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Hair Loss InformationHerbal Treatments – Hair Loss Information – Balding Blog

Hi from Virginia Dr Rassman! I am 27 and am concerned about a receeding hairline I (and my friends) have noticed occuring right above my temples. The hair in this location has always been thin, but has become more pronounced in recent years. What can I do to retard and even reverse this thinning? I have read about Propecia, and they do not recommend it for receeding hairline. Currently I am taking Saw Palmetto (supposedly an herbal Propecia), a sustained-release B Vitamin and MSM (both which supposedly feed and thicken hair). What other treatments are available for receeding hairline, herbal, pharmaceutical, or other?

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If you have been losing hair in the temples and only the temples, then you may have a condition called Triangular Alopecia. IF this is the case, then you need a diagnosis. As I have repeated many times, the hair throughout your head must be observed with high magnification. If the hair loss is only in the triangular temple area, then this diagnosis is probable.

Make an appointment with a good hair doctor and show them this answer. They will know what to do. Don’t rush to herbal or other over the counter remedies without knowing what is going on. Once you get a good diagnosis then you should address the cause or use a treatment that works with scientific proof or at least a reasonable certainty.

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Hair Loss InformationNizoral Shampoo – Hair Loss Information – Balding Blog

Is Nizoral better than other shampoos and can it promote hair growth?

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Nizoral 1% (Ketoconazole 1%) is sold as an over the counter anti-dandruff shampoo. Nizoral 2% (Ketoconazole 2%) shampoo has twice the strength of the over the counter shampoo. The active ingredient, Ketoconazole is said to act as a DHT blocker. While some people who use Nizoral may believe that it does control hair loss, there is no objective evidence that it is anything more than a good shampoo.

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Hair Loss InformationShiny Forehead – Hair Loss Information – Balding Blog

Dear Dr Rassman,
I hope you are well! Thank you for your dedication to providing men with a source of advice and information. I for one greatly appreciate it, and I am sure hundreds (thousands) of others do also!

I have a question that does not relate directly to hair loss, but one that is associated with appearance.

I have a high forehead, my hair has moved back an inch and a half directly in front and two inches roughly on the sides, with thinning on top. I tend to cut my hair short, usually a one or two shaven look. I am comfortable with the way I look, although I wish (as the majority of bald men do) had more hair, I am hoping that I will see more of a fuller appearance in time, since I started using Propecia two months ago.

My question is regarding the shininess I get on my forehead. It is greasy, oily moisture that accumulates during the day, which I usually wipe away with a tissue. I feel that if I could reduce the amount of greasiness I get on my brow I would feel better about my appearance. As the hair is thinning at the front, it makes my head look very shiny, when the back and sides of my head are thick with hair. Is there any product, or dietary plan that you could kindly recommend that may reduce this shiny appearance? I have found it is not good for the skin, to keep wiping the grease away with a tissue, it causes spots, which is the last thing I need at 23, along with the baldness!

Thankyou kindly for your help with this question. I hope you don’t mind me asking questions that are not directly related to hair loss.

Kindest regards

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I gave this question to hair restoration surgeon, dermatologist, and my collegue Dr. Robert Bernstein to answer. Here’s his response:

The easiest way to remove oil from the forehead is with alcohol swabs. If you are acne prone then Erycette and Cleocin Pledgettes are topical antibiotics for acne that come on an alcohol based pad. These can be carried in your pocket but require a doctor’s prescription!

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Switching From Propecia to Proscar – Hair Loss Information by Dr. William Rassman

I have taken Propecia for 4 plus years with some success. I’d like to take proscar but don’t know how to go about it. Could you help? thanks

Proscar is the same drug as Propecia, just in a higher dosage per tablet. Propecia contains 1 mg of finasteride per tablet, and Proscar contains 5 mg of finasteride per tablet. When Merck did their studies on hair loss, it was determined that 1mg of finasteride was just as effective as 5 mg or even 10 mg of finasteride, but that taking only 1/2 mg of finasteride was 20% less effective.

So the only ‘benefit’ to taking more than the recommended 1 mg of finasteride in each Propecia pill, is a higher chance of side effects. If you want to take Proscar because it is more cost effective, you can split the pill into fourths. Splitting into fifths is more difficult and you tend to lose some of the pill in the cutting process. The doctor who prescribed Propecia for you, can prescribe Proscar for you.

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Hair Loss InformationJournal Articles on Propecia (Finasteride) – Hair Loss Information – Balding Blog

Two articles are summarized below which address the drug Finasteride (Proscar 5mg and Propecia 1mg).

