Dear Doc,
I dunno what the lady who posted the question “I Don’t Want to Be an Unmarried, Bald Female at 28!” feels, but there are a lotta men who like bald women…Is there any way she could get in touch with me… I would wanna talk to her!
Maybe I should run a dating service. Interesting idea. Any thoughts from my readership? Any women out there who love bald men, or vice versa? Any ideas what to call the service?
Sir: I am 60 years old with enlarged prostate. I am taking the following: 5mg proscar, 5mg avodart, 4 gel caps saw palmetto, 81 mg aspirin, also terezin for blood pressure. My urine flow is back to normal, however I have not noticed much hair growth in 3 months on these drugs. I have typical male pattern.What do you recommend?
Many men with hair loss, when starting the types of medications you have, will grow hair as a side effect of these medications. The converse of your presentation is also common. In patients we start on Propecia, they get improvement on their prostate problems and their urinary retention improves with the hair treatment. In your case, if the medications failed to grow hair, then only hair transplantation may solve your problem.
Dr. I was reading some of the entries on here and saw in one someone had a side effect from propecia and asked about hair system and transplant. You said you thought it might accelerate his hair loss if he used a system. This made me wonder what other kinds of things could accelerate the loss cause it surely seems like I’ve done something that has. My loss started kind of at the temple area and was slow. but seemed like over night the entire top is falling out. I get large amounts on my pillow and in the shower. Even if I just brush my hand across the top of my head pretty softly I usually get a few on my hand. I’m trying to get propecia online. Which I thank you for telling me in a previous post that I could do that because I thought all those sites were scams and didn’t really look at them before you told me about that. Anyway with this rate of loss it seems like it will be completely noticable withing 2 or three months. I would really appriciate anything you might have to say on this matter. Thank you!!
Men go into hair loss cycles; you might just be going into such a cycle. Hair loss is caused by:
Men who take steriods, who take testosterone or other similar medications, and men who are stressed (from marriage, school, work, etc.) can accelerate the hair loss process.
Before starting Propecia, you should get your scalp mapped out for miniaturization to have the proper diagnosis made and then determine in 6-8 months if the miniaturization was reversing. If you just buy the drug without a proper evaluation, you may never know what you are treating. With regard to Propecia purchases on the internet, I know that they are done, but I can not attest for the products that they are claiming is Propecia. Could be the real thing? It might not be!
The use of wigs tends to produce traction alopecia causing progressive hair loss as the wigs move around on the head, are removed and replaced.
Hello Doctor,
I am a 22 yr old African American that has been diagnosed of folliculitis decalvans. I am losing my hair at my crown area at an ernomous pace through scarring. I have had this for several years (8yrs). I have been on several medications but they only seem to have an impact in the beginning. Please is there anyway of aggresively treating this disease as well as recovering my hair in the scarred regions. If you have any dermatologic recommendations around the Tri-state area i would be grateful. Thank you.
This is a difficult problem and you must find a doctor with a particular interest in this disese as well as the training to deal with it. Check with the American Academy of Dermatology for a referral channel for this problem. If the dermatologist is uncomfortable with this, then he/she should refer you to an appropriate expert.
One month ago I had a small scalp reduction done. I have experienced some telogen/shock loss. Over what period of time should I expect to continue losing hair in the adjacent area and when can I expect that hair to regrow. It has been recommended that minoxidil could help accelerate the regrowth. Your thoughts please.
Hair loss from a single, small scalp reduction is unusual. As you know, scalp reductions have fallen on hard times and the surgery has been largely abandoned because sooner or later, the hair loss will continue and the scar may then become a problem. Scalp reductions stretch the scalp from the sides (it does not bring your ears higher but some patients tell me that it feels that way), therefore they may have a negative impact on hair transplantation by increasing the scar risk from the classic strip harvesting technique because the skin above the ears (some of the donor area) is stretched and gets a reduced density and altered anatomy (which may or may not cause problems). I had three scalp reductions in the early 90s, and became an outspoken anti-scalp reduction doctor because I experienced your complication and a few more as well.
The hair loss you are experiencing may last a few months. It should peak by 3 months, but in some patients progressive hair loss may still occur. The scalp manipulation can cause hair loss and the stretch that is produced is one of the traumatic causes of hair loss. I would want to understand the Master Plan that you and your doctor worked out to understand the significance of the problem you are now having in the long term. Minoxidil may help in the short and long term, but it rarely can reverse the hair loss you have experienced if it not going to reverse on its own.
Question / Comments:
How effective is FUE on African-American hair? What are some of the challenges with African-American proceedures. I would like to have side-burns which I have minimum growth now. Is scarring more prevelant with darker skinned people?Thanks for your responses.
