Florida Hair Doctor Recommendation?

/by William Rassman, M.D./2 /,

I am menopausable, early sixites, and experiencing extreme hair loss. My once thick, course hair is now fine, thin and receding. Many dermatologist in the area do not consult on hair loss. Can you recommend someone in Jacksonville Florida who specialized in women’s hair loss? Thank you

The ISHRS (International Society of Hair Restoration Surgery) membership shows two doctors who are members of the society. I would look to this society as those who are members have focused heavily on the learning process made available through them. Marina Pizarro, 904-246-2024, may be worth interviewing as she has a website at hairloss.md which will give you some information on her background.

Sexual Side Effects from Propecia

/by William Rassman, M.D./3 /

I am going bald, but after reviewing the several sexual side effects from Propecia that are in the drug warnings, I am afraid to take this drug. Is this a real concern or am I over-reacting?

I believe that like most men, any potential threat to your manhood should scare the hell out of you. There are many ways to answer this question. The official FDA studies show that the difference between the placebo group and those that actual took Propecia, is less than 1% of men are impacted by a reduction of libido (sexual drive). There is also a very small percentage of men who have ‘sexual dysfunction’ (I hate this term because is implies that something is ‘broken’) which can be made worse by Propecia. The risk for worsening sexual dysfunction is in the order of 5%. So the proper answer to this question is that there is a very small risk of some type of libido or sexual performance impact by Propecia.

Men are highly suggestive, so if a man thinks that he is going to be the one out of a 100 men who have a decreased libido or sexual performance, men can easily talk themselves into this side effect. If the problem is one of sexual performance (unable to have the penis work the way the man wants it to work), then there may be issues that need to be treated with drugs like Viagra, Cialis, Levitra or the like. There is no need to sacrifice your hair just because your penis does not work as well as it did when you were 16 years old. Hair loss, libido and sexual function have one thing in common in that they are impacted by male hormones. If something is wrong with any of these three, please see a good doctor and fix the problem. I believe it is possible to have a good sex life and get your hair back or prevent it’s loss, so get a doctor involved with your problem if you have one.

Letter from a Patient

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

I received this letter from a patient that we did two procedures on, totalling 1584 grafts. It is the knowledge that we can change lives, that makes my day that much better.

Thank you very much for the work you did on me. It has completely changed my life. You guys are so professional and courteous. You go above and beyond to make people feel comfortable. Your work is flawless and undetectable. I have had two surgeries and people I work with (which is quite a few), have never noticed anything.

The beauty is in the illusion. If anyone reading this is contemplating surgery, just go ahead and book the appointment. I give you permission to look at my before and after pictures. Notice how much younger I look and how different my face is framed. It is the You, You’ve always wanted.

Best of luck and thanks again.

The first two photos were before hair restoration at NHI, and the photo on the right (in black and white) is the final result. This patient is an actor, and the photo was scanned from his headshot. Click the photos to enlarge.




Integrity in Hair Transplant Doctors

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

I am 45 years old and I came to your office 1 year and one month ago. I have a bald spot about the size of a silver dollar in the middle of the back of my head (I believe you call this the crown) which did not go away when I used the drug Propecia for the past year. When we met last month, you suggested that I get the dollar size area transplanted with 700 grafts. I am a careful buyer, so I went to [Note: Doctor’s name removed – let’s call him Dr. X] office for a second opinion. Dr. X told me that I needed between 2500 and 3000 grafts, 1500 in the back of my head and the rest in the front. I was shocked by the difference between the two opinions. Is it possible that you missed any hair loss I had in the front? Even though I did not see any problem in the front, I have been looking at my hair a lot lately, and I am now starting to think that maybe I have hair loss there too. If you are right, then where is Dr. X going to put 3000 grafts? If he is right, will you be chasing my hair loss every few months? Who do I trust? Should I keep getting more opinions?

First, you should see me again and let me review your examination. Although I would be surprised if I missed frontal hair loss, there is no great mystique to the diagnosis of genetic patterned loss. We can mutually review this on the video densitometer which will absolutely show the existence of any hair loss one way or the other. I just met with another man who had a similar story to yours. He had frontal loss and no loss anywhere else, but when he got another opinion, he was told to transplant his entire head. Integrity and medical ethics should prevent doctors from transplanting men who do not need it. The buyer must always beware and is ultimately responsible for such decisions.

With regard to your comments about thinking that you may be losing your hair after staring at it day after day, just make sure you are not talking yourself into something that is not there. You have the power to control what is about to happen to you, use that power wisely and do not get sold on something that you do not need.

Finasteride Made in India

/by William Rassman, M.D./28 /

Dear sir
I am 28 and for more than 6 years I have consumed FINPECIA tablets ( dosage which is 1 mg per day )which is made in India for preventing of hair lost.In this regard I would like to know that wehether this tables has any side effect such as sexual tendency,etc.

