Author: Dr. William Rassman

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Alopecia on Tyra Banks Show – Hair Loss Information by Dr. William Rassman

hi my name is Tia and i am 14 for the last 2 weeks my hair has been falling out…then i watched the Tyra Banks show and this girl with alopecia was on…anyways it has been falling out alot like up to 45 pieces a day and i am really sacred i do not ant to go bald ….how do i tell what is wrong plz help me….

It is normal to lose 100-150 hairs each day for the average person. Unless you have some medical disease or have been losing a great deal of weight, you should not worry about it. I don’t watch the Tyra Banks Show, so I couldn’t specifically make references to things that were said on the program, but I did find this link about wigs shown during that episode.

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Clonazepam and Hair Loss – Hair Loss Information by Dr. William Rassman

I currently take a medication called clonazepam (0.5 mg) once or twice daily as a muscle relaxer. I have been taking this medication since I was 19 or 20 (I am now 28). Could this be a cause in my thinning hair? I do not have a history of men or women balding in my family. My father has a full head (really full) along with both my grandfathers. My hairline is moving back more each year and my hair is all around is thinning and i am extremly worried. I do have a large amount of stress in my life and always have…but is it possible that hair from stress can grow back? I am extremly frusturated and baffled as to why my hair is thinning…If it is the medication, I am willing to get off of it with the consent of my doctor.
Thank you for your time.

Many drugs can cause hair loss, including Clonazepam. Before considering a drug as the source of your hair loss, you should also consider other medical causes. You should see your primary care doctor for a good examination and possible blood work to find a possible medical cause.

In address to the relationship between stress and hair loss, it is well known that stress can accelerate genetic hair loss as it unfolds over time. You discuss the movement of your hairline higher on your head, so I would wonder if this is the normal recession of maturing found in most men (the hairline goes up about 2/3rd inch in the middle and 1 or 1-1/2 inches in the corners). Sounds like you need an expert to evaluate the hair loss as well as your family doctor to assess your medication routine. The question an expert will is address is if you have a genetic component adding to the other factors causing hair loss or are you just seeing a maturing hairline in development. As you indicated you are in Los Angeles, you are invited to visit my LA office for a free consultation. You can call 800-NEW-HAIR to make an appointment, or request additional info via the NHI site.

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How Would New Products for Hair Loss Work? – Hair Loss Information by Dr. William Rassman

Dr. R,

First off i want to say what a great site you have created. With all the nonsense out there on the internet, your site differentiates itself as being very informative and a trusted source for MPB.

A recent post said you were aware of two new drugs that are in the works to combat MPB. I understand there is a confidentiality issue, but is there any insight you can give as to how the product works and a possible viable timeline? I am aware of the length of drug approval from the FDA (5-10 years is your estimation) but a new product has not been released since 1997. Nearly a decade later and there doesn’t seem to be any progress which concerns me greatly. I am sure these drug manufacturers are aware of the multi billion dollar market there is yearly in the fight against MPB. If for nothing more than to make money, shouldn’t these companies be attacking the market as aggressively as possible? Those are just a few thoughts. Please get back.

Regards

The answers to your questions are almost impossible for me to relate them to you. On one of the drugs, the effect was found as a side effect of its use for treating another disease. Once they found that the same medication grew hair, they move it into a topical and speculated on mechanisms of action (looking for the science). One of the drugs is already in a clinical trial in another country and early indications have shown great results. The researchers told me that there were a few hundred people put into a double blind study and although they did not know who was on the topical medication and who was on the placebo, they did note that half of the people who were coming back for hair counts had good hair growth while others had none. They assumed (probably correctly) that what they were looking at was a remarkably strong hair growing medication. Until the study is complete, we will not know for sure, but the entire science will have to be understood and toxicology studies will have to be in hand in thousands of patients before the United States FDA will allow the drug come to market. Sorry, that is all I can say. Coming to market: A few years at the least, I would suspect.

It is interesting that minoxidil was first used as a medication for high blood pressure. It worked poorly and without consistency for blood pressure control but did grow hair on many men and women who took it systemically. As the drug already had some safety and other toxicology data, the move to a topical for hair loss was a bit easier. Propecia was originally used for men who had urination problems, but when taken for the prostate, some men grew hair. Again, another discovery by serendipity. Could you imagine what we would get if we found out about drugs by intent rather than serendipity?

