know what other issues you have in your life — it could be age related, stress related, alcohol or substances, etc. I don’t know enough about you, and this is why a doctor’s appointment should be made to discuss these issues (preferably with the same doctor that prescribed you Propecia).

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April 13, 2009

I Wonder If I’m Experiencing Telogen Effluvium – Hair Loss Information by Dr. William Rassman

Hi. I’m a 24-year-old white male who has been having hair loss issues for about a year now. Based on family history, I know it’s probably AGA, but since I don’t seem to be following the classic NW pattern, and because the thinning became apparent suddenly, accompanied by severe shedding and following a stressful period, I’ve often wondered if I could be experiencing telogen effluvium. A hair pull test I performed on myself in May 2008 seemed to support this notion.

The shedding has long since stopped, but my hair has not returned to its normal density. My question is, how often is telogen effluvium concentrated in one area of the scalp? Almost every description I’ve read says it’s diffuse, but I’ve seen pictures of post-op patients suffering from it who have lost an appalling amount of hair on top but relatively little on the back and sides.

Generally speaking, telogen effluvium (TE) is spread throughout the scalp. This is the time to see a doctor and be examined for:

A miniaturization mapping of the scalp hairs
A genetic test for the balding gene, if appropriate
An experienced doctor who knows what to do

This is not the place to write a textbook for a complex problem like you are describing.

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April 13, 2009

My Local Chinese Herbalist Says Hair Loss is From Sex – Hair Loss Information by Dr. William Rassman

Doc please comment on this as it has worked for me but can’t imagine how on earth it works scientifically?

A local chinese herbalist informed me that in they country men who suffer from hair loss is attributed to a high sex drive and in order to lessen the testosterone levels they would often have sex twice a day for a month and then stop for a month and then start again. I mean I thought Ive tried everything else so my wife was willing to accommodate so we did. After a month I noticed that a real reduction in hair loss. It continued to fall out but no where near what it did before. 6 months on and things are alot better then I expected.

What do you think doc can testosterone levels be reduced and lessen hair loss? it works for me

I do not believe what your Chinese herbalist told you. There may be much more to your experience than the testosterone issue which does not go up when you have sex. I would not give up sex just for hair if what he said was true. Maybe he has a sexual problem (a man with erectile dysfunction, for example) and he came up with his solution by avoiding sex. Sex and hair loss are unrelated, so what you’re telling me about the reduction of hair loss you saw sounds either coincidental or you’re mistaken.

If you have a problem with hair loss, get a diagnosis by getting your hair mapped out for miniaturization and since you indicated that you are in the United Kingdom, I’d suggest seeing Dr. Bessam Farjo (offices in Manchester and London) who might prescribe medications to stop your hair loss.

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April 10, 2009

Can You Preserve Hairs for Transplanting Later? – Hair Loss Information – Balding Blog

Why can’t you transplant hair from one person to another? if the hair is exactly the same colour and close enough the same texture is it possible to do this? Also, on the same note can hairs remove during a procedure be preserved or do they have to be put into a head straight away? honestly it would be a great idea, people with generously thick hair “sell” their hair to you and then you could probably charge 3 times that amount to put it into someone elses head, it would make lots of money.

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There is a lot of experimentation occurring, but nothing that exists at this time. Hair grafts start dying at about 8 hours out of the body while kept in ideal conditions like iced Ringer’s solution at about 34 degrees Fahrenheit. The death rate for grafts occurs at a rate of about 1% per hour after the 8 hour period. In 24 hours, there will be 24% death rate of grafts, 48% at 48 hours etc.

Hair follicles are organs, and like with a kidney, liver, or heart transplant, these organs also have limited times to get them into their new and final resting place. You would have to take anti-rejection medication for the rest of your life if you used anybody’s hair organ other than your own and the risks of these drugs are high for death — a risk perhaps worth taking for a heart or liver, but for hair? No way. These medications can lead to other health complications, and since a hair transplant isn’t exactly a lifesaving procedure (like a heart transplant would be), the end doesn’t justify the means.

April 10, 2009

Grapefruit Juice and Finasteride/Dutasteride Absorption – Hair Loss Information – Balding Blog

Dear Doctor:

This is in response to a post that I saw regarding grapefuit juice and Propecia/Avodart absorption. Grapefruit juice inhibits the Cytochrome P-450 intestinal enzyme CYP3A4. It does not affect the hepatic enzyme apparently. Dutasteride is metabolized extensively by this enzyme. The serum level of any CYP3A4 substrate, such as Dutasteride, will be elevated in the presence of GF juice. Additionally, grapefruit juice takes quite some time to leave the body, so it’s effect is cumulative. If someone drinks 1 glass a day for 5 days, CYP3A4 will be significantly reduced. Additionally, one 8-oz glass of grapefruit juice inhibits CYP3A4 as much as 2-3 double strength glasses, so you don’t need much. Ketoconazole is also a very potent CYP3A4 inhibitor. Now, I am sure most readers would not be against elevated serum levels of Dutasteride/Finasteride as the effects of dutasteride (at least) is dose-dependent. However, many other drugs such as antivirals, statin drugs, antihypertensives, antiseizure medications, and many allergy medications are also CYp3A4 substrates. Elevated serum levels of these drugs can prove deadly, so as a general rule, patients should check with their doctors regarding any drug/food interaction.

Just my 2 1/4 cents. Thanks!

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Thanks for the information. There are some medications that do not do well with grapefruit juices, but here some other links to explore about this —

And there’s more links in a previous blog post here.