As creators of the FUE method, I presume you know what the FUE Plus method is? There is a clinic in my country that claims to have been able to boost the traditional FUE method by using a smaller tools when inserting the transplanted hair. (1) They claim that the increase in density is miraculously high, but still the improvement is impressive. Do you know more about this? (2) A new hairloss treatment called Recapeen, has been realeased. The “engine” in this package claims to be the unique pollen extract the substance is full of. Comments? And finally, 3) What is the strongest reason why to spend money on a hairtransplant rather then a laser treatment?

I looked at the site referred to in your question. There is not enough information for me to judge what FUE plus is. When I purchase a bottle of shampoo and the company comes up with a new version of the shampoo they may add the term ‘plus’ to the name. The detergent market for washing clothes, made the most popular product in the early 1900s. That product was ‘Tide’. Then as they were improving the product, sales did not rise fast enough, so they came up with New Tide. The adjective NEW turned out to be the most popular advertising word in capitalistic history. Everyone came up with a product and then made up a NEW version of that product. I, knowing this, called my company the New Hair Institute and purchased the phone number 800-NEW-HAIR before anyone else thought of it. I was, at the time, an old fashioned marketing person, so NEW did it for me. The modern iteration of this is the term PLUS. I guess, if you did not invent FUE, then the best way to grab onto market presence is to invent FUE Plus, or at least the name. I respect the marketing brain that thought of it. The choice of doctors, of course, should have little to do with PLUS or NEW, but rather who you can trust to do the FUE on your head. Experience and judgments are critical to this choice and you sound (at times) like you are making such choices.

I did look at Recapeen and see that this miracle cure is listed with many other such potions and lotions on the respective websites. If Recapeen worked so well, one might ask why other products are listed there? I call it good marketing and diversification of strategies. Spread out well, and more people will get some part of the message. What are you really looking for?

I agree with you that hair transplants should be obsolete if these miracles worked, but then again, first I would want to see the studies and the scientific evidence that it works, because I am a cautious buyer. Every day that you chase the magical cure for balding is another day that you will continue to lose hair and progress further down the pattern of hair loss buried in your genetic cards.

With regard to laser treatments click here Low Laser Light Therapy for Hair Loss for more details.

Why does hair vary so much with people? Does coarse hair or kinky hair have an advantage over fine hair?

I remember a television piece done by CBS News’ 60 Minutes where they tracked what was claimed to be one of the original 12 tribes of Israel deep into the African continent through genetic testing on the Y Chromosome. In the few thousand years since the migration, the physical characteristics of the African became evident in these people with bigger lips, a wider nose, and kinky hair. I think that thermal regulation has a lot to do with the kinky hair, which allowed better cooling as a person chased an animal in the savannas of Africa during the hunt. Wide nasal passages allowed better air movement for breathing as well. The scalp is a major releaser of heat by preventing overheating in the summer, especially when heat generation adds to climatic conditions. On the other side, we know that when the French invaded Russia in Napoleon times, the winter killed more Frenchman than the battles. We also know that the bald men died during the retreat at a much higher rate than those with a full head of hair. Conservation of our body heat in the cold is another function of hair. In your question, you suggest that there is a better hair type; but better for what? Those with thin hair that sticks to a sweaty scalp may insulate better than a person with kinky hair, but not with coarse hair that lies flat. Also, there are no kinky-haired people outside of the original African population, indicating that kinky hair had an evolutionary advantage, so it evolved as the people adapted better to their geography and climate. If everyone originated out of the middle east, then we should look to our cousins there to see where we may have started from. This could be interesting topics of conversation for those of us who believe that one type of hair/person is better than another. When we put esthetics into the formulae for your question, then culture and vanity act as modifiers that go well beyond the influences of climate. Thanks for the insightful question. I always enjoy the wide variety of questions posed in this blog.

My husband is 33 years old and is losing his hair, he also suffers with body dysmorphic disorder and is desperate to do something about his hair loss. He has already tried many different lotions and potions to try and halt the hair loss because we can not afford for him to have a hair transplant. The problem that I need advice about is Dutagen (Dutasteride soft gel capsules) he has purchased a 6 month supply of this drug from the internet but I noticed the warnings about dangers to pregnant women and the risks to male foetuses. The problem is I am 7 months pregnant with our second son and I have great concerns about my husband taking this drug knowing that there are risks to our unborn son. We also plan to have more children in the future and I am extremely worried about the risks to me and my baby now and for any unknown problems that may arise in the future regarding having more children. What information is available to me to put my mind at rest about my husband taking this drug while I am pregnant and future fertility considerations associated with taking this drug?

