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Propecia and Working Out

Hi.

I’m 35 and loosing hair. It’s likely that Propecia could be one good solution. However, from what I understand Propecia blocks DHT by limiting the creation of testosterone which is why it can stop balding process.

Now, I am working out seriously 4 times a week and trying to add on muscle. Muscle growth is due to testoterone. My question: how can my work out be still beneficial in terms of muscle growth if the testosterone is lowered because of use of Proprecia.

Thanks for your time.

Propecia does not decrease testosterone. It decreases the byproduct of testosterone known as dihydrotestosterone (DHT). DHT is what is implicated in male pattern hair loss. Taking Propecia increases testosterone by about 15% and benefit (although not proven) muscle building. Propecia can also apparently be used to mask muscle enhancers. You may recall from the recent Olympic games the controversy surrounding Propecia — Olympic Athlete Banned from Competition for Propecia Use.


2006-07-12 10:32:47Propecia and Working Out

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Dishonest Doctors Are Still Out There

I am 23 years old and I want to tell you my story. I was worried sick as I saw my hairline starting to climb. I went to a doctor in Toronto who said that I was going to go bald and needed to take swift action to prevent it. After listening to him, I went into a panic, took out most of the money I saved to go to graduate school and got transplanted with 2700 grafts. The doctor lowered my hairline also (about 1/4 inch) as well and transplanted the entire front, top and back of my head. I did some comparative shopping when I was investigating who to see about my problem and found that the price he was charging me was very competitive at slightly under $4/graft Canadian ($10,000 in cash). After the transplant was done, I found my hair falling out faster than before. The doctor told me that the new hair will replace far more than I lost and that I was lucky to get to him before the the hair had fallen out. It is now 10 months since my surgery and I am worse off now than before the surgery. I have less hair and a hairline that is nothing like the pictures the doctor showed me when I was shopping. I am very depressed, so much so that I feel that what I did to myself has created a monster. I needed to tell someone about this, but I am not sure what I am asking of you. What would you advise your son to do if he screwed up like this?

This is a tragic story, one that is hopefully not common today. To be blunt, you got taken advantage of. To do 2700 grafts on a 23 year old with little or no balding and only a receding hairline is not only malpractice, but (in my opinion) it is criminal. You got scammed and fleeced. The doctor who preyed upon you took advantage of his position, breached the Hippocratic Oath and probably violated the law.

I speak over and over again on the importance of commanding this process. You need to meet patients directly, one on one, and see the results for yourself. You need to examine the practice of the doctor you are intending to do the surgery to find out about his/her ethics. Their patients will tell you what you want to know. I can remember an unethical, scummy medical facility from many years ago that gave out a list of patients to call for references. I knew that these doctors were crooks, so when I got the list, I called down the list of patients. What each and every person on the list told me was that they would never recommend their doctor, that they were deformed by that doctor and that they felt cheated, raped, and ripped off. What I also learned from the patient victim that gave me the list is that he never called the patients on that list, because he assumed that these people were 500 good references for the doctor — clearly not the case.

What you should have learned here is that you must protect yourself from the unethical doctors out there. I would certainly notify the governmental agency that controls the doctor’s license. In America, you can file suit and clean up if this was the criminal process that it sounds like. Elective cosmetic surgery is a Buyer Beware business. There are good doctors out there who do practice ethical medicine. So for our audience of readers, I hope that you learn from this young man’s mistake — learn that it is your job to research your doctor before you buy.

I feel empathy for you. If you would like to talk with me, please set up a conference with me at 800-NEW-HAIR.

For more information, please see:

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Propecia Is Growing Hairs, But Can I Still Have a Transplant?

Hi Dr. Rassman! Propecia is slowly regrowing some hair on the front half of my head, and even a few in the hairline. If I were to get a transplant to “fill in the gaps” one the new hair is regrown, will it go through shock loss or should the Propecia protect it like it usually does?

Yes, you can have a hair transplant to the balding area while you are being treated with Propecia. The drug should prevent shock hair loss if you do have the surgery, but the timing of transplants should be tied to a Master Plan which will ensure your long term results. The timing includes just how much of the balding area is transplanted and this depends upon not only the donor density, but the size of the balding area now (and in the future) as defined by a good mapping of your scalp for miniaturization. I cannot answer your specific question as it applies to your problem without an examination, because really it depends on:

  • Your expectations.
  • The degree of miniaturization you currently have and the extent of that miniaturization process.
  • The length of time treated with minoxidil and/or finasteride.

Your worst case scenario should be put in front of you, and this will depend upon your age, your expectations, possible donor scarring for strip harvesting, your family history and who you take after, etc. Get the point?

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Do Doctors Track Transection Rates in Hair Transplant Surgery?

I was curious if you know if any doctors track the survivability of the grafts? I know that there is quite a bit of information on transection rates for different surgeons but was wondering if anyone monitors this metric? If they do – how might the survivability be determined outside of just counting the grafts in the recipient area a few weeks/months after the surgery? Thanks

This is a great question. We track transection rates when we perform FUE surgeries. The transection can vary from 5% to 50%. I believe 5 to 10% is an acceptable number. If there is a high transection rate then we will abort or never recommend surgery. This is the reason why at NHI we always pre-test all potential FUE patients, but I realize other clinics and doctors may not do this.

The data for other clinics and doctors is not available or well published in studies. I believe mainly it is directly linked to business. No one would publish poor results or high transection rates, as it is not good for business. As unfortunate as it may be, the consumers and patients are left to do their own due diligence and trust their doctor, probably by contacting patients who had it done by that doctor. One way around this would be for patients to ask about seeing actual patients in person or seeing their own surgical records of how the grafts were tracked (if it is done at all). In theory, the transection rate should be documented on the day of surgery, but I realize not all doctors will keep this record (as it is not mandatory) and some may refuse to show it to their patients. I can say this because I have heard these issues come up in consultations with some patients that have had procedures done elsewhere previously.

