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Doctors' Answers to "Frequently Asked Questions" - Hair Loss

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Hair Loss and Zomig/Birth control [posted 1/13/99]
Question: Please let me know what you know about Zomig. I am a hair dresser and a customer of mine has been taking zomig has for 3 weeks and she seems to be losing her hair. Can you look up this drug and let me know if this is a side effect from it? She is 41 and also takes birth control pills. I feel something is causing it. I suspect it is the zomig.

Answer: Well, Birth Control pills are notorious for causing hair loss. As to Zomig, it hasn't been available long enough for me to assess hair loss. The PDR does list this as a potential problem, however.

Hair loss due to possible toxicity or perm chemicals [posted 1/11/99]
Question: I have relaxed my hair for over 10 years, and recently, I have taken amino acids for 1 year straight daily, and 3 pills a day in a work out routine. I am now experiencing thinning at the scalp. I know that it is not alopecia, but I am wondering if it is scalp burn from perm chemicals or toxicity to the aminos. Is toxicity from aminos possible? And is it possible to damage your scalp by perming your hair over a period of time. What are treatment alternatives for either scenario?

Answer: Yes, but you will need to see a dermatologist and possibly get a biopsy to determine if this is the cause.

Thinning hair in female [posted 1/6/99]
Question: I developed adult onset diabetes 2 years ago and am on the maximum dose of Glucophage. My scalp hair, especially on top, has been thinning quite a bit. Can you tell me if this medication could cause this or if it is from the diabetes? Also, does estrogen therapy help to decrease hair loss?

Answer: Listed, but not a common problem. I'd look for other causes.

Alopecia / Hair Loss [posted 11/11/98]
Question: I went to a dermatologist because a present a clinic synopsis of alopecia and he took a sample of my scalp (result: alopecia non terminal, doctr said ). Now he want to give me a monthly injection of steroides on my butt and in my head where I have the small scalp bald. I read about steroides effects, & it worries me a lot. Can I hear more about it? Can I use Rogaine or other external medicine, instead? I am a female, 34 years old from Honduras, no other illnesses. For many years I was thinking my problem was stress and I took stress medicine (vitamins) now my problem is bigger. I don't have family baldness.

Answer: Patchy alopecia has nothing to do with familial hair loss. Topical steroids will be ok, if not used excessively or for long periods. I moved into a new house approximately 9 months ago. The water at this house has been horrible. We have seen brownish-yellowish water as well as a sulfer and chlorine smell severe enough to burn your nose when the water is turned on. The water company has been under fire for several years now due the above problems as well as several others. I began noticing that my skin was excessivly dry and peeling and that my hair color was actually lightening as if bleached. After several months, the quality of my hair was deteriorating. It began to get thinner and brittle as well as dry and full of split ends. It got to a point where it was so thin at the ends, there was nothing to make a braid with. I have always had long, thick, full, and healthy hair. I went to several comsetologists and they suggested cutting the ends and it would grow back on its own. But I have since cut my hair and I am watching handfuls of hair come out when I run my fingers through it. I am 21 years old, in good heath, I take no medications, I eat plenty of meats and proteins, and the only real change has been the water (& the stress of watching my hair fall out). It is not leaving "bald patches" but it is getting so thin all around that if I pull it back in a ponytail, you can see my scalp. There is no history of this in my family and I am at a dead end. What can I do to regain my hair? Why is it thinning?? I don't know what to do anymore. I have even begun using a Shampoo and Conditioner called "Nioxin" that is "designed to prevent excessive daily hair loss" I also have taken to showering at my mother's house (different water comany as well as a water softner) I have seen an improvement in my skin condition, but my hair is not getting better. Oddly, enough, on days I shower, I see a lot less fall out then on days I do not shower. Any suggestions or advise would be more than helpful. Thank you for your time.

Answer: Check your thyroid levels to ensure that you do not have hypothyroidism. Hair loss due to water problems would be very rare.

Prostate Medication for Treating Hair Loss [posted 8/5/98]
Question: I recently heard of a fairly new drug being prescribed for prostate problems (unspecified) that has the blessed side effect of encouraging hair growth. Do you know what this drug is? I am now taking Cardura 4 mg and would like to switch over to the other as I have some balding I'd like to stop. Are they complimentary/interchangeable/similar? Also, I have been taking evening primrose oil for two plus years now and it too has helped stop the hair loss.

Answer: This drug was initially called Proscar. It was mildly successful in aiding patients with benign prostatic hypertrophy. Supposedly, it helps hair growth, but I never had any patients comment on this effect. In any case, it won't do any harm and is compatible with Cardura.

Losing Facial Hair - Discoid Alopecia [posted 7/30/98]
Question: I am a 25 year old male. About 3 weeks ago I noticed a large part of the facial hair on my chin had stopped growing. I currently have two bald patches, both on my chin. The two patches are completely bald, smoother than even the closest shave. I also have developed a fairly large bald patch on the left side of my head, all in the last 3 weeks. Balding does not run in my family. The rest of the hair on my head is thick and normal. Do you have any suggestions as to what this could be? Is the balding on my head and face related?

Answer: This represents discoid alopecia. This is usually due to an inflammatory response and should be looked into by an Internist or Dermatologist at the earliest opportunity. This usually represents a systemic medical problem.

Male Pattern Baldness
Question: How can male pattern baldness be predicted?

Answer: This is inherited on the X chromosome and passed to male children only. Consequently, it is "given" to the male children by the mother. Looking at male forebears will give you a statistical likelihood. For example, if the mother's father is bald, 50% of the X genes will pass baldness and 50% of the male offspring will be bald. If the maternal grandmother's father was bald the risk rises to about 75%. And for each male in the maternal tree that is bald the risk rises. There may be chromosome marking available, but I am not aware of it. One can do chromosome marking within the family and predict whether the X in the child comes from the maternal father or mother.

