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Hi,

I was wondering if it was normal for hair to grow out in different directions? I took a month course of Accutane 2 years and in conjunction with the hair loss, my hair feels a lot more brittle and different in texture. Specifically my scalp, I have this dime sized spot on my scalp that grows opposite to what the rest of my hair does. I know this sounds weird but it becomes even more noticeable when my hair isn’t shaved down.

Did Accutane do something to change how my hair grows?

Accutane (isotretinoin) does impact the quality of hair that grows, but it should not change direction. I would suspect that because of the changes in your hair character, the different direction of hair in one area was more easily noticed by you.

Reading some message boards, I see a lot of disgruntled people with regards to Propecia and saying the drug destroyed their hairline, hypandrogenicity, etc. It makes you think everyone suffers from severe hyperandrogenicity because they get a zit. I know you’ve mentioned in the past that people with negative things to say usually are the most outspoken. But it is easy to get an impression reading these boards Propecia is awful because the negativity outweighs the positivity when Merck proclaims the opposite.

My question is: in your practice, have you seen people suffer from in your own practice? And with those patients on Propecia, what percentage elect to stay on it and are generally content with the performance of the drug?

Thanks Doc!

The Propecia side effects statistics from Merck are in line with what I see in my practice. It really is very minimal. I agree that the message boards bring your attention to the agenda of the posters, which may not be pure and objective like mine. I really have nothing to gain by telling people about Propecia, a drug which can regrow hair and halt hair loss (I am, after all, a hair transplant surgeon).

I’ve been on propecia for almost a year now and I noticed that I’ve started shedding hair after 2 months into the medication. Its almost a year now and I am still shedding hair, it looks like its becoming worse. The hair that is shedding has also become finer than usual. You mentioned that shedding usually occurs for a while and we should carry on for at least a year. Its a year now, so should I continue the medication?

It seems that your genetic predisposition may be winning the battle over Propecia. You should see your doctor who prescribed you the medication and discuss your options. You may consider adding Rogaine or even increasing the Propecia dose* (but again, discuss it with your doctor first). You may even consider having the HairDX Test for Finasteride Response done, which may explain a failure to respond to the drug. Have you had the status of your miniaturization compared with your pre-Propecia status? That would give you a great deal of information if you had that test done as miniaturization should have decreased on the drug.

* I have recently blogged of increasing the dose of Propecia on select few patients. This does not mean it works necessarily but for those few patients who have no side effects and are continuing to lose hair it may be worth a shot. Keep in mind there is no clinical study to suggest this approach is the solution.

I’m hoping you can help us. When my daughter was 20 months old, she was diagnosed with a brain tumor. After numerous brain surgeries and chemo, we decided to have a bone marrow transplant just before her fourth birthday. Thankfully, this saved her life. She also had focal radiation to the tumor site - on the right side of her head - and unfortunately most of the hair on that quarter of her head did not grow back.

She has worn hair pieces since she has been five years old. We’ve talked to people about hair transplants in the past, but were told there was too much area to cover and also, that hair transplants do not work on the side of the head.

I’m wondering if this still holds true for this procedure. I could send you some photos so you could see the extent of the hair loss if you think that would help. Please let me know your thoughts.

Thank you

Most people with large defects are treated with balloon expanders, which stretch the normal scalp to cover the defective areas. There are a few doctors who are very skilled in this specialized technique and although I have assisted in this type of surgery, I would not consider myself at the lever of expertise needed. I have seen these expanders done in children, but every person and every situation is different. I would suggest that you send me photographs and I will forward them on to such a specialist. I have seen some miraculous results from this type of reconstructive surgery.

Usually, at the end of the expansion surgery, hair transplants are done to refine the work and cover remaining scars.

Hey doc, In your experience, do you feel that lots of guys tend to over analyze their hair after starting a treatment like propecia? For instance im 5 1/2 months in, for the last week i was convinced it was starting to see some hair come back, then today i look and it looks awful. I go through these mood swings all the time, since i started propecia. I should have listened to you and got a minuturization test done but my derm just gave me the meds, so now all I have to go off of is my memory of what it looked like when i started. Secondly between what months do most your patients see improvement in their hair, or become convinced that propecia is working in some form or another?

What was the phrase — a watched pot never boils? If you’re taking a pill to treat hair loss, of course you’re likely to watch your hair with an intense focus. It’s not unusual, but you shouldn’t stress yourself out about it. It generally takes 8 to 24 months to see the benefits of Propecia (finasteride). Full benefits may take the full 24 months.

The reason I suggest mapping the scalp for miniaturization is well defined by your comment. Our memory is not objective, but scalp miniaturization mapping is objective… so you do not have to rely on your memory.

