Shampoos Aren’t Working for My Hair Loss

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

Dear sir,
First of all i like to thank you you for helping the poor people who are feeling very sad over their hair loss. I am having continuous hair loss for the past 2 years. All of my hairs are becoming thinner and thinner day by day. i used all kinds of shampoo which don’t give me good results. i also have a dandruff problem. if i use oil it goes away, but comes back quickly after 2 or 3 days. please tell me what can i do for preventing more hair loss? please tell me not only which medication to use, but also tell me any useful shampoo which can give more help with medication. thank you.

It is not good medical practice to diagnose and make treatment recommendations without the ability to see and evaluate your problem. Your symptoms are very general, like asking an auto mechanic: “What is wrong with my car? It does not sound right!” A good mechanic likes to see what the problems are, and to be able to evaluate everything about your car.

For me, I need to examine your scalp, looking for genetic balding and other diseases like psoriasis (which sometimes looks like plain dandruff). Make an appointment with a good doctor and do not treat yourself, for your problem may be more difficult than you think.

Female Hair Loss from Iron Deficiency?

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

I am 29 years old and am losing hair. After the shower I can see lot of hair fallen around. In my diet, I dont include iron-rich food. Would it be a possible reason for hair loss? Can you suggest a good diet for preventing hair loss?

Speak to your doctor and have your iron levels measured. This is an important step if you think that you have an iron deficiency, a common occurrence in women. Historically, women needed to eat meat to replace the iron they lose from menstruation which is why iron deficiency is not uncommon in women. A good general diet with red meat may be all that you need if your iron levels are bordering on the low level, otherwise, see you doctor and get his/her recommendation. If you have hair loss, then as I’ve suggested many times in this blog, you need a good examination for miniaturization to get the best diagnosis for cause.

Can I Go in a Hot Tub Days After a Hair Transplant?

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

I had a hair transplant completed two days ago. I was a IIIv. I recieved approx. 2200. I think everything seems to be ok but I am concerned about my post op care. Is it safe to take a bath or jacuzzi bath? I am also doing hyperbaric sessions. Tomorrow will be my fourth 90 minute session. Should I continue with the hyperbaric session? Lastly, what does a raised graft look like? I did sit in my jacuzzi bath for a while got out and the recipient sites looked sort of white. Thank you very much for your insight you are providing a great service.

I generally tell my patients that they can run a marathon 5 days after the surgery, but any prolonged soaking of the head that has had donor wound harvesting may not be a good idea. If you had an FUE harvesting technique, then the rules change and you can safely soak in a hot tub (a clean one) or go surfing in 5-7 days (not in polluted waters of course). Providing that you do not soak your head, I do not see a problem with a series of short Jacuzzi baths at 5 days. Hyperbaric sessions are interesting. I would love to know if your hair continues to keep growing and avoids the surgical shock that usually makes the hair disappear for a few months after a transplant. Please let me know if all the hair is growing at 2 months.

Should I Start Using Rogaine for Women?

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

I am a 27 year old, female of indian ethnicity. I always had extremely thick hair, but have noticed over the last 5-7 years, a dramatic reduction in my thickness (probably half the thickness it used to be). Admittedly my hair is probably still considered thick, but I am concerned that at the rate of my hair loss it could become dramatically worse, and want to prevent this from happening. My mother’s hair has dramatically thinned (you can see her scalp visibly) and I am hoping that is not what I am getting. I do notice slight regrowth but this does not seem sufficient to be replacing all my lost hair.

I notice that I lose a lot of hair in the shower, when I style my hair, and anytime I just pull my hair together, and also see that I lose strands of hair throughout the day (my floor perpetually has a lot of hair on it and my clothes usually grab a fair number of hairs as well). I have been perpetually on different antibiotics for acne for about the last 10 years (not sure if this is an influence).

I want to start using Rogaine for Women but am not sure if I am too young for this, and also dont want to use this unnecessarily. Can you please tell me if I can/should be using a product like this? Also, should I see a doctor regarding this (what type of doctor is best), and what tests should I be asking for? Any feedback you have would be appreciated.

