Prescribed Propecia for Women

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

I have been prescribed propecia, but have not filled the prescription. I am balding on the crown of my head tremedously and have always had my hair chemically permed for the past 15 years. What can you tell me about females using propecia and would rogaine for females would be something I should consider? What type of doctor can I see for my baldness?

Propecia is not prescribed or recommended for women. If you get pregnant on the drug, there is known side effects that will impact your baby’s sex organ formation. Propecia is not shown safe and effective in women, especially those with tendencies for cancer of the breast, ovary or uterus. Rogaine, on the other hand, is approved for women as it is safe and it may be effective in women for hair loss (the response is variable). I would not take the risk of taking the Propecia, whatever that risk is, especially important to note if pregnancy is possible.

Hair Loss from Procerin

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

I noticed hair loss in my hair line back in august and about 2 months ago started taking an herbal supplement called Procerin. Since then instead of just losing it in the hair line the whole top of my head is falling out. I read something about a shedding phase that sometimes occurs when products of this nature are taken. Can you shed some light on this for me please? Thank you VERY much for you time!!

Unfortunately, since Procerin is not regulated by the FDA (as most supplements are not) there is little to no information in the medical literature regarding side effects and very few (if any) scientific studies. To complicate matters, humans will go through a shedding phase naturally and it is nearly impossible to tell if your hair loss is normal or due to some substance (like a supplement) you have added to your diet. You could do a hair count (count all the hairs you shed daily for a week – average should be no more than 100), or you could also just wait and see if the accelerated loss subsides on its own. If it continues, however, I would suggest seeing your doctor (or a dermatologist or a hair loss specialist) to get evaluated for other medical conditions which could be causing hair loss. Get your scalp hair mapped out for miniaturization. Just do not assume that the one thing you may have identified is the only cause of your hair loss; you have too much at risk.

Stopping Further Graying

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

I have MBP. To add to the trouble, my hair has started growing gray on my beard and sidelocks (age 23). What can i do to stop further graying? Whatever is gray, how can I make it black….are dyes unsafe?

Dyes in the hands of a good hair stylist, are generally safe. There is no safe and effective cure to graying that I know of.

Laser Treatments at NHI

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

Greetings!
I had hair transplants last June. They’re growing in great!
I received a letter from you yesterday in which you mention you are experimenting with low level light therapy laser. I’m interested, but could you send me more information? Specifically, what kind of time commitment is needed? The letter says three sessions per week, but not if it’s one week or several weeks.
Thanks!

The recommended treatment by those that are experienced with lasers (not me) are three times a week for 6 weeks, then twice a week for another 6 weeks, then once a week for the remaining one year. If it works, more might be better. I can not attest for its value at this time. You can start it and quit anytime. For our existing hair transplant patients, there is no charge for the treatment.

Moser Clinic

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

Hello!

Here in Austria we have a hair restoration clinic named Moser Clinic. This is a quote from their website:

“Unlike scientists in America Karl Moser and Dr. Krugluger integrated the experience and know-how of organ transplantation into their research. They found out that the time when the hair is removed from the donor area until it gets placed into the recipient area is the most critical and the major reason for reduced hair growth after the transplantation. During this time the FUs need a perfect, humid environment.

While other clinics still use a saline solution for intermediate storage, the Moser Medical Group developed its own solution to stop hair loss after transplantations. After the FUs have been dissected, they are stored in this solution where they are treated against disturbance of growth, until they get implanted. ”

Well they claim they know how to make the hair not fall out after a hair transplant. Could such things be true or is it simply a hoax?

The Moser Clinic is a highly respected organization and the work of Karl Moser and Dr. Krugluger has been presented to the ISHRS (International Society of Hair Restoration Surgery), where I was in the audience. They are credible scientists. Their solution appears to reduce the hair loss shedding immediately after the surgery. I would be interested in trying it, but I am prohibited from using it for many reasons including:

  1. It is not FDA approved in the United States
  2. The technique appears to have many nuances and I would want to master them before trying it on people
  3. I do not perform human experimentation

I spoke to them about the FDA and offered to cooperate with them and help them get it through the FDA process when we met this summer in Sydney, Australia.

Hair Loss After Adult Chicken Pox

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

When i was i think 19 i had chicken pox. i had a fever for about two weeks. after i recovered, one day when i woke up i saw my pillow had many hairs on it and when i combed my hair, many hairs fell out. before i had chicken pox my hair was very thick and long, but now is not so much bald but the thickness is gone. my hair in front of my head is in the shape of an M. and my hair in the top is not very thick now. im 22 now.

What you describe is very common. Significant illness or stress to your body can precipitate a “telogen effluvium”, also known as a “shedding phase” which is transient – it grows back. Now, several years later, the “M” shaped hairline you describe is consistent with male pattern balding – another common condition. These two conditions are likely unrelated. Hope that helps!

