Drugs – Page 325 – Balding Blog

May 15, 2006

Propecia Prescription Questions – Hair Loss Information by Dr. William Rassman

I want to start taking propecia. I just need to know how to get it. Do I make a appointment with a regular doctor and he’ll give me a prescription or do I need to see a dermatologist? and how long can the prescriptions be? finally about how much does a 30 day prescription cost? Thank you

Propecia is a prescription item and requires a doctor to write it in the United States and Canada. Any doctor can write it. I always tell a patient that wants to take it to get his hair mapped out for miniaturization in order to be sure that (1) he is really balding and (2) what is his baseline miniaturization from which we can measure improvement or worsening of his situation and (3) what pattern of hair loss can he expect in the future. Measurements are at the foundation of clinical science and you need to know what you are treating and where you are going. A prescription written by a doctor should be good for a year or so, depending upon laws that can vary from state to state. Propecia costs range from $60/month to as high as $120/month in some pharmacies, so shop carefully.

May 12, 2006

Thin, Colorless Hairs In Front and Crown – Hair Loss Information by Dr. William Rassman

I’m 26 and a Norwood IV. I have many tiny, thin, colorless hairs on the front and the crown. In fact, I can still see quite a few follicles on my scalp that just aren’t producing hair. I just started Propecia a couple days ago. Can I expect these follicles to start producing hair again? Or are they more or less dead? If I can grow hair from them I might not need a transplant.

Thanks in advance. Your blog is a great source of information.

What you are describing is miniaturized hair which tends to be colorless. If you look at it under magnification, you will see very small hair shafts there, showing that the hair may still be there, but not producing enough bulk in the hair shaft to produce visible color. When we map out the hair for miniaturization, this is just what we look for. If it is present, then Propecia may reverse it if it is caught early enough. The longer the process goes on, the less the impact of Propecia for reversal. The younger you are, the better is the prospect for reversal, particularly in the back of the head. Most men will find, however, that Propecia will stop or slow down the loss. I have seen great result in young patients taking Propecia. Remember Propecia tends to produce better result in the crown area than the frontal area.

May 10, 2006

Aspirin and Prostate Cancer – Hair Loss Information by Dr. William Rassman

Below is a medical publication which shows that aspirin or similar nonsteroidal anti-inflammatory drugs taken daily reduce cancer of the prostate risks in elderly men. If it does that on elderly men, think of the great value it would have for younger men who take it for a longer period of time. The link between daily aspirin for prevention of colon cancer and heart attacks have been well documented and generally recommended for all men who do not have a bleeding disorder or specific contra-indications. The saying that ‘An Apple A Day Keeps The Doctor Away’ might be changed to ‘An Aspirin A Day Keeps The Doctor Away’.

ARTICLE: Cancer J. 2006 Mar-Apr;12(2):130-5. Association between nonsteroidal anti-inflammatory drugs and prostate cancer occurrence. Dasgupta K, Di Cesar D, Ghosn J, Rajan R, Mahmud S, Rahme E., Research Institute, Department of Clinical Epidemiology, McGill University Health Centre, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada.

Prostate cancer is the most common malignancy among men in Western nations. Previous studies indicate that nonsteroidal anti-inflammatory drugs have an inhibitory effect on prostate cancer cells. We evaluated the association between frequent use of nonsteroidal anti-inflammatory drugs and prostate cancer occurrence.

METHODS

We conducted a nested case-control study using medical administrative databases. All men older than 65 years of age who had filled at least one prescription for nonselective nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors (coxibs), aspirin, or acetaminophen between January 1999 and December 2002 were eligible. Among this group, we identified men who underwent prostate biopsy between January 2000 and June 2002 and did not have a diagnosis of any cancer in the preceding 2-year period. Cases were those with a diagnosis of prostate cancer. Controls were those who did not receive a diagnosis of any cancer. Logistic regression models were used to determine associations between prostate cancer occurrence and frequent exposure (more than 4 months) to nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors or aspirin during the prior 2 years in comparison with no exposure to any of these drugs, adjusting for age and prior finasteride use.

RESULTS

We identified 2025 cases and 2150 controls. Older men were at greater risk for developing prostate cancer. Exposure to nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors was associated with a reduced likelihood of prostate cancer (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.58-0.86) as was exposure to aspirin (OR, 0.84; 95% CI, 0.74-0.96).

DISCUSSION

Our results suggest that among men 65 years of age or older, frequent use of nonsteroidal anti-inflammatory drugs/cyclooxygenase-2 inhibitors and use of aspirin are associated with a reduced risk of prostate cancer.