Self-diagnosis is difficult for me to recommend, because if you have a medical condition causing the hair loss, then you will not get a proper diagnosis. As I’ve said before, there many reasons for hair loss in women, including hypothyroidism, ezcema, alopecia areata, telogen effluvium, lupus, drugs, stress, crash diet, and infections. As you will see when reviewing the list of problems, hair loss in women is not as straight forward as in most men. Before starting more medications, you should get a metric (measurement) to get your scalp mapped out for miniaturization to determine if you have premature genetic balding for women.

A good dermatologist or family doctor can perform the basic blood tests and a dermatologist will be able to do biopsies when appropriate. Rogaine for Women may work if you do not have one of the medical conditions listed above.

How Long Does The Balding Process Take?

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

I am a 27 year-old male from Toronto, Canada. I have a family history (faternal family and partenal family) of MPB. In the summer of 2005, my stylist informed that I was thinning at the top/front. I was in denial as I have used lots of gel or similar styling products and have been able to see my scalp. I later noticed the front thinning a little, but did not really care as it did not seem to be serious. In late December 2005, my uncle asked me if my hair was thinning (which he has always done b/c of the gel) and my aunt said that my hair was thinning from the crown….my sister said she noticed it as well. The next day I asked my barber not to use styling product and he said that would be good b/c of the thinning on the top (the first time he has mentioned it since the summer!!!). Needless to say I am no longer in denial BUT I WANT TO TAKE ACTION AS QUICK AS POSSIBLE.

I am going to speak with my family doctor about propecia/proscar. I have bought rogaine (2%) but will wait to use it, as I would like to see the doctors say and b/c of your advice to start out with one remedy so that I can know what is effective. I have also bought nizoral (2%). The rogaine seems like a pain to use. I am a very very busy young professional.

I have a few questions:

  1. do you have suggestions for a good doctor in Toronto, Ontario, Canada (preferably downtown core) where I can get miniaturization done?
  2. how long does the balding process take? I am concerned that I will lose a lot more hair before any medication kicks in. I would BE QUITE HAPPY IF I COULD MAINTAIN MY CURRENT HAIR for the next 8 – 10 years as I love my locks.
  3. Is avodart available in Canada?
  4. do you recommend any particular thickening shampoo and styling product? I want to avoid the revivogen and stuff like that.

Thank you for your help.

  1. Check with the ISHRS for a doctor near you by using their physician search.
  2. The balding process varies with each person. The reality is that very bald men are usually on their way to that diagnosis well before their 29th birthday.
  3. If you do have genetic hair loss, Propecia or Proscar (broken down to 4 parts of a tablet) is more appropriate than Avodart at this time. That being said, I do not know of the availability of Avodart in Canada.
  4. I don’t believe that styling shampoos or any topical agents will help.

It sounds like genetic balding is the diagnosis, but I couldn’t properly determine that without an examination. As you know, we tend to follow our family patterns, which also includes the rate of balding. Find out who you take after, and you will have a better idea of what may happen if you do not go on such medications as Propecia.

Hair Loss From an Aggressive Haircut

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

Hi,

I have been using Propecia for about 7 years. The results have been satisfactory. However, the other day, an overzealous hair stylist at XXX Sam’s gave me an extremely aggressive haircut. I mean, it felt like she was ripping my hair out by the roots when she would comb it or cut it. Do you think this haircut could have caused permanent hair loss in any potentially damaged areas of my scalp, or, with or without the help of Propecia, the hair will just grow back? Thanks!

I had a patient who got mugged in downtown Los Angeles. The gang that robbed and mugged him, held him by his hair, and when they took all of his money and kicked him, broke his nose and cut his face, they pulled out most of the transplanted hair I had done in the front (1500 grafts). He insisted that the ambulance bring him to my office and he was the only person ever, who came to my office looking like he got out of a war zone. He did not care about his broken nose, his broken ribs, his cut face, or the many bruises on his body. He was crying for his hair that was then all gone.

