Category: Uncategorized

What are these lines I have on my scalp?

This is a condition called Cutis Verticis Gyrata: shown here in Wikipedia: https://en.wikipedia.org/wiki/Cutis_verticis_gyrata There are varying degrees of this and the Wikipedia photos is the most extreme.

Currently 23 and seriously looking to get an FUE of about 2000 grafts done in the winter or spring of next year. I’ve had consultations a few months back, some doctors saying I’m too young but others giving me a price point with a conservative outcome I would be happy with.

At this point in time, it is good to get an assessment of your donor supply and your hair mass value so that you know, for your lifetime, what is your donor supply from a practical matter. I do this routinely as a person thinks about a hair transplant, even if it is a few years away. It give the patient the ability to plan, budget and obtain realistic expectations.

“Regular, long-term use of low-dose aspirin is linked to a small decrease in overall cancer risk, with much of the reduction due to decreased gastrointestinal (GI) cancers, particularly colorectal cancer (CRC), new research involving more than 135,000 adults indicates.” This was reported in the March 3 issue in JAMA Oncology.

This is so simple, and has benefits to reduce the risks of stroke and heart attacks as well. Just take one baby aspirin each day

A reader sent us an article on Huffington Post. Take it with a bit of sense of humor but there really have not been many bald presidents considering that about 50% of the male population has some degree of balding.

“To more completely describe his actual beliefs, Congressman Gohmert notes the Kennedy-Nixon debates created a line of demarcation beyond which television became the critical factor in being elected President which also meant there would be no more bald Presidents in his lifetime.”

I spent about an hour reviewing a Denmark based hair stem cell clinic with offices around Europe. What I saw was flamboyance with 8 start offices, some out of a castle, very impressive spokesperson, communicative in multiple languages including English, and lots of fluff. When it got down to the reality of what they were doing, it was FUE, plain and simple. It was a limited procedure that they demonstrated, and despite the claims that they were extracting stem cells and that one hair would produce two, and two would produce for and so on, the reality of what my professional eye was seeing was nothing more than a limited FUE procedure. I teach my patients a very basic principle about balding, that the buyer must beware of the con-artists that are always there to take you money.

It is not safe . I know a guy that took 3 pills and have been messed up for years. Check out a site called Propecia help and see the thousands of men there with horrific ongoing symptoms that have not went away even years after stopping this medication. I’ve read one guys post that says he would rather lose a limb than have post finasteride syndrome.

I have 25 years of experience prescribing finasteride so I know first hand what the risks have been. I have been managing finasteride with my patients and am always responsive when they develop side effects. I can’t explain why a man who took any drug that has a half life of 6 hours with just three pills, can have long term side effects, so I can’t help explain this to you.

I have a history of severe depression. Will finasteride harm me?

With a history of depression, you need to discuss taking finasteride with your doctor. There are potential side effects with people who have a history of severe depression so great caution should be exercised when taking this drug and a close supervision of your doctor is important. I have written a post on this subject here: https://baldingblog.com/2017/05/23/finasteride-can-increase-depression-increase-actions-self-harm/

My comments and opinions are really just meant to stand on their own merits or lack thereof. But I can share that I have had close visibility into what research the PFS Foundation has been doing over the past several years. Even once there is an important finding, it can take years before it makes it into the public eye. I wish things moved more quickly, but this is just the reality of research and the media. Just as an example, the legal documents that served as the basis for the Reuters story were (accidentally) filed publicly on the court docket in mid-2016, but it took over 3 years to make it into the mainstream media. The FDA has known about these issues since 2017 from the PFS Foundation’s Citizen Petition, but the FDA has done nothing yet. I hope the media will pick up on this but we will have to see.

The PFS Foundation has accomplished a few things so far:

Their research has established biomarkers in PFS patients. This shows that PFS is a physical condition rather than psychosomatic, as many people have argued for years. The studies looked at small groups of PFS patients and found two very important things. Compared to controls, PFS patients had undetectable (depleted) levels of neurosteroids in their CSF. Additonally, about 50% of PFS patients appear to have their 5AR2 gene silence. It would be great to have these studies done in much larger populations, but it is very hard to recruit PFS patients due to financial and logistical constraints when it is a rare disease. That doesn’t invalidate the findings of these studies of the existence of the disease itself.

Another Northwestern based study was a very high powered epidemiological study that showed about 1% of patients who took 5-AR inhibitors (finasteride and dutasteride) developed persistent erectile dysfunction. This was controlled in many ways using very sophisticated statistical techniques. Even at 1%, this is a low frequency risk but terribly significant if it occurs.

Lastly, a few years ago there was an article published in JAMA Dermatology that critiqued every one of the clinical trials to date that were published on finasteride. The main critique was that they were simply not effectively designed to sensitize for low frequency, persistent side effects. This article seems prescient now because Merck didn’t report the patients who dropped out of their study and there were apparently PFS patients within this group. This does not seem to have been an accident in retrospect in light of the documents that are now available.

Merck has acted unethically throughout this whole controversy. I can share with you a couple anecdotes with you.

Although I can’t specifically provide names, Merck has interfered with the research publishing process. Somebody from company reached out to at least one journal editor who published an unfavorable study on finasteride. Merck pressured them to withhold support to the journal if the editor did it again.

Personally, I had a physician reach out to Merck about a decade ago to figure out what was going on with my health. The physician spoke with a pharmacovigilance contact, but I don’t remember the name it was so long again. The person said Merck had never received any reports of sexual dysfunction. This was clearly false because of the data that was hidden from the clinical trials. Additionally, at that time Merck had already been forced to warn of such side effects in European countries. And this was shortly before the FDA forced a label change in 2012 to include post-marketing reports, all of which happened before my outreach to Merck.

These are all things I know factually to be true but I can’t provide “proof” until it gets into the public domain. I hope it gets there, but it may never be the case. But if you look at Merck’s response to Vioxx, they did many of the same things I just described for their response to the Propecia scandal.

Hi Dr. Rassman. I am 22 years old but have been experiencing hair loss since I was 13. I have already tried Minoxidil (1 year) and Propecia (1 year) when I was 14-16 without stopping or slowing hairloss. I haven’t really lost much confidence due to my hairloss but it is very notorious now and would definitely like to do something about it. From what I can tell baldness comes from my dad’s side of the family (grandfather and father plus many of my dad’s cousins went bald) but no one has gone bald as young as I have. I think I am a class 3A Norwood and have been thinking about getting hair transplant surgery but I am worried if I will have enough of a donor area to cover the bald spot once the balding process stops, especially if I bald like my grandfather but so far it doesn’t seem to be the case. I was just wondering if at this advanced stage it was possible for a doctor to determine how much hair I will have left.

You need to have a good doctor define what is going on with your hair. Hair loss at 13 is rare, but can occur. If genetic balding has started that early, it would have been good to get a base line on the degree of miniaturization and the change over time. You must have that done now, before you get worse, or you will not know where your hair loss is going. With your history, a densitometry examination with quantification of the miniaturization in each area of your head will point to the long term pattern of your genetic hair loss (assuming that this is the correct diagnosis). There are other conditions as well, so it would be of great value to you to have a consult with someone like me, who is familiar with the causes of hair loss.

Transplantation in a person with certain conditions could be contraindicated. You need to be evaluated by a professional and even sending photographs will not give me the detailed microscopic examination I need. Please do not become your own doctor. This is not a game, but your future look we are talking about.