The pill you are taking appears similar in name to the drug Propecia (finasteride) made by the US drug company Merck. If it is finasteride (controlled by US and foreign patents), the side effects are four:

  1. An initial increase sex drive in 10% of men taking the medication
  2. An initial decrease sex drive in 1-2% of men
  3. Breast swelling in less than 1% of men
  4. Some decrease long term impact for prostate cancer

If the drug is not finasteride, then I have no way to know what the side effects or the effectiveness of these drugs might be. For whatever reason many people in the United States promote the idea that drugs made in India are not quality controlled like drugs made in the United States. I think the correct statement for this should be that the United States FDA has not verified that the generic drugs made in India meet the strict standards required in the United States.

Minimum Amount for FUE Surgery

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

Assuming that I am a candidate for FUE procedure, will the institute perform a surgery of as little as 100 grafts on the side of my head(temple region). I want to try it out first before committing for bigger session. /money is no object ,with in reason. Thanks for the quick reply of my previous question (Resuming Physical Activities After Surgery).

Performing a session of 100 FUE grafts is not a problem. I will assume that the area that you want to try will stand alone if you decide, for any reason, not to do more?

Is Weight The Cause of My Hair Loss?

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

I am 21 years old girl. My hair were extremly good, thick, heavy two years back. My friends used to make fun of me that I used to wear a wig. Then I had two operations (teeth and rhinoplasty). For one year nothing happened but then my hair started falling. I had a haircut and it made my hair look better. But even then my hair continued falling and is still falling out.

I have one more problem, I am underweight. My height is 5 ‘7 ” and my weight is 47 kgs (104 lbs). I eat potatoes etc but dont put on weight. Is this the cause of hair loss? My hair is exposed to the sun for most of day because I am an university student. But I am sure its not the reason because I know many people who work in sun but dont affected. Please help me for that. Can you please give me advice that I can make up at home. I dont wanna go to parlours at this age. Plus please mail me the solution preferebly

It sounds to me that you might have either a medical condition (disease) causing the hair loss and possibly the low weight as well, or a dietary/eating disorder. You need a good doctor to evaluate your overall health. Malnutrition, although rare in the United States, is seen with Bulimia. In foreign countries where adequate vitamins and nutrition are problems, hair loss is seen with some frequency. You need to get a good doctor and get to the root of your problem.

Changing Finasteride Dosage

/by William Rassman, M.D./5 /

Can you please tell me if its problematic as far as hair growth/loss to move the dose of Finasteride around ? Thanks

Your question is not clear but i will try to cover a wide scope in the answer. You can take finasteride anytime during the daytime, but best to keep taking it the same time each day. The dose should be 1mg, such as Propecia. A slightly higher dose of 1.25mg, for those that cut the Proscar pill into quarters, is not a problem. Increasing it to an even higher dose clearly produces more side effects. A dose lower than 1mg is less effective.

How To Get Started

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

dear doctor:
you stress on getting a diagnose from a good doctor to determine the baseline. Is regenix a good place to visit? or i can just go any skin doctor to do the diagnose? and where is your clinic located? i am 25 and notice hair lost when i was 22. i am in los angeles, CA. thanks

Regenix offers hair care and accoutrements that make the hair thicker. They cleanse the skin, clean the pores and massage the scalp. Many people feel that this service is very helpful. I have seen visual benefits from thickening the hair shafts with the materials they give.

A good doctor can prescribe Propecia and make a medical diagnosis. If hair transplantation is appropriate, then a good hair transplant surgeon with high ethical standards may be able to diagnose your eventual hair loss pattern and put numbers to the rate and degree of balding. Monitoring the hair loss over time is an important contribution that a good doctor will add to your hair loss protocol.

Yes, I have an office in Los Angeles. Please visit newhair.com or call 800-New-Hair and visit me personally.

Determining Future Hair Loss

/by William Rassman, M.D./2 /

Hi Dr. Rassman. I am 22 years old but have been experiencing hair loss since I was 13. I have already tried Minoxidil (1 year) and Propecia (1 year) when I was 14-16 without stopping or slowing hairloss. I haven’t really lost much confidence due to my hairloss but it is very notorious now and would definitely like to do something about it. From what I can tell baldness comes from my dad’s side of the family (grandfather and father plus many of my dad’s cousins went bald) but no one has gone bald as young as I have. I think I am a class 3A Norwood and have been thinking about getting hair transplant surgery but I am worried if I will have enough of a donor area to cover the bald spot once the balding process stops, especially if I bald like my grandfather but so far it doesn’t seem to be the case. I was just wondering if at this advanced stage it was possible for a doctor to determine how much hair I will have left.

You need to have a good doctor define what is going on with your hair. Hair loss at 13 is rare, but can occur. If genetic balding has started that early, it would have been good to get a base line on the degree of miniaturization and the change over time. You must have that done now, before you get worse, or you will not know where your hair loss is going. With your history, a densitometry examination with quantification of the miniaturization in each area of your head will point to the long term pattern of your genetic hair loss (assuming that this is the correct diagnosis). There are other conditions as well, so it would be of great value to you to have a consult with someone like me, who is familiar with the causes of hair loss.

