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DHT expression in the scalp

I have a question regarding the mechanism of action behind androgenetic alopecia. I see some people saying that we lose hair as males with pattern hair loss because the scalp hairs are more sensitive to DHT in the area of balding (pattern). I also read that some people say that the conversion from test to DHT (via. 5AR) is greater in the scalp tissue than in other body parts. This begs the question: why would you ever need to block DHT in the whole body by using oral meds like fin and dut If the “problematic” test conversion happens in the scalp tissue, then topical dut/fin or a topical anti-androgen should be enough ? Anything I am missing something? Thank you!

Hair loss occurs in males because we carry the genes for hair loss, and our DHT hormones trigger hair loss. The genes are programmed to determine when hair loss starts, but most men get it before age 26. I have seen men develop hair loss as late as in their early 50s, but this is an exception to the rule. If we decided to cut off your testicles, I doubt that you would have hair loss, but that is an extreme approach to reduce the impact of DHT. Topical finasteride goes through the skin and into your body as it gets absorbed through the skin/scalp. You might as well take the oral finasteride. There is a type of liposomal topical finasteride where most of it stays in the scalp, but this is expensive and only covers part of the scalp. If you spread it around the scalp, it raises the cost considerably.

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Problems from Fincar (Generic Finasteride)

Dr. Rassman: Fincar Caused Bizarre Problems for me-please advise. I have used 1/4 proscar daily for 8 years I decided to try Fincar for a while. Supposedly Fincar is identical to Merck’s proscar. After starting Fincar my left testicle started aching. I had read numerous about such a paid although I had not experienced it.

In 30 days of Fincar use, bare spots appeared in my beard and the hair on my left arm diminished significantly. The outer third of both eyebrows have thinned drastically and my skin has gotten dry and wrinkly. I know this all sounds crazy but it’s scary.

I went to my family doctor and he just blew me off and said Im getting old since I’m 48.

Doctor-What did the Fincar do to me? I’ve been of Fincar 3 weeks. No testicle pain. Will I return to normal? I’ve resumed the Merck proscar daily but am scared. I wish I had never touched Fincar. Please tell people to never touch the non-Merck finasteride.

Thanks

From my understanding finasteride formulations like Propecia and Proscar is still under U.S. Patent protection thereby restricting the manufacturing of this drug in companies which are under patent treaties with the United States. Generic versions of finasteride like Fincar are made by a pharmaceutical company called Cipla in India and is not available in the U.S. (although I suspect internet sales makes this possible). I am not familiar with International Patent laws so I am not qualified to comment on patent issues. I do know that foreign manufacturing of drugs are not governed by US FDA regulations, so I do not know if the formulation meets the same criteria. There is real no way for me to know if your symptoms are a direct result of taking Fincar. I also do not know about the additives and other inactive ingredients in the formulation. I am not aware that the official, U.S. brand of Propecia is associated with aching testicles or thinning eyebrows or dry, wrinkly skin. I am curious to know why you took the medication if you had read “numerous” reports that such drug will cause these problems.

Fincar may have caused your symptoms, but it may also have been coincidental. I suspect you do not want to take another chance. It is always a “buyer beware” market. Seek competent medical advice. I hope you return to “normal”


2006-04-06 11:27:23Problems from Fincar (Generic Finasteride)

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Did My Using Minoxidil Mess Up Propecia Benefits?

In October I noticed slight thinning on the vertex and purchased 5% minoxidil. I applied this twice daily to the vertex for 2.5 months at most. I did not see any change at this time, but was tired of applying minoxidil twice a day and switched to propecia. I have now been taking propecia for 4.5 months and there is noticeable thinning on the vertex. I am also shedding quite a bit more than I ever have which has been going on for almost 2 months. I know that Propecia can awaken follicles and increase shedding, but how long does this last? Also, even though Minoxidil did not regrow any hair for me, can it have a negative effect on Propecia possibly reversing hair loss on the vertex even though I used it for only a short period of time and it did not produce any hair regrowth and thickening? Basically, did I screw myself by using minoxidil before Propecia?

No.

You may subjectively notice thinning and changes in your hair. However, it is impossible to tell what is working or not working. Consider the fact that you may be just progressing to losing more hair and taking those drugs may be slowing the process down (even if it does not seem to be). In other words it can be worse, but not because of Propecia and minoxidil. You may also consider seeing a doctor who can examine your hair under a hair densitometer to see its miniaturization pattern and quantitavely track the effects of what Propecia is doing.