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I Urinate Frequently When Taking Propecia – Hair Loss Information by Dr. William Rassman

After taking a propecia tablet. I urinate frequently. It seems I can’t control my bladder. This may seem like a strange thing to say but my penis looks smaller. Almost as if it is shrinking. I can’t get erect because I feelnothing. Should I stop propecia?

Free showerLet me get this straight:

  1. You cannot control you bladder.
  2. Your penis is shrinking.
  3. You cannot get an erection.
  4. You cannot feel your penis.

I would be at my doctor’s office now if these were my complaints!

If you are noticing increased urinary frequency (polyuria), you may have other serious medical conditions such as diabetes which can also produce neuropathies that can change your feelings from sensory nerves. You should definitely follow-up with your primary care doctor or the doctor who prescribed you the drug Propecia. I have never heard of a shrinking penis caused by Propecia nor any of the other symptoms you mentioned in combination.

The “take home message” is you need to go SEE a medical doctor.

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Should I Take Breaks Between Minoxidil Treatments? – Hair Loss Information by Dr. William Rassman

Dear Dr Rassman,

Thank you for this informative blog and your dedication to answering our balding questions.

My question is regarding rogaine or minoxidil and its effects after you have a break after several years of treatment. I for one am 25 and have used minoxidil 5% since I was around 22. My barber here in New York told me that for Minoxidil not to lose its long term effect it is good to have a break after a few years and then go back on it again so to keep its effectiveness. Is this true?

I for one listened to his advice and stopped using minoxidil 5% for three months and I could see an increase in hair fall out after two months specially in the templar areas where I had gained a lot of new growth. Now my second and more important question is will I once again benefit from using the minoxidil again? I went on minoxidil about 6 weeks ago again but havent seen any results yet.

so two questions:
1) Is it good to have breaks in minoxidil treatment?
2) Will the effects of the minoxidil come back after restarting the treatment?

Breaks in the use of minoxidil are disasterous, as you have already seen. So the answer to your first question is unequivocally, “no”. The hair may come back if your ‘rest’ period is under 2-3 months. Read elsewhere on this blog about Propecia and its appropriateness in young men losing their hair. Get a diagnosis and proper treatment.

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Tidbits: Prostate Cancer – Diet, Genetics, and Finasteride – Hair Loss Information – Balding Blog

Israel Medical AssociationIt is important for our largely male readership to understand that we will all confront prostate cancer if we live long enough. We can modify our genetics by a dietary focus (e.g. vitamin D & vitamin E may reduce the risk of prostate cancer while diets rich in fat may increase the risks), and the use of such medications as Aspirin (they call this in the class of NSAIDs), and finasteride (we use it as Propecia or Proscar) daily will clearly impact risks.

The following article may will shortly be published in the Journal of the Israel Medical Association: Harefuah. 2006 Jan;145(1):47-51, 76-7. Related Articles, Links [Nutrition and pharmacological treatment for prevention of prostate cancer], Article in Hebrew, by Segev Y, Nativ O., Urology Department, The Bnei Zion Medical Center, Haifa. Isreal.

Here is an abstract of the article:

