Author: Dr. William Rassman

Hello Dr,
I found this new article from India Times that says dandruff is a hair loss cause. You said it wasn’t.

IndiaTimes.com

This reads like a brief article with bits of truth and bits of confusion all mixed together. I would doubt that this was written as a means to educate by someone who is an expert. The term trichoanalysis (or as the article calls it, Tricho Analysis) indicates the analyzing of hair (tricho) which is really not informative on any level. Look at one of my recent posts on dandruff for the real scoop — What is Dandruff and Why Do I Have More of It Than My Friends?

I developed an infection and met with my doctor who put me on antibiotics. It seemed to get better. I am worried about it harming the grafts in the recipient area. Is that a problem?

It is hard to tell from the pictures if the infection is under control but your doctor will tell you that and you should see no significant pimples or redness. If the infection was promptly treated, it will not harm the grafts. The good news is I see early growth already.

This patient’s recipient area became infected and had this been my patient, I would have drained these infected cysts and place the patient upon antibiotics. I would have cultured the cysts to be sure that the antibiotic I would use is the correct antibiotic. If this infection is not treated quickly., the infection could kill the transplants.

Dr. Rassman’s Comments: There is some good reading here for those interested in finasteride and the many finding of things that go wrong with this drug. One of the referenced article reflect a single case study and show DNA damage to sperm. From any single case study, one can’t conclude that the finding is attributed to finasteride as discussed by the authors. Another article address high grade prostate cancer risks with finasteride and found nothing to suggest that it is a cause and effect. Still, these articles are not authoritative and do not stand alone.

This is a follow up from

https://www.reddit.com/r/tressless/comments/f4hnuy/my_trip_to_the_derm/

Once again I am not a medical professional or giving advice.

Basically I’m in my late 20s and have had some thinning and recession, this has gotten worse despite several years of using minoxodil 5% with good compliance. I also use Ketoconazole 2% shampoo (usually daily). I think they both help, but it’s hard to prove.

So I’m looking into propecia/finasteride. I have the pills with a derm. prescribing 5mg stating that the higher dose is more effective than 1 mg.

I saw a urologist the other day about sexual and in particular fertility concerns prior to using finasteride. Honestly the fertility worries me more because I would like to have children down the road but fertility problems aren’t always known until one attempts to conceive. I feel that if one gets noticeable (like erectile dysfunction) side effects, discontinuing the drug is likely to lead to a recovery whereas keeping on the drug for years seems more likely to impair recovery. The Dr. seemed open and candid about side effects overall and discussed both sexual and psychiatric side effects. He stated that the causation of effects was hard to determine given the number of different reported effects and how many things could cause them. He seemed to think that for how often the drug is prescribed side effects aren’t super clear. He stated that fertility effects were “usually” reversible. He also felt that 5mg was too much and referred me to another derm. (who he said takes finasteride himself).

It says right on the finasteride pamphlet that fertility might be effected. I’ve read some studies that have shown a reduction in sperm parameters in some men, typically reversible. This one is probably best https://academic.oup.com/jcem/article/92/5/1659/2598215 , it states that;

” Some individuals (approximately 5% of the subjects on active treatment) demonstrated greater sensitivity to the effects of 5?-reductase inhibition, with decreases in total sperm count to less than 10% of their baseline values during treatment. “

and

“Partial to nearly complete recovery was observed during the follow-up period for total sperm count and semen volume. Of particular note, approximately 5% of individuals on active treatment showed dramatic declines in total sperm count during treatment, although they demonstrated recovery in the follow-up period. The overall impact of these findings on fertility is currently unknown. “

But even that doesn’t tell the whole story. In particular sperm can be visually (by microscope) OK but have damage to the DNA “fragmentation” that causes the cell the either self-destruct “apoptosis” (although I would think this happens early in spermatogenesis), lead to a miscarriages as the human body effectively aborts a fetus with problems, or result in a child carrying/with a mutation. The sperm (or mother through mechanisms I don’t understand well) can sometimes fix the fragmented DNA. I believe this fixing ability deteriorates with age.

DNA fragmentation is associated with older fathers and I believe is why they are associated with offspring with disorders like autism, Down syndrome, and schizophrenia. A high rate of DNA fragmentation is associated with overall difficulty in conceiving and there are at least a couple of case studies of men who discontinued finasteride and had fragmentation levels improve dramatically.

