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Dear Dr Rassman,

I’d like to ask a question on dust mites. I recently came down with an itchy scalp particularly in the crown area, causing me to scratch during the night. My hair began to look a little thin in that area. I’d had some stress-related hair loss problems in the past and worried it was related.

I then came to think I had head lice and so treated myself for it by combing through the hair with a lice comb almost daily. This eased the symptoms which seemed to confirm I had lice.

However the itching came back and now I think it is caused by dust rather than lice. I have a very small room with electronic equipment which attracts dust, and I had a large fan right next to my bed for the summer heat which I used during the day and overnight, which on inspection was extremely dusty.

My question is, can prolonged contact with dust cause itchy/irritated/dry scalp due to dust mites? Can this also cause hair loss? Or could it be excessive combing with a fine lice comb that could damage follices?

Thank you

You shouldn’t treat yourself without knowing what you have. You need a diagnosis before jumping to conclusions. So far you blamed lice and dust mites without knowing for sure — what’s next? At the least, you must keep a very clean environment where you live and wash your linens often. Perhaps you need to see a good doctor for a diagnosis, as a doctor will be able to find the mites or lice that you think you have.

I suppose if you were constantly scratching or pulling at your hair you could create some hair loss in those areas, though the hair loss is not directly caused by mites or lice.

Could Finasteride cause an increased level of red blood cells in a person’s urine specimen?

No.

Red blood cells in a urine specimen is abnormal unless you are a woman having her period and the urine got contaminated. There are MANY more plausible source of blood in urine not related to drugs that you need to know about. Meet with your doctor — maybe you have kidney stones, a kidney or bladder infection or kidney cancer, amongst other diseases.

Hello Dr,
First I would like to thank you for your great blog which is extremely helpful. I am a medical school student and I was doing some research on the documentation of Merck for approval of Propecia. Some data which was submitted to FDA brought my interest toward these documents. [Link: PDF file]

As you can see in the link above there are some figures regarding the DHT in scalp as well at T serum. I can see clearly that 0.05mg of finasteride would significantly lower T and DHT levels in scalp while this dosage does not effect the hormone levels as much in the rest of the blood (although the numbers are lower for 0.05mg,but still they are very close to 1mg and look very effective). Now my question to you is that why aren’t we using 0.05mg dosage instead of 1mg? 1mg finasteride seems to lower DHT and T levels a lot more in the blood which causes uncomfortable side effects; and we also know that once we lower 1mg to 0.5 (half a pill) or 0.25mg the side effect tend to subside, so we do know that the side effects of finasteride are dosage dependent.

Also I would like to add that I am at one of the UC system medical schools and we have been running and experiment on MPH sufferers and so far (within 1.5 years of our study) we have been successful up to 88.5% to get the same results of finasteride 1mg by using 0.2mg dosage on 749 men. unfortunately I am not allowed to release more information about out experiment, but the results are very convincing and our study will continue for another 3-5 years on these patients.

Thank you

It has been known that a 1/2 dose of Propecia (finasteride 0.5mg) and even 1/10 dose (finasteride 0.1mg) showed efficacy on androgenic alopecia. I am aware of the study you’re referencing, and we’ve written in the past about how the 1/2 dose of Propecia is about 80% as effective as the full dose. So I believe your study! I do wonder why your school would be conducting a study that has already been published and established or why you would not be able to publish your results. I must not have all the story here.

I would say in the real world many patients with side effects elect to take 1/2 dose Propecia and see benefits for their hair. It is my understanding the 1mg finasteride was chosen for Propecia to give maximum benefits for a wide percentage of the general population while maintaining the lowest side effect profile balance. You said yourself, 88.5% get same results on 0.2mg finasteride. Maybe Merck wanted that number a bit higher for the general public.

I would be curious to know the reduction in side effects from 1mg to 0.2mg. If the reduction was not significant then I could understand why a drug company would choose the 1mg option. I do not know if this is what really happened, but it is my speculation and logical guess. Perhaps you should find this information or add it to your experiment/research and publish the data. Good luck!

have had significant hair loss on risperidone and lithium. dr. has me on citalopram(celexa) and geodon. hair is still falling out!

what can i take for bi-polar that won’t make my hair fall out? please help!

Balancing medications for bipolar conditions can be difficult. This would take priority over the hair loss issues, but your doctor may be able to substitute one med for another if they may feel a particular medication is causing your hair loss.

Lithium, risperidone (Risperdal), citalopram (Celexa), and ziprasidone (Geodon) can all cause hair loss according to the medical literature. With that said, hair loss is mostly caused by genetics, and although medications can be a cause it is generally rare. I’m not suggesting the medications aren’t playing a role in the loss, but at the least, you should have an examination by a physician to find the cause.

In other words, you need a diagnosis before you go about thinking of a treatment plan.

Dear Doctor

I am a 22 year old South Asian male dealing with rapid hair loss. I have a large bald spot on my crown along with a receding hairline. I currently use Dermatch in my hair as a cover up but there seems to be a problem. I read in one of your posts that you shouldn’t scrub the scalp hard when getting rid of the dermatch, my problem is that if I don’t scrub there will be a residue left over.

I current use the Hair Club for men Shampoo, but I was wondering if you know of a good shampoo/conditioner to use to get rid of the dermatch without damaging my existing hair. My problem is further constricted by me having dandruff and that I put on dermatch everyday and shampoo my hair likewise. If you could give me some advice I would greatly appreciate that

Thank You

I don’t know of a particular shampoo that works better than any other to remove DermMatch. In other words, any shampoo should do. Just wash thoroughly. I double checked with the DermMatch website and it basically says the same thing.

