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Doctors Disagree About Using Combo of Propecia and Rogaine – Hair Loss Information by Dr. William Rassman

I’m a male in my early 20s and I noticed my temples are now going beyond a NW2 and my frontal region seems less dense. I been to my dermatologist and Dr. Bernstein and both advised me to use Rogaine and Propecia. Should I really do that? I’m ok with Propecia but Rogaine is just too much work! Do you think Propecia is enough or should I listen to those doctors? I read on this blog you don’t recommend combo treatment for various reasons. But I been reading on the net that the combo treatment is a good way to go for frontal loss. I’m confused.

There is no correct answer to your inquiry. Opinions differ. I don’t usually recommend Rogaine (minoxidil) for those of your age unless the hair loss can not be controlled on Propecia (finasteride 1mg). For those who stop the loss and get regrowth from daily Propecia, there is no reason to double the medications. When you start minoxidil you become dependent upon it, so I separate the decision, first with Propecia for 8-12 months and then I re-evaluate the situation.

There is nothing wrong with using both medications at the get-go, but you’re going to have to use both for life, and won’t know which medication is providing visible benefits (so stopping one to cut costs, etc, is going to be a risk).

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Can Toppik Fibers Clog Scalp Pores? – Hair Loss Information by Dr. William Rassman

Hi Dr. Rassman,
Not sure if you’ve heard of any negative feedback about Toppik fibers, but I’ve been using Toppik for approx. 1 month now just to help camouflage the thinning areas. As we know, not all of the fibers adhere themselves to the hair shaft and many will fall to the scalp. I also use hair spray to keep my hair in place. My question is, will the Toppik fibers on my scalp along with the hair spray on top of the fibers, suffocate the existing hair and also will it keep any new hair from growing due to the possibility of clogging the pores on my scalp?

Note: I don’t use much Toppik, but when I should scratch my scalp in the area where I’ve applied the fibers, I’ve noticed the fibers under my finger nails.

Thank you in advance.


Toppik takes time to get completely out of your hair, possibly a number of good hair washes. If you wash regularly, Toppik should not cause you problems. Clogging a hair pore is highly overrated as a cause of hair problems, as the direction of sebum movement is from the inside out. The sebum in effect keeps the foreign particles out of the pores.

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After 10 Months on Rogaine Foam, My Hair Characteristics Have Changed Drastically – Balding Blog

Dr. Rassman,
I actually asked a question on this site before. I’ve been using Rogaine Foam since September 2007, on the back of my head and the hairline. I was 15 then.

My hair was always somewhat thick, and soft. My hairline had been receding and a dermatologist also said that I had a growing bald spot on the back of my head, based on pictures he took. It worked fine, and in January the dermatologist was actually amazed at the results, especially in the bald spot which was practically eliminated by new, albeit smaller hairs.

Now it’s July 2008, almost 10 months later, and my hair has turned from consistently straight and thick to almost two different hairstyles: the back and sides have all become black, and curly. Really curly. And the rest has become thin and weak and lighter than before. My hairline is straight, but right in the center the hair is especially thin and it looks almost liek a second bald spot.

Whereas when I started, no one could notice the bald spot in the back of my head (although some pointed out a receding hairline), everyone can tell that the hair in the front is thinner than normal.

What’s wrong with my hair?

I would need to examine you to understand the variety of problems you are showing in your hair. I’m sorry, but in your case I simply can’t provide much without seeing the problem in person. It sounds like you haven’t seen your dermatologist since January — I’d setup another appointment for a follow-up.




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I Want Hair Transplanted to Grow Forward – Hair Loss Information by Dr. William Rassman

Dr. Rassaman

I’ve never posted on this site before so i’ll try to make this question as understandable as i can.

Im a 33 yr. old male who up until about the age of 25 had a female type looking hairline that grew straight up and backwards very close to my eyebrows like a wall of hair,and hair on the sides of my head in front of the temples that grew very close to my eyebrows that came up to meet my unusually low and thick hairline.However i never liked having a hairline that low and that thick,and quite frankly i never liked that it grew straight up and backwards.It just didnt compliment my face at all.I hated it.The hair behind my hairline grows what seems to be almost straight forward in comparison to the hairline which grew straight back.

When my hairline matured and receded along with the sides leaving only the forward growing (yet thick and still full head looking)hair left it totally changed the way my face looked for the better i was in heaven.But now that hair behind the hairline is starting to recede and thin out badly.

My question is is it possible to receive a hair transplant that only replaces the forward growing hair that was originally behind the hairline and the hair on the temporal area only rather than having to have a full thick straight up and back growing looking hairlne???

I ask this because as foremontioned i never looked good with that full thick straight up and back growing looking hairline and i always force combed my hairline forward and i want to be able to only have that hair back that naturally falls forward and not that straight back and low;wall of hair hairline.All of the hairline transplants photos i’ve seen all look like the Dr. tries to give you back that straight up growing looking hairline when you were a teen which never suited me.But i never find someone whos transplant looks like the hair naturally falls forward without that thick straight up wall of hair hairline…………. Is this possible to achieve at this point in time Dr.????

Thank you for your time,it’s very much appreciated.

