Breast Cancer, Hair Loss, and Dismissive Doctors – Hair Loss Information – Balding Blog

I am among the many young victims of breast cancer (37 y.o. with estrogen+ progesterone+ Stage III breast cancer) who has undergone 16 rounds of chemo, 6 surgeries (including oophorectomy), and 35+ radiation tx, plus am currently on aromatase inhibitors. I am treated at one of the top 10 facilities for cancer in the US, yet trying to get help for my slow growing Ludwig Type II hair while on aromatase inhibitors, esp. 2 years after chemo is proving more daunting. First, my oncologist revers me to dermatology, then dermatology refers me to endrocrinology, then endocrinology suggests I see a hair specialist doctor….but now I read in your archives to defer to the oncologist. It frustrates me that I am being punted around between medical specialties who don’t want to have any liability or necessarily want to work together to come up with a treatment plan for this pervasive side effect which many women in my position are experiencing. No one wants to touch this hair loss issue with breast cancer survivors.

I researched all the medical literature, and although there is plenty of information on observations of hair loss, there is nothing about the treatment of hair loss for those of us who are on either tamoxifen or aromatase inhibitors after breast cancer. I already started 12.5% Rogaine with Retin-A along with 5% minoxidil foam, Aminexil with Madecassoside, and washing with alternating 1-2% Nizoral. Propecia isn’t even an option. Also, I feel I’m relegated to wigs which you deem may accelerate hair loss (although if it not bonded or clipped to hair, I don’t know how that would be the case). Is there anyone in the San Francisco Bay Area that even has the breadth to tackle this problem?

Please tell me there at least some proprietary research out there that is addressing this issue on the horizon, because then I won’t be such a cynic about medicine. Clearly quality of life after cancer involves helping to alleviate hair loss as a result of aromatase inhibitors.

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Pink ribbonI am truly sorry to learn of your frustration (we’ve all been in situations where we’re referred back and forth and feel like we’re getting nowhere), but the hair loss issue really isn’t specific to breast cancer survivors. Hair loss in all women is a very difficult issue to treat. There are many potential causes, and especially with your medical history, it can be hard to pinpoint the cause. The only FDA-approved medication available to women to treat hair loss is minoxidil (Rogaine), but you should be careful with taking 12.5% and 5% minoxidil foam at the same time so that you do not overdose yourself. Some women have had minor success with Propecia, but that would be taking the medication off-label and there are potential serious risks for women that use this medication (so just to be clear, I do not recommend that approach).

Unfortunately, there are very few options available to women that are losing their hair. For men, Propecia slows the process down, could reverse it, or even completely stabilizes it for years; hair transplantation just rearranges permanent hair from the back to the front. For women, the hair loss may be so diffuse that there is not much to rearrange and there is no specific area of permanent hair like is the case with men. Approximately 20% of women may be helped with hair transplantation, so each patient must be individually evaluated. With regard to your specific situation, I would be willing to see you since you are somewhat local (I do have an office in San Jose) and maybe I can add something to help you, such as the possible use of concealers like DermMatch or Toppik. Wigs might work in your case, but one must be careful that there isn’t traction on the existing weak hair or that’s when you might run into problems with further loss.

I don’t know of any proprietary research, and I wish I had a specialist in mind that I could point you to… but I’m posting your message in hopes that it reaches a wider audience that might be able to provide more insight or assistance. As much as I might want to have all the answers, I fully admit that’s not the case.

Propecia and Hepatitis C? – Hair Loss Information – Balding Blog

How is life treating you today?

I have a question but first I have to thank you for providing this excellent resource free of charge. The blog has been an invaluable tool in my continuing effort to learn more about hair loss and unicorns.

My question is this, is there a difference between the effectiveness of Proscar and Propecia? I recently switched to Proscar (I was prescribed it during my consult at NHI). I am a little nervous though because the blue Proscar pill looks to be the same size as the brownish Propecia pill, yet I am cutting Proscar into fourths. I thought a 5mg pill would be larger than a 1 mg pill. Am I missing something or is Proscar simply more potent?

Also, I have Hepatitis C. Prior to starting the medication, I found nothing to indicate that taking Propecia would be a problem for someone with my condition. Does this hold true for Proscar as well? I found nothing in Merck’s online product information to prove otherwise but the internet is so full of misinformation that I honestly don’t know what is what.

If you don’t feel comfortable answering the second question with certainty, do you know of any good Gastroenterologist’s in the LA/Orange County area?

