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Motorcycle Helmets, Finasteride, and Guarantees in Life

Hi, I have a few questions regarding hair loss and finasteride.

  1. Does tight motorcycle helmet causes hair loss.I’ve notice increased hair loss since i regularly started wearing full face helmet which is a bit tight on my hairline and genera crown area.
  2. Could it be possible to experience hair loss due to lack of iron mineral?
  3. Propecia is being advocated very often but how is it logical not considering the loss of 70% of your DHT as a serious issue which is in essence the maleness hormone from a young age of 23?
  4. What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?
  5. I am prone to depression and sexual problems due to antidepressants from time to time, do you still recommend finasteride in my case?
  6. Can you guarantee from your expertise that side effects subside even if you quit the drug after e.g 3 years or more of continued use?

Thanks

  1. There is one patient I have seen that had traction alopecia from wearing a very tight fitting helmet everyday for a year. The hair loss did not look like genetic male pattern balding, but the balding area was where the helmet was rubbing on the side of the head. So it is possible, but not common.
  2. A lack of iron in your diet can cause anemia (low red blood cells). Your mucosal membranes (under the eyelids and gums) will be pale, you will feel weak, and you will have other serious medical issues before hair starts to fall out. Hair should be the last of your worries.
  3. Men in their early 20’s take Propecia without adverse effects associated with lowering of their DHT levels.
  4. If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious. I’ll point out some interesting tidbits about this in my next post…
  5. This is something you’ll need to discuss with your doctor. Assuming you would be a good candidate for Propecia based on your hair loss, your doctor will need to make the decision if you’re a candidate based on your history of depression. There shouldn’t be a problem with taking the medications together though.
  6. There really is no guarantees in medicine (or in life). Actually, the only two guarantees in life are death and taxes. I do not give reassurances to someone who is afraid to use a medication. This is something you need discuss with your doctor.

#4 continued here


2010-02-15 19:19:40Motorcycle Helmets, Finasteride, and Guarantees in Life

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Moth eaten scars following 5000 FUE grafts

We see this type of result when men have large FUE sessions. There is little doubt that this is a vascular problem induced by the FUE technique. The good news is that we can treat this very successfully with scalp micropigmentation, but the hair will never come back so the patient must style his hair appropriate with the treatment (i.e. very short or very long hair). The scars will not show after the SMP is done.

 

moth eaten scars following FUE megasession


2017-03-18 11:17:42Moth eaten scars following 5000 FUE grafts

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Morning Erection and Finasteride Doseage

Your website is a great and informative, objective source of information. Well done.

I’m 48 and been on fin for nearly 15 years under the care of a doctor. I started on 1 mg per day, but reduced to 0.25 mg per day mid last year in response to what I perceived as libido issues. These are now resolved.

I have also noticed a return of morning wood at the lower dose. My question is: do you know of any science to support a negative correlation between finasteride dosage and morning erections, and if so what is the mechanism?

Thank you for your efforts.

I am not aware of any studies and I would be guessing at the mechanism of how morning erections are correlated with finasteride dose. It could just be a perceived effect not related to the dose or it may be the dose change after all. It is not hard to imagine that less drug should cause less side effect. The other issue to consider is that would less drug produce less benefit for what the drug was treating. There is a delicate balance between these two statements.

The observation you pose is real (for yourself) but it is difficult to prove on an absolute basis unless you have hundreds (if not thousands) of patients who are willing to take the a pill that is randomized to different dose or just a placebo (“sugar pill”) and report their erection in the morning. Even the doctor overseeing the patient would not know if the pill was a placebo until the entire study was complete (double blind randomized control test).

My personal thought is that if you and your doctor are in agreement with what works for you, then so be it.

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More Worries About Propecia — I Can’t Risk My Sex Life for Hair!

Hello,
i’ve recently had my second transplant and i’m almost 27, I had my first just before my 25th birthday. I have only had temporal recession mpb in the front, and I had figured that with such small areas to fill and such a good donor sample that I would be able to fill in the areas not fully but maybe 80% of the density it once was when hair existed there. I was semi happy with my first transplant yet wasn’t near the density I wanted maybe 20% with a random guess. I just had my second 4 months ago and from what I see hairs are growing in but it’s hard to tell at this point if it will get to the density where you won’t be able to see through my hair to my skin. I’m a bit skeptical. Also I am not positive but I think I have just a tad of shockloss, which I refused to take finasteride because of all these horror stories on the internet i’ve seen.

