Category: Hair Loss Causes

Dear Dr. Rassman,

I am a 32 year old male with Norwood class 3.In December beginning I had started Propecia and continued with it for 7 weeks. I experienced no apparent side effects and in fact felt more energetic. There was no initial hair loss and at end of 3 weeks my hair felt fuller and it seemed that there was a decrease in hair loss ( lose fewer while combing/shampooing ).

During the 7th week a test revealed some of liver function indicators were elevated:

Value Range
A/G RATIO 1.29 1.2-2.0:1
SGOT(AST) 45.00 U/L 10 – 42
SGPT (ALT) 74.20 U/L 10.00 – 47.00

Subsequently, while still on Propecia, I also got these tested for

TESTOSTERONE 708.0 ng/dl 166 – 877 ng/dl
FREE TESTOSTERONE 4.88 pg/ml 4.25 – 30.37 ng/dl
DI-HYDRO 522.3 pg/ml 250 -990 ng/dl
TESTOSTERONE

A couple of years back testing for DHT had revealed that it was 3 times the upper limit. I was not treated for it.

I would really like to get back on to Propecia. Do you have any insights why SGOT/SGPT are elevated ( A few weeks before starting my Doctor had gotten me tested and LFT were normal then ) ? Could conversion of excessive DHT to Testosterone have caused such ? Would it be safe for me to restart Propecia ?

Regards

This is a question you need to ask your doctor. There are many possible factors that could be in play:

1. To my knowledge, Propecia use will not impact liver function. If you have liver disease, you may have to reduce the dose of finasteride you are taking to take the disease into account.
2. It can be a coincidence.
3. It can be from alcohol use the night before.
4. It can be from other drug use. Many drugs are metabolized by the liver and Propecia is not unique.
5. It can be an insignificant temporary finding, but unlikely.
6. It can be from an infection you are not aware of.
7. The list goes on and on…

I generally do not pay too much attention to testosterone or DHT blood levels. Consider this: If your DHT level and testosterone levels are low (or high) and you are balding, are you going to do anything different? Because chances are, Propecia would still be recommended since genetic androgenic alopecia is visible. Genetic androgenic alopecia is diagnosed with a physical exam and a miniaturization study, not a lab test. I understand there are now genetic tests that can give you a “probability” score for androgenic alopecia, but sometimes even genetic testing does not really change the medical course of action.

One particular 18 year old patient I recently saw paid a few hundred dollars for genetic testing for androgenic alopecia at another medical group. The results were mailed to him and according to what he said, the doctor never followed up with him. He had no sign of balding, no hair loss, and no miniaturization. He had the test done because his grandfather was bald and he was afraid of going that same route. His results showed a “probability” of androgenic alopecia, but all it really did is tell him that he was carrying the gene for balding. Just carrying the gene does not mean that the gene will be expressed, as some men who carry the gene never go to clinical balding. The report given to him got him extremely worried and instead of following up with the medical group (who tried to sell him shampoos and lasers) he came to see me.

In my opinion, in this particular case the genetic test was a source of misery and misrepresentation. Sure, there may be a possibility that he may lose hair to some degree and have androgenic alopecia in his future, but I did not recommend any course of action (not even Propecia) for him, as he had absolutely no sign of balding or miniaturization.

Hi, I have a few questions regarding hair loss and finasteride.

1. Does tight motorcycle helmet causes hair loss.I’ve notice increased hair loss since i regularly started wearing full face helmet which is a bit tight on my hairline and genera crown area.
2. Could it be possible to experience hair loss due to lack of iron mineral?
3. Propecia is being advocated very often but how is it logical not considering the loss of 70% of your DHT as a serious issue which is in essence the maleness hormone from a young age of 23?
4. What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?
5. I am prone to depression and sexual problems due to antidepressants from time to time, do you still recommend finasteride in my case?
6. Can you guarantee from your expertise that side effects subside even if you quit the drug after e.g 3 years or more of continued use?

Thanks

1. There is one patient I have seen that had traction alopecia from wearing a very tight fitting helmet everyday for a year. The hair loss did not look like genetic male pattern balding, but the balding area was where the helmet was rubbing on the side of the head. So it is possible, but not common.
2. A lack of iron in your diet can cause anemia (low red blood cells). Your mucosal membranes (under the eyelids and gums) will be pale, you will feel weak, and you will have other serious medical issues before hair starts to fall out. Hair should be the last of your worries.
3. Men in their early 20’s take Propecia without adverse effects associated with lowering of their DHT levels.
4. If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious. I’ll point out some interesting tidbits about this in my next post…
5. This is something you’ll need to discuss with your doctor. Assuming you would be a good candidate for Propecia based on your hair loss, your doctor will need to make the decision if you’re a candidate based on your history of depression. There shouldn’t be a problem with taking the medications together though.
6. There really is no guarantees in medicine (or in life). Actually, the only two guarantees in life are death and taxes. I do not give reassurances to someone who is afraid to use a medication. This is something you need discuss with your doctor.

#4 continued here

Hi I’m a female of 25. I have used Rogaine for men for about three or four years now, and my hair is relatively thick. When my hair loss began I was under a serious amount of stress, Had just come off of the depo shot (which I’ve heard can cause some hair loss), later developed a pretty serious eating distorter (I know also causes hair loss), and was a drug addict and alcoholic. Quite the laundry list I know.

Recently in the past year and a half I have recovered from the eating distorter, drugs and alcohol, and have a stable stress free life. My question is this, since there were so many factors contributing to my hair loss, and there is no way of knowing if it was onset adult hair loss, If i were to start weening my self off of rogaine would the hair loss start again. Is it possible for me to discontinue the use if it wasn’t female pattern balding, or does your hair develop a dependency to minoxidil. Further more is it possible to drop the dosages to the 2% in the woman’s without losing my hair as well. I appreciate any help you may be able to provide.

thank you

I honestly don’t know, but I can provide a mostly theoretical idea for a best case scenario: If there were hairs gained from Rogaine use, then those hairs will likely fall out when you stop using Rogaine. But if the hairs grew back on their own (without the help of Rogaine), then those hairs would stay.

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