Family History of Hair Loss

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

Hello doctor. Thanks for your time. I have medium length wavy hair. I have notice recently a lot of hairs coming out in the shower and sometimes on my pillow. My fringe feels thinner and i feel a little bit thinner on top, but my hairline does not appear to be very receding. I’ve also had an itchy scalp of late. My brother suffered hair loss aged only 21 and my uncle also lost most of his hair before he reached 30. This would make me believe it is hereditary hairloss but my hair doesn’t appear to follow the pattern that i’ve read about. Could there be another reason? Thanks.

You need to be examined by a good doctor and the diagnosis of genetic hair loss needs to be made with objective criteria. A close microscopic examination of the scalp (all over) will show indications of patterned hair loss common in the genetic cause of hair loss in men. Please, before you jump in and start taking drugs, let’s make a diagnosis and map out the full impact of the genetic balding now. Then, knowing what you have in store for you, Propecia would be a good drug to combat your hair loss (assuming you are a young man) and a repeat microscopic examination of the hair in different areas of your scalp will show the areas that are most improved with Propecia.

CosmeticTrichoGenesis

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

What can you tell me about a company called Current Technology and a procedure called CosmeticTrichoGenesis(CTG) that they have the patent. You sit under a chair with a hood for approx. 12 minutes 1x per week and it emits small amounts of electric energy to both stop hair loss and enhance hair growth. Although not FDA approved, I am seriously considering taking advantage of the treatment. I think I’m a good candidate and not ready to go the transplant route. My wife’s hair salon just got a chair and I know several clients who are very pleased. Please let me know what you’ve heard about the procedure and its efficacy and or results. Thank you.

The new names never cease to amaze me. As I have been reviewing questions people have written to me for this blog, fancy new names of “magical” cures continue to come in from various individuals surfing the net. This one is all in the name. Cosmetic implies elective fixes to improve looks, Tricho means hair, and by linking the two words together you get the loose meaning of “hair improvement therapies”. Genesis means growth, and implies that there is something that stimulates the hair to improve the cosmetic appearance of a person. There is nothing new here, other than the combination of colorful words.

Thinning of Transplanted Hair

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

How big of a problem is the gradual thinning of transplanted hair — have you seen cases where a transplant looks decent but then some years later looks crummy because it thinned out too much?

In about 30% of the male population, men will lose some of the hair we call permanent hair from the sides and back of the head. If that would have been you, then you might lose hair in the transplanted area. There are other causes of hair loss, so seeing a good doctor should help you with the diagnosis. I would want to look at your donor hair and see if there is significant miniaturization in that area. With loss of donor hair, we should see some miniaturization in the donor area.

Hair Coloring and Hair Loss

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

sir,
i sm 20yrs of age. i use to have very thin hairs. i not use any hair oil or any hair ointment, but use to shampoo twice a week. Also i have habit of applying my hand on my hair regularly, but now the problem is that my hair starts falling & shine is also lost. Please tell me if applying hair color is safe or not. so please send me the related information.i shall be highly thankful to you.

Daily washing of the hair is a good idea, but being gentle is important. Fine hair is more fragile then coarse hair, so damaging it is a real consideration with a strong massage or heavy handed brushing. Ask a good hair dresser for advice. Careful coloring should not be a problem provided that high quality materials are used by a professional skilled in the art.

Propecia and Minoxidil Together

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

Dear Dr.
I realize Minoxidil does not work on the front of the head (hairline). I have the classic receding hairline problem and I’m curious if you feel Propecia is worth taking in an effort to (possibly) reduce the receding hairline problem (or at least prevent it from getting any worse)? Also, is it any more or less effective to use both Minoxidil AND Propecia at the same time?

Thanks for all your great work.

For men, I generally like to start off with Propecia first, and if there is no benefit in about 8 months, then add Minoxidil. If there is still no benefit, then transplantation may be the only option, if the hair loss is bad enough. I don’t like to do two things at once, because if you use both Propecia and Minoxidil and they work, the treatment that was responsible for the benefit (it might have only been one of them) is something that you will never know and therefore you will be ‘hooked’ on both for life. For women, there is no Propecia option, so Minoxidil is the only know effective choice available for hair loss.

