Author: Dr. William Rassman

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Propecia Causing Tinnitus? – Hair Loss Information – Balding Blog

Hi Dr,
I’m a bit concerned about a seemingly undocumented side effect of propecia, and I am hoping you can help shed some light given your extensive experience with this med.

Have any of your patients experienced tinnitus as a side effect? I’ve been on propecia for about 5 weeks now, and I believe that I have developed tinnitus as a side effect.

As a note, I spent some time on prozac several years ago. For me, tinnitus was a definite side effect of that medication. After years off the medication, the ringing subsided. As far as propecia goes, is this sort of side effect indicative of a poor tolerance scenario that could degenerate to someting worse?

In searching for more information this, I found this article, upon which I will withold judgement and analysis due to lack of understanding: http://www.bio.net/bionet/mm/neur-sci/2004-August/058929.html

Thanks!

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Tinnitus or ringing in the ears is not a common side effect of Propecia (finasteride). In fact, I have never heard of such a complaint. Your tinnitus may be a symptom of something completely unrelated to a medication you are taking. Rather, it may be a warning sign of other medical issues. You should explore these possibilities with the doctor who prescribed you the medication.

With respect to your article, I do not think it has any significant relevance to your question at hand. Furthermore, it is a study done on mice and the chemical pathways and the questions posed, although interesting, may be an intellectual argument. At best, more research should be done.

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A Change of Seasons – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I have noticed an increased amount of shedding which started at the very end of summer till now. Is there such a thing as increased shedding during the change of season (specifically summer to autumn)? I am also approaching my fifth month on propecia, so I suspect that the increased shedding can be attributed to the medication? I remember you writing that you can experience increased shedding during the first 6 months. In any case, I was wondering if you could provide some insight into my situation. I appreciate your help Dr Rassman; your blog is extremely helpful!

I have heard some of my patients reporting that they lose hair during certain seasons. Humans have asynchronous hair cycling, which means that we generally shed uniformly over the entire hair cycle of about 36 months. We lose about 100 hairs per day and replace that number each and every day. Animals have synchronous hair loss, which means that they molt once a year, usually in the Spring when their hairs go into telogen (the sleep part of the cycle) and in the Autumn when they go into anagen (the growth part of the cycle).

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Diagnosed with Alopecia – Hair Loss Information by Dr. William Rassman

Does propecia effect blood test in anyway.Also I have had a scalp biopsy and was told I have anadrogenic alopecia.So now I have been on propecia for 11 months and now I’m losing hair all over my head like D.U.P.A or something.Also for the last month or so I have been losing my eyebrow hair and eyelashes. I have been to the doctor so many times and they cant find out whats wrong with me.Please help I’m so scared of waking up one day with no hair on my entire face.

It has been long thought that finasteride 5mgs can reduce an elevated PSA (prostate specific antigen test for cancer of the prostate). For this reason, we always ask men over 50 (over 50 because they are at risk of prostate cancer) to get a PSA test prior to starting Propecia. As cancer of the prostate is almost unheard of in a man younger than 50, we do not require a PSA test before starting Propecia. With that said, recent publications indicate that Propecia (1mg dose of finasteride) does not impact the PSA test, even if it is elevated. To my knowledge, only the PSA blood test has been associated with Propecia.

It is impossible to diagnose your condition over the internet. BaldingBlog is not a place to make a medical diagnosis (which you may need). Aside from a scalp biopsy, you may benefit from a scalp hair miniaturization study so that a good doctor can put a listing of possible diagnoses before you. You should get a focused answer. If you are not satisfied with the information your doctor has provided you, see another doctor.

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Do Transplant Yields Vary Per Physician? – Hair Loss Information by Dr. William Rassman

Dr. Rassman:
I’m a 32 y/o physician and have had a high temporal hairline for as long as I can remember. Unfortunately, over the course of the last few years it has gotten higher. I’m thinking about doing something about it but have concerns about transplantation. My concenrs include the durability of transplantation and the potential need for more and more procedures as time goes on. I also wonder about the variability in outcomes from physician to physician, even in your group. Do you keep track of graft yield/take statistics within your group, do you know who the best is as far as the above is concerned, and do you share this information? After deciding on proceeding with transplantation, can one ask that you specifically be the one to do it and, if so, do you charge more? Thanks.

