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Female Patterned Hair Loss (FPHL) Diagnosis Made by Biopsy but No Solution to Hair Loss as I Am Losing over 200 Hairs/Day.

A biopsy rules out specific autoimmune diseases in women that causes hair loss but the diagnosis of FPHL is not helpful.

The first step in evaluating hair loss in women, after a detailed history and physical exam, is to rule out any underlying medical causes of hair loss which can be treated. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. Furthermore, over 50% of women going through a change of life hormone fluctuations (menopause) experience significant hair loss. It is also important to review the use of medications that may cause hair loss, such as (but not limited to) oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin, and prednisone. The following laboratory tests have been recommended to rule out the aforementioned medical conditions.

Some common blood tests for female hair loss:

  • Sex Hormone tests
  • SHBG (Sex Hormone Binding Globulin) used to test status of male hormones
  • Estradiol is a sex hormone
  • FSH (Follicle Stimulating Hormone) *not hair follicle but follicle in the ovary*
  • LH (Luteinizing Hormone) is a sex hormone
  • Free Testosterone
  • Total Testosterone
  • ANA (Anti Nuclear Antibody) used to test for Lupus or other autoimmune diseases
  • TSH (Thyroid Stimulating Hormone) used to test for hyper or hypo-thyroid disease
  • Test Iron status
  • TIBC (Total Iron Binding Capacity)
  • Ferritin
  • Iron

This patient supplied photos. I would want to know more about the tests that I listed above before going forward with any recommendations as problems with some of these tests will not show up on biopsy.


2018-11-01 06:34:12Female Patterned Hair Loss (FPHL) Diagnosis Made by Biopsy but No Solution to Hair Loss as I Am Losing over 200 Hairs/Day.

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Significant Hair Loss on Propecia

Hi Dr. Rassman,

About two years ago, I started taking Propecia for my hair loss and stopped after three months because at that point i noticed a drastically increased rate of hair loss, and assumed that I was reacting negatively to the drug(one hair loss specialist suggested that it is possible that my tissue became hyper sensitive to DHT because of the drug, but I did not experience any increased acne or libido, which he said would also be indicative of that rare kind of reaction to Propecia). Eventually I decided to try Propecia again, and now I have once again reached the three month mark, and once again, like clockwork, I am seeing significantly more hair on my pillows, in the shower, etc, than what I had when I was off the drug, but no acne or increased libido. I am wondering if you think this means the drug wont work for me or if it is just a temporary phenomenon that I should wait out, and that I will probabely still benefit from Propecia. I understand that some people experience sheds while on Propecia that are a sign the drug is working, but have heard that this should happen within the first two weeks of using the drug, not so long as three months into it. Thanks very much for your time.

I believe you must stay on Propecia for 8-12 months. Stopping and starting your taking of the drug is not a good idea. There have been some reports that hair cycling changes in a small number of people with Propecia, such that more of the effluvium (loss) side occurs at the beginning but the anogen (building stage for hair loss) will follow in 6+ months. It does not sound like you have given it enough time. This is a most unusual complaint, one that I have personally not seen in my practice but one that has been reported by some of my colleagues.

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How Does Finasteride Affect Athletic Performance/Gains?

To my knowledge, there is no impact of Finasteride on muscle build up. It does slightly increase testosterone blood levels which is probably why the professional organizations ban this drug as an enhancer, even if it is not.


2018-11-18 22:12:31How Does Finasteride Affect Athletic Performance/Gains?

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Skin Cancer and the Sun

Is it true that sun burns on the bald scalp causes skin cancer? Can hair transplants solve this problem?

Sun is a known carcinogen, which means in simple English that heavy doses of sun exposure can cause cancer in susceptible people. Susceptibility varies with skin color and the type of skin you have, but if you have a full head of hair, skin cancers are far less common than on someone with a bald head. I remember that my bald spot would burn during the summers when I went on vacation. After having my hair transplanted into the crown, I do not remember getting a sun burn. I have had many dermatologists send me patients who have had many skin cancers on the balding scalp. The patients echo my own experience and I am often told that the hair transplant helps to reduce the sun burn. I suspect that anything that reduces sun burn will help deal with the cancer problem, but hair transplants alone may not be adequate cover, especially if the supply / donor ratio is low.

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On finasteride 4.5 months (From Reddit)

Pictures are worth 1000 words. Finasteride produced nice results in a relatively short time; however, I might question if the photograph is really telling the story as the results could be hair length alone.


2019-04-17 14:59:57On finasteride 4.5 months (From Reddit)

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Smoking Cigarettes and Hair Loss

Does smoking cause hair loss, will smoking affect the success of a transplant? Best Regards.

There are known effects on blood supply to the scalp and other areas of the body when one smokes. This may or may not contribute to hair loss. Many hair transplant surgeons warn patients that if they smoke, they run the risk of losing hair from a transplant or reducing the yield from a transplant. I have not found that to be the case, but from a good legal position, I must warn you of that possibility.


2006-01-03 07:04:47Smoking Cigarettes and Hair Loss

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Finasteride (and Dutasteride) increases the risk of low sperm count

There has been a suggestion that sperm counts get depressed by finasteride. We know that this happens with dutasteride and this drug even produces azospermia (no sperm) with sterility in some men. The same may happen with finasteride, but the literature is not clear on it. I have now seen many doctor refuse to write prescriptions for finasteride because of the medical-legal risks suggested by articles that discuss side effects that the doctor just doesn’t want to deal with. I continue to write these prescription but place these risks in a consent document that patients must sign.

https://www.fertstert.org/article/S0015-0282(13)02786-6/pdf


2020-08-02 15:43:59Finasteride (and Dutasteride) increases the risk of low sperm count

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SMP to scar in scalp (photo)

This is a great example when Scalp Micropigmentation is used properly to hide a scalp scar. The operator (I don’t know the operator) did a great job in hiding the scar.

 

 

 

 

 

 

 

 

Click photo to zoom in

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finasteride and pregnancy

Basically I was about to start taking finasteride 0.5mg but I recently found out my girlfriend was pregnant. Will I be fine to take it or would I be best waiting for the child to be born?
There is no evidence that there is any danger to the unborn child when the man is taking finasteride. The woman should not touch the pill.
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Solid Evidence Backs Heart Attack Prevention Initiative

It is clear that if you want to avoid a stroke or heart attack in your life time, there are some simple steps you can take which have proven statistically significant. These are simply: (1) treat high blood pressure if you have it, (2) stop smoking if you smoke, (3) treat your cholesterol if it is high with statins and diet also keep your red meat down in your diet, (4) regular exercises on a daily basis to keep fit, (5) keep your weight in normal ranges for your age, (6) take one baby aspirin each day which has value not only for prevention of cardiac and stroke events, but also prevention of many forms of cancer.

The formula is easy and you don’t have to be a rocket scientist to understand these 6 simple things to keep you healthy.