Author: Dr. William Rassman

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My Friend and I Both Have Missing Patches of Hair – Hair Loss Information – Balding Blog

yesterday afternoon my mom noticed that i had a patch of hair missing from the back of my head. i dont know if its a disease because my friend had the same problem but he had patches missing everywhere in his head and i dont know if im heading in that same direction. i hope not but it scared me when i found out i had a patch of hair missing. could you tell me what i could do to regain that hair back or what i should do to cure it? thank you for your time. have a nice day

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I would like to have more information about your situation. A bald spot in two people who are friends could have environmental or infection causes. What is the age of you and your friend, do you share the same living space (apartment or house), how long have the patches been there? Are they progressive (getting larger) or are they stable and getting better? Are the patches punch like with sharp edges or irregular patches along their rim? Is there any hair inside the patches? I would like to see some photos of these patches. I might be able to give a better indication after seeing the photos, but it might be easier and better to see a good dermatologist in your area and get to the root of the problem. As you can see from my questions, making a diagnosis over the internet can be a problem and a visit ‘one on one’, with a good doctor is the best way to go.

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Can Excess Cortisol and Hypothyroid Cause Texture Changes in My Hair? – Hair Loss Information – Balding Blog

I was recently diagnosed with excess cortisol (adrenal fatigue) and hypo-thyroidism due to the production of excess cortisol in my body. Can this combo of excess cortisol and hypothyroidism cause color and texture changes to my hair, reduce facial growth and thin/miniaturize my whole scalp hair in a uniformed global fashion?

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Adrenal fatigue syndrome is a condition with diverse manifestation. In this condition, hair tends to get thin, wispy and dry. You may also experience some hair loss. In low thyroid function, hair tends to get more coarse and sparse and may become wavy or the hair color may change. You can find a nice table of information here.

For more information, you should see an endocrinologist.

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Blood Pressure Medication and Hair Loss – Hair Loss Information – Balding Blog

Which other BP medications don’t cause hair loss and coughs like Lisinopril does?

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Any medication can potentially cause hair loss as one of the side effects. However, the most common cause of hair loss is not due to medications. If you are losing hair you should have doctor who specializes in hair to examine it for signs of miniaturization in specific pattern or distribution. To answer your question more specifically, there are no studies to compare the hair loss effects of a particular blood pressure medicine against another. That is the type of research I would love to see, but a research project that is unlikely to happen. More importantly, you should always consult with your doctor before stopping or changing any medications.

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Shedding From Minoxidil and Propecia – Hair Loss Information – Balding Blog

Dr Rassman:
I started using Monixidil 5% two times a day combined with Nizoral shampoo 3xweek about two and a half months ago. I also added Propecia to my thinning hair treatment about a month ago. I started experiencing shedding about a month and a half ago and still I am shedding; my dermatolgist did not see anything wrong with my scalp by the time she Rx propecia. Is shedding normal under treatment for this long? The Monoxidil has irritaded my scalp which also seems to be part of treatment but I decided to take a 10 day brake which ends today (11/18/06) so I started using it again. The irritation has ended…so far and the Nizoral definetly helps.

I started the treatment as prevention, I am 43 and thinning but now I am questioning my decision because of the excessive shedding.
May you please offer some advice? When should I expect improvement on the shedding? Are those follicles still intact? My biggest fear is that I have caused more damage than good. Thanks for your help.

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Shedding is occasionally reported when starting minoxidil or Propecia (finasteride 1mg). You must wait out the period until the shedding stops (about 3-4 months). This appears to be an acceleration of the hair cycle before the better growth kicks in. Your reaction to minoxidil indicates that you may not be able to take it. Some people get considerable irritation from it.

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Finasteride and Depression – Hair Loss Information by Dr. William Rassman

For some time now, some studies show a possible link between finasteride and depression. A recent article, titled “Finasteride induced depression: a prospective study”, discussed this connection and was published in BMC Clinical Pharmacology and appeared online in early October.

Some of the relevant points from the article are:

5alpha-reductase is a critical enzyme in the conversion of several steroids such as testosterone, progesterone, aldosterone and corticosterone in the brain. This enzyme converts testosterone to the most natural potent androgen DHT, and also it acts an important role in conversion of progesterone to dihhydroprogesterone (DHP)…..A decline in serum DHT level occurs after finasteride administration. This may contribute to finasteride induced depression. We [the authors] couldn’t find any significant change in the anxiety scores before and after the treatment

The authors conclude: This preliminary study suggests that finasteride might induce depressive symptoms; therefore this medication should be prescribed cautiously for patients with high risk of depression. It seems that further studies would be necessary to determine behavioral effects of this medication in higher doses and in more susceptible patients.

For the complete article, see BioMed Central.

