Hair Loss InformationPropecia and Sex Drive – Hair Loss Information – Balding Blog

I went on Propecia about 2 years ago and my sex drive increased to the point that I could not manage it. I am generally sexually active, at about once per day. On Propecia, I found that I needed to have sex at least twice a day and my girlfriend could not / wound not cooperate. So I stopped the Propecia and went on Minixodil. After stopping Propecia, my hair loss pattern went from a Class 4 to a Class 6 pattern. Any thoughts? I am 46 years old.

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Minoxidil is not as good as Propecia for preventing hair loss. If you have miniaturization in the areas behind and to the side of the balding area, then Minoxidil may not stop further progression. As a rule, people your age are not in very active hair loss. You are an exception.

Increased Sex Drive: Although I find an increased sex drive in about 1% of the patients I put on Propecia, no one has ever had your degree of increase. Again, you are an exception. You might consider higher doses of finasteride to see the impact on your sex drive (up to the Proscar-level dosage).

Decreased Sex Drive: About 1-2% of men report a decreased libido with Propecia. At times we confuse libido (the desire for sex) with Erectile Dysfunction (a performance issue). If a man has a performance issue, he is often ‘gun shy’ about failure in performance and then the libido goes down in response to it. But it is all not that simple. The physical causes for decreased libido or erectile dysfunction include: alcoholism (quite common); abuse of drugs – such as cocaine; anaemia – unusual unless the man has been bleeding for any reason; hyperprolactinemia – an uncommon disorder in which too much of the hormone prolactin is produced by the pituitary gland; obesity – quite common and simply slimming down will often help; some prescribed drugs – particularly Proscar (finasteride), a tablet used for prostate problems in doses of 5mgs rather than 1mg as with Propecia; low male hormone level (testosterone) – contrary to what many people think, this is rare; and any major ‘generalized’ disease, such as diabetes. There are also psychological causes of libido decrease including: depression – very common; stress and overwork; sex hang-ups; or a serious relationship problems with the wife/partner.

September 27, 2005

Hair Loss InformationMedications for Diffuse Unpatterned Alopecia – Hair Loss Information – Balding Blog

Hello. I am 24 year old male, who believes I am suffering from diffuse unpatterned alopecia. My hair is thinning evenly over the top and the side of my head to from the classic horseshoe pattern of a Norwood class VII. I have been taking Propecia since January and i do not believe its working as the thinning has progressed. My dermatologist did not seem to concerned and told me to continue taking it for the full year before asking for any other options. Are there any other effective options available? I have read about Avodart and minoxidil, or the possibily of a chemical imbalance, but I do not know if they are effective for this condition.

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I believe that DUPA can be reversed with Propecia. I see this in about half of the patients who are taking it. For those like you, it may be worthwhile, after trying Propecia for a year, to consider Avodart, but I have said many things about this drug which you should review.

September 26, 2005

Hair Loss InformationBody Hair Transplantation – Hair Loss Information – Balding Blog

Two different BaldingBlog readers had two similar questions…

Dr. Rassman,
recently some hair transplant surgeons reported very good results from body hair transplants. Other doctors remain more cautious and say it may yield good results in some, but not all patients. What’s your view on this?

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Dr. Rassman,
Would you ever consider using bodyhair for some of the grafts in the scalp? I was wondering because it would seem a good way to increase density results. I am a bit paranoid about using only scalp hair to graft because I would not want to run out before getting decent density. I would think that you could mix in some sideburn or beard hair with regular scalp hair in the crown. What is your take on this. Thanks for your time.

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Body hair has generally low densities (contrary to what it looks like on some men) so they do not make for a good donor supply in terms of quantity. A focus upon head hair should be primary. Then if you run out, moving to other body parts may be reasonable, especially as some studies are now appearing that indicate that this type of transplant works (leg and body to head or neck). What is still missing is the yield rates from the leg or body and the growth success from these areas.

As far as using sideburn or beard hair, this is an option in certain circumstances. They should only be considered as a last resort, when all usuable scalp donor hair is used. The other time that sideburn or temple hair can be used is when a patient is going to have a face lift and the sideburn/brow area is going to be excised as the brow is raised up.

Until the research information about body hair transplants is in our hands, it must be looked at as if it were human experimentation. A number of our patients have volunteered for this, so I am clearly interested in following the experience of others who I trust and then possibly get involved myself. I just do not want to sell hype and disappoint anyone.