Using FUE to Fill In Old Donor Scar

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

Some 5-6 weeks ago, i had my first FUT procedure for about 1600 grafts that were harvested by removing a donor strip from the back of my head, but this time its not because my hair is thinning but to increase the facial hair density. I must say that i’m now very concerned since i begun seeing those infinitely many cases who had bad experciences with the donor scar visibility(detectibility) even at this early stage of my procedure. I would like to know the validity that successful FUE could be used to conceal the donor scar so that i can wear my hair short assuming that my scar is (2-3)mm wide and not raised plus that am a good candidate for FUE. Thanks

One of the particularly good uses for Follicular Unit Extraction (FUE) is to address the donor wounds of the traditional strip harvesting methods used in standard hair transplantation. The frequency of significant scarring (a width equal or greater than 2-3 mm) is about 5% in the first procedure and 10% in the second. FUE works well to fill in these scars if you are in the unfortunate few that get significant scarring.

Daily Hair Treatment Regimen

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

Dear Doctor,
Thank you for this excellent resourceful blog! My hair has been thinning excessively since past 6 months to the point that i can no longer apply gel since it shows my scalp. there has also been some hairloss. If I keep my hair dry my scalp hardly shows nevertheless hair is thinning. I recently got on propecia and some other natural treatments. Here is my daily regimen:

  1. Propecia – early morning when I get up
  2. Saw Palmetto – 12 hours after propecia 320 Mg (so that it starts working on the DHT since Propecia has a shorter half life and I doubt its effect will last 24 hours (does it ?)
  3. Nizoral Shampoo twice a week
  4. Biotin and B vitamin supplements
  5. Zinc supplement
  6. regular Multivitamin

I have some questions:

  1. How effective would this regimen be and is there anything else I can add on to it ?
  2. When can I expect to see the results ? (re- thickening of hair and reversal of some hairloss i have had. )

My hair loss seems more on the area right behind my frontal hairline. Vertex is fine.

Family history: Dad started losing his hair slowly at age 35. Grand father had hair till 60. Mom’s brother is 48 and has full head of hair. and his father had hair till 55. I am 27. Please advice. I am passing through a lot of emotions.

Your maximum response to Propecia will be up to two years, with fully 60% seen in the first 8 months or so. Be patient and wait it out for the full course. The approach you are using seems good. The Propecia does have a half life of 5 or so hours, but there is some discussion that Saw Palmetto may block the full benefit of the drug if it competes with the 5 alpha reductase inhibition. I can not certify this problem one way or the other.

I always recommend that the degree of miniaturization that you are having is documented by a good doctor. This will, at the least, tell you if the drugs are doing their job. Long term planning with a good Master Plan needs to take into account everything from your response to conservative treatment and the probable pattern of your hair loss. Minoxidil may be something worth trying if you do not get a good response from this regimen.

Shock Loss

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

Here’s 2 related shock loss questions…

I have been on propecia for 12 months. I had a transplant at the frontal hairline 2 months ago. Since the transplant I have noticed thinning in behind the grafts and complete baldness at the graft area. My doctor tells he this is shock loss but the hair will re grow due to the fact I am on propecia. Is this true? Also, how long can shock loss occure after surgery?

Is it possible that native hair (in the recipient region) can go into shockloss well after the HT procedure, say 6 months or a year?

As a general rule, shock loss with a man on Propecia has a high possibility of reversal. Shock loss usually occurs in the first 3-4 months after a transplant and reverses in 5-7 months. Hair loss after that time may be from other causes, including acceleration of the genetic process. Time will tell you what your fate is. I would need to see your progress over time if you want more opinions from me. Take good pictures and keep a good library of your progress.

Prednisone Stopped My Hair Loss?

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

I am 38 (female) and have had thinning hair for a while. I was prescribed Prednisone for a different problem (poison oak) and went through the treatment process. I noticed while on the drug for awhile that my hair stopped falling out. Have you ever heard of this? It seems that every other time prednisone is mentioned, it causes hair to fall out rather than stopping it. I’m wondering if a low level dosage is ever prescribed as a treatment for hair loss. Once I finished the prednisone, my hair started falling out again.