Transplantation in a person with certain conditions could be contraindicated. You need to be evaluated by a professional and even sending photographs will not give me the detailed microscopic examination I need. Please do not become your own doctor. This is not a game, but your future look we are talking about.

Hair Dye

/by William Rassman, M.D./1 /

Hair dye, it’s long term use and potential adverse health affects, has received a lot of media coverage recently. Do you think that hair-dye should be avoided? Is there any such thing as a safe hair-dye?

Dyeing your hair is not as good as not-dyeing your hair. Many people point out that when they dye their hair they get more breakage. Anytime you apply chemicals to your hair you are changing what nature thinks is the best. Periodically, I hear of people who develop hair loss from dyeing their hair. I suspect that toxic chemicals or high doses of chemicals are being used that cause this hair loss. I am often surprised by the failure of such hair to return in the most extreme cases. There is no doubt in my mind that some people overdo their hair coloring, changing it frequently and in effect ‘abusing’ their hair. Anything done in excess is not good. With regard to long term use, be responsive to what you see. Take a break from the dyeing periodically, going back to your normal hair color to see if it makes your hair better. At least, this way you will know how far from normal you have migrated to.

Human Hair Density

/by William Rassman, M.D./1 /

i am a student at State University of New York College at Geneseo. i am doing a reseach and it requires me to find out the density of human hair, in terms of kg/m^3.

i know that human hair density might have a range. if you have that stat., please also give me.

thank you very much for your concern.

In the Caucasian, human hair density averages 2.2-2.3 hairs/mm square. In Asians, the density averages approximately 1.6 hairs/mm square and in Africans, is averages apprxomately 1.3 hairs/mm square. In the head of an average male with a hair bearing area of approximately 80 square inch area, the density is approximately 1250 hairs per square inch (rounded) bringing the total count to 100,000.

You must keep in mind that this is center point in a Bell Curve, and standard deviations overlap heavily between the races. The highest densities I have measured were in Caucasians at 4 hairs per mm square and the lowest numbers are not trustworthy because they may reflect diseases or some form of genetic balding.

Keloid Scars

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

I have a bad elevated, thick scar from my hair transplant incision. I was told by my doctor that this is a keloid scar. Can you explain this to me and what it means if I ever have another surgery?

In medicine, we always talk about the differential diagnosis of a particular problem or disease. Scars come in many flavors and we are focusing upon healing wounds with this question. Some scars stretch, some get red for a short period of time, some hold their redness for weeks (even months), others get elevated and some form tumor type growths which grow from them – the keloid scar. Many people, even some doctors use the term keloid scars when they are not really understanding what a keloid is. The keloid has become famous from photos in the annals of National Geographic, showing people creating these grape like tumors by cutting into the ears and applying a chemical irritant which produces the keloids. When keloids are found naturally in wounds, they are most often found in the darker skinned races. Doctors have been polled reflecting the cumulative experience of tens of thousands of patients, and keloids are almost unheard of when we talk about scalp scars. When a keloid exists, it is a proliferative process in which the scar significantly exceeds the boundaries of the original wound and is significantly elevated and often globular. Hypertrophic scars can be elevated or simply a thick scar. Burn scars can also be hypertrophic, but rarely keloidal. The trunk and shoulders develop widened and hypertrophic scars quite commonly after mole removal, and this would not be a contraindication for elective surgery. I have done scalp surgery on people who are known keloid formers, but I have never seen one appear in the scalp from which the donor area is harvested.

My Son Is Balding at 19

/by William Rassman, M.D./1 /,

I am the mother of an 19 year old son, who is now experiencing the effects of heritary male pattern baldness. My father was bald, and my son’s biological father is bald. In fact baldness on both sides of the family goes back for several generations. Poor kid; he is really distressed about this. I tried to explain to my son that just because he is loosing some hair on the frontal area does not mean that girls will not be interested in him. Of course he always says, “That is such a MOM answer!” My new husband and I live in Utah and our communication with my son is mostly over the phone to California where he lives attending college. We told him to go see a Pharmacist but I am sure they will just recommend some over-the-counter cream like Rogaine. Also he likes to work out and has been drinking these shakes to help him bulk up. Are those bad adding to premature baldness as well? What do you recommend? Should he contact is primary care physician? Should he see someone in the Santa Clara, CA area? Please help.

Sometimes these ‘shakes’ have steroids in them and they can accelerate balding in people who use them. He needs to be seen by a specialist. I have an office in San Jose so ask him to make an appointment with me personally, and I will try to diagnose him and address the problem. The longer he waits to get to the root of the problem, the more hair he will lose. To set up a free consultation, please call 800-NEW-HAIR or fill out our online info request form and we’ll contact him to setup an appointment.