May 10, 2006

Continued Balding After a Hair Transplant – Hair Loss Information by Dr. William Rassman

What happens if you continue to bald after you have had a hair transplant?

There is no doubt that everyone that has had a hair transplant will continue to lose some hair. The question is not if, but when and by how much. It has to be put into perspective with your appearance over time. The correct answer to the question is that the first transplant must be done according to a Master Plan, one that anticipates further hair loss so that the look you evolve into will always look natural. If the look is not going to be natural, for whatever reason, then your doctor MUST tell you this at the time he/she performs the transplant. There is a logic to both the balding process and the transplant process and these two processes must be coordinated. I can not go into all of the possibilities of this on the blog, but I wrote a book on the subject which covers the process in great detail, titled The Patient’s Guide to Hair Restoration. Mapping out the scalp for miniaturization may tell you something about what the future has in store for you and you need to have as much anticipation of what may be as you can get.

Just the other day a young man came in to show me his progressive hair loss since his hair transplant at NHI nearly 5 years ago. Much of the remaining frontal hair (going back about 4 inches) is transplanted, but the non-bald areas are receding further back behind the transplanted frontal hair (he moved from a Norwood Class 4A pattern, more towards a Class 5A pattern). He had been told that this could happen and was put on Propecia to minimize either the possibility that this will happen or at the least, the speed by which it might happen. Unfortunately, he had stopped taking Propecia after the transplant was done, because he felt it was not helping grow more hair and since his transplant looked so good he had a false sense of security. Had he continued taking the drug, the progression may not have happened. I don’t know that for sure, though. He elected to now go on Propecia again to prevent further progression, but may be stuck having to undergo another transplant to fill in the areas he lost if the drug does not reverse it in the next 8 months or so.

May 9, 2006

I Can’t Take Propecia, I Don’t Want to Bald – Hair Loss Information by Dr. William Rassman

Dr. Rassman, what approach do you take with young men who are not able to take Propecia. Do you never do transplants in them? Do you sometimes do transplants? I am a norwood 2 going on a norwood 3. I am considering getting small transplants to keep up with my hairloss starting in about a year when I will be 23 years old. Is is a bad idea? Going bald is not an option for me, so its either transplants or a system.

I hope you read the blog entry from last week where a patient whom I did not recommend getting a hair transplant was not happy with my recommendation and got a hair transplant from another doctor. Now he is worse off and more bald because he lost more hair due to shock loss.

I would not normally recommend a hair transplant to a Norwood class 2/3, but every patient is different and it would be impossible for me to give you personal medical advice without a person to person consult. You may be a Norwood 2/3 now but without a good exam and a good medical history, there is no way of knowing what Norwood class you would be at the age of 50 (this is where the Master Plan comes in). If you have miniaturization in the areas behind the frontal corners (like the top and crown of your head), then it would be suggestive that you are in for a lot of balding in your future and fixing a Class 2 pattern may not be good timing just now. Alternatively, if there is no miniaturization in the rest of your head and your family history does not show advanced balding, then maybe with the right doctor / patient relationship, a hair transplant could be considered. I am not excited about the idea of doing a hair transplant on someone with such a pattern and at your age, because the pattern of your future hair loss is not going to show up for another few years.

I would also question why you are not able to take Propecia.

May 9, 2006

More on Cipla’s Generic Finasteride – Hair Loss Information by Dr. William Rassman

After the post from yesterday (Fincar, Forcan, and Candid-B), I dig some more digging and found that Cipla is a pharma company in India that does not honor US patents. Apparently, as of late 2005 the country has agreed to enforce patents for new products, but not for products already pirated. So Cipla produces its own version of Proscar to be sold in India. This product is illegal to be used or sold in the US, and there is no way to verify that the product is manufactured by Cipla or even contains finasteride when the product is bought over the internet.

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May 8, 2006

Fincar, Forcan, and Candid-B – Hair Loss Information by Dr. William Rassman

heloo sir, Well i am 21 yrs of age. 2 years back i had thick shiny and straight hair. then suddenly one day my hair started off falling very severly. i ignored it thinking it was the after effect of some new shampoo but then even after using my normal shampoo the problem continued. i let it go thinking it will get solved by itself. but then after 2 years leaving it untreated one day i saw that my scalp had become visible and my hair became thin and dry. i then went to a dermatologist. he advised me the following.

candid B lotion (made by Glenmark)
forcan 150mg (made by Cipla)

after using this for a month my hair loss stopped completely. now the problem is that i am not getting my lost hair back. and my hair is dry and thin. can i regrow my lost hairs or am i too late to do anything. please help me cause it affecting my confidence. please. reply urgently. thank you.

