Author: Dr. William Rassman

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Dry Skin Build-Up on Scalp

Dr Rassman,
I am 24 years old and have been experiencing hair loss since last Sept. I have been on Propecia since Oct. and have since seen less shedding and some slight improvement. What is the most distressing is that I have diffuse thinning all over the top and crown of my head and, most terrifying, no family history of hair loss. My question is this, I have a lot of material build up in my scalp, what I think is white, dry skin, or it could be i’m just not washing my hair thoroughly enough, whatever it is, it’s very noticable and when i try to brush it out, hair sheds along with it, especially when I try to style hair in the front and on the bangs. I have been using T-Gel and the amount of build-up is less however there is still some on the scalp. Is this affecting my chances of hair regrowth? And do you have any recommendations?
Thanks

Sorry, I cannot diagnose your condition over the internet with just descriptions. You need to see a doctor who specializes in hair (like hair transplant doctor) or a dermatologist if you feel you have a skin problem.

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DUPA and Body Hair Transplants?

Are people with DUPA candidates for a body hair transplant?

Body hair transplants (BHT) are not considered a standard method of hair transplantation and may not give you a normal amount of bulk. I realize some doctors perform BHT with success (depending on how you define it), but the visual appearance of the hair that grows is clearly not normal. Body hair simply does not grow like scalp hair and is not the same texture.

In my opinion, even if you are desperate for hair, I would be cautious with this approach and demand to see patients who have had it done before you agree to such a radical approach to your DUPA problem. Any surgery can make the situation worse, and that risk is real.


2010-12-14 12:22:03DUPA and Body Hair Transplants?

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Drs Rassman and Pak Take Propecia

I just have a quick question,

I know that both you, and Dr. Pak have used, respectively, several of the treatment options that you recommend. Why don’t you use before and after pictures of yourselves to disarm the pessimists, while at the same time making a very compelling case as to why you feel so strongly that finasteride is the strongest treatment option available at this time?

The only oral medication that has been FDA approved for treating genetic balding in men (androgenic alopecia) is Propecia. So as the default, I guess it is the “strongest” medical treatment option at this time. This does not mean it will reverse or cure balding. In fact there is no cure! We are physicians. We prescribe medications based on scientific evidence as well as clinical evidence we see day to day. In the end the consumer (the patient) has the choice to take this medication, but he should consult with the prescribing doctor instead of strictly reading Internet postings that may (or may not) be true!

As you mentioned both Dr. Pak and I have personally taken Propecia daily (as well as our family members and friends) without any of side effects. Neither of us has seen dramatic hair growth, but we haven’t seen dramatic hair loss either. In the end, you are looking at the after pictures (on the right). Ultimately though, we cannot satisfy everyone. If you think something bad will happen, then it just may. The power of suggestion can be quite powerful. If you think the medication will not work, then its your choice to simply not take it. We’re talking about hair loss here, and as important as hair is to many men, it isn’t a death sentence if left untreated. We’re educating and informing about a proven treatment and I’ll leave disarming pessimists up to the drug manufacturers.


2009-03-10 10:53:37Drs Rassman and Pak Take Propecia

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DUPA and Aging, are they the same?

Are Dupa (Diffuse Unpatterned Alopecia) and Age related thinning the same condition, just that the former name is applied if it develops in a young person whereas the latter name is applied when it develops in a person of advanced age?

No, these are not the same. DUPA usually has miniaturization well over 50%, if not 70% or more, while aging expresses itself in two manners, (1) Age Related Thnning. This appears with thinning of the hair shafts that are universal and uniform of (2) loss of hair follicles in the follicular unit. This appears as a drop in total hair count per follicular unit and the entire head.

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DUPA (Diffuse Unpatterned Alopecia) and genetic balding

I was wondering if someone who started with DUPA can later on develop male pattern baldness in there life? i have a second question if i may? In those DUPA patients who react to finasteride, was their progression moving faster than who did not react to finasteride?

We really don’t understand DUPA but yes, I have seen people with genetic balding who have DUPA, so the reverse is highly possible.

