Propecia Before a Hair Transplant… and Does Stress Speed Up MPB? – Hair Loss Information – Balding Blog

Dear Dr,

Your Q and A’s are absolutely priceless in an industry where most people would not know where to start looking to gather info, so thank you for that. I have a couple of questions. I’ve read quite alot of your site now and have grasped most of what I need to know but would like to ask you about my specific case now if I may.

I am 27 and have been a Norwood 2 for 3-5 years and thought it was my mature hairline. But within the last year I had drastic life changing circumstances and alot of stress. That lasted to 4-6 months and I noticed I started losing hair around the temples(windows peak area) quite rapidly but in an even MPB fashion. I thought at the beginning it was stress induced but as it was happening evenly around both temples I thought after reading alot of your site that its just MPB getting stronger or whatever. Thus here are my questions!! :)

  1. Started Propecia and it is working amazing, from the first few days hair stopped falling out and every week it gets better. 1-2 hairs from a 4-5 day bedding wash cycle is all I get on the pillow now. I have been on it for 4 months now and obviously will continue for good, who knows what else will happen. But my Q is this, I want to get a hair transplant soon and fill up what I lost so I have all my hair back and keep the hairline I had which is windows peaks, which im fine with, suits my face and age etc.. But I was wondering. Do you think I should wait for 8 more months to see what Propecia can do before getting one or will it continue to improve wherever anyway in conjunction with the transplant?
  2. And secondly do you think in general stress really can speed up MPB evenly falling out like mine was? And if hair does fall out from stress does it ever grow back like it was before the event? Or is stress and MPB just to hard to diagnose other than on a case to case basis. Thank you so much for your time!

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I’m glad you enjoy the site and find it useful. Thanks for visiting and writing.

I usually recommend to young men like yourself with male pattern baldness (MPB) that are interested in hair transplantation to get on Propecia for at least a few weeks before going for a surgery as you want the drug to bind to the hair follicle tissue to get a protective effect. In some people, waiting even longer than a few weeks may have value in seeing the benefit of the drug over time when the hair loss is still early.

Stress can certainly cause hair loss, and in men that are genetically programmed to lose hair, stress can speed up that timeframe. For those without MPB, stress-induced loss might regrow… but for those with MPB, stress-induced acceleration of hair loss is unlikely to see any regrowth even upon getting the stress under control.

Finasteride Decreased My Ejaculate; Is There Anything to Increase Volume? – Hair Loss Information – Balding Blog

I have been taking 5mg of Finesteride daily for a year now and noticed early on a sharp decrease in ejaculate volume. I have since found out that this sympton does occur so any concerns have been laid to rest.

My question though: Is there a medication that can be safely used along with Finesteride that will increase the force and volume of my ejaculation? – Thank you

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VolumeThis is a known side effect of finasteride, particularly with the higher 5mg dose (used to treat the prostate). There’s no medication that I know of, but I’d recommend drinking plenty of water and eating a balanced diet to see if that helps.

There are natural supplements some people swear by to increase ejaculate volume, and while I can’t vouch for any of these, I suppose if you want to try them it couldn’t hurt. See the list here.

Nizoral and Dutasteride Together? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

Just wanted to say a very big thanks on how informative and up to date this website is.

My question is in relation to using both Nizoral and Dutasteride together. I have read in a few places the active ingredient in Nizoral has some sort of interaction with Dutasteride which reduces the effectiveness of Dutasteride in the body. Is this true and if so, is the effectiveness of Dutasteride reduced dramatically.

Thanks in advance.

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NizoralI do not know of any interaction between Nizoral (ketoconazole) and Avodart (dutasteride), and while I attempted to research it, I came up empty. Where did you read that there was an effectiveness reduction? Perhaps I’m the wrong person to ask, as I don’t usually recommend either treatments (Nizoral never, Avodart rarely). If you’re taking dutasteride, you should discuss drug interactions with your prescribing doctor.

