Hair Restoration Blog

Q:

I have been diagnosed with a thyroid problem called Hashimoto’s Disease.  I am 23 and I am losing hair on head, and also developing some bald spots on my beard area on the neck and scalp too.  My eyebrow hair is also falling out on the sides.  Doctors said that I have low function of thyroid and put me on thyroid pills.  Now that my thyroid is under control, I would like to know whether or not that my hair ever grows back.

A:

Hypothyroidism or low functioning thyroid can cause scalp and eyebrow hair loss.  However the balding spots that you are experiencing are not typical for hypothyroidism.  The patchy hair loss spots are usually due to a disorder called alopecia areata.  Alopecia areata (AA) is an autoimmune disease that could be seen in association with other autoimmune disorders like Grave’s disease or Hashimoto’s disease.  Thyroid disease is reported in almost 10% of the patients who have alopecia areata.

To confirm the diagnosis and start with a treatment plan, you need to see a dermatologist.  If the diagnosis of alopecia areata is confirmed then you can choose to wait for spontaneous recovery as it is in most of cases of alopecia areata or seek treatment methods that can facilitate the recovery and re-growth your hair.

DHT or dihydroxytestosterone is a byproduct of testosterone that causes hair loss in men who are prone to baldness. Another negative effect of DHT is increasing the incidence of prostate enlargement and prostate cancer. Other than above effects, no other major physiologic function is known for the hormone DHT in adult males.

During infancy and childhood, DHT accelerates the development of male genital organs. This effect of DHT stops when a male external genitalia matures completely.
By using 5 alpha reductase inhibitor medications such as finasteride in medical hair restoration, we can block the enzyme to slow down the process of baldness in men and prevent prostate enlargement in elder men.

There is a congenital disorder in which the enzyme 5 alpha reductase is lacking that leads to the lack of DHT production. Congenital 5 alpha-reductase deficiency is also known as familial incomplete male pseudohermaphroditism type 2, seudovaginal perineoscrotal hypospadias, 5-ARD, 5-alpha-reductase type 2 deficiency, ambiguous genitalia or male pseudohermaphroditism.

Deficiency of the type 2 isozyme 5-alpha-reductase, which transforms testosterone to DHT is the cause of this disorder. DHT major role is in development of male fetus external genital organs and without that effect male newborn can develop immature or ambiguous external genitalia.

Diagnosis of congenital 5 alpha-reductase deficiency is through testing the testosterone to Dihydrotestosterone level. Elevated ratio is an indication of 5 alpha-reductase deficiency. The Level of testosterone is also elevated. There is also alteration in HCG stimulation test. In congenital alpha reductase deficiency male fetus develops a female phenotype without presence of uterus.

Congenital 5-alpha reductase deficiency could be treated to some degrees and the symptoms could be controlled with high doses of testosterone to make the deficient enzyme make normal or close to amount of DHT in this patients.

Hello, Dr. Mohebi.

I used the Propecia prescription you gave me.  It cost me over 80$ to get 30 1mg pills, since it’s not covered under my insurance.  I looked online to see if I could find it cheaper and found a number of sites selling it for much less.

Do you think it’s not a good idea to buy Propecia online?  The site I found doesn’t require a prescription or anything and I can actually get 270 pills for almost the same price I just got the 30 pill refill for at the pharmacy.

Could you check out this link out and tell me if it’s not a good idea to buy it? It seems to me that the pharmacies can charge whatever they want for it, but 80 dollars for 30 pills just seems outrageous to me…  I wonder if $90 for 270 1mg pills is for generic finasteride, and not actual propecia.

I just want to know what your opinion on buying propecia online is.  Sincere thanks.
See you soon.

A:
I have heard bizarre stories about online medications that are sold to patients. There are many stories about affordable hair loss treatments as there are for affordable hair transplants.  I generally don’t approve buying Propecia or any other medications online.

Think about it, the current medical system closely supervises all stages of production, distribution and sales of the medications. Everything is highly regulated and controlled to minimize the chance of mistakes.

Online medications for hair loss or any other conditions, do not have this regulations and if something goes wrong or you get a product that does not contain the medication at all, you have no control on it and no one will be responsive. The fact that prescription medication is sold online without the doctor’s script is risky too.
You can shop around to find the best price for Propecia or finasteride, but I cannot support online shopping for medication from non-supervised resources.

