Hair Getting Thinner with Rogaine Use

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


I am nearly 23, and my hair has begun to thin out quite a bit (in my opinion). There doesn’t appear to be a pattern at all, so I believe this may be diffuse thinning. About six months I felt that the front of my scalp felt thinner, but the rest didn’t. When I got my hair cut two months after, I became alarmed at the thinness of my hair behind my hairline and decided to go on Rogaine in September. I spoke with a dermatologist, and he described it as “minor thinning” and after a blood test (nothing abnormal although I initially tested positive with the lupus test), he prescribed Propecia for me which I went on in the beginning of November. Since I initially have gone on Rogaine (about 3 months), I have noticed that the thinning has seemed to spread throughout my hair – in fact my hairline has thinned (not receded) significantly in my opinion. I know without a miniaturization test (I’m going to go back to my dermatologist in a month to do this), it is difficult to diagnose, I would like your opinion on my prognosis. Although the thinning only is noticable to me (my parents can’t tell in pictures and no one has commented on it to me) when I apply the Rogaine in the morning and at night, it looks quite thin in parts, particularly behind the hairline. I don’t know if I’m responding to the Rogaine yet (it has only been three months on it, and since its diffuse thinning, it would probably be difficult to see results at this point), although on my hairline, I do feel small hairs (which could either be new hair or old hairs being miniaturized).

My maternal uncle and grandfather both had receding hairlines and went bald at young ages, but my father still has an extremely thick head of hair. I have always had thick and coarse hair like him, but in the last six months I feel that I have lost half the density of my hair. The dermatologist described it as “minor thinning” and said usually when he sees hair loss in someone my age, it is usually stress (I moved to New York to begin a job in finance six months ago), but I don’t believe it’s TE as I don’t shed (either on my pillow or in the shower to the best of my knowledge), nor have I. I would appreciate your advice/opinion.

Thank you.

Nothing replaces a good exam, but it sounds as if you are experiencing (possibly accelerated) genetic hair loss, regardless of your Dad’s currently thick hair. Rogaine typically takes at least nine months for maximum results and the Propecia needs about that long to show a change as well. It will be difficult for anyone in your position to make an objective assessment because of the emotions involved with losing one’s hair. Before starting more medications, you will want your scalp mapped out for miniaturization to determine if you have premature genetic balding. I suggest the following:

  1. Stay on the Rogaine/Propecia for at least a year. Neither of these drugs are associated with hair loss unless you stop them. Be patient and 9/10 times you will see results.
  2. Each month, have a good friend take a photo of your head where you are concerned about the loss. I will warn you that hair loss often looks worse in photos (especially if you use the flash), but the benefit is that if you standardize the lighting and the pose in the photo, you will be able to compare them over time and make an objective assessment.
  3. Do follow up with your dermatologist or a good hair surgeon (since you are in New York, I recommend Dr. Bernstein) to both document any miniaturization and classify your hair loss according to the Norwood-Hamilton Scale. These people can take photos for long term documentation as well.

Did My Pain Pills Cause My Hair Loss?

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

i am 21 years old and i started loosing some of my hair when i was 19. It was all of the sudden after i had a kidney infection and was put on pain killers and cipro. it began to grow back until i got my wisdom teeth out which required me to be on pain pills for a month which caused significant hair loss. That was about a year ago and although i feel it doesnt fall out in the same large quantities i feel that the hair that has grown back is fine baby hairs. Is there anything that can reverse this or will i loose all my hair?

Physical stress and sickness are known causes of temporary hair loss, as are adverse drug reactions. That being said, pain pills are not a known cause of hair loss and are unlikely to be the reason your hair thinning orfalling out, so it may be a coincidence since when you were sick both times you had to take pain pills as part of your recovery. Therefore, the most likely cause of your hair loss is that the physical stress from your sicknesses caused the hair to have weak growth and/or shed.

