Any Supplements to Take With Propecia? – Hair Loss Information by Dr. William Rassman

I’m a 25 yr old man w/ receding at the temples & am deathly afraid of going bald. I’m on propecia right now. Are there any supplements that you would recommend I take as well? Also, can a transplant restore the temporal area & what is the avg amount of days a patient needs to take off from work for the surgery? Thanks.

Propecia alone should be adequate. You can elect to add minoxidil to it as well.

Transplanting the temples are not difficult for a good, experienced hair transplant surgeon. You should take off from work on the day of surgery, but you do not need to take any days off after that. It really depends on whether you mind if people see the initial redness in the transplanted area. You can see some examples of temple hair transplantation at the patient links below:

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Hair Loss InformationPropecia and Cancer – Hair Loss Information – Balding Blog

What about propecia’s safety? The cancer study along with altering hormone levels just doesnt sound like a good idea. What do you think about starting propecia in your 20’s and altering hormone levels for say 15 years?

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Finasteride (5 mg dose of the same drug as Propecia) was first used to treat prostate enlargement and cancer. There have been many studies through the years about this product which demonstrated its safety in the older male population (over 50). I have not seen any dangerous effect in my practice and the drug is carefully monitored by the drug company (Merck) under FDA guidelines. There is no doubt from recent articles published in the past few years that Finasteride in 5mg doses taken daily, reduces the risk of Prostate cancer. There is no suggestion that the slight rise in testosterone that occurs in many people will increase any particular cancer risk.

Hair Loss InformationMy Doctor Told Me To Use Minoxidil After Transplant – Hair Loss Information – Balding Blog

Dear Dr.Rassman, I recently had a hair transplant the beginning of December of 2005′. I only needed a small area above my bangs,(I’m a female with blond, baby fine hair),and was given a mega’ session to my surprise!) It will be three months the start of March. My question is that post-op, I was told to start using minoxidil for 3 to 6 months. I was told that this would help in blood flow to the follicles. Will the transplants grow without minoxidil? I haven’t been using it every day like I should. Shouldn’t a transplant grow without using minoxidil? I lost alot of my hair that I already had when they were putting it the grafts. I don’t see any of the original hair coming back very fast…something about the hairs being “shocked”? Were they destroyed when the new hairs were translanted, or will they come back? I have less hair now, than when I went in for the procedure! Not to mention the “ear to ear” donor site, that is slowly coming back! Thank You.

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Minoxidil may help improve the rate of hair regrowth, however, transplanted hair does not need minoxidil for growth. It sounds to me like you may have some shock loss from the surgical procedure. More than likely, the shock hair loss will reverse (it usually does in women) and your hair would then grow back somewhere between 3-5 months following the surgery.

I am frankly surprised and dismayed by your comment that the megasession was a surprise. There should be no surprises in this process so I would think that your doctor failed you in this regard as good communication is the key to the entire hair restoration process. Your concerns are real, but I wonder if you lost faith in your doctor by my observation that you came to the internet for advice that should be part of the standard of care that one should expect from their doctor.

For the information of the readers reviewing this blog, hair transplantation in women is usually restricted to a sub-set of balding and thinning problems because female genetic hair loss does not occur in patterns like it does in men. In the fringe area around the sides and back of the head (donor area for the transplant), men usually have healthy hair (99%) while women often do not (20% have a good supply of healthy hair). That means that if a women does not have healthy hair and is transplanted, the unhealthy hair is moved along with the healthy hair (not a good use of a surgical procedure). Women with female genetic hair loss can have 4:1 unhealthy hairs:healthy hair ratios. What that means is that for every good hair transplanted, four unhealthy hairs get moved. This is the reason we do not transplant many women as the value may not be there. I have met some doctors who claim that women make up a sizeable part of their practice and generally I have the view that the value proposition here is totally favoring the unscrupulous doctors that do this and give this industry a bad name. What makes women easy victims for the unscrupulous doctor is the general hopelessness that they feel as they move from doctor to doctor looking for the magic cure for their balding so when a doctor brings the promise of a cure, they will easily spend thousands of dollars to go that route. I do transplants on women, but very few of them as women make up less than 5% of my transplant practice and of those women, half of them are treated for non-genetic balding problems such as complications of facial surgery. The old axiom remains, ‘Let the Buyer Beware’.

