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Hair Loss and the Inevitable Cure?

I have a couple questions regarding meds as being direct causes of MBP among other things. Well, I have been on antidepressants for quite some time now, and for a while I stopped taking them, around the time inbetween the ages of 16 and 17. Around the time I was almost 17 and a half I got back on them and when I turned 18 is when I started noticing a change in my hairline.

Currently im 19 and a half and the left side of my hairline has gone up maybe a bit more than half an inch and the right side about an inch. Are antidepressants directly linked to MPB? Do they trigger hair loss? Or when they talk about hair loss as a side effect are they talking about the patchy kind that just falls out and regrows when you stop taking the meds? My family history of hair loss is very inconsistant so its hard for me to tell if I really am experiencing MBP or just a mature hairline. Unfortunately I have a very skinny long face and naturally pronounced hairline so it makes it all the more noticable….. My other question is, this whole gene therapy thing. If we do find a cure for hair loss through this what will happen to your buisiness? Will you continue working for the hair loss industry? Just curious, heh. Thank you for your time sir.

While many medications may cause hair loss, the most common cause men is genes, unrelated to medication use. Genetic hair loss causes male pattern baldness (MPB). It is possible that your medications could have accelerated changes in your hairline or balding, but there is really no way to be 100% certain. Mapping out your scalp hair for miniaturization may give you insights into any gene expression that is active at this time. Male pattern baldness is also known as androgenic alopecia (AGA), because hair loss is from the effects of androgenic hormones, such as dihydrotestosterone (DHT). While we all have androgenic hormones, only the men with the gene for hair loss will lose hair. The change in your hairline, if it follows a specific pattern as MPB, will generally mean you have the gene for hair loss. To be certain though, you should be evaluated by a doctor for a physical exam and a miniaturization study. I really cannot diagnose your hair loss problem with just brief descriptions. BaldingBlog is merely a source of the opinions of our staff physicians and is not a source for diagnosis.

With respect to gene therapy, I sincerely hope it will come to fruition in my lifetime. While it is undoubtedly still many years away, it will definitely impact my field in a positive way. After all, we are the physicians in the field of hair loss. Gene therapy will only empower us to offer more options to our patients.


2007-12-19 15:05:58Hair Loss and the Inevitable Cure?

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Hair Loss From an Aggressive Haircut

Hi,

I have been using Propecia for about 7 years. The results have been satisfactory. However, the other day, an overzealous hair stylist at XXX Sam’s gave me an extremely aggressive haircut. I mean, it felt like she was ripping my hair out by the roots when she would comb it or cut it. Do you think this haircut could have caused permanent hair loss in any potentially damaged areas of my scalp, or, with or without the help of Propecia, the hair will just grow back? Thanks!

I had a patient who got mugged in downtown Los Angeles. The gang that robbed and mugged him, held him by his hair, and when they took all of his money and kicked him, broke his nose and cut his face, they pulled out most of the transplanted hair I had done in the front (1500 grafts). He insisted that the ambulance bring him to my office and he was the only person ever, who came to my office looking like he got out of a war zone. He did not care about his broken nose, his broken ribs, his cut face, or the many bruises on his body. He was crying for his hair that was then all gone.

I told him that he had to go to an emergency room to get himself fixed up and I assured him that his hair would come back. In just a few months, all of the hair came back. I doubt that anything that any person can do with a hair cut can match this story. To conclude, your hair should be fine.

With regard to your stylist, remember her like you remember an old discarded flame, what brought you and what sent you packing.


2006-01-09 09:19:23Hair Loss From an Aggressive Haircut

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Transplanting Between Miniaturized Hairs

Hey doc. How are you today?
I have been diagnosed as a Norwood 5 thinning pattern. Originally when I started finasteride I was a Norwood 3 vertex only, but obviously the medication is only slowing the process down. I had a consultation with a reputable Toronto Dr and he said it would not be be worthwhile performing surgery at that time. But now that things have progressed is it possible to perform surgery just to give me more density? I am fine with my hair line. Or is it dangerous transplanting in between miniaturized hairs? I’m 22 and have been on finasteride for 2 and a half years with a gradual decline in my hair count but hairline is still thick for some reason. What do you think ?