Q:
I am 24 with a strong family history of hair loss in the male members at and around early 20s. Recently, I started seeing hair in my sink and on the bed that is much lighter my regular hair. Is it normal? Am I balding and can I use a hair transplant to prevent further hair loss.
A:
Male patterned hair loss is characterized with miniaturization of hair shafts before complete losing them. In genetically prone men to male pattern baldness, hairs of an affected area gradually become thinner and thinner, before they ultimately become nonexistent.

Miniaturization hair shafts make them look thinner, because of the smaller size and then the smaller amount of darker pigments that could be seen.

It seems that you started with hair loss phenomenon and you only need to get it diagnosed by a good hair specialist who can also get you started on medication treatment if need be. A miniaturization study can give you some ideas of where you are heading before starting with the medications.

Q:
I am 30 year old man with male pattern baldness. I have been on Propecia for two years. I have been feeling hot flashes in the last month to the point that I cannot tolerate them at night. My doctor thinks that I have to stop Propecia, but I am hesitant to do so because I have seen good results from Propecia in last 2 years. What do you think I should do?

A:
Hot flashes are seen in some hormonal imbalances. More commonly it is seen in pre menopausal women and in men following castration or using anti-androgen medications. Hormones such as FSH, LH and lactogene are responsible for hot flashes. None of the Propecia studies did prove association between those hormonal levels and Propecia use.

Since you have been on Propecia for about 2 years, but only experiences hot flashes in the last month it may not be related to Propeica. There are many other medical problems that can produce hot flashes such as other hormonal disorder like thyroid diseases.

You need to be seen by an endocrinologist and be evaluated for other medication problems, which can mimic hot flashes. Many of those conditions could be easily diagnosed by a simple lab work. Some medications can also be responsible for hot flashes and need to be considered.

One simple solution is to stop taking Propecia for a short period of time and see if your hot flashes get better. If that is the case then you have the option of switching to other medications that can help your hair loss but don’t give you hot flashes.

Q:

It’s been just over 4 weeks since I had my hair transplantation. I still have a few scabs. It just happened that while shampooing my hair, I ended up accidentally removing a scab and the area underneath the scab appeared red. The area that has gone red, I could not say for sure if there was any bleeding as I would have been washing it at the time with shampoo. Did I lose any graft? Its 4 weeks post op and I am not sure when I can get to my normal hair wash and I really don’t want to compromise with the results.

A:

Transplanted hair is vulnerable in the first 4 days. The most important day is the first day after surgery in which I would like to bring patients back to wash their hair professionally. You can read more on Dos and Don’ts after hair transplant in our web blog. Washing after hair transplant surgery is very meticulous, but after day 4 following a hair restoration surgery, transplanted hair follicles become part of your skin and you cannot dislodge them even if you remove hair. I usually recommend that my patients follow our washing and after hair transplant care directions on the first four days to minimize scabbing after hair transplant surgery and don’t use any other products.

In your case at 4 weeks after hair transplant, you should have been able to wash your hair in your routine long ago. At this time, you can use your regular shampoo and conditioner without being worried about losing your precious implanted hair grafts.

I am in the Detroit airport on my way back to Los Angeles from the 16^th annual meeting of international society of hair restoration surgery (ISHRS) that was held in the beautiful city of Montreal in Canada last week. This five day meeting was filled with a variety of presentation on the clinical and basic science aspects of hair transplant surgery and medical hair restoration.

I gave a lecture on psycho-social impacts of hair restoration on men on the first day of the meeting. The lecture has been prepared based on my other article on Psychology of Hair Transplant that was previously presented and published on the Hair Transplant Forum International on April, 2008. In the current presentation on psycho social impacts of hair transplantation, I explored some other social and psychological aspect that hair transplant patients experience after their hair restoration procedures based on experience we had with our Los Angeles hair transplant patients and what we found in our research last year with New Hair Institute (NHI).

Several other interesting studies were presented on the aesthetic planning and designing of the hair line and frame of the face with hair transplantation. There were many articles on the hair transplant surgery techniques that could be used for optimization of the final appearance of a hair transplant.

Few articles were presented on hair stem cell research and hair multiplication. However based on the presented evidences, there were no signs of an upcoming solution for hair multiplication or hair cloning any time soon.

One article discussed an innovative method of hair graft harvesting that can produce more hair from an existing follicular unit. The result of this study, although interesting was very controversial among the experts and the author could not release the study details on the methodology to elucidate this matter.

I will publish the highlights of this meeting on the website of US Hair Restoration soon.