Female Scalp and Temple Hair Loss

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

I have had a worsening problem for over 2 years now.
I am a woman with have a problem with thinning hair and some recession primarily in the scalp temple and frontal area of my hair line. It appears in a male pattern. I don’t have any balding but do have miniaturized short hairs that no longer grow to their previous length or fullness and they are sparse. The frontal hair strands are fragile and tend to have a fly a way appearance. Some hair strands do fall out with a telogen hair and they do grow back but not to the previous length or fullness and some hairs fall forward and seem to rest on my forehead. This problem started after having a eb virus which I had a rash and took acetate fluocinide ointment for which I noticed seeemed to further aggravate the receding appearance of my hair line. So, I stopped using it long ago. I also have eye brow and leg hair that is sparse and does not grow to its previous fullness and some areas on my legs where hair no longer grows at all. I have tried many medicines and they seem to aggravate and cause my fragile hair in the front to break and have not helped. I notice that the problem is worsen during my menstrual peoriod. I have had a full work up of blood tests etc. and all labs have been returned within normal range. I had a biopsi which did not yield any definitive cause either. I have been to many derm doctors, endocrin, rheum etc. and noone is able to provide a definitive diagnosis or a treatment that will help. Please note I am primary concerned with the scalp hair loss the hair loss in the other areas I can deal with. This is a very odd problem. This has been very frustrating any help or advice would be greatly appreciated. I am ok with out a dx if I can get something that will improve the problem.

It is rare, but women can experience male pattern balding or thinning as you describe. In these women, the miniaturized pattern follows the Norwood Classification, sometimes leaving the very frontal 1/2 inch almost normal. You may be experiencing a Telogen Effluvium which is more common in woman. I am not certain about the association of EB virus causing hair loss unless there is a cross reacting antibody to EB virus which mistakenly attacks your hair follicles at the same time. You have a very interesting problem. I would like to see photos from all angles or if you can, drop by for a free consultation so that I can evaluate in detail using a magnifying video camera of your entire head. Have you tried Rogaine for women?

Does Hair Transplantation Hurt?

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

Hair transplanting looks like it hurts! Does it hurt is my question? I saw the video and almost threw up. So please respond to my question! Does it hurt? Especially with at least a couple of thousand grafts! Please respond! Thank you for your time.

Yes, part of the process is painful. The first part (with anesthesia) hurts for about 1 minute. This part can be subsidized with appropriate medications to reduce the pain and possibly eliminate it if you choose this option. The more medications, the slightly more risk you may experience with side effects. Pain is also present after the surgery. If you elect to have an FUE procedure, the pain is very minimal and rarely takes any medications after surgery. If you have a strip harvesting procedure, then there is pain in the donor area, particularly more on the first night, which is easily treated with strong medications that are supplied by us. Some doctors do not like to use the word ‘pain’ because its meaning might frighten patients away, so the word discomfort is used instead. Discomfort = Pain!

On the other hand. there is also the pain of hair loss. This pain is often described by our patients as far worse than anything that they experienced in the surgery. As the old saying goes, “No Pain, No Gain” which essentially means that you need to weigh what you are willing to experience against what you are not willing to experience. A 2,000 graft procedure does not really hurt more than a 500 graft procedure. I prefer the larger procedures, because the patient has to invest less time and have less surgeries to get the final end product of their hair restoration desires.

Donor Scars from FUE

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

Dear Dr. Rassman,
I have had a FUE procedure from another doctor and have some white donor scars that you show on your website. If there anything that can be done to make this scarring less visible. (permanently and not a coverup). Thank you

This is unfortunately the reality of FUE. Tattoos can be placed in each one, but do not tattoo the entire white area — just speckle it. Questions to ask:

  1. What size punches did your doctor use? They should have been 1mm or less.
  2. Did your doctor tell you that this was a natural outcome of the surgery? They are obligated to tell you this in the informed consent.
  3. Did you see patients who had an FUE prior to having one? We often show these patients in our monthly open house events at our Los Angeles and San Jose offices.

I personally don’t like surprises. Good reading, shopping, and solid research is needed for anything like FUE or hair transplants.

Hairline Receding on One Side More than Other

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

Hi Doctor Rassman, I’ve read your profile. You’ve made quite a lot of achievements. Congrats!
And now on to my question, I’m 19 years of age and my hairline is receding a lot towards the left than the right. My left side is roundish but the right side is still squared yet receding. I can actually feel the emptiness on the left side and that’s really freaking me out. I am also able to see through the hair…meaning that I’m seeing less hair up there but I dunno if it shrunk in diameter. Its like it went from jungle thick to like how a forest would look after a large fire. There’s also small bald gaps in my hairline. This is all very embarrasing for someone my age as it depicts an unhealthy aging teenager. I tend to wear tuques most of the time and I know I can’t do that all my life. I only work part time a few hours a week therefore I dont think I can afford Propecia. Are there any other drugs or methods you can suggest? Thanks.

