Author: Dr. William Rassman

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CoQ10 and Finasteride

Dear doctor, this site has been helping me and guiding me a lot about hair loss. I suggested my brother to start Propecia 3 years ago and with doctor’s prescription he started it and has really been doing very well. Propecia controlled his hair loss and he even got some reversal. He was very happy about it till 2 months ago, where he was prescribed COQ10 by one of his endocrinologist. He started reading all kinds of information regarding COQ10 interactions with finasteride and found this article.

He became so nervous about parathyroid tumor they mentioned in that web site. He is blaming me for suggesting such drug to him now. He has been taking Co-enzyme 10 since 2 months and is worried a lot whether the parathyroid tumour has already started. Please please help him with his anxiety. Do they really interact with each other? What is the solution for such problem.? Your reply will help him get rid of his anxiety.

The COQ10 interaction is news to me. Although I doubt a parathyroid tumor connection, if that is one of his worries, he should seek medical attention to calm his fears. Parathyroid tumors can be diagnosed if he has one.

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Could a Traumatic Experience Cause My Transplanted Hair To Fall Out?

Have you ever had or known in your experience of a man having a hair transplant and everything was going wonderful for the first six or seven months and then a traumatic event reversing things? My age is 62 and I was doing well until I started having severe stomach pain at about 6 months after the procedure.

I guess I passed out and was taken to the hospital unconscious. I had to have a transfusion of a small amount of blood. I had a stomach aneurism and almost died. I had to have some metal clips placed in my stomach so I had to have general anesthetic. Could this event have caused me to lose a lot of my transplanted hair? I seem to be losing more all the time.

I’ve been taking iron pills because I’ve been told that I’m anemic. Is it possible that the implanted hair could be coming out due to this incident? If that is true do you think my transplanted hair will ever grow back again once I regain my full health again? I have asked my surgeon these questions but feel like I’m gettin the “run around”. My surgeon has recommended that i start taking propecia or rogaine. I did take propecia for at least a couple months before my surgery and about 5 months afterwards. I did have some sexual side effects with the drug so was told that I had taken it long enough.

It has been 10 months since my surgery and I am feeling like I went through all this and may not end up with all the hair I had after about 5 months after the HT. Could you give me your thoughts and feelings on my story because I read your column frequently and I do respect your opinion. I would be willing to have another HT if you think that would be the answer to this mess. I had 2400 implants the first time. Thanks for your opinion.

It sounds like you are lucky to be alive. We do know that stress can cause hair loss and I guess it could delay the growth of your new hair for 10-12 months, so all may not be lost.

Most people who lose hair after a traumatic event, will lose their non-transplanted native hair, but I have heard and have seen some patients lose their transplanted hair some 3-5 years after the transplant was done. We say that transplanted hair is permanent, but that is a general rule… and all rules can be broken.

Your hair growth is clearly delayed, so I would wait out another few months and see if the Rogaine helps. I am assuming that your transplant doctor knows what we/she is doing and generally gets good responses from the transplants he/she performs.


2013-03-04 10:49:03Could a Traumatic Experience Cause My Transplanted Hair To Fall Out?

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Could Alopecia Areata Evolve to Totalis or DUPA?

I have been recently diagnosed with alopecia areata (one spot) and have had several HT session in the past. Recently been under a lot of work related stress. and my hair has been thinning all over event in the safe zone (I am 48 Years old). And the back of my scalp has a see thru appearance. So I am wondering if this is diffuse alopecia areata that could evolve to alopecia totalis or DUPA since my donor area is very thin?

Anything is possible, but not probable. Alopecia areata without any treatment often will resolve over time (which can take up to one year).

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Could a Fungal Infection Mimic a Norwood Classification of Baldness?

Does fungal infection if not treated mimic Male pattern baldness say (norwood 5)?. Could u explain types of infections or fungal infections in general a little better?? would we see hair loss in patches or one might start losing hair from the front due to infection to all the way back? if treated do these conditions reverse back to having a full head of hair??

Simply put, if you let the fungal infections go on for years, it might look like patterned hair loss to the inexperienced eye. For more on fungal infections, see Wikipedia – mycosis.


2007-09-13 09:31:25Could a Fungal Infection Mimic a Norwood Classification of Baldness?

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Could a Little Sun Each Day Damage a Hair Transplant?

I received a hair transplant about 5 months ago on a norwood 3/4 scalp. I have been told that I should begin looking for regrowth between now and the 5 to 8 month mark, so I realize I am just at that point. My question is, given that I use minoxidil and wear a hat for any prolonged sun exposure, could very light sun exposure on a hatless head, like 5 or 10 minutes total a day, have damaged the transplanted follicles? Thanks for the help.

No, I highly doubt 5 to 10 minutes of sun exposure will damage the transplanted follicles. The UV rays from the sun can however discolor your scalp wounds immediately after a hair transplant. It wouldn’t have much effect on the follicles. I would follow up with your doctor.


2008-06-17 11:58:08Could a Little Sun Each Day Damage a Hair Transplant?

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Could Aggressive Styling Cause Uneven Hairline Maturation?

Dear Dr Rassman

I am a male in my early twenties with extremely fine hair (which tends to get curly/wavier as it gets longer) and so I tend to have to style it aggressively to make it look the way I want (i.e. make it look straighter, imitating coarser hair). This usually involves blowdrying and hairspray, and combing through with a wide-toothed comb, even after it has gone ‘hard’. Sometimes this involves straightening too. I’ve done this for years without worry, though a few years ago I did notice my hairline was moving up a bit (when I was around 19), and in my panic I consulted the internet. I found the concept of ‘mature hairline’ and was reassured. However I’m not sure if this type of aggressive styling could be causing it to develop prematurely or unevenly (since the left side has indeed risen higher than the right – though I know you say this isn’t completely unusual), or lead to some patchy baldness.

