About     Contact     Archives     Videos     Events     Hair Transplant

Dr. Rassman,

I enjoy reading your blog, and nearly always agree with you, but I do feel you are a bit to pessimistic about ketoconazole. In another response to another member you dismissed of a Japanese, justifiably I suppose, because of the small sample size. (Have you seen the pictures of the impressive regrowth seen in three of the six patients? They shows an obvious reversal of AGA.)

What about this controlled study: “Comparative efficacy of various treatment regimens for androgenetic alopecia in men”

In this study men were divided into four groups: “Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.”

I don’t believe this has been mentioned on your blog before, and the results are exactly as most men would expect them to be:

Finasteride + Minoxidil > Finasteride + Ketoconazole > Finasteride Alone > Minoxidil Alone after one year.

I’m sure, like every study, this one also has it’s flaws, but together with all the other research — from Piérard-Franchimont C (1998) to Rajput RJ. (2010) — I’d say that the evidence for the efficacy of ketoconazole in AGA is highly suggestive. It’s certainly much stronger than for the majority of the things men try outside of finasteride/dutasteride and minoxidil.

And we know that all anazoles are somewhat antiandrogenic, but only ketoconazole will compete for the AR, and is used in androgen modulated prostate cancer.

How can you be so pessimistic about it in light of the totality of the evidence? Do you believe it to be dangerous?

I am not pessimistic about ketoconazole. Our job on this site is to educate you, the reader, on the realities of such claims and treatments and warn you if there is danger in using such “stuff”. While I don’t see ketoconazole (better known as Nizoral) as dangerous, it has yet to be proven to my satisfaction that it’s a treatment for hair loss. I’ve always maintained that Nizoral is a good shampoo for treating dandruff and fungal infections.

What I have always maintained is that nothing stops a genetic trait. There are drugs that slow it down and there may be other remedies that also work, but my mantra has always been “buyer beware”. The small study you referenced is indeed suggestive of positive benefits, and if the readers out there want to try it, I think that is their choice to make. But keep in mind that while the 1% ketoconazole is available as an over-the-counter shampoo, 2% ketoconazole (as used in that small study) is a prescription medication and as such, you need a physician to oversee the treatment. Side effects include burning and itching sensations.

Doctor,

When my hair is wet, I can see thinning on the sides and back although it is still thicker than the top. I had taken SSRI’s in high school to treat an incredibly difficult case of OCD that left me very emotionally messed up for several years. Since then, I thinned out gradually most of which is over the top of my head and now I’m noticing some on the sides. Could it be that the medications and high stress situations have lead to sort of premature senile alopecia, or maybe took away many life cycles my follicles had because of such a hard time in my life?

I have been on propecia for about 15 months and it’s hard to tell if it’s doing much, maybe it’s slowing down the progression but I have avoided minox because of people claiming it causes skin problems and other serious side effects, luckily I haven’t had that problem with propecia. If the hairloss is due to this and I wasn’t destined for MPB (baldness in family is extremely limited, maternal grandfather was maybe a NW3/4 but had strong sides and back in his 80’s) could it just be that my hair follicles aged prematurely due to the stress and hard times. And if this is the case, is there anything I can do at this point or do I just cross my fingers and hope something like what Histogen is doing works?

There might be something going on, but given your history of OCD, medication, and stress, without examining you I can not render you a good opinion. If I examined you, I would perform two tests that might just nail the problem. These tests would be:

1. Bulk measurements of your hair in different parts of your head with a specialized instrument
2. Miniaturization studies on the different parts of your scalp

In addition, I would be able to take a careful history from you and also use my clinical skills to understand your exact situation. Simply put, you can not get a good assessment without a personal interview and examination.

