Hair and Love

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

Will my wife love me the same after a hair transplant?

On first blush, this could be conceived as a funny question, but I thought hard about it and looked back on my experience with hair restoration and relationships. There is clearly a connection best exemplified by one patient story, which says it all…

A 50 year old successful, powerful bald man (Class 6 pattern with a runway on his head) had two hair transplants, each time accompanied by his caring and loving wife. I got to know them personally and his personality was the type that would stand out in a room with 100 other men. He had a dynamic character with a warm side to his powerful presence. After two transplants with me of around 5,000 grafts, he finished his restoration and appeared happy. A year after I last saw him as a patient, his wife came to my office when she was on a business trip to Los Angeles. She said, “I owe you an apology”. I could not understand the statement and probed her for clarification. “I do not know if you realized that I was against the hair transplant from the onset, but I would never challenge him in public so I kept this a secret between he and I. I loved him without hair as much as I did when I married him with hair years ago. Now that he has his hair back, I realized that the bald man I was married to had changed over the years, but with his hair back he became more like the man I married. I realized that this hair transplant was about him, his vision of himself and not about me at all. I was selfishly looking at the inside man I love, but his pain was created by the outside man he saw in the mirror. The man I married came back with the hair transplant and it made our relationship far better than I could remember in years. I never realized the pain that his balding caused, and that is why I am apologizing to you.”

This story has always stuck in my head, because it reflected the reason men have their hair transplanted in the first place. A woman who loves her man, cares about what is important to him. To conclude with an answer to your question, she will love you more if you love yourself more and are more self-confident. Men who are free to love and who are not burdened with an image of themselves that interferes with who they are, make better lovers than men with an image problem of themselves, no matter how small. Loving these men with their freedom is easier than watching them be less than they can be.

Kevis, Avacore, Regenix

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

Dr. Rassman,

I am 25-years-old and for a year or two my hair has been thinning along the hairline (just above the forehead). I can see that it is not nearly as thick as it used to be, but it is not yet noticeable to others. About ten months ago I started taking Propecia and using Nizoral Shampoo, but I am not satisfied with the results as I have only seen a moderate slowing in the rate of hair loss and no detectable re-growth.

I want to take further action and would like to know what options I should consider. I am currently looking into Avacore, Kevis, Avodart/Dutasteride, a laser brush, and Regenix. Are any of these products worthwhile? Are there others I should know about? I feel like I need to do something fast before it looks like I am losing my hair. What should I do?

I look forward to hearing form you. Thank you for your help and for the website. Best regards.

I have a somewhat standard answer to your question. First get yourself analyzed for miniaturization with your scalp mapped out so that under a good doctor, you can have your hair progress or lack of progress measured over time as you move between different treatment modalities. With this mapping, you will (at the least) know if anything is really working and put numbers to it.

Of the suggested treatments you intend to try, some have minoxidil as the active ingredient, but at a much higher price than you can purchase it a Walmart or other discount stores. If you like paying more then by all means go for it. Avodart (dutasteride) has been discussed on this site in great detail. The laser comb is not well documented for benefit, but there is clearly a lot of hype and only costs between $500-800, so again, if you feel that spending money might help, by all means try it. I have had good reports about Regenix, but no objective measurements for hair regrowth.

If you are in the Southern California area, I would be happy to see you if you’d like to setup a consultation for your problem. The alternative is going bald, unless you can gain better control of what is happening to you.

Does Wearing a Tight Bandana Cause Hair Loss?

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

Hello Dr.,
I am a 22, almost 23, year old male. From the age of 14 until 20 I wore a bandana very tightly on my head everyday for at least 12 hours. Although it has been claimed a myth that head-wear does not cause hair loss, I believe that this has had something to do with it. I wore that thing to the point where my scalp actually hurt, and yet I continued wearing for at least another year in this state. My hair loss originated in the front, at the peak of my hair line. After I quit wearing the bandana, my hair loss either stopped or continued at an unnoticeable rate. I didn’t like the balding spot on the front of my head so I began wearing a hat that rested on the lower part of my forehead, not putting any pressure on my hair line. With too many people asking what my hair looked like, I decided to pull the bandana back out, as to expose a majority of my hair. I then began to notice an increase of hair loss. What should I do?

Thanks for your time!

Yes, a tight bandana can cause traction alopecia. Many Sikhs have hair loss from the turbins they use throughout the adult life. I have even seen 13 year olds who have been wearing turbins with complete traction alopecia and no side or frontal hair left. These tight turbins can produce hair loss in a relatively short period of time. I have transplanted some of them to address this traction hair loss.

Get a diagnosis from a competent doctor, then follow his advice. If you stop the tight bandana and the hair loss is not permanent, give it a year or so for recovery before doing anything more radical to it.

