Massive Hair Loss in 15 Year Old Girl

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

im only 15years old (female) and every time i wash my hair its falls out in massive clumps, i used to frequently straighten my hair, but thinking this was the cause over the past fortnight i have not been straightening it. My hair is still falling out as bad as ever what could be the cause and the prevention as i really dread washing my hair now!? many thanks

For our American readers, a fortnight is about 2 weeks. Something serious is wrong. If you used something to straighten it in the past few weeks, that could account for chemical damage. If you can not account for it by something you did, then you need to see a dermatologist. Before you panic though, look carefully at what you might have done to damage you own hair. Chemical damage should reverse over a few months.

Recent Transplant in 19 Year Old

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

I would like to get some information on hair loss. I’m 19 and lost my hair on the temples. It’s not that bad because I can cover it. It’s the only hair loss problem.I had hair transplants in that area done by Dr [name removed], 250 grafts on each side. it’s been 2 and a half month’s now,can’t see any results yet. also the Doctor prescribed propecia for me but he say’s it only stops the hair loss in the crown area and there my hair is full and is in my family as well!!! I have been taking it for 5 months now and am not sure if should continue taking it!!! What would you recommend? I don’t want to lose anymore hair and also after I see the results from the transplant I had and want to still fix my hairline I really like what you are offering!! Please email me on your suggestions!! Thank you

If it has only been a few months since the transplant, you must wait this out. I suspect that you had 250 grafts in each corner, similar to a Norwood Class 3 pattern. The full benefit of Propecia will take 8-12 months, and the transplant should show 80% of the benefit in 8 months. Keep on the course you have started and do not stop the Propecia.

I am concerned that you had a transplant at the age of 19. If you are in Los Angeles, please come by and introduce yourself for a second opinion. You need to have your scalp hair mapped out for miniaturization and you need a Master Plan in hand, particularly now that you already started the process.

Hair is Smelly Even After Washing

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

i have a niece that has a very strong odor coming from her hair. she washes very well yet the smell does not cease. do you have any ideas of what could be going on? thanks!

There are many things that can cause bad smells from the body or hair, and they include:

  1. Washing incorrectly. I had a patient who came here with his family with the same complaint. He smelled badly to me in the office, like someone who did not wash his body or his hair, yet the family told me that they knew for a fact that he washed his hair twice a day when he showered. When questioning him about what he was doing in the shower, he told me that he stood under the shower and let the water flow on him, his hair and his body. I then questioned him on how he uses soap and shampoo. He told me that he never used them and on further questioning the family, I found out that he had a learning disability. I suggested that his father should go into the shower with him and make sure he washed, or if necessary teach him how to wash correctly. It turned out that I hit the bullseye. His odor went away and neither he, his hair, or his clothes smelled anymore.
  2. Infection. There are infections that can cause odors and these include fungal and bacterial problems on the skin. Treatments for bacterial problems are different than those for fungal problems. A good examination by a completent doctor would help review her entire body and determine where the actual odor is coming from. Appropriate cultures of the skin/scalp/gland area, etc. may point to the problem.
  3. Disease. There is a disease called Hidradenitis Suppurativa (other related names and diseases include: acne inversa, acne triad, acne tetrad, hidradenitis axillaris, apocrinitis, intertriginous acne, pyoderma fistulans sinifica, Verneuil’s disease, Verneuil disease, dissecting cellulitis of scalp and neck, acne conglobata, follicular occlusion triad, follicular occlusion tetrad, pilonidal sinus, acneiform disorder, apocrine occlusion). As noted from these names, the scalp may be impacted. This condition or a variant of it may be present in 1-4% of the young adult population to some degree (see this article on eMedicine.com).

Interesting Letter From Patient

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

So, Dr. Rassman, it’s the day after my surgery and I don’t think I’ll be able to sleep for a few days. No, it’s not because of any pain or discomfort; rather, what you and your team did today will forever change my life.

