About     Contact     Archives     Videos     Events     Hair Transplant

Hi,
I’ve been having some pretty severe anxiety over potential hair loss over the past few months. I went to my primary care doctor, barber, and mother who have told me that I just have fine, blonde hair and a high forehead. I specifically asked if there was any receding or balding, and each said no. Hoping to get closure,n I went to a dermatologist that I randomly found on the internet. This dermatologist has only been in practice for two years, so I’m a little skeptical when he said I had early hair loss by running his fingers through my hair a few times.

That’s where this blog comes in. I feel you’re a pretty trustworthy source of information, and hopefully you can help. My primary doctor actually did bloodwork, specifically DHT and testosterone, and they came back fine. This dermatologist almost disregarded the blood test and said he saw things as a dermatologist that no other doctor would see. Now I’m not sure what to think. So I have to questions.

1. Can a blood test determine genetic hair loss?

2. Is it possible that I just have fine, light hair? It’s darker and a bit thicker around the sides, but my maternal grandfather has the same hairline and fine hair as I do, just looks a but thinner as his is gray.

It may also be of note that this dermatologist said I had mild hair loss, and then was somewhat eager to prescribe Propecia. He also assured me that once on Propecia, it would not stop working and I would be fine and keep what I had for the rest of my life.

Sorry for the long inquiry, but hopefully you can set me straight. Thank you in advance.

A blood test can determine a “probability” for genetic hair loss based upon your carrying of the gene, but carrying it does not mean that it will be expressed. More importantly, any good doctor can tell you if you have genetic hair loss without a blood test by simply mapping out your hair for miniaturization, which shows genetic effects well before the naked eye will show it.

Yes, it is just possible to have fine, light hair or just a high forehead that may look like hair loss. In any case this seems to bother you. If you want to find out more, see a hair transplant doctor who can see your hair under a microscope to see evidence of some pattern of balding.

Hello - I’m curious about the possible interactions or side effects between propecia and diflucan (fluconazole). Would diflucan hinder propecia’s absorption or cause it to become ineffective in any way? Also, how common is hair loss as a side effect to diflucan? Is it fairly normal? Thank you.

There are no interactions I am aware of between Propecia and Diflucan (an anti-fungal treatment). I do not believe it is common to have hair loss from Diflucan, and the medical literature lists that side effect as “incidence not determined”.

There was a small study from 15 years ago that looked into the connection, but I am unable to find any larger study or anything that definitively links Diflucan and hair loss.

Hi doctor, I was involved in a car accident four years ago where amongst much more serious injuries I lost a section of hair at the back of my head approximately one inch long and half an inch wide. Because of this I had to visit a hair loss specialist local to me who is an expert in trichology, she thinks it is alopecia but this hasn’t got any worse over the four years post accident.

Any way my actual reason for messaging you is that I asked her if I was suffering from any kind of male pattern baldness and after being examined she said that I am not balding nor displaying any type of MPB at present but it in all probability it is extremely likely that I will later in life which concerns me. I am 25 years old, my father has a full head of hair at 55, his father died at 89 with a full head of hair and my father has 6 brothers with full heads of hair. My mothers father died at 40 with a full head of hair. My mothers brother is 55 with a full head of hair. The only bald male in my family tree to my knowledge is my mothers uncle.

If I have a full head of hair now at 25 with minimal balding family history how could she say that in all probability I will go bald later in life? I have always had very fine hair and quite a high hairline but this has been the case since I was a very young child. Please reply!

Regards

Maybe your trichologist has a side job of being a fortune teller. Ask her to pick the winning lottery numbers for you!

If you have hair loss from a serious injury following a car accident, this is obviously not genetic pattern baldness, particularly in the area you describe. Simply looking at family balding history isn’t a way to guarantee whether you’ll keep or lose your hair (it can skip generations)… but even if it was, it would look favorably to you since hair loss isn’t common in your lineage.

I have no idea how your trichologist came to that conclusion, but I’d probably meet with an actual doctor if you’re worried about this. Most trichologists are not physicians.

Hi,

I had been on propecia for 5 months and after suffering from a lack of erection I talked to my doctor and told him of my fear of being on this regime. We decided best that I shall have a hair transplant once it gets really bad.