Does Wearing a Beanie or Hat Cause Hair Loss?

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

I wear Beanies (stocking cap/tuc, whatever you wanna call it) everyday. I usually where them for about an hour in the morning and then later in the evening I may where it for a couple hours. Overall, each day I wear a beanie for about 3 hours on average. Can they cause hair loss? Thanks for your help!

In 2003, I appeared on MTV’s Big Urban Myth show to dispel this myth. Wearing a beanie or cap for many hours a day for many years probably will not cause hair loss. This is an old wives’ tale that has been around for a long time. Many men wear hats to cover their balding, so the association of balding and hats has been clearly recognized for centuries. It is a classic chicken and egg problem: which came first?

Provillus

/by William Rassman, M.D./454 /

Hi Doc

I have been reading info on Provillus a DHT blocker that is said to work for as long as i take it unlike other drugs (propecia) that stops working after 5-6 years. Do you know if this is true as i dont look forward to start losing hair again and be back were i started.Could you also tell me any info on Provillus tnat you have. thanks

This sounds like a load of bull. Claims like this are not only illegal (from an FDA point of view), but unethical as well. This opinion seems to be common from reviewers of the product on the web.

Size of Miniaturized Hairs

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

Hi there,
I have read your explanation of hair miniaturization, and have a question. I am a 30 year old female and I am experiencing hair loss. My hair loss seems to be diffused, with areas that are worse which are my hairline, as well as the crown (alot of my scalp can be seen at the crown). I have been obsessively reading about it on the internet and have found it helpful but confusing information. Anyways, back to the question. I have alot of miniaturization hairs throughout my hair. By alot I mean alot, they stick up everywhere. Do these hairs every stay at a certain size, or do they always end up being very small and thin? Some of mine are extremely thin, and others are thicker. Thanks in advance

This is a good and insightful question. The general belief is that miniaturized hairs are impacted by hormone and genetic influences. As some hair is impacted and others are not, I would think that the impacted hairs (the miniaturized hairs) remain impacted and thin, unless things change like hormone balance, or the effects of medications such as Rogaine/minoxidil. As no one has ever actually tracked a single hair in a follicular group when cycling occurs (anogen through catogen phases), one really can not tell the actual answer to this question other than make a good guess (like I am doing here).

Follicular units usually contain a number of hairs. Mature healthy hairs are called ‘Terminal Hairs’ while the small hairs in a follicular unit are called ‘Vellus Hairs’. Miniaturizated hairs are thought to be ‘sick’ terminal hairs, not vellus hairs. Does a terminal hair become a vellus hair or visa versa? I doubt that, but do not know for sure. Do the hairs in a follicular unit play musical chairs (opps hairs) and change their appearance over time in a single hair cycle? I can have fun with these types of questions, but that is my intellectual exercising of random thoughts that you stimulated have no particular value to help you with your question.

Propecia and the Penis

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

I took propecia for around three months and stopped taking it around 86 days ago. I am experiencing side effects from it. I have soft morning and night errections. In order to get my penis hard, I have to touch it. And even then it does not get as hard as it used to get prior to I used Propecia. I also feel slight pain in the base of my penis and testicles. Can you please give me an idea that approximately how long will it take for me to get normal. And what are the chances that I will get normal again.
Thank you.

Propecia side effects have been covered on this site before: here, here, here, and here. It is important to note that many people who complain about decreased sexual drive with Propecia are actually having erectile dysfunction (ED). In men in their 40’s, it has been estimated than almost half have ED problems at some level. As men age, the penis blood flow and responsiveness of testosterone change as well. Most men deny changes, but deny it as they may, it happens.

Fondling the penis is an important part of stimulation for obtaining an erection. This is more important as you get older. Very young men barely have to think about sex to get an erection. I am a bit concerned that you may be obsessed about your penis function. If you are with a partner, is there a problem? Sexual stimulation between two people will produce a stronger erection than by yourself, particularly if you have ED. In the Wall Street Journal some years ago, the day after Viagra was first sold, a urologist was interviewed about the drug. He told the story of a man and his wife who thought that Viagra did not work for them. On the only time he used it, the patient took a Viagra at about 10pm and he and his wife lay on their bed watching his penis and waiting for it to become erect. They both fell asleep by 11pm and nothing happened. The urologist told them that Viagra will not work unless he became sexually involved with his wife. The next night he tried again, and with some amorous involvement, they had great sex and he had a wonderful erection for the first time in years. Maybe this story will point to a problem you are having in a different light.

Lost All Body Hair After Infection

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

12 years ago I had a long term infection after an operation. Soon after that I began losing hair all over my body: pubic, anal, chest, under arms, even nasal hair. Beard and mustached nowhere near as thick as they used to be. Please help me; what could cause this?!?!?!

