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Dear Dr,

Have been using topical minoxidil for 5 to 7 years or so now, however have recently more concerned it may cause long lasting damage. Have had some minor surgeries were I have bled more then expected. Could this be due to the minoxidil having a systemic effect through vasodilation ? Have also noticed a slight increase in trembling of fingers again if the topical minoxidil is getting into my system, could it be playing havoc on my CV system. I recently came across a journal from the 80’s claiming topical minoxidil at 2% was affecting LV volume. So What are your thoughts overall ? I am 29 year old male and the topical minoxidil I use is at 15%.

Topical minoxidil for treating hair loss should be 5%. In my opinion, 15% is way too much and it probably does not have much more impact on hair growth. I would think it would have unwanted negative side effects, as it would be absorbed in to your circulation. In other words, I wouldn’t be using 15% minoxidil.

The cause of your bleeding issue might be related to minoxidil, but I doubt it. People who take minoxidil orally for blood pressure problems do not really have bleeding issues. Bleeding problems are most likely related to something else. It may even be hereditary (for example, von Willebrand disease being one of the most common inherited bleeding disorders). Also, taking aspirin or ibuprofen (Advil/Motrin) can affect bleeding.

My daughter is 7 years old and her hair his shedding alot. No bald spots. After her shower and when I brush her long hair. Many hairs fall onto the floor or into the brush. It seems like she has new hairs growing in or can this be breakage. She otherwise is healthy and not showing no sign of illness. Is it normal for a 7 year old girl to be shedding this much. When should I see a doctor. She has been shedding for about 3 weeks.

If you are worried about something that you are observing that is not normal, then go see a doctor now! After all, you know your daughter best.

Do keep in mind you can lose 100+ hairs a day. Sometimes we seem to lose more hair at times or notice more hair loss and that can also be normal. There is nothing wrong with getting a physical exam to make sure your daughter is healthy. Abnormal hair loss can be a sign of undiscovered health issues, but it is a very vague secondary symptom. It is a challenge to most doctors.

Snippet from the article:

According to the U.S. Center for Medicine in the Public Interest, the sale of counterfeit prescription drugs is a booming international business.

The indictments are the result of an investigation by the FDA, U.S. Immigration and Customs Enforcement and the U.S. Postal Inspection Service, with assistance from U.S. Customs and Border Protection.

Read the full article at StarTribune.com

Basically, two guys were importing fake drugs to resell in the US and got caught with thousands of fake Cialis, Viagra, Levitra, Propecia, and Xanax tablets. Hat tip to the reader that sent me this link with the following warning, “People should get their drugs from legit sources only. You pay cheap and you wind up losing in the end.”

Well said!

What is your opinion on the german products pantostin and ell cranell? They contain Alfatradiol, could this be effective for AGA. Thanks.

Take a look at this study I found. It is not the best study, nor is it the most promising… but it is something. Personally, I don’t think alfatradiol is effective for AGA (androgenic alopecia).

This is an article I wrote that was published in the Hair Transplant Forum International (volume 19, number 5), the official publication of the ISHRS. I’ve become more and more outspoken about the problem with ethics among some hair transplant doctors, and have written a number of posts about it on this site. I was pleasantly surprised that the ISHRS made my article the lead story on the front page. Here is the text of the article as I originally sent it to them:

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Download article (PDF)

I am disturbed that there is a rise in unethical practices in the hair transplant community. Although many of these practices have been around amongst a small handful of physicians, the recent recession has clearly increased their numbers. Each of us can see evidence of these practices as patients come into our offices and tell us about their experiences. When a patient comes to me and is clearly the victim of unethical behavior I can only react by telling the patient the truth about what my fellow physician has done to them. We have no obligation to protect those doctors in our ranks who practice unethically, so maybe the way we respond is to become a patient advocate, one on one, for each patient so victimized. The following reflects a list of the practices I find so abhorrent:

1. Selling hair transplants to patients who do not need it, just to make money. I have met with an increasing number of very young patients getting hair transplants for changes in the frontal hairline that reflect a maturing hairline, not balding. Also, performing surgery on very young men (18-22) with early miniaturization is in my opinion outside the “Standard of Care”. Treating these young men with a course of approved medications for a full year should be the Standard of Care for all of us.
2. Selling and delivering more grafts than the patient needs. Doctors are tapping the well of the patient’s graft account by adding hundreds or thousands of grafts into areas of the scalp where the miniaturization is minimal and balding is not grossly evident. I have even seen patients that had grafts placed into areas of the scalp where there was no clinically significant miniaturization present. Can you imagine 3,000-4,000 grafts in an early Class 3 balding pattern? Unwise depletion of a patient’s finite donor hair goes on far more frequently than I can say.
3. Putting grafts into areas of normal hair under the guise of preventing hair loss. There are many patients who have balding in the family and watch their own “hair fall” thinking that most of their hair will eventually fall out. A few doctors prey on these patients and actually offer hair transplantation on a preventive basis. This is far more common in women who may not be as familiar with what causes baldness and do not have targeted support systems like this forum. They become more and more desperate over time and are willing to do “anything” to get hair. They are a set-up for physicians with predatory practice styles.
4. Pushing the number of grafts that are not within the skill set of surgeon and/or staff. The push to large megasessions and gigasessions are driven by a limited number of doctors who can safely perform these large sessions. Competitive forces in the marketplace make doctors feel that they must offer the large sessions, even if they can not do them effectively. A small set of doctors promote large sessions of hair transplants, but really do not deliver them, fraudulently collecting fees for services not received by the patient. Fraud is a criminal offense and when we see these patients in consultation, I ask you to consider your obligation under our oaths and our respective state medical board license agencies to report these doctors.
5. Some doctors are coloring the truth with regard to their results, using inflated graft counts, misleading photos, or inaccurate balding classifications. False representation occurs not only to patients while the doctor is selling his skills, but also to professionals in the field when the doctor presents his results. Rigging patient results and testimonials are not uncommon. Lifestyle Lift, a cosmetic surgery company settled a claim by the State of New York over its attempts to produce positive consumer reviews publishing statements on Web sites faking the voices of satisfied customers. Employee of this company reportedly produced substantial content for the web.

The hair transplant physician community has developed wonderful technology that could never have been imagined 20 years ago. The results of modern hair transplantation have produced many satisfied patients and the connection between what we represent to our patient and what we can realistically do is impressive today. Unfortunately, a small handful of physicians have developed predatory behavior that is negatively impacting all of us and each of us sees this almost daily in our practices. Writing an opinion piece like this is not a pleasant process, but what I have said here needs to be said. According to the American Medical Association Opinion 9.031- “Physicians have an ethical obligation to report impaired, incompetent, and/or unethical colleagues in accordance with the legal requirements in each state…”

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Download the article as it was published in the Forum magazine, which includes quotes from other doctors (PDF file)!

I am 19 years old and I have fine, straight hair. The hair growing on the right side of my head is significantly thinner than the left side. I don’t remember having this problem as a child, but I have had it for awhile. I used to have such pretty hair, so it’s really upsetting. I think I have had this problem since I was about 11 or 12 years old, which is a pretty young age for hair loss. I remember getting my hair pulled really hard on the right side by a girl when I was in 7th grade, but I don’t know if that is the cause.

Also, I used to wash my hair everyday since about 12 years of age until earlier this year. I stopped after I realized how bad it is for your hair. I’ve been eating pretty healthy for the past 2 years(mostly fruits, veggies, and fish) and I take vitamins. Will that help at all? I switched to an all natural brand of shampoo and conditioner that is made of aloe vera, and I’ve stopped using harsh chemicals, however I still have problems with dry, irritated scalp. I have pretty low self esteem because of this, and I just don’t know what to do. I’m going to see a dermatologist soon, but according to this information, what do you think the cause is and can it be reversed?

Also, do you know of any good hair specialists in my area (Austin, TX)?

I am assuming that you are a male, since you didn’t specify…

Your diet won’t help regrow your hairline, but a healthy diet is always good practice anyway. First, as always, you need a diagnosis. This is likely your genetics, but you are doing the right thing by seeing a dermatologist, particularly with your irritated scalp condition. The genetic balding problem may play a role in the asymmetry, which is common in those going through male patterned hair loss. I don’t have referrals in Austin at this point, but you can review ISHRS.org to find a doctor in your area.