Men with window’s peaks or even the juvenile hairline may have hair that does not point in the normal forward direction. I have never seen it as a problem for the hairline reconstruction, but I would be hesitant to make a comment about your unusual hairline without examining you personally. When I do a hair transplant in the frontal hairline, the hair is placed pointing forward parallel to the floor and when I go back further, that angle increases upward slightly. If some of the hair is sticking up, I might conclude that the hairs that point up will just follow the ‘crowd’ of the thick transplant hair and be outweighed.

I’d have to either see you in person or if you have access to a video camera and can upload the video somewhere like Youtube, that’d be a great way for me to see your hair (make sure the lighting is good).

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Get a Scalp Biopsy! – Hair Loss Information by Dr. William Rassman

(female)
Could you please make sure you tell everyone to get a Scalp Biopsy in all of your replys. It took 3 years of different “doctors” before I asked for one. Immediately it determined what type of Baldness I had and I was given appropriate drugs for the diagnosis. Many thanks

Some women have telogen effluviums, diffuse alopecia areata, and other conditions. The use of scalp biopsy for some women is part of the diagnostic work-up. Be sure that the doctor who does it is a dermatologist and works with a good dermatopathologist who knows how to read what he/she sees under the microscope.

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Dutasteride vs Propecia – Hair Loss Information by Dr. William Rassman

Is dutasteride better for treating hair loss than Propecia?

In the Journal of the American Academy of Dermatology (Volume 55, Issue 6, December 2006), a 24 week randomized placebo-controlled study compared the two medications. DHT levels went down and testosterone levels went up on dutasteride. The results of this limited study suggested that in high doses, dutasteride had more hair growth than Propecia (finasteride). A total of 416 men were tested. There were more side effects on the higher doses of dutasteride.

This question has come up over and over again. We are waiting for the results of the Korean study to understand the meaning of the above publication. To get to the root of the question of effectiveness, we must know the results of dutasteride over a long time period and we must know the risks. There are reports of not only increased side effects such as more impotence or decreased libido, but there is also a significant impact on sperm count and possibly fertility in men. As there is a long half life of the dutasteride, the reversible nature of decreased sperm counts are not known. I would not suggest that every person rush to get this medication unless Propecia is a failure and there are reasons for trying the alternative. Please note that dutasteride is FDA approved to treat the prostate (marketed as Avodart), but it is not approved to treat hair loss, so it would be off label for the doctor to prescribe it and most doctors will not take the medical-legal risk for this off label use.

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Does Rogaine Foam Cause More Shedding than the Rogaine Liquid? – Hair Loss Information by Dr. William Rassman

I have read all over that Rogaine Foam causes vast more amounts of shedding than the liquid form. Is this true or do both cause the same amount of shedding (which of course varies by person)? I would like to know this because both are using the same growth agent in Minidoxil so I do not see how one could cause more shedding then the other. I have used the liquid form of Minidoxil for 2 months and have not experienced great amounts of shedding so I do not want to switch to Rogaine Foam if it will cause alot more.

I have not seen this in my patients, so I can not comment on the shedding comparison between the Rogaine foam and the liquid. If any readers want to share their experience with this, please leave a comment.

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Adding Rogaine Years After Starting Propecia – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I have been on propecia for roughly 6 years. I recently felt that it had lost a little bit of effectiveness, although I am also obsessive compulsive which probably played into that line of thinking. My question is if I begin to add rogaine to my regimen will I have some benefit. I guess I am confused whether or not any lost hair is salvageable after 6 years. Would the propecia keep some hairs salvageable for rogaine to take effect after this long?

Lost hair is likely not “salvageable” after many years. Remember that there is no cure for genetic hair loss. Drugs such as Propecia (finasteride 1mg) will slow the process. Propecia is not losing its effectiveness, your hair loss process is continuing so that your genetic predisposition is showing through. Or, as you said, your OCD may be causing you to over-examine your hair to try and find fault where there is none. I couldn’t say beyond speculation.

Hairs grown or maintained from Propecia will not be maintained using Rogaine, so if you stop taking Propecia, you will likely have “catch up” hair loss. In other words, your hair loss will progress to be as if you never took the drug in the first place. I believe Rogaine (minoxidil) can help, but it is the same story as Propecia on its limitations.

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My Hair Fell Out After Brow Lift Surgery and Regrew With Different Characteristics – Hair Loss Information – Balding Blog

(female)
Dr Rassman,

After having a brow lift type surgery ( no lift but same incision ) a lot of hair all over my head fell out. What grew back were strange hairs. Some are very fine only about 3 cm long, and look crimped. Others are thick coarse hairs that look like afro or pubic hairs. Together these hairs are all over the crown and have been growing this way for about 4 years now. My Dr said these hairs have nothing to do with the surgery but they all started a few months after the surgery.

I am 99 % convinced that they are related and would appreciate any information you might have. Also some of the coarse hairs have are less so closer to my scalp, that would indicate that time is possibly helping a bit. The very fine ones have not changed.

With Kind Regards

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I have not seen this type of change associated with a brow lift incision. I have seen hair loss with a finer hair appearing in front of the brow lift incision, but I have not seen someone change variable parts of the scalp hair and not other parts. I would have to examine you to make sense of the process you are discussing. The use of good conditioners after washing should minimize the kink in the hair.