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Dear Dr. Rassman:
I have a question about finasteride as a topical solution. There is much speculation that topical usage of finasteride is as effective as oral administration. I even heard that some chemists are grinding finasteride and dutasteride into some vehicle like alcohol and apply it topically. There is also a company (www.hairgrowthmd.com) selling combined minoxidil and finasteride as a spray product and claiming the success with no side effects. Considering the fact that finasteride has large molecule size ( C23H36N2O2 with a molecular weight of 372.549), it is hard to predict that the topical form is to have any effect on the hair follicles (they have to penetrate the epidermis and enter the capillaries in the dermis and subcutaneous layer). As far as I know, FDA has approved only oral administration for 1mg a day for male patterned hair loss.

Do you have any opinion or suggestion regarding to use finasteride in a topical form?

P.S. There is also one publication on this: “Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol 2009;75:47-51″

thanks

I would like to believe that the problem is solved with topical finasteride, but I need a good solid peer reviewed article to make these claims credible. The study you mentioned does conclude with, “Finally, we suggest replication study of more samples, with longer period and assessment of patients’ satisfaction after treatment.” — and I agree that it needs more work done before one could reasonably conclude that a topical finasteride is as good as the oral treatment. The problem I see is that if it is not effective and you take the topical preparation instead of the oral proven medication, you will lose hair irreversibly the longer you delay treatment.

Hi doc,
I am a 30 year male with seborrheic dermatitis. I have been shedding some hair for the last 3 years. My doc said that I am Norwood scale 2.

I went to a trichologist some days back and she gave me some “so called” FDA approved Saw palmetto capsules. I got some pain in the arm and dizziness after using the capsules. I have now discontinued the medicine. I know Minoxidil is the way to go for me but considering that I have SD, would it aggravate my SD? What other options are good for me?

Thanks again

Saw palmetto is not FDA approved, as it is a supplement. If your trichologist said it was FDA approved, she’s mistaken. It has known effects on reducing hair loss in some men, but it is inconsistent and it will not help seborrhea.

On the other hand, minoxidil will aggravate seborrhoeic dermatitis. Option-wise, Propecia is the only other FDA approved medication for treating hair loss (along with minoxidil), but it is available by prescription only.

Snippet from the article:

Work or personal stress may make you want to pull your hair out, but it’s cellular stress that actually turns it gray, a new study has found.

That’s because DNA is “under constant attack” by damaging agents, such as chemicals, ultraviolet light, and ionizing radiation, according to study lead author Emi Nishimura of Tokyo Medical and Dental University.

A single mammal cell can encounter up to 100,000 events a day that damage DNA, Nishimura added in a statement.

The stem cells within hair follicles responsible for color are the most impacted by this irreparable DNA weathering.

Read the rest at National Geographic — Gray Hair Caused by Stress (Cell Stress, That Is)

Essentially, the stem cells that produce pigment in your hair follicles dry up as you age. The study was done to learn more about aging in general, and the findings could eventually lead to an anti-gray-hair lotion. For now though, stick with hair dye.

How long do you have to be taking Propecia to then quit and see “catch-up” loss? I only took it for 3 months and quit due to sides. My hair loss never really stopped, and I heard it took a year for a real effect. Is that enough time to cause accelerated shedding/loss thru the catch up process as opposed to the regular speed of the balding process? I mean, my “real” pattern three months on should not be that much worse.

I believe you are probably safe, as you have not taken the drug long enough to get the benefit you would lose by stopping it.

Dear sir,

about 3 months ago, my girlfriend (33 years old) was submitted to a surgery in order to remove a benign uterine myoma, treat an inguinal hernia and remove the appendix. Now she is having some hair loss localized at the top of her head where we can see about 3 cm of her scalp (there is no hair loss at the sides or front). she went to a dermatologist and he asked for a blood test to see if she is anaemic (the test is ok, she isn’t anaemic) and says that this situation is temporary due to the surgery, but I’m a little sceptical after what I have read in this blog and in other web sites as well.

Her mother, father and sister don’t have hair loss, but on the other hand a few years ago she started to have a few hairs in her chin.

So my questions are: what kind of tests do you suggest her to do , and is this a case for a dermatologist or an endocrinologist?

thank you

I would start with a primary care doctor who can do some basic tests to rule out anemia and thyroid causes. You said she’s been tested for anemia though and was OK there… but the primary care doctor will then be able to refer your girlfriend to the appropriate specialist if other basic tests are done. In other words, my advice is to start with the primary care doctor and take it one step at a time.

Generally, major surgeries or general anesthesia can sometimes precipitate hair loss (called telogen effluvium) in some men and women, but some of the autoimmune alopecias can be stimulated from the stress of a surgery as well. The hair loss is generally temporary and can take as long as a year to normalize. It is thought that such surgery or general anesthesia is a “triggering” factor in a genetic predisposition to hair loss. If this is the case, you won’t know for a year or so.