Hair can take some time to recover, especially if your body is still recovering to full health – getting healthy is the best way to reverse this sort of loss. You may want to get evaluated by a dermatologist or a knowledgeable hair doctor to see if there is some component of genetic/pattern loss and get your hair mapped for miniaturization, but you should be reassured that it is unlikely you will permanently lose all your hair due to the events and medications you describe, unless you are amongst the unfortunate few who has hair shaft thickness changes early in life.

Risks and Pain in Transplanting a 50 Year Old

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

I am considering a hair transplant of 2200 grafts and am 50 years old. I am in good health and I have plenty of donor hair. I feel that this would make a tremendous difference in my hairline and appearance. What are the risks and pain involved for a man my age and with that amount of micrografts? How long would it take to heal? thank you

2200 grafts is a moderate-sized surgery that would likely take about a week to heal in the donor area. The risks for someone of your age if you are in good health are roughly the same as those for most other ages – to be more precise, there are surprisingly few. As with any surgery you risk the possibility of scar formation, infection, and possible adverse reaction to anesthesia or other drugs are very, very rare. These are the big ones we worry about and incidences are very uncommon in a proper surgery center and with a trained and experienced doctor and team. There is also no excuse for this elective surgery to be any more painful than a mild dental visit. Good pain medicines and effective techniques are available, well known, and should be used.

To be completely honest, your biggest risk is in the choice of your surgeon and the team they use. Choose a surgeon with a good reputation whose hairlines you like, and make sure they are willing to let you meet their patients and evaluate their results for yourself. Check the facility and ask the surgeon who is on the surgery team. An experienced staff makes all the difference in the world both in your experience that day and in your final result because of the way the staff members treat the grafts. Lastly, choose someone with whom you feel comfortable. Many of my patients who come in for corrective work had a less than good feeling when they went to their doc or they chose them solely on price. Remember, you are the one who gets to live with the permanent results after all, so be a little picky.

Will I Go Bald if Dad is Bald?

/by William Rassman, M.D./13 /

If my dad is bald will i be bald too?? If so, when will I start losing my hair. I am 26 now.

We inherit our genetic balding from both sides of the family, even from our grandparents when our parents do not express the balding gene and have a full head of hair. Do not obsess with what may happen to you for if it has not started by 26, it is less likely that you will follow a signficant balding pattern. Ask your dad when he first noticed balding, and if it was after 30, then maybe time will yet unfold an outcome like his. If he started before 26, then it is likely that you will not follow his pattern. Most bald men have signs by the age of 26 that balding may happen.

Happy Holidays!

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

I am taking a few days off, so there will be no updates until Tuesday, December 27th.

Wishing you a Merry Christmas, Happy Hanukkah, Happy Kwanzaa, or whichever holiday you may be celebrating this time of year!

If you happen to be reading this during the holiday season, be sure to scroll down to read the latest blog entries…

 Happy Holidays!

 

Hair Restoration Societies and Accreditations

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

I am researching the hair transplant doctors to find someone I want to tie my hitch to. On your New Hair site I noticed that you had four links at the bottom of the left column. Why do you link to them and what is the significance? Some doctors have similar links on their sites, but I haven’t seen the AAAHC triangle logo before.

Here’s a little on each external link you’re referring to, as found on the New Hair Institute homepage:

  1. The Accreditation Association for Ambulatory Health Care (AAAHC) is one of two national accreditation agencies for surgical centers. The “accreditation from this organization is a voluntary process through which an organization is able to measure the quality of its services and performance against nationally recognized standards. The accreditation process involves self-assessment by the organization, as well as a thorough review by the Accreditation Association’s expert surveyors, who themselves have extensive experience in the ambulatory health care environment. The accreditation certificate is a symbol that an organization is committed to providing high-quality health care and that it has demonstrated that commitment by measuring up to the Accreditation Association’s high standards.” I believe that our clinic is the only fully accredited HAIR TRANSPLANT facility in the United States (other than those that have plastic surgical accreditation) that has taken the effort to obtain such recognition. The reviewers have always rated our service as meeting or exceeding the best standards in the country.
  2. The International Alliance of Hair Restoration Surgeons (IAHRS) is an organization of physicians who have banded together setting a standard for the industry’s standard of care, the Follicular Unit Transplant.
  3. The American Hair Loss Association (AHLA) is an organization focused on consumer education.
  4. The International Society of Hair Restoration Surgery (ISHRS) is a non-profit medical association of over 700 physicians specializing in alopecia and hair loss. The ISHRS provides continuing education to physicians specializing in hair transplant and restoration surgery and gives the public the latest information on medical hair restoration and non-surgical treatment for hair loss.