FUE on African-American hair is very difficult to perform, but if you are serious, we can test your hair to find out how good a candidate you are. If your hair is kinky, you might not want kinky hair on the side burns. This is a real risk. Darker skinned people usually have more scarring risk, but this is not the case in the scalp as much as other parts of the body. As I have an office in San Jose and you indicated that you are there as well, you should come by for a visit. If, after the consultation you want to take the next step, then a biopsy would be indicated to determine your candidacy for FUE. Call my office at 800-NEW-HAIR to setup a free consultation.
Dr. Rassman:
You recently responded on 1-9-06 on this website to a male that had some questions regarding the possibility of taking a jacuzzi soon after having a hair transplant. He had then undergone hyperbaric therapy and succesively (evidently) underwent hyperbaric therapy. You asked him to respond as to whether or not the hyperbaric therapy allowed him to possibly avoid the approx 60 days hair loss that typically follows such surgeries.I recently underwent a 2 day megasession of 3800 grfts. I had 3 small hair transplants 10, 9 & 7 years ago (Only 300, 300 & 400 grafts then). The right side donor incision was very tight and when the stiches were removed – huge opening 1″ x 2″ now. Hyperbaric Candidate?
The posting you’ve referenced can be found here: Can I Go in a Hot Tub Days After a Hair Transplant?
One of the challenges of megasessions (you had 3800 grafts) is to harvest large numbers of grafts safely. The physicians must make judgments with regard to balancing an aggressive approach to harvesting hair and complications (safety issues) that will put you at an increasing risk. This is actually true for any harvesting process of almost any number of grafts (even small sessions), but it is particularly the case with megasessions. In your case, it is not a long stretch to assume that this delicate balance was tipped such that a tight scalp produced a wound problem because, in hindsight, the harvested strip may have been too aggressively pursued.
The tight scalp and the wound problems that occur as a result, are what has brought a focus on donor wound scarring. In people who have had three transplant sessions (as you did) tighter scalps are often present. Most of the time, the desire of the surgeon/patient to get large enough quantities of hair to cover areas of high demand (recipient area), has been the cause of the scarring problems. The actions and techniques used by the surgeon may compound this problem. The amount of hair (scalp) that is safe to move, depends upon the ‘looseness’ of the scalp, the density of the hair in the proposed strip of scalp that is removed, and the amount of scalp that is actually removed. The more scalp that is removed (in the patient with a tighter scalp), the greater the risks, such as what happened to you. When wound problems exist, they start off with unusual prolonged pain along the wound edge and develop a pink, purple, or dark color of the skin (indicating possible vascular problems to the skin). The darker the color, the worse the risk and the worst short term risk (that of gangrene of the skin). The long term risk is of hair loss extending back from the wound for a distance of one – two inches above and below the tight parts of the wound occurs not infrequently when a wound is too tight. What will happen to you will be determined by the degree of blood supply compromise brought on by the tightness. If these problems are only mild, hair loss often follows. The hair will generally, but not always, return in 4-6 months (along with the timing of the growth of the transplants in the recipient area). You will know the full impact within approximately 6-8 weeks, but the risks of gangrene should have been passed in a week or two. Patience is a virtue here and a good communication with your doctor is critically important to deal with any and all of your concerns. Ask your doctor about hyperbaric oxygen as well.
To avoid this problem, the experience of the doctor is important (especially when it comes to safety in these megasessions). Decisions made at the time of surgery are many. Sometimes I get a feeling from patients that hair transplantation is all about price so discount shopping is very common. But is a megasession in the hands of a very experienced doctor equal to the same in a doctor with much less experience? That is the question! The answer is clearly that doctors are not equal, even if prices are.
Now to get to your question: I have no experience with hyperbaric oxygen in situations like yours. Theoritically, it might help, but timing may be everything and delays in administering this therapy along with frequency will certainly work to your disadvantage if this modality was to work at all.
I’m currently using Rogaine. Is it safe to apply an application of Procede (supposed to be once every 90 days, applied to the scalp and then rinsed off)?
As I’ve said before, I do not know much about ProCede. Read the material in their package carefully. I would personally doubt that the two are incompatible, but if you get any side effects, any at all, then stop what you are doing and abandon whatever you changed. A patient called me yesterday and told me about an infomercial he had just seen on Procede. When the claims are too good to be true, they usually are.