These article are very technical and may not be good reading, but I have put them here as part of my effort to educate the readership. Both of these articles discuss what we have learned on preventing prostate cancer with finasteride (very important as most men who live long enough will develop prostate cancer) and the cost/benefits of taking finasteride over time. In medical circles, these are controversial articles in many ways. I have included the comments of one doctor in the hair restoration field. Dr. Bill Reed, states: “An oversight on the author’s part that would probably negate the need to reduce the price of finasteride is the enhanced quality of having more hair! With regard to the authors’ basic approach, it’s an awkward premise to attempt to attribute a monetary value to quality. For example, is the real quality and value of treating BPH (enlarged prostate) with finasteride [to produce a] better sleep and absence of urgency or the money saved from a TURP? I’ve always loved how a healthier prostate and more hair probably go together with this drug [How does one quantify this value?]”

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European Journal of Cancer. 2005 Jul 29; The article addresses the finasteride prostate cancer prevention trial (PCPT) and asks: What have we learned?

Author: Mellon JK., Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.

In 2003, the first of two large NCI-sponsored prostate cancer chemoprevention trials was reported. The prostate cancer prevention trial (PCPT) demonstrated a 24.8% reduction in the prevalence of prostate cancer in men taking finasteride 5mg/d for 7years. However, despite the overall reduced risk of prostate cancer, men in the finasteride-treated arm of the study were more likely to develop high-grade disease. This article examines some of the controversies aroused by the PCPT and evaluates some of the arguments that have been advanced in an attempt to explain some of the unexpected outcomes of the study. In addition, some of the recent studies assessing the potential impact of an effective chemopreventive strategy on population mortality are reviewed. To conclude, there is some discussion of factors, which need to be openly discussed with male patients who might be considered for finasteride therapy.

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The American Journal of Medicine. 2005 Aug;118(8):850-7. The article addresses the lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer.

Author: Zeliadt SB, Etzioni RD, Penson DF, Thompson IM, Ramsey SD., Fred Hutchinson Cancer Research Center, Seattle, Wash.; Health Services Department, University of Washington School of Public Health and Community Medicine, Seattle, Wash.

PURPOSE: We estimate the lifetime implications of daily treatment with finasteride following the results of the Prostate Cancer Prevention Trial (PCPT). In this trial, prostate cancer prevalence was reduced by 25%; however, an increase in the number of high-grade tumors among the treatment group necessitates the long-term projection of the likely benefits and costs. METHODS: We use a Markov decision analysis model with data from the trial, the SEER program, and published literature. The model measures the cost per life-year and cost per quality-adjusted life-year (QALY) gained for a cohort of men age 55 years who initiate preventive treatment with finasteride. RESULTS: Finasteride is associated with a gain of 6 life-years per 1000 men treated at an incremental cost of $1,660,000 per life-year gained. The quality-adjusted analysis results in 46 QALYs gained per 1000 men treated at an incremental cost of $200,000 per QALY gained, due primarily to the favorable effects of finasteride on benign prostatic hyperplasia. Under the assumption that the increase in high-grade tumors observed among finasteride treated men is a pathologic artifact, the incremental costs are $290,000 per life-year gained and $130,000 per QALY gained. CONCLUSIONS: The cost burden associated with finasteride is substantial, while its survival benefit is small and only realized many years after initiating treatment. To achieve an incremental cost below $100,000 per QALY gained, the price of finasteride must be reduced by 50% from its current average wholesale price and finasteride must be shown to prevent high-grade as well as low-grade disease.

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Hair Loss InformationZocor and Hair Loss – Hair Loss Information – Balding Blog

I have noticed that my hair is thinning though it still grows as fast as before. I have been taking Karvezide medication for high blood pressure and Zocor for high cholesterol this has started since the Zocor was increased to 40mlg a day.

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Hair loss has been a reported side effect of Zocor. In many of the drugs on today’s market, it seems that hair loss is frequently cited as a possible side effect so I sometimes wonder if the language is not routinely put in to protect the drug companies.

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Hair Loss InformationLimit on Donor Area – Hair Loss Information – Balding Blog

I had two hair transplant procedures approx 5-6 years ago. Obviously back then it was done by the strip surgery and not the new technique that seems fabulous. Being that I already have a scar from those sessions, is there any reason why I would go with the newer technique that limits scarring or does it matter at this point?