Wow, that would require a long dissertation to answer it all. Yes, there are differences between medical groups in the survival of grafts and the yield of hair as it relates to different procedures. As you may know, there are many techniques being used today. The golden standard is Follicular Unit Transplantation, a process which we pioneered. See Follicular Transplantation: Patient Evaluation and Surgical Planning? and The Aesthetics of Follicular Transplantation for more.

Hair transplants, once grown out, are quite durable and they should last your lifetime. The issue you should be concerned about is the progressive nature of hair loss in the balding man. Propecia (finasteride 1mg) is a good way to address this problem and in most men with a good Master Plan, they (in conjunction with a good doctor) should be able to define what will happen to your hair situation over time. Good miniaturization studies are critical to the development of a Master Plan for hair loss and treatment.

The average clinical doctor does not keep records on graft survival, but the different doctors have learned over time that they must have graft survival if they are to survive in the competitive marketplace. So what they have done is modify what they can do effectively. Some doctors do not do Follicular Unit Transplants (FUT) and instead have developed modifications of this technique so that their survival will be high. But, in my opinion, the FUT standard is the Golden Standard and has been so since the day we first published the article on it 9 years ago. The reason that it is the golden standard is simply, it produces the best and most natural results possible.

Pricing does vary between medical groups and even within my medical group by doctor (my price being higher than the other doctor because of availability issues). I suspect that the quality of work in any one medical group should be consistent with doctors in that medical group. Dr. Pak, for example, does as fine work as I do as he uses the same staff and the exact same techniques. As you should realize, the crux of the quality of the work you get is tied to the staff as much as the medical group, something we proudly show off at our monthly open house events, where our patients come to meet with prospective patients.

For further reading, here are some past blog posts that I’d recommend:

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I Was Unaware of the Maturing Hairline Process – Hair Loss Information by Dr. William Rassman

Hello Doctor,

I’m 24 (male) and noticed my hair thinning around my temples and a bit in the very front less than a year ago. At first, I wasn’t accustomed to the new hairline and worried that I was beginning MPB. I was unaware of the “maturing hairline” between ages 19 and 29 and feel better knowing this. However, I recently noticed what seems to be minaturization in the front of my scalp. My hairline is still defined, but the hair in the front seems finer and a bit more separated (to me). I notice about 15-20 hairs coming out after washing and more coming out throughout the day. Could this be just a cycle, part of the maturing process, or the beginning of Type IIA. Also, I just began Rogaine Foam as a preventative measure and heard shampoo containing Panthenol without sodium laureth sulfate is good. Would Propecia be good to take or am I overreacting? Your thoughts?

Generally, I like to get a map of your scalp hair to examine for miniaturization and only prescribe Propecia (finasteride 1mg) if there is miniaturization present (meaning, if genetic balding is present). If there is no genetic balding, then there is no point to the use of Propecia. I am not certain if Propecia stops the maturing hairline from happening, but it probably slows that process as well.

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Laser Comb and Miniaturization? – Hair Loss Information by Dr. William Rassman

In the past you were evaluating the laser comb. What was your impression? Do you think the laser comb would have any effect on hair miniturization?

There is no evidence that I’ve seen one way or the other that the Laser Comb will help with miniaturization. I did review the studies on the Laser Comb on the product’s official website and developed some opinions worth reading. See Analyzing the Results of the HairMax Laser Comb for the analysis of the Laser Comb’s photo before and after results.

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Hair Loss InformationHow Can I Convince My Transplant Doctor to Refund My Money? – Hair Loss Information – Balding Blog

Hi

I had a hair transpland done in May of this year and i am very unhappy and dissapinted in it, since i had it done all i do is suffer becase the docotor that did it made it to high and is very rude when i tryed to tell him the problem
Im 22 years olds and came into the clinic with NW 2 hairloss, my hair stated to fall out and stoped when it became a ugly widows peek. I had over 800 grafts done and paid over $7.000 with little or no change in my hairline, the only difference is my hair is a little thicker behind my hairline. I tried to call the docter and tell him about it but he would not listen he was very rude and told me he is a doctor and he knows whats better for me. thats all got from him. I dont know what to do, this has made my life very bad, all i do is think about my hair and look at people with normals hairlines that did not have a hairtransplant and compare it to mine and it hurts to see that i spent over $7.000 with bad results.