Dutasteride is a known DHT blocker. I am not familiar with this drug’s concentration in the sperm and how much of it could cross into the baby. If it follows the experience with Propecia, it should be safe in this regard, but without first hand knowledge, I can not tell you the answer to this question for sure. There is a theoretical problem if it did cross the placenta and into a baby’s body, it might affect the baby’s sexual development as the drug has a very long half life. You might ask your husband to use a condom until the baby is born.

Soft Gelatin Capsules, because of the possibility of absorption of dutasteride through the skin of people who handle this drug and the potential risk of a fetal anomaly to a male fetus in a pregnant woman who absorbs any amounts of this drug, could impact gonadal development. This is a risk that is not well defined for this drug. For this reason, women should use caution whenever handling Dutagen Soft Gelatin Capsules. Your physician should inform you and your husband that the ejaculate volume might be decreased during treatment so that for women wanting to get pregnant, this might also pose risks, particularly for the fetus if the sperm contains the drug and the drug last months inside the sperm (and possibly inside the fetus).

The known side effect of a decrease in sperm volume (with Propecia and Avodart) does not appear to interfere with normal sexual function in most men, but in clinical trials, impotence and decreased libido, considered by the investigator to be drug-related, occurred in a small number of patients treated with this drug. I hope that your husband’s body dysmorphia is being managed by a good physician.

Hi, i been taking propecia for a month and 1 week, this last 2 week i notice that i lose over 150 a day ( Each morring i lose around 50 hair on my pillow and around 80 in the shower). It been going on over 2 week.
Will this stop and Is this normal for taking propecia? if yes how long will this hair lost last? Do propecia cause initial hair lost?

thanks

A typical person does lose 100-150 hairs per day. If what you see more recently reflects a change in your norm, you may be experiencing an acceleration of your hair loss. The relationship with your taking Propecia may be circumstantial and I would believe that the two are not related, but you can stop taking the drug and see what happens. The drug is out of your system usually in a day or two. If it stops the loss, then maybe there is a connection, but I have never seen that connection in others. If the loss continues, then I would go right back on the Propecia because that is the best hope for you.

There are some doctors who believe that some shedding after starting Propecia or Avodart is due to an acceleration of the hair cycling. See my previous posting on this subject here.

Dear Dr. Rassman,
First of all please let me thank you upon your excellent work (as i overheard from sources). Am 25 year old and had a HT procedure of about 1600 grafts by strip method 4-5 weeks ago for increasing my facial hair density around the chin and goatee region and due to the fact that i live in the middle east i didn’t have the chance to perform it with you,otherwise things would have been different. Without any exaggeration am now having cruel restless nights with lots of suffering. I have two major problems or should i call them concerns, first is that the recipient areas are exhibiting significant redness (even after more than 4 weeks post-op). Add to this a long battle with infections, second is that after going through many forums, i’ve found that infinitely many people are depressed about their donor area linear scars as the scars tend to stretch and looks ugly which restrict them from having their heads shaved or get a simple buzzcut. Is there anything i can do about the redness of the transplanted areas? Sorry for elaboration but you are saving a man’s life Dr. Rassman

I am assuming that you had only the chin and goatee region hair transplanted. With that assumption, 1600 grafts seems a bit high. If larger than one hair grafts were used, I can imagine a great deal of reaction to them. including skin changes like puckering of the skin. If you look at typical beard hair, these hairs rarely are more than one hair per grouping so if you had more, then there are wound issues in healing which might point to problems. Without seeing you myself or knowing what you had, I can not be certain. Infections are rare indeed, but if you are having them they are most likely the results of cysts at this early stage where sebaceous glands from the transplanted hair are producing sebum below the skin and becoming reactive cysts. There are usually best treated with soaks at least twice daily and meticulous hygiene. Antibiotics may have value but good cultures should be done prior to starting antibiotics in the event that you have a bad organism causing the infections.

We have spent a great deal of time discussing scars in previous blogs.

HI DR. RASSMAN, I would like to tell you what I am using… propecia, monoxidil 10% with retina-A .. revivogen, nizoral and n-t gel shampoo. I would like to know if you can offer me something better then this or is this plan good???? PLEASE get back to me.

