Category: Hair Loss Causes

Itraconazole inhibits the enzyme ‘CYP3A4′ and the same enzyme metabolites Finasteride.

Does it mean that Itraconazole decrease the effectiveness of Finasteride?

Many drugs and even fruits (grapefruit) can inhibit CYP3A4 but it may not have a significant clinical impact with other medications. Itraconazole from my brief Internet research seems to be a “strong” inhibitor of CYP3A4. Thus in theory it would been you will have less finasteride metabolized by the enzyme and thus have more finasteride circulating in your blood stream. How it relates clinically in treating hair loss is likely not significant since some have taken a larger than recommended dose of finasteride with no significant impact on hair. In the end, I am not a biochemist or deal with theoretical enzyme metabolism.

Hello, I was hoping you could clear up something regarding the percentage of men who go bald or experience thinning.

I’ve read that only 50% of men are bald by 50, but I’ve also heard that the American Hairloss Association did a study that found 2/3 of men are bald by 35, and 85% of men are thinning by 50. These statistics seem in conflict with each other.

Does the American Hairloss Associations study reflect the percentage in ALL men, or just American men? Websites I’ve been on are inconsistent on which one it is. If you could clarify, I’d appreciate it.

To my knowledge there isn’t a landmark study of epidemiology or the prevalence of male pattern balding in men. Male pattern balding is genetic and it follows a “pattern” as the name implies. Thus by the definition, a slight front corner recession of a Norwood 2 could be termed a mature hairline which is not “balding”. However, when most people hear the term balding they assume a full Norwood 6 or 7 type of balding. The Class 3 pattern reflect the early corner recession in a maturing hairine (see: HERE)

I often write that about 50% of men have the genetic make up to have some type of balding (Norwood 3 to 7). I often write about 7 to 8% of men are Norwood 7 (completely bald with only a 2 1/2 inch rim of hair around the back and sides of the head). It is also understood most male pattern hair loss may begin after puberty, but most men start their balding process in their teenage years to their late 20s, and by the time you are in your middle age 40-50 you would have an established pattern of balding (or no balding). You will find these numbers may be variable depending on the source as you suggested.

The American Hairloss Associations on the website claim that by the “age of thirty-five two-thirds of American men will experience some degree of appreciable hair loss (I doubt this statistic), and I believe that by the age of fifty approximately 50% of men have significantly thinning hair” not the 85% suggested by the American Hairloss Association. I do not know where these statistics come from. Furthermore the term “thinning” can also mean gradual change of the character of the hair as one ages that is not genetic balding (just more fine hair evolves). Men who never go bald will have some thinning as they age but they will not go bald or show a “patterns” of balding as depicted in the Norwood scale.

The forelock is the pancake size area of hair located in the center of the frontal area found in some family lines and are often independently genetically programed to outlive the hair of the frontal area around it. David Letterman (TV late night host) has a persistent forelock and for years, it was strong while the hair around it starts to fade away. In recent pictures of him, the forelock is now fading. His father and/or grandfather probably had a forelock as well, even if they developed advance balding.

In this picture, the man (BB) showed a strong forelock, not too deep forelock with an advanced Class 6 balding pattern (leading to a Class 7 pattern) with one transplant session of 2121 grafts. He used a comb-back to cover the large balding pattern, although some hair was put in that area to hold back the ‘comb-back’ hair style. From his after picture (just one session), he had a remarkable result because his hair was medium coarse in thickness (one hair was equal to three fine hairs from other patients). We never promise such results, but when it happens, everyone is happy. Maybe he will get around to adding another session so that his comb-back style will be more minimized. From almost every angle with his hair long, he looks great.

Hi Doc, I’ve been on propecia for 4 months now and have been shedding a lot of hair to the point where my baldness is getting more visible. I’m going to stick with the treatment for a year to see how it goes I just wanted to ask if this is normal? Also the hairs that have been shedding for the last few weeks seem to only be the miniaturized hairs on the crown and hair line, could this be a good sign that propecia is working?

Genetic male pattern balding affects each individual differently. It can happen fast or slow. It can affect the front part of the scalp or the top (as it occurs in a certain “pattern”). Drugs such as Propecia help but it is not a cure or a complete solution. Each individual responds to medication (all medication) differently. Sometimes the genetic predisposition wins out. Please follow up with your doctor as it can take about 6 to 12 months to see the effects of Propecia.

Doctor Rassman I have a question. I apologize before hand if the question is inappropriate, but a lot of people online say sexual activity, and masturbation causes hairloss in those with the genes with hairloss. Im not sure if this is true, but I have read masturbation increases prolactin levels and prolactin tends to increase DHT. I know sex and masturbation doesn’t cause hairloss by itself or else every male out there would be bald, but can it cause the hairloss to speed up in those with the Genes for hairloss? I would really appreciate your input on the matter. I might be wrong.

I rephrased your question in the title of this post. With regard to any association between Masturbation and hair loss, which men would want to give up their sex lives to slow down a hair loss process that is going to happen anyway? We have talked in previous posts that the genetically impacted hairs for hair loss, just die out (apoptosis) when their time comes. It is clearly associated with age, modified by the drug finasteride. I can’t say one way or the other that sex (which ever way you have it), will increase the speed of the hair loss, as I believe that is the crux of your question.