I believe in excellence, whatever the cost. There are no shortcuts to delivering a quality product. I have a terrific staff and pay them well so that they have a quality life at home and can focus upon my patients when they come to work. For this reason, I retain 100% of those that I want to retain and many have been with me for more than a decade. The AAAHC (a completely voluntary effort that is a very costly process for us and equates to the rigorous standards imposed upon hospitals today) is a way that I guarantee to myself that our standard matches the best standards in the world. To comply with these standards, I calculated that my annual cost exceeds $100,000/year and both of our offices are certified by the AAAHC. Our focus upon supporting national and international hair restoration / hair loss societies (like IAHRS, ISHRS, and AHLA) are reflective of our patient and physician educational efforts, which should be supported by those in this industry. Our involvement with them is consistent with the massive efforts we have made over the years to innovate (leading the standards that are accepted and adopted by everyone of value in the industry) and force an improving hair restoration environment along with others who share this objective. See the History of NHI and the NHI Timeline for more.

Can My Grafts Be Dislodged 4 Years After Transplantation?

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

Hi there
I’ve had three graft procedures – the first of these 6 years ago and the last 4 years ago. The results were not that great (I still look balding) though there is quite a bit of new hair overall.

This past year I’ve been considering having another procedure done. However, just lately i’ve been waking up once or twice a month to find very tiny-pin pricks of blood behind my hairline in the area where the grafts are – sometimes just one, sometimes two or more. Despite all the time that has passed since the procedures, I am concerned I am managing to somehow dislodge some of the (still vulnerable?) tiny grafts while I’m sleeping (I’m told I’ve been thrashing around a lot in my sleep the last few months due to various stress going on). Have looked on my pillow and cannot establish whether this is the case or not. However, it seems the only logical explanation I can think of …

Grateful for your comment.

Thanks

Transplanted grafts are permanent, except for those that may have been taken from areas of the scalp where the hair may not be the permanent hair. These areas include grafts taken too high on the back of the head (where the donor area balds like it normally would) or from the neck (where the hair is not always permanent). But in your case, something else is going on and you need to see an expert to let you know what is happening. Could you be picking on it at night and not knowing that you are doing this?

Sarcoidosis and Female Hair Loss

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

Female – In 1986 I was on a high dose of prednisone for sarcoidosis.The disease affected my eyes and my lungs.Within 3 weeks of taking the medication, my hair was thinning. I ended up being on the drug for a year. Needless to say all my hair fell out. Even after being off the drug, my hair never grew back. To this day I am still bald. I do believe that the sarcoidosis was started from fumes. I worked with a very strong glue and liquid rubber at work. Some of my co-workers were having nose bleeds also .I find the whole ordeal very upsetting. But I didn’t know how to prove the the fumes were the cause of my problem. Being on prednisone has been a life time nightmare for me. I kept the hair loss a secret for 14 years.I wore wigs or glued on weaves. I finally decided to tell my family in 2000. This situation has caused me much grief. I can’t date because I’m afraid that the person will reject me because of no hair. Thank for reading this.

