Category: Drugs

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Does DHT Supression Have Negative Effects? – Hair Loss Information – Balding Blog

Dr. Rassman,

I will try to keep my inquiry short. I am 23 and have been taking propecia for 15 months. I do not think that I have regrown hair and due to my obsessive practice of frequent checking, it is nearly impossible for me to tell how much hair I have kept or if I am continuing to bald. While I do not have a bald spot and have no discernable loss along my hair line, my crown has thinned significantly. I have read your posts regarding dutasteride. I am under the impression that you do not perscribe it. I have reached a point where I am desperate for hair regrowth and I would like to try the drug. My concern is regarding the supression of nearly all dht in the body. I am a natural bodybuilder and concerned that supression of DHT will have a negative effect on my muscularity. I cannot find an article or study relating to this specific inquiry. If you could help me I would greatly appreciate it. Additionally, I have actually visited your los angeles facility and impressed by the professionalism of the doctor I spoke with, he informed me that I would not, at my age be an acceptable transplant candidate.

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I do not know for sure, but I would suspect that the testosterone levels will increase to substitute for the DHT drops in effectiveness. Now with that said, you should be evaluating the degree of miniaturization to find out what is happening. In addition, I have no idea where your hair loss pattern is now, so before you jump into more drugs and act blindly, get the assessment properly done.

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Hair Loss InformationWigs and Hair Club for Men – Hair Loss Information – Balding Blog

Just wanting some info, I am thinking of doing hair club and getting a piece. Do you know the cost and is it cheaper than hair transplants? I would rather do something that will grow mine back, but I am skeptical and weary of trying something like this, especially if the cost is what is rumored.

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Costs for wigs (hair systems) are much higher than most people think. I met Sy Sperling and the executives of Hair Club for Men in the late 90s and I was informed that the average price that they got from people with ‘systems’ over a 5 year period was around $12,500. That price included the hair system and constant repairs, replacements, and adjustments with frequent visits to their offices. When washing one wig and letting it dry, you need a second to wear. These hair systems are expensive and they do wear out. These cost figures I presented here are not based upon anything other than the cost quotes given to me in about 1998. I suspect that with inflation, the costs will be higher today, but that is only speculation on my part. The problem with hair systems is that they tend to accelerate and/or cause hair loss (traction alopecia) from the glues and tapes that are used.

Most hair transplants can be obtained for less than that figure (for the early balding man) and the transplanted hair will last a lifetime and grow as long as you want it to be. If you also take Propecia, the progressive hair loss may stop. This approach is far less expensive and totally natural. Men with hair systems are always afraid of other people touching their head. If the hair is attached to the existing hair, then cleanliness becomes a problem and odor becomes very distinct when you get close to men who use them. When romance opportunities appear, you might have a no-touch / no smell zone around your head if you are wearing a wig. Most people who have these systems, hate this no-touch zone more than any other single factor in hair systems but few men realize the odor that surrounds the systems that are attached, particularly if they do not come off at night so that you can wash the scalp and remove the dead skin than normally sheds every day.

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Hair Loss InformationNatural Supplements for Hair Loss – Hair Loss Information – Balding Blog

hey doc… thanks for your reply. A few weeks ago I posted a question to you: Maturing Hair Line at 18 Years Old

what I would like to add is I’m of east Indian origin and my hairline is in the form of an U curve and is thinning badly. I will try Procepia eventually but I would like to know your opinion on natural suppliments. I’m taking multivitamins + 2 capsules of saw palmeeto every day. The thing I don’t like about procepia is that its a drug and most drugs produces side-effects…and I think that there are natural remedies for every ailment.

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I have answered this type of question many times. Natural remedies include every conceivable thing, some of which is safe (saw palmetto), some of which can kill (arsenic), some of which may be different by different suppliers (saw palmetto), some of which is effective (vitamins that are antioxidants), some of which are ineffective or have variable effectiveness (saw palmetto). I only picked saw palmetto, because it meets many of these opposing criteria, but it plain does not work.

There is all of this focus upon side effects. Remember, arsenic is a natural supplement and it kills; death is a side effect. Sexual side effects are known with saw palmetto, but the sexual side effects with Propecia only occur in 1 out of 100 people. Why assume that you will get the bad sexual side effect from Propecia, just because a drug company is honest and compelled by the FDA to tell you about it? The suppliers of saw palmetto do not have to disclose it; the drug company that makes Propecia does.

If you really care about your hair loss, why do you want to risk losing it or your health, when there are safe alternatives? I am afraid that I do not understand the logic here, but you are not alone with that type of thinking. Sorry if I am harsh, but I do not seem to get the message over to my readership and I really do not understand where I am failing to communicate.

