Category: Uncategorized

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Bilateral Varicocele and Propecia

Yes, another Propecia question for you. Sorry 🙂 I am 37 and have a bi-lateral varocele, grade 2 on the left and grade 1 on the right. If I started on propecia, could its side effects be more potent or affect my condition? From what I remember, the Merck studies did not get into the issue of results or drawbacks of people with Varocle.

This is a question you must ask the doctor who is following your problem. There is no obvious answer, other than you cannot just correlate any medical issue with a side effect. I am not a urologist nor do I treat varicoceles, so I am probably not the one to answer the question.

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Mom’s Male Family Is Bald — Dad’s Family Has Hair

if my mom’s father and brothers are all bald and my dad’s family including my dad all have hair, where does that leave me in the genetic mix?

Balding genes can be inherited through the mother or father’s family line (54% may be the maternal side connection). Even if you have the gene, there must be environmental influence to express it and for men it is hormones, time, and stress. The balding genes are not fully understood and there is what is called “expression” of the gene, which means that having it and showing it are two separate things. In other words, you may or may not have the gene and if you do, you may or may not show the gene with genetic balding in your lifetime, yet you can still pass that down to your children or children’s children who may then show it with balding in their lifetime. You won’t know until you begin to lose hair and then you will have to be examined thoroughly.

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Bleeding with Microneedling

When you bleed with microneedling, it shows you are at the correct depth. From a numbers perspective, I recommend a 1.25 mm depth. I particularly like the “Dr Pen” device because you can hold it over each area and deliver an effective injury to induce the healing cascade. Once per week is adequate; more frequent use is unnecessary. The photograph shows that you are using it where you want your hairline to return. I can see that clearly by the bleeding that shows in the photo.

 

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More Opinions About Finasteride and Prostate Cancer Risk

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.

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Body Hair Transplant for Alopecia Sufferers?

Hello Dr. Rasman
I have Norwood class 7 diffuse ‘patterened’ alopecia. I am 26. You have seen my scalp and said I am definitely not a candidate for hair transplant because my donor density is poor and I have ‘see through scalp.’ I have been on propecia since then for almost one year. My question is: what is the current success rate of using non-scalp hair for a donor region, such as chest. Do you do these procedures for people with poor donor density? Last question: When will hair cloning become available w/Aderans?
Thank you very much.

Body hair is not the solution you are looking for. I do not expect to see hair cloning for at least 5 years or more. For the moment, if I saw you only once, then you should have a yearly visit with me to follow what is happening to you. There is not much to offer other than Propecia and possibly Avodart (something that I might consider using in your case).


2006-09-15 12:49:41Body Hair Transplant for Alopecia Sufferers?

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Born Without Pubic Hair!

I was born without pubic or underarm hair, I have eyebrows but they never grow long. The hair on my head is thick and lustrous – other body hair sparse. What causes this?

There are genetic patterns that each of us inherit associated with both our heritage and our ancestry. American Indians, like their Asian ancestors, have very little body or facial hair. Many Asians do not have pubic or under arm hair. We have transplanted many Asian women who want pubic hair, but it will grow like your head hair, a bit more curly, so you will have to cut it to keep it short.

For your eyebrows, it sounds like you have very short hair cycles there, which means that the eyebrow hair may only be there for a very short time when it falls out and eventually gets replaced by other hairs. When this happens, the length is usually very short and the growth rate is always slow in the eyebrow, possibly slower on you then in many other people of similar ethnic background.


2006-06-22 10:51:01Born Without Pubic Hair!

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My friends (26, and 27) who are balding are making fun of my hairline

You have kept your 5 year-old hairline. Don’t feel bad, assuming you are the same age as they are, you will be in the category of people like Bill Clinton who kept his 5 year-old hairline into his early presidency. The juvenile hairline is rounded, concave in shape. All boys and girls at the age of 4-6 have this hairline and you were fortunate to keep it. Maybe you will become president one day. Tell anyone that makes fun of you that you and Bill Clinton share the same hairline, that should be on-up for you.


