Hi Doc

Any thoughts on MDF Advanced (site), seems like it’s a mega all in one treatment - but i thought duta wasn’t allowed to be used for hair loss?

keep up the good work

MDF Advanced contains a very high level of minoxidil (15%), dutasteride (a prescription medication), and flutamide (I’ve yet to see a study that proves it does anything to treat hair loss topically). I don’t see how this is safe or why a doctor would sign off on this. The way they sell the topical treatment is interesting — you order it and supply your doctor’s info, they fax something to your doctor asking for him/her to approve prescribing this medication, then they have their own pharmacy send you this formula containing a prescription medication. Is that even legal? It might be a gray area.

There’s a couple of red flags that I need to point out:

1. Dutasteride is yet to be FDA approved as a hair loss treatment (it is a prostate medication), so the doctor would be signing off on something for off-label use. Doctors have to consider their liability when prescribing off-label medication. Also, the FDA controls all claims on lotions, potions, drugs, and any variation left open for misinterpretation can be actionable. Many doctors won’t do what this company wants them to do. I certainly would not!
2. It contains dutasteride in a topical form (the limited studies I’ve seen have been for oral dutasteride). You’re risking a lot to use an expensive treatment that hasn’t been proven safe or effective.

I started taking propecia when i began noticing my hairline receding and hair becoming thin in the crown. About 1 year later i decided to give dutasteride ago. Throughout both medications my testosterone increased quite alot, causing increased libido to such a degree that i was getting an erection almost 3 times a day compared to almost never (unless needed) when i wasnt on the medication. i have been taking these medications now for 3 years and my testosterone shows no sign of of decreasing back to normal.

My question is, if i am taking medications to reduce as much DHT as i can and my medications are actually increasing my testosterone which inturn is creating more DHT as its a by product isnt it a paradox and useless. I have however heard that this increased testosterone isnt almost a momentary thing that may last a while because my bodys thinking ‘we need to make more testosterone’ due to the decrease caused by the medication.

Thanks NHI Team

Few men will complain of an increased libido or an increase in the frequency of erections. As you noted that the increase in erection function has been now two years since you started it, I would imagine that it will continue. How do you know your testosterone levels increased? Did you have them measured before and after you are taking Propecia and/or dutasteride? These blood levels need to be compared to the normal values established by the lab testing you.

The connection with your sex drive and the DHT block from the drugs you are taking, and possible increased levels of testosterone are unclear. Without knowing testosterone levels before and after you started taking the DHT, I can not tell you much. I personally think that you are going overboard with analysis here, and should just enjoy the moments as long as everything is working well.

There was a wallstreet journal article talking about the efficacy of the laser comb. It said that it works. Do you think there’s any evidence to support this? Here is the link.

By the way your site has been a big help. I’ve been balding since senior year in high school and am now twenty years old. Your site is the only site I have found that doesn’t seem to be pushing or selling anything, thank you.

The Wall Street Journal really didn’t conduct any research on their own to determine efficacy, but just quotes the study provided by Lexington (makers of the LaserComb). I guess if you took a vote from experts in the field, you could count my vote as thumbs down towards these hair lasers. I conducted a study on some of my patients for over a year when I had the large hair laser machines in my office (and offered their use free of charge to my surgical patients). I did not see any value on those using the hair laser, and honestly, it seemed like a waste of time for patients that don’t have time to waste.

Thanks for your kind words about this site. We work hard to make it what it is.

Dr. Rassman
I have started using scalpmed. It requires daily twice application. I cannot go to office with greasy head. I either have to take bath after applying or have another minoxidil based solution that needs daily once only application. So

1. What should be the minimum time between application of minoxidil and shower?
2. Is there any minoxidil based treatment that requires once nightly application?

The minoxidil will have been absorbed by the skin within an hour or so, so that should be the time in between applying and showering.

Using Rogaine Foam might solve the greasy head problem for you. Since both the foam and ScalpMed are minoxidil based, you wouldn’t lose benefits by switching between the two. Most minoxidil products recommend twice daily use, but some people do apply just once a day.

I’m worried that the combination of continued balding and my very fine hair will make it difficult to naturally and densely cover my scalp via transplant. In the case of having a fraternal twin, female family members, or maybe even friends with hair to spare, is it ever possible to retrieve grafts from a donor that is not the patient? Would grafts from a female donor be viable on a male MPB scalp? Thanks!

Unfortunately, transplanting hair from any person other than an identical twin will fail and get rejected. Hair is like any other organ transplant, which would require anti-rejection medication that could lead to further health complications. I’ve written about this process and the medication required before.

