Author: Dr. William Rassman

I recently started taking proscar in addition to the doxazosine I’ve always taken for BPH. I soon noticed that my pulse goes quite high (95-100 bpm)and stays there if I have a glass or two of wine; even hours after I stopped having wine. None of the literature mentions such a side effect, but is that the likely reason.

You need to speak with your doctor regarding these symptoms! You may have a heart condition unrelated to the medication you are taking. If medication is the only issue, I would suspect Doxazosine which can lower your blood pressure and cause a higher pulse rate. Your medical problem may be more than a medication issue. You really need to speak with your doctor.

Thanks for your great blog. It’s really helped me be informed about hair loss. If I am shedding many short, thin hairs that are tapered at the end, not the root, is this an early sign of male pattern balding? I assume that my hairs growth cycles are shortening and falling out before they can get long. Any advice would help. Thanks.

Many readers ask about the morphology of their hairs falling out and how it relates to Male Pattern Balding. We can lose about 100 hairs a day and the morphology of each hairs are variable. The miniaturized hairs are skinny and thinner as the hairs may be going into the telogen phase. Some hairs that fall may be bulky and thick and may have been just pulled out inadvertently. Some hairs may have white waxy substance known as sebum on its ends. Many readers or websites may try to correlate the hair morphology with some disease process but for the most part all of these are normal part of the hair cycle. When it comes to Male Pattern Balding, it is about the PATTERN you see in the balding pattern. If you want to take it one step further, you can put a microscope to your scalp to see if there is a variation in the diameter of hair at different locations to establish a “pattern” of miniaturiation. The very fine hairs should not constitute more than 20% of the hairs that you are looking at. This is what I often refer to as a Miniaturization Study.

Would it be reasonable to restore a hairline to look like the actor in the picture i’ve provided? would you say that the actor is balding? if so, what norwood pattern? assuming the texture is the same.

It would be reasonable to restore a hairline as in the photo but it would depend on what you are starting out with. If you are starting out with a Norwood 3 pattern it would be relatively easy. If you are completely bald (Norwood 6) it would be very difficult unless you have a very high donor density. You would likely need multiple surgeries as well.

This patient came in today to ask for Scalp Micropigmentation to make his hair appear thicker. It was a pleasure seeing him today. He still remembered the upbeat environment that the surgery was performed in 22 years ago! In addition, he sent a friend after he had it done.

This patient had some old plugs prior to meeting me which I camouflaged at the time of the 1993 surgery with great success. We discussed the ‘standard of care’ for hair transplants at that time and I may have been one of the few doctor who did not perform plugs then (I never performed plugs), something that he knew and appreciated. Today, we still see patients with the old plugs and I love to help them deal with it. After he has his Scalp Micropitmentation done, I will share his ‘after’ picture with you.

I was reading about minoxidil and finasteride as I am wanting to start one or the other but am curious about something.

According to the wikipedia article for minoxidil, the reason minoxidil gains are lost when treatment is stopped is that DHT is then able to re-shrink the follicles unimpeded. But if finasteride inhibits or blocks DHT, shouldn’t one be able to keep minoxidil gains longer if they switch to finasteride with a, say, 6 month overlap of the two? Everything I’ve read indicates you lose everything from minoxidil if you ever stop it no matter what.

Despite how many seek information in the Internet, Wikipedia is not always a definitive or correct source of information.
Propecia (finasteride 1mg) and Rogain (topical minoxdil) does not have the same mechanism of action on hair growth. They work in different ways. Both medications will lose effectiveness once you stop using the medication. In other words, you will lose the hairs you gained when you stop the medication. Overlapping the medication or switching from one medication to another does not mean it will sustain the effects of the former medication.

Doctor. I appreciate that you always advise patients to try one product at a time so they know what’s working. And you always advise men to try Propecia first and minoxidil later. Propecia is obviously more effective. But couldn’t it be less effective if minoxidil was started before propecia?
I’m just guessing here but if minoxidil is used first you now have susceptible mph hairs addicted to a less effective medication. The suggestion is minoxidil dependent hairs aren’t protected by Propecia. So you now have a lot of hairs that could been Propecia dependent giving greater and longer protection dependent on much less effective minoxidil and more susceptible to loss. Adding Propecia after affords no protection to those minoxidil dependent hairs. I’ve seen nothing that says hair can be dependent on both. So I would think its always best to getting hairs dependent on Propecia first then starting minoxidil 6 months to a year later. Is my reasoning off here?

You ask an interesting question. The simple answer is that there is no right answer. What medication you choose (Propecia vs Rogaine) is up to the individual and its results may not be a significant issue because the two medication work in different ways (different mechanism of action). The hairs you gained from Rogain may not be the hairs you would have gained from Propecia. I generally suggest that our patients do both, to get the big-bang right up front.

A new meta-study finds the following:

“Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic under detection…”

From Wiki definition: A meta-analysis comprises statistical methods for contrasting and combining results from different studies in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.[1] Meta-analysis can be thought of as “conducting research about previous research.”

The report is interesting but a Meta Analysis is only as good as the clinical trials it is analyzing. All studies have its advantages and pitfalls. If adverse or sexual side effects were being examined, I question why other (much larger and comprehensive clinical trials) of finasteride 5mg was excluded.

During period of two months October – December 2014 I lost 35 pounds, cca 15% of my total weight. I ate mainly vegetables, basically it was starvation and gym. At end of december noticed diffuse hair loss. Immediately normallized my eating pattern, went to dermatologist. Dermatologist ask for hair loss genetics and looked thru microscope. No signs of miniutarization, no vellus hairs and my hair genetics is perfect, no balding in my familly, I am 39 years old. 5 months after, there is no significant hair regrowth, and no further hair loss. What to expect, what will be real time frame for possible hair recovery? After hair loss I lost good amount of chest hair, could easily pull 70-80% of picked chest hairs, now it is ok..

Starvation like a crash diet and extreme work outs do not sound very healthy. It isn’t such a surprise you suffered some unintended consequence such as loss of your hair. I can’t tell you if your hair will grow back. Only time will tell.

A patient who had a surgery yesterday, told me about his experience as he was walking the two blocks to his hotel. His surgery was finished at about 4:00 pm and he was wearing a surgical cap (to cover his FUE and hair transplant surgery) and a doctor’s scrub top (given to all of our patients for surgery). He was approached by two beautiful women who seem to be tourist with Russian accents. They flirted with him and struck up a conversation eventually asking him what type of doctor he was. While he loved the attention and as a single eligible man on the dating scene, he just had a hair transplant procedure and it was not the time to flirt back. He thought “what would be the chance of meeting women like that after his hair grew out wearing a surgical garb?”. We both had a real good laugh.

I am 21 year old male suffering from moderate hair loss. The males from my mothers family are all bald and I share the same blood group hence the problem may be genetic. I have been prescribed anti DHT drugs by my doctor. The dosage will be 4mg per month for 6 months initially. Will the hairfall start again or even increase if I stop the medication after 6 months? Also what dosage causes side effects like difficulty in getting an erection and libido loss? My doctor said my dosage is very mild and wont cause any side effects.

The only oral medication for treatment of male pattern hair loss is Propecia which is finasteride 1mg. I do not know what DHT medication you were prescribed but you should ask your doctor and ask him these questions (directly to your doctor). The only other DHT reducing medication is Avodart (dutasteride) but 4mg is not a standard dose. Too many people think that they are getting a DHT treatment medication with something advertised on the internet or given by unethical doctors. This is a classic story of “Buyer Beware”!