Hair Loss in Child?

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

My new doctor recently told us that my 3 year old step-son has alopecia. She didn’t get into specifics with it but said that his condition seemed to be improving on it’s own. He has a bald spot on his right side and it was really bad in January when he first moved in from living with his mother. Is it possible malnutrition caused his hair to bald? He was also extremely underwieght according to another doctor?

There are many causes of hair loss including fungal and bacterial infections. In children, fungal infections are not uncommon. Malnutrition would be unusual, particularly without dieting. Included are other conditions of genetic origin such as Alopecia Areata. If it is going away on its own and your doctor already has seen it, is involved, and is comfortable with your step-son’s situation, then just wait it out.

Repairing Plugs From 25 Years Ago

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

I have 25 yr old plugs in frontal and crown area. Interested in repair work. Can repair work be done unilaterally so one side can be used to cover (comb over) the treated side, wait 6-12 months, then do the other side using the first treated side as a comb over to cover the second treated side? Do not want to walk around with scabs/scars and don’t want to wear hairpiece to conceal surgery while healing. Second question: How do I request the surgeon at NHI who has done the most repair work and who is the most talented at doing repair work. I’m not interested in any special pricing. Thank you.

I am one of the most experienced surgeons for hair work, along with Dr. Robert Bernstein in New York. Read our articles on the NHI website and make an appointment to work out the details of what you need to do, along a timeline that makes sense to you. My offices are in Los Angeles and San Jose, and are reachable by phone at 800-NEW-HAIR. Some good places to start for repair information:

Hair Loss from Xyrem

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

I have been using GHB (Xyrem) to treat insomnia. Nothing in the Xyrem literature mentions hair loss as a possible side effect. However, Xyrem induces deep – stage sleep in which larger amounts of growth hormone are released naturally by the pituitary gland. Synthetic HGH supplements list hair loss as a possible side effect. My hair loss had been well controlled by Avodart and Rogaine prior to using Xyren. Now, however, I am noticing some mild hair loss. Could this be caused by the Xyrem?

Xyrem may cause alopecia, acne, and rash. However, there is no known specific mechanism explaining how Xyrem causes hair loss.

What pattern of hair loss do you have? You may want to give Propecia a try to help stop your hair loss. Although Avodart is in the same class as Propecia, the data for this medication is ‘officially’ limited. Switching from Avodart to Propecia is a very long shot in helping you out here, particularly if the relationship with Xyrem is as direct as you suggest. You will want to evaluate other causes of your hair loss. You need a good doctor and a good mapping of your scalp for miniaturization to get a proper diagnosis. A thorough endocrine work up must be updated and complete. Talk to your doctor about Xyrem and the possibility of switching to another medication.

Minoxidil and Propecia in 22 Year Old

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

Hello Dr.,
I’m 22, experiecing thinning of the hair and a receding hair line. I’ve been using Propecia since the beginning of the summer. While I haven’t noticed any changes yet, I wanted to know the effect of taking Propecia along with Rogaine or Minoxydil. Does it help if you take both at the same time? I’ve been using Minoxydil since the summer also, and I’m not satisfied with it. I’ve experienced itchy hair and excessive dandruff. So does it help if I take both of them as treatments together? I was hoping to get your suggestion on this matter…Thanks so much for your time.

I generally advise young men to start with Propecia first, wait out a full 8 month course and make a reassessment at the end of that time. I always measure the degree of miniaturization to quantify the amount of thinning and loss, as well as the progression or reversal of the hair loss. I would suggest that you get that assessment before you make further decisions. The side effects of minoxidil is as you described in your question, making its use probably unacceptable in your case.

Clarify Scarring Opinion

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

In an answer to a previous post, you wrote:
“Only about 5% of former patient developed noticeable scarring. Most of these scars are the result of the healing properties of the patient, although some are technique dependent.”

But another top hair restoration practice, Hasson & Wong, asserts a different view:
“The single most important factors in donor scarring is the ability of the surgeon to excise the strip and close the wound from the donor site correctly. The ability of the individual to “heal well” is much less important except for a very small percentage of individuals who either heal with keloid formation or have an abnormality of collagen formation.” (from their website)

My questions are, how can two leading medical groups in the field hold such seemingly polar-opposite opinions? And, do you base your assertion on anecdotal observations, or have formal studies been published on this topic?

Much of what I say about scars is based upon: (1) anecdotal observations that I am constantly researching on my patients, and (2) direct measurements on patients whose scars I have measured before and after repairs.