I would like to know - if after hair transplant the patient MUST take propecia ? What will happen if the person does not take that pill. Will it cause the transplant operation to fail ? Could you shed more light on taking Finasteride after a hair transplant o/p ?

Thanks

Taking Propecia either before or after a hair transplant means simply that the hair loss will slow and possibly stop. If you do not take it, then whatever is normal hair loss for you will happen on your genetic clock. Shock loss seen in young men who had a hair transplant and are not on finasteride, just means that the hair loss process accelerates from what it might have been without the drug.

Propecia isn’t a requirement following a hair transplant, but you’re running the risk of the transplant causing accelerated hair loss around the transplant area, basically leaving you with a similar thinning problem following the surgery. Talk to your doctor about possibly cutting the dose if you’re considering a transplant.

Hello Doctor,
I am a 30 year old male who has been taking propecia and/proscar (2 months propecia and 10 months 1/4 proscar) for a year. My partner who is a physician first noticed my hairloss when I was sitting down about a year ago. It is only in the Crown, so I was a bit shocked because I could never see it. I went on the medication and within a few months my partner noticed an improvement (looking back at pictures, I had been thinning in the crown for at least five years before). I also tend to blow dry the spot as it fills the hair out more and is barely noticeable.

Questions
1. At about 11 month mark, I noticed about 5-7 hairs on my pillow in the morning of mainly longer length (about two inches). I’ve also noticed that when I shampoo my hair in the shower on the top back, I have about 5-10 hairs come out. They are longer but not super thick - I don’t have really thick hair anyway. Does this fall under the definition of “shedding”?

2. If so, is it a sign my genetics are overtaking the medication?

3. I’ve been under a lot of personal stress over the past few months as well, the weather has gotten considerably warmer and I haven’t been storing the cut proscar properly (just realized this) - I’ve been cutting like 6 pills and leaving them cut in the pill cutter in the cupboard (no pregnant women or children nearby), could this be impacting the effectiveness?

Thanks

Stress does accelerate hair loss, and improperly storing your cut Proscar pills could limit the drug’s effectiveness. You need to have a good relationship with a doctor you can trust to answer your questions. Hair loss does, at times, accelerate. The drugs do not always work to stop the loss and that is why you need a good doctor who can perform a miniaturization study, get a baseline on the loss process with a measurement he/she can compare as finding like yours appear without explanation.

If you’re seeing a few hairs here and there, that may reflect normal hair cycling, not frank hair loss.

Hello Dr Rassman,

Thank you for your amazing blog. I would like some advice from you.

I started Propecia months ago. I am often tired, have headaches or stomach pain. My doctor said to me that I should take some Magnesium chloride daily. He said that it removes “bad material” of your body. Does this treatment represents a danger for my Propecia treatment?

Thank you for your answer

I have not heard about these side effects from Propecia from any of my patients (though I’ve received some emails about this over the years). If you believe that these pains are from the medication you can always stop the drug for a week and see what happens. Perhaps you have an allergy to finasteride or a filler ingredient that is causing the problem.

As for magnesium chloride, I have no experience on the use of this.

Happy birthday, USA! It’s BBQ and fireworks time, so to celebrate July 4th we’re taking a long weekend.

We hope everyone has a happy and safe 4th of July! We’ll be back here on Tuesday.

Hello,

I have some questions. I am a 36 year old female who has had hair shedding since my 20’s (my dad lost his hair at 21). I have all the signs of androgenic alopecia. However, I use to have alot of hair so it didn’t cause me much concern until the last few years. At the age of 30, I lived overseas and took the Birth Control Pill, Diane 35 which was wonderful for hair, but when I moved back to the US I stopped it since it was not available here. 3 weeks after I stopped, I noticed a large amount of increased shedding that went on for months until my thinning was very noticeable. I tried 2 % Rogaine and saw even MORE excessive shedding. I lost a huge amount of hair and it was very noticeable and devastating. Finally, I was able to stabilize my hairloss with 100 mg of spironlactone and have been on it for a year. I started also using 5% rogaine after stabilization and I also saw an improvement. I was basically content.

