Smokers may have more or earlier hair loss

https://onlinelibrary.wiley.com/doi/10.1111/jocd.13727

Results

The majority of smokers (425) had a form of AGA, while only (200) nonsmokers had a degree of AGA (P < .01). Of the smokers group, 235 (47%) had grade III AGA and 120 subjects (24%) had grade IV AGA. In the nonsmokers group, 100 subjects (20%) had grade II AGA and 50 subjects (10%) had either grade III or IV AGA.

Conclusion

The prevalence of AGA among smokers was statistically higher than among nonsmokers, while severity of AGA was not associated with the intensity of smoking. Nicotine and its derivative cotinine might be responsible for accelerating AGA progress pending further validation.

Dr. Rassman’s Comments: This is a fascinating study strongly suggesting that smoking (possibly nicotine) accelerates male pattern balding, in those who I suspect in those who have a genetic predisposition for it.


2021-04-13 09:48:40Smokers may have more or earlier hair loss

Finasteride and Cholesterol Reduction Pills

I just performed my blood test and discovered that i’m having high cholesterol level. The doctor advised me to take medicine to reduce my cholesterol level in my body.

My question is, i’m about to take Finasteride to combat my hair loss. Is there any problem of taking Finasteride together with cholesterol reduce pills concurrently as advised by my doctor?

Kindly give your advise and comment?

What is the succesfull percentage recorded after using Finasteride treatment (out of 100 people)?

Many medications interact with one another and they all have a potential for side effects. I do not know what cholesterol medication you are taking, but most that I know of do not interfere with Propecia. I strongly advise that you address your medication concerns with your doctor or pharmacist.

SMP Over the Years?

How does SMP look like after 5 years? 10 years or 20 years down the road. I’ve seen some really bad SMP jobs on YouTube where the color looks smeared all over the scalp. Maybe these SMP jobs were done by novices or bad tattoo artists but if only a handful of Dr’s do it and do it well. How can there be a guarantee that a Dr with proficiency will be around in 20 years performing SMP when I need a touch up? I am interested in the procedure but worried that the color fades too easily or the dots expand to form a cloudy look. The bad SMP jobs on YouTube make the head look like there is a permanent giant bruise on the entire head. Looks like some sort of disfigurement.

Has any of your SMP patients been unhappy with the results after so many years?

We have been performing Scalp Micropigmentation (SMP) now for two years, so I can not address a longer time frame. I have seen one patient who had scalp tattoos done elsewhere about 9 years ago and he touched it up often (possibly too often). His scalp took on the appearance of smeared color. The black ink turned green and when it covered the entire scalp, the scalp appeared green. Certainly, it was not a good end result. He was experimented on, so his result probably reflected the many techniques that evolved and possibly many different pigments.

With regard to our practice, yes, we have had dissatisfied patients. In analyzing the reason for the dissatisfaction, we concluded that: (a) they really did not understand what they were getting, (b) they were expecting Toppik level concealers which produces better camouflage and are much darker, (c) they noticed irregularities in the ‘dots’ where some of them were larger than others, (d) the pigments faded irregularly, (e) they came from long distances and needed touch-ups that required them to make another trip to California and (f) the color changes in the black to a green or blue tint was more than they expected to see.

A few patients tried to push us to repeat the process more times than we wanted to do, and early in our experience we wanted to make them happy, so we were swayed by their desire far more than we should have been. Now, we stick to our guns and keep to what we believe is in the best long-term interest of the patient. Even though we still want to make the accommodations that will make the patients happy, we will not do anything that will lead to a complication or poor result.

We have addressed these complaints by spending a huge amount of time with each prospective patient, explaining every detail of the process and expectations. The patients seemed to be more satisfied with the end results.

Finasteride and Other Medication in Women

There doesn’t seem to be a consensus among studies with finasteride’s or dutasteride’s effect on women?

Premenopausal women should not take finasteride or dutasteride because if they became pregnant, the baby would have genital developmental problems. These drugs work in about half of post-menopausal women for hair loss.


2020-04-01 09:52:37Finasteride and Other Medication in Women

Sodium Hydroxide is in My Shampoo!

I read that sodium hydroxide is one of the chemicals used for hair straightening, and it can burn the scalp if it comes in contact with it too long. I also noticed that sodium hydroxide is an ingredient in both my shampoo. Is this bad for my hair?

At the low concentrations, the sodium hydroxide should not hurt you or your hair (such as in shampoos)… but when you are using higher concentrations for straightening it, you must be careful.

Finasteride and Balding Problems

I have been taking finasteride for 10 years now, and I have been slowly losing my hair since, though at a much slower rate. I was wondering, will I eventually become slick bald in a class six pattern if that’s what my genetic fate is, even if I continue to take the medication? Does hair have to miniaturize to the point of completely not being visible anymore, or is it possible for the process to stop in an intermediate stage of miniaturization?

Look at the miniaturization pattern and try to predict your hair loss. Or, better yet, see a doctor like me with specialization in hair loss who might be able to answer your questions after a detailed examination of your scalp. Hair does not have to miniaturize for balding to occur, and most patterns can be predicted after a man is 26 years old.


2018-06-21 06:12:01Finasteride and Balding Problems

Speed of Hair Loss

Once miniturization of the hair begins, how long does it take until a person notices his hair is even slightly thinner ?I go back a year ago and it was still good and today less dense. A year seems pretty fast, but doesn’t it take longer?

The hair loss process varies with the individual and his/her genetics. There are no rules here. Some people take a long time to lose the hair while others can lose it in a year or two.


2008-08-11 14:13:08Speed of Hair Loss

Does Finasteride ever lost its ‘effectiveness’ after a while?