I told him that he had to go to an emergency room to get himself fixed up and I assured him that his hair would come back. In just a few months, all of the hair came back. I doubt that anything that any person can do with a hair cut can match this story. To conclude, your hair should be fine.

With regard to your stylist, remember her like you remember an old discarded flame, what brought you and what sent you packing.

My Connection to Merck, Again

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

Dr. Rassman. It’s obvious through the few blogs that I’ve read that you have no faith in any hair restoration product other than Propecia. You have mentioned Avodart, but it’s quite clear that you are a proponent of finasteride.

There are decades of successful clinical trials with natural herbs (simply look in the PDR for Herbal Medicines or online at PDRHealth.com to find them). For example, saw palmetto has been tested against finasteride many times with virtually equal results (both with BPH and hair restoration). Foti root, grape seed extract, green tea, amino acids and other nutrients also have significant clinical data behind them to show that they are and can be effective at halting or slowing the effects of androgenetic alopecia.

Since you discard the thousands of other proven products that exist and have helped millions of men over the decades, I have to ask… are you in some way connected to Merck or Propecia? Are you a stock holder? Are you on a board of directors? Are you compensated by Merck for speaking engagements, travel, endorsements, etc?

Do you have any affiliation whatsoever with Merck that could possibly sway your opinion?

If so, I think it’s important that you share this information with your readers and patients. And as you know, it wouldn’t be difficult to find out on our own.

Respectfully

I’ve answered this question before, but I am glad that you are inquiring if I am being paid by Merck to speak highly of Propecia. For the record, I do not work for Merck, am not on its payroll and have never been paid one dime for any of my opinions or activities in recommending a good drug. I do not own the drug company’s stock and have never purchased it. I also prescribe aspirin, and many other prescription drugs and am not on any other drug company’s payroll either. As a hair transplant surgeon, I make a living by doing hair transplants. Thus, some might say that it is not in my best interest to endorse a particular medication to help grow hair or stop hair loss, but I will of course do it if that is best for my patients. As a physician with sincere interest in my patients’ well beings, I will endorse any medicine with clear, concrete medical data that help’s my patients improve thier hair loss situation. As of now, Propecia and Minoxidil have been shown through many studies to improve hair growth or stop hair loss. Through my experience, I have noticed Propecia to have a better effect than Minoxidil when genetic hair loss is in full swing (for men only). I am not convinced of the many herbal remedies because there is no scientific data to support the many claims that are made by so many of the herbal companies.

When I recommend Propecia to stop or reverse hair loss, one might say that I am undoing my business because a successful treatment with hair loss reversal will not produce a hair transplant for my practice. That must mean something to the reader, because I do this for the benefit of my patients. That is what my Oath is about, to take the interest of my patient above my own at all times. Nothing makes me happier than to have a successful drug course of treatment. I bond with these men and they send me their balding fathers, brothers, uncles, best briends, etc. Losing one patient to Propecia brings many friends and family, so I get back far more than just appreciation, although as a doctor, appreciation is all I hope for. I just met a patient who I sent home with Propecia, because he was too early to get a hair transplant and would not get a benefit from a transplant without first trying Propecia. If it has a chance to get him his results without surgery, that is better than rushing into a transplant. He had just seen another doctor who told him that he needed 2,000 grafts. What do you think? I get a growing, thriving surgical hair transplant practice just because I care and want to be the best doctor I know how to be.

Transplanting to Thinning Areas

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

I am 21 and had wavy hair that is receding and thinning on top and in back. I worry that if I get this transplant procedure done to early that it will not look right. I am not bald but yet but the recede bothers me. How do you cope with filling in thin areas where hair is still falling out around it.

First, you need a diagnosis with a good mapping of your scalp for miniaturization to find out for sure that you have genetic hair loss. You are correct that surgery is not the first stop along the path to deal with your hair loss, but probably the last. There are effective medications. Please get a diagnosis first, then a master plan on what to do next.

Masturbating and Hair Loss, Again

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

How do you conclude that mastrubating will not effect hair fall (baldness). After that you body generates a lot of heat.. so i think even that may lead to baldness ?