This plan seems to cover everything and every potential as the ads state. Some of the things you use are not in my bag of tricks (like retin A, which I believe probably does more harm than good because it produces a type of chemical burn to the skin). Nothing more to add.

Hi. I had my procedure with you in April. I am out of my propecia. Online purchases? Prices? I am in school, your envelope non-specific? Thanks.

Call my office at 800-639-4247 to renew the prescription and find out our current charge. There are options: you can buy it directly from us, we will mail it to you in a white box with green trim and the first time you buy from us we do give a free sample; you can provide us with the name of a pharmacy and we can call in the prescription for you; or you can ask us to send you a written prescription and you can hand carry it to a pharmacy or use it for an online purchase. As far as prices, call a few pharmacies – some of the warehouse stores are slighly less expensive, check online prices (make sure that you are getting the actual drug, not a knock-off), and see what works best for your budget. We do ask that patients sign a consent form for the prescription, and that they come back to see us each year, so we can gauge the effectiveness of the Propecia.

Hi! I’m 21 years old and female. In feb 2004 I started taking birth control pills, and 3 months after starting them, i started losing hair. Then after 7 months of using them i stopped, because my hair was falling out in clumps. No I have been off more than a year and i still dont see any improvement. Doctors have made bloodtests, and they were OK! Hair loss is diffuse all over and they have a little white tip at the end. In my family no one has hair problems, not even my two grandfathers or my father! Is it normal to lose hair for such a long time ? i truly believe i am going to bald soon :(
Thank you for your time!

Please see my previous post about Depo-Provera which answers the question about birth control pills and hair loss. Unfortunately, some women with hormone changes can precipitate female genetic hair loss and once it has started, it may not be reversed ‘if it was to be in her cards’. About 30% of women over 50 are affected by this genetic process. Although we can reasonably accept hair loss as normal in men, women have a unique type of suffering because it is another ‘attack’ on their feminity in a society that is heavily hair conscious and weighted to beauty and youth. When a young women get genetic hair loss prematurely (I fully realize that it is always premature for a woman of any age), then it is the worst type of insult that flaunts aging very painfully. What the male and female genetic hair loss is, is the ‘miniaturization’ of the hair (the thin hair that becomes even thinner as the process advances), but the location of this miniaturization is different in women than in men. Men have it develop in patterns (front to back) while women generally have it all over the head: front, top, back and sides. Some women will retain the frontal 1/2 inch of hair as healthy, even with the process of miniaturization everywhere else.

When you discussed that your tests are completely normal, I would raise the issues of Thyroid and pituitary function, as well as the absence of circulating angrogens, amongst other causes. Some doctors talk about chronic effluviums or the presence of diffuse alopecia areata (you need to have a dermatologist evaluate this).

Minoxidil does work on some women, often better than men. Some men have a diffuse patterned hair loss like women (about 1-2% of men) but some of these men are helped by Propecia (about half) while that drug has not been determined to be safe for women and even when experimentally given to women by a handful of doctors, few if any benefits were observed.

After going through this web site and reading your blog comments, I have come to believe that you are closed minded and inflexible when it comes to using homeopathic, natural herbs and other natural remidies for treating hair loss. Are you just unwilling to show flexibility and open mindedness?

Natural supplements and homeopathic medicine may be a great alternative means to treat a condition or an ailment. Unfortunately, these supplements are not well regulated by the FDA, so claims that are made can not be often substantiated, except by rumor mills and word of mouth communications that tend to praise the remedies more than criticize them. You can’t truly know what chemicals are included in the supplements that may have been used to process the product that you are buying. What the FDA calls Good Manufacturing Processes (GMP) may not be adhered to with food, naturopathic herbs, or potions and lotions sold over the counter in natural food stores. Furthermore, these products may not be covered in the regulatory process that confirms the dosages and the purity of such product, including the safety and efficacy of them. The research and studies that show efficacy are often funded by the manufacturers of the supplements which may bias the reported results. Finally the proper dosage for such products seem arbitrary. Just because the friendly neighborhood natural food outlet, their sales rep, or a salesman in a white lab coat can attest to its efficacy, does not mean that these are safe and/or effective.

