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hi doctor Rassman. Is it true that propecia can cause weight gain due to its antiandrogentic properties? I heard that androgens like testosterone and DHT promotes fat loss in the body. Also, would taking propecia affect the heart at all? I read on propecia forums of users reporting heart synptoms after using the drug. Some reported a “dipping” feeling of the heart. I really wanna try the drug but now im highly discouraged by these negative claims.

Not everything you read on the Internet is always true. There may be a great wealth of information available, but I wouldn’t rely on the Internet for your source of medical diagnosis and treatment. A doctor will know better than some anonymous guy on a forum that has no liability or reputation (not to mention experience or even a real name). You need to see a good doctor and ask him/her if you have genetic balding… and if you do, talk to them about taking Propecia. I have not heard of such weight gain side effects from the patients I treat and side effects are rare in general with Propecia.

Keep in mind that all medications can have side effects. Have you ever taken Tylenol or Advil? Do a search for the side effects of those medications and you will likely lose more hair over it (pun intended). For example, Advil side effects include rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn (see full list).

My dad isn’t bald nor are his brothers or father. But my mom’s dad is bald but some of his sons aren’t. Could you tell me how likely i am to be bald?

It’s not that easy to tell. Balding can be passed down from either side of the family and can skip generations. There is some new science for genetic testing to let you know if you are carrying the gene for balding. If you test positive, then you could bald, but if you test negative, you will not undergo patterned genetic balding. Even if you carry the gene, it may not mean that you will express the gene and have balding. So the answer is that a negative test will let you know if you inherited the good genes from your family.

I could really use some advice. I am 28 years old and started to notice my temples recedding about 1 1/2 years ago. I started using rogaine but after about 3 months I stated shedding alot of hair. I went to see a dermatologist and they did a hair pull test and told me that it was MPH and that I should use propecia. Once i started using propecia I started shedding alot of hair but I have stuck with it because I read that shedding occurs on these medications put generally the lost hair returns. Well after a year and half I lost alot of hair and none of the shedded hair has returned. I went from a NW 1 or 2 to a NW Va in a year and a half.

So I am thinking about see my physician again and I was wondering if there are any tests that I should have them do to help with my hair loss problem. If you know of any good hair loss doctors in the Seattle area I would appreciate any recommendations. I also may be traveling to the L.A. area next week for work and was wondering If you would be willing to meet with me.

I have to take your word on what you had when you first noticed the hair loss process. Usually, a 28 year old man does not ‘fast-track’ hair loss, especially when taking Propecia. I am humbled by the few people who show very rapid hair loss while using finasteride (Propecia) and find this phenomenon very, very rare. One of the genetic tests may show what you can expect from Propecia, so it might be worthwhile getting the test (see here), but it will not reverse the hair loss that you experienced. Of course, I would be pleased to meet with you, but it does sounds like you have genetic hair loss that has been fast-tracking its course. I don’t have any recommendations in Seattle at this time.

What do you think about the website www.nanogen.co.uk and it’s various products? There’s some pretty big claims on the site about effectiveness of their products, what do you think of them? Are any of them any good or are they all just lies?

To be honest, I’m not familiar with them by name. They make a few products, but their Nanothik sounds like DermMatch or Toppik… and their Nanogaine is being marketed as an alternative to Rogaine. The line of products may be of good quality, but they shouldn’t be claiming that it’ll regrow lost hair or preventing hair loss. In the United States, the FDA regulates claims like that, so if a shampoo or cream were to be labeled as a preventative measure for hair loss (for example) the FDA can shut the company down if they do not pull all mention of outlandish claims. This company is UK based though, so I’m not sure how it is regulated.

Hi,

I have a problem of severe flaking, scabs, and an itching scalp. I am a picker so i often pick off the scabs, thinking that the dandruff will go away. Now I have a bald spot where I’ve been constantly scratching my head. It also seems I have hair loss in other areas as well. I’ve also moved from Canada, US to Jamaica. I am also under a lot of stress.

THe last time I was under severe stress and I had relaxed my hair and put a weave in I had extreme hair loss and extreme large flakes. Although my hair has grown back and my dandruff was under control and almost gone, I have had permanent hair loss around my hair line. I used to have braids in my hair for 7 years..so i think it was from that. That hair loss incident happened when i was 19. Since then I have worn my hair natural without any processing. I am 25 now. I am concerned.

The bald spot at the back center of my head - is it permanent? HOw can I stop scabs? how can I stop dandruff? If it is a stress trigger from high cortisone levels in my body what can I do to normalize this? Is it my diet, exercise? Please help? What can I do to restore hair loss?

Picking skin flakes is an OCD-like condition called dermatillomania (for pulling hair it is called trichotillomania). This picking produces traction alopecia, so there is little doubt that this is what is happening to you. If you stop picking and the hair returns, then you’re lucky… but if you continue to pick at it, the hair loss you are experiencing may become permanent. Braids can also cause traction alopecia. The solution may be simply get rid of the braids and stop picking (that might be easier said than done, though).

Will wearing a hat all day, (approx. 11 hours) every other day create thinning of the hair? Always have been curious. I wear hats…at least 3-4 times a week, all day. Wondering if the tight cap is bad for the head? Hmmmm. Thanks so much!

You do a fabulous job!

We have answered this many times and it is outlined as well as one of the many myths in our Hair Loss and Replacement for Dummies book.

