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Hi,

A friend of my fathers has recently had a hair transplant to cure his baldness and it got me thinking of a possible solution to a problem I have. I have a cowlick at the front of my hairline and I was wondering if it would be possible for me to have this removed by laser treatment and then replaced by hair transplant. Is this a viable option?

Yes, this is a viable option. Many people with these ‘licks’ complain about them to me. Of course, I only see those people who are not happy with them. I happen to like the look, as one of my sons has a cowlick and I think it makes him look handsome.

Dr. Rassman, et. al, the Journal of Sexual Medicine has recently published an article describing the permanent sexual side effects of using finasteride. I quit taking propecia approximately 2 weeks ago and am terrified that I have permanently damaged myself. What are your thoughts on the article?

Adverse Side Effects of 5?-Reductase Inhibitors Therapy

Many of my patients have been taking Propecia for over a decade without side effects. I have yet to meet a person in my practice who complains of permanent side effects associated with Propecia after they stopped the drug. The few that do have side effects at all elect to stop taking the medication and the side effects have subsided as their hair tumbles to the ground. But that is just my humble experience.

The article itself doesn’t provide anything new, just reviewing previously published reports from a subset of men that raises the possibility of a casual relationship. They did report a single case of a man with total sexual function loss, but that sounds peculiar and I’m not convinced. I would wait for confirmation by other investigators on claims of permanent damage from finasteride. The Journal article was digested by the Boston Globe here and even mentions what we’ve been saying for years about the percentage of those that saw side effects:

“In one trial, about 1.9 percent Propecia takers who took the drug for up to two years experienced a loss of libido compared to 1.3 percent of placebo takers; 1.4 percent of Propecia users had erectile dysfunction and 1 percent had an ejaculatory disorder compared to 0.9 and 0.4 percent of the placebo takers.”

For most of the frightened men, I wonder what they’re so terrified about. Did they actually have side effects? Are these men willing to risk balding over a 1-2% chance of side effects? As I’ve often said, the medication is completely elective. You don’t have to take it and I am not trying to convince anyone to do so. I am just presenting my opinion based on experience. The Mayans predicted the world will end in 2012, so I would be more terrified about what will happen in 11 months!

Snippet from the opinion article:

I read with interest your article Chemotherapy Hair Loss Invention From Sweden Might Help Patients Keep Hair but it really is old news !

Around thirty years ago, Dr. Bill Williams, of NASA, conducted research on thermo control of body temperature (very important to astronauts in space suits). He patented his invention of the “Cool Head and Cool Neck Band”.

Read the rest at the Epoch Times — Chemotherapy Hair Loss Prevention Pioneered by NASA, Thirty Years Ago

The above is part of a letter by a retired NASA researcher, and it should be noted that it is in the opinion section.

It basically says that a NASA scientist helped develop a cooling system for helmets, and although the headline might lead you to believe there’s more info about hair loss and chemo, it only briefly mentions an “experiment to save the hair of chemotherapy patients“. But that’s it. Unfortunately, it doesn’t discuss the study or what that experiment was… and I’m coming up empty when trying to find if the study was ever published. Anyone?

DR. Rassman,
I just started taking Finasteride 5mg. I cut it up into 4. My question is, since the size of the pills are very small are the less effective? I mean small! size of a large crumb.

No, the size of the pill wouldn’t have much to do with effectiveness. The 1mg Propecia pill isn’t 100% finasteride alone. There are fillers used to help make the pill a reasonable size, plus give the pill a distinctive shape. So if the 5mg finasteride pill is cut into four pieces, it won’t be the same size as 4 Propecia pills.

Check with your pharmacy about other makers of generic finasteride 5mg — different pharmaceutical companies may have different shapes that are easier to cut or a little bigger if that’s what you’re looking for.

Dr. Rassman,
I noticed Merck is offering men who are prescribed Propecia to save money ($260 for a year).

Link: Propecia Persistence Program

Regards

Yep, this is a good program and relatively headache free. If you’re buying the name brand Propecia, it’s an easy way to get some money back from Merck.