My question is where can I get the straight facts, not opinions but actual documented cases that the FDA uses in it’s analysis? I get conflicting opinions everywhere I go and it’s hard to decipher which is correct, based on fact, logical, and applicable to my situation. Now I’ve read posts on your shockloss and i’m a bit bummed I hadn’t atleast known that shockloss in men in their 20’s with an HT without using Finasteride is common. My Doctor said shockloss most of the time is temporary. Your posts say otherwise. Also I have seen posts on finasteride some saying side effects such as decreased libido or penis size is permanent, others say no. I can’t risk my sex life and would rather be bald then mess with it, but I do like having hair on my head as well. Which side do I take? It’s probably already too late to counter any of the hairloss 4 months after the surgery right? Sorry for the long question. Thanks.

I appreciate your situation, but your fear of Propecia (finasteride 1mg) makes no sense to me. If you took the medication and experienced a negative sexual side effect (1% of men), the drug will be out of your blood stream in 24-48 hours from the time you stop taking it. There is nothing permanent about it. Concerning your hair transplants, you need to have a Master Plan for what might happen to you. If you got 20% of what you expected, then do you have enough hair to follow your hair loss without Propecia as you lose it? Your doctor is just plain wrong when he tells you that hair loss from a transplant (shock loss) is temporary and I would challenge that comment if given the chance.

I agree that giving up sex is not an option, but where are you getting the idea that it is either sex without Propecia or no sex with Propecia? That is not what millions of men are experiencing today, including 99% of the men I treat with that drug.

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More than one hair transplant?

In your experience do patients typically require more transplants down the line, if so how many typically? I can stay on fin to help with this, but I’d like to avoid having to do multiple down the line. Maybe one more in my 30s/40s to keep the hair looking natural if recession drastically continues, but I’m a little hesitant as I don’t want to get roped into having to do continuous surgeries every 5-10 years for the rest of my life.

I have had patients stop at one hair transplant, more common in the older male population when their Norwood Balding pattern is stable. In younger men who jump the gun, following the hair loss with additional hair transplants is not uncommon. That is why careful planning is critical in using up a limited donor supply. A good Personalized Master Plan for every man is needed.

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More reviews of finasteride pills, dutasteride and topical finasteride

More details keep emerging that address the sexual side effects that have been well documented. Here is another review medical article for those of your who read this. The topical form of the drug finasteride seems to have fewer sexual side effects, but they are still present.

https://www.practiceupdate.com/journalscan/39062/2/3?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_uro&elsca4=urology&elsca5=newsletter&rid=NTYwMzM3MDM4NTkS1&lid=10332481


2020-09-15 09:10:34More reviews of finasteride pills, dutasteride and topical finasteride

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More questions on ‘hair plugs’

When you say pencil size from the 1980w, you mean the shaft of a pencil? Presumably this little bit of tissue had several follicles? When I heard the term in the past I thought they were little wigs you wore in the receded area!

A hollow drill was used in the back of the head that cored out a pencil size plug of hair. These were placed in the front in rows. Only a quarter of an area was covered with each of four surgeries with the idea that when eventually filled in, the four quarter patterns would cover the balding areas. Unfortunately, the idea was flawed, because after the plug was put into the scalp, it would contract squeezing the plug to a very high hair density. The the central part, would die off so that the plug looked like donuts. With these high density plugs surrounding a hole in the center, the unfortunate victims has a pattern of hair plugs that anyone could see within 20 feet. I, personally, can’t believe that the public accepted this result, but they did, maybe because they felt that a dolls head of hair was better than a bald head of no hair.

 

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More Opinions About Finasteride and Prostate Cancer Risk

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.

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More on Rogaine Foam

In a previous post, I discussed Rogaine Foam when it just came to market. There appears to be good information now that the foam delivery system for Rogaine seems to increase the effectiveness of the medication by a factor greater than two. With greater effectiveness as measured by increasing blood levels, one could and should assume that the delivery into the skin is more effective than the traditional oil or alcohol base of the ‘old’ standard product. Greater skin delivery will almost certainly bring better benefits. Time, of course, will tell us what it all means, but for the moment, I would recommend using this product and sticking with it for a full 8 months before drawing conclusions one way or the other.


2006-10-23 09:10:54More on Rogaine Foam