Drug-induced Alopecia
Question: While on rotation I was questioned as to whether fosinapril in combination with conjugated estrogens may induce alopecia in a 73 year old female patient with urinary incontinence, osteoporosis, DJD, TIA, lyme disease, and bilateral hip replacement She developed male pattern baldness after being placed on fosinapril for HTN. I performed a fairly thorough literature search and concluded that neither fosinapril nor conjugated estrogens have been associated with drug induced alopecia to any great extent. Please let me know if you have come across any conflicting information. Any references you might provide would be greatly appreciated.

Answer: I agree with your initial assessment that neither should cause the problem. However, some women will metabolize estrogen to testosterone (responsible for the baldness). I'd guess the estrogen is the culprit. Rogaine is very effective in women for this type of baldness.

Hair Loss
Question: I have heard that there is a drug or pill (newly researched) which ceases the continuation of Hair Loss due to Male Pattern Baldness. I am 33 and in the early stages of Hair Loss and am very interested in this topic.

Answer: The only current drug is Rogaine. It is available over the counter as a topical lotion. This works about 40% to decrease the loss and about 20-30% to increase hair in male pattern baldness. It works about 80% in women with thin hair. There is a drug to be released in the next 6 months for hair loss, but I am not currently familiar with its mechanism of action.

Hair Loss
Question: Are there any medications to stop or slow hair loss?

Answer: Rogaine, now available over the counter, is the only documented drug treatment for minimizing hair loss. It works about 40% of the time and particularly works if the balding starts on the top of the cranium (so called monk's head). It takes 3 to 5 months for any effect to be seen. I recommend that you take a photo of your hair before and after 3 to 5 months of daily use to see if there is any change. Stopping the Rogaine will result in continued loss, so it is a life long treatment if it works.

Hair loss
Question: Last January I began taking Pondimin and Fastin. I succeeded for 3 months with no side effects and wonderful weight loss. I took only the 3 month supply and did fine. In June, I went back on the prescription. One week later I began to notice slight thinning of my hair. I immediately quit taking the supply and have experienced the slight hair loss ever since. I have had periods of a couple of weeks where the thinning has stopped, but started again. I am wondering if the hair loss has anything to do with the Pondimin and Fastin or if there might be another explanation.

Answer: Hair loss is a common complaint of many patients, both men and women. There are many factors which contribute to the distribution, texture, thickness, as well as longevity of an individual's hair. Genetics (family pattern) plays a large role, but general health, physical and emotional stress, diet, and gender are all involved to a variable extent in the individual patient's hair loss symptom.

Pondimin is the trade name for fenfluramine hydrochloride, and the Physician's Desk Reference (PDR) does not list hair loss, or alopecia, as a known side effect. Fastin is a trade name for phentermine hydrochloride, and the PDR does not list hair loss, or alopecia, as a known side effect. On occasion, other symptoms can provide insight into the cause of hair changes, such as itching, rash, recent illness, change in shampoo or conditioner, etc. The rate of thinning or loss, as well as the pattern, and other findings on examination can sometime provide clues as to the cause, as well. See your doctor about your hair loss. He or she can help in determining if there is a treatable cause for your hair loss, discuss with you the available therapeutic options, and refer you to where help is available.

Hair Loss and Depakote
Question: I'm currently on Depakote and Lamictol for epilepsy. I've been on the Depakote for 16 years. I'm currently coming off the Depakote. Is it true that depakote can affect hair loss? Do you tell the difference when you first lower the level or do you have to wait until it clears you body? I have not noticed any difference yet.

Answer: Depakote(valproic acid) is a drug used mainly to treat seizures. Major side effects include occasional severe liver toxicity(even death), problems with platelets and white blood cells, skin rash, transient hair loss, pancreatitis, and endocrine problems. It is a very effective drug, but needs to be watched very closety. The hair loss seen with this drug will normally vanish after the drug is discontinued after about 6-8 weeks.

Oily Scalp
Question: I am 22year-old and I have this hair loss problem, there is obvious of hair loss at the back. I have discovered that I do not have new hair growing and I have fallen hair about 50 per day during the day including washing. I realized that I have oily scalp(very) even though I wash my hair everyday. Could this be one of the reasons, if yes what should I do? I use shampoo for oily scalp and control my diet. However, all these do not help much.

Answer: There are many reasons that one loses hair. The most common is male pattern balding which always runs in families. This is transmitted through the mother's side, so check your mother's male ancestors and your maternal uncles if they have balding you probably will also. This is inherited roughly according to the number of men bald, that is 50% bald you have a 50% chance-100% bald you have 100% chance. There are other medical reasons to lose hair and if you have patches of baldness(spots)-especially not on top of your hair you need to see a physician. However, this is probably male pattern balding. This can respond to Rogaine if used topically; but, it needs to start now before you lose further hair. Rogaine works best at preventing further loss although it does occasionally restore some hair in men.

Hair Loss & Cancer
Question: I am having this hair problem now. My hair have been dropping in a large amount. I would like to know if it is because I am having cancer??? This have been going on for many months. My hair will after I comb my hair and also when I am bathing.

Answer: If baldness runs in the family, this is probably male pattern baldness. If there are no bald males it needs to be looked into. There are many medical conditions that cause hair loss-too numerous to name her. Rogaine (available over the counter) if used every day will slow male pattern balding in about 35% of patients and eliminate it in about 10%.

Surfing & Smoking
Question: Does surfing or smoking marijuana contribute to hair loss?

Answer: No association that I'm aware of.

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