Hello Dr,
I was wondering if stroking your eyebrow with an eyebrow comb can cause hair loss in the brow to the point where it gets incredibly sparse? In an attempt to shape my brows in the morning I comb them say maybe ten times or so to get them just right and then sometimes more so throughout the day. Well certain days I see anywhere from two to four hairs that look weak and then fall out. I used to brush them quite often as a teen and this would never happen but as of late (I am in my twenties) they fall out when I do this and I was wondering if you think this is the cause or could it be something else? I did have thyroid levels checked and they were fine. Thank you for your time.

I wouldn’t think that gently combing your eyebrows in it of itself will cause hair loss. Traction alopecia can possibly occur from the process you are describing if you’re pulling on the eyebrows… and the hairs you see falling out may indicate that what you are doing is too much. I really couldn’t pinpoint the cause for you, unfortunately. As some men and women age, they lose the outer edge of their eyebrows due to unknown reasons.

Hi,
Two years ago, I had lower eye-lash hair root infection which caused puss filled bump. After it got burst, I lost that eye-lash and still there is discoloration. Will that eye-lash grow back and discoloration will disappear or it is permanent?

Thanks

Sorry, but you need to see an ophthalmologist. This area is not my specialty. Blepharitis is what initially comes to mind, but I’d have no way of knowing for sure if that is what you had. You can learn more about that here.

Dear Dr. Rassman,

I am looking to start using Rogaine (beginning with 2% and then moving up to 5% if I don’t experience side effects), however I am a bit confused with usage/dosage and side effects.

1) Everywhere that I’ve read says that the first 4-6 weeks can have accelerated temporary hair loss. Does this mean that the hair that is lost in this stage will grow back normally even if I were to stop using Rogaine?

2) I have been told to use the 5% solution only once a day. Can I do the same with the 2%?

and finally, 3) what is the best way to apply the solution? I have been given a dropper and a pump spray.

Thank you!

1. Usually “temporary” hair loss means hair loss will return (in the case of hair loss from minoxidil, the loss is usually over a 2-3 month period). I’ve written about this shedding before here.

2. If you were told to use 5% once a day, why don’t you ask the person who told you if that is OK for 2%? I am not your physician and I do not know what your overall treatment plans are so I really cannot give you the right advice for your needs. The general instruction is to apply Rogaine (minoxidil) twice a day, and that is usually what I recommend. If you’ve got other treatment advice, follow-up with that doctor.

3. If you were given a dropper and a pump spray what is the confusion? Are you requiring instructions on how to use the pump spray? Whatever the confusion, the best way to use it is to follow the instruction and apply the solution to your scalp (not hair) as best as you can.

I am 31 years old, and have Stage 2 hair loss. It’s not major yet. I am missing maybe one inch on each side.

My question, if I get a hair transplant - and fix those two small spots, what happens if my hair recedes further? Won’t it look horrible to have two spots of hair up front and continual loss behind it? how is this situation remedied without further surgery?

Again, I’m stage 2 - not bad at all, maybe an inch pushed back so far. Thank you!

This is why a Master Plan is needed before you have your hair transplant surgery, so you can build a plan with your doctor about how to address a worst case scenario of further progression of your hair loss.

I will usually recommend that my male patients stay on finasteride to help prevent the loss from continuing (or at least slowing it down considerably), but ultimately, progression of the hair loss is a risk and probably a reality for balding men sooner or later.

I just had a 2000+ graft transplant 5 days ago. I trust my doctor implicitly and felt his staff was wonderful and professional.

My question is regarding post-op care. There doesn’t seem to be a consensus among surgeons. I suspect this is because good evidenced based studies are lacking but I was particularly curious for an opinion regarding concealing products like Toppik. I’ve heard ranges regarding safe use from 2 days post op to 1 year. Seemed like quite a range? Do you have an opinion? Thanks.

Generally you can use hair camouflaging products, such as Toppik, as soon as the scabbing is gone. That depends upon your cleaning technique or just the type of instruments your surgeon used during the procedure. If the granules get under scabs, they will act like a foreign body.

Refer to your transplant surgeon, of course.

Good doctors….I’ve written before and have had a couple of posts placed on your website. This is more of a story with comments.

