At Age 19, Do I Need to Take Propecia Before a Transplant?

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

hello im 19 from london, i want a hair transplant, but dont want telogen shock, i would like to have a hair transplant as soon as possible, but do i need to be taking a drug eg propecia to avoid it long before my operation or can i start just before, also would it be worth having the operation w/out drugs and hopeing telogen shock did not occur

At 19, I would be hesitant to have a hair transplant. You need to have your hair loss measured and should absolutely be on Propecia for a trial of at least a year. Have measurements for miniaturization taken prior to starting Propecia so that they could be compared after a year on the drug, and a good doctor can then determine if you have the hair loss under control. The last thing you should be considering at this time is a hair transplant. As I say all the time, Let the Buyer Beware. No one will protect you other than you. Look at my website and become familiar with what we do and the field of hair transplantation in general.

If I Quit Smoking, Will My Hair Regrow?

/by William Rassman, M.D./165 /

While it is a reasonable hypothesis that smoking can cause hair loss, will giving up smoking lead to/assist in hair regrowth – or is the damage that has been done by smoking permanent? i.e is it reversible?
Thanks in advance.

Generally it is believed that damage from smoking is additive. We know that about the lungs, heart disease, and emphysema. We also know that for those that stop smoking, the additive impact does slow or stop, but the smoking-induced coronary disease or emphysema does not go away. Now if you extend that logic to hair loss, then by stopping your smoking, you may stop whatever balding smoking is causing, but it would not reverse.

Seborrheic Dermatitis and Artificial Hair

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

I am female and have had seborrheic dermatitis for several years and have consistently scratched at it over several years causing gradual hair loss that I have recently noticed, which has led me to stop scratching despite the itching. Is it possible to regrow my hair after such an extended period of time? If not, I was wondering if you might know the cost of artificial hair surgeries, NOT hair transplants.

Scratching your hair can cause Traction Alopecia, which sounds like the diagnosis. Wait out a period of 6-12 months without scratching and see if it returns.

With regard to the artificial hair, the process has been banned in many countries (it is not FDA approved and is known to cause many problems). First, you would have to find a country that lets the product be used at all, then finding a doctor is the second problem, but worse is that many of the people who get artificial hair, get infections in the scalp so the cost must include the costs to control infection and replace the rejected hair (almost a daily process). I do not have information on costs, however.

Very Unhappy With My Hair Surgeon, 4 Months after

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

Hi Dr. R!! 4 months ago I had transplantation surgery with Dr. X [doctor’s name removed]. I have been unhappy with every aspect of the surgery (Hardly any filling of my front hairline) 1600 grafts “supposedly” and the negative responses to my many questions following up. What do you know about him? I am Very discouraged after 4 and a half months and many $$$…Thanks!

Dr Jekyll and Mr HydeI won’t comment on the doctor, but I will say that after 4 1/2 months you will not see the results of your surgery. The first and final element of what Dr. X did for you will be in the results that you get as compared with your expectations at about the 8th month after surgery.

Clearly, you have a problem with Dr. ‘X,’ so possibly you did not do your homework. A caring physician should be a critical qualifier in choosing your doctor. Showing concern means that he/she is making an attempt to establish good communication with you. By listening to you, reading your body language, and being available to you after he/she ‘got your money’, the doctor would be showing the essence of the man/woman. By not doing these things, the doctor would show the “Mr. Hyde” from “Dr. Jekyll”. Any cosmetic surgery, particularly one that is not an ’emergency surgery, is a procedure where the choice of a doctor should reflect good market research on the patient’s part. Things everyone should look for:

  • A good office environment.
  • In the meeting with the doctor, does he engender your faith and trust?
  • Is a salesman used to insulate him from his patients? I am firmly against the use of salesmen as their job is sell you on the doctor not address your issues. 
  • References from other patients so you can view his art and craft results.
  • History with the Better Business Bureau, record with the medical board of the state/country the doctor practices in (license clean of violation, probations, complaints filed).
  • Training and credentials.
  • How does the medical profession assess the surgeon you are selecting?
  • Staff rapport with you, the patient.

Those are things that spell out a good decision in doctor selection. I have always believed that a good decision today is a good decision tomorrow. These types of decisions include the doctor choice.

Now with that said, I suspect that even if you get good results from this surgery (which can be seen 7-8 months after a hair transplant is done), Dr. X just did not make the grade for you.

Propecia’s Major Side Effects

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

Hi Dr., I am a 20 year old male who is goin bald and is considering a hair transplant. I was wondering what you recommened to maintain hair after a transplant, other than propecia because i have heard of major side effects. What is your opinion on rogaine and other topical treatments ?

