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Snippet from the article:

If you thought vitamin D’s main role was preventing rickets and strengthening bone, think again. Many researchers now believe that the “sunshine vitamin” may one day play a key role in preventing the growth of prostate cancer, and in killing rogue prostate cancer cells that have escaped into the body. The data are quite suggestive and vitamin D is a most promising area for prostate cancer research.

Read the full article at John Hopkins Health Alerts

It’s not hair loss news, but important health news nonetheless. There’s been debates about this for years, with some saying it provides no decreased risk (see CBS News) and others saying the opposite (see ScienceDaily), but the latest link above is the most current that I found.

If saw palmetto works for hair loss, would it work better topically rubbed into the scalp? I read an article online that mentioned that and said it might be more effective that way.

I have no idea if saw palmetto even works when taken orally to treat hair loss, as there is much controversy on this. Going through the skin is even less scientific and so really, your guess is as good as mine. In fact, I’m probably the wrong person to ask about this. Perhaps an herbal specialist would be able to tackle it better, though even then, take that advice with a grain of salt.

Hi there Doctor Rassman, I’ve got a question for you about graft safety/anchoring. It has been roughly 13 days (12 days, 14 hours) since my procedure - I had a temporal/hairline restoration of about 2200 grafts.

My question is simple, at 12-13 days post-op is there any single circumstance that can dislodge a graft? My crusts started flaking off about 9 days post-op. I have been washing using the fingertips to gently massage and soak the crusts, and they seem to be flaking off no problem. Sometimes throughout the day, i will gently massage the scabs with my fingertips (without washing my hair, just dry) and the crusts will continue to flake off. I am noticing hairs in many of the scabs, but I know this is normal.

However, I noticed a few particularly persistent scabs. I did not peel or pull on the scab, but rubbed it much more vigorously with my finger tips until it came off, however, I noticed a slight bit of bleeding in the area where the scab was.

I have two questions.
1) If you do not see any bleeding, but see a hair/bulb in your crusts as they flake off, is it 100% certain that the growth center has not been dislodged?
2) If you DO see bleeding, is that generally a guarantee that the growth center has been dislodged with the scab?

There are no 100% guarantees, but it is probable if there is no crusting and you did not pull out the graft (and it shed on its own), a hair with a bulb after 12 days will leave behind the growth center. See the medical paper I co-authored, Graft Anchoring in Hair Transplantation (PDF file).

Bleeding should not change what I said above, but why are you bleeding 12 days after a surgery?

I have been experiencing some thinning of my hair in the top. My dermatologist suggested that I use Rogaine. I relax my hair and wanted to know if it is safe to use the rogaine while continuing to have my hair relaxed.

Yes, relaxing your hair and using Rogaine (minoxidil) is fine.

I just have a quick question,

I know that both you, and Dr. Pak have used, respectively, several of the treatment options that you recommend. Why don’t you use before and after pictures of yourselves to disarm the pessimists, while at the same time making a very compelling case as to why you feel so strongly that finasteride is the strongest treatment option available at this time?

The only oral medication that has been FDA approved for treating genetic balding in men (androgenic alopecia) is Propecia. So as the default, I guess it is the “strongest” medical treatment option at this time. This does not mean it will reverse or cure balding. In fact there is no cure! We are physicians. We prescribe medications based on scientific evidence as well as clinical evidence we see day to day. In the end the consumer (the patient) has the choice to take this medication, but he should consult with the prescribing doctor instead of strictly reading Internet postings that may (or may not) be true!

As you mentioned both Dr. Pak and I have personally taken Propecia daily (as well as our family members and friends) without any of side effects. Neither of us has seen dramatic hair growth, but we haven’t seen dramatic hair loss either. In the end, you are looking at the after pictures (on the right). Ultimately though, we cannot satisfy everyone. If you think something bad will happen, then it just may. The power of suggestion can be quite powerful. If you think the medication will not work, then its your choice to simply not take it. We’re talking about hair loss here, and as important as hair is to many men, it isn’t a death sentence if left untreated. We’re educating and informing about a proven treatment and I’ll leave disarming pessimists up to the drug manufacturers.

Hi Dr Rassman,
I’m 29 yrs old and have been on propecia since 1st Aug 08, so its just coming to 7.5 months now. My hair growth has gone from strength to strength since then, mainly on the top and cranium of my scalp where the hair was thinning. However i’m suffering from sexual side effects mainly erectile dysfunction (ED) and a libido drop. I got them in the 3rd month but i thought I had to give it a fair period of time to see whether it was a passing phase. But the problem has persisted and the volume of semen has gone down and my erections are not as full as before I started taking it. I have decided to half the dosage. What is the best way to incorporate this? Shall i stop taking propecia for say 3 weeks or perhaps longer or shorter and then start taking half a pill on a daily basis instead?

