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Hi Dr. Rassman,

Is it always best to start Finasteride sooner than later? I’ve read some information suggesting that finasteride only works for a certain period before losing its effectiveness. Should it be started at the first sign of balding, or should one wait a bit until it is absolutely necessary?

I am 26 male and have started to thin in the front. Dermatologist confirms male pattern baldness by inspection only, no mapping. He is hesitant to prescribe me finasteride for life, considering that we don’t know its long term effects and he’s considering that it might cause more aggressive forms of prostate cancer (though it lowers prostate cancer risk overall). But reading your archives it seems that you think finasteride is the best treatment option for young men who are starting to bald.

Do you have any concerns about its long term safety? Say usage for 10 years plus?

Thanks!

I think that your dermatologist is off base. The medical facts do not support him and the earlier you start Propecia, the less hair you will lose. Propecia should be started at the early onset of hair loss. Hair loss is a one way street, progressing only to more balding when it is caused by genetics in the male. I haven’t seen you, so if your dermatologist says you are experiencing early genetic loss, you may consider getting a second opinion for the Propecia.

Propecia has been available on the market since early 1998 (FDA approved in 1997), but I’m unaware of any recent studies on patients that have been taking it for that long. I do have my own patients that have been taking it for over a dozen years with great success. Some have experienced a perceived reduction in benefits after 5-10 years, but the medication is still working to some degree. If the medication were to be discontinued at that time, more hair loss will be seen (catch-up hair loss). It’s the tug-of-war between the medication and your genetics.

(female) I have been experiencing hair loss for about 2 months now. It is just beginning to be noticable when I lift up sections of my hair. The hair loss is now accompanied by an itchy scalp but that may be due to the fact that I have had a problem with winter dandruff my whole life. I am wondering if the hair loss could be due to NSAID use.

I have been taking 4-8 200 mg ibuprofen almost every day for the past few months. There has been no major stresses in my life but I was told that I had low iron after giving birth to my son 2.5 yrs ago. Any information would be greatly appreciated. Thank you very much.

Just to clarify for those readers that may not be familiar with “NSAIDS”, it stands for “Non-steroidal anti-inflammatory drugs” and you likely have them in your medicine cabinet. Some common NSAIDs are aspirin and ibuprofen.

Back to your question — as I am not your doctor, it is difficult to answer this. Low iron can cause hair loss, and even ibuprofen has been reported as a cause of hair loss in some. As I’ve said many times before, causes for female hair loss are difficult to nail down and could be from a variety of possible issues. I’d run some tests with your doctor.

Dear Dr Rassman
Question about Monistat Vaginal Cream. I have read that this is helping woman to thicken there scalp hair. Is there any truth to this and if so can you tell me how it works and can it be of any help to men? Thanks

Monistat is used to treat fungal infections in the moist vagina which, in some women, has a tendency to produce yeast infections. There is no basis whatsoever in using this medication for the treatment of balding, though.

One of the ingredients (miconazole nitrate) is considered by some to be a hair growth agent, but I’ve yet to see a study that gives that theory any legs. There’s a great blog post at HairBoutique about this very issue.

This regards traction alopecia/scarring. As a kid, roughly around 11 yrs. old, I was over a friends house and another kid locked me out of my friend’s room. They pulled the old trick on me where I was pushing hard against the door to get it in and WHOOOOOSH - the flies open and Newton’s First Law comes into effect and ends with me tripping head-first into the corner of a wood dresser. An extremely large and painful bump emerged on my head, but no bleeding and no hospital.

Ever since then I’ve had a bald spot the size of a silver dollar on the impact spot and have noticed something interesting. The scalp there is not smooth/glossy and I can still see plenty of hair follicles or “buds” everywhere, but they produce no hair or very thin hair and have been doing so the last 13 years. I realize these follicles have become weak/dormant, but is there anyway to reawaken them? Guessing propecia would do nothing considering it responds to DHT, not some sort of scarring.

After 13 years, I would think that there is no medication that would bring the hair back. You might try Rogaine for a year or so on the bald area, but do not expect a miracle. A hair transplant or some other surgical procedure may work, but I would have to see you and draw my own conclusion (a good photo would help). The little “buds” you speak of are interesting, and I’d like to see what that is.

Snippet from the article:

An “alternative doctor” who sexually assaulted a female reporter seeking a cure for hair loss has been jailed for nine months.

Chan Tung-choi, a practitioner of natural therapy, yelled he was innocent as he was led away from Eastern Magistrates’ Court yesterday. Chan, 68, who denied four counts of indecent assault, was found guilty by Magistrate So Wai-tak. He said he would appeal. Earlier, the court heard how Chan fondled the private parts and breasts of a 28-year-old online journalist, who cannot be named, between late 2005 and October 2006 at his Sheung Wan clinic.

He told her such actions would help make her hair grow.

Read the full article — `Sex therapy’ doc jailed for hell of hair-loss patient

A pathetic incident beyond any doubt.

Dear Dr. Rassman:

I am a 44 year old male with obvious hair plugs. I had three sessions from strip grafts back in 1995. In considering all of my repair options, I would like to just be naturally bald. Two surgeons have dissuaded me from having plug removals claiming that scarring would be a limiting factor. I was wondering how you would feel about a staged FUE removal of individual hairs over time allowing healing between sessions. I noticed that you replied to another inquirer that individual graft removal take a week to heal. Therefore, why not just space out the sessions to allow for adequate healing in the meanwhile? I’m not averse to small scarring as anything would be better than my current state. I am not interested in additional grafting as I’m convinced I am continuing to bald and will eventually have an island on the top of my head.

