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Dr. Rassman I have an odd question for you. I plan to have a hair transplant with you in the near future. Playing devils advocate here, let’s say that hair cloning is a viable option in five years and the demand would be great.

Would having a prior surgery with you give me an advantage of getting this procedure done sooner? (i.e. cutting in line)

Thank you for your time.

First and foremost, having posted over 8000 questions on this site and answering some real doozies, I don’t think yours is all that odd.

Hair cloning just means there will be more hairs available for transplantation and you will not be limited to the donor hair. With respect to priority, our surgeries are scheduled on a first-come, first-served basis… but when it comes to procedures done with hair cloning, it’s all hypothetical at this point. I’d like to hope that in 5 years from now we’ll be transplanting with cloned hair, but that remains to be seen.

We look forward to seeing you!

Greetings Dr. Rassman. I just would like to know why most MPB only occurs on the top of the head(meaning frontal, top and crown area) and not on the sides?? What is the difference of the scalp on top of a male’s head and the scalp in the sides?

There is no clear answer as to why the hair only falls out at the front, top, and crown. The reality is that the fringe seen in the Norwood Class 7 pattern is permanent hair that is never lost in 99+% of men with male pattern baldness.

My father start to lose his hair at 45 and my uncle at 35-40, and no grandfather have hairloss problem. I have 21 now and for 2 years i’m fighting to keep my hair with avodart, kirkland and some vitamins named forcapil, but this seems that not work very well for me. Why i begin to lose my hair at 19 if my father start to lose at 45. I can make something else for my hair?

Family patterns do not necessarily follow either by the degree of balding or the onset of balding. Sometimes they can be used as a guideline, but it’s not a guarantee. So why did you start losing hair at 19 years old? I guess you can attribute it to bad luck.

You’re young with early hair loss and you’re using multiple treatments. Let’s break down your regimen:

Avodart (dutasteride) — I assume you don’t have a prescription, as I’d expect most doctors would not prescribe this strong prostate medication to a 19 year old with early hair loss. Avodart is not approved to treat hair loss at this time. Although there is evidence it works to treat genetic hair loss, most doctors would not be comfortable prescribing this until at least dosing and safety data is available. If you do have a prescription, you should be talking to your doctor about this.

Minoxidil (I believe this is what you meant by Kirkland) — This is fine, but I don’t know if you’re following the dosing instructions. Apply it twice a day to the area that you’re losing hair. If you’re losing hair in the frontal hairline, it probably won’t be much help there.

Forcapil (vitamin supplement) — Their site describes it as a “special formula combining vitamin B complex, sulfurated amino acids, zinc and vitamin D3“… which means if you’re taking it with hopes of regrowing your hair this is probably a waste of time and money. I hadn’t heard of Forcapil before, but it appears to be made by a French pharmaceutical company and not sold in the US. I found the dosing instructions are to take 6 pills a day for the first 2 weeks, then 2 pills a day for the next 6 weeks… so I hope you enjoy taking pills.

Hi doc! Thank you for your excellent and informative blog! I’ve been hearing things recently about using the very potent aromatase inhibitor anastrozole to prevent the ‘estrogenic’ side effects of finasteride. Anastrozole drastically reduces estrogen levels in men and, unsurprisingly, raises free testosterone as well. Would you be comfortable with one of your patients adding anastrozole (’Arimidex’) to his propecia regimen, or would you see this is opening up a whole other ‘can of worms’, and potentially serious side effects?

Arimidex (anastrozole) is a anti-breast cancer medication for post menopausal women. There are no clinical trials in men. You would basically be experimenting with your body without any knowledge of the consequences. I would recommend against this. Especially since I’ve seen the complaints/worries people have about side effects from Propecia, you would be just adding fuel to the fire.

According to the Arimidex website, some of the most common side effects seen with the drug include, “hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache”. Also, a less common side effect of Arimidex is hair loss.

I have quite a lot of hair in my neckline. The hair is thick and straight, which makes me wonder whether it could be transplanted to my head. I have already had 1000 grafts via FUE, and I see the diffuse pattern from the FUE transplant whenever I trim my hair very close to the scalp. Using neck hair seems like a way to augment the donor pool, but I don’t know how receptive the scalp is to that type of hair and whether FUE performed on the neck would leave visible scarring. What do you think?

Neck hair is not considered “permanent” like the hair on the back of your scalp. There is a chance that as you get older your neck hair will fall out, so if neck hairs were used for a hair transplant it would also fall out. This is what makes neck hair not ideal for transplantation.

In addition, as you clearly have found out, follicular unit extraction (FUE) still produces small round punctate scars. So if you have a FUE procedure to the hairs on your neck you will definitely see the same type of scarring, which would be more difficult to hide.

In non-hair-loss news:

Dr Annelieke M Roest (Tilburg University, the Netherlands) and colleagues performed the first-ever meta-analysis on the association of anxiety with the incidence of CHD in initially healthy people, using data from the US, Europe, and Asia. Even after multivariate adjustment, anxious people had around a 25% greater risk of CHD and an almost 50% higher risk of cardiac death over a mean follow-up period of 11.2 years.