From a practical point of view, yes it does lose effectiveness as the genetic balding process advances beyond what finasteride can help. This often takes time, but even though it may lose effectiveness, it still has value and if you should stop it, you will see that you may undergo significant loss, not only what you gained, but what you would have lost had you never taken the drug.


2018-05-20 13:40:45Does Finasteride ever lost its ‘effectiveness’ after a while?

Standard of Care Consultation for Hair Transplantation

I just had my consultation at your office last week. I want to congratulate you with a professional way of managing your practice.

This blog entry is a little lengthy, but it is important to retell this man’s tale as he told it to me. For the purposes of privacy, I’ll refer to him as Joe.

Joe had received three opinions from different doctors over the past few months. The one with me was the last of the consultations. After receiving the nice note from him, I asked him for a competitive analysis. Joe had planned to get multiple opinions over a three month period and he had already attended one of our open house events prior to seeing me privately.

He had some comments about our practice, some of which were not flattering. He criticized the quality of our video as tired and out of date (it is 14 years old) and our brochure was not nearly as fancy as the ones that he had seen elsewhere. He might not have been aggressive at pursuing us if it were not for the generally less than professional presentation of the other two practices. With the two previous groups he had met, both were front-ended with a professional salesman who went through well-scripted processes, each recommending what the salesmen thought Joe might need to address his balding problem. Both of these groups applied considerable pressure to get him to schedule a hair transplant. At one of the two clinics, the doctor came into the office, but spent very little time with him, only confirming what the salesman told Joe about his needs. When he left each of the two previous groups, he was somewhat impressed, but skeptical of their sales process. Later, he did some internet research and found considerable legal problems with one of the groups and many generally negative comments on internet chats. Both groups were eventually crossed off his list.

Our office was his third stop. He came by an open house event and met with many patients that had been through the same thing he was now facing. Three patients came in without notice and they showed results that he felt were normal looking. He was impressed with the openness of the patients attending the open house. He met two patients with the exact balding pattern that he had, both in their 40s and they had Joe’s hair and skin color as well.

Joe went into the operating room and talked to the outgoing fellow who was having the hair transplant that day. When we eventually met, he was impressed that I had committed a full hour to the interview. The night of the consultation he went to the internet and found that every claim that NHI had made on its website (reflecting their authority as a pioneer in the field) was easily validated. This was quite different than the claims made by the other groups which he felt were over-hyped in their representations. The very next day, he got an email from me with what he said “was an amazing and thorough summary” of the conversation we had on his visit the day before. I had included a full fee schedule for the quoted estimate of work. None of the other transplant office took the time to produce such a document, not even the doctor who performed surgery on his broken nose a few years ago.

I developed my hair restoration practice as I did when I practiced a more traditional ‘general surgery’. I’ve always believed that a medical practice should be classy and that means to me that the doctor should take every effort to provide what he would want to see if he or a member of his family were a patient — and that would include an honest, open communication. Unfortunately, too many medical groups who are now dominating the field of hair transplantation, have applied heavy sales tactics (which I believe is either immoral or unethical). The patient can easily become a victim if critical information is held back. As a case in point, throughout this blog, I discuss the need for assessments with mapping of the scalp hair for loss looking for miniaturization, and even with multiple articles written by me on this subject, the metrics in this field have not been incorporated into the standard of care. I would never transfuse a unit of blood without knowing the hemoglobin of a patient who was bleeding, nor would I use potentially toxic medications without understanding the working efficiency of the liver or kidneys, yet many hair transplant doctors seem to constantly offer extensive hair restoration surgery without measurements of the patients existing hair status or in giving the patient some help in predicting his future hair loss.

We need a standard of diagnosis for the consultation process and we need to exclude the salesmen who dominate the process and make recommendations that should be in the exclusive domain of the doctor. We need to incorporate such processes as mapping of the scalp for miniaturization, in order to give the patient a fighting chance in understanding what he is agreeing to when he undergoes a hair transplant. We need to provide educational material about what the patient may experience, including all of the risks (not sugar coated) associated with a transplant process. If we don’t do these things, then I will continue to speak out about our standard, hoping that the consumer will press those in this industry to discard shoddy sales tactics.

Finasteride Interactions?

Hi Dr.,

I am a big fan of your site. I get to read your new posts everyday by subscribing to your RSS feeds. My question is, given that I take 1 tablet of 1mg Propecia everyday, will it interact with other supplements or even certain food?

For example, here’s a list of supplements that I take daily (i take throughout the day, separate times):
1. vitamin b complex and biotin
2. vitamin c
3. vitamin e
4. multi vitamin
5. omega complex
6. co-q10
7. methatione (gluthatione)

Or how about foods:
1. coffee
2. green tea w/ honey
3. soy milk
4. fiber (like wheat bread, fruits)

Just wondering if trying to be health by consuming these will counteract w/ Propecia or vice-versa? Hope this is a valid inquiry.

I have been getting these sorts of questions quite frequently lately. The supplements and foods you’re consuming shouldn’t have any negative interaction with Propecia. The only interaction I can think of with food is with grapefruit, which causes problems for a variety of medications.

The following 16 drugs are listed as having a moderate interaction with finasteride (Propecia): bosentan, diltiazem, diltiazem/enalapril, efavirenz, efavirenz/emtricitabine/tenofovir, fluconazole, fluvoxamine, itraconazole, nefazodone, nelfinavir, posaconazole, rifapentine, saquinavir, sirolimus, tacrolimus, and voriconazole. And there’s 1 drug that has a mild interaction: terazosin. These are the generic names, and for a more complete list (including brand names) see Drugs.com.