Hello Dr. Rassman,

As you seem to be the leader in your industry (in my opinion, at least), I assume many patients travel from afar to see you. Do you treat Canadian residents? I am in the eastern part of Canada, and while there seem to be some good surgeons in my area, I feel a visit to you is my best option. Any thoughts about this? Thank you.

Yes, I can treat any patient that sees me from any part of the world. We also offer a travel discount for surgical patients. Before we arrange that we should have a telephone consultation and that works best if you send me photos so I can see what your problem areas are. If you’d like to setup a phone consult, you can fill out this form so that someone on my staff can get back to you to schedule it and get those photos.

Here’s the info about the travel discount from our website:

“If you live more than 150 miles from the office where your surgery is performed, you are eligible to participate in our travel program. NHI will reimburse you for up to 5% of your net procedure cost for reasonable transportation expenses incurred while traveling to one of our facilities for a seminar, consultation or procedure. If you drive to one of our facilities, you can choose to be reimbursed for either mileage or gasoline expenses. If you fly to one of our offices, please note that frequent flyer miles are not reimbursable. NHI can only reimburse you for your flight-related out-of-pocket expenses. In all cases, please remember to provide receipts. In addition, you will receive one night’s stay at a pre-selected area hotel at our expense. This program is based on a minimum procedure fee of $3,000.00.“

Is their a Dr.in the Sacramento area who specializes in hair loss. My 18 year old daughter has been experiencing hair loss for about a year. I took her to the Dr. last year and was told it was probably due to stress. Her blood work showed no abnormalities. She has another appointment soon. I am thinking it could be heredity. My father stated losing his hair at 18. I have Kaiser Insurance and I don’t think they are going to do a whole lot to figure out what is going on with her hair loss. What would be the next step? Should she be referred to a Dermatologist? If you could give some assistance, that would be appreciated, thanks.

Women’s hair loss is very different from men’s hair loss. Finding the source of the female thinning isn’t as simple as looking to the history of hair loss from the male side of the family. You should take a look at the female hair loss category of this site and read the many posts on the subject. A doctor who specializes in hair transplantation and has the intellectual capacity to analyze it may be able to help. Usually this is an elimination process for known causes.

I would be happy to give you an opinion, but you would have to fly to Los Angeles to see me. Or Dr. Pak goes to our San Jose office and may be a first start to the process of analysis. It’s not quite Sacramento, but it’s closer than Los Angeles. If not, you can try the physician search at ISHRS.org.

I’ve heard the Hardy-Weinberg principal can help determine your probability of going bald. Is this true?

If you know what the Hardy-Weinberg principle is all about, you should know it is a GENERAL principle… and at the risk of seeming like I’m just brushing this off, I doubt most readers have heard of it or would be interested in it. Moreover, genetic male balding only applies to men, but the trait is not sex linked (meaning women can carry the gene), and the gene in question may be more than just one gene, as nobody has found the specific gene(s) for balding.

In the end, if you have it, you have it! It is not that difficult to see the balding. And even if the principle works, how useful would it be?

Snippet from the article:

You’d have thought a fur coat would have been the ultimate bear necessity.

But not for the unfortunate Dolores who has lost all her body hair and has just been left with a few tufts around her head.

Vets have been left baffled by the condition of the bespectacled bear, who lives at a zoo in Leipzig.

Read the full article (with beautiful, large photos) at: DailyMail UK

This is very peculiar. I don’t know much at all about alopecia in animals to even begin to speculate what the cause is, but the article hints to genetic causes and I’m sure the veterinarians there are going to continue to study it.

Hi there,

I have an unusual question! I have noticed mild temple recession over the past 6 months. I am not aware of my hair “falling out” in the shower or anything like that, but rather when I look at photos of myself of late, it is noticable that my temples are more receded. I still have hair in the temple point region, but it is not as thick or prominent as it used to be.

However, something occurred to me today. I have for the past 6-8 months been using a “self-tan” moisturizer, of which the active ingredient is DHA… The areas where I have noticed hairloss (frontal hairline & temples) are the exact areas where my hairline comes into contact with the tanning lotion. The instructions for the self tan state that you should avoid the hairline, as it may cause mild discoloration of the hair, which I have noticed in this area.

After googling DHA and DHT, my initial understanding is that it seems that there may be some correlation between the two? My question therefore is could the DHA in self tan be having an impact on my hair and causing slow but gradual hair loss? And if so, if I stop the self-tan, will the hair likely return in these areas? I look forward to hearing from you. Thanks

I do not know the connection to the tanning solutions and hair loss. If you think that it may be the cause, then stop using the self-tanner and see if your loss subsides. Most tanning lotions like that will advise to not let it touch the hairline, but that is because it could dye your hair.