African American Hair Expert

/by William Rassman, M.D./7 /,

I’m an African American female and want to know which is better for my hair, pressing with a hot comb or using a non lye relaxer (like Precise). Also, I have hair loss and hair is very thin. I had a hair restoration in June 2005 by Bosley. Can you please recommend things I can do to improve my hair? Do you consider yourself an expert in dealing with African American hair?

I believe that I was the first person to place follicular units into an African American and started the trend that allowed for the use of small grafts in African hair types. As you may know, hair transplantation is a ‘peg in a hole’ surgery, but African hair is curly (like a cork screw) and therefore placing it into a round hole can be a difficult challenge to the inexperienced hair transplant surgeon. I guess that would make me an expert for transplants into African American hair types.

With regard to your other question, I am not an expert in the best ways to ‘relax’ hair, but I see problems with those individuals who have this done improperly. I am an expert in the complications of such treatments. I would have to examine you to make any recommendations.

Female Hair Loss from Diet Pills?

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

I am getting bald in the top of my head and also on the left side of my head. Not sure what the problem. I was told that if you took a lot of diet pills in your younger days (of which I did) that would cause it. Please help me on this matter. It is very embrassing to go bald at the age of 42. Not that is matters but I am a black female.

Actually, race and sex do matter since certain backgrounds tend to produce certain types of hair loss. In your case, diet pills taken many years ago are not high on my list of causes for hair loss, although extreme diets and conditions such as anorexia and bulimia definitely do weaken hair and cause loss. For a final and accurate answer, you would really have to be examined and tested by a hair doctor (get your scalp mapped out for miniaturization) or a dermatologist, but I suspect you might want to review the many previous blog entries about Female Hair Loss to understand the various causes of hair loss that must be considered.

On a more positive note, hair loss in certain hair types (for example African-American hair or kinky/curly hair types) gets better results from replacement surgery and/or other treatments. Depending on what type of hair loss you have, you may still have many options for treatment, so don’t despair!

Is Stress Causing Gray, Lifeless Hair?

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

Hello –

Recently, I’ve had a heavier load of stress in my life within my marriage. Last night when I got my hair colored my stylist asked me what’s been going on in my world? The reason she asked, is because I was intensly more grey than normal on the crown of my scalp & the sides, my hair was lifeless and dull and when she washed my hair after coloring, she noticed alot of hair on the drain. I’ve noticed my hair greying much faster and the same thing with washing my hair at home in the shower, lots of hair on the drain. I’m 37 years old and female.
My question is: Is my hair greying faster, texture of my hair lifeless and dull and the hair loss on the drain due to heavy stress? Thanks for any help you can give.

Genetic female hair loss can be precipitated by stress which can also bring on the graying process as well. Changes in the character of the hair also occurs as we age, as well as from the stress. Sounds like you need to surround your stress better. Also see a good doctor for the diagnosis of genetic female hair loss.

Remember to Vote for Balding Blog

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

Vote!

I need your help!

This is the last reminder to please vote for Balding Blog in the annual Medical Weblog Awards! When you click the link below, find the little circle to the left of “Balding Blog” (4th in the list), then click the Vote button. It just takes a few seconds of your time and is very appreciated.

Thanks again for your support!

 

UPDATE: Voting is now over. I’ll make a new post about it when I know the results.

Miniaturization?

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

I have gone to a number of doctors and asked, as you have advised, to map my scalp for Miniaturization. They do not know what I am talking about? What should I do? Are you the only one who does this? How important is it?

There are a series of hair metrics (measurements) that any good doctor must do for a proper analysis of your scalp. First, if the doctor waves his/her hand over your head and says that you have a fine hair density, run for the hills. Good metrics require scientific measurement and the science of densitometry as I have defined it in scientific publications (such as this article from 1993 which discusses densitometry) .

If you step back for a moment, you will see that if you do not know just how much hair you have and the value of each hair, then you do not know much about the way your hair (or lack thereof) will meet your needs as you replace it. Metaphorically, think about a house, where half of the house has been eaten by termites and you need to replace the wood that is not any good. Then you want to add a room on at the same time. It would be crazy to try to do this job without assessing just how much wood is rotten (miniaturized hairs), how much wood is available from the lumber yard (assuming that you have a limited amount of wood/hair from the donor area), and how much area you intend to build up from scratch (the balding area which needs to be restored). If you can not measure any of these factors, you can not determine your needs, which must be matched against supply. It is not very complicated when you know what you are doing.

