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As regular readers might know since I’ve mentioned it in the past, I’m part of an email group of hair transplant doctors. We share clinical stories, exchange ideas, etc. There was an article in O Magazine about female hair loss and we were asked about percentages of female patients that are candidates for surgery. Dr. Robert Bernstein had said around 20%, but one physician in the group disagreed with him and stated that close to 80% of his female patients are surgical candidates! From my own personal observations, some doctors will perform surgery on the majority of female patients that come through their door, but in my opinion, that would just be taking advantage of these women. Ask the doctor you selected what percentage of the hair transplant practice is women. If the number is high (over 20%) then I would seek another doctor.

Every once in a while a doctor will say something completely outrageous, and without mentioning who the doctor is, I wanted to share my reply to the group of doctors with you all. It will likely ruffle some feathers, but it needed to be said:

i wanna know that can armpit hairs be the donor for scalp hair transplantation???? plz reply me soon

I suppose anything is possible, but I doubt you’d really want to do this if you knew what the end result would look like. I have seen everything from transplanting armpit hair, pubic hair, and even beard hair to the scalp (I’ve not done these procedures, but have seen patients with them done).

Not only is the hair quality and texture just not the same as scalp hair, but more importantly, the growth rate and success of body hair transplantation is not as high as scalp hair transplantation (despite what the doctor may tell you). Plus, underarm hair will carry its glands with it so you may have to use deodorant on that hair. In my humble opinion, it is an experimental surgery with a potential for problem results.

Snippet from the article:

Molecular dermatology research and development innovator HairDX today announced the results of a six month pilot study that presents, for the first time, evidence that genetic mechanisms may predict treatment response to Finasteride for postmenopausal female Androgenetic Alopecia (female hair loss).

Read the full article: Study indicates Finasteride therapy may benefit women suffering from hair loss

This is a very positive early study from HairDX and the first I’ve seen which targets the post-menopausal women who have a high sensitivity to the effects of Propecia (finasteride). With that type of information, I would be willing to treat post-menopausal women with Propecia after they get the testing which predicts response.

Dr. Rassman,

I really can’t think of any other industry - medical or professional - that has a preeminent member so willing to directly interact with the general public. You do a great service (and a excellent technical execution of it with your website) and I wanted to start off by thanking you for your contribution. Imagine a world that had this sort of “hands-on” information from the most knowledgeable people available on other life and business topics.

Just a quick note - I recently turned 30 and marked my 6th year with Propecia. I’ve never had a single side effect, and I wanted to highlight your point about the internet being filled with the loud minority that have problems. Us folks with happy results tend to keep quiet and go about our business. I was certain when I started I would be bald by now, but happy to report a full head of hair - it really does dramatically stop the speed of genetic MPB. Good thing smart Doc’s like you are not afraid to stick up for it.

Cheers!

I’m glad the medication has been successful in maintaining your hair and I’m also pleased that you enjoy the site. I really appreciate emails like yours (we all like a pat on the back once in a while), so thank you for your kind words.

Good day Dr. Rassman, Great forum with lots of useful info. What is your position on prescribing Dutasteride? I believe in the past you’ve stated you wouldn’t, but I also thought I remembered reading a post where you said you might under certain circumstances. I’m 45 years old and have been on Finasteride for 7 years and have noticed the diminishing returns over the last year or so. I would like to try Duasteride but not without talking with a professional such as yourself first. I guess what I’m asking is, provided I meet your criteria, are you open to prescribing Duasteride? I would like to schedule an office visit with you so I could get your analysis of my particular situation. Great excuse to go to a Laker game.

Under the following circumstances, I would consider prescribing dutasteride before it is FDA approved to treat hair loss, but see the qualifier below:

1. It is a man over 40 years old and has had all of the children he expects to have.
2. Even better for me is if the patient had a vasectomy done to ensure that there will be no more children.
3. At least a year on finasteride with poor results or slipping backwards.

The qualifier is — realistic expectations, such that we develop a good doctor/patient relationship. It is important to note that your question itself is a problem, as I do not create rules for prescribing something that the FDA has not approved of. I created this above list under stimulus of this question. Some of you might think I’m crazy for the 2nd item in the list (vasectomy), but honestly, it is just a way to highlight to the patient that we’re not fully aware of all risks when it comes to this medication. The drug was FDA approved to treat the prostate, and while it may treat hair loss, the dosing and age criteria haven’t been established for prescribing it off-label. This is a powerful medication and it has been shown that the half-life of dutasteride is far greater than the current hair loss treatment of choice, finasteride (Propecia), thus the side effect risk is possibly also greater.

I’ll go into a little greater detail about this tomorrow… so please check back.

Hi Dr.Rass . I have been under OCD treatment for the past 11 years. I am undergoing SSRIs (Es-Citalopram oxalate) Would you recommend Finasteride in my case.