I often receive questions on finasteride (Propecia) from patients like you quoting “adverse” or “major” side effects. All drugs have side effects (even Tylenol), but when used correctly under the supervision of a qualified medical doctor it serves its purpose. I often find people are misinformed from the mass amounts of uncorroborated information available on the internet or just word of mouth. It is the source of folk legends and superstition. It is one of the reasons why these medications can only be prescribed by a medical doctor.

Propecia has been well studied for male pattern hair loss in men. The following is taken directly from the Healthcare Professional Information Label for Propecia (finasteride 1mg).

Drug related adverse experience for healthy men taking Propecia during a 12 month period:

  945 men on
Propecia		 934 men on
placebo (sugar pill)
Decreased Libido 1.8 1.3
Erectile Dysfunction 1.3 0.7
Ejaculation Disorder 1.2 0.7

Rough translation: 1 in 100 (1%) patients had some form of sexual dysfunction. “Resolution occurred in men who discontinued therapy with Propecia due to these side effects and in most of those who continued therapy”.

There have been incidence of breast enlargement or tenderness (gynecomastia) reported. This occurred in 1 in 200 (0.5%) patients taking Proscar which contains 5mg finasteride (5 times the dose of Propecia) in a 12 month period. There is probably less than a 1 in 300 chance of gynecomastia from Propecia (which is 1mg rather than 5mg finasteride). This is also reversible.

Please note inb my practice experience there is a 1 in 10 chance of INCREASED libido (some may call this an “adverse” or “major” side effect for married men). I experienced this when I started taking it myself.

I believe the take home message for anyone who is serously concerned about their hair loss is to be make an appointment with a medical doctor (primary care doctor, dermatologist, or a hair transplant doctor) to discuss possible medical causes and its treatment options.

With regard to your second question, some doctors recommend the use of Rogaine (minoxidil) with a hair transplant on the belief that it accelerates the hair growth. I have used it on patients (half of the head with minoxidil and have without anything) and there was no difference with the use of minoxidil. The beauty of the hair transplant process, with the robust donor hair from the back and sides, is that no matter what you do or do not do with additional medications, the transplanted hair grows.

Spironolactones and Hair Loss

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

I posted a question some time ago but didn’t hear back from you so here goes. I am a 33 year old female with hair loss for the past year and 7 months. Started to notice the loss after going off the birth control pills. I went to see a hair loss expert at Duke University who said it was TE. Still hasn’t stopped thinning. I am back on the pill and spironlactone. I also have Hashitmoto’s disease. No family history of female hair loss although my dad has lost his hair. My testosterone levels recently came back at 86 which my doctor thinks is high and probably due to some PCOS. I have several questions. First, could the spiro be making my hair loss worse? What can be done to combat the high testosterone levels? I have a diffuse loss but also hair loss at the sides of my forehead (what I consider the temples) and my hair line has receded (which is what bothers me the most). Thanks for any insight.

The cause of your hair loss seem multifactorial. Birth control pills has been linked to hair loss even if you have stopped taking it. In other words, stopping or starting birth control pills may have ‘triggered’ your hair loss process. Hashimoto’s Thyroiditis is also a reason why you may have hair loss, because of its autoimmune process (your body may be attacking your hair). Polycystic Ovary Syndrome (PCOS) may also be related to hair loss by the virtue of hormone imbalances that this disease produces. Spironolactone, which is a common blood pressure lowering drug, can also be the cause of your hair loss as much as a help for it (now that sounds crazy, but it does say much about its value). Some doctors believe that Spironolactones may also grow hair, because spironolactone works by inhibiting a hormone called aldosterone, which is similar to testosterone (note: this is a very simplistic way of putting it). To my knowledge, there is no reliable scientific evidence of using spironolactone to grow hair. Most importantly spironolactone is not approved by the FDA to treat hair loss. Finally, your high testosterone levels should be addressed by your primary care doctor or a specialist who knows your complete medical history. PCOS can cause virulizing traits, and with high testosterone, that will just accelerate these traits. You may have already guessed, but spironolactone is commonly used to treat PCOS to decrease the androgenic hormone (testosterone) levels.

You seem to be doing the right thing by seeing the appropriate doctors. Unfortunately, sometimes there are no solutions.

No Hair Transplants for Alopecia Universalis Sufferers

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

Dear Sir,
Does alopecia universalis (genetic) have no cure? I’ve been losing scalp hair for the past year. Now i’m losing eyebrows too and the hair which i thought was POTENTIAL DONOR hair is also becoming thin (not losing though). I guess now the importance of miniaturization is understood….