Vigorous scrubbing will pull out already weak hairs, but a gentle wash (even gentle scrubbing) should not make your hair fall out any more than usual.

I have a question about Vitamin K. Since it helps with blood coagulation, would it be OK to take it before and during a hair transplant procedure? My platelets have always tended to run a bit low, which has made previous surgeries last a bit longer than they should. Thanks, and you are still doing a wonderful job with the blog!

I do not think taking vitamin K supplements would help with a hair transplant surgery. Blood coagulation is not as simple as adding a vitamin. Please ask your doctor to address your blood coagulation and platelet issues. Do you have von Willebrand disease (vWD)?

As one might assume, I receive quite a few emails each and every day from prospective patients both through my NHI site and this blog. It seems that everyone knows the Norwood patterns of hair loss (that’s a good thing), so these emails fundamentally focus upon identifying where the person believes his hair loss is on this chart and asking how much it would cost to get a hair transplant.

For example, Joe Doe says he is a Norwood Class 3 and asks if I can tell him how much a transplant would cost to give him back his hair. Wouldn’t it be nice to be able to have a formulae that determines the costs of a Norwood Class 3, 4, 5, 6 and 7 pattern of hair loss? Like five price categories that fit all needs, or like a compact car to a full size car that you might rent from AVIS. These naive men, unfortunately, do not understand that the variables in determining costs reflect the weight/thickness of the hair shafts (finer haired men will frequently take more surgeries to accomplish the same goals as a coarse haired person), the character of the hair (the curly haired man will take less hair transplants to cover his balding area than the straight haired man), the contrast in color between the scalp and hair (the blond haired man with white skin will require less transplants than a black haired, white skinned person), the density of the donor hair, and the available supply of donor hair that meets the needs of the various classes of hair loss. Do all Class 3 patients have the same need? Of course not! Some can get their hair back in one surgery while others may take two or more procedures to achieve their goals.

Unfortunately, the hair transplant industry seems to have gone into commodity pricing and at least in the pricing process, the prospective buyers are demanding that the doctors’ bid on the cost of the surgeries, the costs of the grafts, or even the cost of each transplanted hair that the doctor will move around. Does commodity pricing really give the buyer something of value to compare what they are going to get?

I have said here before that buying a hair transplant is not like buying a car. A BMW or a Chevy is a BMW or a Chevy in any dealership that you would go to, because the cars have consistent quality from one dealer to the next. Manufacturing is done off-site in Detroit or in Japan or Korea, so one model in any one brand is identical to the other. In hair transplantation surgery, this is not the case. A certain number of grafts for a specific balding pattern will not give you the same results between doctors, because of the art and the experience in doing these surgeries. I have seen more hair transplant failures recently coming into my office than I can remember. What problems I saw 15 years ago were often mutilations caused by poor techniques, plugs, and/or inappropriate surgeries like scalp reductions. Today things have gotten better with far fewer mutilations, because almost every doctor seems to be “pitching” the same surgery, the follicular unit transplant technique published by us.

I am 25 years old and, for the past several years, I have had a mature hairline (rather than a juvenile hairline). But, there is no evidence that i am going bald elsewhere. If, in another few years, I appear to not be going bald, I am wondering if repairing my juvenile hairline would be an option, to make me look like I did as a teenager?

I really don’t mind - Bill Clinton, Ronald Reagan, a lot of movie stars, Asians, etc. - all have/had juvenile hairlines and it looks great on them. Would this be a possibility?

Thanks

As long as you know what you want and have realistic expectations, there is no problem with having a juvenile hairline. The doctor should do their best to understand that you will not have further balding (remember, your donor hair is limited) and you would be willing to accept the Bill Clinton or Ronald Reagan look.

The mature hairline is normal, but if you insist on having your juvenile hairline back it is entirely possible. After all this is a cosmetic surgery!

By the way, are you considering running for the next President?

I read your blog everyday, and really appreciate the advice you give to the balding community.

This is my question: If I had negative side effects from taking finasteride (Propecia) that actually made me stop taking the medication even after cutting the dosage, does this mean that I will likely experience the same or similar side effects if I decided to take Dutasteride? Do they contain the same side effect-causing ingredients, or do they work in different ways? The answer to this would really be helpful, as I am interested in taking Dutasteride, but was wondering whether the side effects that I had from Propecia would occur with Dutasteride (or even in a worse way).

Thanks so much for your time.

Those two medications work in similar ways, so I would expect the side effects should be similar. In fact, dutasteride is a stronger drug with a longer half-life, so if you experienced side effects from finasteride I would have to assume you’d see them with dutasteride… perhaps even to a greater degree and taking more time to disappear.

Remember though, dutasteride is not FDA approved to treat hair loss at this time. Your doctor would have to be willing to prescribe it off-label to you, something many doctors will not do.

Hi Doctor,

I was in a physical fight last night and the girl who attacked me grabbed my hair out of my head and I can actually see my scalp. Right now, it is still red and hurts when I press my head. I have two bald spots but will my hair eventually grow back or are my folicles too damaged?

Thanks

You should give it about a year (at most) to regrow. In most cases the hair will regrow, but to be honest, only time will tell. Your scalp suffered an injury, so I’m not surprised that it hurts in the area when you press on it.