You need want to stop masturbating and see if this helps with the hair. Let us know how that goes, or you can search your topic from our previous posts

Dr. Rassman, you prescribed Propecia (finasteride) to me about 5 years ago. I initially had some sexual side effects, namely a loss in getting a good solid erection and some loss of my desire to have sex. You told me to continue to take the drug for another 2 months, at half the dose and then if the sexual side effects were less, try to go back to a full dose. After 4 weeks at half a dose, the sexual side effect disappeared and as you said, I then went back to a full dose. I had not recurrence of any sexual side effects and have been on the drug now 5 years. On today’s visit, we both concluded that the drug stopped the hair loss and today, I have the same amount of hair as I had when I started taking the drug 5 years ago.

This is not an uncommon problem. It seems that whatever change in this man’s hormones that took place after starting Propecia, it self corrected after a month or so. Staying the course is critically important to get the benefits of the drug but this decision should be make between the doctor and patient on a case by case basis. The comment that the status of his hair loss is the same today as it was 5 years ago, is what I commonly hear. Hair loss is a progressive process. Fortunately for this man, he stopped that progression nicely.

I Found the posts that you referenced from your galleries very informative. Can you show more such illustrations that show the balance between balding patterns and the various hair types in hair transplant patients and scalp micropigment patients?

Thanks for the comment. I realize that showing is more believable and more educational than talking about these point that we so often covered in baldingblog over the years.

Blonde woman with very fine hair and thinning corners after one procedure. A second procedure was done just after these photos were taken: http://baldingblog.com/2014/09/05/female-hair-line-lowering-rounding-surgery-temple-recession-correction-with-photos/

One large session (2678 Grafts with medium weight hair and a Class 5A balding pattern): http://baldingblog.com/2014/08/06/one-session-of-2678-graft-hair-transplant-with-photos/
Note that this patient’s average hair weight reflected twice the hair bulk per hair as a person with fine hair. The thicker the hair shafts, the more likely a single session can address the presenting balding pattern.

I was just wondering if a diet high in sugar causes hairless. The reason I’m asking is because i looked up online and it says that sugar increases DHT which leads to hair loss.

I often write the Internet is a great source of information as well as misinformation. Are you trying to find answers or trying to quell your guilt from a high sugar diet? You don’t need to ask this question if you look a bit more online. But if you’re looking at a source to assuage your concerns, hair loss in men is mostly genetic. Hair loss is not related to sugar.

I had a hair transplant of 2900 grafts 14 months ago, but my his is too thin. The doctor recommended that I have another procedure of about the same size to address the thinning look that I have. Is this the right thing to do?

I am going to assume that you have fine hair. As you did not send pictures with this email, I went into our picture file and found two people who had fine hair and a single large session, one younger man has a single 3226 graft procedure with us (see: http://newhair.com/photos/patient-bba/) and the second older man had a large single session (see: http://newhair.com/photos/patient-bfa/). This younger man was happy with his thin looking results, and although he could have done another procedure to thicken it, he decided (for financial reasons) to hold off doing it again for the moment. The second older man was fully satisfied with his results. In both procedures one more procedure could have addressed the thinning problems and I am assuming that your results are similar to the shown results of these two men if the growth was 100% of what was transplanted.

Fine hair and large balding patterns require more grafts to get a thicker look thatn people with average weight or more coarse hair (see: http://newhair.com/photos/patient-aqq/). Graft counts can rise in the 4000-6000 graft range and it is not unusual for such people to get 2-3 sessions to see ideal results. Of course, more transplant sessions are expensive and many people just don’t gor for more surgeries for financial reasons. In 2009, we developed scalp micropigmentation which adequately addresses a ‘fuller look’ on such patients without further hair transplants. In our gallery site (scalpmicropigment.com), we have many examples of such patients on this site. One good example of SMP addressing a post hair transplant result with thinning hair can be seen here: http://scalpmicropigment.com/#!portfolio-item/patient-149/. The cost of SMP is far less than hair transplantation and is a good alternative, but it is a look of fullness, not the reality of it. Is is an option worth considering for you as a non surgical alternative to address your problem and it would be a good option for those patients with thinning hair that we referenced above.

I’m 26 and I was curious about the shape of my hairline. On my left side, there is a noticeable gap, whereas on my right it’s pretty much a stark “V” line (or what *would* be a “V” if the other side were consistent). The corners are a bit above an average mature hairline but, in that sense, I don’t find it too noticeable (I’ve seen people my age that are in worse shape in that regard).

I suspect this has to do with my fathers’ side. Looking at them now, i notice that both my old man and my uncle (both in their 50’s) have a similar shape. Aside from their prominent foreheads, my uncle seems to be pretty thick everywhere else, while my dad is only now starting to get thinner. Frankly, I can make peace either way. What would concern me, though, is ending up like my grandfather (their father) who was an early NW3 (by his early 30’s, looking at old pictures).

Does any of this info indicate at all a specific direction in which I would be headed?

Perhaps your question may be better suited at a fortune tellers shop.
Most men and women are not made perfectly symmetrical. Some have mismatching arm or leg length, crooked nose, odd shaped hair lines, etc.
You also cannot predict how your hair will turn out based on your family tree.
Just because one’s mother, father, or grand parents were smart and had graduate degrees and succeeded in life does not mean one will follow in their foot steps.
As you say, make peace!