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New Study – Dutasteride vs Finasteride – Hair Loss Information by Dr. William Rassman

In a recent article in Journal of the American Academy of Dermatology (J Am Acad Dermatol. 2006 Dec;55(6):1014-1023), dutasteride and finasteride were compared over a limited 12 week and 24 week study in 500 men in a study which had also compared placebo effects. The authors of the article are Olsen EA, Hordinsky M, Whiting D, Stough D, Hobbs S, Ellis ML, Wilson T, Rittmaster RS; for the Dutasteride Alopecia Research Team.

Based upon photographs taken, dutasteride was superior to finasteride in this time frame. Dutasteride blocks both Type one and Type two receptors and the suggestion of the authors was that the combined block of these two receptors may be better than a block of one receptor in reversing the process. Clearly, the study needs to be extended well beyond 24 weeks.

The long term safety of Type 1 clocking for DHT production is safe and there is a natural model both genetically and through eating finasteride, but no comparable model exists for the DHT block of both receptors for safety, as the study above just discusses limited views of efficacy. The FDA’s position is still that dutasteride is not an approved drug for treating hair loss.

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I Have Very Patchy Facial Hair (with Photo) – Hair Loss Information – Balding Blog

I’ve got some horrific facial hair coverage. From the jawline up it’s just atrocious, very thin coverage of hair, and it’s very patchy. however from the jawline down, I’ve always thought I had really nice thick coverage. Not that I’m really thrilled about it, I’m not too fond of the “amish beard” look. Is there any way to fix patchyness in facial hair? And what would cause this to happen? I didn’t have any injuries to this area as a child (no scarring or burns or anything that i remember that might prevent hair from growing there). I have attached a photo which you may use on your site. I’m 25 years old. Thanks

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Some people have uneven facial hair distribution and others are delayed in their beard growth, which may develop well into their 30s with more uniformity. You should wait and see what grows out as your beard matures.

Alternatively, you may consider transplanting hair from your head to the beard area, assuming the caliber of the hair is similar (it must be close to the same texture). If it is not, then you might have two types of hair which may be obvious and another type of problem. Even though beard to beard transplants would work, I would not recommend this approach, because it would thin out the beard you have in other areas (where you are happy with it) — unless you take the hair from below the chin where it is not easy to see. This may be a bit extreme and costly, but it would work beautifully. Although the transplantation may be an option, I actually think that this may be overkill and would ask you to wait until you fully grow out your beard. If it continues into your 30s and you still want to do it, then go for it. I will take you on as a patient.

Here’s the photo that the email included (with permission to post it here):


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Months After Transplant, Hair Became Thinner – Hair Loss Information – Balding Blog

Dear Dr Rassman
First of all i would like to thank you for the great support you have been providing.

I am 27 year male. I had my hair line done(1400 grafts) 5 Months ago in LA. Around 4 months after the surgery i had good number of hair on the left side. But with in last 1 month i have noticed that my hair have become thinner in this region. Is it possible that i have lost few newly transplanted hair. And also i do not see much hair (not even baby hair on the right side). I am a social smoker i smoke between three or five cigarettes a week. Does this has any thing to do with poor hair growth .

Thank you very much for your advise.
Regards

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Patients react differently to their newly transplanted hair. In some people, the transplanted hairs completely fall out before regrowing after a few months. In rare times, they grow and keep growing after a hair transplant. The final results of a transplant must be assessed no sooner than 8 months from the time of surgery, because you want styling length to about 1 1/2 inches to see the benefits of the new hair. Your thinning may have been part of the initial shock loss and may grow it back (I recommend that my patients use Propecia to reduce the risk of shock loss). With a good surgical technique more than 90 percent of your grafts are expected to take.

Smoking, as we discussed several times here before, is bad for your overall health and decreases blood micro-circulation in tissues, possibly contributing to poor wound healing. Proper wound healing is essential for the transplanted grafts to ‘take’. Smoking may potentially stop the growth of implanted grafts and in your case you may have lost some of the grafts as a result of that. Again, most patients who have less than targeted results from transplant are smokers. Maybe it is a good time for you to quit smoking. See the doctor who did your hair transplants and hold him accountable to give you the direct answers to your questions with you in the same room. If I were your doctor, I would want you in front of me at about the 8th month after the surgery.

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Would Hair Multiplication Work After an Existing Hair Transplant? – Hair Loss Information – Balding Blog

Hello,
If hair multiplication becomes reality one day, can it still be performed on hair where strip transplantation has been done before? Thanks. Regards !

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The way the research is going, hair follicular units that have intact stem cells will be taken out of the scalp from the permanent zone. One hair will make many hairs and therefore, as long as you have some donor hair left, hair multiplication, when it is available, will be able to be done on people who had previous hair transplants. Just don’t hold your breath for the technology to come about anytime soon.