At 19 years old, I wouldn’t rush into a hair transplant surgery to balance out the hairline, but for those readers with a similar problem (that are a bit older than this young man), hairlines that are out-of-balance in men can be easily fixed with hair transplants.

I am experiencing hair loss for the past 6 months. I approached a skin specialist and cosmetologist a month ago. she suggested to use minoxidil 5%. I am using it for one month, but now i lose more hair than earlier. My marriage is in the next month, but she is asking me to use for 3months. I have a plan of becoming pregnant, but once if i stop using minoxidil after the third month, wont i get in to the hairloss trouble again? i am totally worried. please help me out.

You might experience some initial shedding from the medication, but if you stick with it those hairs should regrow. However, if you stop the medication any benefits you see will disappear.

Pregnancy changes things, though. Since you’re planning on starting a family, you might want to stop it now, particularly since you have not been on it long enough to see benefits. There are warnings about using minoxidil when you are pregnant, so if you do become pregnant you should stop using it until after you’ve given birth (and if you plan on breastfeeding, you should wait until that is complete, too).

Hi,

I’ve been on Propecia for 5 months now. I’ve noticed a lot of the people who write in say they switch to Proscar after about a year. Why the change, isn’t it the same drug? Is Proscar a higher dose of finasteride per amount taken?

Many people switch because of the cost difference. Proscar (5mg finasteride) is the same drug, but you can cut it into 4 pieces to get about the same dosage as Propecia (1mg finasteride). Generic 5mg finasteride is legally available in the US, but generic 1mg finasteride is not here yet, as it is still under patent protection. I believe generic 1mg finasteride will be out of patent in 2013. Remember, you need to have a doctor’s prescription for either medication.

I’ve recently lost a large circle on my inner thighs. The spots are just below my inseam and are the exact same on both legs. What could this be? I’ve also been getting stabbing pains in mostly my left leg but some in my right.

I suppose it could be your thighs rubbing together or rubbing on the material of your pants, creating traction alopecia in that area. The pain might be unrelated. I’d get examined by your doctor though, as this isn’t something I could even guess on via the Internet.

Hi Doc,

I was wondering if you had heard of any new information regarding Neosil’s NEOSH101? This seemed fairly promising for a while but it seems like things have gone silent on this one, has this one bitten the dust?

Also in my travels around the internet i found this, a study based around using roxithromycin lotion to treat baldness. What are your thoughts on it?

Finally i hear a fair amount about Saw Palmetto and how great it is as a natural alternative to Finasteride but if this where true why hasn’t there been any decent studies on it? And why aren’t the producers of it funding studies to prove it works? That indicates to me that perhaps using Saw Palmetto for hairloss is a load of bunk. Surely if they had a product that could potentially help fight baldness you’d think they’d want to be able to prove it scientifically.

Cheers

I haven’t seen any news about Neosil or the NEOSH101 product they were working on. Last I remember, Neosil was bought out by Peplin, who in turn put NEOSH101 on the backburner to focus on their other products (though they said their hair loss treatment would be a future product). I can’t find anything since then…

Regarding using roxithromycin (a drug used to treat infections) as a hair loss treatment, your guess is as good as mine. I’ve never seen such study and the clinical trial link basically says to me that if there was a study they were starting to conduct, it didn’t go anywhere. They haven’t updated any information in years and there are no results or info available. I’ve not even seen any information about why this medication might work as a hair loss treatment.

The saw palmetto / hair loss treatment controversy has yet to be proven. Saw palmetto does not work like finasteride to treat hair loss. People jumped on the bandwagon because saw palmetto is used for prostate treatment, and as you probably know, finasteride is also used for prostate treatment. People put the two together to create pseudoscience through association. The thing is, it is an over-the-counter herbal that is readily available, so nobody is going to take the time or money to fund a proper study. They figure — why prove it when people will buy it regardless? When it comes to hair loss treatments, unfortunately people are willing to spend their money on just about anything with a hint of a promise.