As you know, my journey began in late 1993 in Beverly Hills. One scalp reduction and two 100-graft sessions later, even I could tell my ‘Master Plan’ at the time was bunk, BS, a no-go situation. And I’m no doctor, mind you.

Because I was still losing hair and now my large grafts began to show, I entered the world of hair systems ala Hair Club for Men two years later in the fall of 1995. The cover charge for entry into Sy Sperling’s party was a steep $2625.00, however, and that took me by surprise. Funny thing is, I now look back at those photos from that period of my life, and the hair looks shiny and oh-so-fake. Kind of like a horse’s tail. Maybe it was? No, that’s too harsh. I’m sure it was farmed from ladies in the far east, stripped of its cuticle and dyed to my hair color. It just had this otherworldly sheen to it and in no way did it appear real. Man, I wonder how many people knew?

Flash forward to the year 2000. I joined the Directors Guild of America (DGA) that year, was making union wages as an Assistant Director, and then stepped up a notch to a Richard Farrell hair system. Farrell reminds me a lot of you. He blows the lid off the hair replacement industry, and has a completely transparent salon. His systems are indeed the best, but no matter how much they appear to be growing out of your scalp, they are not. Further, they never will. My first two systems in August 2000 were just over $3000.00, reasonable for the quality I was getting. Since the lace bases were very sheer, they eventually ran their course and were replaced. In 2005 I did just that, except the cost of two systems at that time was $5000.00 (inflation of course). So, that’s $8000.00, excluding the monthly servicing, coloring, hair additions and haircuts I received. When you include those items, I spent $16,2000 from August 2000 through January 2006. OUCH!

Of course, the sad truth is I work in the film industry on set as an Assistant Director. I had the good fortune of working with Scorsese, Coen Brothers, Clint Eastwood, and directors of that caliber who attract similarly-accomplished crew members. I was unfortunately busted wearing a hair system by the hairstylist of a prominent Hollywood actor by none other than George Clooney’s personal hair stylist, a guy named Waldo Sancez. He is a cool cat, and he personally didn’t make fun of me or even let one that he knew (a class guy). He simply relayed to me that the entire hair and make-up trailer was abuzz because they were convinced I wore a hairpiece. When I was in the dressing from, he looked at my hairline the entire time, and never asked me if it was true. Conclusion: They all knew. OUCH!

Don’t get me wrong, if I were an accountant, mortgage broker, etc, I could have gotten away with a system of Farrell’s quality. It’s a completely different story, though, when you are standing eye-to-eye with an Oscar-winning hair and make-up artist giving warnings to the actors sitting in the chair getting ready for set.

After Waldo’s revelation, I was never the same AD. My self-confidence deflated like the proverbial balloon. I wore a ballcap every single day on set since 2000. All the while paying thousands of dollars to upkeep the systems that were supposed to allow me to NOT wear a ballcap. Irony anyone?

Flash forward to today, Feb 23, 2006. NHI is the real deal! You are every bit as caring and accomplished as any doctor I’ve met. I’d even hire you as my primary care physician if you moonlighted on the side. Bottom line: Your patients come first; your company’s earnings are secondary to the end result (and safety!) of those who enter 9911 Pico Blvd. looking for help.

I CAN NEVER THANK YOU FULLY for what you did for me–hell, and my career, for that matter–today. I am in the queue for a HUGE movie later this fall, and I know my confidence will be at an all time high. You can’t put a price tag on that. It’s about value, and what you’ve done for me far exceeds the “price” of what I paid NHI yesterday.

This fall, I can’t wait to knock on the trailer door, look the hair department head in the eye and proclaim, “Camera will be ready in 10 minutes. What’s your best guess on having actor _______ ready?”

I edited this letter before publishing it here, because it contained things that should not be the focus of such a letter (even for humor). I always believe that if you have nothing good to say about someone/something, best not say it. This man was a delight to work with and we bonded in a very special way (I always seem to develop a special bond in this strange world of the hair transplant repair process). Many repair patients have a unique type of pain that they live with, a type of pain that fortunately does not happen much with the modern techniques used today. The bonding requires building trust where none existed because of the history of the bad experience, well defined by this patient. I was humbled by reading his letter as I am every day working in this field.

