Category: Uncategorized

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Taking Avodart Bi-Weekly To Avoid Propecia-Like Side Effects?

Dr. Rassman:

Prior to reading this, thank you for your time. Your insight and knowledge is of great appreciation.

My situation is as follows:

I started propecia, was on it for a month, then underwent a HT of 1,900 grafts mainly in the front hairline. I continued to use propecia for 2 more months and began to experience some serious sexual side effects. I stuck it out for another 3 weeks however the side effects continued so I stopped the propecia. The sad part is that the propecia began to halt my hairloss however I could not deal with the sexual side effects.

Sadly my hair is shedding. After another apt with my hair restoration doctor, he suggested I take Avodart 0.5mg twice/week. He had mentioned that some of his patients who were having side effects from Propecia took the Avodart bi-weekly, (due to the drugs long half life) and were able to halt hairloss but did not experience the side effects which I was experiencing from my daily 1mg Propecia regiment. I have read all of your posts in regards to Avodart and I understand that it is not FDA approved nor do you prescribe it to your patients.

My main question to you and issue at hand:

I know that when people start taking Avodart they experience a shedding phase which generally kicks in after the first month or two of starting the drug and can last a few months there after. My first question – If I am only taking the drug twice a week and have only been off of propecia for 4 weeks will I also experience a shedding phase? I am confident that the shedding phase is the transition to a greater good…as the weaker hairs fall out months later they are replaced by stronger, new hairs. My problem is that I am in the entertainment industry and will be starting a one month taping of a TV series from June 30th-July 30th. I would like to have as much hair as possible by that time so would I be better off waiting to take the Avodart after the taping is complete, or should I start now and hope that the avodart will not cause a drastic shedding phase and help me stabilize the hair that I currently have? I guess this really comes down to a game of timing.

It will be 5 months since my HT when the taping starts in June so I am hoping that the transplanted hair will already be popping up. Also, most of the hair that I am losing is from the front hairline and temples. The crown seems to be doing ok.

Thanks again for your time and I would also be interested in undergoing a transplant with your team following the taping.

I really do not have a clear answer to your situation. In general, Propecia or Avodart will not be as effective on your front and temple areas. They each work best on the top/crown areas of your scalp. I do not know if you will have more or less shedding as everyone has different results, different side effects, etc. Shedding isn’t seen by all men that start the medication. Really, only time will tell and there is no clear way to predict this.

It would be interesting to know if Avodart did indeed change your sexual side effect issues, as I would expect that it would not make it better. There’s not enough reported about Avodart dosing in the treatment of hair loss for me to suggest that bi-weekly pills are the way to go.


2010-05-06 08:59:29Taking Avodart Bi-Weekly To Avoid Propecia-Like Side Effects?

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Taking Propecia After Morning Exercise

Hi,

I go to the gym 5 days a week starting at 6:45am in the morning till 8:30am. I do a workout which involves weights and cardio. I also take a protein supplement called whey.

I just want to know if it is wise to take propecia AFTER the work out at 9:30AM. I am really use to this time now. Also I heard that propecia decreases hormones and as a result will not help you improving in body building. Is this true?

Thanks for your help

Really, you can take it anytime. I generally recommend taking it upon waking up, first thing in the morning. Testosterone levels peak in most men in early morning. Blocking the formation of DHT should not impact bodybuilding.

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FUE without taking finasteride

I did research and saw it’s important to take fin for a year prior to FUE, but did my research a little too late, and discovered this sub after I had my FUE a week ago…. It’s too late to turn back time, and I started taking fin now post-op, but I have anxiety that my FUE will be a waste and unsuccessful. Will my transplanted hairs survive if I never took any fin/min prior to FUE, but will continue to do treatment after my FUE?

FUE harvests the hair from the back and sides of the head which are never DHT sensitive, so finasteride has no impact on these hairs. If the FUE was done by a good surgeon with a good team, they will grow and last your lifetime; however, your native hair around the hair transplant may still be impacted by your balding process made worse by the FUE surgery. This is particularly relevant if you are in your early 20s, so I don’t do surgery on men under 26. The older you get, the more secure your native hair will be. Finasteride started prior to your FUE will protect the native hair in most men.

