Hair Loss 1 Year After Pregnancy

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

I am 32 years old & had my 3rd child 1 year ago, in August. Approximately 4 years ago I was treated for multiple symptoms of malnutrition from losing too much weight too fast. Ridges in my fingernails, major hairloss, hardened areas under the skin on my face & finally an MRI was ordered for an orange sized induration on my hip- it was negative. I got the issue under control & resolved all of these problems. I gained nearly 100lbs with my last child & now a year later my hair has begun to fall out at an alarming rate. I am not dieting & have slowly lost some weight from the pregnancy but in a healthy way. I take no hormones or birth control & I am not on any other meds. I am also in nursing school clinicals which I started 5 days after the baby came. Would I be more likely to suffer hair loss, having a history of it, than I would normally be, related to stress or diet? With it being a little over a year since the birth, I didn’t attribute it to post-baby hairloss, could it be? Thanks for any advice you may have.

You have many variables here which are hard to put together. You clearly recognize that hair loss can occur with pregnancy along with malnutrition. You also recognize that pregnancy hair loss often reverses after a year or sometimes two. I would ask for many tests to rule in or out a series of medical conditions such as thyroid disease, which does start post-pregnancy in some women. The relationship with these hormonal diseases can also cause hair loss, particularly when combined with the genetic predisposition for female genetic hair loss.

Be sure that you are evaluated by a good generalist doctor first, then get your hair graded for miniaturization and patterned hair loss. These may fit together to point or narrow down the possible diagnosis. Start with a good, well-trusted doctor who cares about your overall well being.

Bald Spots in Beard

/by William Rassman, M.D./19 /

I recently started getting bald spots in my beard. My guess would be due to bad dieting cause I have a full head of hair and my dad’s beard is still very full at 62. I just pray you can give me some info about how to get this spots to regrow in, cause I love wearing a beard. Thanx for your time!!!

Bald spots appearing in any hair bearing area may point to alopecia areata. A biopsy done in the hands of a good dermatologist is critical in ruling out this problem. I would recommend that you see a dermatologist, and have them take a look at all of your hair bearing areas, first and foremost. Beyond this suggestion, it is hard to diagnose what the problem may be through the Internet, especially having never seen you.

Different Races, Different Surgical Hair Loss Treatments

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

Do you treat the different races differently when they bald?

With non-surgical treatment, all races are treated similarly. Each patient who chooses to have surgery requires different treatments based on skin thickness, hair color, hair characteristics and density, and these do vary between the races. For example, the highest hair densities appear in Caucasians, while the lowest densities are in Africans. But because Africans have less color/contrast and better hair character, often that will offset the lower hair counts found. Best to read my book, which talks about this subject (and lots more), which can be found here. The text of the book is downloadable in PDF format, or you can request a free copy of the book by mail — both options are available on that link.

Proxiphen

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

Dr Rassman,
Can you please comment on the product Proxiphen as compared to plain Minoxidil. Thank you

Proxiphen is a cream that consists of minoxidil, phenitoine, spironolactone, varied types of SOD, NANO, arginine, allantoine, NAC and more. It contains more than 5% minoxidil (reported to be 5.5%). You asked about comparing Proxiphen to regular Minoxidil, but I can not state the value of the Proxiphen combination of medications, as there are no independent studies to document it. However, there are clearly wonderful endorsements by those that profit from the sales of it.

Hair Loss, Lasers, Drugs and Transplants

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

I am undergoing a hair loss treatment. This treatment involves lasers, basically a helmet that shines light on my head to deter DHT. I am somewhat skeptical, but it was the only option that was within my price range at the moment. I am 20 years old; my hair loss is not substantial. I am thinning on the top of my head and the most severe areas are in my hairline and the back of my head. I took this treatment to prevent my hair from thinning anymore. The thinning is not very obvious but I can tell it is still progressing. I wanted to know if transplanting hair from my own head would leave an area in the back of my head that hair will not grow on anymore. I also wanted to know if there are ways of getting transplants from other donors. Lastly, I want to know how much these treatments would cost and how effective the treatment I’m receiving is.