Nizoral is an antifungal shampoo, and although some people insist it helps to treat hair loss, this has yet to be proven. I honestly don’t think it works much better than any other shampoo.

There is some suggestion that dutasteride is more effective at treating hair loss than Propecia (finasteride), but this hasn’t been proven yet. Dutasteride has some history of sterility problems that concerns me (which is why I’m reluctant to prescribe it), whereas Propecia has no significant sterility problem history. Plus, Propecia is FDA approved to treat hair loss and dutasteride isn’t.

Can Rogaine Retain My Current Hair? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I understand that Minoxidil is generally ineffective at regrowing hair in the frontal and temple regions of the scalp. However, since I am in the early stages of male pattern baldness, I would like to know how effective Rogaine is for maintaining my current hair count.

Is it true that rogaine stops working after a certain number of years?

Thank you for your time.

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Rogaine is not a cure. It is not that it stops working, but it is more of the fact it is not a cure. Everyone is different and responds differently to Rogaine, so there is no way to tell how long it will retain your hair or even if it will retain your hair. Excellent response to Rogaine generally is seen in about 15% of the population.

Does Cut Proscar Have a Shorter Half-Life than Propecia? – Hair Loss Information – Balding Blog

Is it possible that cut pills (generic Proscar in fourths) have a shorter half life than Propecia with its protective coating still intact?

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ProscarPropecia and Proscar aren’t time released medications, so the protective coating wouldn’t change the half-life of the medication. A big reason for the coating is to protect pregnant women, as women that handle a cut finasteride pill run the risk of absorbing the active ingredient through the skin. The coating also helps make the pill easier to swallow and helps to extend the shelf-life by protecting it from the environment to some degree.

I know you realize the following information, but just in case some readers out there aren’t aware — some people choose to cut a Proscar (5mg finasteride) pill to make it equal to Propecia (1mg finasteride). Different generic pharmaceutical makers may make different shapes and sizes of the pill, but generally it’s easier to cut the Proscar into 4 equal pieces (making the dose 1.25mg). Why do people cut the Proscar? Well, Proscar (and the generic variant) is much cheaper than Propecia, which has no generic legally available in the US due to patent laws.

After 10 Years, Finasteride Seems to Have Stopped Working! – Balding Blog

I have been using propecia, now generic finesteride, for at least 10 years. Recently, I noticed that I have a noticeable bald spot extending from my front to my back of the head. I am 58 years old. Is it true that in a lot of cases the treatment simply stops working as we get older?

It’s not that finasteride stops working altogether, but rather, your body is likely starting to win the war against the drug. I’ve seen this happen in some patients that have taken the medication for many years, though I also have patients that haven taken it for a decade without any problems.

I’d imagine that if you quit the medication completely you’d see further loss. Besides, at 58 years old the finasteride is good for prostate health. You should be under a doctor’s care and discuss your problem with him/her. Perhaps you should talk to your prescribing doctor about increasing the dose to 2mg to see if that might help.

I’ve written about this before here and here, so you’re not alone.




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Dutasteride 0.5mg (Avodart) Phase III Study Results – Hair Loss Information by Dr. William Rassman

AvodartA recently published study in the Journal of the American Academy of Dermatology shows that in a 6 month limited span, 0.5mg dutasteride (commonly known as Avodart) was shown to be effective at treating hair loss in men aged 18-49 years. Now we have known for some time that this drug is effective, but I’m still unclear about side effect risks. This is a stronger medication than finasteride and there is no real statement by the FDA on the issue of fertility with dutasteride that has been reported by some medical authorities. I have prescribed dutasteride at this point on a very limited basis with the caveat that the sterility factor is unknown.

It is worth pointing out that dutasteride’s half life is measured in weeks, while finasteride’s half life is measured in hours (finasteride currently being the only FDA approved DHT blocker for treating hair loss). In other words, if you do experience side effects from dutasteride they’ll take much, much longer to clear.

