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Hello Dr. I have often seen you say that those who claim that Propecia has ruined their sex drives in a permanent way are really suffering from something that is all in their heads. Even if this happens to be true, does it really matter? Take a converse example with the placebo effect. I’ve heard some people suggest that if, for example, an anti-depressant makes someone feel better that it doesn’t really matter if it’s just the placebo effect or not. So why not have the same standard for Propecia? If it’s all in someone’s head after they quit the drug, did not the drug still cause it in some way? Thank you

I didn’t definitively say that those claiming side effect persistence were just suffering from something in their own heads, but it’s a possibility. In fact, I don’t think I’ve ever said the claims of persistent side effects from Propecia are completely false. I did say that the medical literature and my own experience hasn’t shown any permanent side effects among my patients. I’ve also said that those with sexual issues should see their doctor and have a proper, complete history and physical exam to make sure that there are no other causes that can be identified, such as testicular tumors. I do not diagnose medical problems on BaldingBlog. I do not medically treat or give medical advice to people here on BaldingBlog. I just give my opinion and write about hair loss issues.

I feel like I’m beating the same drum over and over here, but I do not force medications on people and have always left the decision to my patients, as they are not sheep that are herded into a direction. Most come to me prepared after doing their research via the Internet.

The placebo effect is well documented in the research studies and appears almost as high as the actual reports of sexual side effects. I suspect that many of the negative writings about Propecia contribute to the psychological effect that produces a placebo impact. There is a small group of disgruntled readers that want me to acknowledge a possibility of permanent side effect associated with taking Propecia (even one dose)… and while it’s not likely, perhaps in extremely rare cases it could happen. I just don’t know. The science isn’t there, but anything is possible. Correlation does not equal causation.

Here’s two similar questions from two different readers:

I know scalp pigmentation is great for people with short cropped hair but my hair is about 1.5″-2″ long. Can scalp pigmentation of the crown play the same role as concealers like Toppik and DermMatch in people with my kind of hair?

Would SMP procedure on the thin areas of a scalp, covered up by some of the balding hair, serve as a sort of permanent hairloss concealer or at least aid in the cover up of hair loss? Has anyone tried this, any pictures ?
Thanks for your time!

Scalp MicroPigmentatation (SMP) is a great way to decrease the contrast between your scalp color and hair color, giving an illusion of fullness. So yes, you can think of SMP as a “permanent” cosmetic concealer… but with SMP, you won’t have to worry if your scalp is showing from an uneven application. Another added bonus is that unlike with some cosmetic concealers (like Toppik or DermMatch), SMP doesn’t run the risk of leaving a stain on your clothing, pillow, or on your significant other’s fingertips.

For further reading, see the SMP FAQ and female patient example (longer hair).

hello doctor Rassman.
im using minoxidil %5 and propecia for about 40 days now. i think i’m seeing some regrowth because when i gently touch the more empty areas of the scalp,i feel some spine-like little hairs which i think i couldn’t feel them before. am i right or is this just my imagination?

another thing which scares me a lot is the non-stop shedding even after this long time use. is this normal? i’m 18 and i’m really confused about continuing these drugs or not.

Growth after only 40 days of Rogaine and Propecia use would be unusual. Initial shedding is known to occur at times from both medications, though it is more common from Rogaine. It shouldn’t last beyond the first few months.

I do not know what is going on in your case. Perhaps you need a good examination (including a miniaturization study under a microscope and bulk measurement).

I am male aged 34 years having mild seborrheic dermatitis . My hair has started greying mostly on the sides and back. Can i do something to reverse or atleast control it?

Is it due to excessive use of medicated shampoos (Ketconazole, Coal Tar, Salicyclic Acid, Clotrimazole, Selenium Sulfide etc.) or stress? Thanks doc.

Hair dye is the only sure way to control graying hair.

I doubt your shampoo is changing your hair color. And although it’s been thought of to be related, there’s no clear scientific connection between stress and graying. Read more about that at Scientific American.