It would be absurd for a doctor to tell you that measurements are not important in determining early balding (miniaturization). It would be as if he/she is saying that the pending termite damage is irrelevant, and to just wait until the house caves in. Crazy? If you do not know if your wood supply is in 2×2’s, or 4×4’s then you do not really know the value of the essential replacement resources you have. If you have miniaturized hairs in the donor area, then you might have a disease which will contradict a hair transplant, but without measurements you can not say. If the termites have invaded the wood supply (miniaturized hairs in the donor area which is a disease in men and a common finding in women with genetic hair loss), then you can not build a house (trusses and all) with 2×2 studs alone (damaged or otherwise inadequate in quantity), you need wood beams and 18 on center 4×4 studs to support a wall properly. Likewise, you can not put in single hairs or damaged hairs into the transplant to do what god’s follicular units are doing for you now like when you were young.

So, to conclude, a doctor adds very little value to your Master Plan to help you determine what you must do over time, when the doctor does not use measurements to determine:

  1. what the status of your scalp is at the time he starts Propecia with regard to miniaturization and in predicting your final hair loss pattern
  2. what you are losing
  3. what you have for supply to replace what you are losing or lost

This is not about the doctor making money doing hair transplants to all balding men, but rather using a full arsenal of treatments available to you, determining the value of those treatments over time and using his/her skills to your overall benefit. You have must a real clinical scientist / caring physician on your team who puts your benefit and goals above all else.

Best Hair Thickening Agent?

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

I am a 42 year old male with thinning hair both at the front & crown area of my head. Without entertaining hair transplants, what do you recommend to improve the appearance of my hair? What is the best Thickening agent/shampoo out there? Are there any products that actually work in your opinion? I used minoxidol years ago but gave it up quickly.

Thanks

There are many thickening agents/shampoos on the market and people respond differently to each depending upon texture, shaft thickness, the wave in the hair, and other factors. I generally tell people to buy a series of such products and then test what works best, or ask a hair stylist who works with such products daily and get a recommendation from them. Minoxidil does not impact the texture or shaft thickness from above the skin as thickening agents/shampoo will.

At What Age Does Hair Stop Growing Naturally?

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

Hello
I am 23 years of age and I am losing hair (mainly because of dandruff). I would like to know until what age does hair regrow naturally.

We generally say that the hair wreath around the sides and top of the head, a 2 1/2 inch high area that runs from ear to ear, is permanent. We see this in the men who are very bald; they really never become fully bald as this wreath of ‘donor’ hair stays for life. The rest of the hair on the head of a very bald man may or may not last the lifetime of the man, depending upon their genetics. In women with no genetic hair loss, the same applies and the hair loss remains for the life of the patient. The small wreath of hair that we say is permanent in men, may not be permanent in women. Therein lies one of the differences in women’s genetic hair loss as compared to men’s genetic hair loss. On many women and men, the overall population of the hair may be decreased with age (unfortunate medical term is senile alopecia), but that rarely impacts more than 30% of the hair in impacted areas. So, worse case, an answer to your question is that fully 70% of hair on the head will last a lifetime, if genetic factors do not force it into an early death.

My grandmother lived to 114 years of age, and her hair was long (2-3 feet) and still growing when she died. She had a full head of hair. My grandfather died at 102 years of age with a full “Ronald Reagan” type head of hair with a hair line like he had when he was 10. He had a hair cut about every 3 weeks, and died at work behind his desk, a few days after his last hair cut (something he enjoyed doing very much because he got out and about). It’s all in the genetics of what our parents and grand parents gave to us (life span for ourselves and for our hair).

Bald Spot in Back of Head

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

I have lost a circular patch about an inch and a half of hair in the back lower center of my head just above the neck line. The rest of my hair is naturally very thick and healthy. Any prognosis? I am 27 years old male. Thank you.

This is the ideal case for Propecia — crown balding in a young man. A good number (more than 50%) of men your age (in my experience) will regrow hair on this drug and many of them will reverse the visual impact of the loss. Get yourself checked out for miniaturization to see where else on the scalp that you may be losing hair and get it quantified and then remeasured after 8 months on the drug. In young men, many of the early signs and measurements of balding will disappear if the miniaturization is subclinical.

Tachycardia from Minoxidil?

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

What is the likelihood minoxidil caused an episode of tachychardia where patient is a healthy 48 year old female with no cardiac history or risk factors who used it on her scalp for a week prior and whose symptoms did not recur upon cessation of use?

There may be a direct association between tachycardia (fast heart rate) and minoxidil (which is a hypotensive agent that drops blood pressure). Many people complain of dizziness with this drug and what they are probably experiencing is a small drop in their blood pressure. When blood pressure drops, the first thing the body does to compensate for it is to increase the heart rate, so your symptoms fit nicely into the physiology of the cardiovascular system.