Just a few days ago, I posted a blog entry on Masturbation and Hair Loss. We all sweat from jogging and exercise and yet that does not cause balding. You are misguided here, but as I said, don’t stop masturbating or having sex in the hope that hair loss will not occur. Masturbation and our sexuality is part of being a normal sexually active man and sex is one of the fruits of life.

Pimples After Surgery Caused Skin Change

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

Dear dr. Rassman. Thank you for having time to answer questions concerning hair loss.

I am a black man. I had an FUE operation about 6 months ago. The donor area at the back of my head healed very well, but in the receiving area I got small pimples almost in every grafts incision (1000 grafts) in the front area of my head which looks different from the rest of the smooth skin. The hair is growing but it is not that dense to cover this area. These pimples are well seen especially from certain angles or according to the light reflection. I am really worried about if these skin changes will be permanent. What shall I do? Do you have any advice for me???

Pimples can be caused by sebum collections below the skin edge, but should have gone away within the first few months. FUE grafts should be trimmed, for if they are not trimmed and divided into their respective follicular unit, they will contain too much skin. The added skin will produce a skin deformity at the recipient site like the cobblestonning I talk much about in my published articles. The way light is reflected is an indication that too much skin may be have been left on the FUE graft or that the FUE graft was not separated into individual follicular units. Rarely, people with dark skin will tend to cause more scarring than those with very fair skin. Changes in the recipient area with a hair transplant do occur if you had atrophic skin (skin that lost much of the supportive infrastructure from blood vessels to glands, muscles and fat) or your hair is coarser, or if the surgical instrument used was large (by large I mean greater than 1mm, as a slit graft) or combinations of any of these factors. Today’s surgeons will use very small cutting instruments to minimize the skin wounds, hence the pitting or skin changes that could occur when the wounds are made too large. Skin deformities in the recipient area are rarely detected with small cutting instruments. Without seeing you directly, it would be hard to determine if any of these factors (or other factors) are playing a role here. I would expect that most people should not have this complaint, but just the other day I met a patient who had surgery from another medical practice with a similar complaint and I barely could see what was bothering him. This man had a body dysmorphic disorder. To determine your situation, either come in to my office (if you are in California) or at the least, send photos to the address on the Contact page.

Another Procedure to Thicken the Hairline

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

Hi. I have a few questions for you that I hope you can help with.

First off, I have had multiple transplants so I would ask you not to insult me by sending me advertisement-type answers. I found you by Google searching so I don’t know much about you.

As I stated I have had multiple transplants. Dr. X and then Dr. Y were the two physicians I met with. Dr. Y’s scars from the donor area are rather large, Dr. X’s less so. But I did have a problem with one large graft falling out that essentially left a small ‘holish’ scar on my bald spot in the back of my head. Something I am not happy about but it is not that bad.

My hair is thin. It always has been. I am 39 years old now. I do not think I have much hair left to give from my donor areas without the back of my head starting to look bald too. I am right at the brink of what is acceptable re-distribution of the hair from the back of my head to the front of it.

It seems like you are strictly a hair transplant outfit but I thought I would ask for your opinion anyway. I do not think of myself with a full head of hair, I just want enough up front and even on the bald spot to have a stronger looking hairline overall. What would you recommend? Thank you for your time.

To address your question, you need to be evaluated directly. As you are local to Los Angeles, I ask you to please visit our open house on January 12 to meet some of the repair patients we have done. We have an open house event every month in our office if you can’t make this one. Read our repair articles published in respected medical journals, and get a private consultation to walk away educated with your options clearly defined. I will not insult you with propaganda and if you look at our website you will see that we are quite professional in the way we manage the medical hair restoration practice.

For more information about repairs, please read these articles:

Thinning Hairline in African-American Woman

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

I am a 42 y/o black female. My hair started thinning around the hairline about 2 years ago. At first I thought it was some of the chemicals being used by my hair stylist. I have changed to another stylist, but the problem persits. I recently went to a dermatologist who started me on Rogaine. However, the site for Rogaine states that it is for hairloss in the top of the scalp. Is there any treatments that will help thinning hair around the hairline? I understand that this is uncommon for women? Please help, this has effected me emotionally.