Your hair loss maybe due to both Sarcoidosis and steroid. Sarcoidosis involves inflammation that produces tiny lumps of cells in various organs in your body. The lumps are called granulomas because they look like grains of sugar or sand. Sarcoidosis can occur in almost any part of your body, although it usually affects some organs more than others. Thus, in theory, Sarcoidosis could cause hair loss. I am not certain about fumes causing sarcoidosis, but that is clearly a distinct possibility and more research would be a good idea (not something that I can do through the site). You may want to see a dermatologist and ask for a referral to a toxicologist for better evaluation of your hair loss and possibly biopsy the scalp to rule out inflammation and disease that may cause your hair loss. Good luck and please let me know the outcome from the referral sources I discussed here.

Female Thinning Hair and Kevis

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

I am a 41 year woman and for the past two years I have noticed my hair beginning to thin. My Mother (67) and Aunt (58) both have thinning hair which did not begin until their fifties. I am hypothyroid but it has been well undercontrol for 8+ years now. The texture of my hair has changed significantly over the past 3 years or so, much less thickness etc. I do not want to see my hair thin anymore if I can avoid it, would I see a dermatologist or an endocrinologist for this issue? Also there is a “natural” hair loss product called Kevis on the market that is suppose to stimulate new hair growth – do you have any experiecnce or knowledge of this product? Thank you

There is no scientific data to support Kevis is any different than minixodil, which is actually the active ingredient in Kevis (but many times more expensive). Minoxidil comes in generic form or Rogaine (brand name). Use the minoxidil made for women, which has alcohol and is easier to style your hair with, rather than the variety made for men.

If the thinning is already in two members of your family who turned through menopause, then it is likely that this will also be your fate. I would like to see that you have an accurate diagnosis, which can be obtained by mapping out our scalp for miniaturization. In addition to pointing to the diagnosis, it should clearly show the degree of hair loss and give you a good baseline for future comparisons. Please be sure that you are medically OK; read through the Female Hair Loss category for more info.

Patients with Forward Hair Direction

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

Hi Dr. Rassman,
I was curious after looking through all the before/after pictures on your website, and also on some others, why I can’t find any pictures of people with hair direction going from back to front. They all seem to have either a comb over, or a slicked straight back look. Is there some aspect of transplantation that makes these hair styles “work” in an aesthetic sense while hair that falls forward (like mine which just falls forward when i comb through it) will not look as good after a transplant?
Thanks.

Hair normally grows forward and that is how it is transplanted. Patients use styling to accomplish their goals, whatever they are. I have seen men go from spiked styling to side combing all in a week. Some people feel that once their hairlines are fixed, they must show them off, so the photos that you see in our patient galleries reflect what the patient wants his hair to look like. Plus, when we photograph these patients, the hair is usually combed back just to show the status of the hairline.

FUE for Wavy or Curly Hair

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

I don’t see too many people on the website with wavy or curly hair. I have wavy hair and I’m wondering about how well this type of hair responds to the FOX procedure. For instance, does it inhibit harvesting and when it is transplanted would it go along with the naturally wavy pattern of the hair that is there now or would the individual hairs wave in different directions?

I have performed the FOX Procedure (Follicular Unit Extraction / FUE) on many wavy/curly hair patients with great success. After shaving the hair down to a short buzz cut, most hairs will stand straight and show their angle as they exist in the skin. I will harvest the hair to the exact angle where the hair grows in order to extract the follicle with high yield. Most of the African American patients will have spiral roots to the hair below the skin, while Caucasian, Hispanic, and Asians do not. The yield of viable hair from FOX/FUE will depend on the physician’s expertise/skills.

The way your hair grows out reflects both the angle the hair is put it in and the character of the hair itself. When grown out, other than density considerations, you should not be able to tell the transplanted hair from your original hair.

As for the patients in the NHI photo galleries, we only post patients that have signed a photo release. Some folks just do not wish to participate, and that is totally fine. Upon first glance, I can spot quite a few curly haired patients, including:

More information about FUE can be found at the links below:

17 Year Old with White Hairs

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

I am a 17 year old male. I started noticing that I was losing just a little bit of hair when I use shampoo. I know its normal to lose a little bit of hair. I also started using a hair dryer to style my hair. I noticed that I was starting to grow white hair. I have only a few white hair right now. Is this normal? Does this mean I will be losing hair??

