Dostinex (Cabergoline) and Propecia

Dear Dr. Rassman,

I’m a 28 year old male. About 6 months ago I was diagnosed with a rare pituitary condition called hyperprolactinemia. This disorder is genetic in my family, and mine is a very mild case. The treatment is a single half-dose of cabergoline (marketing name Dostinex) taken once a week.

Male pattern baldness also runs in my family and I’m starting to show thinning on the crown of my head. My dermatologist suggested I try the propecia/rogaine route. Since propecia affects the endocrine system I am a bit reluctant to take it without knowing more about possible side effects or interaction with the cabergoline. I don’t think it should and my dermatologist said she wasn’t aware of anything and I haven’t found anything about it on the web, but I wanted to get another opinion before I started propecia. I also read online that minoxidil from rogaine may have a side effect of increasing prolactin – the condition I have too much of. Do you know of any cases like this? If so, should I reconsider starting propecia, rogaine, or both?

Thanks!

At this point, it is very difficult to accurately assess the cause of your thinning hair. As far as I know, cabergoline does not have hair loss listed as a potential side effect, however, this does not mean that this drug can not cause this in you. Also, certain diseases / stresses to the body have also been known to cause hair loss. Lastly, as you have mentioned, male pattern baldness could be the cause of your thinning hair. You definitely need a miniaturization study to determine the extent and locations of most of your hair loss (i.e. does it correspond to MPB?).

There have been reports that minoxidil may be related to the development of hyperprolactinemia, definitely something you don’t need more of (see Drugs.com – Interactions between cabergoline and Minoxidil). The main point here should be that before you start any medication, whether it be Propecia or Rogaine, you should have a coordinated discussion between your physician that is treating you for the hyperprolactinemia and your dermatologist. To answer your question though, I haven’t read about Propecia (finasteride) and cabergoline interactions, but again, please discuss this with your prescribing physician.


2008-01-15 13:12:15Dostinex (Cabergoline) and Propecia

Dr. Rassman Speaks About The Tedium Of Doing FUE Manually At The Artas User Conference

There is little doubt that the ARTAS robotic System is less stressful for the surgeon than than the manual Folliclar Unit Extraction (FUE). Some of our patients are driven by the technology as we have seen some of them ask for the ARTAS robotic system. We offer both the manual and the ARTAS FUE for our patients at the exact same price of $8/graft at this time. From a quality perspective, both techniques are identical. We have been doing FUE since the mid-1990s, so we are pretty good at it. The manual FUE in Dr. Pak’s hands is a faster procedure when compared to the ARTAS system making for a shorter surgery.

Please comment in our comment section and ask more questions about these two FUE procedures. If we are doing an ARTAS FUE on the day you visit us, ask if you can see it in action and if the patient agrees to allow visitors, we will let you observe the ARTAS in action. For more about the ARTAS robotic system go here: https://newhair.com/procedures/fue/fue-artas-robot-robotic-fue-surgery/

Scalp Burn Treated with Balloon Expander, How is it Done?

let’s assume that the burn is in the front and top of the head. A balloon is then placed in the crown to expanded in the scalp over a couple of months. Each week, about two times, fluid is injected into a ‘port’ on the balloon. With each injection, the balloon expands until it is stretched enough with enough redundancy to cover the burned areas. Then the burned scar is removed and the new scalp is advanced forward. I have been involved in a number of these challenging cases and the results are very rewarding. I have seen fully half of the scalp burned and treated successfully this way, sometimes with added hair transplants for fine tuning the process.


2020-03-05 15:03:59Scalp Burn Treated with Balloon Expander, How is it Done?

Dreadlocks cause balding (photo)

This is an example of a man who is balding and is making it worse by wearing a dreadlocks hairstyle. He would be better off shaving his head to preserve his hair than by pulling it out and getting traction alopecia from this hairstyle.


2020-09-01 09:48:52Dreadlocks cause balding (photo)

Scalp MicroPigmentation of FUE Combo Review for Norwood 5 Patient

This is a review of what is possible when you combine Scalp MicroPigmenation (SMP) with a hair transplant surgery using the Follicular Unit Extraction (FUE) technique performed at New Hair Institute by Dr. Jae Pak.