Hey Doc,
Thanks so much for reading my message. I’ve been on rogaine + propecia for almost 5 months now and am not sure whether I am seeing results. Rogaine has definitely given me new and very small hairs which is promising, however the balding process still seems to be underway (although that might be my imagination. I hope is stops in any case).

As a result though, I’ve been looking to reinforce my regime. Firstly, do you think this is a good idea? Should I wait a little longer to decide? It is true that most of the hairs that I notice falling out are small, however my hair line seems to be receding still and I can definitely feel thinner hairs behind my hairline (I am in between NW 2 and NW 3 so there is still hope!)

Secondly what would you recommend? I already “Regentresse” which boasts a 3 step regime of an “anti DHT topical serum” as well as a hair follicle stimulator and a shampoo. The other alternative I was thinking about was a laser comb. Do you think one of both of these ideas are good ones? Are regenetresse or lasercombs good supplements to the FDA approved regime? I am 19 years old as of now and am not at all ready to lose my hair!
Thank you!

I’d wait a little longer before you see the Propecia benefits. I don’t think the Lasercomb does anything to help hair loss, and a topical anti-DHT serum doesn’t strike me as something I’d expect to work, but you’re open to try it. I’ve not heard of Regenetresse specifically, but the product’s packaging says “Compare to Nioxin“. As I’ve written before, I don’t see anything in Nioxin that would regrow hair. So if the two are similar, I’d expect Regenetresse to also not regrow hair.

At 19 years old with early loss, you should be having your scalp mapped for miniaturization every 6-12 months so you don’t have to play the guessing game when it comes to being sure about results. You’ll be able to see if the medications are working…

I have been considering a hair transplant for some time now and after having recently moved to Austria, I decided to have a consultation in Vienna. I was told that the procedure, in my case, would require between 800-900 FU’s and that the total cost would be 7,300 euros. As I am new to this and have not had the opportunity to meet with any other clinics, wanted to know if this price is exorbitant or fair and what is the quality of the clinic’s work?

Also, I did not meet with the doctor during my consultation and was told that I would meet the doctor on the day of the procedure shortly before the transplant. Is this normal? I would have felt more comfortable speaking to the doctor during the consultation than a rep/sales person.

Many thanks for taking the time to answer this.

I personally believe that not meeting with a doctor and getting surgical recommendations from a consultant (AKA “salesman”) is just plain wrong! Ask yourself this question — why would you trust a salesman to diagnose you (which only a doctor can do) and accept his recommendation of a treatment plan? That’s ridiculous! Would you have heart surgery that way? If you can’t meet with the doctor before the day of surgery and get his opinion, I’d look elsewhere.

Dear Dr. Rassman,
I started losing my hair after using hair gel at the age of 15 and now i am 19 years old. i lose hair from the top of my head and from the sides, is there anything that i can do to stop the hairloss. also could you tell me please if i could get a hair transplant from the NHS in england for free, because the hair loss has caused me to become very depressed and a hair transplant would solve my depression.

Hair loss is not from hair gel. If your loss started around the time you started using gel, it’s a coincidence. I doubt England’s National Health Service (NHS) would just hand out hair transplants because you wanted one. Genetic hair loss is found in roughly 50% of all men, so your case is not unusual. To halt the hair loss, you should talk with your doctor about the genetic process and a prescription for Propecia if your doctor believes it is genetic in origin.

I am a 62 yr. old woman who has been using Minoxydil for about 15 years since I had always had very thin hair and its usage really helped prevent fallout and even made my hair a bit thicker.

About 3 months ago, my doctor prescribed a blood pressure medication (Benicar) and it appears to be causing terrible hair loss (even though I am still using the Minoxydil). I will speak to the dr. about the hair loss but is it harmful to continue using the Minoxydil if I am taking BP medications? I am hoping to find a medication that will not have this side effect. I look forward to your answer as this is very depressing and worrisome

Benicar causes hair loss in 1% of patients… so it is quite rare. Speak with your doctors and see if there is an alternative medication that he/she would consider. The blood pressure impact of topical minoxidil should not be enough to impact your blood pressure management, but again, discuss this with the physician that is already treating your blood pressure.

Hi,
I had a hair transplant about 7 months ago. What I noticed is that the transplanted hair which never shed has remained but I have yet to see any other growth. The hairline looks sparse and not what I was told that they would achieve, which is thickness. Can the transplants still develop or will I expect to see no more improvements.

Thank you

At 7 months after surgery, I would expect to see most of the growth. Wait a few more months and if there’s still nothing, then ask your doctor what went wrong (I am taking what you said at face value).