Hair loss is often asymetrical. Usually, when one side becomes worse, the other side catches up with it. Eventaully, if you have male patterned genetic hair loss, you will continue the process. Propecia works well to stop it, slow it down, or reverse it, particularly in young men like you. You need to have your scalp mapped out for miniaturization and get a diagnosis first. Then a good doctor can treat you properly.

DHEA and Hair Loss

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

Doc Rassman:
Hope everything’s been going well with you on your end…had a quick question, there’s an over the counter supplement, believe some sort of hormone based supplement, called DHEA that’s supposed to help recuperation after exercise…says essentially that the body manufactures it naturally and starts tapering off in the 20s. Do you know anything about it and if so would I have any concerns about taking it regularly as one of the potential effects I understand would possibly be hair loss although what I’m reading says that side effect would be extremely rare. Does the supplement work and is it worth taking, even at reduced amounts…ps, I’m 35 years now so i was thinking if i were to start taking it I would simply just take half dose. thanks for your time…

DHEA is one of the medications that may accelerate hair loss, so I would not go that route. There are safety issues related to this very potent medication, which many people use as an anti-aging medication. I have generally been less enthusiastic about things that I do not understand the long term impact of. Some of the literature I’ve read addresses the world of the unknown, and DHEA certainly fits into that world.

Doctor Recommendation in Boston Area?

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

Hello Doctor,
Thank you for a great website. I find it very informative. I’m 25, male. I have been losing hair for almost 2 years now. My frontal hair is shaped like an M now. I’m thinking of consulting a dermatologist or some doctor like yourself and find out what’s the best treatment for my case, but not sure who to approach. I live in boston, Massachusetts. Do you know any good doctor or any colleagues of yours in this area that reliable enough that I can go to? Do you think it’s better to consult a dermatologist first or just take the propecia? Greatly appreciated for your help.

Dr. Robert Bernstein in NY is my favorite, as I have seen his results over and over again through the past years. At least with him, you can go to an open house and get a consultation on the same day. The trip from Boston by train is a nice ride.

Propecia must be prescribed by a doctor, so you’ll need to see someone first. You can generally find doctors who specialize in hair restoration surgery through ISHRS.org. Just be sure to do your research.

Head & Shoulders Shampoo

/by William Rassman, M.D./534 /,

Somebody mentioned losing hair after using Head ‘n Shoulders shampoo. In the fall of 1975, I started using Head ‘n Shoulders shampoo and immediately started losing hair and even though I could not prove the causal relation between the two, I immediately quit using Head ‘n Shoulders. Even though my hair has still receded and thinned somewhat since then, I have always been curious if anyone has taken a look at Head ‘n Shoulders and complaints about that brand of shampoo as a possible cause of hair loss.

Head and ShouldersHead & Shoulders shampoo, to my knowledge, does not contribute to hair loss. You are the first person who has presented this complaint to me. It is very possible that there was a coincidence between the shampoo and the change in your hair loss status.

Update August 18, 2008 —
Although I initially posted this almost 3 years ago, this has become a very hot topic as of late and the readers have provided some good commentary below.

8 Months After Transplant Procedure

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

Hi Dr. Rassman,
I had a procedure of 1,600 grafts done on my front hairline just over 8 months ago. My situation was exactly like that of Steve Hartman’s, whose pictures are on the NHI website. The growth of my grafts didn’t really begin to show until about 2 months after the procedure. Now, after 8 months, the hairs have grown to length, but are very fine and thin in appearance. To compare, my transplanted area at 8 months looks like Steve Hartman’s photos at 5 months. It seems like everywhere I read, 8 months is roughly a good time to indicate how successful a transplant was. I realize that every situation is different, but I’m just wondering if (according to the averages) can I expect more density and fullness in the coming months? Am I just being impatient?

I’m very pleased with my results so far, I think I was just hoping to see a bigger difference sooner. Thanks for any help and I hope to see you the next time I’m in California!

At 8 months, the transplants usually show about 80-90% of the results, with more length coming in the following months. Steve Hartman‘s hair was an average thickness and your hair is very fine, so an apples to apples comparison may not be appropriate. You are asking if all of the hair has grown and the answer is effectively most have grown. You may need another transplant, which is not unusual for a person with very fine hair.

Itch on Scalp from Rat Mites?

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

For a couple of months now, my head has been extremely itchy, and my hair is falling out much more than it should be. I don’t have any bald spots, the hair just falls out all over the head. The itch is so intense and sometimes it feels 100 times worse than the itch from headlice. I’ve been to the dr’s twice, and hairdresser and many friends have checked, all have confirmed that i don’t have headlice. My 2 teenagers just told me tonight that they have been having the same symptoms. Hair also can just pull out without feeling a thing. I’m making another dr’s appointment, but i think the dr might think it’s all in my head (no pun intended). He says my scalp is in great shape, no flaking or anything. I’m just more concerned now that 2 of my kids are complaining of the same thing. Someone suggested it could be something called rat mites. We do have a lot of mice in our house, as we live in the country, now i’m wondering if rat mites could be the problem. Thanking You in advance for your reply

That certainly is an interesting one. You should look into finding someone that specializes in skin problems, rather than just a general practitioner. I would see a good dermatologist and have your scalp and hair evaluated. There is a hair pull test that the doctor can do for you, which I would recommend having done rather than going to the Orkin or Terminex folks to get your head fumigated. Clearly, fomr my answer, you can see that this is not an area of my expertise.