Please tell me what i can do to convince the doctor to repaid the hair line. r to refund my money s i can find another doctor. If your intrested to help me i can send you the pictures if my hairline when you email me back.

thanks

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If your surgery was done in May, your results will just be appearing at this point, so you really do not know what you have achieved in terms of yield. From what you are describing, I am appalled at this doctor’s attitude and behavior. Disrespect and rudeness is intolerable, especially from your doctor. Understanding and compassion is what you should expect from him and his staff — nothing less.

First, please send me pictures, preferably at the 7-8th month (and please reference this post when sending). Then, armed with a candid opinion from me, you can decide what you should do. A doctor is not legally required to respect his patients, nor to treat them with dignity, but that does not excuse bad manners. Having hair transplants at 22 years old is a bit young and if the balding was very, very early, he may not have met the ‘Standard of Care’ in making the decision to offer you surgery. Did you try to treat your ‘hair loss’ with Propecia before you elected to have a transplant? Are you on Propecia now (as you should be)? You need to work out and fully document just what is going on here. Yes, you can ask for your money back, but there is no obligation for the doctor to refund it. You can write a letter to the medical board of your state and file a complaint with them, but it is better to get that message to the doctor first. If you are not comfortable to speaking with him, then you can set up an appointment and be accompanied by someone older and wiser who can speak with this doctor with an authoritative personality. If you get an opinion from me, and I agree with you that you were not treated with the ‘Standard of Care’, then I might even place a simple phone call to him on your behalf, but for that, I would need to be your doctor and we would need to meet somehow. Let’s start off with a picture at the 8th month post surgery and then go from there.

You will never see me run from being a patient advocate and my heart goes out to you. Doctors have the legal responsibility to produce a full ‘informed’ consent for your surgery. That means that it is his obligation to be sure that you understood what you were agreeing to and what he was going to do for you. If you did not communicate with him adequately, it is his responsibility (legally) to close the information gap. Assuming that his behavior is as you described, I would think that you have every right to confront him, but you might need some help. I am hoping that you will be surprised and find that your doctor is not the ‘bad’ person you believe and he will surprise you with compasion and caring. Let me hear from you.

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I’m Taking Propecia, But I’m Not Convinced I Am Balding – Hair Loss Information by Dr. William Rassman

Dear Dr.,
I have been taking propecia for three days and I’m now not convinced that I am suffering from male pattern baldness. If I stop taking the drug and wait to see if my hair starts thinning or falling out would starting propecia again work? In other words, would propecia still be effective after taking it briefly and then starting again in the future? i want to see if my hairloss is attributable to other factors. Also, I have no history of male pattern hair loss in my family. Many thanks for your thoughts.

If you are not treating genetic balding and have only been taking Propecia for 3 days, stop it now. If you ever need it, you can start it then. Follow the old adage: If it ain’t broken, don’t fix it.

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What Can I Take with Nioxin? – Hair Loss Information by Dr. William Rassman

Hi there. I am a 21 year old male that has experienced hair loss. I’ve always had wavy hair but at around 19 I started losing my hair and it reached Stage 2 on the Norwood scale. My hair stylist recommended Nioxin for me to use about 5 months after my hair started falling out. Since using Nioxin, my hair loss has either stopped or slowed down tremendously (not really sure) but no new hair has grown in. I have grown my hair longer and styled it so most people cannot tell that I have lost some of my hair. Since it has been 1.5 years since my first loss of hair, is there anything that I can take with Nioxin to help regrow my hair? What are my options? Thank you very much!

What you are calling a Norwood Class 2 pattern, I might call a maturing hairline, which is something common in young men of your age. The first 3/4 inch from the highest crease or the wrinkled brow is the juvenile component of the frontal look. Behind this first 3/4 inch starts what I call the mature hairline and if this is what you believe is a balding Class 2 pattern, then you are not balding at all — just developing the mature look.

If you are truly concerned about hair loss, you should want to see a doctor to have your scalp mapped for miniaturization. If genetic balding is present, Propecia (finasteride 1mg) would be a good choice, especially at your age. It is available by prescription only, but it is one of only 2 FDA approved medications for the treatment of hair loss (the other being minioxidil). As I have said previously about Nioxin, they make a good set of products that are popular but there does not appear to be anything in it to stop hair loss.