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Hair Loss InformationThinning Pubic Hair from Finasteride? – Hair Loss Information – Balding Blog

Dr. Rassman,

I am experiencing what I think may be a finasteride side effect that is really alarming and embarrassing.effect My pubic hair has been thinning for over a year. I am a 48 year old male and have been using finasteride (1/4 proscar) for a about 7 years with decent maintenance results, and also I have been using minoxidil 5% for the same time period.

I told my GP of my concern at my annual physical this past spring and he had no answer, but included testosterone in my blood work and it came back as in the normal range at 575. I have noticed some reduced body over the past 7 years on the finasteride and attributed it to the reduced DHT. I thought reduced DHT increased testerone which is responsible for axillary hair growth? Could the reduced DHT actually be thinning my pubic hair as well? I don’t want to quit finasteride, but should I do so?

Thanks for your advice

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DHT does historically cause the appearance of pubic, underarm, beard, ear and nose hair. The pseudo-hermaphrodites that were studied in the original research who were devoid of DHT from very high doses of finasteride in their diet since birth and therefore largely absent of DHT, had very little facial or body hair. I would expect, therefore, that some people may see reversal of some of the things that DHT causes with DHT blocking drugs, but prior to your email, I have not seen or heard of any patient who complained about it. There is logical reasons to see this side effect, although clearly not common in my experience. If you stop the drug, then the benefits may be lost as the pubic hair returns (if it does do that at all).

If finasteride actually reversed nose, ear, beard, and ear hair, I am sure that most men who have too much hair in these places would rush to take finasteride, but alas, the stampede did not happen. That says a great deal about this type of a hair ‘removal’ phenomenon.

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Hair Loss InformationTaking Minoxidil and Propecia Together – Hair Loss Information – Balding Blog

Hello Doctor,
How effective would a combination of propecia and Minoxidil be to fighting hair loss in the initial stages ? My hair started thinning in the past 11 months and now the scalp is noticeable. I recently started propecia and the Dermatologist advised taking Minoxidil 5% with it. I cant do it twice a day so he advised to apply it at least once a day at night. My question is I cant commit to the cumbersome process of applying it for more than 3 months. Will it benefit me if i take the combo for 3 months and then stop minoxidil 5% but continue on propecia indefinitely ? Will I gain/thicken my hair with minoxidil 5% once a day and will it sustain after 3 months once I stop taking it ? Please Reply
Thanks so much

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I get this question quite a bit. Using minoxidil once a day has limited value. Using it for 3 months and then stopping has no long term value — once you stop it, you will lose any hair you may have gained. For men, Propecia is the right thing to do for hair loss caused by genetics. I generally tell people to start Propecia first, then to consider minoxidil after a year, only if the result from Propecia does not get them what they want. There is no guarantee that one or both will work for you.

Using the higher 5% dose of minoxidil may be more effective than the 2% solution, but unless you are really willing to commit to the process required for either of the drugs, do not embark on that path.

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Hair Loss InformationFinasteride & Prostate Cancer – Hair Loss Information – Balding Blog

In a recent article in the Journal of Urology, an article was published which addressed the relationship between prostate cancer and the drug finasteride. The authors came out of various universities (Dr. G. Andriole was the lead author, Ref: J Urol. 2005 Dec;174(6):2098-2104)

Simply stated, what I read suggested to me that they reviewed the 7 year Prostate Cancer Prevention Trial that was finished a few years ago and published in the New England Journal of Medicine. The conclusions of the original study showed that this drug (finasteride 5mgs) reduced the appearance of prostate cancer by a statistically significant degree. There were some questions about the ‘control’ group when compared to those that actually received the drug. These authors suggested that the difference in the severity of the malignancies that were identified between the two groups may not have been real, but rather they were the results of patient selection criteria based upon blood testing, amongst other things. This group still did feel that prostate cancer chemoprevention with finasteride needs further research, although I personally believe that they are ignoring good statistical evidence to the contrary. Keeping an open mind is always good.

Please note that I just wanted to share what I read with the readers of this blog. I do not own Merck stock and can not benefit from any opinions expressed here.

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Hair Loss InformationBalding Fast, Even on Propecia – Hair Loss Information – Balding Blog

I am 22 years old and have been taking Propecia for 2 years. Although the hair loss slowed a bit, I now see the rim of hair that my dad has around the back and sides of his head. What can I do? Are hair transplants the only option left for me?