Good luck to you.

Hair Loss InformationSubstantial Non-FDA Testing on Avodart? – Hair Loss Information – Balding Blog

I am 24 year old currently on propecia for the last 8 months. While the results have been satisfactory, I am not thrilled. I have had zero side effects from the medication. I am looking into taking avodart .5 mg. I know you are not legally permitted to condone the use of it for MPB, but is it more effective than propecia? I am looking to get a little regrowth that i have not seen with propecia. Is it safe to use for MPB and is there substantial non FDA controlled testing credibility regarding regrowth? Please Advise

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There are no FDA studies on Avodart related to hair regrowth, but Avodart has been studied for prostate problems and it is safe in the older population. To my knowledge, there are no good studies on Avodart with a hair loss focus either. If any readers out there are aware of such studies, please feel free to send me links to the address on the Contact page. Please follow past blog entries related to Avodart by using the search.

Hair Loss InformationRecent Transplant in 19 Year Old – Hair Loss Information – Balding Blog

I would like to get some information on hair loss. I’m 19 and lost my hair on the temples. It’s not that bad because I can cover it. It’s the only hair loss problem.I had hair transplants in that area done by Dr [name removed], 250 grafts on each side. it’s been 2 and a half month’s now,can’t see any results yet. also the Doctor prescribed propecia for me but he say’s it only stops the hair loss in the crown area and there my hair is full and is in my family as well!!! I have been taking it for 5 months now and am not sure if should continue taking it!!! What would you recommend? I don’t want to lose anymore hair and also after I see the results from the transplant I had and want to still fix my hairline I really like what you are offering!! Please email me on your suggestions!! Thank you

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If it has only been a few months since the transplant, you must wait this out. I suspect that you had 250 grafts in each corner, similar to a Norwood Class 3 pattern. The full benefit of Propecia will take 8-12 months, and the transplant should show 80% of the benefit in 8 months. Keep on the course you have started and do not stop the Propecia.

I am concerned that you had a transplant at the age of 19. If you are in Los Angeles, please come by and introduce yourself for a second opinion. You need to have your scalp hair mapped out for miniaturization and you need a Master Plan in hand, particularly now that you already started the process.

Finasteride Makes My Nipples Erect – Hair Loss Information – Balding Blog

This question is related to sidew effects from Finasteride. I have been on Fin for about 5 months. Over the course of that time I have experienced nipple erection/chapping and irritation several times. Mainly in the cold weather and mainly when I don’t wear an undershirt. Is this a tell-tale sign of gyno? I am pretty fit, so I think I would notice breast enlargement. With that said, when i wear a tight t-shirt, my nipples and aereola seem much more noticable than they used to. Is this in my head or am I starting to develop gyno? Please answer my question, I have spent a great deal of time and money on my prescription and doctor’s visits, as most have…I’d really like to put this issue to rest.

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The Propecia website states that “In general use, the following have been reported: allergic reactions including rash, itching, hives and swelling of the lips and face; problems with ejaculation; breast tenderness and enlargement; and testicular pain. You should promptly report to your doctor any changes in your breasts such as lumps, pain or nipple discharge. Tell your doctor promptly about these or any other unusual side effects”.

I would suggest that you get your chest (breast) examined by the prescribing doctor. It may be that what you are experiencing has some lump below that is causing your nipples to appear erect.