I am fine. Thank you for asking.

Transplanting between the miniaturized hairs may likely result in you losing those weak hairs, so you won’t be any better off than you are now (except with less donor hair and less money in your bank account). I can’t say for sure since I haven’t seen you, but based on your description the surgeon you saw might have done you a favor.


2010-03-23 08:51:49Transplanting Between Miniaturized Hairs

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Hair Loss From Propecia – Update

There has been some discussion by physicians about patients who take Propecia, or Avodart, who may experience shedding of hair. When this occurs, they believe it may be simply a phenomenon that as the finasteride or dutasteride begins converting the telogen hairs into anagen, the shedding reflects an acceleration of hair cycling. The same theory implies that some people may have a significant amount of hairs in telogen, so their shedding may be increased in the first few months of starting the drugs. If these people wait out the cycle, I believe for a 3-5 month time frame, the benefits of the drug will come on strong.

In my practice I do not remember hearing this complaint so what I am presenting here was precipitated by some questions that came through this blog and information I gleamed from my recent trip to Sidney at the ISHRS meetings where I asked other people about the experience hair loss on Propecia. But the explanation above makes sense to me, assuming the premise that hairs in telogen may be shed more once they are moved along into their anagen (hair building) cycle.

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Transplanting Into Scalp Scars

i have an unsightly scar on the side of my head approximately 4 inches long and 1/4 inch wide. is there anyway of repairing this? i tend to wear my hair short and i am fairly conscious about it.

Scars of the scalp can be difficult to deal with. I am assuming that the scar you are talking about is not related to a hair transplant. The management of scars is not well understood by many doctors because they generally do not look at the hair solutions that are, at times, critical in the final repair of the scars. Neurosurgery scars, accident scars, burn scars and the like require specialized knowledge of the scalp’s ability to heal in the area treated and the direction and location of the scar determine much of the outcome. Many scalp scars may have come with good medical care, so one has to think differently about scalp scars: what will make the next treatment better than the last one?

Send me a photo (preferably digital) and be sure that the scar location is clearly shown. Your confidentiality will be assured. My email address is on the Contact page.

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I have hair loss all over my head, even the sides and back, can I transplant it?

If you are local to my office in California, visit me so that I can perform a miniaturization analysis of your hair throughout the front, top, crown, back and sides. IF you have miniaturization on the sides and back, then you may have Diffuse Unpatterned Alopecia, something we published about in 1996. This is a difficult problem to have as you are then not a hair transplant candidate. I wrote about how people can find out for themselves in a post https://newhair.com/digital-microscope-examine-hair-balding/ where I stated: “Amazon has started to sell a Digital microscope with magnification up to 500 times normal. This allows a person like any reasonable balding person, to examine his own hair and look for miniaturization. I need to give you all some help on how to do this. First purchase a digital microscope on Amazon ($16.95), then look up on Amazon Digital Microscope (the one I purchased can be found here: https://amzn.to/28Tktzf. Look it up to your computer and then you can place it on your scalp and examine your own hair. You don’t have to be a doctor with a good digital microscope in your hand.”

You can send me photos of what you get from this instrument and I will be happy to review them for you if you are not local. Write to me at: wrassman@newhair.com

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Trapped Nerve After a Hair Transplant?

Your blog is incredibly insightful and useful, can’t believe its a free resource. I’ve had a strip excision, my question is that there is one area directly above the scar line, about 3 cms wide and maybe 3 cms high (where scar is probably about 20 cms long) that feels raised and different. if I run my finger from below the scarline in that area up and over you can feel how that area becomes distinctly raised even sometime after transplant. the other areas above the scar dont have that feeling. could it be a trapped nerve ? and how easy is it to treat ? my doctor (even though giving good cosmetic hair results) doesn’t have your diagnostic capabilities. thank you !