2020-08-18 06:59:42My friends (26, and 27) who are balding are making fun of my hairline

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Breast Cancer, Hair Loss, and Dismissive Doctors

I am among the many young victims of breast cancer (37 y.o. with estrogen+ progesterone+ Stage III breast cancer) who has undergone 16 rounds of chemo, 6 surgeries (including oophorectomy), and 35+ radiation tx, plus am currently on aromatase inhibitors. I am treated at one of the top 10 facilities for cancer in the US, yet trying to get help for my slow growing Ludwig Type II hair while on aromatase inhibitors, esp. 2 years after chemo is proving more daunting. First, my oncologist revers me to dermatology, then dermatology refers me to endrocrinology, then endocrinology suggests I see a hair specialist doctor….but now I read in your archives to defer to the oncologist. It frustrates me that I am being punted around between medical specialties who don’t want to have any liability or necessarily want to work together to come up with a treatment plan for this pervasive side effect which many women in my position are experiencing. No one wants to touch this hair loss issue with breast cancer survivors.

I researched all the medical literature, and although there is plenty of information on observations of hair loss, there is nothing about the treatment of hair loss for those of us who are on either tamoxifen or aromatase inhibitors after breast cancer. I already started 12.5% Rogaine with Retin-A along with 5% minoxidil foam, Aminexil with Madecassoside, and washing with alternating 1-2% Nizoral. Propecia isn’t even an option. Also, I feel I’m relegated to wigs which you deem may accelerate hair loss (although if it not bonded or clipped to hair, I don’t know how that would be the case). Is there anyone in the San Francisco Bay Area that even has the breadth to tackle this problem?

Please tell me there at least some proprietary research out there that is addressing this issue on the horizon, because then I won’t be such a cynic about medicine. Clearly quality of life after cancer involves helping to alleviate hair loss as a result of aromatase inhibitors.

I am truly sorry to learn of your frustration (we’ve all been in situations where we’re referred back and forth and feel like we’re getting nowhere), but the hair loss issue really isn’t specific to breast cancer survivors. Hair loss in all women is a very difficult issue to treat. There are many potential causes, and especially with your medical history, it can be hard to pinpoint the cause. The only FDA-approved medication available to women to treat hair loss is minoxidil (Rogaine), but you should be careful with taking 12.5% and 5% minoxidil foam at the same time so that you do not overdose yourself. Some women have had minor success with Propecia, but that would be taking the medication off-label and there are potential serious risks for women that use this medication (so just to be clear, I do not recommend that approach).

Unfortunately, there are very few options available to women that are losing their hair. For men, Propecia slows the process down, could reverse it, or even completely stabilizes it for years; hair transplantation just rearranges permanent hair from the back to the front. For women, the hair loss may be so diffuse that there is not much to rearrange and there is no specific area of permanent hair like is the case with men. Approximately 20% of women may be helped with hair transplantation, so each patient must be individually evaluated. With regard to your specific situation, I would be willing to see you since you are somewhat local (I do have an office in San Jose) and maybe I can add something to help you, such as the possible use of concealers like DermMatch or Toppik. Wigs might work in your case, but one must be careful that there isn’t traction on the existing weak hair or that’s when you might run into problems with further loss.

I don’t know of any proprietary research, and I wish I had a specialist in mind that I could point you to… but I’m posting your message in hopes that it reaches a wider audience that might be able to provide more insight or assistance. As much as I might want to have all the answers, I fully admit that’s not the case.

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My Daughter and I Diet Together and Lose Hair Together!

January 2008 my daughter and I went on a diet. By June 2008, I lost 40 lbs and she lost 30 Lbs. We went off our diets for the summer. Enjoyed the sun and baseball games, but both got minor sun burns on our heads. By July we noticed too much hair coming out in our brushes. Our heads are itchy and dry and it is now October and our hair continues to come out too fast. In the shower and on our combs and brushes we get balls of hair. We had blood work done, we are fine. We are going to see a dermatologist but they are booked up untill the spring. By that time, we could be bald. We were using pantene shampoe, and recently we are trying Infusium shampoe. I am 42 and she is 15. My husband and 12 year old son are fine. They also aren’t itchy and dry. We tried extra virgin olive oil more in our diet. We are taking salmon oil pills. We rubbed aloe vera on our heads and wash our hair every two days. I dont know what else to do. What could this be and what can we do, why are our heads dry and itchy and what can we use. We dont have dandruff or any other problems. Anything you can tell me would be really appreciated. Thank You.

Diet can cause hair loss and if you lost too much weight too fast, then that could be a problem. Caloric restriction in conjunction with a balanced diet is the way to losing weight and not losing your hair (assuming that you have this connection). Without examining you in detail, I can not offer you other advice here.


2008-11-03 09:21:01My Daughter and I Diet Together and Lose Hair Together!