Drugs – Page 218 – Balding Blog

April 9, 2008

Biotinidase Deficiency from Accutane Causing Hair Loss? – Hair Loss Information by Dr. William Rassman

Hi Dr Rassman,

firstly I would like to thank you for your website, I’ve been a keen reader for many months. Well about me, i’m 23 years old and ever since I stopped a nine month course of Accutane at the age of 19 I suddenly began to lose my hair rapidly in a diffuse pattern on the whole scalp area. This is very depressing as I used to have long thick hair. My hairline is relatively intact but I would say i’ve lost 60% volume at least, so you can see my scalp through it. There is some balding on my mothers side but they didn’t start balding till age 40+ and not in a agressive diffuse pattern like me. I strongly believe this is from the Accutane, maybe it has accelerated my mapped out MPB that I would get later in life. But also I’ve heard of people suffering Biotinidase Deficiency after a strong course of Accutane that can last for years and cause severe hair loss. Do you think biotin or any other vitamins could benefit post accutane treatment? I’ve been on 1mg propecia for 1 year with no regrowth or noticable benefits and Rogaine also with very slight regrowth, so these seem to not be helping my hair loss at my tender”ish” age.

Also i’ve was diagnosed with arthritis a few months ago and i’m on 4x 500mg paracetamol/30mg codeine tablets a day to help with the pain, but i’ve read that paracetamol reduces the effectiveness of rogaine do you know anything about this?

thanks for your time.

Marc P DiFazio, MD authored a good source for botinidase deficiency information, available at eMedicine.

I don’t know enough about the connections other than what I have learned via the web (researched briefly after your question was received). I am sure that you know the information on Accutane (isotretinoin) and hair loss seems to be a real problem for many people, but the solution to this problem is not evident. I did write to an email group of experts on the subject and there was no real insight into the connections you are looking at. I do not know if there is reaction between minoxidil and paracetamol, so I’d discuss this further with your prescribing physician.

April 8, 2008

Should I Take Propecia at 16 Years Old? – Hair Loss Information by Dr. William Rassman

Hi doctor, I have a question. I am sixteen years old and I feel my hair is falling because I have like a balding twirl in the vertex. It seems like if the hair in my vertex is starting to fall. Also, the hair on the top of my head is thinning. I don’t have a receding hairline, but I am scared to loose all my hair before I am twenty. I don’t know if this could be the cause of genetic hairloss (my dad is bald, but he is 52) or if it is another thing. Also, my pubic hair seems less dense. Do you recommend any drug like finasteride or propecia????

Any good doctor can do this and it is critical (particularly at 16 years old) that you get excellent metrics from a miniaturization study to determine what is happening to your hair before starting on a life long course of Propecia (finasteride 1mg).

You need a Master Plan for your overall management of your hair loss and you should have your scalp hair mapped out for miniaturization prior to starting any treatment. There is no reason not to take it if you are really balding, but you may not be balding, so find out first! That being said, safety of finasteride was studied at age 18 and above. Your prescribing doctor will have to be the one to make the call on whether the benefits outweigh the risks. Get a good doctor to help you with this.

April 8, 2008

Took Finasteride for Years And It Didn’t Stop My Hair Loss – Hair Loss Information by Dr. William Rassman

I took finasteride 1mg for two years, and it did not stop my hair loss. Five weeks ago, I switched to dutasteride .5mg, and I am still seeing the same level of hair loss. What are some of the possible factors resulting in my continued hair loss? Might it have something to do with the DHT still residing in my scalp?

Also, how much of a decrease in DHT is generally required in the blood and/or scalp in order to stop hair loss?

Male, Age 31

Thank you

Neither dutasteride or finasteride are guaranteed to stop the hair loss. There is a race between your genetics and your attempt to stop the loss and from what you are saying, your genes are winning. If you were to become a Norwood Class 5 balding pattern by the time you are 23 years old, for example, I would doubt that finasteride or dutasteride will stop the progression completely, but it may slow down the process a bit. Do you get what I am saying?

There is no magic DHT level that you must hit as your genes do not seem to care (metaphorically speaking). You are under the illusion that DHT can be controlled, but the issue is with your genes, not DHT levels. Certainly what you are reporting appears that way.

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April 7, 2008

Stopping Minoxidil Shrinks Capillaries? – Hair Loss Information by Dr. William Rassman

Dear Dr.

I have been taking Minoxidil 4% plus progesterone for 16 years and stopped 3 months ago because I was worried about the possible long term effects and I wanted to look at a more natural approach. Since then the shedding had increased dramatically (over 150 hairs during shampooing), my scalp can now be seen through my hair for the first time ever and the hairs that are falling out are thinner and in some cases shorter than before I stopped.

It was suggested by a trichologist that I am seeing that when you stop using Minoxidil the capillaries shrink to smaller than their original size, reducing the blood flow to the hair and causing them to fall out. He also suggested that they dont return to their normal size for up to 9 months and in some cases never as the damage is permanent.

