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Hi

What’s your opinion on the new Xandrox15 Plus product which includes 0.01% finasteride?

Does finasteride work as part of a topical solution? Does it still carry the same risks ie erectile dysfunction, male breast etc…

Thanks

I have reviewed the product’s website. Xandrox15 Plus seems to have two known active ingredients:

• minoxidil, which is known to be absorbed through the skin
• finasteride, which is not known to be absorbed through the skin at the very low dose they utilize

They say it contains, “15% minoxidil, 5% azelaic acid and 0.1% finasteride by weight. Xandrox15-PLUS is available in 125mL bottles. Each mL of Xandrox15-PLUS contains 150mg of minoxidil, 50mg of azelaic acid and 1mg finasteride.”

You would have to take the word of the seller here, something that I generally do not like to do as we do not like becoming a third party endorsement. The seller does warn about sexual side effects of this product and worse, the finasteride is a controlled drug that requires a doctor’s prescription. So it seems that the company has violated some FDA issues including labeling, safety, and effectiveness proofs, and the ability to sell this over the counter. Even if the seller is a doctor, I believe that does not allow the seller to make unsubstantiated medical claims on safety and effectiveness, particularly with regard to the topical Propecia.

I am a 21 year old suffering with MPB. Even though I have not been mapped out for miniaturization,I know I am a NW2 and what made me realize I MPB was the back of my crown felt thinner. My question is this.

Can Telogen Effluvium occur along with Male Pattern Baldness? The reason I ask is the fall of 2007 I lead an extremely stressful nine months of school combining with that I did crash diet where I ate healthy but I did not eat enough, I was technically starving myself. From 2004 to 2008 I wore my hair to my shoulders and when I cut it off this past April I noticed how thin my hair specifically my front and back had become.

Did TE set in along with MPB or did my stressful life speed up my MPB?

Thank you also for this website, it is very informative.

Yes, telogen effluvium (TE) and genetic hair loss can co-exist. Your history of weight loss and stress can cause TE, but with this in your past and the stress and starvation corrected, the hair should come back to normal within a year or so. The risks here are that your stress and poor diet could also have kicked in the genetic hair loss, but a good miniaturization study should show that if this is the case. Also, if you do a hair pull test this will show TE if you have it.

I’m borrowing the following paragraph of text about the hair pull test from DermNet NZ:

“Hair loss associated with excessive shedding results in a positive ‘gentle hair pull’ test. Grasp a lock of hairs to determine if any can be extracted with firm pull. Normally 0-2 telogen hairs can be extracted: these are hairs in the resting phase, identified using magnification by a rounded bulb at the proximal end. An elongated or tapered end indicates anagen hair (growing phase); anagen hairs extracted by the gentle hair pull test are pathologic.”

Dear Dr. Rassman,

First, thank you for your great site which is daily helping thousands of hair loss sufferers.

I am a 21 year old male. I suffered from trichotillomania in my teens for 6 years. Now I am 2 years pull free and had full regrowth. But there is something else I am worried about and would appreciate your valuable opinion. I have read that hair repeats its cycle only a determined number of times. So even if hair regrows, it will one day fall out before other hair that has not been affected because their number of cycles was reduced from plucking? Is something like this possible to happen?

Thank you for your time and consideration

That is an interesting question. I would doubt that you will have hit your cycle limit, but there is no way to tell that I know of. The general experience of those with trichotillomania is that once the pulling stops, if the hairs are not lost permanently, they will return to normal (and by normal, I mean the number of cycles that will be found in the surrounding hair). With that said, I do not believe that anyone can tell how many cycles are left in the hair that was victimized by the traction alopecia. Sorry, I am just a mortal doctor with limits in my knowledge!

I been on Propecia for 11 days now and since like day 5 I had constipation and lack of bowel movement. I couldn’t find any info that Propecia causes this. I also take Zegerid 40mg 2x daily and Carafate Liquid 2x daiy but I been takin those for like almost 2 years for my severe throat acid reflux. But I never had a prob with those. Also within this time I had no food or lifestyle changes the constipation was just sudden.

Could it be that Propecia is kinda interacting with those meds? But my doc said Propecia doesn’t interact with anything especially my meds.

Propecia (finasteride) is not known to cause constipation. It is unlikely that Propecia when taken with your other medications is causing you to be constipated, however, all medications have the possibility of interacting with one another. You need to discuss with your doctor other varied yet potentially treatable causes of constipation such as hypothyroidism, dehydration, depression, etc. Perhaps you need more fiber in your diet?

My husband was smacked by a 2×4 on top of his head and left him with a bald spot, about 2 years ago now. Wondering if there is anything he can try to regrow hair in that spot. (Hes in his 20s)

Thank you.

Did your husband have sutures or staples placed to fix a laceration/cut over the area in question? Often times, areas of sutured/repaired hair can cause strangulation of the surrounding hairs, leading to a bald spot. Although there is no specific hair regrowth treatment for this type of loss, hair follicles can be transplanted into the area in question with good results.