I am sorry, that was 3 questions.

Thank you very much for your time and patience

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Life is going well, thank you. I hope you’re doing fine and I’m glad you enjoy the site, but if you got your medication prescribed from us (NHI), you should call our office to discuss any issues/concerns at 310-553-9113. You’re our patient and we are here for you!

In general, I think some drug companies make it hard for patients to divide up and cut pills sometimes because it’s all about economics and making a buck. The reason the 1mg and 5mg pills might be the same size has more to do with the inactive fillers, which you can learn more about here.

With respect to Hepatitis C, as long as your liver enzymes are normal and your primary care doctor (or gastroenterologist) is aware that you’re taking the Propecia, I am fine with it. As for gastroenterologists in the Los Angeles area, you can try Dr. Norman Panitch.

I Pull Out My Hair and My Doctor Recommended Propecia – Hair Loss Information by Dr. William Rassman

hello doctor,
my hair is thin and i dont know if all the hair that falls out is because of the telogen stage. my family has no balding but my hair getting thinner and always falling out. i keep on pulling it out all the time and i am always stressed about it so i am all day pulling and freaking out. i went to a doc but she recommend me propecia right away. i dont know if i wanna be on a medication. what should i do? thanks!

Did you tell your doctor about your hair pulling before the Propecia was recommended? Propecia might help if you are a man with genetic hair loss, but it won’t stop you from pulling the hair out.

It sounds like what you’ve got is an obsessive compulsive disorder called trichotillomania. I’m not an expert on OCD, but a good place to learn more and seek treatment help is at the Trichotillomania Learning Center.

Balding Forum - Hair Loss Discussion

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Kidney Disorder, Propecia and Rogaine? – Hair Loss Information – Balding Blog

Hi Doc
Can a person with Kidney disorder take Propecia or can he apply Rogaine.

Thanks

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Finasteride (Propecia) is metabolized in the liver so the presence of kidney disease is usually not a problem for taking this medication. For liver disease, finasteride could be a problem and you must check that out with your doctor.

In the case of minoxidil, the presence of kidney disease will cause more retention of the drug in your body, so there could be a greater impact if you take regular doses of minoxidil as the blood levels may rise.

I Don’t Want to Invite Breast Cancer by Taking Finasteride! – Balding Blog

Dear Dr,
My dermatologist has suggested me “Finax” (Dr.reddy’s Lab) 1 MG and 2% minoxidil and Aminexil topical lotion (Since Iam allergic to 5% it causes itching in my case). Now I went through this web site: MHRA

It explains the possibility of breast cancer in men with Finasteride(5 mg). I dont know whether you have answered this question previously or not. Now After purchased finax for 3 months (90 tablets) what am I supposed to do? I dont want to invite the risk of breast cancer for the sake of hair. And have you seen any cases of male breast cancer which I think is very rare compared to female.

FinaxDr. Reddy’s Finax is generic finasteride and sold in 1mg and 5mg doses. I believe that their production in India is an FDA approved facility, but sale of the generic 1mg in the US would be a violation of the patent rights of Merck… which is why this medication isn’t available here in the US yet.

I’ve never seen a case of breast cancer from finasteride and some recent studies of a few thousand men failed to show the connection that the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) warns of. For women who have a history of breast cancer, there may be an increased risk when taking finasteride… and this is just one of the reasons the medication isn’t approved for women. The MHRA warning itself states, “Fifty cases of male breast cancer have been reported worldwide with the use of 5 mg finasteride (Proscar) and three cases have been reported with the use of 1 mg finasteride (Propecia).” So there have been 3 cases of male breast cancer out of the million+ Propecia users?

The warning also mentions, “the overall incidence of male breast cancer in clinical trials in patients who received 5 mg finasteride was not significantly different compared to patients who did not receive finasteride” — so why was there a warning at all? I don’t know how a connection could even be made. If you’re really worried about this, don’t take the medication. It’s not worth the anxiety. Personally though, I don’t see how this is significant enough to warrant a warning at all.


Balding Forum - Hair Loss Discussion

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Hair Loss InformationHair Transplant and ITP – Hair Loss Information – Balding Blog

I am considering having a hair transplant. I am have a bold spot of the right top side of my head and a similar one is gradually developing on the left. My biggest problem is that I have ITP. I had been scheduled to do a transplant a few days ago and had gone for ITP treatment- I was given IVIG but it had no impact; infact it seems the platelets dropped. So I had to put off my surgery. The problem is it is difficult to schedule an appointment for surgery without knowing for sure that I’ll have the right platelet count on the day of surgery. Do you know of any hair transplant centre whether they can handle both the haematological and transplant aspects?