There is anecdotal evidence in Europe that hair lasers (Low Level Light Therapy / LLLT) increases hair growth. I’ve written about LLLT previously, here. Thinning of the hair in young men often starts off insidiously and gets slowly worse. At the beginning, you might actually lose 50% or more of your hair before you notice it. If you are a platinum blonde, you could lose 85% of your hair before it becomes noticable. The key is to make the diagnosis early and get on the only good, FDA approved DHT blocker that is out there: Propecia. This drug is the best and possibly the only real hope at this point to slow down, stop or reverse the hair loss. In young men, I have seen some wonderful reversals of hair loss. Transplants in a 20 year old without noticable hair loss is NOT something you should pursue at this time. When the donor area is harvested for hair transplants (the back of the head) it does not produce a bald area as you suggested in your question.

Laser treatments can be obtained from those who sell those services. We have a laser in our Los Angeles office, but do not sell the service at this time. I am told that the company that provides the service charges about $3000/year for treatment. Propecia costs range from $55/month to as high as $120/month depending upon the pharmacy you purchase it from. We sell it in our office at $53/month (very close to our cost). Transplants are sold by the graft. These surgical procedure generally cost a few thousand dollars per surgery, but they do last your lifetime. The more transplanted grafts you buy, the higher the fee.

ScalpMed

/by William Rassman, M.D./468 /, ,

PLEASE NOTE: I do not sell ScalpMed. I’ve been getting quite a few angry emails from people stating that they feel deceived by this product, that they want their money back, etc — but I have no relationship with ScalpMed’s manufacturers. I can’t help get your money back, nor can I offer much advice about this product. It is not FDA approved and I would not recommend it for that reason alone.

 

Let me begin by letting you know my situation. I am a 22-yr.-old female who has been diagnosed with both AGA and alopecia areata. My dermatologist tried steroid shots in one of the areata spots but they didn’t cause any growth.

That said: this morning I saw an infomercial for a product called “Scalpmed.” I don’t usually give infomercials a second thought, but I thought, what the hey, I’ll ask Dr. Rassman about this one. The product is *supposedly* for women and men, contains the highest FDA-approved dose of minoxidil, and does not cause sexual side effects or dry out the hair or scalp. The website admits that individual results will vary but offers a full refund of the purchase price (less shipping and handling, of course) if one is not satisfied.

Just thought I’d ask if you’ve heard of this, and, more specifically, if you’ve heard of this scorching anyone’s scalp off or anything similar. Don’t worry, I don’t intend to make any rash phone calls :D

It took a bit of research and a call to a consultant for FDA issues to answer this question properly. I could not find Scalp Med or Vitadil in the FDA database. The website says, “These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.” If this product were FDA approved, the FDA would certainly evaluate the labeling for the product. The second statement is part of the FDA definition of a drug. The second part, “Affects the structure or any function of the body of man” is relevant to the use of this product. It is strange that the first part of the website says it is FDA approved while the second part says the FDA has not evaluated the labeling. This is clearly an inconsistency that indicates that you should take what is claimed here suspiciously.

The website says that “Vitadil-5A and Vitadil-2A are FDA-approved formulas for hair growth.” The company may be saying that they used a formula that had been approved for another company. This is possible. However, a company cannot just copy the formula of an FDA approved product. The company must submit an Abbreviated New Drug Application (ANDA) and may be required to do bioequivalence studies before the FDA will approve it for this company. The company also has to meet Good Manufacturing Practices (GMP) as well.

I always end such comments suggesting as a consumer you must ‘BEWARE’ and be your own protector. The government can not always enforce its regulations in a timely manner to protect you.

Can Someone Control DHT?