First, with regard to the free service, I have never turned down money offers or checks in the mail. I haven’t received any, but still… 🙂

You raise a series of questions that pose different problems. Some people heal with elevated scars that are like mini-keloids (heaped up scar tissue on the skin edge). These scars can be difficult to control and the wider they are, the more difficult they are to treat. Steroids injected into the scar helps on those that are fresh (under 6 months old). When you don’t have feeling about the scar, if it is just the area within an inch of the scar, it may be attributable to cut nerves, which occur in everyone who has had a strip. The feeling usually returns in weeks of months after the surgery. If the area is more extensive, like a hand’s width, then you may have a cut major nerve trunk. The nerve may be cut or just squeezed in the scar tissue. You will need a skilled surgeon to make the diagnosis.

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Treatments Available for Female Hair Loss

Over the over again, women from all over the world are writing to me asking, “What can be done for me?” I will list alternative options below, but I want to warn those of you who are reading this material to recognize that none of this is proven to solve the hair loss problems of most women. If it works, it may work in selective women, those that have a more clear androgenic (male-like) component of their hair loss. In addition, some women with combined genetic hair loss and Polycystic Ovaries (PCO) develop male-like patterned hair loss and could be candidates for the hormone treatments discussed below. I am loathe to recommend these treatments, because I do not personally feel comfortable with recommending hormone altering therapies, as some of them may impact ovarian, breast, and uterine cancer risks — so with that warning, please read on.

Finasteride use in women:
There have been articles on the failure of 1mg of finasteride to impact women’s hair loss. Now, for the use of higher dose finasteride than normally prescribed in men, the Iorizzo article (see references below) concludes, Sixty-two percent of the patients demonstrated some improvement of their hair loss with the use of finasteride, 2.5 mg/d, while taking the oral contraceptive. It is unclear whether the success was due to a higher dosage of finasteride (2.5 mg instead of 1 mg) or to its association with the oral contraceptive containing drospirenone, which has an antiandrogenic effect. These two drugs may complement each other and to get the effect, they both may be needed. Further studies are necessary to understand which patterns of female pattern hair loss respond better to this treatment, for I am sure that all women will not respond the same way. The article leaves us confused. It is not clear which are those who can be treated and there are no statistics on safety and side effects (this was not the focus of the article, however). The entire article is based upon conjecture, something that the authors recognize is the problem that the limited study creates. What concerns me is that with the promise that 62% of women may be helped by Propecia, desperate women with the help of inexperienced doctors will start taking finasteride without understanding the long term impact of these drugs on women. Maybe downstream, we may see a Vioxx type side effect with regard to cancer. With that said, there is a suggestion in this article that finasteride may have value for women and if this can be seen with better, more controlled studies, then this may be a breakthrough. I suspect that women with a ‘male pattern’ to their hair loss may experience more benefit over those without it. This is conjecture (an educated guess) on my part.

Antiandrogen treatment for hair loss in women:
The second article (see references below) starts off, “It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy.” This opening correctly set the tone of the article. Two different medications were used: spironolactone and cyproterone acetate. Neither was clearly better than the other. Discussion of the authors said, “The treatment under a doctor’s care went for 16 months. 44% had improvement, 44% had no improvement and 10% had further hair loss“. Many dermatologist are presently using spironolactone and cyproterone acetate and there is selective enthusiasm for these drugs, but it is not universally accepted as the mainstay for treating women’s hair loss. Doctors come under a great deal of pressure to do something. The question here is will spironolactone and cyproterone acetate treatment provide enough benefit for the costs and the pain of the injections that are required with repetitive treatments over a prolonged period of time?

References:

  1. ARCH DERMATOL/VOL 142, MAR 2006: Matilde Iorizzo, MD; Colombina Vincenzi, MD; Stylianos Voudouris, MD; Bianca Maria Piraccini, MD, PhD; Antonella Tosti, MD, Titled Finasteride Treatment of Female Pattern Hair Loss
  2. British Journal of Dermatologist 2005, Article by R. Sinclair, M/ Weweromle amd D. Jolley from Australia titled: Treatment of female patterned hair loss with oral antiandrogens