A few times each month, I will post some random hair-related information, which I’m calling “tidbits”. I spend hours each day writing responses to questions I receive on this blog, so it is a nice change of pace. This one came from guest writer, Dr. Jim Arnold…
Many rastafarians and others with dreadlocks notice that hair which is not in a dreadlock never grows as long as the dreadlocks do. If you have ever examined a person with dreadlocks, you would have probably noticed this yourself — the “dreads” are longer than the the rest of their un-cut hair or beard.
The occurance is related to felting. Felting is the phenomena of hair (or fur as in the making of hats) matted together in a complex entanglement which is almost impossible to separate back to individual hairs. It occurs as a result of the scales on the exterior of each hair. All the scales point in one direction, back toward the follicle. In entangled hair, the rearward pointing scales allows each hair to easily move forward but not backward. With the hairs moving in only one direction, the mat gets tighter and tighter. Beaver hair, which is fine, demonstrates this phenomenon extremely well which is why beaver pelts were of such great value in making hats. Some hats, especially American cowboy hats, still mark the quality of a hat with the amount of beaver fur in the hat, ie “Beaver X” for a little, and a high quality hat having more X’s such as “Beaver XXXX”.
By Dr. Jim Arnold
I am a 44 year old female. Over the past 4 years, I have experienced a series of extremely traumatic events (far above average) resulting in a variety of stress related symptoms. Approximately 18 months ago, (almost overnight) I began to notice a significant amount of hair loss. It only caught my attention at first because of the dramatic increase of hair in the tub after showering. I was put on thyroid medication approximately one year ago (my levels were normal but my MD thought the hair loss might be related to a thyroid condition.) This did not seem to be effective. At this point, it seems the hair loss (although all over to some degree) is primarly at the temples / sides of the head, where the hair is now patchy and thin, with visible bald areas. Could this be a reaction to the years of extreme stress? I am at a loss as to what to do next, and so is my physician.
Stress is a major cause of hair loss in women with a genetic predisposition to it. You need to have a complete medical work-up to try to identify diseases or conditions that cause hair loss (such as hypothyroidism, eczema, alopecia, dieting, malnutrition, autoimmune, drugs, infection, genetics, etc). Then you need to have your hair mapped out for miniaturization to determine if your have the genetic patterns of female hair loss. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. Show the information from this blog to your doctor to help him point to the various medical tests he should perform.
Thanks for the blog. I’m male, 21 years old and started taking propecia at age 18 when I noticed some receding in my temples. I’m not exactly sure when the hairloss started but I did notice junior and senior year in highschool that I was shedding large amounts of hair which I thought at the time was normal. Although it is not yet “socially” noticeable as you put it, it still bothers me a lot and I feel that it is only getting worse even with the propecia. I don’t want to have hair loss be a problem or something I worry about in my life so I was wondering what I should do at this juncture? If I feel like it is only going to get worse, should I consider a hair transplant? Or should I start taking other medicines like Rogaine or Revivogen?
The key is first getting a diagnosis by having your hair mapped for miniaturization. This is when you have a doctor examine you to determine if you have genetic balding in the first place. There is no point to treating yourself, because you will never know if you actually are balding and whether the hair loss is getting better or worse.
Rogaine or Revivogen may have a place in your regimen, but in the unknown place you are presently at, you need to get a diagnosis first. Transplants on any 21 year old, except in extreme circumstances, would be inappropriate.
I am a 29 year old woman. 5 years ago a number of symptoms creeped up on me (this started 1 year after i stopped ortho-tri cyclen). The symptoms got progressively worse over the years. They included: hair loss, decreased metabolism (irregular bowel movement inspite of high fibre diet), cold intolerance, fuzzy headedness (lack of concentration), depression, dry skin, increasingly recurrent mild yeast infection.
My TSH was normal, so thyroid probs was ruled out. 2 months ago, i went to another doctor who listened to my symptoms and put me on synthroid. He thought i may be suffering from sub-clinical hypothyroidism. All my symptoms (except hair loss) have since compeletely clerared up … (i feel like i was given a new lease on life …and feel normal for the 1st time in years).
I am hopeful that the medication will resolve the hairloss as well, however i am worried since i have a lot of Hair miniaturization all over my head including back , side and top but most pronounced on top of my head and temples and sides. Do you think that thyroid problems could also cause miniaturization and i should wait and see if the problem gets helped. Or should i be starting another regimen…
Also , where can i get the desitometer measuring the progress or worsening of hair miniaturization, to figure out if my hair is improving with thyroid meds or not…
Thanks in advance !!
Female hair loss precipitated by birth control pills and thyroid disease in women programmed for genetic hair loss may not reverse. Only time will tell you.
The best place to get your own densitometer is at Radio Shack or a local small electronics shop. Look for something they call a hand microscope which should sell for around $15. Someone other than you will have to do the measurements at the same place each and every time you are examined and plot it out over time, possibly monthly.
