Hey doc, I have just recently started to lose some of my hair and my doctor prescribed Propecia. He warned me against drinking too much while taking the medication and told me to keep it to 3 or 4 beers during the weekend. Seeing as how I am still in college, I see this as a potential problem. Ignoring all the other health related issues with binge drinking, what could happen if the two were combined? I haven’t been able to find anything on the web that warns against this.

Also, is there any chance of my insurance covering this? I don’t see myself paying $60/month for this.

As far as I know, insurance companies do not cover any drugs for male pattern hair loss, since it is a cosmetic issue from their point of view.

If you are concerned about the cost, you can ask your doctor for a prescription for generic finasteride in 5mg strength and then split the pill in four to five pieces, taking each piece daily. Propecia is a brand name for finasteride in 1mg strength (the recommended dose for the treatment of male pattern hair loss). Currently there is no generic finasteride in 1mg strength legally available in the US. Taking more finasteride per dosage does not mean it will work better.

Binge drinking is never good and keeping to 3 to 4 beers a weekend is good medical advice. This may conflict with your college lifestyle, but I do not see any physicians condoning excessive drinking. With that said, using Propecia in the morning and drinking in the evenings should not cause you any problem with the Propecia.

I have been looking into this dutasteride thing and now see that they are conducting tests for male pattern hair loss in korea.

my question is, is it really wise to conduct a test for hair loss in a country like korea? I assume that they are only testing koreans? Koreans dont seem to get as effected by male pattern hair loss as others do. Infact i noticed asians usually have alot thicker hair than most other nationalities (and thast very lucky for them)….

I just thought conducting it in a country like USA or Australia would be smarter since its multicultural so we can see benefits for all ppl. what do u think?

There should not be any racial differences between the way men respond to drugs like dutasteride or finasteride. I asked such a question to Merck, and that was the answer I got. The tests are for safety and effectiveness. Safety includes all types of side effects (for dutasteride this would include impotence, sexual dysfunction, organ dysfunction from any part of the body, interaction with other drugs, and the like). Effectiveness with a classic double blind statistical scientific methodology includes determining the optimum dose to be used and the impact on the target organ (hair re-growth or slowing down hair loss). It is not unusual for tests such as this to be performed in other countries, because costs may be lower.

My 3 yo Grandaughter has 2 spots on her scalp where she had gotten too close to a candle and burned the hair. The spots did blister and have healed nicely. They are still red-pink in color. Is there a chance that hair will grow back in these areas?

If the time since injury is within a year or so, it might come back. Otherwise, see an expert and a simple approach with hair transplants might easily solve the problem. Of course, a 3 year old requires special considerations and I am not suggesting a surgery. Start off by getting an opinion from an expert.

Patient’s Guide — How Many Grafts Will I Need?

Mar 2, 2007/by William Rassman, M.D./0 /Favorites, Hair Transplantation, Training

Reprinted from the New Hair News, Vol. 12, 2007.
Click here to request your free copy, included with the “complete information package”.

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People always ask, “How many grafts will I actually need to have transplanted?” Time and time again, that graft number answer will vary by doctor. When a doctor recommends a certain number of hairs/grafts, the doctor’s experience and his/her artistic skills are used to estimate what it might take to fill in the balding area with enough fullness to meet the person’s needs. I have seen estimates that could be a four fold difference and when you are shopping for a hair transplant, the differences in the estimating abilities of the doctors can be very unsettling. Who do you believe? Clearly you want to believe the doctor who has the lowest estimate for hair moved (transplants are priced by the graft), but then you are locking yourself into what might become a never ending series of hair transplant surgeries with an unrealistic amount of hair transplanted that may not meet your goals.

Does your doctor have the necessary artistic ability, not just to estimate the number of hairs/grafts, but also to take advantage of the hair supply to create a distribution that maximizes the value of the transplants for the most fullness? We have put some factors together to address how a surgeon actually calculates the numbers of grafts. These factors may not apply equally to all people. No two people are the same. The various factors like the thickness of the individual hair shafts (coarse vs. fine hair), the character of the hair (curly vs. straight hair), the color of the hair and the skin (the closer the match, the more full appearance of the hair), and any special needs defined by the patient, make us very different. On white skinned people, those with blonde hair have a fuller look while those with black hair will have a more ‘see through’ appearance. The blonde haired man, the very fine haired man, or the very bald man who has a hair supply that might not be adequate to cover the bald area will be different in their needs for fullness. When the calculations are not clearly evident, it is the doctor’s art that saves the day to maximize the value of the hair transplants that are received. We generally try to restore 25% of the original hair density in a ‘typical’ patient. Some people may require more than 25% of the original density and if you are one of these people, you should understand what you need and why you need it. Even if the overall achieved density is 25%, some areas may require more and some less than 25%. In people with fine or dark hair and light skin, a higher density than 25% of the original density is often required. In blondes with fair skin, less than 25% of the original density might meet the ‘fullness’ requirement. This is critical, because you look for fullness in the end result of the transplant process and it is the doctor’s art that addresses just how that fullness is to be achieved. Keep this in mind as you look to the analysis below.

The math for estimating number of grafts needed for a bald area:
We have proposed a 25% rule, which means that the balding person can go from a completely bald area to 25% of the original hair density that was there prior to the balding. The following calculation also assumes that the person used in this example has an average density of 2 hairs/mm2 (average density of a Caucasian). Every person is different, so the final number of grafts that will produce the fullness that a person wants to achieve (and can afford to purchase), are independent variables. These calculations were originally defined in a classic medical journal article written by Rassman in 1993 (Rassman, W.R.; Pomerantz, M.A. Minigrafts, the art and science. International Journal of Aesthetic and Restorative Surgery. 1(1): 27-36; 1993).

by William R. Rassman, M.D. and Jae P. Pak, M.D.