I do not agree with you that our two statement are polar. I always assume that doctors are all competent and the techniques are all consistent between doctors. I know that is not always true, but I generally like to believe that doctors try their best to do their best. When it comes to wound closure, it is not rocket science. I am a surgeon by training, so I am more qualified to make that statement then others who did not invest the years of training and experience that I have. With that said, both of us are in agreement. I suspect that Drs. Hassan and Wong are not making the same assumption on the uniformity of techniques in the first place.

Tidbits: Fur vs Human Hair

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

A few times each month, I will post some random hair-related information, which I’m calling “tidbits”. I spend hours each day writing responses to questions I receive on this blog, so it is a nice change of pace. For example…

Australian Platypus

Some mammals require thick fur to keep themselves water proof and they have much higher fur density than humans have with hairs on their heads. For example, the Australian platypus has an incredible 700+ hairs per square mm which is 350 times as dense as the average human hair (2 hairs per square mm). The Merino sheep with its 5 micron thick wool is amazingly dense as well but not in the same league as those aquatic mammals who require waterproofing.

Some of the animals have two types of fur; the guard hairs are the long glossy hairs that overlay the shorter, denser under-fur. The guard hairs help to repel moisture in addition to protecting the under fur from damage which keep the animal warm in cold frigid waters.

Occasionally, a person comes into my office with their pet poodle, for example, and I joke with them about volunteering the dog’s fur for the transplant. This does not always go over well. Perhaps we can do some strip harvesting from the Australian platypus and get enough fur to cover a half dozen bald men.

No Improvement After Two Hair Transplant Procedures

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

I am a 42 going into 43 years old. I have been losing my hair slowly but steady for a good 12 years now. Only about 5 years ago clear spots started to become more and more evident. I had 2 transplants. Both of them about 1300 grafs. The count of insertions was about 270 so I figure it must be in groups of 3 and 4 grafts. In the areas where I had the transplants done I dont see any improvement.IF any I see it getting more and more bald. I don’t know if is that I am just not holding the transplanted graffs. Is there such a possibility. My operating physician said that that was imposssible. That they will never come out. The first procedure was in October 2001 and 2 and 3 weeks after I had a lot of dry roots and hairs come off. I asked the Doctor that operated and he said that was normal. I was doubtful specially because of the roots being dry and out. Then last year I had another procedure. And I dont see any improvement from that either.I dont smoke , dont drink. I exercise, and I tried to eat healthy. I am contemplating a 3rd procedure but I am concern that I may not be holding it.

It sounds to me like you are having confidence problems with your present doctor and certainly have not adequately communicated on the problem as you’ve presented it to me. Before you go at it a third time, get a second opinion. This is not something I can do over the internet, and since you indicated that you are on the east coast, I can recommend Dr. Robert Bernstein in New York and New Jersey at 866-576-2400 to get that second opinion from. If you are willing to make a trip out to California, I have offices in Los Angeles and San Jose and can be reached at 800-NEW-HAIR if you’d like to set up a free consultation.

Some of the things you are saying do not leave me comfortable. Clearly, that is your view as well. I would advise you to not rush into a third procedure if the other two did not work out. I find that we always get results and rarely have I heard of one of my patients have the issues that you’ve mentioned.

Bio Matrix, Extreme Hair Therapy, and High Pressure Sales

/by William Rassman, M.D./10 /, ,

I have recently turned 21 years old, and have been out of school last semester saving for some kind of solution to get my hair back. I have visited Bosley and Hair Club for Men (HCFM). Bosley was very cordial and did not pressure me or get me to sign a contract during my consultation or anything. They answered my questions at the time and left me with info and the consultant’s card. HCFM on the other hand views me more as a walking dollar sign rather than someone with a concern. I visited them 3 weeks ago and I still get calls from the consultant or salesman, I should say 2 to 3 times a day. I walked in, watched a tape, and then he told me I was too young for transplant surgery and he recommended the all new “Bio Matrix Transplant”. Within minutes he hustled me into signing a 3500 dollar contract. I called the next day and cancelled after reading more about it. Its basically a wig, which disgusts me. Anyways, then I met with him again to talk to him about EXT Extreme Hair Therapy. He said it was the same price as the Bio Matrix thing, which I think is a lie because I can’t imagine vitamins, shampoos, and monoxidil can cost over 3000 dollars for a years supply!!! It is my firm belief that he works on commission, and that is why my voicemail has 10 messages on it right now.

I tell you all that to say this: I need a good doctor to speak with to give me honest answers and someone who can give me the best route to go with this thing. I go to you because I read from this site and see how much knowledge you have and know you are trying to help and educate people, and I appreciate that.