I’ve heard that the marigold flower, if rubbed on the head, will promote hair growth. True?
At the least, you can pick them from your neighbor’s lawn. This sounds like the most cost effective remedy I have heard lately and it may be as good as so many of the products I have been asked about over the past year. Be careful, the hair that grows may be yellow.
I hope my sarcasm was not missed. The short answer is most likely false.
Dear Dr. Rassman,
I am male, from Nebraska US. I’m suffering hair loss for about 4 years, as far I can see I think I lost hair on every region of my head… but basically I can see baldness on the front the most. I didn’t consult a dermatologist yet because I’ve been told that there is not alot that I can do to get my hair back. My questions are: Do you think is worth it to go to a dermatologist (I have a dandruff case also)? Since I have frontal hair loss, will a minoxidil treatment work for me?Thank you
It is worthwhile to visit a dermatologist for your hair loss. He/she can decide which type of hair loss you have and possibly the cause for it. There are many reasons for hair loss besides just male pattern baldness. Minoxidil and Propecia will mostly likely help slow down your loss, if not stop it completely and in men, Propecia for stopping hair loss in the frontal areas is more effective than minoxidil.
Dr.Rassman, What is hair mapping? I have a derm doctor. He did a biopsy that showed AGA. I am 59, female. I started taking Prempro again, with hope of keeping what hair I have. Who do you think I should see in the Orland Park IL. area? I have lost more than half of my beautiful hair! I am at the moment using steroid gel on the bald spots every day, I really value your opinion.Where do I go from here? I will travel any where…
P.S. My doctor loves your site/ He said he would follow your instructions!
Hair mapping means that a physician is using a densitometer or video magnifying camera to look for miniaturized hairs at multiple sites on your head. The percentage of miniaturized hairs and the thickness change in those miniaturized hairs will determine:
Based upon the many different published patterns of hair loss, the doctor can determine:
For example, if a man has extensive miniaturization of hair in the Norwood Class 6 pattern (under microscopic examination), he may advance to a fully bald Class 6 pattern (even if it is not evident to the naked eye). Miniaturization is looked at in two ways; first, the total number of normal vs miniaturized (narrow shafted) hair, and second, the degree of overall miniaturization on a per hair basis (e.g. 80% of the hairs are miniaturized with an average hair loss 50% of its original diameter). If, over time, the percentage of miniaturized hairs stay the same, but the diameter of the hair shafts increase to, let’s say, 80% of their original diameter with a person on Propecia, the change can be documented as benefiting from the Propecia, or reduced to 20% of its original diameter, indicating a progression of the miniaturization and a failure to respond to the Propecia.
For women with genetic hair loss, miniaturized hair follows very different patterns than for most men. For the transplant surgeon, it is critical to know the miniaturization that is going on in the proposed ‘donor area’, for if the hair in that area shows significant miniaturization (diameter reductions and the percentage of hair involved in the process), then most of the hair that is used for donor hair will fail to survive a transplant, because the miniaturized hair will not have value in the new location. As an example, if a woman needs hair in the frontal hairline but has 80% miniaturized hair in the sides and back of the head, then one would assume that 80% of the hairs that are transplanted will fail when moved from this donor area.
For the male patient who is going on Propecia, getting baseline measurements will tell something about the changes in the hair after a reasonable treatment period. An example of this would be: a young man who had 90% miniaturized hairs in the hair population from a balding area measuring a 3 inch circle in the back of the head. Let’s say he was started on Propecia and then 8 months later, the miniaturization came down to 50% of the hair in the circle. That means the drug is working nicely and some reversal of the impact of genetic balding on the 3 inch circle in the back of the head had responded to treatment.
So you can see that the value of measurements here are both for diagnosis (what is causing the hair loss and how bad it is) and prognosis (predicting the future with and without treatment). If measurements are not made, then there is no sense of control for the doctor or the patient and the cause of the hair loss can not be followed intelligently. Measurements are the foundation for clinical science. A patient with compromised kidney function gets a blood test to see the progress of the disease and the value of any treatments given. The electrocardiogram (ECG) measures the damage of the heart after a heart attack or predicts a pending heart attack. I can go on and on here, but basically, hair should not be treated any differently than other sick organ systems. There must be an end of the days when a doctor runs his fingers through your thin hair and says (somewhat magically) that he knows what is wrong and how to fix it, he knows that the density is good or you are not going bald.
Blood work will help rule out other causes of hair loss such as hypothyroidism, anemia, hormone imbalance, and malnutrition.