Shall I try topical minoxidil will it in any way interacts with my OCD medication.

I can’t recommend finasteride to you, since I do not know if you’re even a candidate and it is a prescription medication. Talk to your doctor about a prescription and you can learn his/her thoughts on it. As for minoxidil, that is over-the-counter so you can use it without my input (read up on it and use your best judgment). You shouldn’t have any interaction problems with your OCD meds and minoxidil, but without knowing which medications you’re taking I can’t say for sure.

There have been some reports of some mood / behavioral changes with Propecia, although these changes are very infrequent and it needs to be studied further. That is why you need to have a good relationship with your doctor.

How do you do the miniturization map of the scalp for a woman? I want to do it myself using your procedure with the small digital microscope.

Can you recommend a good hair specialist in the Boston area?

Yes, mapping the scalp for miniaturization is a good idea for women. Significant miniaturization in the fringe area (donor area) is indicative of diffuse unpatterned alopecia, which is more common in women and rare in men. Also, if your fringe area is normal (no miniaturization) and there is a pattern to your balding, then the alopecia is very different and if there is enough balding, transplantation may work.

Try calling doctors in the area and ask if they will map your hair for miniaturization. I know that Dr. Bernstein in New York does this for women, but if you want someone in Boston you’ll have to check the doctor search at ISHRS.org.

hey doctor, it seems everywhere (mainly hair loss forums) i read it’s saying that propecia is meant to just maintain hair and that any regrowth is an added bonus. But propecia’s website says in their 2 year study that 66% of men had visible regrowth. 2/3 sounds like the majority of people should regrow hair. furthermore the 5 year study says that almost 50% regrew hair. could u shed some light on this as nearly every forum i visit states that hair regrowth with propecia should not be expected.

I have seen substantial growth from Propecia, and even a complete regrowth in the frontal area once or twice in my years in practice. Regrowth in the crown is much more common and expected in men under 30 years old.

As for forums vs scientific data, well… let’s put it this way. If you got great growth, are you going to spend time on a message board letting everyone know? Probably not. But if you didn’t get the results you expected, you’ll be more likely willing to spend the time to warn people. So when it seems like a lot of posts say the same thing, its because it can be easily skewed.

Dear sir,

When I started on finasteride I noticed a very strange but rather pleasant side-effect: an increased libido. This makes sense since finasteride raises the levels of total testosterone; it is, however, contrary to the science literature, which commonly reports DECREASED libido as a potential side-effect.

Why do some men suffer a decreased libido when finasteride actually gives them more testosterone? Thank you and best regards

We really do not know the reasons for the increase or decrease in libido that some rarely observe after taking finasteride. The decrease is seen in 1-2% of men, and the increase is even more rare… so congratulations!

Dr. my hair loss started when I was 23. At that point I started researching my options. I’m now 27. My hair loss has progressed at slow pace (thank god). I tried propecia based on my research, a lot of which came from your blog. Right around the 3rd month I really felt like the loss at least stopped where it was at and if I would have kept taking it possibly could have had some regrowth. I was deployed to Iraq at this time. When I came back I came into your office for a consult. Where I saw Dr. Pak. My hair loss was determined to be I beleive the 4a pattern. (can’t remember for sure)

Anyway to get to the point. someone had pointed out to me that that my chest was getting kinda big. I definitly had some breast enlargement which I ended up having reduced by lipo suction. (Very happy with the results by the way incase anyone else has this issue) I’m not sure if the enlargement came from propecia or a combination of bad diet and heavy heavy drinking. My question is whats your opinion on me trying propecia again? and when there is enlargement from taking propecia is it fat deposits as mine obviously was or is it actual breast tissue like a female would have? As this could possibly answer where my enlargement came from propecia or something else. I am not sure how fast I got the enlargment. It could have been very gradual which is why i didn’t notice myself or maybe sudden when I was taking the propecia. I would really love to stop my hair loss. what do you think I should do?

Thank you very much for your time!

I would try the Propecia again and follow closely what happens. While it is possible you experienced gynecomastia from the medication, a poor diet with weight gain could also cause the same symptoms. I wouldn’t be able to determine if it was just the medication, just your weight gain / poor diet, or a combination of everything. I believe the medication (as rare as the side effect is) would cause the mammary glands to enlarge. This is mostly composed of fat, so it’s difficult to visually distinguish if the enlargement was caused by diet or medication. That’s one of the reasons I’m skeptical about a lot of the reports I’ve read on various forums. People might be seeing it, but it doesn’t necessarily mean it was Propecia.

Coincidences happen all the time. At least you recognize that. I’m glad your liposuction was successful, and if you’re in the LA area and would like to come in again, we can get a good baseline on your chest size before restarting the medication.