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Hi
Great blog you have, really useful. I have a question about topical Finasteride. I take 1mg Finast and think it might be holding my hair loss + scientifically expect it probably should be, therefore very much don’t want to stop. However, I am convinced that I get sexual side effects whereby my penis is just not as full and pumped (flaccid and erect) when I take it. I’ve tried experiments of washing it out for 3 weeks and then going back on it and I’m pretty sure there is quite a marked difference.

This has left me in a dilema and I was very glad to see a recent Indian paper in which they’d compared topical Finasteride with oral for a few months and found that, though the effect took longer to come on, it seemed as strong after 6 months.

Do you know how far away we are from topical Finasteride being available? Whether there is any other data on efficacy? Whether there is any data on whether systemic absorption occurs? And whether one has to apply it for long periods which would make it problematic to use? Many thanks for any light you can shed!

I’m not sure which Indian paper you’re referring to, but to my knowledge topical finasteride doesn’t have proven value. It would require special formulations for topical use and some drug company would have to push it through the FDA before it was determined safe and effective. Some doctors sell it online and armchair chemists on hair loss forums have their own tips on how to make your own, but I’ve not read any formal studies that show topical finasteride works the same as the oral finasteride. I’ve written about this before.

I occasionally take a treatment for erectile dysfunction called CIALIS (tadalafil). The tablets belongs to a group of medicines called phosphodiesterase type 5 inhibitors. The inhibition of phosphodiesterase type 5 (PDE5) enhances erectile function by increasing the amount of cGMP. I was wondering a few things. First and foremost would such a tablet such as CIALIS increase my hairloss, which i do have. I am receding and have slight crown hair loss. Is it possible (if you know anything about this type of medicines) that it could increase DHT. Secondly is it ok to take propeica or avodart if you are taking this drug. I dont really know if taking a drug such as CIALIS which inhibits type 5 inhibitors could cause a reaction with the main chemical in propecia and dutasteride and stop it working or even worse make it dangerous. with the knowledge you may already know, or if not i would like your expertise and suggestions to wether or not its ok to take both or wether it could increases hair loss. Thank you very much

I don’t see why Cialis would increase hair loss, and hair loss is not listed as a side effect (see list). In many cases medications like Cialis, Levitra, and Viagra may be prescribed to counteract any erectile dysfunction side effects from Propecia (finasteride) and Avodart (dutasteride), and I’ve not heard any cases where they negate the benefits of the hair loss medication or make it dangerous. It’s best to talk to your prescribing doctor, of course, and make sure he/she is aware of your other prescription medications in case there is a concern.

Dear Dr. Rassman,

I’ve now been on Propecia for a little over a month and a half and it appears that I’ve noticed a slow down in shedding since before I started taking it. I know that on average we lose 50/150 hairs a day and I’m positive that I don’t notice all of the hairs that I lose over the course of the day (that would be impossible), but I am almost certain I’m not losing 100 a day, and it appears I’m shedding much less than before.

Is it pretty common for Propecia to start working noticeably a month and a half into treatment? I’ve read that it takes three months at least for it to start slowing down hair loss. I still have a pretty full head of hair (with some thinning at the crown and slight recession in the front. Not seeing as much hair shedding has me feeling really good that Propecia might work really well for me. Thank you, Dr!

Many people will report a reduction in shedding within the first month of taking the drug. I don’t know the hows or whys of it, but the medication doesn’t work exactly the same for everyone. In your case, it sounds like you’re seeing a positive result in a short amount of time. That’s good news!

Hi, I recently tried out a new shampoo and conditioner set called Herbal Essences Hello Hydration. It has silicone in it, and can help improve shine quality in your hair, so I gave it a shot. I noticed afterwards more hair coming out after I rinsed the shampoo and conditioner out, but thought it was just natural. I switched shampoo and conditioner for a bit, came back to the Hello Hydration set, and when I rinsed out a clump of hair immediately came out between my fingers.

Is this coincidence, or do you think there is a relation??? Please help!!!

Maybe it is a coincidence. If the shampoo actually causes hair loss, I am sure it would have never been introduced/sold. I have personally used the shampoo before and did not experience anything different. If you believe there is a relation, then I would suggest not using it.