William Rassman, M.D.

Switching from Rogaine Back to Propecia

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

Dear Dr,
Thank you for a most informative web site. I wanted to ask a question on how to progressively reduce reliance on Rogaine, which as you have noted gradually looses its effectiveness.

I am 40 and had mild thinning over the crown and frontal areas..just becoming noticeable. I used Propecia for an initial 3 mths period only in 2004 then stopped, then continued on with Rogaine (5%) for the past 14 months with good response. It now seems to be slowly loosing effectiveness with hair shedding.

Is there an option to restart taking the Propecia on a daily basis and then slowly reduce the application of Rogaine? Or after close to 1.5 yrs do you feel the hair would have become conditioned to it? I would welcome your advice as I would like to ‘switch over’ to Propecia and one day cease the Rogaine if this is an option.

Thank you for your advice.

Sounds like you have lost the benefits of Propecia. Go back on it. As you are already on Rogaine, stay on it, at least until the process has stabilized. Then work with a good doctor to put together a good Master Plan for you.

Hashimoto’s Disease in Women

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

I am a woman, 40 years of age, and having a hair loss problem for over 18 years. I used to have very straight and thick hair, but now very thin and fluffy. I tried too many kind of shampoos, vitamins and programs. One of them, 101product, was no help. I have had an autoimmune disease called HASHIMOTO for 16 years. I’m taking medication and everything is under control. My doctor told me after he did all kinds of tests that i don’t have any physical problem causing my hair loss. My question is what do you think could help me? My sister has the same problem and she doesn’t suffer from anything physically.Your replying back will be appreciated.
Thank you

You may have both female genetic hair loss plus Hashimoto’s Thyroiditis and your sister may have the genetic element, which tends to run in the female line in particular families. The existence of Hashimoto’s Thyroiditis or any auto-immune disease can precipitate hair loss. Medications that treat these autoimmune problems often have hair loss as a side effect. Woman’s hair loss is extensively discussed here and I suggest that you and your sister read my many answers to questions which will contain many bits of insights for you here.

Healthy Lifestyle and Hair Loss

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

Hello, I am 24 years old, around a year and half ago I noticed a lot more hair coming out when I combed and in the shower drain. Prior to that and pretty much up till now my lifestyle was poor: gained weight, bad diet, no exercise, smoking marijuana, bad sleep… Also I was dealing with depression (and still am in some ways), took Wellbutrin, a common anti-depressant, for a little bit, but stopped when I noticed my hair thinning fearing that it was the cause. Things are better now and I am getting back in shape, gradually and getting my life back together. My hair is nowhere near as thick as it used to be, so my question is: Will living a healthier lifestyle now get my hair to the way it was at all, or are the hair follicles just dead and this is as thick as it will ever be? Thank you very much for your time.

Often, men with genetic hair loss will accelerate it when they live the lifestyle you’ve described above. The drug Wellbutrin does have hair loss as a side effect. Living healthier is clearly better, but if you are undergoing aggressive dieting, it will not help your hair loss as that is another cause of hair loss. Eating a healthy diet and consistency on that diet is the key. Get a good hair doctor and find out if you have genetic hair loss, get a diagnostic mapping of your scalp for miniaturization to confirm if it is actually male patterned balding and then being smarter you can decide what, if anything, you need to do.

Can Propecia Retain My Childhood Hairline?

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

If I want to stop a receded mature hairline, and keep a childhood hairline can propecia help do this? I actually believe its more MPB now than a mature hairline yet I have no to little MPB family history. I want to stop my hairloss im 23 years old. I have always had bad acne since I was young as well as a very bad itch thats been with me since about 14. The itch never went away and i tried every shampoo including prescriptions I could. I tried saw palmetto 320 a day and the itch vanished. I quit saw palmetto and recently restarted, but the itch was unaffected this time. Could this be MPB?