The absence of body hair is alopecia universalis, an autoimmune problem which is most frequently genetic. Clearly your infection precipitated the condition but the genetics were hiding under the surface. You need to see a good dermatologist. Visit MedlinePlus and DermNet NZ for more information about alopecia.

Hair Loss 5 Years After Taking Accutane

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

Hello Dr. Rassman, I am a 21 year-old male and 2 years ago a friend mentioned to me that my hair was thinning. I had never noticed, I wore hats all the time, but then I started to notice shedding and thinning. I took acutane when I was younger (16 years old). Balding is not in my genes. I stress about it a lot. Do you think my hair loss has anything to do with accutane? I have seen doctors and they have just suggested rogaine or propecia if it starts excelerating. I would love any advice or tips you could present to me. I know I am not ready for a transplant, but what can I do to slow this down? I recently have started using nioxin hair therapy shampoo and condidtioner, haven’t really noticed much. Thanks a lot.

I am not certain if accutane could cause your hair loss after not taking it for more than 5 years. Starting Propecia and Rogaine is a good idea in an attempt to regrow, stop, or slow down your hair loss. As for Nioxin hair shampoo, I am not completely sold on this product for hair regrowth, but it is a good shampoo. If you have good result from this shampoo, then I think you should continue using it. If you have concerns that you are really going bald, I recommended that you call me at 800-NEW-HAIR to schedule a free consultation in Los Angeles or San Jose. You need to have your scalp mapped out for miniaturization and a proper diagnosis made by an expert.

Scar Length

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

I am 25 and about a Norwood 2. Of 10 Uncles, father and Grandparents, one has been a Norwood 5 (mom’s father) the rest 2/3 or 4. My father had no hair loss. I had a hair tranpslant a year ago. It is pretty good, however there is not as much density in my temples as i would like. The doctor transplanted 600-800 hairs, and the scar left behinid is about 4 inches – it seems like a long scar (I have quite dense hair). Is this a normal lenght for such a small hair graft? I have been for a consultation and have been told that I have at least 7000 hairs remaining on the back of my head. I am considering if I should have more grafts in the temples, but i am not sure if i should, considering i am not sure how much more hair i will lose. Would another transplant of about 600 hairs make a huge difference? I would love to have the hair line if possible, but I am not sure what to do. Also, I am on Proscar, is it as effective as propecia, and does it REALLY stop further hair loss in the front hair line (temples and or the mid area?) Thank you.

If you are taking Proscar, make sure you cut the pills into 1/4 or 1/5th size. The higher does could cause more side effects.

Your narrative above leaves me uncomfortable. As a Norwood Class 2, I would want to see you before I draw conclusions. Temple hair transplants in a Class 2 is unusual. That bothers me a bit. Can you send me digital pictures to the email address on the Contact page, or come in for a consultation with me?

Scar length reflects the size of the area removed. For 800 grafts and a 1.2 cm width, the scar might be 4 inches in length but should not be more than 1-3mm wide in normal healing. I can not comment on your remaining supply, other than to guess that with normal densities and normal laxities, a man should be able to supply 8,000 grafts of 16,000 hairs from the sides and back of the head. This number can vary between patients.

Female Hair Loss When Hair Gets Long

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

I’m female and I like long hair but I have noticed when my hair gets about 2 inches past my shoulders it starts to fall out. But when its short I don’t have any hairloss at all.

Your hair length is determined by your hair cycle. What that means, is that longer hair may not be possible for you, because your hair cycle ends when the hair gets just beyond shoulder length (let’s say 14 inches). Assuming your hair grows at 1/2 inch per month, at 28 months the hair cycle kicks in and the hair falls out, being replaced by a new hair grown from the scalp. We cycle hair all of the time ‘asynchronously’, which means that we do not shed our hair like furry animals at seasons, but replace hair at about 100 hairs per day. This is a normal process for you. If your hair grew out 3 feet, then your hair cycle would be 6 years rather than 28 months.

Transplanting Eyebrows

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

After using SELECIA 10m (homeopathy overdose), I lost all hair on body, eyebrows and scalp (also had scanty hair anyways…probably due to MPB). I developed thyroid problems after that. Now i am on altroxin 150mg per day. NOW, can i transplant some hair for EYEBROWS???? I have NO EYEBROWS and NO BODY HAIR… just some scanty beard growing…

If you lost hair everywhere, you might have a genetic condition called alopecia universalis. That would impact eyebrows, pubic and underarm hair as well. Whatever the problem, with the complexity you outline above, you need to see an expert in this field. Do not be an amateur treating yourself. The product you are referring to is a known medication that will cause hair loss. I even found a site recommending it to remove hair permanently. Does sound suspicious, yes?