In such a case, what can i do?? My doctor says to just learn to deal with it because medications are not effective in alopecia universalis. Can you please comment on it.

If you have been diagnosed with Alopecia Universalis, there is really nothing much you can do in terms of regrowing or transplanting hair.

I’m sure you know much about this disease, but for readers of this blog that may not be familiar with Alopecia, please see:

Gynecomastia and Rogaine?

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

I have a few questions for you.

– Does Paxil cause hair loss or thinning? I have been on two drugs for mental health reasons for about 8 or 9 yrs now; Paxil and Klonazapan (also called Klonopin). Have you heard of either of those causing loss or thinning if used long term?

– I think my hair would probably benefite from Propecia. However, I’m afraid of the risks around the chest / breast area. As a teen, I suffered from gynocomastia (sp.??) and had to be surgically corrected. I am too afraid of risking that happening again to try this drug. How likely is it to happen were I to try it? Would it be reversible if I stopped?

– Does Rogaine have the same risk ? Does it , or can it rather, cause gynocomastia, etc ?? Perhaps just rogaine or generic minoxidil over the counter is a better option for me, given my severe concern(s) about the possible Propecia side effect.

Thank you for your time.

Many drugs cause hair loss. Paxil or Klonopin may cause hair loss, but it is very rare. You hair loss may be due to male pattern baldness and its relationship with the drugs (Paxil or Klonopin) may be coincidental. There is no real way to tell.

Before starting Propecia, you should be seen by your primary care doctor or a hair transplant doctor who can discuss its risks and benefits, plus have your scalp mapped for miniaturization so that there will be metrics to compare with any progress the drug might give you over time. With respect to Propecia’s side effects, there is approximately 1 in 300 chance of getting gyencomastia (breast pain or enlargement). I do not know your detailed medical history to say whether your risk is increased since you had it in your teen years. You also have a 1 in 10 chance of getting an increased sex drive and a 1 in a 100 of a decreased sex drive. In medicine (as in life) it boils down to risks and benefits and compromises.

Rogaine (minoxidil) has different risks from Propecia, and those risks do not include gynecomastia or reduced sex drive. The risks generally reflect skin irritation, fainting or light headedness, or drying of the skin.

Hair Loss and Testosterone Replacement Therapy

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

i have been on testosterone repl. therapy on and off for 7 years. i get a 300mg shot every 2 weeks and use androgel in between. i have noticed rapid hair loss in front and on top in a 3 week period. the doctors office called and said my t level was over 2200mg. would this cause the hair loss and will it grow back when levels are back down thanks

Your situation is described on the New Hair Institute website:

The specific relationship between testosterone and hormonally induced hair loss was discovered by a psychiatrist early in this century. At that time, castration was commonly performed on patients with certain types of mental illness. The rationale behind this procedure was that it was believed to be a treatment for mental illness at a time when there were no other forms of real treatment. Castration seemed to have a calming effect upon many patients and castration reduced the sex drive of patients who had no outlet for their desires. The doctor noted that the identical twin brother of one patient was profoundly bald while the mentally ill twin had a full head of hair. The doctor decided to determine the effect of treating his patient with testosterone, which had recently become available in a purified form. He injected his patient, the hairy twin, with testosterone to see what would happen. Within weeks, the hairy twin began to lose all but his wreath of permanent hair, just like his normal twin. The doctor, then, stopped giving the testosterone to see whether the process would be reversed, but the balding process continued and his patient never regained his full head of hair. It was apparent to him that eliminating testosterone will slow, or stop, further hair loss once it has begun, but it will not revive any dead follicles.

In short, you are experiening androgenic hair loss or male pattern baldness. Stopping your testosterone replacement therapy will not make your hair grow back.

Hair Too Thin For Transplant?

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

my son who is 24, and african american went for a consultation this morning for possible hair transplantation, and he was told his hair was too thin. does that make any sense to you? too thin to transpant?

Being turned down for a hair transplant because of thin hair does not make sense to me, but I do not have the benefit of examining your son’s scalp to map his hair for miniaturization. Sometimes hair transplant doctors who are not experienced in the field are reluctant to perform hair transplant on African Americans because of their unique hair characteristics. African American hair can be very fine and thin naturally and it can also be very coarse as well. That does not mean he cannot have a hair transplant and someone like your son is just as much a candidate as anyone else, provided that he meets reasonable criteria standard for ALL men. The race card is not in play here. You or your son should research hair transplant doctors who are willing to show pictures of their patients. At NHI, anyone has the opportunity to come to one of our monthy Open House events to meet many of our hair transplant patients and see an actual surgery in progress. Everyone coming in can have their scalp mapped out for miniaturization as part of the basic diagnostic process we carry out for everyone.