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You situation reflects that there will be progression of hair loss over a period of months/years, probably taking you to your father’s pattern sooner or later (sounds like sooner, rather than later). The variable response to finasteride speaks to the complexity of the factors at play. Included in these factors are variables like the sensitivity of your androgen receptors, as expressed by androgen receptor gene polymorphism. Simply stated, we can not come up with one treatment for all people, as each of us are different and have different sensitivities to the hormone environment in our body. We make androgens in our adrenal glands as well, and these androgens impact the hair end organ as well as DHT.

It is possible that you might respond better to Avodart, but even that medication may not do what you want. Avodart is not approved by the FDA for hair loss, so if you find a doctor willing to prescribe it, you should weigh the disadvantages of taking it (see previous blog entries) and the safety factors that may relate to having children when you are on the pill.

If you can already see the Class 7 pattern in the mirror that your father is showing, much of what you have lost may not be reversible. You should be checked out for other diseases, but in the probable event that your hair loss in only genetic, then hair transplantation is an option that you might consider. If your densities are good, if you have blonde hair or become blonde, if your hair thickness is reasonable, if you are willing to style your hair to take advantage of hair redistribution, you might have an amazingly good response to hair transplantation. As a general rule of thumb, most good hair transplant doctors do not take on young men prior to 25 years old, but with good support from your family, adequate financial planning, and a maturity that can allow you (best with the help of a parent) to make an informed decision, then you should explore the hair transplant option with an ethical and experienced hair transplant surgeon if you do not try the Avodart option or if the Avodart option fails to solve your problem.

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Hair Loss InformationPropecia for Stopping Hair Loss – Hair Loss Information – Balding Blog

I am 26 and my hair has been thinning for a couple of years now. I have some loss on the vertex and some at the corners of the front of my hairline. I have been on propecia for about a month now. I know propecia will not regrow the hair on my hairline, but what is the likelihood it will stop further loss?

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It is highly likely that Propecia will slow or stop the hair loss and possibly reverse the crown thinning. Frontal reversal is less likely. Still, I think that you should plot the miniaturization of your impacted area at least once a year, so that you know what is actually happening. The plot will paint your future much better and will help you plan accordingly.

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Melancor – Hair Loss Information – Balding Blog

Hey Dr. Rassman;
Concerning the subject of graying hair…I have look at about everything the internet has to offer on what causes it, and how to stop it, even reverse it. I would like to hear your take on the subject if I may. Do you know anything about Melancor or is it another “snake oil”? And what’s up with gray chest hair?….mine is 3 times as long, seems twice as thick and curlier than my dark brown chest hair. Why is that so? What is taking place here?
Always thankful for you time!

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I know very little about Melancor, but based upon your question, I did research it. The claims appear to me as marketing hype without documented scientific evidence to back up claims of safety or effectiveness that satisfy my scientific mind. That concerns me. The substance is in a pill form and that concerns me even more. I would doubt that this passes FDA or FCC standards and without safety studies, I would not want to risk my health taking an unproven medication.

With regard to your long chest hairs, I can only tell you that this is exactly what I see on my hairy chest. At least there are two observant people watching their chest hair grow far too long for their particular likes.

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Can Miniaturization Be Reversed? – Hair Loss Information by Dr. William Rassman

Dear Doctor,
If you have miniaturization developed in the past 6 months at a rapid pace is it possible to fully reverse it or maybe most part of it ? I Got onto propecia last month once my derm confirmed I have MPB. I am thinking of adding Minoxidil too to the regimen the logic being since the miniaturization/ slight halr loss too has been in the past 6 months Minox might help steer those hair follicles slipping away into complete dormancy. Is my thinking right ? or will propecia and something like a 2% nizoral shampoo be enough to do the job/revive thoseminiaturized follicles ?. My miniaturization is mostly on the top and my hairline is intact. My hairloss history is about 7 months. I am late 20s. Also What is the ideal times a week you should wash hair for a male who has a desk job from 9-5 and works out 4 days a week. ?
I will appreciate your feedback.

In my opinion, I would hold off on the minoxidil and stick to the Propecia for the first 8 months. If the hair loss is as you have defined, then there is a high possibility that it will reverse because it seems to work best for short term genetic hair loss. If you take other drugs like minoxidil and make too many changes at once, then you will never know which one worked best and you’ll be ‘hooked’ on both of them for years. Play your bet out and try the 8 months of Propecia first.

As for washing your hair, I’ll just quote what I said in an earlier blog entry: “Frequent shampooing does not hurt, but aggressive massaging during shampooing and rough brushing will cause fragile hair to break easily.”

To conclude, yes miniaturization can be reversed. The more advanced the balding you have and the longer time you have had it, the less likely will be reversal of the balding process. But the resuls with Propecia (in particular) have at times been very powerful and I have seen a few men who I would have never guessed would reverse, reverse it nevertheless.

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