I have performed one body hair transplant. The transplant was done from the abdomen to the eyebrows and it failed to yield hair in 10 months. I lost contact with the patient so I do not know if the transplant showed delayed growth or reflected some mechanism that caused it to fail. What I believe is that we need better scientific evidence on the following questions:

Does it works reliably 100% of the time?
If #1 is true, is that for all donor sites?
What is the yield of viable grafts?
What are the risks of body scarring / complications?
Is it cost effective?

I would want to see many successful patients before I recommend it routinely for my patients.

While I can perform body hair transplants, I choose not to until they have been proven as a reliable procedure. If I make representations to my patients, I must be able to support what I say. If I embark on body hair transplants now (even on a limited basis), my patients must know the many uncertainties associated with the procedure. Until my comfort level is higher, I will not be doing body hair transplants.

September 26, 2005

Hair Loss From Propecia – Update – WRassman,M.D. BaldingBlog

Hair Loss From Propecia – Update

Sep 26, 2005/by William Rassman, M.D./1 /Drugs

There has been some discussion by physicians about patients who take Propecia, or Avodart, who may experience shedding of hair. When this occurs, they believe it may be simply a phenomenon that as the finasteride or dutasteride begins converting the telogen hairs into anagen, the shedding reflects an acceleration of hair cycling. The same theory implies that some people may have a significant amount of hairs in telogen, so their shedding may be increased in the first few months of starting the drugs. If these people wait out the cycle, I believe for a 3-5 month time frame, the benefits of the drug will come on strong.

In my practice I do not remember hearing this complaint so what I am presenting here was precipitated by some questions that came through this blog and information I gleamed from my recent trip to Sidney at the ISHRS meetings where I asked other people about the experience hair loss on Propecia. But the explanation above makes sense to me, assuming the premise that hairs in telogen may be shed more once they are moved along into their anagen (hair building) cycle.

September 23, 2005

Hair Loss InformationHair Loss from Cancer Drugs – Hair Loss Information – Balding Blog

Dr. I am currently in the Star study and taking either tamoxofin or reloxofin and a placebo. I am having ample hair loss every time I brush or wash my hair. One of the questions on the form that I am to answer every year (this is my second in the program) is regarding hair loss. Within the past few months I have also started taking Glucosamine and Condroitin. I think the hair loss has increased in this time. Is this a conincidence or which drug, if any is causing the hair loss and is there anything I can do about it other then stopping the meds?

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Many drugs that attack potential cancer cells because of their high metabolism, will also impact other cells with a high metabolism such as hair (one of the highest metabolic organs in the body) and the lining of the intestine (these cells have a high turn-over) with symptoms of loose stools and general ‘stomach’ troubles. Also, some of the other sensitive cells to anti-cancer drugs are the blood cells in our body, some of which live only a short time, even under normal circumstances. That is why many cancer patients have frequent blood tests and are monitored for side effects so closely. Hair loss is not one of the points that have become the focus of anti-cancer drug treatment by doctors, yet hair loss is often the most worrysome side effect from the patient’s perspective.

Unfortunately, there have been no effective medications that have been shown to protect against hair loss. That is the bad news. The good news, however, is that the hair in women that falls out from the impact of these anti-cancer drugs, always comes back within a year or so in most women, that is, unless they have genetic hair loss. Those with female genetic hair loss and hair loss from anti-cancer drugs in combination, find that although the hair usually returns, it does not come back as strong hair. Show patience, and the hair will probably return to its pre-treatment quality, again as long there was not genetic hair loss prior to the commencement of treatment.

September 23, 2005

Hair Loss InformationHair Transplantation in Filipino Man – Hair Loss Information – Balding Blog

I am a filipino male with brownish black hair that is semi thick in nature. My hairline is receeding and would like to have the FUT procedure done. but before this takes place, have you done this procedure on clients that fit my description, and if so, may i see pictures of them? may i also call them if possible. as far as medication goes, do i need to take propecia, rogaine or any other prescription? because i rather not. my next question is time off work. because i am self employed and serve clients face to face i can not afford to take more than 5 days off from work. is there way to discreetly hide my surgery as it heals? my last question is i enjoy having my hair cut very short, is possible to do that without showing that i have had hair transplant surgery? do you have pictures of your clients like this?

thank you

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What you have is typical for our practice. Our website has many, many patient pictures of what you are talking about in our Before and After Photo Galleries. Our monthly open house events allow you to meet former patients and see the results for yourself. You do not have to rely solely on photographs when you get to meet the patients in person. In addition, an open house allows you to see a surgery, talk with the patient having the procedure, and see how he looks immediately after surgery. We also invite patients who have had surgery during the previous week to stop by, but I can not guarantee that they would have the same hair characteristics as you.