I Lose 50-70 Hairs a Day

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

I am 33 years old, male. You say it is normal to loose 100 to 150 hairs a day. Until about 8 months ago I estimate I lost about 1-5 hairs a day, having a thick, full head of hair. Since then, I have been loosing about 50-70 hairs a day and my hair is certainly feels and looks thinner, for example, I can now see gaps in my hair line. Since I am not loosing over 150 hairs a day, how is it possible that I can go in such a sort time to loosing almost no hair daily to loosing around 50-70 hairs and have noticably thinner hair? Surely if it was ‘normal’ my hair would not be getting thinner, as it is?

Also it is possible to have my hair analyzed for hairloss and an opinion made after just one appointment with a specialist?

Your last question is the answer to your first one. Get your scalp mapped out for miniaturization and then with a diagnosis in hand in just one visit, you can make plans accordingly. It is often difficult for me to make assessments about hair loss when I do not have the opportunity to see the patient first-hand. A good doctor will be able to assist you further once your scalp is mapped.

Using Grafts from Other People

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

I am a 49 year-old African-American female. My mother and her two sisters suffer from female pattern balding. They are all in their 60’s. None of them have balding to the degree that I have. My two sisters still have the very thick hair we all had as children. I have general thinning all over. The top of my scalp and the sides have very thin, and in some cases bald spots. I never permed my hair. I am now wearing my hair in dread locks. Short of shaving my head, I don’t know what else to do. I would like to see if I am a candidate for transplant. Not the strip kind. Maybe the very small graft units. Do you have any experience in using hair grafts from other people. Or is this science fiction. I do not know if I have enough hair to transplant.

I do have experience transplanting hair from different people but they were identical twins. Otherwise, the difference in our individual genetic makeup will reject the ‘foreign’ hair.

Intercytex and Hair Cloning

/by William Rassman, M.D./5 /

Dr. Rassman, I have some questions about hair cloning and paritcularly about the company Intercytex which is working on hair multiplication. The company says they have completed phase 1 human safety trials and are going to began phase 2 human efficacy trials in mid-2006. They have also been quoted in newspaper sources as projecting that they will have a commerical product by 2010. I take this projection as a grain of salt as I did Ken Washenik’s projections circa 2003 which appears to have been incorrect, but I have some questions about the company and its developments. First, is the company legitimate? It is in a partnership with Johnson and Johnson so it appears to have some legitimacy, what do you think about the company? Second, is it significant that they are doing this in humans, it this a leap forward in the progress of cloning? I believe Aderans and other hair cloning research companies are still playing around with mice. Third, what do these phases mean? Are they part of the FDA approval process, for example is each phase required to follow FDA guidelines and then if the product makes it through all three phases is it then FDA approved, or does it have to go through an FDA approval process following its completion of the phases. Also, can you give some general comments on hair cloning. I know you don’t have a crystal ball and you are probably tired of this question, but how long do think it will be before hair cloning is an established medical practice, 10, 20, 50 years? Hair transplantation was first done in the 1950’s and it took 30-40 years before it became a safe, developed procedure. Do you think hair cloning will have the same kind of growing pains and take a similiar lenth of time to mature? Your answers to these questions would be greatly appreciated by myself and I believe many others. The internet hair loss community seems to be abuzz over this topic. Also, thank you for this blog!!

I have no particular inside knowledge about this company. I read the press releases just like everyone else.

To address your curiosity on phases for drug development and what it means, see: Phases of Product Development

Hair Cloning Timelines: In 1987, Dr. Colin Jahoda first cloned hair. When that happened, the excitement was wonderfully high and the entire world thought that the solution to cloning a human hair for clinical use was around the corner. The cloning worked in petri dishes, but when these cloned hairs were put into bald mice, the cloned hair killed the mice. Now, almost two decades later, we are really no further along. If you look at the drug development steps referenced above, it is important to note that this entire process runs about 16 years and that count is taken from the point where the drug or the approach is first put into the line. For drugs or solutions not yet identified, you must add this timeline of 15-16 years to the first identification of the substance. With the recent debacle just recently on a new drug (Parexel) that went into phase 3 clinical trials (Parexel in hot water) you can see how easily the solution can hit a snag and just how potentially dangerous this process is. For Parexel, it may spell disaster and this event may very well end its short life span. Unfortunately for the 6 people used in the study, their life span may also end with the drug’s life. Of importance, please note that this drug was for treating very disabling or deadly diseases, conditions including multiple sclerosis, rheumatoid arthritis, and leukemia. Hair loss in the classic sense, is neither deadly or painful so risks to protect the consuming public will have standards that are even harsher than with Parexel. As a consumer, we want to believe that miracles are around the corner, that cures for all ailments are within the grasp of modern medicine, but alas, reality is nowhere near our hopes and optimism on such issues. I personally do not believe that the safety issue can be resolved in anything less than 10 years, so do not hold your breath.

