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doc,
i have used steroids and few years ago in my 20s and started to lose hair for a while. i went to a doctor and he told me take propecia, so i did for 8 months but my sex drive dropped. stopped taking propecia and now in my 30s i feel i need to take steroids to get my testosterone level to go back up. plus i am about to hit the gym again. my question to you is should i take propecia and steroids together so my hair doesnt fall out again? what should i do about low level of testosterone to bring it back up?

I am not your doctor and messing around with the steroids and Propecia is not a place where I wish to go, particularly over the internet. There is no doubt that taking steroids causes hair loss and although Propecia may help a bit, I doubt that it will prevent you from going with your genetic hair loss path.

Hi,

I would firstly like to thankyou for your blog, i have found it extremely helpful. Recently i have noticed elevated hair loss accompanying a receding hairline. I am 20 years of age and therefore a little startled. It currently does not surpass your definition of a ‘mature’ hairline and i am hoping it will arrest soon. However it seems to have occurred very rapidly. In what sort of time scale does the ‘mature’ hairline tend to develop? and does it stop at a similarly prompt fashion?

Thanks very much

The appearance of the mature hairline may occur over a year or two, or it may take up to 10 years to complete. The key for genetic hair loss is to look for miniaturization beyond the confines of the juvenile hairline.

Hi.. 5 years back a lady left the relaxer too long so I had a bad burn and ever since hair started to get thinner & thinner. I ended up with a bald area on top of my head. its pretty big in size. around 2 inches wide & 1.5 inches deep. Do you think my hair would never grow again in that area? are there any products that you suggest I use to help me fix this mess?

Its very unlikely that you would see hair growing back again at this stage. It sounds like the chemical treatment may have caused scarring to that area of the scalp or burned the hair follicles resulting in permanent hair loss. This could be confirmed with a scalp biopsy.

On the assumption that you have a good supply of donor hair at the back and sides, hair transplant surgery could restore hair to a reasonable result. Another option is a reduction or excision of the hairless scarred area. This excision might be likely to need scalp expansion in your case if the area is very large.

Without further information, I cannot recommend any products that would restore significant hair in your case. However, you can try temporary camouflage type products like Toppik that can disguise the loss when the need arises. The picture on the right shows a badly damaged hair with the fibrils inside the hair shaft broken out like the spindles inside electric wires.

Hello, I was wondering if you could help me understand a little bit about what Im going thru. At the current moment, The only thing I know is that I have hyperthyroidism. I dont know whats causing it yet, but soon I will find out. It could very well be Graves Disease. Well, because I have this its making my hair real thin and fall out. I was wondering if propecia could help me keep my hair? Is it safe while having a thyroid problem? Also would I have to go to a dermatologist to find out if my hair is falling out for another reason besides my Thyroid or what kind of Doc should I seek? Do you know of any Docs in the Houston area that you would highly recommend I should go see. Perhaps one that has knowledge of propecia/proscar? Thank you so much for any help/advice you could give me. Oh yea Im 29 years old if that makes any difference. Less than a year ago I swear it seemed like I was in perfect health hair or not. Now…well. Sorry this was so long. Thanks again.

Thyroid problems can cause hair loss and hair texture changes (as well as many other medical problems). You need to see your doctor and ask him/her these questions. Thyroid might be the cause of your hair loss, or it could be something else entirely. I cannot give you medical advice this way… not because I do not want to help, but because I have not examined you and taken a good medical history with you. I do not even know if you are a male or female! If you are female you should not be taking Propecia, but with Graves’ disease, I would not expect Propecia to work regardless if you are male or female.

I don’t have any physician recommendations in the Houston area, but About.com has some tips here. For more on hyperthyroidism, see thyroid-info.com.

Hello. I’ve had trichotillomania for about 6 years now. I’ve pulled non-stop because it is REALLY hard to quit, but I haven’t pulled any hair out in a week now. I have a large bald spot on the top of my skull and there are several others scattered elsewhere. I am seventeen years-old. I can’t even go to the hair dresser’s to get my hair done because I’m so ashamed and I always worry someone might say something. I’ve adopted the name ‘bald spots’. I was wondering if my hair was going to grow back if I let it and if not, if there were any options available for me. Thank you.

If the hair loss has been there for around 6 years, I doubt that the hair will come back. First, you must get control of the pulling (not just for a week) and you may seek help from your doctor for medications that will help you through this. Once you have gone a year or more with no further hair plucking, then you might consider hair transplantation, assuming that your donor supply is adequate. But if you should start pulling again, then any transplanted hair can be lost by the exact same mechanism.

There’s a great reference site you should visit to read more — Trichotillomania Learning Center.