However another trichologist told me that the hair loss could not be so sudden and it would take 6-12 months before I would notice any hair loss and even then it would only be the hair that was “saved” by the Minoxidil in the first place that would fall out. Can you tell me:

Do you know of any research to support either of these claims?

Is there anything I can do to stem the shedding if the cause is the fact I have stopped using Minoxidil?

Could blocked follicles (as the first trichologist suggests) also be a contributing factor?

Thank you for your time.

You are asking me to comment on what your trichologist told you and I don’t know what to say about blood vessels, shrinking capillaries, etc. What I do know is that for 16 years you used minoxidil and that you most likely have minoxidil-dependent hair that will not grow back unless you go back on the minoxidil and are not too late in doing so. So to answer your questions:

I’m not aware of any research, but I can’t say that it doesn’t exist.
Stopping minoxidil will result in losing benefits of the minoxidil — which would be any hair retained or regrown by the medication. You’ve been on the medication for 16 years, so you’ll have a difficult time guessing which hairs were saved by the minoxidil (meaning, the hairs that will be lost).
Isn’t this the same as question 1? I don’t have an answer for you, unfortunately.

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April 4, 2008

Hair Loss InformationClarifying Finasteride Dosage – Taking More than 1mg to Treat Hair Loss – Hair Loss Information – Balding Blog

Hello Dr. Rasman,

First I would like to thank you for such a wonderful site. I have been an avid reader of this blog for some time now and find your dedication to this field quite remarkable. I have a question that I would like clarification on regarding finasteride dosage. It seems you that you frequently state dosages higher then 1mg have no increased effectiveness in treating MPB. Most recently quoted here: What If I Take 5mg of Finasteride to Treat Hair Loss?

“Taking finasteride 5mg (Proscar) daily will not have any benefit over the finasteride 1mg (Propecia) in the treatment of androgenic alopecia (AGA).”

But I have come across some blogs in the past were you seem to state that there “may” be an increased effectiveness in higher doses. I have quickly searched your site and here are two examples:

1: Propecia and Dosage
The dosage of Propecia was arrived at because when Merck went through the FDA the 1mg dose was found to be lowest effective dose to get the desired result based on the clinical trial program that was done.

“That may suggest that a higher than 1 mg dose may be more effective, but that was not studied for treating hair loss.”

We do know that higher doses of finasteride will increase the known side effects. A decreased ejaculate is one of those side effects. With regard to brain fog, there is nothing that I know of that will support this as a known side effect of finasteride. Be careful that you are not setting yourself up for this and obsessing too much.

“If you want to play around with the dosage, wait a few weeks between changes as it takes that long to change the tissue levels of the drug.”

2: 1mg vs 5mg Finasteride for Hair Growth
I am not familiar with any study that directly compares the 5mg dose to the 1mg dose, but I would suspect that like any bell curve, the 1mg recommendation applies to those individuals in the center of the bell curve and that “some people most certainly would be better with a higher dose,” possibly worth trying if the 1mg dose is not adequate to meet the needs of the patient’s problem.

Even your colleague Dr. Bernstein makes refrence to this on his own site, which is linked here: BernsteinMedical.com

So then is their truth to the statement, that though unproven, a higher dose of finasteride may be more effective in treating MPB?

I thank you again for your time and this wonderful site.

Best Regards

Block Quote

Propecia (finasteride) When I discuss finasteride dosing, I’m referring to the dose that the studies show is effective and safe. There is never one dose for every person, because we all have different body weights, different metabolisms, different hair loss (possibly from sensitivity to DHT that may vary by time, where you are on your hair loss cycle, your genetics, etc.). You can pick and choose and interpret all that has been said about the dosages of finasteride, but in the end 1mg finasteride works and in a large population it is the dose that worked most effectively.

Looking at the big picture, a higher dose is probably not going to make a huge difference. All drugs have limitations and a higher dose is not going to give you dramatic gains. Case in point: think of all the bald men who are taking 5mg finasteride for their prostate issues. I believe that the men on 5mg finasteride are not much better off than men taking 1mg finasteride when it comes to their hair loss.

I am afraid we are beating this issue to death, but I appreciate the time you took to find out about my consistency and respect you for it.

April 4, 2008

Taking Propecia for My DUPA – Hair Loss Information – Balding Blog

Hi Doctor,
I began noticing my DUPA a year ago. Since then i have been on propecia (almost 8 months now). I have made the decision to finish atleast a the full year of treatment. My DUPA has definitely been getting worse over time. My entire scalp is getting thinner. Do you suggest that i stop propecia if it continues to progress after a year? Does this mean that i am just one of the people that propecia does not help? I ask because it is a large financial investment… Please advise.

Thank you for the great site doctor.