Also, I never tried minoxidil but I have read people complaining about dark circles and skin roughness on the face as permanent side effects. And apparently the results are nowhere near as good as propecia? Is this true? Also, does it also cause ED & drop in sex drive? If i do decide to go on Minoxidil would you recommend the 5% solution or the 2% solution?

If you have just erectile dysfunction (ED), Viagra might help. If you can not solve your libido problem with Viagra, you may have to stop the Propecia. Cutting the dose in half often helps and even 1/4 of the dose might help further. You should discuss this with your prescribing doctor.

Rogaine is not a DHT blocker and as such, stopping your Propecia will cause a significant hair shed even if you take Rogaine at the same time. Rogaine does not have the sexual side effects you are experiencing with Propecia, but it also doesn’t work to halt the hair loss (though it can grow hair). You can start with the 2% and go up to 5%, but it’s up to you. Both are available over the counter (at least here in the U.S.).

Dear Dr. Rassman,

Article at hairlosstalk.com includes the following statement of “Spironolactone effectively prevents DHT from attaching to the receptor sites on the hair follicles. As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body.”

1. Is it sufficient just to block scalp DHT levels, or serum DHT reduction also necessary to combat MPB? If scalp DHT inhibition is sufficient for MPB, is serum DHT inhibition dangerous for the body as claimed by this doctor?

2. You’ve told in one of your comments that propecia is a anti-androgen, but the prospectus states that it does not have an anti-androgenic effect. Could you please clarify?

3. It’s mentioned that Androcur is the best against MPB. Is this the case?

Your reply will be much appreciated.

Finasteride needs to go through the blood stream to get to the hair follicles. When it gets to the hair follicle it then fixes to the tissue and blocks the DHT. Finasteride is not dangerous to the scalp.

Finasteride blocks DHT and when it does this, the testosterone levels often rise. If the body would not produce testosterone in response to a DHT block, then one would say it is anti-androgenic, but it is foolish talk like that because testosterone needs to be present to have DHT made by the body (DHT being a byproduct of testosterone).

Drugs like Androcur are good blockers of androgens and can produce major side effects on the male sex drive, something I would not recommend for patients with male patterned genetic balding.

I’m a relatively healthy 63 year old woman. My hair began thinning at the frontal hairline about five years ago. Recently, to my horror, I noticed that bald strips about two inches high and three inches long have appeared above each ear. This loss appears to have occurred in the past three or four months. Can you advise me of what might be the cause?

This is where pictures would help, as well as mapping out your hair for miniaturization. What you are describing is clearly not normal. To make a diagnosis of forms of alopecia, I need my eyes to look for patterns and science to tell me about the health of your other hair. With that knowledge I may be able to answer your question, but without it there’s not much I can offer.

I am 24 y.o. male and i’ve been losing hair since i was 19/20. My father (52 y.o.) and uncle (46 y.o.) are NW 4A and i think i am balding the same pattern. I’ve seen many results where people with NW 4A achieved almost complete coverage with 4000 grafts. Is miniaturization going to show if i will be in my 50’s like my father so that i can start thinking for a HT? I think I’m too young to go for a HT and end NW6.

Mapping out the scalp for miniaturization can be used to forecast balding patterns, particularly if your eye is telling you that you are losing hair. For a Norwood Class 4A pattern, 2500-4000 grafts can do a good job depending upon the thickness of your hair. Finer hair takes more grafts than coarser hair.

Hey doctor,

I thought i’d share this article with you: ScienceDaily.

It seems the article is suggesting that mice lacking a certain enzyme, produce an excess of RA which caused alopecia in the mice. A quick search of retinol and retinoic acid on the internet provide many sites linking this to hair loss treatment products. I haven’t had time to actually look at the paper itself but the article seems to suggest that in some individuals (those lacking the enzyme), RA can either accelerate or initiate alopecia. I have read posts you made earlier in regards to RA and minoxidil being paired together suggesting that the former likely did not improve the effectiveness of the later, but this study seems to go further in suggesting that RA could even be detrimental. Furthermore, as RA comes from vitamin A, those individuals that lack the enzyme might benefit from decreasing their daily intake of Vitamin A. Obviously this all conjecture, but i thought it was a pretty curious article. Do you have any thoughts on it?

Thanks so much.

I have posted your email and the link to the article at ScienceDaily for the interest of our readers. Thanks for sending it. I have no opinion on it yet as this is all new to me, but as I have time to research it more I’ll be sure to write about it on the BaldingBlog.