2006-06-20 09:21:10Did My Using Minoxidil Mess Up Propecia Benefits?

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Propecia and Cancer

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?

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.

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Did you have permanent or temporary scalp micro pigmentation done?

I had a small thin spot on my crown that I’d like to darken with smp while I wait for possible results on finasteride. I was considering temporary smp. What do you recommend? I’m 25 with hairloss only in the crown, 6 months on fin. Thank you

We don’t do temporary SMP, but many people who had it grew their hair without it being detectable. We actually offer it for hair transplant patients who may not be as full as they want.


2020-12-03 10:29:58Did you have permanent or temporary scalp micro pigmentation done?

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Propecia and Minoxidil Made My Hairline Look Eaten!

ive been on propecia and minoxidil for four months and am going through a horrible shed, my whole temple point has thinned out, my hairline looks eaten and my hair feels horrible, from your experiece is this common?

thanks

I am not sure what “eaten” looks like other than some erosion that is asymmetrical. We are all different — and that includes hairlines. It could be accelerated shedding from either of the medications, but you need to see an expert in the field to give you and examination, or at the least send me a photo so I understand what is “eaten” about your hairline.


2009-09-03 11:02:37Propecia and Minoxidil Made My Hairline Look Eaten!

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Diffuse Hairloss and Sebum Plugs

I’ve have consistent diffuse hairloss universally around my head for about a year and a half, to the point where I believe I’ve lost about 60-70% of my hair. Many of the hairs that fall have large white plugs attached to them (see pictures), which I believe may be sebum.

Is this in fact sebum? Can these plugs cause diffuse hairloss? Any idea what may cause them or what might treat them? So far, I’ve tried zinc, ketoconazole, salicylic acid, coal tar, and other “sebum reducing” shampoos. I have also been on propecia for 6 months, but with no noticeable reduction in the pace of my loss.

2

Sebum is a waxy substance from the production of oil from your sebaceous glands. It can be seen on ends of hair follicles that fall out but this does not mean you have a hair loss condition or disease process (because of the sebum). There are products that claim better control of sebum and Internet posts that claim the sebum is the cause of hair loss. It generally makes for great marketing campaign to sell a product to those who are looking for a hair loss cure. Sebum does not cause hair loss, if it did, the many men and women on skid-row would be balding as they often do not shampoo their hair and reduce their sebum buildup. If you are experiencing diffuse hair loss, I doubt sebum is the root cause (no pun intended). You need to see a doctor for your hair loss condition to establish a good diagnosis.

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Propecia and Testosterone Booster

is it ok to take propecia with a testosterone booster? and will i still lose my hair like crazy if i already am losing my hair?

Propecia is not 100% capable of undoing the hair loss effects of testosterone. It may have some protective effect against the testosterone (in hair loss), but better just to not take the testosterone and you will not have to protect yourself against something that you are not taking. I hope this is as obvious to you as it is to me.


2006-10-26 07:51:02Propecia and Testosterone Booster

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Disasterous Hair Transplant Horror Stories!

I saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

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Propecia Effectiveness Statistics?

Hi Dr.,
I’m a 19 year old with a head full of thick hair. However, I have a slight recession that is following the pattern of my grandfathers. His hair receded into his early thirties and then stopped suddenly. I believe this is called a mature hairline, but it didn’t look like a mature hairline, it looked much worse. I really would prefer my hair not get like that. I think a hair transplant would be unwise this early, and getting one after the recession is finalized would kind of defeat the purpose of having one. Do you have any statistics on the effectiveness of Propecia, and would you recommend me taking this.

If it is a mature hairline, there isn’t much you can do. Medications may help, but I can’t say to what degree (each person is different and will react different to these drugs). At 19 years old and with very little (if any) male pattern baldness, you are definitely not a candidate for hair transplantation and any doctor that would do any surgery like that on you is taking you for a ride.

For Propecia stats, I’d say one of the the best places would be this page at the official site — Propecia.com – See the Proof — which is setup by the manufacturer, Merck. Although you may think that would be a terrible place for unbiased info, I should point out that Merck is heavily scrutinized by the FDA to make sure any claims, statistics, or other information provided is accurate.