Well 3 months ago, I took Plan B the backup emergency contraceptive. 3 weeks later, I started noticing a large increase in shedding again. This time I was on 100 mg of Spirolactone and it didn’t stop it (I even saw myself develop acne.) I tried 5% Rogaine to only see my hair fall out even for excessively like before. My doctor has now put me on Propecia. I am worried about this “hyperandrogenicity”. I do not have much hair left and I hope the propecia does not make it worse since I am obviously going through some type of “withdrawal” from the hormones in the birth control. However, nothing seems to stop this withdrawal anymore. I’m very worried and sad. Any feedback would be very helpful.

Thank You

Your treatment plan doesn’t make complete sense to me. I don’t follow why you are taking all these medications and doing what you are doing.

Lets start with the facts:

Hair loss from Plan B (progestin) is a less common, but known side effect (see here).

Rogaine can cause initial shedding which scares people into stopping the medication. If you continue on with Rogaine the shedding will eventually stop and hair will grow. 2% Rogaine is same as 5% Rogaine — the only difference is the concentration. So I don’t understand why you would say you lost so much hair on 2% Rogaine then started 5% Rogaine to have the hair loss stabilize. Then later start the 5% Rogaine and have more hair loss. Maybe you are not using the medication correctly. Once you start the medication, you need to use it for life. If you stop it, the hairs that grew or the hair that were stabilized will fall out. And if you restart it, you risk the initial shedding (the way you saw with the 2% Rogaine a long time ago) all over again. Could the Rogaine be working for you, but you aren’t using it consistently?

Spironolactone is a blood pressure medication that has an effect on blocking androgens, but it has never been proven to grow hair or slow down hair loss unless you had an excess of androgens like women with polycystic ovarian disease (PCOS). I realize many patients use it and doctors prescribe spironolactone, but I would need more information on your hormone analysis. If you are using Rogaine and spironolactone, how do you know which is working or not?

Finally, Propecia only works for androgenic alopecia (more specifically, hair loss related to DHT hormone). I do not know if you are one of the very rare women who have male pattern baldness, and even if you do, I do not know that Propecia would work for you. Regardless, Propecia is NOT recommended for women because it can cause birth defects if you are or may become pregnant. I see you are of child bearing age, and you are obviously sexually active (as you had to take the Plan B “morning after pill”). I personally would never recommend Propecia to young women who can get pregnant. If you must take it, you need to be on a birth control pill, but this is something you and your doctor need to talk about.

Unless you have strong male features, I would think that hyperandrogenicity would not be something you should worry about. My point being that hair loss is not the only symptom of hyperandrogenicity. But that’s just my guess.

You have a complex problem and even the cursory discussion I gave here will not really help you. You need to have a doctor who is focused on hair loss and if your doctor has such an interest, then you need to know why he is doing what you described here. Sometimes, hair loss is self limiting and whatever you are doing or NOT doing may or may not stop the hair loss.

My final thought is you should see your doctor for a good diagnosis and a comprehensive treatment plan.

Snippet from the article:

Rick Scott might have a glaring liability in his quest for the governor’s mansion: his hair. Or lack thereof.

Scott, a Republican businessman, would join a small club in American politics — as just the fifth bald governor currently in office. He’s also vying to be the first hairless head of the state since Florida became one in 1845.

Read the full story at Sun-Sentinel.com– Is hair a factor in Florida governor’s race?

This question comes up during every election cycle, and we’ve talked about it a few times before… though usually about world leaders. The candidate with the better hair always seems to have the upper hand. At least Rick Scott’s campaign seems to have a good sense of humor about it, based on the quotes his spokespeople have given (see the article).

For past political balding talk, see:

• Bald Presidents and Prime Ministers
• Americans Haven’t Voted a Bald President Into Office in 51 Years

Hi Doc.

I would appreciate your views in relation to whether it would be worth trying medications like minoxidil, finasteride to regrow all or some hair back after the hair as be absent as in a fully blown NW 6-7 for twenty years? If you could fine the time to answer, i would also appreciate it if you could advise if the answer is on the blog or a personal reply. Many thanx

Some men who are a Norwood Class 6 or 7 pattern of hair loss will have fine hair along the upper edge of the hairy area which may not have completely fallen out, but may in the future. Those individuals may be helped by some medication, but I would have to see you to make that determination.

This is not a question that can really be answered without an exam, except for a general hand sweep, but if you want a specific issue addressed you need to see a good doctor.