I looked up Cipla and found that they make a generic Proscar: Fincar launched by Cipla is a hair loss pill, indicated for male pattern hair loss or Androgenetic alopecia. Even though Cipla’s Fincar contains the exact same chemical Finasteride as Proscar (5mg of finasteride), its cost is significantly less than that of Proscar. Each film-coated capsule of Cipla’s Fincar contains Finasteride 5 mg.

Assuming this is correct, the Finasteride 5mg is a much heavier dose of finasteride than is needed to control hair loss and would therefore have more side effects unless the pill is divided into 1/4 or 1/5. I am surprised that this can be obtained in the United States, because I am under the impression that this is covered by U.S. Patents from Merck.

Forcan is an antifungal medication, which suggests to me that your doctor thinks that the hair loss may be do to a fungal infection. The use of steroid/antibiotic combinations like candid B lotion are often used to reduce the inflamation from infections, although this is not my area of expertise. If you have any questions about what your doctor is doing and why, just ask him. An open line of communication with your physician is a good step to take.

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May 8, 2006

Paxil and Hair Loss – Hair Loss Information by Dr. William Rassman

Hi Doctor,
I started taking Paxil about 3 months ago and have recently been expieriencing increased hairloss. Prior to taking paxil I hadn’t expierienced hairloss for about a year. Do you think there is a connection between the paxil and the hairloss, and is the hairloss irreversible if it is?

It is not clear if you are male or female, which is important in the way I construct the answer. I will assume that you are a male. If you had hair loss 1 year ago when you were not on Paxil, maybe this a coincidence, maybe not. Hair growth and hair loss both go in cycles, so perhaps you just kicked in the loss cycle.

As I stated in a blog entry from just last week, but it is worth repeating –

I have three important points to make with regards to medications causing hair loss:

Before identifying a drug as a possible cause of hair loss, you should find other medical causes.
People take medications for a health problem. You should not stop taking a medication just because you think it may be causing hair loss. Your health should come before your hair (especially if you are not certain that the medication is causing the hair loss).
Most importantly, you should follow up with your doctor for medication changes and concerns.

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May 5, 2006

Hair Loss InformationUsing Non-FDA Approved Medications As Last Resort? – Hair Loss Information – Balding Blog

Hello Dr.

27 yr old male, Norwood 2~2.5

use propecia regularly for 3 years. This has helped greatly in preventing mpb.

use minox once a day (used to do 2x a day) 1ml on hairline and 1ml on crown

Within the last year my temples have drastically recided (sp?) and now my hairline is starting to go.

I am noticing even beyond my hairline there is diffuse thinning and it’s frightening to look at.

Do you offer any advice on any other medication to add to the propecia and minox mix? It seems one would have to try a non-fda med as a last resort before surgery.

I was considering adding revivogen (non-fda approval considered) but I am unsure of how it’s anti dht properties will affect my hormonal levels (i.e. will the combo of propecia and revivogen cause a severe loss in the production of dht that would lead to make gyno?). Obviously propecia is a systemic medication, but what of topicals such as minox, revivogen, spiro, etc.? Are they systemic or only confined to the scalp.

Block Quote

As a Norwood Class 2, I think that you should be tested for miniaturization to see if there is balding behind the hairline. First, you need to measure just what is going on to determine if you really have the problem that you think that you have. Second, if the Propecia is working, why go to non-FDA medications and put yourself at possible risk? You need a doctor to take charge of you and give you the guidance you need.

May 5, 2006

Penis Is Not Hard with Propecia Use – Hair Loss Information by Dr. William Rassman

I took propecia for almost two months and noticed immediately a change in the hardness of my penis during sexual encounters. They were not as hard. At my doctor’s advice, I switched to taking it every other day, but still the same result. I have since quit taking the drug and my hardness has returned, but I wish to gain the benefits of propecia. Any suggestions. I have heard that going on and off the drug can cause increased thinning of hair. Please help. Should I try rogaine instead?

Buff Problems with erections are a known side effect with Propecia. In normal young men, this rarely happens, but if you are like most men, your sexual performance is going to be less spectacular as you get older. This problem normally impacts 20% of men in their 20s, 30% in their 30s, 40% in their 40s and over 50% in their 50s. Where your performance may be at the verge of showing this change, Propecia can accelerate the process. The solution for most men is taking one of the sexual enhancing drugs like Cialis (works a full 36 hours) or Viagra (lasts for about 12 hours). This way you can get the best of both worlds (hold your hair and keep up good sex). Ask you doctor to write you a prescription and if you try it you may like it.

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