For example, Vitamin A is one of the few vitamins that when taken in high doses, can cause hair loss. I have read that this vitamin is recommended for hair loss, so many people think that if a little is good, more may be better. In the case of Vitamin A, excess doses (overdoses) can cause death, so who cares about hair loss when you overdosed on this vitamin? Vitamin C, when taken in low doses is an antioxidant that theoretically prevents heart disease, but when taken in high doses (according to a UCLA published study) it accelerates coronary atherosclerosis (heart disease). Saw Palmetto, which is believed to be a DHT blocker for the treatment of hair loss, may compete with Propecia for the enzyme block that stops DHT production, making it less effective. What is not commonly known, however, is that Saw Palmetto was used by the military in WWII as a sex drive reducer for our troops. It was added to our soldier’s food supply. In studies performed by an independent agency, the dose of Saw Palmetto varied widely by the manufacturers. As such, some people get poor response from the drug as a DHT blocker (it is a weak blocker) while others get sexual side effects, reducing a man’s sex drive as the dose is possibly too high.

Kava is a widely used herb root in Polynesia that can be used to treat anxiety. There are case reports that this herbal supplement has caused liver failure that eventually led to a liver transplant as a life saving procedure, when used on someone who could not tolerate it. Did she lose hair? Possibly so. As part of our medical education, doctors learn that fava beans are harmless, yet they can cause death in very small quantities in those people who carry a rare genetic defect . People who carry a defect in the enzyme glucose-6-phosphate dehydrogenase, can not process the fava bean toxin. This toxin then poisons the red blood cells of the body. This is a genetic defect passed from mother to child. In the Mediterranean, where fava beans long have been a dietary staple and where the genetic mutation is more common than in the U.S., physicians frequently test children for the enzyme deficiency. The fava bean’s effect on hair loss is not as well known but on a positive side, look at the statement made by Hannibal Lecter in the movie “Silence of the Lambs” who recommended it by saying: “A census taker once tried to test me. I ate his liver with some fava beans and a nice Chianti.” I guess that Hannibal Lecter did not have the enzyme defect I just discussed and it made his meal memorable.

The question I am posing here in answer to your somewhat caustic challenge to me, is that I tend to protect my patients from the unknown. When I do not know something as a fact, I might ask myself: “How many undocumented side effects or enzyme defects float around that are either caused by natural herbs that could threaten a person’s health or life that are not researched or understood?” Arsenic is a natural substance used historically to treat syphilis, but as I have said before, I would not recommend arsenic as an alternative to penicillin, which is safe and well tested (also FDA regulated through GMP standards) and accepted world-wide.

The answer to this blog entry was partly written by Jae Pak, M.D., an emergency room physician with great interests in hair loss and hair surgery. He has worked with me for almost 9 years.

Hey doc, I’m 18 years old and I have long wavy hair. I’ve noticed that my hairline is receding in the front…more so on the right side and a few small bald circular spots in the front. My dad is in late 50’s and he has a head full of thick hair while my mom is in her 40’s and is showing signs of baldness. However, she is constantly stressed out about various issues so I’m not too sure if its heridetary. My grand-dad passed away in his 50’s and he was balding. I tried shaving my head before and i look absolutely horrible! Is there anything I can do to promote the regrowth of my hairline? I am not exactly the Brad Pitt look-alike and my hair was the only thing I had! Are there any new treatments under development and on the market that can do something about this dire issue? Thanks for your help.

What you are reporting is the maturation of your hair line, which occurs between the ages of 17-29 in most caucasian men. The corners rise about 1 to 1 1/2 inches and the center rises about 1/2 inch to 3/4 inch. To see if this rise is normal, look into the mirror and lift your eyebrows up. There is a high crease, which reflects the top of the Frontalis Muscle, the place that hairline transition zone usually starts in boys and most women. As caucasian men go through an aging process (I like the term maturing process) where the hairline rises as discussed above, but for many non-caucasian men, the hairline is flatter and does not rise as far in the corners or not at all. If you have sisters, have them lift their eyebrows and look at that crease and you will see hair just touching that crease. This is a normal male process and nothing to be concerned about, provided that it does not rise higher than the measurements I just referenced. If it does, or if a doctor examines you and determines that you have miniaturization (too many fine hairs behind the mature, adult hairline location), then you may have early male patternedgenetic balding and the best drug to slow or prevent hair loss is Propecia. I have seen many wonderful, miraculous results from this drug in young men. Propecia has been on the market for about 7 years and it is safe. My son, many members of my family, and I take this drug and none of us has defined any negative side effect, sexual or otherwise.