The answer is NO. A hat doesn’t cause hair loss.

In all of the studies trying to determine whether natural supplements like saw palmetto or green tea block DHT, they never refer to Type I DHT or Type II DHT — just DHT. Why is this? Good question, huh?

Good question. Propecia (finasteride 1mg) blocks mainly DHT type II, and Avodart (dutasteride) blocks both DHT type I & II. You would think if you block ALL the DHT it would be better against androgenic alopecia. Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. There are clinical observations that suggest that dutasteride is better than finasteride, but it is not approved for hair loss by the FDA and the long term safety on human reproduction for dutasteride (reports of sterility is a complication) have been suggested in some rare patients. We have received many reports by varying doctors who switch people from finasteride to dutasteride and get a better response. The next logical question should be: If we increase the finasteride dose to 5 mg or so, will it be better to treat hair loss? I don’t know if anyone really knows that answer for sure. Some of the original studies on finasteride suggested that the 1mg dose is the most universal dose, but it may be that a high dose in those who are refractory to finasteride may help. Some doctors are using a higher dose of finasteride on long term users. It’s a prescription drug, so I’m not suggesting you should take a higher dosage. The problems for either finasteride and dutasteride is that side effects rise when increasing dosages.

To get back to your question though — it’s been proven that type II is linked to male pattern baldness, but type I hasn’t been linked yet (though it’s possibly just not been proven yet). I couldn’t tell you why the studies out there don’t provide a breakdown by type, but I have not found scientific evidence that saw palmetto or even green tea actually block DHT anyway. And even if it did block some DHT, there is nothing in the literature that shows saw palmetto or green tea being effective for treating androgenic alopecia. I don’t mean to be a pessimist, but even Propecia does not completely stop androgenic alopecia.

The real quest should be finding other (non- DHT related) mechanism for androgenic alopecia. DHT is not the only solution out there… we just haven’t discovered the other yet.

Dr. Rassman,

Thank you for answering my last question. I have one more for you, if you do not mind.

I mapped my own scalp for miniaturization per your instructions, and found it a very useful tutorial, though I took a nod from a recent entry and snipped a few bits of hair from my head instead. I compared 5 locks of hair from all around my head (temples, forehead, crown, donor area) using my donor area as a control, and to be perfectly honest I could not see a difference in the hair shaft width between any of the samples. Unfortunately I do not have equipment to give hard numbers, but my hair does not seem any less pigmented or thinner in any of the areas compared to my donor zone. I examined it under a magnifying glass, but have access to a microscope if that is insufficient.

I’ve also visited a dermatologist. He did not have the equipment to map my scalp but he said I was a NW2 and was fine.

That said, how often do you suggest this process be repeated? Every three months? Six months? Yearly? Is there a certain age after which you can just stop as there is unlikely to be further progression?

I am 26 with no known male-pattern baldness in my family; both grandparents died with Norwood 2 patterns, and none of my uncles have any hints of balding.

Thanks!

I am assuming that the mapping showed no significant miniaturization. If that is the case, once a year mapping or more frequent mapping may have value if you think that the problem may be appearing or getting worse. The mapping exercise is best when comparing:

1. The hair in the back of the scalp (donor area) with hair elsewhere on your head, or
2. Hair within various local areas with hair-by-hair comparisons where the miniaturization shows up well

As for age, some men will lose hair in their teens, some in their 20s and 30s… it can even happen in the 40s and beyond (though it’s less likely). You might be one of the lucky ones and not have any hair loss problems, but I really have no way to tell at this point (and without at least an exam).

I began losing hair in the back of my scalp towards my neck when i was 18. My parents took me to a dermatologist and i received 2 rounds of shots. The balding subsided about 6 months after than and i almost even got all my hair back. I am now 24 and about two years ago i began loosing hair around my ear on the right side. Now i have a fist sized bald spot ( which until recently i was very good at concealing). I am also balding on the other side of my head. The sides of my scalp itch badly and i cant help but to run my hands though it because its all i can think about. This makes me very self conscious. I have an extremely busy work week and meet with customers constantly. I feel that in my industry image is everything and being so young it makes it that much more important. This disease is starting to effect every aspect of my life and i need a solution. Please tell me where i can go ( preferably in houston ) to get treatment by someone who will not waste my time and my money.

Thank You

You certainly need a diagnosis, but I do not know who you can see. Either check the physician search at ISHRS or you can consider sending me a set of photos from many angles so I can get an appreciation of what your problem is (email address is on the Contact page. The thing is, this is a most unusual problem and I’m not sure just randomly picking a local Houston doctor, even on the ISHRS site, will be the greatest solution. It’s worth a shot if you’re low on options. If you send photos and I’m still stumped, I can send them to other experts in the field (I’ll block out your face in the images).

Hi dr. rassman, thanks for the great blog

I have extensive shockloss around the scar from a recent strip hair surgery.

Do you think minoxidil would be good to help reverse the problem, and help the shocked hair to “fully” come back around the scar?

Loss of hair from around the scar is often the result of a surgical closure which was too tight. Sometimes the hair returns on its own and sometimes it simply doesn’t. Minoxidil won’t hurt, but probably will not help.

This has the potential to cause a very wide scar. Speak with your transplant surgeon about this problem and ask him/her if the closure was tight.