Can Propecia Retain My Childhood Hairline? – Balding Blog

If I want to stop a receded mature hairline, and keep a childhood hairline can propecia help do this? I actually believe its more MPB now than a mature hairline yet I have no to little MPB family history. I want to stop my hairloss im 23 years old. I have always had bad acne since I was young as well as a very bad itch thats been with me since about 14. The itch never went away and i tried every shampoo including prescriptions I could. I tried saw palmetto 320 a day and the itch vanished. I quit saw palmetto and recently restarted, but the itch was unaffected this time. Could this be MPB?

The short answer to whether your childhood hairline can be retained on Propecia is most probably “Nope.” Propecia works best at the crown of your head and although it seems to have some effect on the frontal region and hairline while you are less than about 35 years old, after that time one sees more hair loss in this area. Hair surgeons jokingly call this “Job Security.”

As for your itch, I have heard anecdotal reports of scalp itchiness related to hair loss, but no scientific evidence exists linking the two. To find out if you have male patterned balding (genetic), you should get a diagnostic mapping of your scalp for miniaturization to confirm if it is actually male patterned balding.

Finally, please do not go out and find a hair surgeon who will tranplant your childhood hairline (there are some unscrupulous people out there who will agree to do this for you – avoid them). Just remember that transplanted hair is permanent, and that as an older man you may not want a childhood hairline – it would look out of place or odd. You can always bring it lower in subsequent surgeries, but you cannot move it higher! I always tell my patients that the good and bad news about hair transplants is, they are permanent. This is not a place to make a mistake.




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Switching from Rogaine Back to Propecia – Hair Loss Information by Dr. William Rassman

Dear Dr,
Thank you for a most informative web site. I wanted to ask a question on how to progressively reduce reliance on Rogaine, which as you have noted gradually looses its effectiveness.

I am 40 and had mild thinning over the crown and frontal areas..just becoming noticeable. I used Propecia for an initial 3 mths period only in 2004 then stopped, then continued on with Rogaine (5%) for the past 14 months with good response. It now seems to be slowly loosing effectiveness with hair shedding.

Is there an option to restart taking the Propecia on a daily basis and then slowly reduce the application of Rogaine? Or after close to 1.5 yrs do you feel the hair would have become conditioned to it? I would welcome your advice as I would like to ’switch over’ to Propecia and one day cease the Rogaine if this is an option.

Thank you for your advice.

Sounds like you have lost the benefits of Propecia. Go back on it. As you are already on Rogaine, stay on it, at least until the process has stabilized. Then work with a good doctor to put together a good Master Plan for you.

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Should I Take Propecia Before Having Hair Mapped? – Hair Loss Information – Balding Blog

hello dr. rassman,
i am a 46 year old male and my hair has started to thin a little, but yet it’s very thick. baldness doesn’t run on either side of my family, but i know that sometimes doesn’t matter. i was curious as if i should start taking propecia, or should i first have my hair analyzed by a hair surgeon. also, how long does the effectiveness of propecia last if taken for a lifetime, otherwise could one still keep their hair if it they stay on it. thanks very much for your response.

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Getting your hair mapped out will give a metric to the degree of miniaturization, so that after you have taken Propecia for a year, you can measure any progress you’ve made with the medication. You must stay on the Propecia for life, or you will lose all of the benefits accrued quite quickly.

Taking a Lower Dosage of Propecia? – Hair Loss Information – Balding Blog

What is your opinion on a lower dose of Propecia. I have heard that some doctors recommend every other (or every 3) days dosing. What is your stance on this?

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Propecia has a half life of 4 hours. That means within a day, it is essentially gone from your system. Taking it every 3 days makes no sense, for you are undoing the DHT block that Propecia impacts. If you are going to reduce the dosage, then take a half tablet a day. I am under the impression that 1/2 tablet is 80% as effective as one tablet and 1/4 tablet is basically ineffective. I would want to know why you want to reduce the dosage from the most effective dose? The goal here is to grow hair, not see how little Propecia you can take.