Dear Dr. Rassman,

Just a quick note. I’ve been an avid reader of your site for some time now, so, firstly, I’d like to congratulate you on your blog, to thank you for taking the subject of male pattern baldness so seriously and for answering the questions readers have posed over the years so professionally.

I’m 30 years old, I’ve been taking Propecia for 16 months now and while my hairline has continued to mature (which can only be expected), I have found that with the help of Propecia my hair loss has stabilised. However, one side effect that I wasn’t expecting is the thinning of my arm hair! Can I take this as proof that Propecia is indeed blocking DHT (and therefore working)!?

Many thanks in advance

Yes, loss of body hair is a known rare side effect with finasteride. Hair on various parts of the body does seem to be dependent upon the presence of DHT (more in some individuals than others). I wish it had that impact on my body hair also.

I’d say that if your hair loss stabilized that the Propecia is indeed working.

Doctor Rassman,

I have used minioxil and got ear infection, so I have stopped using it. Presently, I am only taking finasteride for the last 1 year and my hair loss has stopped. I was thinking of hair growth so could you please suggest any alternative to minioxil. Also, I have contacted a surgeon for hair transplant and he thinks that I do not need it right now as I have sufficient hairs. Please suggest.

I have reported on an association between ear infections and minoxidil in the past — see here. The use of Propecia alone may be enough without minoxidil (I am assuming that you did not use minoxidil very long). With regard to a hair transplant, I would need to see you to determine your candidacy.

Can a hair dx test point out causes for balding in DUPA diffuse unpatterned alopecia patients?

I don’t believe that the HairDX genetic tests can explain the causes for DUPA.

Thank you very much for answering our questions and for having this site. Thank you Dr. Farjo for joining. These questions are for Dr. Farjo re: hair multiplication/intercytex study:

1. Is Intercytex going to phase 3 trials with the procedure they currently have?
2. Is the current product marketable given the current results, if it does go into phase 3? (It sounds like it is not, but that it created an enterance into another idea that may be marketable)
3. How long do you think it will be before a marketable product exists?
4. You mention that further studies are planned. When do you think this new Photo-hair technology will be tested on humans?
5. Will Intercytex be doing these studies? It sounds like they are waiting for someone else to buy them out. If not Intercytex, who will be doing these studies?
6. Intercytex has mentioned they have given Bosley the option of purchasing them or parterning. Bosley has their own theory on how to make this work, so why would Bosley buy them? (Speculating of course)
7. Who else besides Intercytex and Bosley/Aderans seems to be doing hair multiplication testing/research?

Thank you for any or all all answers to the above questions.

The following response is by UK-based physician Dr. Bessam Farjo:

Response by: Dr Bessam Farjo United Kingdom

1. A decision has not been made yet on timing. One reason is that we are still waiting on the analysis of the global photos concerning the larger of the injected areas. A second reason is the more promising finding of growing hairs out of the multiplied cells in the lab in the mouse, which will hopefully lead to a new clinical trial. Finally there are financial restrictions at the moment due to the global economic situation that is affecting most biotech companies.
2. See Q1. A product goes into market only after successful phase III.
3. Due to all what I mentioned it would be foolish of me to predict that with any accuracy.
4. A clinical trial should take place once the lab studies on human hair produce results reliably and predictably. We’re not at that point yet.
5. No, that is not the case. They said they are looking for funding from outside the company for this project. Given the funds, Intercytex will continue with these studies.
6. Bosley has an option to market Intercytex’s product should they succeed ahead of Bosley (or more accurately Aderans). I take this opportunity to confirm that I am neither a director nor a shareholder with Intercytex plc.
7. I am not aware of anyone else.

You’re very welcome.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

Hello Dr,

Thanks for providing all the information you are providing to hair loss sufferers. I have a question. I had a Transplant a 7 weeks ago(Strip method) on my crown area. I was on (and still on) Finasteride prior to my Transplant. Lately I lost my native hair and I am seeing that I have less hair on my top now compared to hair that I had before the transplant. I learnt that this is because of the shock loss. But I was on finasteride before the HT. So, do you think this is temporary and can expect m native hair back. If so how much time does it take?

I try to educate my patients and readers everyday… and this must be one of the top ten things I want the public to understand.

Taking Propecia (finasteride) does not protect you 100% from experiencing shock loss — it only lowers the risk. If you have shock loss, there’s not much you can do (actually, nothing you can do)… and if it is in miniaturized hairs, it may very well be permanent! Statistics do not matter to those who have shock loss even while on Propecia. This is one of the risks of a hair transplant and you must always balance the benefits of surgery with the risks of surgery.