Also, does there come a point in time where you can no longer continue to take from your donor area for future procedures? Does the new technique allow one to continue having more procedures in the future where the strip would not have allow such an option?

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Once you had a strip procedure, it probably is good to continue that route. The FUE procedures you are referring to, do not allow you to make more hair. In fact, they may limit the available donor supply simply because the best area for donor hair is in the central area of the back of the head and FUE does not maximize this area for donor.

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Revising Non-Transplant Scars – Hair Loss Information – Balding Blog

Dr. Rassman,

This is a bit of a tangent. I had 3 surgeries with you folks between 97 and 2000, and I continue to be pleased with the results. It appears it will be quite some time before I need more work done. When I researched different groups, you folks stood head and shoulders above the rest in terms of professionalism and especially how much research you had done. It was clear you were at least as interested in advancing the art as being successful from the business end.

Thus I am interested in your opinion on scar revision. I have two 6-7 inch scars – one on my elbow from nerve transposition surgery, another one that is horseshoe shaped above my armpit from reattaching a torn pec from a snowboarding mishap. Both scars spread kind of badly, such that at spots they are about as thick as my index finger. Apparently both those spots tend to be high tension, which causes the spreading. Both incisions were sutured with plain stitches or staples, not any interior stitches.

I’ve been doing web research on and off for several years, but I haven’t been able to convince myself that there is any group or technique that has a good chance of making a big improvement. What are your thoughts about the state of the art of scar revision? Perhaps this is a new area of study to apply your innovation. 🙂

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When a person has stretched scars on many parts of their body, I often think of diseases that produce this problem. You should first be sure that you do not have any of these diseases such as Ehlers-Danlos Syndrome which is a connective tissue disorder. You are correct that some scars that come from wounds which are located in areas where the skin is stressed, can stretch in any person, even those without a connective tissue disorder. Plastic surgeons are often good at dealing with changing the way forces are applied to these stretched areas. One common procedure for managing scars is a process called a Z-plasty, where a linear scar is change to a Z type scar so that the forces do not oppose each other to stretch the scar. In the scalp, there are other factors far too complex for me to cover in a blog response here.

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Minoxidil and Propecia Together – Hair Loss Information – Balding Blog

hey doc,

im 22 yrs old, experiencing receding hair line, and thinning of hair. i have been using propecia for the past few wks, and will continue using it for a while. should i also use rogaine? i wanted to know if it would benefit to use both or not. also, if i use rogaine, can i use a monoxydil subsititute, found at local grocery stores instead? will the cheaper generic product give the same intended effect as rogaine? please let me know.

thanks for your help.

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Minoxidil is the generic form of Rogaine. Both are over the counter medications, sold at many places, you do not need a doctor’s prescription, like you do for Propecia.

I generally tell my patients to just take Propecia alone for at least 8 months to a year to be able to gauge its effectiveness. When you combine both Propecia and Rogaine from the beginning, you will not be able to tell if any effect is due to just one of the drugs or the combination, and you will be incurring the cost of both drugs for as long as you want the hair loss stopped or slowed down. If you find that Propecia by itself is effective and you are happy with the results, you have saved the cost of Rogaine for that period. If you are one of the few patients who do not get the desired results with Propecia, then you can stop taking the drug.

The two medications work differently. Minoxidil must be applied twice a day and it is messy. Propecia is a pill that should be taken every morning. Propecia attacks the hormone DHT that causes hair loss. Minoxidil was developed as an oral medication to treat high blood pressure and was found to have a side effect, which is the ability to grow hair in a small percentage of the population who took the drug. Minoxidil was then approved as a hair loss treatment in a topical solution called Rogaine. The topical Minoxidil can cause blood pressure drops and skin reactions, so you need to be careful taking it, and it does not work very well in the front of your head. Although Propecia does not impact regrowth in the frontal area most of the time, it will slow down or stop the loss in the front, particularly in young men.

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Scalp Discomfort from Finasteride? – Hair Loss Information by Dr. William Rassman

I know MPB can cause itching and scalp discomfort in some….have you ever seen the same problem occur with taking Finasteride long term —perhaps via hormonal upregulation? Thank you

I am not familiar with itching as a common complaint with Propecia/Finasteride, however, any medication can cause skin complications. If you suspect that Propecia/Finasteride is causing itching or scalp discomfort, you can go off of the medications for one or two weeks. Any skin complication due to the drug will go away because Propecia is out of your system in a day or two and the skin turn-over in your body is usually under two weeks.

Balding Forum - Hair Loss Discussion

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