I’m 32 years old with near norwood 4 loss and am still confused over both these techniques. There were two previous posts that you replied stating that both procedures are identical but according to Dr. Coles website he claims that FIT is much better than FUE.

My personal search has led me to either pursue your new FUE² or Dr. Coles but I’m at a standstill and not sure which path would be better. IF both procedures are the same then the only criteria left for me in my decision would be $ cost per graft. My last question would be how much you charge per graft for a shaved head for a FUE² procedure? Thank you!

Follicular unit extraction (FUE) is the core terminology that I used to define the surgery when it was first published and is the recognized term worldwide. Could there be marketing hype used here? I would think so (my opinion). The tools have been overblown and unless the technique is substantially different, an FIT is an FUE. The FUE² is different from the FUE in the basic technique deployed, because it uses a dissecting technique with high pressure fluid to assist in the extraction.

Our fees for FUE are as follows:

• $10/graft for procedures done by Dr. Pak
• $15/graft for those done by me (Dr. Rassman)

Some doctors charge more if the head hair is not allowed to be clipped close (shaved), though our fees are the same. At the moment though, by not allowing us to clip the hair, the total number of grafts available will be less.

Dear Mr Rassman,

First of all thank you for your very informative and helpful site.

I am 30 years old and lately I started worrying about my temples. I have a feeling that I have rececing temples and want to take action in case this is the case. Unfortunately I do not have old photos taken from the right angle to compare. Could you please tell me what you think and my Norwood class according to the attached photos. I do not have any balding or thinning on top.

By the way, you can use my photos on your blog if you please.

Kind regards

Click the photos to enlarge:

First of all, thanks for allowing me to publish these. What I believe you’re talking about are the corners of the hairline, not the temples. The temples are below the corners (above the ear) and those look fine in the photos you provided. People seem to get the temples and corners confused all the time when labeling them.

It appears that your hairline is now convex in shape and the central area does meet the side areas, suggesting that the maturing hairline is locking into place. If there is no miniaturization present, I would do nothing other than observe your hairline yearly. This is a Norwood Class I or II.

I have folliculitis which has caused hairloss at the crown. Will minoxidil regrow this hair? If it does, will the hair be lost once application has stopped or will the hair continue to survive on its own as my dermatologist says I have no MPB only the folliculitis.

There is a condition called folliculitis decalvans, which is an autoimmune disease that often reflects extensive hair loss. First, one would have to make a diagnosis (something I can not do without seeing you myself). If it is just a small patch from the infection of a few hair follicles that caused hair to fall out and does not reflect an underlying disease, then it might regrow. Minoxidil may help. I can’t say much more without knowing much more about you, what it looks like, and more of your history with the folliculitis. There’s a lot of info and photos of folliculitis decalvans here.

I too am taking omeprazole and finding that my hair is thinning severely. I want to weigh in on this because I see other comments to this effect on your site and others. I think you should not be too hasty to dismiss the connection.

On researching this, I did find references to a rare connection between Prilosec (omeprazole) and hair loss. As I’ve explained before, it is difficult to conclude whether omeprazole is the cause of your hair loss, as hair loss is quite common due to genetics. Hair loss reported from the medication is in less than 1% of cases. See eMedTV for more.

I had a hair transplant nearly two years ago now. every 6 months or so it looks thick and occasionally some months it doesnt. Now becuase the transplant to place maybe as the rest of my hair was at a resting phase, could the hair transplant section and the rest of the hair always be at a different rate of growth as in resting phase. I was wondering whether this was the reason for certain months it looking thick and more hair and other months lacking as much hair. Also as the transplant section isnt as dense and compact could it be that when some hairs fall out in order to be replaced it just isnt as thick?

Thanks NHI TEAM

The general hair cycling is somewhat random when we look at it. I can not imagine why your hair looks better sometimes than other times. We’ve all heard of a “bad hair day,” so maybe that is what you are talking about. Are you doing anything different with your hair during the periods in question?

Hello Dr. Rassman.

I have a theory, can the type of skin (texture, etc) determine if a person will go bald? Sensitive skin equals sensitive to DHT? For example a Caucasian male can freckle easy and have allergies easily.

Thanks.

I suggest that you scrap that theory. I assume by “sensitive to DHT” you’re equating it to mean genetic hair loss. What is below the skin and what is above the skin (what it looks like) are very different things.