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

HI DR. RASSMAN, I have a question for you…. you say propecia slows the hairloss, but mphl still progresses. I would like to know why the radio show host Spencer Kobren (The Bald Truth) has been able to stop his hair loss for 11 yrs now. Is he from another planet, or someone very special because he say that DHT is scared of him???? I mean you say the studies on merck site show hairloss continues even on the drug but yet I know Spencer has stop his hairloss. I think you might be reading that propecia curve wrong. I believe that when you start taking propecia you ” SHOCK THE SYSTEM” and you hairs go into a angen phase so appears like more hair is growing in the first 2 yrs but are hair does not stay in that phase forever . The hair on our head is not all in sync at the same time. I would also like to point out that the graph shows hair that was grow from vellus hair and does not count the hair that was maintain.. like the the terminal hair. That means at 5 yrs you will have 277 more hairs then when you started but what about all the hair you maintained. There is a difference between maintenance and the growing of lost hair. He has kept his so I think that proves his point, don’t you? DO I make sense..

What you’re saying is speculation based upon little fact. You are confusing things like vellus hair and miniaturized hair. The vellus hair is in each follicular unit (with or without balding present) and miniaturized hair is hair that is impacted by the genetic balding process. All hair goes into anogen, the longest part of its growing cycle and it may last years. You are implying that vellus hairs grow into normal hair on Propcia, but that is not a fact that I am aware of. One can not put all of the pieces together the way you did. The fact that Spencer did not lose his hair may have been in his genetic cards, and certainly not because he “scared” his DHT away. I would not say that former President Bill Clinton “mastered” keeping his hair or that he “frightened” his DHT, even with the Pentagon behind him. Sorry, but I have little to add.

Propecia and PSA Testing

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

I am on Propecia and I want to get my unmedicated PSA level. How long will I have to be off this medication to get the unmedicated level?

I checked with a urologist and he tells me that he believes that the magic number is 3 months. I am not sure of the reasoning here because the half life is less than 5 hours. But I guess that supression of the PSA blood level may take longer than the half life, which is another measurement. The urologist thinks that the PSA may relate to prostate volume in those with enlarged protates(which can be “permanently” shrunk with finasteride). I hope that this makes sense. Some feel that finasteride may shrink the PSA levels 40% or so.

PSA is a test used for Cancer of the Prostate. Elevations in thie PSA may indicate Prostate cancer and a person should be evaluated by a urologist it this value is elevated.

Doctor Recommendation in Turkey?

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

Hello doctor. I was wondering if you knew any good doctors in Turkey. I live in turkey and it would cost me alot to travel to the united states. I was wondering if you knew any doctors with a good clinic and staff..

It is important to read as much as you can about hair transplantation. Know the different types of techniques and know what the standard of care should be. Our website, www.newhair.com, has a tremendous amount of educational material for you to review. Then look up the list of doctors in Turkey on the International Society of Hair Restoration Surgery. I do not have any personal recommendations for Turkey, but ISHRS is a good place to check. See if any of the doctors have websites that detail the type of procedures they do. You’ll want to find a doctor that at the minimum does ‘state of the art, follicular unit transplantation’, and has their staff use microscopes for graft dissection. See if they post patient photos of their results or allow you to meet their patients to show examples of their work. After you have narrowed down your list, make consult appointments with the doctors, try and see their patient results in person, tour their facility, ask questions, and get as many recommendations that you can. Find a doctor that you feel comfortable with, and one that gives you the best plan for your hair loss treatment. If you have access to a digital camera and would like me to also give you a diagnosis, email them to me and I will review them.

Hair Loss From Poor Nutrition?

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

my hair is falling out dramatically. i have suffered very poor nutrition and stress along with some drug use. what should i eat, take, and/or do to stop the loss?

The reason that we do not see hair loss from dietary causes in the United States is because we are well nourished and generally without vitamin deficiencies. In your situation, with a history of poor nutrition and stress, these alone can cause hair loss. To correct this, a proper diet should be followed with a professional dietician. If your hair loss has a pattern to it (front, top, or crown), it may be genetic — in which case, Propecia combined with a good diet correction might be your best bet. If the loss is generalized, the malnutrition and vitamin deficiencies (as well as other causes of this) must be properly investigated and professionally treated.