Hello,

I am a 25 year old woman and I have been losing my hair since the age of 12. All of the women in my family have been affected, but I am the first to lose it as such a young age and actually have it the worst. I am generally bald in the front and have thin hair everywhere else, but it’s not bald. I currently am using a weave, but I’ve noticed that is has actually become worse and I’d really like to lose the weave and have a natural hair line. Is New Hair catered for men only, and if not, can I be helped?

Desperate in Brooklyn

First of all, you should see a good doctor who knows about hair loss in women. Since you are in New York, I would recommend you set up an appointment with Dr. Robert Bernstein at (201) 585-1115. He has offices in Manhattan and New Jersey and can address your unique problem. It sounds like you do have genetic female hair loss, but first let’s get an expert to determine it. You must have a full check-up to determine if you have any metabolic diseases as well. For more questions and answers about female hair loss, please click here for previous blog entries.

Hi DR,
i have been through all the entires in the blog and find it quiet useful… here is my problem/question…

I am almost 26 yr old male and experiencing considerable thining. This probably started 7 months ago although it was not that noticeable and there was considerable self denial on my part. My frontal hair are thinning althogh my hairline is maintanied and now even the crown area is thinning considerably. It a very emotional rollercoaster for me and i’m feeling depressed. today I started on propecia and saw palmetto and maybe i ll use nizoral shampoo too. I want to know how long will it take to see a complete stoppage of hairloss and regrowth of new hair ? I may be a BIT late in starting but the thinning started occuring 6 months back and considering that I had a head of full thick hair until october last year… I was in total self denial that my hair was thinnnig. My dermatologist confirned its a case of MPB since my dad started losing his hair in his very late 20s. I am not even married and its very emotionally distressing :(. What are my hopes ?? Also will a sinus surgery(with local IV sedation) cause any further hairloss on me or contibute ?

Please write back. Thanks

With a 7 month history of hair loss, there is sill a possibility of controlled loss or reversal of some or all of the hair loss within the first two years you are on this medication. You must wait this out. I would recommend against taking Saw Palmetto with it, as there may be competition for the DHT enzyme sites between the two medications making the Propecia less effective. Any added stress can impact the rate of hair loss, and sinus surgery is no exception. Still, if you need the sinus surgery, do it and continue to take the Propecia regularly.

Good luck.

i am a 26 year old female from scotland, and i would like to know if you could recommend a clinic in the UK who do the hairline lowering procedure. Please say there is one!

I don’t have any personal Scotland-based recommendations, but I would check the International Society for Hair Restoration Surgeons (ISHRS) site at ISHRS.org. Use the physician search section to look up doctors in the UK. You can then call and get a direct referral from someone within the United Kingdom.

Hi Dr. Rassman,

About two years ago, I started taking Propecia for my hair loss and stopped after three months because at that point i noticed a drastically increased rate of hair loss, and assumed that I was reacting negatively to the drug(one hair loss specialist suggested that it is possible that my tissue became hyper sensitive to DHT because of the drug, but I did not experience any increased acne or libido, which he said would also be indicative of that rare kind of reaction to Propecia). Eventually I decided to try Propecia again, and now I have once again reached the three month mark, and once again, like clockwork, I am seeing significantly more hair on my pillows, in the shower, etc, than what I had when I was off the drug, but no acne or increased libido. I am wondering if you think this means the drug wont work for me or if it is just a temporary phenomenon that I should wait out, and that I will probabely still benefit from Propecia. I understand that some people experience sheds while on Propecia that are a sign the drug is working, but have heard that this should happen within the first two weeks of using the drug, not so long as three months into it. Thanks very much for your time.

I believe you must stay on Propecia for 8-12 months. Stopping and starting your taking of the drug is not a good idea. There have been some reports that hair cycling changes in a small number of people with Propecia, such that more of the effluvium (loss) side occurs at the beginning but the anogen (building stage for hair loss) will follow in 6+ months. It does not sound like you have given it enough time. This is a most unusual complaint, one that I have personally not seen in my practice but one that has been reported by some of my colleagues.

I have been bald since I was 30. I am now 73. There was no hair to speak of (you call it a Class 6 Pattern according to your book). I finished my chemotherapy for prostate cancer and my hair grew back. Any comments?

The chemotherapy must have taken away your ability to make testosterone and it’s byproduct, DHT. That would account for a regrowth of your hair (as if your testicles were removed, in the chemical sense). It would be unusual to grow your hair back completely if you have been that bald for so many years (I’m assuming it has been at least 20 years), unless there was still hair present that was heavily suppressed by the testosterone you had circulating around. I would love to see before and after photos of your hair growth.