I know you aren’t a fan of body hair transplantation because of the different growth cycles it has compared to the hair on your head and just a general difference in the type of hair but do you think it would work when used in a donor scar from a hair transplantation? I just figure it would work pretty well when you’re just trying to cover up a smaller area like that and aren’t as concerned how the hair looks just so long as it covers.

I would agree with you on this, although Body hair Transplanation in general is not ideal for Hair Restoration surgery, it would probably work ok to give some coverage in a Donor Scar.

It may work, but as the body hair is not as thick as regular scalp hair, the coverage per hair shaft will be less than that of scalp hair. Do you have enough hair for FUE from the scalp which may be better? A stronger hair can be found in the pubic and beard areas and both of these areas can be used as donor hair sources as well.

I just renewed my persciption of propecia for anther 3 months, but my dermatologist has added clobex spray for the burning and itching that I am experiencing in the areas that I am thinning. The only odd part is, during his exam he seas nothing like flakes, excess oil, or irritation. I would just like your opinion on the clobex and or your experience with it. Thanks for all that you do, and it was cool seeing you on John and Kate plus 8…

Clobex is a strong topical steroid and I generally save prescribing that drug until I try something more mild if it is for treating eczema. Ask your doctor what he is treating you for.

In your post here you say: “This is your worst case scenario. I have had 3 such cases over my years in practice.”

Can you clarify what you mean here? Are you recommending not getting cosmetic surgery if the disease is under control? Or, are you just saying that as a general warning of what could happen if one did get cosmetic surgery? Have you only had 3 cases of this disease to treat with a hair transplant?

My areas are I guess you could say small, but they feel like they are the size of a baseball on my head. Right now, only one area is really noticeable. How long should one wait, to consider the disease under control to have any type of cosmetic surgery? I have not had any activity in a few months now. Three doctors have recommended that because my areas are “small” a doctor may be able to just remove the scared area and fuse my scalp together. Is this a viable option?

If the areas are smaller, what are the typical prices for hair transplant?

The medical field is not clear about the cause of folliculitis decalvans. It is thought to be an autoimmune disease that presents like an infection of the hair follicles, but it does not respond to traditional treatment. The disease can be aggressive and destroy many hair follicles and badly scar the scalp. Hair transplants into this area may likely fail and may reactivate the disease (bad news when this happens). I always want to know if the benefits will significantly outweigh the risks.

The decision to have another surgery within less than a year from a previous episode may not be a good decision, but you and your doctor are in the best place to make that determination. I haven’t treated you, and I couldn’t make any recommendation without examining you at the very least. Our fees are listed here.

Hi, I have some questions about Propecia. First, after about nine months and a very disappointing 1 month bout with Hair Club (which I think did more harm than good), my hair loss seems to have stabilized. Currently, I’m somwewhere between a Norwood 2 and 3 and there is actually a little bit of regrowth around the temples of all places.

Here are my main questions:

1. I seem to have inherited my baldness gene from my maternal grandfather, who went totally bald. I’m 26, so, if Propecia has currently stopped the process and there are reports of patients keeping what they have up to 10 years, is it possible that my ultimate hair loss destiny may be signifcantly postponed?
2. I read on one message here that “even though you inherit the baldness gene it can be expressed differently.” Does this mean it is possible for you to get a slightly diffeent pattern than the person you inherited it from. My hair loss seems more like that of my maternal grandfather but not exactly.

I know without a personal meeting you can’t answer 100%, but I just wondered if these things are a possibility.

You’re right — a personal one-on-one examination of your scalp is best, but I’ll try to answer your questions as best as I can:

1. I do not believe genetic hair loss (androgenic alopecia) can be completely stopped with drugs. Propecia (finasteride 1mg) is a great medication, but it may not stop the process completely… and it almost certainly will slow it down. Results are variable for each patient as everybody has a different “destiny”.
2. Just because your maternal grandfather was completely bald does not mean you will be completely bald, even if you inherit his genes, because the expression differs. Also, there is more than one gene for balding and if you inherit one, it does not mean that the rest follow. Again, everybody is different.

Hi Doctor,
I had a look at thread Ultra-Refined Follicular Unit Transplantation (FUT)?

I could not understand completely if Ultra Refined Follicular Unit Hair Transplantation (URFUHT) and Follicular Unit Hair Transplantation (FUHT) were same if additional care was taken while performing FUHT. My doctor mentioned that both are same and he suggests a 2 sitting complete transplant using FUHT. He also said that people would be happy with a single sitting. Is this multiple sitting (2 sittings) required for URFUHT also?

These are just different names for the same thing. The people who defined the term “URFUHT” have a marketing agenda which is supposed to say that this is the best form of follicular unit transplant (FUT). If you do FUT correctly (as defined in our published articles from over a dozen years ago), then a classy job is a classy job by any name you give it. Any good doctor should try to get your surgery completed in one session if it is possible.

Here’s a short list of some of the earlier FUT articles:

• Follicular Unit Transplantation - 1995
• Follicular Unit Transplantation Megasessions - 1995
• Follicular Transplantation: Patient Evaluation and Surgical Planning - 1997