There are a few important issues to address in your question. The first thing to note is that all salons use similar chemicals so you might want to stop chemically treating your hair altogether for several months to see if it recovers. The second issue is whether or not you have a tight braid/ponytail type of hairstyle or have had recent facial plastic surgery (like a brow or a face lift) since both of these can result in the hairline thinning you describe. You are correct in that women rarely lose their hairline with female pattern/genetic hair loss, but it can happen and that is why you should be examined by a doctor who specializes in hair with an indepth assessment for miniaturization.

Finally, Rogaine has been studied best at the top of the scalp, but I have seen some hairline results in women so it is worth a try. Unfortunately for women, there are no medical alternatives for thinning hair other than Rogaine. It is also noteworthy that hairloss can profoundly affect a woman’s emotional health, much more so than with men although men suffer hairloss more commonly. I would urge you not only to proactively address the hair loss, but to take steps to treat the emotional impact it is having on you as well.

Waxy Substance Attached to Lost Hairs

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

Hello, i am a 21 yr old male who has been noticing hair loss for about 3 years. It is becoming evident now more then ever. My hair line is reciding and thining on top. One thing i have noticed is when i look at the hairs that have fallen out of my head there is always a tiny white/light yellowish waxy ball attached to the bottom of it. I also notice them in my hair. What could it be? I have talked to my doc about propecia and will probally start that.

thank you very much!

That little ball at the end is either the bulb of the hair, a normal part of the hair that is often present when it falls out, or a tiny plug of sebum (waxy protective substance produced by the hair follicle) which is also normal.

By the way, contrary to popular belief, plugging of the hair follicles by sebum, oil, or other substances is not the cause of genetic/male pattern hair loss. Often people think this because when they start to lose hair they also start to see the shininess of their scalp which was previously covered. You will be addressing one of the main causes of hair loss (DHT attacking and weakening the hair) by taking Propecia so that is a good first step.

Transplanting a Norwood Class 2

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

Dr. Rassman,
I am 21 years old and I have been losing my hair since I was 16. I am now a solid norwood II and I am getting to the point where my hairloss is a cosmetic issue. I started using propecia, but I experienced the side effect of gynocomastia which fortunately subsided when I stopped using the product. Unable to use propecia, I feel a hair system or a transplant are my only options. Am I a candidate for a transplant considering that my hairloss will have to be chased across my head with multiple and frequent transplants? Thanks for your site. It offers a much needed service.

There is a need to establish a good solid relationship with a good doctor for someone like you. Having tried Propecia and developed a side effect, clearly you are doing the right things. A good baseline for miniaturization needs to be mapped on your head. Both you and your doctor must be able to command just what is happening to you and project what might happen and when. With that relationship in hand, you will be in a better position to analyze your situation. I personally think that if you start off with a hair piece, you will absolutely accelerate the hair loss process. Again, get a good doctor and work with him/her before undergoing something as radical as a hair transplant at your age. With that said, anything is possible if it is well planned out with a good Master Plan for your future in hand.

When to Start Using Propecia?

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

Hello Dr. I am a Marine stationed in Twentynine palms CA. I am currently deployed to Iraq and out here my hairloss isn’t exactly priority so there is no Dr. I can see about this right now. I did some reading and wanted to try propecia Is there any way it can be perscribed to me without being seen at an office? I would greatly appriciate your help with this. I am also considering starting transplantation before the loss becomes noticable to others. Would you recomend starting that early? Thank you VERY VERY much for your time!!!

If you are in your early 20’s, then I would recommend that you give Propecia a try first. Starting Propecia early is a great idea to help regrow your hair, stop hair loss, or reduce hair loss. You should notice its full effect after 1 year. I recommend against hair transplantation for you right now at this age, as you should first be sure that the Propecia is working or not. On some websites, you may order Propecia online through an interactive doctor. The medication should be over the counter, but alas, the FDA does not listen to me.

As a former Vietnam veteran, I appreciate in many ways what you are doing for our country’s efforts. Thanks.