18 Year Old Female with Thinning Hair

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

I am an 18 year old female college student and I have been noticing for about 3 months that right at my bang area, my hair is thinning and I can see my scalp. It not real bad, I mean you cant look at me and say your going bald.I am the only on that notices it. So yeah its not in horrible condition to where it is noticable. I just see it because of cousre I am a girl and look for things like that. What could it be: stress, diet, dying my hair? How can I help my problem? Please help me it bothers me so much even though its hardly noticable except by me when im staring at it…HELP!!

There is a typical female pattern of hair loss just behind the first 1/3 inch of hairline, in the area of the forelock. Whatever you have, you need to see a doctor who can evaluate you in person for miniaturization and determine if you do have female genetic balding. For your peace of mind, you should know that there are things that can be done for it. Overall testing of women for a variety of conditions are well discussed in this blog (see Female Hair Loss category).

Hair Loss from Crash Dieting

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

In response to the blog posting Female Hair Loss After Braids…


Hi Dr. Rassman i just wanted to know about the recent 18 year old girl who is losing her hair because of the braids… I wanted to know if it could be possible that she could be suffering from Telogen Effluvium, because of her taking diet pills causing her to crash diet and her hair falling out as much as it has?

Yes, this is possible. Crash diets are a major cause of hair loss in young women, especially compounded with the braids, if there is substantial pulling on the hair.

Where to Apply Minoxidil?

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

Hello Dear Doctor:
I’ve been using Proscar for several years and it works for me. A year ago I started to use Minoxidil 5%, twice a day. It works too, noticiablly in the topical area, and possibly thickening other areas. But recently, I started to apply Minoxidil 5% once a day. I’ve been doing so for about 2 months, didn’t see any bad effect. Should I continue to apply it once a day, or change back to twice a day? Another important question, I usually try to apply it everywhere not only the topical area. Do you think that helps more? if not, I wouldn’t waste the time. Or, even if I only apply it to the topical area, it works the same as I apply it in other areas too? Can you define the topical area more precisely for me? You answer will save me lots of time each day, so change my life significantly, I appreciate it.

Apply the minoxidil twice a day to the area that you want to see the benefit from it. Although there is some systemic absorption, minoxidil’s greatest impact is at the point it is applied regularly.

Red Dots on a Burning, Itching Scalp

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

i’m female and have been getting red dots on me that get a circle then the hair falls out, it burns and itches. Do you think I will go bald? Or will my hair grow back?

Based on your description, an itchy, red, circular ring lesion with hair loss might be due to a fungal or bacterial infection. If it is a fungus on the head, it is called Tinea Capitis. If the lesion is located on your body, it is called Tinea Corporus. If the infection is due to fungus, then the hair will grow back. You should see your doctor to get the diagnosis and appropriate treatment.

Doctors Not Allowing Patients to Take Propecia?

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

Sorry for troubling you so much on finax (guess its propecia in US). I have been hearing varied views on finasteride side effects. Some websites project it scarily. Very few doctors here in India recommend it. It’s confusing. Whats your final take? Why is this scary thing all over? I mean why do you think many doctors do not allow their patients to use this drug?? Thanks

I have great difficulty with doctors who do not use this drug in men who are losing hair. The main motivation for many of them is to get the most money from their patients by chasing hair loss. This is a question of priorities. Who comes first, the patient or the doctor’s pocket?

Stopping Rogaine

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

doctor,
i have been using rogaine for about 4 years. i went to the 5% a couple of years ago, not too long after that, i only have been applying it a night, because it does tend to irritate my scalp. i thought it was helping me keep the hair i have, no regrown hair at all, but now at age 40, in the last 6 months i have seen an increase in hair loss. i have a good amount of hair on the top, but it is thinning worse and my bald spot has gotten bigger. should i stop rogaine even though i only use it at night, and if i do stop it will it accelerate my hair loss because i have been using it for the last few years? i realize i should have kept up with my dermatologist. any info is appreciated.

The use of Rogaine once a day has poor value. Twice a day is the recommended dosage. If you are a male and you have not started Propecia, then I would suggest that you do so,as it is the best way to control the crown loss and possibly reverse it. That does require a doctor’s prescription and should be accompanied by an examination of your head for miniaturization. If you have any Rogaine dependence (unlikely with a once a day treatment) then withdrawing it might risk more hair loss. So if you are a male, then continue what you are doing and make only one change, taking Propecia for 8 months. If you are a female, then there is no other choice but to go on Rogaine twice a day.