Block Quote

Diffuse unpatterned alopecia (DUPA) has an unknown cause and as such, we are just using medications that may help. It may reflect a variety of diseases, including diffuse alopecia areata or chronic telogen effluvium, because it has similarities to both in the way DUPA looks when you see it with the naked eye. But microscopically, it is different. I would suggest that after a year without any benefit, you should speak with your doctor about the possibility of stopping the Propecia (finasteride 1mg). If it gets worse, then you could start it again. My heart goes out to you and I know what I said here may just add to the confusion, but frankly we really do not know enough about DUPA to be more scientific in its treatment.

April 4, 2008

Dr. Proctor’s Proxiphen – Hair Loss Information by Dr. William Rassman

I started using Dr. Proctor’s proxiphen – his combo topical and shampoo in September. After a month he had told me to ween off of minoxidil application as it was included. While he offers this “prescription” without a visit, the follow up is a little difficult. By December/January the shedding was so incredible and hasn’t stopped – now shedding long thick hairs, not just weaker ones, that after seven months, I decided to stop. Going back on minoxidil foam, three weeks later, yet another shed, making my head begin to look like a mess. The front third of the scalp is a disaster area (all things considered in the world, there are many worse things, but alas, this isn’t all that good…) And after the “almost” guarantee of correcting a thinning problem, not only is the hair much thinner, but a couple of thousand dollars later, the response becomes “well maybe it is the balding process continuing…” Indeed. No sh*t, sherlock.

As far as Proctor, I think there is a REAL problem there. He promotes his meds but refuses to tell anyone what exactly is in it. Some of the so called aficionados swear by his product, but I can tell you. I lost more hair using that crap (at a hundred bucks a tiny vile, mind you, now about eight viles) than with any form of MPB. Worse, it is a script med (god knows what’s in it) and then he asks you to forward a script for Propecia which then allows him to script his stuff, and does no follow through, and sort of sells and well, you know. And then he says to ween yourself off of Minoxidil. At any rate – the long and short of the story is, that my guess is I lost tons of hair on this – and stopped. I wonder though if it will recover now that I have started the minoxidil again, but I rarely think so – I wonder if I have really depleted the supply to amount to really diffuse thinning which is likely what I did… I can use a little topic and still look like I have great hair, but alas, no…

So, back to tradition, rogaine foam, continued use of propecia (which I have been religious about) and feel free to post.

One wonders – could this be a “having left minox” shed, followed by a “return to minox” shed. God only knows.

Although I wrote briefly about Dr. Peter Proctor’s Proxiphen a couple of years ago, I wanted to share the above email from a friend/patient of mine who experimented with this treatment. I have no personal knowledge of this approach, but felt this email was worth sharing for those curious readers.

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April 4, 2008

Why Not Just Wash Your Hands After Applying Rogaine Foam? – Hair Loss Information by Dr. William Rassman

This is a follow-up question I received from Should I Be Applying Rogaine with a Rubber Glove?

once you apply Rogaine foam can’t you simply wash your hands with anti-bacterial liquid soap instead of wearing a glove?

The minoxidil absorption is probably fast, but I do not know how fast. If you are absorbing it with more hand hair, then a glove is the only guarantee to stop it getting through the skin and into your hands and body.

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April 4, 2008

Will ScalpMed Make Me Go Blind? – Hair Loss Information by Dr. William Rassman

Doctor, I have a question to make you, I’m wondering if a comment from one user of Scalp Med it’s true, I doubt it honestly, the commentary says, ‘I have using Scalp Med since 3 months and im started to lose a little vision in my eyes since this three months’. I honestly don’t believe that, but I wanna be sure that Scalp Med doesn’t have these side effects.

So I would really like if you know from this side effects of Scalp Med, cause I’m thinking seriously in use this product.

Thanks in Advance.

ScalpMed contains minoxidil, which is known to cause blurred vision as a rare side effect in some people. For more info, see:

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April 3, 2008

Is Women’s Rogaine Making My Hair Loss Worse? – Hair Loss Information – Balding Blog

ive been using women’s rogaine for about 2.5 months, my hair was just thinning when i started, then in the last few weeks it started to just fall out in my brush, the shower, etc. my hair seems to be very thin, and very easily pulled out, like it’s not holding on to its roots. now my hair is so short I can barely make a pony tail! what’s going on, is this normal from taking the rogaine, and how long before i start seeing real growth, and when will the shedding stop!

thanks

Block Quote

Women's Rogaine We have heard of people who initially lose hair when they start Rogaine (minoxidil), the theory in this process is that Rogaine resets the hair cycle and hair that is falling out is actually the hair follicles going into a dormant stage (telogen and catagen). Have you seen your primary care physician or a physician about your hair loss? I want to make sure that there is not another reason for your thinning hair that may be related to a medical condition or medications.

Generally people do not see the results of Rogaine for 6-12 months. You need a diagnosis for what is causing your hair loss, and this is not something I can offer to you without an examination.