“Prostate cancer is the most common neoplasm and the second cause of cancer death. It is an excellent target for primary chemopreventive strategies for the following reasons: it is highly prevalent and has a long latency period, there are identifiable risk factors and a precursor lesion and it produces a biochemical marker (serum PSA) which can serve as an intermediate end point in chemoprevention studies. The goal of primary prevention strategies is to prevent development of clinical life-threatening neoplasms in asymptomatic patients with no evidence of clinical disease. Identification of populations at risk for developing cancer is the cornerstone of chemoprevention. Well-established risk factors for prostate cancer include African-American race, older age and family history. Data on diet and obesity are less clearly defined. Since high grade prostatic intraepithelial neoplasia (PIN) is an early predictor of prostate cancer, preventive strategies focusing on men with high grade PIN are being explored. It was demonstrated that finasteride could significantly reduce prostate cancer in asymptomatic men with normal PSA and no abnormalities on rectal examination. Elevated prostaglandin levels, and upregulation of cyclooxygenase-2 (COX-2) are found in prostate cancer cell lines. There is some epidemiologic evidence that regular use of NSAIDs, which inhibit COX-2, may be associated with a lower risk of prostate cancer. In the field of nutrition, data from prospective large-scale studies demonstrated that increased consumption of lycopene-rich tomato-based foods referred to a reduction in the risk for prostate cancer. Vitamin E was also found to reduce prostate cancer risk. Prospective data showed that vitamin D has an inhibitory effect on prostate cancer development while increased calcium consumption, independent from dietary intake, might increase the risk. Dietary fat intake, particularly from animal sources, may also increase the risk for prostate cancer. Whether this effect is strictly due to the already identified compounds or to other compounds, remains to be explored. Further study will hopefully help to establish a core set of nutritional and dietary factors that can positively or negatively affect prostate cancer development, as well as a set of pharmacologic agents that can reduce the risk of prostate cancer development and/or progression in selected patients.”

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Hair Loss Around Donor Scar After Hair Transplant – Hair Loss Information by Dr. William Rassman

Dear Dr. Droctor,
I am 3 weeks out of a hair transplant and just experienced a telogen effluvium episode(shock loss) on the area surounding the scar on one side of my head. The affected area is about 2-3 square inches. Have you ever heard of such post traumatic patchy hairloss? is this common? and is all the hair automatically back after a while? same thickness?
For this particular case, would you suggest a treatment?

Thanks in advance for your answer… I’m a little bit worry.

You should ask your doctor first. Hair loss after a transplant in balding men in the recipient area is often not reversible, but if it happens in the donor area it will frequently return in 2-5 months. Good before and after pictures will help make the assessment for the recipient area. If you are young man (under 35), then you should have been on Propecia which does protect against the hair loss induced from surgery in the recipient area.

I am assuming that what you are talking about is hair loss around the donor wound. When this occurs, it is often the result of wound tightness with the surgical closure, but it can happen to almost anyone. You must wait out a period of between 2-7 months before you will know. Returning hair growth may occur over a long period of time.

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Scalp Itching – Hair Loss Information by Dr. William Rassman

I have experienced pruritus mainly to the crown since I was a teenager. I have used all types of products, prescription and OTC, including Nazoral, Neutrogena products, etc. The only one that I have found to be efficacious has been Neutrogena T-Gel. It stinks (literally), it produces sun sensitivity, and it dries my hair. Do you know if continuous daily use of this product will impact my health? I have heard that chronic exposure to coal tar may cause cancer. I do appreciate your professionalism and your desire to help those of us who have issues with the prospect of balding.

You might try hydrocortizone cream (0.5%) applied two or three times a week to the scalp. It should not be used more frequently than that, because it could be absorbed with high doses. If you keep its use down to two or three applications directly to the area every 12 hours for 2-3 applications, you might find that the problem will disappear. What you are calling Pruritus may actually be other conditions, and a dermatologist might give you the diagnosis you need.

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Why Did I Start Balding at Age 15? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,
I am a twenty-seven year old man, and I began to lose my hair at age 15. I went to several doctors when I was younger but they all told me the hair loss was male pattern baldness and not the result of any health problem. I am already as bald as my father, who is thirty years older than me.
When someone begins to lose hair at the age I began to lose mine, will the baldness progress until all of my hair is gone? Will I ever be able to use a hair transplant system? And what the heck would cause my male pattern baldnes to start so early anyway?
Thanks.

Don AmecheAndrogenic hair loss or male pattern hair loss starts as males enter puberty, as their testosterone levels increase, bringing on voice changes and pubic hair and other male sex characteristics. Although it is usuual to start the genetic process at 15, the DHT is clearly working on young men of that age. There is an issue of ‘gene expression’, which means that the trigger for the gene may have started early on you. Unfortunately, some men have the gene that causes male pattern hair loss to trigger earlier, while others do not see this until later in life. For example, Don Ameche, a popular old-time movie star in the 1930s and 40s known for his perfect hairline and good looks, started to bald after the age of 50 (late onset trigger for gene expression) and was almost completely bald when he was in his mid 70s (and starred in the movie Cocoon in 1985).

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