Eyebrow hair transplants work well, but not in a person who might have an autoimmune problem. Please check yourself out for the various conditions that only a good doctor will identify.

Losing Grafts 1 Week Post Surgery?

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

I had my HT surgery 1 week ago. My scalp is still pretty scabbed up. My concern is that when Im in the shower (or when i pick at my scalp), I continually see what looks to me like the implanted hair coming out with the scab. I understand that the hair would be lost following the surgery, but I thought that was when my scalped was healed, not during the healing phase. Am I overreacting or am I losing grafts?

Essentially, when the scabs are gone, the risk is over. That generally takes 5-10 days, depending upon the fastidious washing technique. We promote aggressive washing to reduce the risk period to 5 days and to get normal looking in that same period or time, or earlier. With regard to picking it, that is not an option so stop that ASAP, because it might cause you to pick out the grafts that are still attached to eschars and eventually you can get folliculitis (an infection of the hair follicle).

Mane-Tail-Groom Hair Products

/by William Rassman, M.D./5 /

do you know if mtg also known as Mane-Tail-Groom hair products are safe i know that when they first came out it was for men with hair loss but more recently has been used for horse hair, so is it safe for humans to use.

I would doubt that any permanent damage would be done by using Mane-Tail-Groom hair products on your scalp and hair, but it would not be my first choice. When I had horses, they were kept outside and were used more for riding, and I am sorry to say that I did not spend a lot of time grooming them, so I am not familiar with the myriad of grooming products for horses. I asked one of my patients about this, and he told me that this is common family of products used for hair loss and hair grooming in his native Ireland (for people). It is used especially with horses trained for the competitive dressage market in Europe. Many Irishmen liked the results on horses so much that they used it on themselves. When I mentioned this family of products to my female office staff, a few commented that it worked nicely to make the hair glow and shine. There is anecdotal evidence that it may have value for humans, so the final laugh may be on me as I announce my ignorance to all of my readers.

The actual herb is taken from a plant called equiseteum, which is a botanical that has been recognized for its medicinal purposes in cultural lure. There are many claims of benefits that cover curing urinary infections, bleeding, helping broken bones, brittle nails, arthritis, athlete’s foot and hair regrowth due to its high silica content. Frankly, I don’t know much about these things and am frightened by its wide range of claims, but then again, I have not spoken to any of the horses myself about how they felt about the product line.

Tests to Run for 13 Year Old Girl Losing Hair

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

Dr. Rassman, my 13-year-old daughter (caucasian) has been experiencing thinning hair these past few months. Her dark wavy hair in the past had always been pretty thick. Her pediatrician ran anemia and thyroid tests which came back normal. We then saw a dermatologist who ran free testosterone and DHEAS–these too came back normal. The next step we are doing is seeing a endocrinologist (appt. not available until February). Are there some other tests that ought to be run in the interim, or should we see a hair specialist (do you know of any in the Metro Detroit area with a female (teenage) hair loss specialty?)

Her diet is fairly balanced, she has not experienced any stressful episodes, and she feels fine physically. I have recently been giving her Women’s 1-A Day vitamins since this problem has occurred. In the Spring of 2005, she began taking Cephalexin (Keflex) for acne. The dermatologist gradually reduced her intake, and she has recently stopped taking it entirely. Another note is we visit the Islands every February (during the past 7 years) whereby she has her hair braided. She would generally keep the braids in for a week, which looking back must have caused a lot of stress on her hair, but again, that would be 8 monts after the fact that the problem began. Thank you for any insight you may be able to provide.

-Very concerned parent

You daughter can go through periods of shedding hair and then reverse and regrow the hair. It is normal to lose up to 100 hairs per day. Now, if she continues to lose more than 100 hairs and she begins to show bald spots or more scalp, then it is a concern. There are many causes for hair loss in women as you outlined she is or has been evaluated for. The list includes: hypothyroidism, alopecia areata, telogen effluvium, androgenic alopecia, repeatedly over plucking, surgery, trichotillomania, stress, chemotherapy, radiation, cancer, eczema, seborrhea, scleroderma, lupus, hormonal imbalance, psoriasis, parasites, fungal, autoimmnune disorders, poor diet, poor nutrient, burn, trauma, leprosy and drugs. The common medications which may cause hair loss are beta-blocker, coumadin, oral contraceptive pill, antibiotics and chemo-medications. Braiding hair could cause permanent hair loss if it is kept for a long period of time and especially when a person has sensitive/weak hairs. I believe visiting a hair doctor in your area is a got start. A full analysis for miniaturization with a good microscopic evaluation of the scalp hair is critical in understanding the process. Continue with your present course and get the scalp mapped out as well.