The short answer to whether your childhood hairline can be retained on Propecia is most probably “Nope.” Propecia works best at the crown of your head and although it seems to have some effect on the frontal region and hairline while you are less than about 35 years old, after that time one sees more hair loss in this area. Hair surgeons jokingly call this “Job Security.”

As for your itch, I have heard anecdotal reports of scalp itchiness related to hair loss, but no scientific evidence exists linking the two. To find out if you have male patterned balding (genetic), you should get a diagnostic mapping of your scalp for miniaturization to confirm if it is actually male patterned balding.

Finally, please do not go out and find a hair surgeon who will tranplant your childhood hairline (there are some unscrupulous people out there who will agree to do this for you – avoid them). Just remember that transplanted hair is permanent, and that as an older man you may not want a childhood hairline – it would look out of place or odd. You can always bring it lower in subsequent surgeries, but you cannot move it higher! I always tell my patients that the good and bad news about hair transplants is, they are permanent. This is not a place to make a mistake.

Losing Hair in the Middle of My Hairline

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

Hi Doc,
I have noticed that i have started receding slightly on the sides of my head. Could be as you say just a muturing hairline, but recently I have noticed a little divit in the very middle of my hairline right between the eyes. I have always had it a little bit..bit it has recently gotten worse. Is this male pattern balding?

Without pictures it is difficult to make a diagnosis. These divots in the hairline that you are referring to may be the early part of hair loss in a forelock. Some genetic patterns have weak forelocks. I need to know your age, see pictures and get a family history from you. When this happens in the forelock, you often can see the same pattern in the family. If you are above 30 years old, these changes reflect a less aggressive ‘progressive’ hair loss that may be controlled by Propecia. If you are under 25, then this could be a reflection of a more aggressive pattern of hair loss and as you record the degree of miniaturization that is present around it, a good doctor can predict what may actually happen to you and estimate the time-frame it may occur. If you send me good photos, they will be kept private (a medical record requires privacy by law) and then we can arrange a time when we can speak and I will personally give you a private consultation. Without seeing you in person, such a consultation may or may not fully address the diagnosis, but it is a starting point.

Finasteride Makes My Nipples Erect

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

This question is related to sidew effects from Finasteride. I have been on Fin for about 5 months. Over the course of that time I have experienced nipple erection/chapping and irritation several times. Mainly in the cold weather and mainly when I don’t wear an undershirt. Is this a tell-tale sign of gyno? I am pretty fit, so I think I would notice breast enlargement. With that said, when i wear a tight t-shirt, my nipples and aereola seem much more noticable than they used to. Is this in my head or am I starting to develop gyno? Please answer my question, I have spent a great deal of time and money on my prescription and doctor’s visits, as most have…I’d really like to put this issue to rest.

The Propecia website states that “In general use, the following have been reported: allergic reactions including rash, itching, hives and swelling of the lips and face; problems with ejaculation; breast tenderness and enlargement; and testicular pain. You should promptly report to your doctor any changes in your breasts such as lumps, pain or nipple discharge. Tell your doctor promptly about these or any other unusual side effects”.

I would suggest that you get your chest (breast) examined by the prescribing doctor. It may be that what you are experiencing has some lump below that is causing your nipples to appear erect.

Tingling Hair in Woman

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

My hair is tingling, thin and is coming out strand by strand. I haven’t change anything in my eating schedule or anything, what is the problem and how can I take better care of my hair?

Women do experience hair loss during stress (physically and emotionally), hormonal changes, and hair loss with new medication like contraception. It is normal to lose up to 100 hairs per day. You may want to see a dermatologist or a physician to examine you with a densitometer or a magnifying video camera in order to understand if your hair loss is really significant and if it is, find out what the hair loss pattern is telling us.

Hair Wax Plugging Follicles?

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

Thank you for creating this blog, it has been very helpful!