White hair has nothing to do with hair loss or the shampoo you select unless there is a bleaching component in the shampoo, which could bleach your hair. Some people genetically grow gray/white hair earlier than others. It is normal to lose up to 100 hairs per day. Excessive blow drying may affect your scalp and hair by making it more brittle, thereby leading to hair loss.

Cowlicks, Widow’s Peaks, and Hair Transplants

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

I have a question. The hair on the left side of my head, from the hairline to about 1 to 1.5 inches behind it moves in a fully forward direction instead of backwards and down. This cowlick creates a very messy look and contrasts with the normal direction of hair on my right side.

Is there any procedure that can be done to just change the angle of direction of those hairs? If so, who performs this?
Thanks very much

Cowlicks are hairs that grow in a different direction than adjacent hairs. They can be very sexy or they can be annoying, much like your complaint about them. Grooming can be a problem if you are a perfectionist, your hair character is strong, and the direction abnormality is in an obvious place, like the very frontal hair line. This is most often seen in the central area of the frontal hair line, frequently in association with a ‘widow’s peak’ or as in your case, it can be off center. There is little to do about them without damaging the frontal hair line. When we transplant near them and they are strong, there are many artistic judgments that the surgeon must make on how to deal with them. I love and hate them, depending upon what I am asked to do with them and the patient’s opinion of what he wants and what he can reasonably achieve.

My suggestion is for you to accept the cowlick, learn to style around it and not to aggressively go after it unless it is very limited to a small area, in which case, FUE might be possible. You need an expert to evaluate this in person and to protect your interests.

Advised To Not Take Propecia?

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

HI Doc,

Im a 20yr old male and have just noticed that my hair is thinning out and im losing it. My hairline has been reduced and in the middle and back ive lost a significant amount of hair too. I can see through my scalp now in many parts. Also, in the front you can see through my scalp and actually count the hairs that are in front! I look at my pictures from last year and even this summer and im seeing a huge difference! im really getting scared.

Im using rogaine now, started a week ago. I want to take propecia but been advised not to. i ve also looked in getting FUE or FUT! Please let me know what you think? And also do the hairs extacted from the donor area grwo back or not?

Thank you very much for this amaizng service!

Propecia is only for male patients treating male pattern baldness and it is the ideal drug to prevent or possibly reverse your hair loss.

I would say that you are too young to consider any type of hair transplant. At the very least, you should try the medications and then develop a Master Plan for your future with a good doctor. You need to be evaluated for miniaturization. I am the physician who helped shape the Follicular Unit Extraction (FUE) procedure, which extracts 1 follicular unit at a time using special instruments leaving very minimal scarring. The hairs are moved from the donor area — so no, they can not grow back into the donor area.

More information can be found at the links below:

Options After Propecia Loses Effectiveness?

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

I’ve used propecia for about 5 years (28 now). I started really at the first signs of trouble, as there is a lot of baldness in my family- my older brother was about 21 when he started thinning very quickly. The propecia worked well (1 mg) up until about 1 year ago, when I started losing quite a lot, so I bumped up to 2mg, which stopped it for another 6 months, but now it is really coming out again- I guess the effectiveness is just wearing off. I’ve also used 5% minox 2xday as well (the whole time). My question is: what options are available for me? I see that legally you cannot recommend avodart since the FDA has not approved it, but do you know whether its mechanism is similar enough to propecia that a resistance to propecia would also imply a resistance to avodart? I’m not looking to regrow really, just to stop the shedding and keep what I have. Thanks!

Avodart is a more effective DHT blocker than finasteride (Propecia) and in the hands of those who prescribe it, it does work in situations like you describe. Find a doctor who understands this medication and consider its use.