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DUPA and Propecia

In earlier posts you mention that half of men with DUPA receive benefits from propecia, but in more recent posts you seem less certain. In the past few years have you seen DUPA patients receive worse results with propecia, causing your optimism to diminish?

Also, you mention that propecia MAY have a better chance if the underlying cause of DUPA is genetic-what does this mean? In your experience, does the presentation of DUPA differ when “the underlying cause is genetic”?

(My brother, only two years older than me, is losing his hair in a traditional MPB fashion, while I am experiencing DUPA in a presentation similar to FPB). Any insight, at all, would be helpful. Thank you.

With more and more exposure to diffuse unpatterned alopecia (DUPA) patients, I am less convinced that Propecia works for them. If there are no side effects seen though, maybe there is value in taking it. Other industry experts tend to have adopted that view as well.

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DUPA and Propecia

hello i have Diffuse Unpatterned Alopecia (DUPA) and was wondering if propecia worked for me would it thinken the existing hair or would it have to shed and grow again as a new hair? and if possible could you tell me how long i’d have to wait to see if the propecia was working for me?

Propecia works by blocking DHT effects on scalp hair that is affected by male pattern hair loss (androgenic hair loss). Hair loss from DUPA (diffuse unpatterned alopecia) is not related to male pattern hair loss and it may not be affected by DHT. Thus, Propecia may not work, but it is the only drug that can be used. That being said, some doctors (include me in this group) will prescribe Propecia to patients with DUPA in case there is an underlying androgenic component to hair loss. In some patients with DUPA, I have seen improvement with Propecia.


2007-07-10 13:33:10DUPA and Propecia

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Dutasteride and length of side effects

I recently discovered that Dutasteride has a half life of 4-5 weeks. I am considering getting off of Dutasteride (daily usage for about 3 years) completely because I feel like it is heavily contributing to my anxiety (timing is very similar). I am on no other hair loss remedies currently but have had one temporal area hair transplant. If I discontinue Dutasteride or take it less frequently, what therapies seem to be working for people nowadays? With such a long half-life, couldn’t Dutasteride hypothetically be taken once a week or potentially less and maybe still have similar results?

In theory, you are correct; with a long half-life, one would expect that a once-a-week dosing might be enough, but for reasons I personally don’t understand, dosage recommendations have been more frequent. As the FDA has not cleared dutasteride for hair loss use, this is a real problem for doctors, i.e. to find the correct approved dose. The blood levels may have a half-life of 4-5 weeks, but the tissues in which the dutasteride is embedded have a much longer presence in your body that could go up to a 1/2 year or more. That means if you get side effects, it may be a long time to get rid of them because dutasteride is in your tissues 6 or more months.

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Dutasteride and depression

Hello dr rassman Im from south korea and i ve heard about you from NHI in korea I ve took finasteride for over 10years with out side effects 2month ago i started dutasteride After 5-6weeks i felt depression. First time in my life. 8 weeks i finally give up taking dutasteride to go back to finasteride. Now its almost 10 days and still have depressive mood. I’m wondering is it ok to maintain finasteride 1mg untill dutasteride half life ends (i know its 5weeks)

The drug dutasteride will last a good 3 months or possibly more as there is tissue fixation that also occurs. Six weeks is the blood/serum half-life. Be patient.

 

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Dutasteride dosing

I was reading up on a few dutasteride studies and was curious what your thoughts were about the recommended dosage of dutasteride given it’s rather extended half life.

https://academic.oup.com/jcem/article/89/5/2179/2844345 for example.

Clark noted that the DHT suppression in patients after drug cessation for .5mg dutasteride only had a minor deteriation after 2 weeks with greater DHT in the following weeks, and I’m just wondering what the medical benefits would be from continuing on the recommended .5mg daily when there doesn’t appear to be a specific clinical benefit?

Just curious, not taking this as medical advice. I just have questions and no friends in medicine to ask.

This is a complex issue. Do you really want a 94% or high reduction of your DHT? The article indicates it is possible with dutasteride. The recommended daily dose is .5/day, but I suspect that same benefits might be reasonable at a dose of once a week but since I do not prescribe this medication, I would rather not weigh in on the dosing issue. Most articles I have read indicate that the DHT block is 85% with dutasteride and 70% with finasteride