I’m a 41 year old white male, who started to recede in college. I had a ceaser haircut in the early 1990’s that was popular at the time. I tried Rogaine in college when it was an RX and $130.00/three months. I tried snake oils, etc.

Finally, I started buzzing my hair all through my 20’s. I got tired of shaving my head and started growing it out. My hair was still quite thick, but had a more mature frontal hairline and the crown was thinning (by my late 20’s). I still had hair, but used Toppik, to help my confidence. So too with Rogaine 5%.

Eventually, in my late 30’s I discovered this site and started to educate myself. I switched to Rogaine foam and started Propecia in 2008. After about a year, there was/is a noticeable difference. My crown filled in. Areas that were completely skin, have hair. The hair itself is thicker (diameter) and my front hairline/forelock is incredibly strong and I can wear my hair up (think Joel McHale from “Community”….after his alleged transplant). I finally have good hair again. And I love it. I get compliments, and have massive confidence.

I was at Starbucks on Monday, and an older woman turned to me and said, “You have great hair. Most men would KILL for that.” I stopped, told her that she made my day. I jokingly said I spent a lot of money on my hair to look good (Rogaine, etc.). But it’s true. Moreover, with your suggestion, I shifted to the generic Finesteride for 4 bucks a month at Target. 4 bucks!!!!! Thank you!

So, to wind this up, I have better hair than I did in my 20’s. I have an actual style and love to look good. I’m an academic, and I get checked out by coeds all the time. This NEVER happened 10 years ago. Never.

So, to all the crybabies about Propecia, all I can say is quit whining. Quit acting like a woman and worrying. To those that say that male vanity is bad/doesn’t exist, I say, you’re nuts. It’s good to feel good about yourself.

Thanks, men. Keep up the good work.

Well, there you go. I’m glad to hear you’re successfully treating your hair loss, and wish you continued happiness. Thanks for writing in!

I am here in Dubai for last 4 years. Two years back my hair loss started then i tried few products like keshyog hair oil for 3-4 months but no use, regain for 4 months no use. Now somebody told me Amazonia Natural Hair Lotion from Brazil is good and having good results. If anybody used it then please help me to decide or share any other product which is good.

I’m unable to find any listed ingredients on the product site, but there are some completely unbelievable before/after photographs shown. In this apparent before/after photo set, it looks like they’re trying to say that this lotion will make someone go from a Norwood Class 6 to a nearly juvenile hairline. That’s absolutely ridiculous.

I’ve got no idea what magic is in this lotion, but in all of my years I’ve never seen any product that could even come close to producing results like that. If this lotion could really do what their photos show, that would make this essentially a cure… and I’m sorry, but a cure for hair loss doesn’t exist. I’m going to go out on a limb here and say I believe that it’s fake, but you’re welcome to try it and report back.

Also, it’s worth noting that Rogaine (or Regaine) should be used for more than just a few months if you hope for benefits. I understand your impatience (we all want hair right now), but if you expect miracles when it comes to treating your hair loss, you run the risk of being extremely disappointed and bald.

–
Update: See Dr. Bauman’s comments below. The makers of this product are using transplant patient photos and passing them off as results from their product.

Why would someone that already has his hair loss documented suddenly step out in public with a new head of “hair”? I know all of us that are losing hair show some level of vanity (which is why we want our hair back!!!!) but John Travolta is in the public eye. Who is he kidding?

Check it out : thesuperficial.com

Everyone is entitled to their opinions, just as everyone is entitled to look any way they want. I don’t think by John Travolta wearing a hairpiece that he’s trying to fool anyone. Perhaps it’s just a personal choice of style and taste. I would bet that he frequently does not wear the hairpiece, as he looks so relaxed without it.

Like so many actors, various movie roles may call for different looks… so maybe he’s wearing this new piece for a role? I haven’t spoken to him about his hair, so I’m not going to speculate on why he went from receding to a straight hairline while out in public.