There are many causes of hair loss other than classic genetic female hair loss (alopecia areata, various autoimmune processes, etc..) that might be helped with steroids, while the genetic process might be harmed by these same drugs. You need to have a good working diagnosis made by a competent dermatologist to ascertain what you have. Steroids can be dangerous when used long term, so be sure you are properly managed by a good doctor.

Scalp Testosterone?

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

Dr Rassman

Can you please tell me the role of scalp testosterone (not serum) in hair loss/growth?
Thank you

The scalp does not make testosterone, but it does metabolize it with the enzyme 5alpha-reductase, the same enzyme that Propecia (finasteride) blocks. During the metabolism of testosterone in the scalp, 5alpha-androstane-3beta-17beta-diol appears to be formed and the formation of androstanediol (a steroid byproduct created by the hair apparatus in the metabolic process) has some effect on the functioning of the sebaceous glands, as well as (possibly) accelerating the hair loss. It probably impacts the sweating and the sebum production. We really do not know this for sure so I would consider what I said here as an intellectual logical exercise (taken from what I read which incidates that much of this information is based upon experimental work from in-vitro research studies).

On a practical level, I think that you may be thinking about the length of time it takes to block DHT production. The answer here may be in the duration of action of the particular DHT blocker you are using. Propecia has a 5 hour half life, Avodart has a half life in months and other claimed DHT blockers do not have a clearly defined life of action. It is better off sticking with known drugs that are fully researched by standards established by such bodies as the FDA.

Frontal Hair Loss

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

I have a receding hair line, similar to my fathers’. As of right now if i were to lift my bangs up, the two ends of my forehead are pretty far back(much like the shape of an M from a top p.o.v.)How can i grow this hair back before it’s too late? And will i ever loose the thin hair that is slightly covering this hairline?

Assuming that you are older than 24/25 and you have genetic balding, then it would be reasonable to assume that you will probably not get your frontal hair back with anything short of a hair transplant. Take a look at this celebrity with a similar sounding problem to yours. We performed a hair transplant on Steve Hartman, a CBS sports correspondent with his own radio sport show every day in Southern California. He had a single hair transplant session of 1,895 grafts to accomplish his goal of restoring the hairline (see Steve Hartman feature for photos and details). You should also be on Propecia, a drug that can stop, slow down, and on rare occasions can regrow hair.

I’ve written previously about Steve Hartman on this blog. For more info, please see: Where Are the Celebrity Transplant Photos?

Dermatix

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

Had a FUT procedure (not with you) and since i noticed the big deal about the donor scar i started worrying which made me try to avoid any strenuous activities. I bought some scar reduction product called DERMATIX which claimed to smooth raised surfaces and reduce redness associated with scarring. Ever heard about it? its also mentioned that it musn’t be used until the wound is completely healed,so how long does i take donor scar to be healed?

Dermatix is a transparent, self-drying silicone gel with claimed advantages over other silicone formulations that are used by some people to smooth or soften scars and as a result, reduce itching. It is reported to be FDA approved in the US and Europe (it has a CE mark). It appears to be recommended for the prevention of hypertrophic and keloid scars, possibly in their treatment as well. Hypertrophic and keloid scars are your body’s reaction to wound healing, so I would be doubtful that it would prevent these scars, but frankly I am a skeptic, so take what I say here with a perverbial ‘grain of salt’. Some people use sheets of silicone to try to soften such scars when they occur, and that might work.

For most hair transplant donor scars, it is usually not hypertrophic or keloid scars, but rather widened scars, and here I would really doubt that Dermatix would prevent the widening of the donor scars. It is the widened donor scars that cause much of the internet comments about scars, not the hypertrophic or keloid problem. From your question, it sounds like you are more concerned about prevention. In that case, the best solution for a future surgery is to have a good surgeon use a ‘fascial’ closure to minimize the donor scar for traditional strip harvesting (second surgeries do run a higher risk of scarring of 5-10%), or consider having a Follicular Unit Extraction (FUE) procedure, where the surgery does not produce a linear scar (see our FUE page for details).