Hair Club’s Bio-Matrix Process

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

I began losing my hair at 21. I began taking HCM’s EXT therapy and had no effect. I am now 24 and the balding is apparent. According to HCM representatives, a full head of hair consists of approximately 100,000 hairs and I only have approximately 50,000. The rep added that one hair transplant will only add approximately 2,500 hairs. Is this true? I can’t see this being noticeable. Further, HCM quoted me 12k for one hair transplant then stated that I would also need to take Propecia to “prevent” further hair loss. I am a graduate student, so money is scarce, but my desperation isn’t. So, I am on the verge of calling HCM tomorrow and purchasing their Bio-Matrix process because, according to an HCM representative, it replaces all 100,000 pieces of hair, looks and feels natural, isn’t noticeable to anyone, and it’s porous (so it doesn’t create bacteria/odor).

I’ve read you comments regarding the Bio-matrix process and you seem to see it just as a hairpiece. But, as stated above, its qualities are unlike those of a hair-piece. Are HCM representatives deceiving me? Is the Bio-matrix process not what it’s portrayed to be? According to an HCM representative, Bio-matrix attrition rate is only 7% (n=30/month). I would love to know why people like/dislike this product. Do you personally know anyone who is satisfied or disatisfied with the Bio-Matrix process? If not, do you know where I could read testimonials of such individuals?

Thank you for your time and consideration

I am not a Bio-Matrix representative, nor have I had any scientific proof of their claims. I do know that a hair transplant is for life and it is a permanent way to replace hair. Male pattern baldness is also for life. Your questions and what you have been told has many truths. I have nothing bad to say about the Bio-Matrix product other than it is costly on a yearly basis. Be absolutely sure that you know the full costs before you buy into that system.

It is true that we are born with 100,000 hairs. That you have 50,000 left takes good metrics, something I estimate all of the time. Did your salesman measure your hair densities in each area of your head and show you the calculations? To have 50% of your original density, you would have to be a Class 5 or 6 pattern balding, so look at those charts and see if that makes sense. If you have only lost hair, say a Class 4A pattern, then you might have lost only 20% of your hair population. Clearly the less hair loss, the easier it is to transplant with a high density if that is your goal. Some people are willing to deal with hair systems like the Bio-Matrix system offered by Hair Club, but I am a freedom man. I do not want to have a no-touch zone around my head, something that you will have with a hair system and not transplants. Finances are a real issue as well, and I am convinced that these hair systems are far more expensive and they produce an annuity for companies like Hair Club, a revenue stream from people like you that keeps on giving. I particularly don’t like to use the term densities unless it is meant in measurement purposes as a doctor uses it. I think that patients need to focus upon fullness, because that is what they see. Take a look at Steve Hartman’s photos and see what he accomplished with around 4,000 hairs (1,895 grafts) put into an area that originally had 15,000 hairs. It is absolutely full in one surgical session in our hands, although he has less than 30% of his density returned.

If you are “desperate” as you state, you may consider a consultation with a medical doctor regarding your hair loss so you can map your hair loss and its miniaturization to plan your treatment accordingly. Most doctors offer consulations at no cost (yes, even a consulation with me is free)!

Hair “Cloning” Is Not Really Cloning

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

It seems that your prediction regarding the effect of regulatory and legislative hurdles to hair “cloning” is based in part on the idea that any type of “cloning” technology will necessarily take longer go get past those hurdles because of our country’s (i.e., the public, legistlators’, and the administrative agencies’) cynical views regarding cloning. Isn’t that a flawed premise? Hair “cloning” is not really cloning at all. No organs are being cloned. Instead, cells are being encouraged to divide and multiply. Those cells then are implanted in the scalp. Although the process is cellular therapy, it is not cloning.

With this in mind, does your analysis change? Thanks for your response.

Hair is actually the biggest organ on our body next to your skin. Hair does not divide naturally and multiply to create copies of itself. That would be cloning.

My views on cloning is independent of the government’s views. It is my opinion that current technology has not progressed to a level where cloning an organ (as simple as it may seem) is in our immediate future. Any process like this will require FDA involvement. That takes time.