Hello Doctor

I was wandering whether chronic buildup on the scalp (of shampoo and styling products) due to poor hair washing (rare washes, low shower pressure, no thorough washing) could eventually lead to permanent hair loss

Thank you

No. Styling products, shampoo, sebum, regular washing, or irregular washing do not cause permanent hair loss. Genetic inheritance causes hair loss in men for the majority of cases.

Thank you for baldingblog, a wonderful source of information on hair issues. My wife just started on chemotherapy for colon cancer with a drug known to cause hair loss. She wrote this to a friend about her chemotherapy and the Cold Cap experience and with her permission, allowed me to send it to you to post on your site.
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“The chemo was on Tuesday – and I slept through the entire event. I thought to call Dr. Rassman and thank him for the reference to this cold cap therapy. He is among the most caring people I know.

They loaded me up with lots of anti-nausea meds and some Benadryl which really made me sleepy. Now you might wonder how one can sleep with a turban at -24 degrees Fahrenheit on your head – well I did. In part to counteract the cold, you wrap yourself in an electric blanket set to sizzle – and that put me right to sleep. My husband had to wake me every 30 minutes or so to trade the cold cap for a newly chilled one. You keep up the cold caps till 4 hours after chemo is done so I didn’t really wake up till about 6:15 PM on Tuesday – that included the drive home. We were quite the spectacle at the clinic and had many doctors and nurses coming in and out to see the changing procedure. I actually think my husband was enjoying the attention. Almost everyone at the clinic knew about cold cap but none had direct experience with it and all were very interested to see if they work. Needless to say I am too.

I did hook up a small group of patients in a support group, a couple have used the cold caps successfully for their chemo. It is more involved than just the turbans – there is a lot of extra hair care but all say that it is worth it. So we are “all in”. We did look like we were moving in to clinic for a week wielding our two coolers on a rolling dolly, a rolling suitcase filled with the blankets and extra needed accoutrements (including welders gloves to handle the dry-ice), and an extra bag of layering clothing.

I am feeling ok – I wear out easily and then crash hard. I am still not sleeping well – what they have given me is helping a bit but I don’t get more than 5 hours of solid sleep and then doze as best I can. Today is the last day on the heavier anti-nausea meds and when the steroids will wear off – they say that tomorrow is the trail day.”

I try to get involved in the lives of my patients and have developed many close friends from this group of wonderful people. I’m glad I could offer some help to this patient and his wife, and I wanted to post this so people considering using Cold Cap Therapy during chemotherapy might know what to expect. There’s a good article about this treatment here.

This reminds me of another time that I wanted to share, when a hair transplant patient got a routine heart scan on my recommendation and found that he had an aortic aneurism. This is a time bomb that kills almost everyone when the aorta (the main blood vessel that exits the heart) leaks and bursts. I helped him find a great doctor who brought his body temperature very low at the time of surgery, stopped his heart, and replaced the blood vessel with a cloth one while everyone hoped that his brain would function after they restarted his heart. He lucked out and survived, brain fully intact.

Right place, right time.

Thanks for taking my question. I am a 23 year-old who had the OCD scalp-picking issue you mentioned in a previous post. I managed to completely quit the behavior approximately a year ago after doing it for about 2 years at varying levels of severity. As a result of the disorder, I have hair pulling back on one side of my head much more aggressively than the other. I also have hair that is thinning all over, but the thinning is not yet visible when dry. I also have a very dry scalp, which I have read may cause hair to grow thinner. I wear my hair at a medium to medium-long length.

Could you please provide suggestions? Suggestions in all aspects of hair care are welcome. (Shampoo, hair regrowth treatment, etc.) Thank you very much for your time.

Best Regards

Many people who reported to me that they stopped pulling their hair out, were not being honest with themselves. The good news is that if I examine you, I can tell you if you have pulled hair out in the past 3 months. Minoxidil might help — try it for a full year before considering it a success or failure. There’s no shampoo that will regrow your hair. Even with medication in a best case scenario, you’re not going to get back to where you were before your picking or pulling began.

Hair transplants are a known and proven option, but this requires you to visit a specialist in this field as it can not be done by just anyone.

I find it hard to believe that the only two FDA approved medications for balding were both approved over 20 years ago. How come there has been such little real progress since then? Is balding considered a “solved problem” due to the current status quo (surgery + finasteride/minoxidil)?

Why can’t we routinely exceed the sound barrier when we fly, since after all, the airplane was invented 110 years ago? If you answer this question, you might better understand that it does take time to find a cure for balding. Many groups from around the world are working hard on a cure or a better treatment, and I suspect that it will arrive when it is ready. The FDA process for such treatments may take years to obtain the approvals needed for human use.

Dr. Rassman, you alluded to a simple cure for gynecomastia. For those of us who are plagued by this condition, & are financially tight, would you please share what this cure is, & will the continuance of Propecia or Avodart nullify the surgical benefits? Thanks so much for a great Forum!!!

There are different surgeries that can successfully treat gynecomastia from a cosmetic point of view (removal of breast tissue or liposuction). The drugs Propecia or Avodart will not reverse or cure this problem and in very rare situations can produce it. I don’t know that these medications would nullify the surgery completely or at all.

