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Hi Dr Rassman,

I have been writing to you for the last 2 years about my hair loss and contributing factors.

I took your advice and had my hair looked at under a microscope by a FUE specialist in Glasgow, he confirmed that my loss was most likely due to my dermatitis and that i was not showing any signs of MPB apart from some slight recession that can be expected at my age. He told me that he didnt recommend using Rogaine as it might aggravate my dermatitis that is pretty well under control at the minute. I have also been told there is chance that my hair isnt regrowing due to my on going health issues.

I have high levels of prolactin that can suppress, IGF-1 levels and that IGF-1 is important in hair growth. Can you confirm that this could be possible ?

Also would you be able to recommend a safer Hair Growth Stimulant for someone who is needing to battle DHT but just needs something to help recover hair without irratating my Dermatitis ?

thanks

I do not know what more I can say or contribute. It seems you are under the care of a physician and you are doing well. It’s not that I don’t want to help, but please understand that I can’t give personalized medical opinions online. Despite how accurate and descriptive you may be I cannot diagnose or give a treatment plan. I can just give generalized personal opinions… and some bulletpoints:

1. Dermatitis shouldn’t cause hair loss.
2. I’ve written about prolactin here.
3. I agree that Rogaine could aggravate the dermatitis (I’ve written about that here), but it doesn’t block DHT.
4. Finasteride (Propecia) is an oral pill that does block DHT, but if you’re not showing signs of MPB I don’t know what you’re trying to treat.

Snippet from the article:

A lock of hair cut from Napoleon Bonaparte’s head after he died has sold for US$13,000 at an auction in New Zealand.

Extra phone lines were installed for the sale to cope with an expected rush of international buyers seeking to snip up the hair cut from the head of former French Emperor a day after his death in 1821 while he was in exile on the island of St. Helena.

The circle of hair was part of a collection brought to New Zealand in 1864 by Denzil Ibbetson, a British commissary officer and artist.

Read the full article at Reuters — Lock of Napoleon’s hair sells for $13,000

I don’t remember a lock of hair being sold for so much before, but I guess this proves that there’s a market for everything.

I have been diagnosed with Pityriasis lichenoides chronica which I have had since I was 15. About the same time my hair started thinning. I am now in my mid 30s and I have general thinning (no hairline recession) from the crown to the front. Both sides and the back of my head is fully thick. I have started propecia and minoxidil.

Is there any connection between the PLC and my hair loss?

I have no personal experience with pityriasis lichenoides chronica (PLC), but as I understand it, there’s not much known about the condition. How it relates to hair loss is unclear. For those readers that are curious, PLC “is characterised by the gradual development of symptomless, small, scaling papules that spontaneously flatten and regress over a period of weeks” (source: DermNet NZ).

What I do know is that the most common cause of hair loss in men is genetic male pattern baldness (MPB). It occurs in a pattern from crown to front as you describe, leaving the hair on the sides and back “fully thick”, as you also describe. It could be possible that you have PLC along with MPB and the two are unrelated.

It seems you need a good diagnosis and you cannot get that here on the Internet. You need to find a physician who can examine you and give you his assessment. A miniaturization study may be helpful as well and may point to the association of genetic male patterned hair loss if that is also present.

I’m 22 years old and so far looks like I have began to thin. Funny thing is about 2 years ago My hair was super thick like horse hair and there was plenty of it. I decided to straighten my hair and I did then I did it a week right after the first straightening myself. I’m curious If that could of caused my hair to thin out over the 2 years cause after the straightening it, like a month in it started to shed, but slowly. Currently it stopped shedding completely and just stays on my head.

Now My 2 older brothers who are 33 and 28 have thick head of hair and I’m 22 I mean I’m hoping that I don’t go bald before they do cause at this rate It looks as though I am. Seriously bugs me need to figure out my problem…

Chemical straightening is not the cause of hair loss in general unless you burned your scalp. Either way, after two years it is hard to correlate if chemical straightening was the cause. Perhaps it was a coincidence, but I really cannot say! It’s also entirely possible that your older brothers got “lucky” and the hair loss gene didn’t get passed to them, as it can skip generations.

Since the hair loss really bothers you, I suggest you see a physician and get a good examination. You’re not too far from my Los Angeles office if you’d like to make an appointment (the consult is free). You can call my office at 310-553-9113 if you’re interested.

I have been consistently taking propecia for 3 months and starting noticing sexual side effects one day away from completing my first 3 months of consumption of the drug. Obviously, that was the same day that I stopped taking drugs. It’s been four days since I have stopped taking the drug and I want to know if the “no erection” (erectile dysfunction) sexual side effect of propecia will go away, and how long does it take for propecia to get out of my body?

Thanks in advance for your help

Propecia (finasteride 1mg) lasts about one day in your body. The half life (the time it takes for half of the medication to be cleared by your body) of Propecia is about 4 to 6 hours. Some have said there are still traces of Propecia that are left that can linger for about one week in general, thus the side effects should be dissipated by one week timeframe.