On hairspray, it seems as though you advise people with any form of alopecia to avoid rough brushing lest they make hair loss worse: Hair Spray and Hair Loss

Is it otherwise okay for people without alopecia, so long as it is not extremely rough? It seemed okay before I noticed some recession, but now I am concerned about styling practices when I know my hairline is changing. I would hate to inadvertently cause some form of hairline or uneven progression. Will hairs that are pulled out grow back fine so long as the trauma isn’t severe?

First, you need to be evaluated by an expert in hair. You can try to quantify the degree of thinning by measuring hair bulk throughout your scalp to see if there are components of genetic hair loss present.

Yes, you are right, people can damage their hair from aggressive styling (extreme form is traction alopecia from tight braids), but I don’t know exactly what you are doing in this regard. Generally, I tell people to be gentle with their hair when styling and use only good grade commercial products for grooming.


2013-04-19 11:18:19Could Aggressive Styling Cause Uneven Hairline Maturation?

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Correction – Propecia is Like Testosterone?

hi, doctor in one of the topics you said propecia is like testosterone. here is the link

I thought finasteride wasn’t a steroid hormone.

Thank you for pointing that out. It was an error in our part, and I guess it went unnoticed for nearly 6 years. It should have stated DHT (not Propecia) is like testosterone in that it is one of the male hormones.

We have corrected it. Sorry for the confusion.

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Could FUE Make My Linear Non-Transplant Scar Worse?

I have a small, linear non-transplant scar above my ear. It has healed pretty well, and is looking more and more like normal skin each day. I’ve been thinking about transplanting hair into the scar by an east-coast doctor, about 100 grafts is my guess. If this were to be done with FUE, is there a huge risk that the scars produced from such a small FUE procedure will be worse than my linear scar? I want to be able to wear a buzz cut (somewhere around #2) as I believer my hair is thinning and short hair is a better look. Should I be very worried about moving just 100 grafts from the back of my head into this scar to minimize it?

Follicular unit extraction (FUE) is a good way to fill in a scar, but not all FUE is the same. Different doctors use different techniques and instruments. As long as the FUE instrument is less than 1mm (ideally 0.8 of 0.9mm diameter), you should be OK.

I am flattered you would ask me, but I would ask this question to your doctor since you need to trust the surgeon that will be performing the procedure on you!

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Could FUE Move Hair and Skin to Eliminate Scarring?

Dear Dr Rassman, please excuse my question if it is stupid. I’m not medically trained!

What is normally discussed is the movement of hair follicles *from* the donor site *to* the recipient site. And this inevitably leaves some form of scarring in the donor area. But is it technically possible (in FUE) to also implant skin *from* the recipient area *to* the donor area, in such a manner to “eliminate” scarring? i.e. for every follicle the surgeon would swap tissues A and B, where A would be the tissue originally at the recipient site, and B the tissue originally at the donor site.

I’m sure this would be more costly for the patient, buy I’m wondering: has this ever been tested? And would it eliminate scarring?

A number of years ago, a well-known doctor preached that small punch extractions of scars would produce “mini-scalp reductions”. It never worked. This sounds like what you are asking about, and if one removes scar from a scarred area, you just get scar to replace it. Not such a good idea.

By the way, there are no stupid questions. Your question reflects an inquiring mind.

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Could Gabapentin Be Responsible for My Female Hair Loss?

I have been taking gabapentin for years and just started to notice increased hair loss, more than would come out naturally. I’ve had chemo and all my hair came out, but that was about 6 years ago and my hair came back, but not all the way. A lot of women told me that when their hair came back it was their natural color, most women color their hair so didn’t even know what their natural color was, plus their hair came back thicker and glossier. They were all delighted.

Mine didn’t come back like that. I was taking gabapentin then and ever since. My hair came back weak, very fine, some gray in natural ‘mouse brown’, limp, awful looking and very easily broken. It was workable but I didn’t really notice it being really thin. Just in the past year and a half it has really been disappearing. I’m now wearing the wigs I used when my hair all came out with chemo.

I’ve had both knees replaced, one last July,2011 and the other last January, 2012. I thought it might have been caused by the anesthesia or the high doses of demeral? or the oxycodone I was taking for back pain. Also, beside the demerol? in the hospital the first time and then morphine the second time. But I don’t take any of that stuff since about April, 2012, around eight months ago and my hair seems to be coming out worse now. I’ve checked out all of those drugs and none of them seem to have hair loss as a side effect. Then I accidentally came across this blog and I have been enlightened. I never would have thought of gabapentin, but it sure makes sense. Is there a different medication to take the place of gabapentin? Someone help me out here?

I’m female, 64 years old, some baldness in the male side of the family, none on the female side. I take gabapentin, prilosec, atenalol?, effexor, Flexeril, Claratin, metformin, and Lantus, oxycodone/acetaminafen? when my back goes out. I take a multivitamin, vitamin C, magnesium, and iron beside the other prescription meds. What am I doing wrong? Can I be helped?

I really think you should see your doctor for your issues. Based on your medication list, you have a significant number of medical issues. You cannot just point to one drug as the source of hair loss. I wish it was that simple, but it does not work that way. In most cases the medical condition itself may be the cause (not the medication). Your issue is beyond the scope of a simple blog post. Sorry.