Hello Dr. Rassman,
I was considering eyebrow transplant surgery after many years of overplucking and abuse to my once bushy brows. I have read that as a side effect the hairs may be “raised” or grow in awkward directions. I was wondering in your experience how often does this occur? Say in 150-200 grafts how many may grow this way? And can they be “trained” over time to grow correctly? Thanks

Eyebrow transplantation is a delicate art and even for skilled medical groups it is never perfect. As you correctly state, the eyebrows can grow slightly raised and grow in slightly different directions, regardless of how precisely you pay attention to detail. And since the focus is right above your eye, the eyebrow transplant subtleties are not as forgiving as with hairs transplanted on the scalp.

I can’t give you a generalization of what to expect, as each and every person is different. It depends on hair texture, curl, shaft diameter, follicle length, orientation around its central axis, how it lays down, etc. I can say that male eyebrow transplants are more forgiving, as men have bushier eyebrows. My eyebrows seem to be admired by many men who request eyebrow transplants, as mine are the spitting image of Albert Einstein (see right).

I can also say that if you don’t like a certain eyebrow hair in the mix, just pluck it out! Often times patients usually have at least two eyebrow transplants to get it just right.

I have been taking a generic Finasteride called Finpecia for just under 3 months and I’m unsure whether it is doing anything for me or not. I am aware that buying generics is risky but I simply cannot afford Propecia, being a student.

I have read on forums that side effects are a sign that the drug is working. I experienced a couple of sides very early on (around a week after starting) which subsided soon after, I was wondering if this is a sign that the drug is legit? Or could this just be caused by some other ingredient found in the pills I am consuming?

Thanks

I do not believe that seeing a side effect is an indication of whether the drug you are taking is real/legit or even if it is working. A side effect is just that… a side effect. Placebos can even provide side effect-like instances. After only 3 months though, that’s not enough time to really notice benefits from finasteride.

It also sounds like you are self treating without a doctor’s supervision. There is a generic finasteride in the U.S. that doctors can prescribe available in 5mg strength (approximately $30 to $60 for one year supply) that patients cut into four pieces to make the dose semi-equivalent to Propecia (which is finasteride 1mg). If you’re not under the care of a physician and taking a prescription drug, you really should see a doctor.

I am a 24 year old African American female who was just diagnosed with CCCA on yesterday. I have no idea what it is that I can do other than take the steroids that were prescribed in order to slow down the progression of the condition. Would I not be a candidate for hair transplantation or a scalp reduction?

If you were just diagnosed with central centrifugal cicatrical alopecia (CCCA) and didn’t get your questions answered by your doctor, you can find a lot more information at the Ciicatricial Alopecia Research Foundation site.

It’s possible steroid treatment would help, because steroids can alleviate the inflammatory reaction associated with CCCA… but there’s no specific cure. Hair transplants are not recommended for patients with CCCA.

I’m turning 17 this summer, is it too early to start taking propecia? My doctor and I already know I’m going bald.. my hairs thinning and I have a receding hair line. Can I start a 17?

I would make a firm diagnosis with bulk measurements, miniaturization measurements, and great photographs of your hairline location. Then if you decide to take Propecia with your doctor’s assistance, you will know for sure what your diagnosis is and how the drug is working year after year.

I’d suspect that most doctors do not feel that 17 years old is too young for this drug, though I can’t speak for all physicians.

I have heard you mentioned many times that Proscar has a longer half-life than Propecia. For people who are taking Proscar, will it be longer before they experience catch-up hair loss if they stopped taking the medication?

Proscar is a brand name for the generic drug called finasteride in 5mg strength. Propecia is a brand name for the generic drug called finasteride in 1mg strength. Despite the difference in the strength dose, the half life is exactly the same… because they are the same drug.

Perhaps you are thinking of a drug called Avodart, which is the brand name for the generic drug called dutasteride. Dutasteride (Avodart) has a very long half life in the order of many weeks, whereas finasteride (Propecia or Proscar) has a short half life in the order of hours.

The half life of a drug refers to the time it takes for your body to rid itself of half of the drug in your system.