I must caution that dutasteride isn’t FDA approved to treat hair loss at this time, but these results appear to be a positive step in the right direction. Also, this study does not compare dutasteride to finasteride, but rather dutasteride to placebo… so that’s still a big question mark.

Read the study abstract — Efficacy, safety, and tolerability of dutasteride 0.5 mg once daily in male patients with male pattern hair loss: a randomized, double-blind, placebo-controlled, phase III study.

Photos from the study can be found at Regrowth.com

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I’m Seeing Asymmetric Temple Regrowth from Propecia – Balding Blog

Hey Drs at NHI,
I am currently on my sixth month of finasteride and have been applying rogaine for about a month and a half (once a day). I am a Norwood 3 at 18 years old (turning 19 very soon) and cannot tell if the drugs are working. I have however, noticed growth at the temple area of very small hairs (1/4cm – 3/4cmm). It is growing in asymmetrically though, I have more growing in on my right side than my left and I can see an “outline” of where my hair would be if I had a perfect hairline. I just want to know if it is a good sign? It does seem like my hairline is continuing to recede but I am wondering if it will eventually reverse, despite it being a frontal loss.

And just out of curiosity, Dr.Rassman could you tell me more about your son who had success with frontal regrowth? Like what balding pattern he was at and his age when he started using finasteride?

Thank you your blog is very insightful and has helped me in my high school years.

Asymmetrical hair loss is common with genetic balding when it occurs, and reversal of that loss can also be asymmetrical. I’d say any regrowth is a good sign, particularly at the temples.

I believe my son was in his mid-20s at the time he started on finasteride. He was thinning in a Norwood Class 3A pattern and the drug reversed all signs of miniaturization symmetrically.




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Could Retin-A Gel On My Face Cause Scalp Hair Loss? – Hair Loss Information – Balding Blog

Hello doctor. About 3-4 weeks ago, I was prescribed tretinoin gel(Vitamin A acid – mild gel 0.01%) for my facial acne. I haven’t noticed anything, but as I was browsing the balding blog entries, I noticed that someone in the past had brought up a question about acne medication causing hair loss.

My question is: does tretinoin gel(Vitamin A acid)cause hair loss if it is applied to the face/cheek region? My doctor did not go over the side effects and the box doesn’t mention anything about side effects. I was told to take one cream and night and another one at morning.

Thank you very much.

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Hair loss is listed as a known common side effect of tretinoin (also known as Retin-A), but it is also used by some people in conjunction with minoxidil to grow hair.

Here’s what I wrote in a blog post a few years back — “Retin-A is applied to the skin and can produce burns to the skin. It is believed that a light burn will make the skin more able to absorb other medications (like minoxidil for hair loss), because increased vasculatiry is induced by the burn.”

So will it make you lose hair even if you apply it only to your face? I can’t say for sure, but it is a possibility.

I’m 20 Years Old, Taken Propecia for 2 Years — When Can I Get a Transplant? – Balding Blog

How many years of MPB does one have to go through before considering an HT considering the following facts: I started to notice hair loss at age 17 and now am 20. I have been using Propecia for 2 years now and it has maintained most of my hair (temples and crown have thinned out a bit since then but nothing cosmetically significant). My father and my grandfather are both NW6 and my uncles are mostly NW5-6. I have been losing my hair for almost 4 years now, how much longer do I have to wait before I go for an HT?

It is not about how long you should wait, but rather it’s more about building a Master Plan with your doctor to address this concern. A good doctor will always work off a Master Plan that you and the physician will create. Your questions will then be answered, because you will have a customized plan to meet your exact problem and address the rate of your hair loss. As you were already prescribed Propecia, stick with it and hope the results continue to be positive.

I don’t know enough about your current hair loss, but hair transplant surgery at 20 years old is not usually recommended. There isn’t a real minimum age for having this procedure, but we generally don’t do these in men under 24 years old, because the hair loss pattern is not clearly defined.

You can read more in these past posts about hair transplants in the young man:




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