Hi Doc, I have a question about the hairline maturation process. I’ve heard mixed things and I’m a little bit confused. Does the (non-balding) maturation process occur with or without miniaturization? Or can it be either/or? You have suggested that the hairs just fall out, but I’ve also read from you that they miniaturize. Can you please shed some light on this for me?

When you age from the teenage years to your twenties, your hair can recede a bit. This does not mean you are balding and you probably do not go through the miniaturization process. How this happens is not an exact science.

I would say your very front hairs will thin out over time as it miniaturizes and falls out if you have the balding process. In many of the young men who have come to see me and who appear to be developing a mature hairline let’s say half way up to the mature position, I rarely see miniaturization… while those men who eventually develop male pattern baldness will show miniaturization in the leading edge of the hairline.

The location of the mature hairline can be seen here.

I had diffuse hair loss all over my scalp at 30. My hairline was OK. My thinning was noticeable when separating my hair. But, when I combed it right, it was not very noticeable. I thought I would be completely bald and was worried. However, this year I turned 60 and have about as much hair now as I had at 30, and it looks pretty good. So, the point is that thinning does not mean balding. Some men thin out like a woman, and it just stops thinning. Instead of having their lifetime hairs in the back, they have them all over the scalp.

You’re right, but what you’re describing is seen in a minority of men. Some people have low hair density hair with a fine character, and this combination is particularly bad for a see-through appearance. Could this be you?

If we measure the bulk of your hair on top and compare it to the bulk of your hair on the back of your head, we can determine if your overall thinning was something that was always present versus a variant of the balding process, much like the presentation in women.

Dr. Rassman,

Does it matter what time of day I apply Rogaine? I like to apply it when I get home from work (6pm) and before I go to bed (11pm). Rogaine’s website says do it in the morning and the evening, but is that necessary?

Thanks

Well, if the makers of the medication tell you to do it once in the morning and once at night… I would try to follow their directions.

I’d assume the reason behind the morning/night instructions is so that the applications are evenly spaced. If you cannot do it in the morning and want to space it 5 hours apart, I think that wouldn’t hurt, so long as you are applying it twice a day.

If, over a period of time your body wins the battle over the effectiveness propecia has on hair; in the same regards won’t your body win the battle over the sexual side effects that propecia can sometimes pose?

There is no correlation between the two impacts of Propecia (hair growth and sexual side effects).

3 months after my transplants i’m still getting ingrown hairs (pimples on my scalp). also i see no hair growth as of yet. do i have anything to worry about yet? also i was told the ingrown hairs is a good sign because it suggest there is growth beginning under the scalp. is that true?

Ingrown hairs are caused by three factors:

1. Leftover remnants of the hair transplant inside the recipient site, which then go on to produce reactive pustules
2. Hair grafts that are piggybacked one on the other as a result of a technical problem during surgery
3. Folliculitis that evolves into abscess formation

Usually, the third one comes about with less than skilled technicians or technicians with poor eyesight. The other two are just the risks of the process. We see an occasional eruption and on some patients more than a few eruptions. The may come from a progressive folliculitis (infection of a hair follicle) or from one of the other causes listed above.

On very rare occasions, the follicular remnants will act like a foreign body and stimulate an autoimmune process (folliculitis decalvans). Fortunately, we have seen less than a half dozen such reactions in the 20 years history of this practice, but when they occur they are very difficult to treat both in time and visible problems at the wound sites.

I had an allo stem cell transplant in 2007 for lymphoma and had graft versus host disease(GVHD) of the skin amongst other things. GVHD attacked my hair follicles all over my body and scalp while sparing some areas on the scalp with a non uniform (male balding) pattern. I have to constantly shave my head as if i let it grow; its very weird the places the hair grow. Is there any hope for me regrowing my very full and thick head of hair?

I would want to examine you, but GVHD can produce permanent partial hair loss.

So the question then is whether the balding spots support a transplanted hair graft. FUE placed into the affected area will address that issue. If the test transplant works, then the analysis of supply vs need of hair can be analyzed. The use of transplants in a test area (10 grafts harvested with FUE) will tell much about the spontaneous reversibility of the process and the existence of a scarring alopecia in the impacted areas.