My hair loss started probably at age 17 or so. I have no “bald” spots but my hair is thin on top now and would like to get it back to the way it was. I believe doing something now will help since it is still early. People can see through to my scalp. I used to spike the front of my hair and now I comb it forward and cut it short to try to hide the thining. Is hair transplantation out of the question, is hairgenesis an option, and perhaps is HCFM’s EXT an option? Please give any help you can as I am looking to act now with whatever solution necessary. Also if you can direct me to a good ethical doctor in my area that would be awesome!!! I will supply before and after pics in another email another day when I have access to a computer. I am typing this on my sidekick2. I am also curious about your thoughts on procerin. Looks like a good product. Thank you for your time and I appreciate what you are doing on this site!!

I have heard horror stories about hair salesmen in the past and yours is, unfortunately, very typical. Commission sales are the driving force for the free enterprise system we live with. Car salesmen also get to me in a similar way, so I hate buying a car just because I do not want to deal with the saleman. I absoletely believe that salesmen should not be turning men into victims and certainly salesmen have no place, absolutely no place, in a medical practice.

Take a look at my post yesterday titled The Truth About Cheap Hair Transplants, for it goes into the entire process of shopping for hair restoration. Also, see the post on Hair Club for Men from earlier today. As you are aware, you need a good doctor, but to be more specific, you need one who can map out your scalp and give you a good diagnosis. Young men often can reverse genetic hair loss by using Propecia. Go to the ISHRS site to find a good doctor in your area.

Hair loss from age 17 to 21

We generally do not like to transplant young men, but according to your pictures (thank you for granting me permission to post them), the pattern you show is classic male patterned genetic hair loss. Your scalp needs to be mapped out for miniaturization. If you do have genetic hair loss, this is best treated with Propecia first. Allow the drug 8 months to have a good chance to reverse or at least stop the hair loss. With a good doctor managing you and understanding where you are coming from, a hair transplant is possible if you do not respond to Propecia, but you must have a good assessment of your donor supply and your final pattern should be estimated prior to considering a hair transplant. Also, the issue of your maturity, your financial ability to follow the process, and a worst case look at your Master Plan must be commanded by you in advance of such decisions. I would love to get to meet with you, so if you plan on a trip to California on a discounted airline, you might be surprised at what you will learn and find it of great value for the trip. The consultation is free.

Oh, and in regards to Procerin, please see my previous comments here.

Good luck.

Is Shock Loss Permanent?

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

Dear Dr Rassman,
I am a 39-year-old male. I recently underwent a transplant procedure at Bosley in Boston. My class was a 3 vertex. I have been using Propecia for 4 years, and it has worked great! However, I still saw some daylight in the frontal region. Admittedly, 99% of friends and family would only say I had slightly receding hairline, and follicular enhancement surgery was ridiculous. My objective was to simply augment my existing hair and stay a head of the curve. With that said, I’m now learning of Telogen and “shock-loss”. Several web sites claim that the shock loss can be permanent, and I could wind up with thinner hair than I began with. I knew up front that trauma could case this to happen. Moreover, I could have waited several years before taking this step. I would be greatly disappointed to lean that this was futile and I could be worse off! My HTP counselor says, new evidence claims healthy non-miniaturizing adjacent follicles should, and will come back after a few cycles. Can you please expound on this topic.

Hair transplant shock (shock loss) is often prevented in men of your age by Propecia, so you have done the right thing by taking it. The shock loss can be permanent if the hair that is lost was in the balding zone. When it occurs and impacts hairs in the balding area in men, the hair loss is often, but not always, permanent. This will only impact non-transplanted hair, so if you had transplanted hair that was lost (very, very rare) that hair always returns. For women who lose hair (with shock loss), the hair almost always comes back.

You need to wait it out. Chances are that it will not come back, but the newly transplanted hair may make enough of a difference to adequately address the area of loss on a worst case scenario.

Itchy Scalp Where Hair Is Thinning

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

Hello Dr. Rassman
Am 25 year old male whose fighting the deadliest enemy of all men, that is hair loss, which has attacked my frontal hair causing a diffused loss, yet my temples and crown seems fine. My point is that i have noticed alongside my falling hair, there is a persistent itching in my scalp especially within the regions where hair loss is occuring most, slight scalp redness can be seen upon close inspection. Is there any possiblity that the two are related?