The following patient is in his 30’s and always wore hats. Even in the house with the family or with friends he wore hats because he was not happy with his balding pattern. He eventually decided on a FUE procedure because he didn’t want the linear scar on the back of his head in case he wanted to shave his head in the future. If all else fails, he thought at least he can shave his head without any worries about scars. He eventually went on to have 3 FUE surgeries over the years as his hair loss progressed and received about 5000 grafts. Despite the new look and the permanent transplanted hair, he wanted fullness and even wanted to shave his head for a buzz cut look.

Eventually, he had the Scalp MicroPigmentation procedure and he had the best of all scenarios: He can cut his hair long or short and he will always have the look of fullness.

Note that hair transplant procedure is a great option for those who are balding. But you will never get full thick hair since the basic concept of a hair transplant surgery is just relocating hair from one location (back of head) to another location (front and top of head). There is nothing new being added. Hair transplant is basically artistically rearranging the hairs around. Scalp MicroPigmentaion is used to augment the limitation of a hair transplant to provide the look of fullness by minimizing the contrast between hair and scalp.

This patient finally threw away the hat he wore for so many years.

FUE immediate after/  FUE scars hidden by SMP

FUE immediate after/ FUE scars hidden by SMP

Before and After FUE Hair Transplant (NO  SMP)

Before and After FUE Hair Transplant (NO SMP)

Before and After FUE Hair Transplant (NO  SMP)

Before and After FUE Hair Transplant (NO SMP)

Before and After FUE Hair Transplant (NO  SMP)

Before and After FUE Hair Transplant (NO SMP)

Before and After FUE Hair Transplant  AND Scalp MicroPigmentation (SMP)

Before and After FUE Hair Transplant AND Scalp MicroPigmentation (SMP)

Before and After SMP - BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After SMP – BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After FUE Hair Transplant  AND Scalp MicroPigmentation (SMP)

Before and After FUE Hair Transplant AND Scalp MicroPigmentation (SMP)

Before and After FUE Hair Transplant (NO  SMP)

Before and After FUE Hair Transplant (NO SMP)

Before and After SMP - BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After SMP – BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After SMP - BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After SMP – BOTH photos are after hair transplant surgery (NOTE: shaving does not make hair transplant look as full)

Before and After FUE Hair Transplant (WITH  SMP)

Before and After FUE Hair Transplant (WITH SMP)

Before and After FUE Hair Transplant (NO  SMP)

Before and After FUE Hair Transplant (NO SMP)

Dutasteride and length of side effects

I recently discovered that Dutasteride has a half life of 4-5 weeks. I am considering getting off of Dutasteride (daily usage for about 3 years) completely because I feel like it is heavily contributing to my anxiety (timing is very similar). I am on no other hair loss remedies currently but have had one temporal area hair transplant. If I discontinue Dutasteride or take it less frequently, what therapies seem to be working for people nowadays? With such a long half-life, couldn’t Dutasteride hypothetically be taken once a week or potentially less and maybe still have similar results?

In theory, you are correct; with a long half-life, one would expect that a once-a-week dosing might be enough, but for reasons I personally don’t understand, dosage recommendations have been more frequent. As the FDA has not cleared dutasteride for hair loss use, this is a real problem for doctors, i.e. to find the correct approved dose. The blood levels may have a half-life of 4-5 weeks, but the tissues in which the dutasteride is embedded have a much longer presence in your body that could go up to a 1/2 year or more. That means if you get side effects, it may be a long time to get rid of them because dutasteride is in your tissues 6 or more months.

Scalp MicroPigmentation vs Traditional Concealers Like Toppik

I recently started using Toppik and I’m always worried that it’s going to come off on my pillow or I’ll get caught in a rain storm and have my “hair” wash away. SMP would be like a permanent Toppik, yes?

I had a discussion with one of our hair transplant patients who continued to use Toppik to get the fullness he needed despite having a reasonable hair transplant result. This man in his late 50s received around 5500 grafts, which was not quite enough to cover his entire Norwood class 6 balding pattern, so he became dependent upon using concealers like Toppik and DermMatch even after the transplants were completely grown in.