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Taking testosterone, the debate goes on but heart attacks are up for those who take it (debate below)

After years of studying the twists and turns of hormone replacement therapy among women, Montreal-based epidemiologist Christel Renoux, MD, PhD, shifted her focus to its use in aging men — a path that’s proving no less controversial. “There is a passionate debate around testosterone replacement therapy; you have strong, strong believers it is really having a benefit and others say the benefit is modest and not worth the risk. You can see that it is really dividing even the scientific community,” she told theheart.org | Medscape Cardiology. Following the publication of two articles linking testosterone replacement therapy with an increased risk for myocardial infarction (MI) and stroke, the US Food and Drug Administration and Health Canada issued warnings about using testosterone products for age-related low testosterone and required a warning on product labels. The European Medicines Agency, however, found no consistent evidence for such risks.

Prescribing patterns appear equally conflicted, with one recent study showing testosterone prescriptions plunging in 2013 after publications of the cardiovascular safety concerns, while another report found spending on testosterone nearly quadrupled from $108 million in 2007 to $402 million in 2016. Rates of hypogonadism, however, have remained stable, suggesting that aging but otherwise healthy men with low testosterone may be turning to testosterone replacement therapy (TRT) as an elixir for aging and dwindling sexual function. “We are at the early stage of the debate. We need much more work to clearly delineate is there a place, possibly, for testosterone replacement therapy and in which clinical scenario and at which age,” said Renoux, from Jewish General Hospital and McGill University, both in Montreal, Canada.

Renoux and colleagues’ latest work provides no easy answers, despite a large cohort of 15,401 men, aged 45 years or older (mean 60.4 years), diagnosed with low testosterone without evidence of hypogonadotropic or testicular disease in the UK Clinical Practice Research Datalink database between 1995 and 2017. Most patients received testosterone gels or creams (56.8%) and 33.6% received injections. The results show a 21% increased risk for the composite of MI and ischemic stroke/transient ischemic attack (TIA) in current TRT users vs nonusers after adjusting for more than 20 potential confounders (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.00 – 1.46). This corresponds to an adjusted risk difference of 2.4 events per 1000 persons per year, the authors reported July 18 in the American Journal of Medicine.

MI and stroke risk was highest in the first 6 months to 2 years of continuous use and mostly driven by an increased risk among men aged 45 to 59 years. Risk was also increased in men with and without prior cardiovascular disease (CVD), but the results did not reach statistical significance. Surprisingly, current TRT use was associated with a lower risk for all-cause mortality (HR, 0.64; 95% CI, 0.52 – 0.78) and past use with an increased risk when compared with nonuse (HR, 1.72; 95% CI, 1.21 – 2.45). “It’s difficult to reconcile on one hand an increased risk of cardiovascular disease, which is one of the leading causes of mortality in older men, and at the same time finding a strong predictive effect on all-cause mortality,” Renoux said. (Text taken from Medscape)

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Garlic Gel for Treating Alopecia Areata?

For those of us with Alopecia Areata, – this study may be beneficial to you guys. The study is quite positive. Please read the link below:

Link: Local Study on Garlic for Alopecia Areata

Nice find and thanks for sending. I don’t recall seeing too much about using garlic as an alopecia areata treatment.

This was a small study of 34 people presented last year at a conference in Australia. It does sound interesting, and I found another small alopecia areata study discussing the use of topical garlic gel in combination with betamethasone valerate, but I don’t know that the study mentioned in the link you sent was ever published in a peer reviewed journal. While the article is from the Philippine Dermatological Society site, it just mentions that the presentation was by one of their members…not that it was published in a medical journal.

I am glad there are new alopecia areata treatments being explored, regardless of how stinky they may be. And it’s worth noting that a few years ago the NY Times wrote about unlocking the secrets of garlic for use in medicine.


2011-07-27 14:16:06Garlic Gel for Treating Alopecia Areata?