(Articles below)

So, my opinion is that finasteride might effect fertility and this effect is likely reversible. I do feel however that there is a real risk. If I’m one of the 5% with a huge drop in fertility and I take the drug for I dunno 10 years, maybe it’s not so reversible, or some of the less detectable factors don’t fully reverse. It seems odd to me that fertility isn’t a bigger concern with this drug when prescribed to young men.

https://link.springer.com/article/10.1007%2Fs11255-012-0315-9

Herein, we present an unusual case of secondary infertility after prolonged use of low-dose finasteride for androgenetic alopecia in a 40-year-old man. We detected sperm DNA damage in the patient. Despite such a long-term use, we observed that impairment in semen parameters and sperm DNA fragmentation index regressed after the drug was discontinued. Consequently, pregnancy occurred and resulted in live birth.

https://www.ncbi.nlm.nih.gov/pubmed/21292254

To report a case of low-dose finasteride-induced secondary infertility with associated elevated sperm DNA fragmentation index (DFI) and otherwise normal semen parameters.

Case report.

University hospital.

A 48-year-old man on low-dose finasteride and his 37-year-old wife with normal menses and normal gynecologic exam.

Determination of sperm DFI and discontinuation of low-dose finasteride.

Sperm DFI.

The sperm DFI done a year earlier was 30%. This value was unchanged when repeated 2 months later. The patient was advised to stop finasteride. Three months after discontinuing the finasteride, the DFI decreased to 21% and subsequent DFI after another 3 months improved to 16.5%. To date, there is still no documented full-term pregnancy or live birth.

The significant reduction in DFI within 3 months of finasteride cessation and continued improvement suggests a causal link between finasteride and sperm DNA damage. We hypothesize that low-dose finasteride may exert a negative influence on sperm DNA integrity, resulting in increased pregnancy losses. We suggest that in infertile men using finasteride, sperm DFI should be measured in addition to semen parameters, and a trial of discontinuation of finasteride may be warranted.

Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

You will not know if the hair will grow back until the hair cycle time has passed, which is usually between 4-7 months from the onset of the infection. If it does not grow back, then another hair transplant into this area should grow.

I am a cosmetologist and have been so for over 25 years. I’ve been doing extensive research on hair loss for several years. Recently I’ve been experiencing hair loss myself. I have rosacea, the kind that results in acne like bumps. It creeps into my scalp also. After finding out that I have an inflammatory condition found in my lungs, it’s all starting to make sense. My pulmonologist is drawing lines connecting imflamation in my skin and scalp to this. Many people who have acne or other inflammatory conditions also experience hair loss. This is believed to stem from inflammation brought in by either infection, autoimmune disease or allergic response. I have rosacea and hairloss. I’ve not taken any oral antibiotic for this although it has been prescribed (minocyline) . This drug is used to treat inflammation, not so much as an antibiotic. I’ve used metrocream on my face with no great results. My dermatologist switched me to soolantra andnit and is working wonders on my breakouts and redness. She says this cream works to fight against the allergic response to skin mites. So interesting that the inflammation is due to an allergy. It’s probably also in my scalp too. If you have an inflammatory skin condition you most likely also have the same in your scalp. Because the cycle of the hair growth and shedding, you might be experiencing the loss a while after the inflammation began at least 6 months or so. I’m curious how many of you have experienced other inflammatory problems like IBD, joint pain, high blood pressure.

Thank you for writing. There has been microscopic evidence that some inflammatory process is present in female hair loss. We also have seen many autoimmune conditions such as FFA, LLP, Alopecia aerata, etc. that are known inflammatory autoimmune diseases that attack the hair. I would not be surprised that the presence of other inflammatory conditions could overlap to the hair follicles. Unfortunately, our clinical science is not there yet.

ive been on Fin for a couple months with great regrowth. 1 month ago i started noticing some scalp inflammation, and it got really bad last week. Although i couldnt see alot of hairshedding, some parts of my hair took a big hit, and thinned out really fast. Anyone know how long it will take to regrow after ive adressed the inflammation?

See your doctor. This is important to understand and get the right advice.