The first thing that comes to mind is ‘what came first, the itch or the hair loss’? It is possible that you have a skin problem and that the skin ‘itch’ is actually making your scalp flaky and red. If you scratch the itch, you can produce traction alopecia (in your case, it would be hair loss from pulling hairs with scratching), or you can have other skin disorders like Psoriasis (visit National Psoriasis Foundation). It is also highly possible that you have male patterned balding and you need a good doctor to determine if there is miniaturization corresponding to the genetic process in the frontal area.

Female Bald Spot — Alopecia Areata?

/by William Rassman, M.D./8 /,

Hey Dr. Rassman, I just found out this bald patch in my head and wondering if there’s anything i can do to prevent it from getting worst? I’m 27f and there’s no bald history in my family that I know of. My hair is thinning as well, and have not tried any products at all… what kind of re-grow hair products would you recommend?

Thanks.

If you have a bald patch that appeared on your head, I would be concerned that you might have Alopecia Areata (search this site). First, get to see a good dermatologist. This can be a serious problem and it should not be washed away with topical solutions and hair care products.

Patchy Hair Loss Pattern

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

Dr. Rassman,
I’m a 21 year old male and I’m quite physical fit and eat properly without excessive drinking or smoking. For the past four months now I have been noticing some patchy hairloss on different parts of my head. One being on the left side and the other largest being on the right rear near my crown. At first it looked like perhaps alopecia but the patches were not round and also not smooth. Now the balding on the right side has turned into what looks like a circle, almost like a crop circle at least 3 to 4 inches in diameter and the left side it also a random pattern that is not fully smooth. I have also noticed a small circle on the back of my head down by my neck. I saw a dermatologist and apperantly she has never seen this before and now has me taking a bunch of blood test for HIV, syphilis, and lupus. I am most certain I dont have HIV or syphilis and I do not have any other symptons of lupus. Do you have any ideas what this unusual hair loss pattern could be? Thanks for the help.

If you have a series of bald patches that appeared on your head, I would be concerned that you might have Alopecia Areata (search this site for “Alopecia Areata”). I am surprised that your dermatologist said that she’d never seen this before, as it is a common problem in the study of dermatology. This can be a serious matter and you may want to see another doctor if what you said is true. Read the website material and learn about this condition. Then when you meet with either your present doctor or the next dermatologist, bring this up as a diagnosis possibilities. You also must realize that I am taking what you say as what you reported here.

Wigs and Hair Club for Men

/by William Rassman, M.D./32 /, ,

Just wanting some info, I am thinking of doing hair club and getting a piece. Do you know the cost and is it cheaper than hair transplants? I would rather do something that will grow mine back, but I am skeptical and weary of trying something like this, especially if the cost is what is rumored.

Costs for wigs (hair systems) are much higher than most people think. I met Sy Sperling and the executives of Hair Club for Men in the late 90s and I was informed that the average price that they got from people with ‘systems’ over a 5 year period was around $12,500. That price included the hair system and constant repairs, replacements, and adjustments with frequent visits to their offices. When washing one wig and letting it dry, you need a second to wear. These hair systems are expensive and they do wear out. These cost figures I presented here are not based upon anything other than the cost quotes given to me in about 1998. I suspect that with inflation, the costs will be higher today, but that is only speculation on my part. The problem with hair systems is that they tend to accelerate and/or cause hair loss (traction alopecia) from the glues and tapes that are used.

Most hair transplants can be obtained for less than that figure (for the early balding man) and the transplanted hair will last a lifetime and grow as long as you want it to be. If you also take Propecia, the progressive hair loss may stop. This approach is far less expensive and totally natural. Men with hair systems are always afraid of other people touching their head. If the hair is attached to the existing hair, then cleanliness becomes a problem and odor becomes very distinct when you get close to men who use them. When romance opportunities appear, you might have a no-touch / no smell zone around your head if you are wearing a wig. Most people who have these systems, hate this no-touch zone more than any other single factor in hair systems but few men realize the odor that surrounds the systems that are attached, particularly if they do not come off at night so that you can wash the scalp and remove the dead skin than normally sheds every day.

Tamoxifen and Hair Loss in Women

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

Hello Doctor,
I have been taking Tamoxifen for 2 years after Breast Cancer treatment in 2003. I have noticed that my hair is thinner lately and am wondering if the drug is the cause? Any suggestions? Thanks!

When hair is lost secondary to a drug like Tamoxifen, it is not unusual for it to come back with a different texture. You may not know the entire story until you undergo an entire hair cycle (2-6 years) or have the drug impact completely gone (2-6 months after stopping the Tamoxifen). No real suggestions, other than to get a good baseline on miniaturization and the distribution of miniaturized hair to, at the least, command the diagnosis of female genetic hair loss (just in case you are in that category of women with thinning hair).