I know of one doctor who promotes and reports 96% good FUE grafts (4% or less transection), yet I have see many of his patients and found a high degree of failures in those of his patients who came to me for a second opinion. This is a buyer beware business. Sometimes you can expose poor practices through reports by the chamber of commerce or the courts in the areas where the doctors practice. I’ve also been asked to post the names of doctors to be weary of, but if I were to speak up and identify those who may not be honest in their representation, I would become a target for slander. I have better things to do than take up residence in the court system.

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Propecia Side Effects

I am 28 years old, and I have had the unfortunate expierence of losing my hair for the past 2 years.
I had a consult with a Bosley representative, and reccomended that I go on Propecia for about 9 months in order to retain my hair to be a good risk for hair transplantation. I would like to know, if this is a good reccomendation, and is the risk of side affects worth the effort? I have been on propecia now for almost 3 weeks, and I have had some side effects. In fact, I feel like I’m losing more hair due to propecia…Is that possible? With all this drama and money involved with going bald, I am about to resort to just shaving my head. It seems all the effort is in vain. It’s hard to beat genetics with a natuaral look.

It is almost always a good idea to try Propecia if you have genetic hair loss, especially at your age, BEFORE you go through a surgical hair transplant. You may decide that after 9 to 12 months, you are happy with the results and do not need surgery.

I suspect that in the past three weeks, you have spent more time looking at your hair, watching for growth or hair loss, than you have in the past two years. It may take up to 12 months to see results from Propecia, and by watching your hair very closely and very often, you may miss some of the subtle growth that will hopefully be taking place. As far as side effects, erectile dysfunction, decreased libido and ejaculation disorders were reported about by .5% more men taking Propecia, than those taking the placebo- according to Merck. If the side effects are greatly impacting your life you will have to make the decision if you want to continue Propecia.

You sound like you are conflicted about your hair loss and solutions that are open to you. My suggestion is to take your time and research all of your options before you make the committment to surgery.

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Do I have DUPA (Diffuse Unpatterned Alopecia)? (Photo)

i’d really appreciate if you could have a glance at these pictures taken with a microscope to confirm whether i have dupa hair loss/miniaturization. pardon the oily hair and hair fragments (recent haircut) 🙂

There are 9 slightly miniaturized hairs (arrows point to them) out of a total 50 hair count. This is not DUPA as it requires substantially more than 20% of the hairs. Also it is important that these miniaturized hairs are usually part of a follicular unit with at least 2 normal terminal hairs, so your donor hair count may be just dropping slightly, something I see as boys become men, or as men get older.


2019-09-14 09:49:25Do I have DUPA (Diffuse Unpatterned Alopecia)? (Photo)

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Propecia Worked for Me, Saw Palmetto Crushed My Libido

Dr. Rassman –
An anecdotal, first-hand report on my experience with finasteride and saw palmetto/beta-sitosterol for your readers: taking the latter for about 10 months, my frontal area continued to thin and my libido was crushed. Taking the former for now about 13 months, my frontal area has maintained and my libido is totally normal.

In other words, you’re saying saw palmetto and beta-sitosterol caused libido issues. I don’t know what dosage you were taking or if you were strictly taking it for treating hair loss, but thank you for the reporting your experience.


2011-04-10 19:29:58Propecia Worked for Me, Saw Palmetto Crushed My Libido

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Do I Need to Wash Off Concealers?

Hello Doctor

Is it necessary to wash off concealers ( such as dermatch or toppik ) daily or is it safe to use them daily but keep a 2 – 3 washes per week schedule

Thank you

You don’t need to wash off these camouflaging agents every day. I’ve seen patients who keep these concealers on for 2 to 3 days (since they wash their hair that often), but it’s up to you. Concealers will not damage your hair or cause hair loss, even if you keep them on for a few days.

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Prostate Cancer Risks and Male Pattern Balding

Is my risk of prostate cancer higher because I am balding?

Men with Male Pattern Balding (MPB) have a consistently higher incidence of prostate cancer compared with those without MPB.

In summary, we found a significantly increased risk for prostate cancer among men with MPB, independent of established risk factors including aging and race. Although remote from the prostate, MPB may represent an early, clinically obvious marker of susceptibility and may provide clues to the pathogenesis of prostate cancer.

(source: Male Pattern Baldness and Clinical Prostate Cancer in the Epidemiologic Follow-Up of the First National Health and Nutrition Examination Survey)

When finasteride is used, “cancer prevention should be recognized as an additional benefit of treatment“. When compared with alternative treatments, “chemoprevention may also provide an excellent strategy for diminishing treatment-related costs and adverse effects such as erectile and urinary dysfunction“.

(source: Should finasteride be used to prevent prostate cancer?)

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Does thinning hair lead to balding?

Do the thinning areas in whatever balding pattern you have always end up totally losing all the hair in those areas? Or can those areas just thin to a certain percentage of it’s original density and then stabilize remain that way

Miniaturized hairs, if left untreated, will become balding areas. I have to follow the same people for more than one visit, and many balding patterns start with miniaturization (seen as thinning) and then advance to complete balding if untreated. The only patients I follow are those I am treating with finasteride, which is likely slowing the process and preventing balding. When discussing thinning, we discuss miniaturization in the front, top, or crown of the head, not the donor area. Donor area thinning reflects a condition called Diffuse Unpattterned Alopecia (DUOA)

[If you have any questions, you can reach me at williamrassman33@gmail.com]