Recently a friend told me that using hair wax causes hair loss because it plugs the hair follicles. He said to go to a hairdresser and get a stripping shampoo, I guess to get rid of any wax that may be plugging follicles. My question is, do you know anything about using hair wax and it causing hair loss?

Thank you!

I am not clear what your question is. If you are asking about the wax that is made from the hair follicle (sebum) which is made in every person with hair, then this does not cause hair loss for if it did, the homeless people we see on the streets (who never washed their hair and probably have considerable wax buildup) would be bald and the compulsively clean person that washes their hair many times a day would be the hairy population. Sometimes I wonder if there are less bald homeless people out there then well washed coiffured people who hold real jobs. At the least, the homeless people I see in Santa Monica (sleeping on the beach) may have less stress than those people with big house payments (with heavy debt) and we know that stress does cause hair loss (not wax or dirt).

If you mean hot wax, as used in hair removal, I would not recommend any stripping shampoo or wax that strips hair. Any reasonable chemical assault that goes after hair or wax should cause hair loss, eventually permanent.

If you are referring to the wax in grooming/styling products, then I do not believe that these will cause you any problem.

Hair Loss from Hot Showers?

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

I am a 22 y/o man, and I started losing my hair when I was 19. When I was 18 I moved from a tropical country to a cold country and I started taking hot showers. I think that could be the biggest problem. I lost about 40% of my hair at the rear top and front, both sides of my head, and whatever hair I have left on those spots is very thin, and I still am losing hair. I have no history of hair loss in my family but my father started losing hair when he was over 40 y/o. Should I visit a doctor to know the reason of my hair loss before I start using any product? I used rogaine for 1 year but I had no change.

I am certain that hot water does not cause hair loss. Many people love hot showers, so if your suspicion were correct, everyone living in the US (or other parts of the world for that matter) that took regular hot showers would be bald or balding. This is simply not true. As a man between the ages of 19-24, advanced hair loss indicates that you probably have strong genetics for balding (assuming there is no medical cause). Propecia and possibly Rogaine may help with your hair loss, but you need a working diagnosis by mapping of your scalp for miniaturization to confirm if it is actually male patterned balding. Based upon your history with 40% or more of the hair lost already, you are on the fast track for becoming a bald man, so I would not delay in seeing a hair doctor and finding a correct path to take.

By looking to find a cause for your hair loss, you are exercising a psychological trick that the mind routinely uses when it does not want to face ‘bad news’. Psychologists call this denial. My own son used denial to justify that he was not losing his hair, under constant pressure from his brothers and sister who recognized his pain. He eventually accepted that Propecia might actually be a good thing to take, accepting that he was the victim of his (my opinion) mother’s genetics. It took him over a year to recognize his Norwood Class 4A thinning pattern. I would see him suffer over his early hair loss, in silence. Now, his hair loss has partly reversed. He does not appear to be balding anymore. A victory over hair loss for my own family, thanks to the proper use of Propecia. Happily every after? Unfortunately, there is no way to tell what the future will hold or how long the medication will last.

Full Activity After Hair Transplant

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

How soon after hair transplant can I lift heavy weights and also go surfing? Are there any vitamins for the hair, so that the transplanted hair grows healthy and strong?

If you have a traditional strip harvesting technique for hair transplants, I would suggest that you wait until the stitches or staples are out (14 days or so) before going to soak your hair for long periods of time with activies like surfing. Heavy weight lifting also is included with some restriction for a month or so (to be safe, you should wait around 4-6 weeks before doing any heavy lifting where you have to strain your neck muscle). Running, biking, and such can be started within 5 days after a strip harvesting hair transplant.

If you have an FUE (Follicular Unit Extraction) harvesting technique, you can resume full activity including scuba, surfing, or weight lifting within a week of the surgery. You can go surfing a few weeks after surgery, including light weight lifting.

All healthy people will grow the hair after a hair transplant. You can not stop it from growing; well, almost true, except for those people who do not exercise good judgments.