On a separate note, having a side effect appear after 3 months of consistent use is fairly rare and there are also other possibilities of sexual issues. These things can be discussed with your physician. Good luck.

It seems like you have prescribed 1.25 mg of Finasteride (Proscar cut in fourths) to many people who were previously taking 1 mg Propecia. Have any of these people expressed concerns of temporary increased shedding after this switch? Do you believe that its possible that such a small increase in Finasteride could be the cause of increased shedding?

I was taking Propecia for approximately 15 months with great results. However, I am now experiencing shedding that began approximately three weeks after making the switch from daily 1 mg Propecia to 1.25 mg daily generic Proscar (from a reputable pharmacy). It seems unlikely that such a small change could increase effectiveness of the drug, and thus cause shedding.

Of course, I am aware that the effects of progressive hair loss very well could be the culprit of my sudden shedding…

Thanks for your time.

I randomly get these questions and reports from my patients, but I do not see any pattern or change as patients switch from brand name Propecia (1mg finasteride) to the 5mg generic finasteride split into four pieces. It is very difficult to pinpoint and establish a direct relationship, as most patients are very happy with the cost savings and same effectiveness of the medication.

I have been losing hair since I was about 17 (I am now 23), and I’m confused as my hair loss seems to have characteristics of both DUPA and typical MPB.

For example, I have a receding hairline and a small bald spot at the vertex - typical of MPB. However, I also have general thinning on the crown, forelock and down the sides and back of my head. Is it possible to have a receding hairline with DUPA? I was under the impression men with this kind of hair loss retained their hairlines.

If you have the gene for male pattern baldness (MPB), the expression of the gene will dictate when the hair loss starts and which balding pattern that you will evolve into. In most people, the frontal loss starts at the leading edge of the frontal hairline, but a few people will keep their frontal hairline while they lose the hair behind it. When it comes to those with diffuse unpatterned alopecia (DUPA), the loss of the hairline as you describe is possible.

Here’s an excerpt from a paper published in 1997 referring to DUPA that may clarify: Diffuse Unpatterned Alopecia patients have a similar progression of balding as the DPA [diffuse patterned alopecia] patient except that the progression is often more rapid and will more likely eventuate in a “horseshoe pattern” resembling the Norwood class VII, except that in contrast to the Norwood VII, the DUPA “horseshoe” can look almost “transparent” due to the low density.

The hair on the sides and in the back of the head (a 3 inch high part of the scalp that starts at the body prominence of the skull aka the “horseshoe pattern” mentioned above) is looked at as permanent hair in most men. In the diagnosis of DUPA, this permanent zone has miniaturized hair in excess of 20%. The higher the miniaturized hair count in the permanent zone, the more difficult it will be to get enough good healthy donor hair for a hair transplant.

Women have what looks like DUPA in that same area and also often throughout the head. This makes most affected balding women poor candidates for hair transplantation.

Doctor,

I had a hair transplant in July 2009. The physician completely re-constructed my anterior hairline. There was no hair growing there before he transplanted some. In September of 2009 I began monthly injections of 1ml of testosterone. I noticed my hair really filling in from the transplant until about 6 months ago. Since then I have noticed a definite thinning of my hair including the reconstructed frontal hairline which was exclusively transplanted hair. Is it possible that the testosterone treatments have caused the transplanted hair to fall out? I have been taking 1mg of Propecia religiously since the transplant, but it doesn’t seem to be making a difference. Thank you.

It is possible that the testosterone impacted the transplanted hair and almost certainly may have impacted the native hair that is present. If the hair transplants are falling out due to the testosterone injections, it might even suggest that the hairs used in the transplant didn’t come from the donor area (permanent zone in the back of the scalp). You need to discuss this with your surgeon, as he has the insights into your case and I only know what you told me above.

I realize you indicated that you’re not in the Los Angeles area, but if you make it out this way I would be happy to examine you.

I’ve been looking at different types of minoxidil and again there seems to be the branded version of rogaine which is about £35 for 3 months, but also another brand called kirkland which is about half the price, is there difference however?

Many Thanks

There should be no difference. Rogaine was the heavily marketed version but once the drug went generic after the patent expired, Kirkland (Costco’s house label) and other brands were able to come out with the same product under different names. Thus, cheaper pricing.

This is why there is now a Rogaine Foam (which is under patent protection) and why you don’t see generic minoxidil foam available.

Dear Sir,

I have psoriasis and may be it has caused some hair loss. I would like to know if I conduct hair transplant on the affected area can the hair grow there or the skin become worse?

I too have psoriasis and had a hair transplant twice. The psoriasis did not impact the hair transplant or vice versa. I wrote about this very topic in one of my earliest blog posts way back 5 years ago — Scalp Psoriasis and Transplants.

It’s worth noting that I doubt the psoriasis caused your hair loss unless you picked at your scalp and developed traction alopecia.