In the second study, almost 50 000 Swedish men who were medically examined for military service and followed for an average of 37 years were assessed by Dr Imre Janszky (Karolinska Institute, Stockholm, Sweden) and coworkers. Depression was not a predictor for subsequent coronary disease, but those with anxiety disorders—as diagnosed by a psychiatrist—were twice as likely to suffer CHD or acute MI, even after adjustment for baseline confounders.

Read the full article — Anxiety predicts heart disease years later

The meta-analysis combined the results of 20 different studies with nearly a quarter of a million people (it mentions that in the article, but I wanted to highlight it here). It remains to be seen if treating anxiety will also treat heart disease, but I’m sure studies about that will be taking place soon enough.

Hi there,

Thanks for this blog it really is so helpful to many of us! I am 24 and definitely going bald, all the men in my family on both sides have MPB. Although I am going bald, at the moment I am hiding it pretty well with what I have but it’s getting to the point where I can’t hide it any longer, so I plan on going on Finasteride in the hope I can conserve what I have.

My only concern is that I have heard some awful stories about Finasteride actually causing an initial shed, or at least worsening the hair loss before it makes it better. In your experience have you encountered this with patients? Although I am determined to put a stop to it I would be devastated if taking Finasteride made my problem rapidly worse even if it would help in the long run.

Thanks for your time.

I have not seen patients in my practice who shed hair after starting Propecia (finasteride), though I have seen patients who shed initially after starting Rogaine (minoxidil). I’ve also seen patients who continue to lose hair while on Propecia, but it may just be regular genetic balding that is outpacing the medication itself. I really haven’t seen a case where someone has accelerated hair loss after starting Propecia. Either way, both medications do help most men in treating their hair loss.

If you are worried about these issues, please discuss them to your prescribing doctor. When you take ANY medication or partake in ANY medical treatment, you need to consider the risks and benefits and understand why and what you are treating. Just being scared will not solve any problem without a good solid assessment of what you are trying to do.

Here are some recent past replies about finasteride shedding, if you’re curious:

• Propecia Shedding Indicates That It’s Working?
• I Feel Propecia Has Dramatically Increased My Hair Loss
• Propecia Shedding Started After 6 Months

Snippet from the article:

A product promoted to parents of children with autism is not a harmless dietary supplement, as claimed, but a toxic unapproved drug that lacks adequate warnings about potential side effects, including hair loss and abnormalities of the pancreas, the U.S. Food and Drug Administration has warned in a letter to its maker.

The FDA’s June 17 letter to Boyd Haley, a retired Kentucky chemist and hero to the autism recovery movement, details five violations of the Federal Food, Drug and Cosmetic Act related to his product, OSR#1. Failing to correct such violations can result in fines, seizure of products and even criminal prosecution.

The Tribune in January reported that the compound, sold as OSR#1, had been developed to treat mining wastewater, and that it had not undergone rigorous testing to ensure it is safe and effective. The report was part of an investigation into unproven autism therapies offered by health providers who say they can reverse the disorder.

Read the full article at the Chicago Tribune — FDA warns maker of product used as alternative autism treatment

Wastewater treatment turned unproven autism therapy? Wow. Just wow.

When the Tribune first broke the story about this industrial chemical (sold as OSR#1) being fed to autistic children, the maker of this “supplement” stated that it was tested on 10 people before being sold to the public, yet provided no proof of even that much. You can find that earlier report here.

Greetings Dr. Rassman,

I am a very happy patient of yours. (Background: I’ve had two procedures and am taking Propecia.)

I wanted to pass along the information below. Perhaps it would be useful for your blog. I was flying the other day, and in the airline magazine, there was an article on preventing cancer that mentioned finasteride: “Dr. Peter Greenwald, director of the Division of Cancer Prevention at the National Cancer Institute in Bethesda, Md., notes that the drug finasteride could prevent about a quarter of prostate cancers from ever developing.”

Full Article: Pursuing Prevention

Best regards

Thanks for sending this. The information about finasteride reducing the incidence of certain prostate cancers is correct, but that study is based on taking 5mg of finasteride daily (Proscar, a prostate treatment). I’ve actually been writing about this for years. Propecia is 1mg finasteride and you cannot establish an exact parallel, but the inference is there.

Many experts, however, feel that the 1mg dose may have the same impact as the 5mg dose, but without proof, one can not state this as a fact. The reference to Dr. Peter Greenwald is correctly stated, but the dose was not in the quote offered.

Dear Dr. Rassman,

I understand the debate regarding the appropriate dosage of finasteride to be taken seems to have no end. I am currently taking 2.5mg (half proscar since 3 years ago where Propecia stopped working as well), so far so good. I would not say propecia stopped responding, but more of my genetics are catching up. Anyway, by upping to 2.5mg , hairloss has stopped drastically but still very gradually.

My conclusion is that, any amount of finasteride is better than none when it comes to fighting hair loss. And according to scientific results, 1mg vs 5mg has similar effects on hair loss prevention. Therefore 2.5mg should be a safe and worth-trying dosage provided no major side-effects are present. Hence, I think its ok to recommend to people who has stopped responding well to propecia to try 2.5mg (half proscar), even though there is no guarantee that it might work better - ultimately, any finasteride is better than none?

Thank you for your thoughts. In general, more does not necessarily mean better and the recommended dose of finasteride for the treatment of male pattern balding is 1mg a day. As always, please discuss your treatment options with your prescribing physician.