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For those unfamiliar with idiopathic thrombocytopenic purpura (ITP), I’ll turn to Google Health for a good description — “a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the blood.” Idiopathic is just a fancy way for doctors say we really don’t know what is going on. There are some treatments as you know, but sometimes it can be difficult to treat.

Having surgery when your platelets are low can be dangerous, because your blood will not clot and any bleeding may not stop. I understand you want to have a surgery, but any surgeon in their right mind would not knowingly perform surgery on a patient with ongoing ITP with low platelets. The key point is that you need to have your ITP treated and wait until your platelets return to normal levels. Until then, I would worry more of your health than your hair.

My final thought is that you mention a bald spot on a part of your head. While I really cannot diagnose you with a description, are you sure you have male pattern baldness? Something about the way you described your hair loss makes me think you have alopecia areata (which is also a condition where your immune system attacks your hair follicle, the way it destroys your platelets in ITP). Just a hunch. Please follow up with your physician and I wish you well.

Hair Loss InformationFacial Hair Loss Started with a Tiny Spot, Now It’s Half My Face! – Hair Loss Information – Balding Blog

I am a man of 29 years old but i noticed when i was 27 years old at the lower part of my jaw on the left part of my face, the hair on a part there started going bald. It started gradually with a tiny spot of hair loss then it started expanding and now it as expanded to its limit and it stopped expanding but my hair won’t grow back and i can’t have my proper shave. please doctor i need an advise to know if or how i can grow my hair back.

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I couldn’t say precisely what it is, but alopecia areata starts like how you described. You need to see a dermatologist and your condition will probably require a biopsy for confirmation. Learn more about this disease at the National Alopecia Areata Foundation.

All of My Scalp and Body Hair Has Thinned! – Hair Loss Information – Balding Blog

Hi I have something weird that happened. All of my hair on my head has minimized. On the sides, back, front all over. Is this DUPA? I went to my dermatologist and he brushed me off and didn’t even know what DUPA was. The weird thing is is that it’s all over my body hair, genital hair and underarm hair.

Is this DUPA or is it hormonal?

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To answer your question with regard to DUPA, I would need to map your entire scalp for miniaturization. In men, DUPA shows significant miniaturization in the donor area. That would start answering your question.

With regard to body hair, I think that you are lucky (as I hate my body hair), but we do see changes in body hair with age in some people and this may be genetic in men. With that personal candid view, I don’t want to minimize the importance of getting a doctor involved so that the ‘rare’ conditions that are either genetic or hormonal are not overlooked.

Doctors That Don’t Do Miniaturization Mapping – Hair Loss Information by Dr. William Rassman

When attempting to find a good HT Doctor, should one that doesn’t do a Miniaturization test be a strong factor in determining whether to use them?

There are many doctors that do not map the scalp for miniaturization. It is a relatively easy procedure, and in my hands it is basic to using medications like Propecia, in determining the health of the donor area, and in developing a long term Master Plan for the patient. If they do not use a high-powered video device to examine the hair, they will miss things like diffuse unpatterned alopecia (DUPA) on many patients who have it. And to continue that example, I am sure that if they end up performing surgery on a person with DUPA, they will absolutely harm them.

I am not a fan of doctors that do not do a complete examination of the scalp before they go forward with hair transplantation surgery. Of course, you should make your own determination of that issue.

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In the News – 12 Year Old Girl’s Battle with Alopecia – Hair Loss Information – Balding Blog

Snippet from the article:

Sophie NixonWhen football fanatic Sophie Nixon started losing clumps of her hair, no one in her family knew that bullying at school was making the youngster ill. Now the 12-year-old from Lowestoft has spoken out about her alopecia to encourage other young people to seek help if they are being bullied.

Sophie’s hair started falling out two years ago and she soon lost her eyebrows and eyelashes. It was only when her parents took her to see a doctor that she told them she was being teased at school and she was diagnosed with the condition, which causes sudden hair loss.

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Read the full article at the UK’s East Anglian Daily Times.

She’s quite brave to speak out about her condition and I wish her well. This story reminded me of an article from a couple years ago, where a young girl’s hair loss was triggered by bullying (see here).

There are genetic disorders that cause hair loss at the young age, starting at 2-4 years old. This can be alopecia totalis or a form of ectodermal dysplasia, which are often genetic in origin.