I have been asked the question posed in the title of the post many times, and each and every time I answered it on this site, I was emphatic that this could not be done because of the problems that we see in kidneys, livers, and hearts when they are transplanted (i.e. they get rejected by the body). Now, the possibility that this may not be the case was raised by Dr. Sharon Keene after she read this article in the LA Times about a small pilot study which may lead to the elimination of taking anti-rejection medication for life following organ transplants — Study suggests breakthrough in organ transplants.

Japanese doctors tried homografts and allografts of scalp hair back in 1928 and again in 1938. They left detailed descriptions of the results. The growth rate was zero percent; however, we have learned much about transplanting organs since then and maybe we can apply what we learned to allow for a better outcome.

Of course, I am not saying that my answer has changed, but who knows for sure what could happen. Successful transplants have been done between different people, in baby hearts under a year of age and in face transplants where the anti-rejection medications can be far less and possibly stopped, but the experience is still very sketchy, as not many face transplants have been done to really know what it takes to sustain such a transplant without anti-rejection drugs.

There are also ethical considerations and medical-legal ones imposed on doctors who think that they could experiment on people without legal ramifications. When I was in medical school our most famous surgeon was Dr. David Hume, who made his reputation in Boston at the Brigham hospital doing a kidney transplant from one twin to another in the wee hours of the night without the permission or knowledge of the medical staff. It worked and he became a hero, but had it not worked, he would have become vilified and this act could have ended his career. With stem cell progress and some of the tricks outlined below, who knows what the future holds; however, I have long believed that the really important problems we, as doctors, will be allowed to treat, will not initially be for the vanity of perfectly healthy men who are balding.

Hi,

I’m curious about Propecia dosage. From reading various forums it seems as if doses from .25mg all the way up to well over 1mg of Finasteride are being taken. I am 25 years old, but am very short and underweight. Is it reasonable for me to consider taking say .5mg a day? My question is, does your weight etc. affect the amount of Finasteride you should be taking?

Many thanks.

The data is not available that relates your weight to the dose required in using Propecia (1mg finasteride) effectively. From early finasteride research in the use of this drug for treating hair loss, it was determined 1mg was the best dose for the effect that was the target of the study. At half the dose (0.5mg) finasteride was reported to be 80% as effective as the 1mg dose. At 0.25mg, the effectiveness of finasteride was reported at about 50%. This is all I know about dose and response.

Hello,

Thank you for wonderful blog. I had my hair transplant done in September last year. It has been 7 months now. After shedding I had new hair but they are all tiny baby hair and they are not growing at all. I can only feel them by touching my scalp and they are not visible. They are really really tiny. I was not prescribed any medication after transplant and had none complications as well. They new hair are of same tiny size as they were 2 months ago. I followed everything told by my surgeon religiously.

My Surgeon is not in this country and I have spoken to him over the phone. He told me it never happened to any of his other patients and I should see him on my next trip which is in October. Can you tell me what could be the problem?

By the 8th month, you should have 80% of the results of the transplant and approach 95% by the 10th month. Sounds like the transplant may have failed. I would be happy to see you and render a second opinion after the 10th month milestone has been reached.

This is a purely hypothetical question. Would a man taking female birth control pills have any effect on male pattern baldness? What would be the effects on DHT, Testosterone, and hair health. Thanks!

The following post is by UK-based physician Dr. Bessam Farjo:

Written by: Dr Bessam Farjo United Kingdom

Female birth control or contraceptive pills are most often a combination of synthetic forms of the female hormones, estrogen and progesterone. With regards to effect on men’s hair you may get a decrease in facial and body hair in terms of thickness and growth, although male-pattern baldness may improve somewhat or at least stabilises in a similar vein to finasteride for example. We see this effect most commonly in our practice when dealing with male to female transgender patients who use similar hormones to achieve their transformation.

However, these medications may cause a number of adverse effects in men similar to those seen with the use of other female hormones. You may experience changes in the appearance and function sex organs. Risks may include erectile dysfunction, decreased libido and lowered sperm count. Some men may also develop gynecomastia (man boobs). There may be a negative effect of general body muscle mass. In addition, the bones may develop osteoporosis (brittleness). There are other potential general health side effects of course making this an unreasonable approach to control male pattern baldness.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

Dr. Rassman,

I am a patient of your who last saw you a few years ago regarding hair loss prevention. We decided the best course of action for me is to take Propecia and use Rogaine. I have since been taking Propecia and using Rogaine daily and so far, am pleased with the results and think that my hair loss isn’t progressing. I wanted to get your opinion because I have recently read articles which discussed sexual dysfunction as a result from taking Propecia. Even more recently, the FDA issued a warning with regard to this issue. Do you know anything about this and can you provide any insight? Also, would you recommend continuing usage? Any advice would be greatly appreciated.

Thanks in advance

You should be aware of these alerts, which is why we post about them here; however, the risks are very low and sexual side effects are rare (2%). If you have not had them, it should not be a problem… and if you are young and considering having children, you should see your doctor and get a sperm count to be sure that this problem is not impacting you.

As I’ve said before, one of my sons is taking Propecia, and it is working very well. I have not advised him to stop it when he recently asked me about it.