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Teenage Female with Thinning Hair

Hi I am 17 years old. I’m going to be 18 in 2 months. I used to have very thick, long, black and beautiful hair. Over time it started thinning. I dont know why. Is it that Im not eating enough vitamins? Or that I dyed my hair? I’ve dyed it about 5 times my whole life. I also blow dry and straighten my hair. Is that bad for my hair? I really want my long thick hair back. Will it grow back? What can I do? Is there anything I can take to make it grow faster?

You need a proper examination of the scalp looking for miniaturization. First you must rule out that you are not early in the female genetic hair loss course. Then, if positive, you need to have your overall health checked out, looking for a variety of hormonal issues and diseases that can cause hair loss. If you do not have miniaturization or other causes of hair loss and hair thinning, then you may be having changes into a new adult hair type. Some people as they mature from teens to adults, will change their hair character. Sounds like you need a good doctor to point you in the correct direction.


2005-11-23 14:26:06Teenage Female with Thinning Hair

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Genetics and Family History – Can You Give Me A Diagnosis For Balding?

Hello Dr! First of all, english is not my native language so please bear with me.

My question is about the genetics regarding male pattern baldness and if it’s only a “guessing game” to determine the future outcome of my hair situation.

I need some advice on my hair situation. I’m a 30 year old male who has been “struggling” with high temples since about high school. I’ve been obsessing about my hair since about january (never even thought about it before then). Probably a nw 2,5-3.

My family history is making me so confused over the outcome of my, probable, upcoming hair loss. Making a list for an easy read;

Moms side;
Granddad, full head of har until his 60s then a diffuse thinner. (Always had “fine hair”)

Grandmom, curly hair, little temple recession.
Uncle 1, fine hair. Receding hair line and vertex thinning in his 50s (maybe later)

Uncle 2, full head of hair, curly. Mom, thin fine hair.

Dads side;
Granddad, bald. Probably started in his late 20s. Uncle, bald. Noticeable when he was about 25. Dad, straght hair, high temples (like me). Full head of hair.

Brothers;
3 year older, diffuse thinner. Noticeable at vertex in his early 20s. 6 years younger, high temples, a little bit diffuse thinner.

Question:
Is it possible to pick up my grandfathers balding pattern later, for example, he started too notice thinning at the age of 28.. Can i follow hes pattern but 5 years later?

We don’t generally go into this much detail into family history or give a diagnosis or a prediction based on family history. In general male pattern balding is genetic but it does not always follow a family line. The best way to diagnose MPB is through an exam (in person).

If you have a Norwood 3 hair loss pattern then that is what you have.
If you think you are going to have a Norwood 5 hair loss pattern, then the best way to find out is through a detailed exam. Looking at your hair under a microscope (MINIATURIZATION STUDY) or testing the bulk of your hair over a period of time (BULK STUDY) is the best way to diagnose the balding pattern.


2015-09-24 13:57:35Genetics and Family History – Can You Give Me A Diagnosis For Balding?

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Temple Hair Loss and Transplantation (with Photos)

Hey Doc,great site!
I know people ask about temple thinning a lot, but are usually referring to the corners of the hairline. Well, I have a question about the real temple area (above the sideburns). If this area is thinning does that point to MPB or something else? Thanks!

Losing hair in the area that I call the “temple peaks” may be part of the balding process in some men. Hair transplants to this area takes a special skill to make it look truly natural. I have seen more problems with the transplants done in this area from doctors who have not mastered the hair process. I posted an example of one such patient that came to see me for a repair after he went to a doctor that obviously didn’t understand the art of transplanting to the temple area — Temple Hair Transplanted in the Wrong Direction.

Here’s a patient we did at NHI with 150-200 grafts places into each temple. The before photo is on the left, after on the right. Click the photos to enlarge.

 

And here are even more patient temple hair transplant examples:


2010-03-19 12:44:09Temple Hair Loss and Transplantation (with Photos)

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Girlfriend dictates balding solution

Girlfriend just said to me “what if you started balding by shaving your head first” immediately followed by a “hair transplant”

This is not your girlfriends head, its yours. You should decide what you want as if she didn’t exist because whatever you do or don’t do, you will have to live with it.