Any thoughts? Thank you.

I can not really address your specific issues, particularly when it comes to scarring, without at least seeing what you’re dealing with. You can use follicular unit extraction (FUE) to extract the big hair plugs, but sometime excision of the plugs work well. It all depends upon the extent of your problem. How many plugs do you have and where are they located (photos should tell me the answer)?

Sometimes if the frontal hairline is very pluggy and there is a concentration, removing the frontal hairline does not leave much scarring in many people. Is it your intention to be go completely slick bald (very difficult) or just a repair (much easier to do)? Send me good digital photos (reference this post when sending) and then we can set up a telephone consultation.

For those interested in seeing the difference a repair can do for a pluggy look, take a look at this patient.

Is Propecia safe to take everyday the rest of my life. I’m 33. Pretty healthy with no known issues. I work out.. Thinning a bit in the middle of head and I heard Propecia will slow down or stop completely hair loss. Internet is vaque on question. So Doctor is it safe to use on a everyday basis on the ones liver or a other life threating issues taken it long term..

There is no evidence to suggest that taking Propecia for life could cause problems with your health. Evidence that it may be harmful is what the FDA wants to know as well. Taking the medication for your lifetime is important, because the hair loss problems are lifetime problems.

I’ve had a patient taking Propecia for over 12 years, and the results show that his hair loss visibly stopped and his crown hair regrew within the first year of taking it. I have recommended that my son, who has been on it for 5 years now, stay on it for his entire lifetime. All of his frontal thinning stopped on the drug and I am convinced that if he discontinued the medication, he would experience hair loss.

Hi Dr and thanks for your time.

I am a 34 year old male and have been thinning for roughly 12-14 years. I feel I used to shed ridiculously bad- I would tug at the hair kind of obsessively and lose around, I dont know, 100-200 per day. This went on for 10+ years but I have since slowed the loss to tolerable levels, say 5-25 hairs per day with improved diet (which I swear had a lot to do with it) and minoxidil 5% 1X per day. My main thin spot is on the vertex, or top of the head, not bald, but somewhat thin, where I really want regrowth. For the past 6-8mos I have been applying minoxodil 2X per day, and recently I decided to take propecia at .5 mg every other day.

I know people say it is hard to regrow hair lost years ago, but I have read of people who do it using finasteride and minoxidil. Have you witnessed this and if so what is the oldest hair lost you have seen men regrow? I have heard of people in their 40s doing this from 5-10 yr old hair loss… I am aware that all meds work better on people who have lost hair recently, and are younger. Also, if the placebo effect worked in some finasteride trials, (even if slightly) what is the power of positive thought here? Thank you very much.

I believe in positive thinking, but I can not say that I have seen it grow hair lost years ago. I think that everything you did has worked for you a little here and a little there — and by that, I mean the medication you’re using and when you stopped the pulling on your hair.

As for the oldest regrowth from finasteride that I’ve seen, well, I have a 79 year old friend who went on Proscar for his prostate and had the great unexpected cosmetic benefit of hair growth when taking a medication for his health. Generally speaking, this is a rarity.

Based on the questions and answers on your excellent blog, you seem to have taken an ambivalent position on creatine and hair loss in the past. I am 25 and very athletic, and I have a medical background so would never consider taking steroids or other dangerous substances. Creatine is a safe and effective athletic supplement that I have been taking for some time, but a recent study published in the Clinical Journal of Sports Medicine found that creatine raised serum DHT by 40 percent when taken at the moderate dose of 5 grams per day. In addition, creatine has recently been shown to increase the ratio of DHT to testosterone in young athletes. Do you think this is sufficient evidence for young hair loss sufferers to entirely avoid this otherwise excellent ergogenic aid?

I found the study you’re referencing — Three Weeks of Creatine Monohydrate Supplementation Affects Dihydrotestosterone to Testosterone Ratio in College-Aged Rugby Players

The study was very limited (only 20 men) and the amount of creatine taken can vary wildly amongst those that use it, but I would avoid creatine if it indeed increases DHT levels in the body and you’re worried about possible hair loss. The study itself concludes, “Further investigation is warranted as a result of the high frequency of individuals using creatine supplementation and the long-term safety of alterations in circulating androgen composition.”

I appreciate you bringing it to my attention.

I seemed to have damaged a small area of my mustache, and I’ve waited 6 months and the hair hasn’t grown back.

I was using 1 of those luffa (loufa) facial scrub pads, and went across my mustache, when I looked at the pad, I noticed complete hairs on the scrub pad, and the bottom tips of them were wait. And now there is a clear small bald spot in my mustache to the point that, I’ve decided to shave my mustache completely off. It just looks ridiculous with that patch missing.

My question is, is the area forever damaged, and what can be done to regrow the hair. My wife misses my mustache as much as I do.

If your mustache does not come back in another 3 months, the only way you can get it back is to transplant it. Hair transplantation works well in facial beard defects. At that point, you can make a trip to my LA office (you indicated you weren’t too far away) for a free consult. I’d give it some more time though to regrow on its own.