What happens to DHT with age?

/by William Rassman, M.D./0 /

Been balding since 2014. The type of balding I have is related to DHT. What happened to my scalp from 2014 to now? Did my body produce more DHT? Or am I producing the same amounts of DHT as before, but something that used to use DHT is lowered? If it increased, then theoretically, fin and all should have no negative effect on me, and I should be like pre 2014.

DHT often goes down with age because it is the product of testosterone metabolism and the older you get the less testosterone you produce, hence less DHT

Iron supplements worked in one month

/by William Rassman, M.D./0 /
After a month of taking iron, my iron level normalized and my hair has continued to thicken up in much of the top (to where the barber thinned a section for the first time since ~2006).  Not really the left corner and not the crown or back, though all that looks stable now and very little hair comes out in the shower. I do not have celiac. Invasive examination so far hasn’t found anything that would affect hair or absorption.
How long should I wait to see if any regrowth in the problem areas happens?
Always give hair changes 6 months to kick in a significant number of new anagen cycles (about a quarter of men have a two year growth cycle).  Then you will know much more and we should meet then

Hairline location in a very bald man

/by William Rassman, M.D./0 /

When I had hair, I always had a high hairline. Should I put my hairline high as it was when I had hair?

There are two ways to determine where the midline hairline belongs. (1) one finger width above the highest crease of the furrowed brow and (2) balance the distance between the nose and chin to the grove above the nose to the hairline (that is what Michelangelo did). When designing a hairline, I always use these rules and if the forehead has always been high, then these rules allow you not to have a huge forehead for the rest of your life. Attractive people are always in a balance with their facial features.

Cardiac Effusion and Minoxidil

/by William Rassman, M.D./0 /

Thank you this is helpful. Logically speaking wouldn’t it follow that if oral minoxidil were dangerous at these doses, we would have case reports correct? I imagine you have a portal as a physician that lets you check of any such case reports? Is there any retrospective data that shows what the minimum, average, median doses are for severe side effects?  Hopefully I’m making sense here but i could only find one case study of a woman with kidney disease in her 60s having a cardiac effusion at 0.625 mg. Wasn’t shown to be causal. She had several preexisting conditions and poor health to begin with but used the min for lowering BP it seemed.

I guess my main issue is that I have yet to see literature where a cardiologist is closely following patients on low oral minoxidil over a period of 2-5 yrs +. I really would like to take oral minoxidil but this is my limitation.

The cardiologist, I don’t believe, use minoxidil for high blood pressure anymore as there are much better drugs. The dermatologists and hair doctors look out for Cardiac Effusions reports and when they see them, they look to see the dosage that caused it.  From the research I did, this particular complication has not occurred with doses of 2.5 mgs or less in a healthy person.

Long Term Class 6 pattern, what happens under the skin?

/by William Rassman, M.D./0 /

From what I’ve read, the underlying theory for advanced classes not responding as well is due to scalp fibrosis, however that is understood to be reduced by an increase of bloodflow and microneedling. If scalp fibrosis is the culprit as to why NW6~+ don’t respond as well then hypothetically in time, enough microneedling and enough of an increase in bloodflow should result in an increase in hair growth right? I’m certainly getting vellus growth in my hairline at the sides and towards the middle front.

That being said, after almost an entire year on my regimen, I’m having what seems to be my first shed and it’s almost exclusively my intermediate hairs that have grown from vellus in my frontal mid scalp region. What has me excited is that I’m not getting any bulbs pushed up like when you lose hair so it seems like this is an expected healthy shed. I’m excited to see what replaces them in the next 3-6 months!

When an area of the head has been bald for quite a while, it loses its blood flow as the body regulates blood flow where it is needed. Normally, hair is a high metabolically active organ, so it commands blood flow. When the hair dies off with apoptosis (hair cell death as we believe it does), then the body figures that the blood flow can be better used elsewhere. This means that the skin of a older bald area, becomes atrophic and looses all of its support infrastructure for the hair which includes blood vessels and fat.

SMP before I lost all my hair?

/by William Rassman, M.D./0 /

Hi Dr. Rassman. Hair loss has consumed my life recently and I’ve opted for SMP. My only worry is that my scalp is considerably paler than my skin and the last time I buzzed my hair it really stuck out. Thanks so much for what you do, have a good one. Thoughts?

I have seen many young people get SMP. The problem with SMP is two fold: 1) the inks often spreads so that the dots must be very small to account for this and 2) the color of the dots may change with time (become gray). Make sure you don’t get a black ink because those take on the color or blue or green and stay out or prolonged exposure to the sun (wear a hat) as sun causes the inks to fade.

Male to Female and hair growth

/by William Rassman, M.D./0 /

What part of the process of their transition actually stops and reversed hair loss? I have heard that people who go MTF are able to regrow a full head of hair even if they started balding prior. So I’m curious. Is it the hormone blockers? And do you think that a baldness cure could come from scientists looking more into how MTF people can completely reverse their hair loss?

If you take testosterone out of the equation (chemical or surgical castration) and add estrogen, and the hair loss is recent, hair may yet grow from the balding area. The fall back position is hair transplants which is a common surgery with MTF.

Balding or blood flow, which comes first?

/by William Rassman, M.D./0 /

I’m showing clear signs of MPB and have started Fin, Min and Biotin. I’d be happy with maintaining my current hair and will only hope to see some thicker hairs and maybe revitalize some dormant follicles along the way.

But I did notice just this year that the thinning was happening very quickly. I have pictures from just 5 months ago where I have much thicker hair front to back. I have short hair too, so it’s noticeable now. Around the same time earlier this year I went to an urgent care facility when I was feeling extremely strange with my heart. They ran a few tests and said I was OK. Since then, almost everyday I have spurts of faintness, lightheadedness, dizziness, etc. Especially if I have caffeine, after I exercise or getting up and down a lot. I’m going to the doctor this week as I had written off all the symptoms since I showed normal test results when I was concerned last time, but now want a bit more of an answer and treatment.

So, I’m just wondering if abnormal (low) blood flow to my head may have accelerated hair thinning and loss.

The scalp has an extremely high blood flow because actively growing hair has a high demand for oxygen and other nutrients.  As hair start to miniaturize or fall out, the demand for blood flow decreases and your body is smart enough to redirect that blood flow elsewhere.  When you look a men with long standing balding, their scalp is very thin (no fat or hair follicles) so the blood flow is significantly reduced to this scalp.  The good news is that when it is transplanted, this process runs in reverse, building back blood flow to nourish the newly transplanted hairs.  The other parts of your questions need to be addressed with your doctor.