(female)
I have skin cancer which required graft closures. I have had MOH’s surgery and grafts twice and once (one year ago this past March) I had hair transplantation from the nape of my neck. Approximately two months after the surgery the right side of my scalp regained feeling but the left side did not. It still hasn’t so I told my plastic surgeon and he injected a steroid thinking it was scar tissue. While he was examining my scalp (after the injection, which did not work) he touched an area of my scalp on the left side that shot pain up to the top of my head probably right on the occipital nerve (greater). He didn’t know what to do so I went to see a neurologist who told me that some of the lesser occipital nerves are not as deep and are in fact at scalp level. My scalp (at the donor site) is so tight it is difficult to move my head to the right and down. Now he says I have cervical dystonia. I don’t believe that because in my research I found nothing that even resembles what I am feeling or going through. What do you think?

Persistent pain and/or numbness is a relatively rare risk of hair transplant surgery from small nerve damage. It is always stated in our pre-surgery consent form that we go over with our patients. Tightness of the scalp is also a side effect of a hair transplant surgery. The more surgeries you have, the more risk you may have of tightness or nerve damage. As your neurologist explained to you, some of your nerves may have been cut/irritated during the surgery and this may be contributing to your problems. I really have no way of knowing, though.

Hello,

Thank you for answering my question about smoking and hair loss (posted in your archives in 6/25/09). I thought you might be interested in this link, which provides info on a medical study between hair loss and smoking: Could Your Bad Habits Be Causing Your Hair Loss? Stress - Smoking And Baldness

Summary:

Smoking has been proven to have a profound effect on hair loss by changing the dynamics of hair growth and restoration in the scalp. In essence, it works by promoting the level of DHT (dihydrotestosterone) in the hair follicles. According to a clinical study by the Harvard School of Public Health, DHT levels in randomly sampled smokers were 13% higher in smokers than in non smokers. In addition, testosterone was about 9% higher in smokers than non smokers, which means there are more levels for the enzyme Alpha-5-reductase to act upon in producing DHT. In conjunction with each other, testosterone and DHT increase the amount and rate of hair loss.

I haven’t seen the actual study that is referenced, but assuming this is true, it speaks for itself. Thanks for sending.

Hi,

I’ve been going for hair transplant surgery last 2 months and after the surgery the doctor recommend me to take propecia to maintain my existing hair as i was indicated of suffering from Male pattern hairloss. Just 3 days ago i start to apply Proscar and split it into quarter 1.25 mg as financial problem and use it daily without side effect so far. Surprisingly my hair stop to fall off immediately as only used for 3 days..

My question is now i am taking 1.25 mg of proscar daily, and i plan to switch to Propecia 1 mg after 2 years from now on. Is there any case of intensive shedding happened if switching from Proscar 1.25 mg to Propecia 1 mg? As most of the cases is only mentioned switching from Propecia to Proscar for cost saving.

Thanks for your sincere advice.

Cheers.

Proscar and Propecia are both the drug finasteride just at different doses. Switching between them is no problem at all. The difference in the 1.25mg dose and the 1mg dose is relatively insignificant.

Tomorrow is Independence Day here in the US, so we're taking today off for a long weekend. We'll be back Monday with new content, but please use this opportunity to check out our new featured articles:

1. Selecting a Hair Transplant Doctor
2. How to Avoid Dishonest Doctors
3. Why Should You Visit Us?

Snippet from the article:

The ‘baldness calculator’ - said to be the world’s first reliable tool for predicting hair loss - has been a huge hit with men in other countries.

The program calculates the exact age at which someone will go bald or have lost most of their hair or provides reassurance by predicting that they will still have a full head of hair in old age.

Read the rest at Telegraph UK

A PR firm sent me the press release and apparently the Telegraph in the UK got the same release and ran with it, presenting the article above. This “baldness calculator” is a clever way to market a caffeine-based shampoo called Alpecin, but I don’t know how this thing can claim to be accurate. It’s guessing the year you’ll lose your hair based on these factors you feed it — age, number of hairs lost daily, current hair loss pattern, scalp dryness, how often you wear a hat (???), stress, activity level, family history of hair loss, location (which apparently is limited to the UK), marital status, and career. Most of the questions are yes/no, and some have zero relevance. And surprise, surprise — when the answer is “calculated”, the solution is a special shampoo! I am completely and utterly SHOCKED (note sarcasm)!

For fun, I asked one of my employees to go through the steps of the “calculator” to see where he’d end up. It determined he’d go bald at 60 years old (though he’s not in the UK, so he had to choose a region that he doesn’t live in and probably has never visited). How’d it come up with that age? Your guess is as good as mine. He’s got miniaturization on the top of his scalp already (he’s been taking Propecia to maintain it), so clearly 60 years old may be completely wrong (who really knows).

My verdict: Fun way to try to sell you a shampoo, but to call this “accurate” is completely ridiculous. In fact, it’s laughable. Determining the age you’ll go bald is just not that simple, folks. If you want to try it yourself, go here, but keep in mind what I just wrote about the accuracy. Perhaps their claims for the shampoo are equally as accurate?