This patient is a daily swimmer, and with his primary exercise being in the pool he was always wearing a swim cap to deal with the Toppik running down his head once it got wet. I told him about Scalp MicroPigmentation (SMP) and how it could be done to supplement his hair transplant to increase the illusion of fullness, much like what he was doing with the concealers. He had the SMP done and was able to give up the Toppik dependency.

He said, “Now I swim without a swim cap and you can not believe the freedom I got by that SMP treatment. I am single and now that my hair looks like I am 40 again, my life has turned another page“.

Dutasteride vs Propecia, Round 2

Another Propecia question, this time from Thomas…

I have been on propecia now 9 months and have receded more and gotten thinner on top. Propecia either accelerated my mpb or did nothing for it. I am worse off now then when i started. I never used to have hair in the shower, on my hands, or in the sink..Ever since the 3rd month on propecia, it has not stopped. My head even itches now sometimes when it NEVER used to before. My question is can Dutasteride help me or because i had no response to Propecia, is it a waste of time?

I do not know your age or family history, when you started balding, or what pattern you are heading to. This information is critical. Already you know that Propecia has not helped you (slowed or stopped the hair loss) so this is already atypical. It is possible that you have other than a genetic cause for hair loss. Thyroid disease and some other medical conditions can produce hair loss that will not respond to Propecia.

With regard to Dutasteride, there is no doubt in my mind that it is a better DHT blocker than Propecia, but it has not been proven to be by appropriately controlled studies. A few doctors who I respect have used it for genetic hair loss and they tell me there is significant benefit in some patients that do not respond to Propecia.

First and foremost, you need to have a competent doctor make the assessment. If it proves to be genetic hair loss, then using a non-FDA approved medication (called off label use) has implications for both you and your doctor. If you are in the California area, I would be happy to see you personally and make that assessment.

ScalpMed

PLEASE NOTE: I do not sell ScalpMed. I’ve been getting quite a few angry emails from people stating that they feel deceived by this product, that they want their money back, etc — but I have no relationship with ScalpMed’s manufacturers. I can’t help get your money back, nor can I offer much advice about this product. It is not FDA approved and I would not recommend it for that reason alone.

 

Let me begin by letting you know my situation. I am a 22-yr.-old female who has been diagnosed with both AGA and alopecia areata. My dermatologist tried steroid shots in one of the areata spots but they didn’t cause any growth.

That said: this morning I saw an infomercial for a product called “Scalpmed.” I don’t usually give infomercials a second thought, but I thought, what the hey, I’ll ask Dr. Rassman about this one. The product is *supposedly* for women and men, contains the highest FDA-approved dose of minoxidil, and does not cause sexual side effects or dry out the hair or scalp. The website admits that individual results will vary but offers a full refund of the purchase price (less shipping and handling, of course) if one is not satisfied.

Just thought I’d ask if you’ve heard of this, and, more specifically, if you’ve heard of this scorching anyone’s scalp off or anything similar. Don’t worry, I don’t intend to make any rash phone calls 😀

It took a bit of research and a call to a consultant for FDA issues to answer this question properly. I could not find Scalp Med or Vitadil in the FDA database. The website says, “These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.” If this product were FDA approved, the FDA would certainly evaluate the labeling for the product. The second statement is part of the FDA definition of a drug. The second part, “Affects the structure or any function of the body of man” is relevant to the use of this product. It is strange that the first part of the website says it is FDA approved while the second part says the FDA has not evaluated the labeling. This is clearly an inconsistency that indicates that you should take what is claimed here suspiciously.

The website says that “Vitadil-5A and Vitadil-2A are FDA-approved formulas for hair growth.” The company may be saying that they used a formula that had been approved for another company. This is possible. However, a company cannot just copy the formula of an FDA approved product. The company must submit an Abbreviated New Drug Application (ANDA) and may be required to do bioequivalence studies before the FDA will approve it for this company. The company also has to meet Good Manufacturing Practices (GMP) as well.

I always end such comments suggesting as a consumer you must ‘BEWARE’ and be your own protector. The government can not always enforce its regulations in a timely manner to protect you.