Hairs Falling Out in the Shower, and How It Relates to Growth Cycles

Feb 22, 2007/by William Rassman, M.D./0 /Hair Loss Causes

how do the hairs that come out in the shower relate to hair growth cycles?

As stated here before, it is normal to lose about 100 hairs a day. To clarify that more, as hair falls out there are hairs that are also starting to grow. Hair grows in cycles and you may notice more hair falling out some days. Hair follicle cells have three phases of growth:

1. Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
2. Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
3. Resting phase (Telogen phase) which lasts about 1- 6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.

If you think about it, the average person has 100,000 hairs on their head, with 100 hairs falling out each day. So in three years, the total hair population will have been replaced (you can do the math for yourself).

2007-02-22 15:35:302007-02-22 13:39:32Hairs Falling Out in the Shower, and How It Relates to Growth Cycles

Dr. Rassman, my son had a medulloblastoma at age 10. He underwent whole brain radiation with a posterior fossa boost. This left him with very little frontal hair and no hair in his inferior occiput. The hair he does have is somewhat thin. Could your type of transplant help? Is there benefit with your method for him over other, standard methods?

Hair loss is one of the most common side effects of brain radiation therapy. It usually occur about two weeks after you have the brain radiation. Hair loss is usually limited to the area of treatment, but patients may occasionally lose all of their scalp hair. Hair loss after radiation could be temporary and it may grow back within weeks to months following radiation. Higher doses of radiation and frequent radiations may damage hair follicles permanently and leave patient with baldness.

In some patients, the hair grows back with a different character. Hair color or character may also change, becoming thinner and more fragile.

If your son did not grow hair one year after radiation therapy, he needs to be evaluated by a hair specialist. If his hair loss is limited to a particular area and he has preserved good quality hair in other areas, he may be a candidate for hair transplant. What I want to know is whether there are any areas where the hair is normal. If the answer is yes, maybe there are things that might be offered.

I had 2 hair transplants. 1 in 2002, about 300. And I had to go back in 2004 to get about 90 more because most of them fell out. Its starting to do it again. Please help me.

I don’t mean for this to sound rude, but how do you want me to help you?

Hair transplants should be permanent, as permanent hair from the back of the scalp is transplanted to the balding area. You may have hair loss from the native (original) hair that was around your transplant, and the hair transplant may have failed.

What troubles me is that typically 300 grafts or 90 grafts are very low numbers to transplant and may not provide the adequate coverage, unless perhaps you are filling in a very small area. If that is the case though, I might question if you needed a procedure (or 2) at all. You may want to get a second opinion. If you would like, I can review your case, but I’ll need more information and photos. Please arrange for a private consult by calling (800) NEW-HAIR. Emailing pictures to the address on the contact page will help. Your privacy is guaranteed and they will not be placed on the internet unless your permission is given. Please reference this blog posting when sending photos or calling.

Does the prescription drug Lamictal contribute to hair loss?

There are reports that Lamictal can be a contributing factor to hair loss. This drug is used in the treatment of seizures and bipolar problems. People on it need strict adherence to the regimen and the medication should not be stopped without a doctor’s directive.

HI! Doctor. I have been reading many blogs and I need to ask you one imporant question. I am a twenty year old male and its been six months since I had my transplant in the crown area. The only reason why I went for this transplant so early is that cause I had started losing my self confidence cause of really thin hair on my scalp. Now my crown area is becoming thick day by day. But on the other hand, I am losing my hair on the top of my head. Is there any way to retain my existing hair now? I am really worried and it would look really bad if I get bald at such an early age. I have been taking Genesis ‘finasteride’ and it has done a lot for me too. Like it helped me a lot before I had my transplant. But since transplant, I think it has started losing its affect . Please doc I need help. Is their anyway I can stop my existing hair?

I am very concerned that you had a hair restoration procedure at such a young age, especially in the crown area and many doctors including myself might think that this is not an approach that an ethical doctor would do. Of course I do not have the luxury to examine you in person, but surgery is rarely recommend at such young age, particularly in the crown. More importantly, having surgery too early may actually accelerate hair loss and you may end up with negative (worse off) results. It sounds that way to me.

While finasteride (Propecia) is a great drug at slowing and sometimes reversing hair loss, it is not a cure either. Men of your age should start off with a one year course of finasteride first. This drug (in a 20 year old) may reverse hair loss in the crown. If it does not reverse, it will slow down the progression of hair loss, but if you have a transplant too early, the acceleration of the hair loss is an almost predictable conclusion. In one scenario, the hair loss you are experiencing may have been accelerated by your transplant and now you are faced with “chasing” the progression of hair loss. You could eventually run out of hair before completing the hair restoration process if you have one of the more advanced hair loss patterns. With the amount of hair loss you are telling us about, it sounds like you are well on the way to a more advanced balding pattern and may find yourself running out of hair. If anything, I would continue the finasteride treatment and have your scalp hair mapped for miniaturization to track the progression and the rate of your hair loss. You must create a long term Master Plan with a good, reputable, honest doctor before doing any more surgery. Don’t feel like you need to contribute to your doctor’s BMW car payment. Even after one mistake, you still might be able to build a plan that will work for you, but more surgery without a plan is like an airplane running out of fuel at 30,000 feet, for there is no soft landing.

I am 29 years old and I have been slowly receding at the hairline since my early twenties. Although I am still at the “Pattern II” category, I am extremely paranoid and would love to know statistically what usually lays ahead for someone in my boat. I appreciate the help.

There is no certainty, but I might guess that you will not bald. If you have no miniaturization anywhere on your scalp, then the certainty of my prediction goes up. It’s really all guessing until you have an examination. There’s only so much info I can provide online without seeing you.