15 Year Old Female with High Hairline

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

Im fifteen years old with a weird high hairline. It is goes into an ‘n’ shape like my hairline is receding. I’ve been made fun so much and I need to find a surgery quick!

There is never a ‘quick’ answer for a 15 year old. If you are like my daughter was in her teens, yesterday is never soon enough, but if you have a high hairline, it can be treated (see previous blog answer on this subject in High Hairlines in Women). If you bring your parents in to a competent plastic surgeon’s office or a hair specialist like me, we can discuss what can and should be done to deal with your concerns. At the same time, a specialist’s opinion is valuable in itself.

Am I a Female Hair Transplant Candidate?

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

I have MPB running rampant in my family. I am a 42 yr old female who is experiencing diffuse shedding mostly in the summer months. It seems to let up after that. I have noticed an overall change in texture from when I was in my 20’s & 30’s and also it’s not as thick (# of hairs total) by maybe 25% or so.

I heard females weren’t as good of candidates as men since the thinning is diffuse therefore hair taken from a donor site might also thin eventually. That said, what female would be a good candidate for transplantation if any? I’m not a supporter of any drug. Your comments & info?

Humans as a general rule, have asynchronous hair loss (not tied to seasonality) but that rule could vary for you. Hair transplants in women should be confined to women who have a healthy donor area (enough to supply the need), localized hair thinning or loss, or those that have hair loss from other causes such as traction alopecia (common in black women who had their hair pulled very tight when they were children), hair loss from cosmetic surgery, etc…

You need to have a doctor who is ethical and can judge the value of a hair transplant for you. I generally do not recommend hair transplants for about 80% of women because they do not fulfill the above criteria. What is important to me is that if I recommend a transplant, then I would want the patient to be happy and meet realistic expectations. It is the doctor’s responsibility to set those expectations properly.

Transplants Growing In (with Photos)

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

A picture is worth 1000 words, and this nice patient of mine agreed to share his 4 month growth with everyone on this site. His business colleagues watch him daily and with the gradual growth of the transplanted hair, nobody has noticed anything unusual over these past 4 months. In the coming months, the hair will continue to grow and thicken, but because I’ve received quite a few emails asking what a transplant looks like as it grows in, I wanted to show this patient.

The “before” photo on the left was taken in May, and his “after” photo on the right was taken in September. He had 2,189 grafts transplanted. Please remember, this is only 4 months after the procedure and some of the hair has grown while other areas look like he is balding. Slowly over the next few months, the open areas will fill in continuing the gradual transition from a bald front to a non-balding frontal view. While it is growing in, if notice at all, it will look like the patient is losing hair, but day by day and week by week, the patient will be looking less thin. After 8 months, one can expect 80% of the growth and in 12 months, this patient will have over 90% of the results visible.

For more information about the post-op timeline, please see Post-Op Course in Follicular Unit Transplantation.



Crown Transplants or Propecia?

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

Here is an example of a patient of ours who refused to take Propecia, but had 2,027 grafts transplanted in 2001. He had a remarkable change from the transplant, even filling in some of the upper part of the crown. At his recent visit a few days ago, I suggested again, that he try Propecia before undergoing a hair transplant, even though his results from the single procedure he had was remarkable. Much of the original hair in the upper crown that he had a few years ago, fell out. But even if the transplants still saved the day, he may have avoided the loss with Propecia.

Why would I suggest Propecia rather than transplants? First, I tell my patients that I make my living doing transplants, so if I recommend the drug approach rather than a transplant, I must be thinking of something other than the money I might make from the transplant. The answer should be obvious to the readers. I care about what is best for the patient. The drug, in many patients, will postpone or make transplants unnecessary. If this man succeeds at regrowing hair in the crown with Propecia, he will avoid surgery, saving money and donor hair for some time down the road when/if he might need it. A doctor should always put his patient’s interest first and foremost and if this young man was my son, that is what I would recommend for him. If the drug does not work, then a transplant is a reasonable option. He should wait for 8 months before facing that decision again. He was very appreciative.

Below: His “before” photo in 2001 is on the left, and “after” photo in 2005 is on the right.