The use of medications relates to the natural hair that you are losing. Medications may be necessary to hold on to hair that is genetically not going to last, but medication is not needed for the hair that is transplanted. I strongly recommend that my patients use Propecia, to maintain their existing hair.

You can return to work fairly fast. I have performed FUT surgery on a number of celebrities who have appeared on television within days or even hours of their surgery. I have had a few people run a marathon within 5-7 days of the surgery. Going back to work is easy, but the question relates to just how bald you are and if you care if someone notices that you had a hair transplant. For the very bald man, this can be an issue, yet for those not very bald, they can be undetectable within a day or two. There can be a little redness in the recipient area for the first few days and if you allow your hair to grow a little longer than usual, it will hide the donor area nicely. If you do schedule a surgery, you may want to shoot for a Friday, taking the following week off, then you will have nine full days before your next work day. As far as wearing your hair short after the healing is completed, that will be up to you. FUT surgery will leave a thin scar in the donor area, the length of which is determined by the number of grafts you need, your hair density, and scalp laxity.

My advice is to visit us at an open house event and get comfortable with what we do. Review our website, where hundreds of patients are shown, and get the book I wrote, The Patient’s Guide to Hair Restoration, which is probably the most comprehensive book ever written in this field.

September 22, 2005

Hair Loss InformationLosing Hair Grafts After Transplant – Hair Loss Information – Balding Blog

Hi, Dr. Rassman, I hope that this email finds you well. I had my surgery in June and have lost about 9 grafts (4 in the last 3 weeks or so). I didn’t lose this many last time. Should I be at all concerned?

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Nice to hear from you. I would doubt that you lost any hair grafts. After 5-10 days, once the scab is off, most of the grafts actually can not come out even if pulled on. What you may have lost was the remnant of the graft and the hair shaft. The growth center will remain and will grow its hair in 4-5 months. If you are at all concerned, call my office at 800-NEW-HAIR and make an appointment to come in. I will be happy to take a look at your early results.

September 22, 2005

Transplanting the Crown – Hair Loss Information – Balding Blog

What do you think about filling on the crown on 39 yr old because that is where my hair loss is. I was told that I am in good shape because most of a person’s hair loss happens between 20 and 40. They also told me because I am on propecia that chances are very good I can keep most of my hair. Please let me know you thoughts.

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A crown transplant uses hair from the donor area, which may be needed for frontal area transplantation should you continue to bald. If the hair loss is controlled, then transplanting the crown in a person of your age may be reasonable, provided that your donor density is good, your laxity is good, and the pattern of genetic hair loss is predicted. Being on Propecia may help slow or stall the hair loss, but long term planning is critical.

It is also reasonable to postpone transplants in the crown for 8 months or so if you are just starting on Propecia, as sometimes the drug has remarkable results on restoring hair loss in the crown. It generally takes more hair than most doctors think to fill in the crown, so balancing supply and demand in the short and long term requires special estimation skills when transplanting the crown. Be sure that the doctor you select has those skills.

September 22, 2005

Hair Loss Worse on One Side of Head – Hair Loss Information by Dr. William Rassman

I am clearly losing my hair and my right side is much worse than my left side, although the left side has the same problem, just not that bad. Could I be pulling on the right side when I brush my hair to the left too much?

Hair loss is rarely symetrical. Many people will notice one side is worse than the other. Based upon your email, you are combing it right to left. That means that the right side has more sun exposure than the left side and the sun exposed side generally has more ultra-violet damage than the other side which has been protected by the combed hair.

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September 21, 2005

Hair Loss InformationHair Loss Following Pregnancy – Hair Loss Information – Balding Blog

Hello,
I recently had a baby at 28 weeks, due to a serious kidney infection that was almost fatal. since then we’ve been doing wonderful. Though, for the last month I have been noticing excessive hair loss. I know its probably due to a serious infection or hormonal but, how long do you think it will last and could I go bald before it then? Please help me!!!!

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Hair loss following pregnancy is not uncommon and can be expected to reverse in most women within a year or so. In addition, I am sure that your serious illnesses contributed to the hair loss as well. You must show patience while you are going through this waiting process. I am assuming that you did not have a hair loss problem prior to the pregnancy. If this is incorrect, then I would have to know more about your history.