Hair Loss Advice Sites

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

Doctor, I am very impressed by your objectivity and sincere advice. It is very difficult to find ESPECIALLY in the hair restoration biz. Keep up the good work.

Now here’s my question and I’m really putting you to the test. Could you recommend some other web sites which offer the same candid advice found here (Yes, I know you may be encouraging the competition, but I think you’ll agree to the value of other peoples’ advice and experience)

Thank you for your support. This blog site is unique. In fact, it is the first (and perhaps still only) of its kind. If anyone knows of another hair restoration / hair loss medical doctor that has his/her own blog and updates as frequently as I do, please let me know. I post between 8-10 new blog entries Monday through Friday, and it keeps me quite busy in between surgeries (and on my weekends in some cases). That being said, I do enjoy it, especially when I get new and interesting questions from the readers.

So to answer your question, I can’t think off the top of my head of other sites that may be similar to this site. I know HairLossHelp.com has a section of their site where various doctors answer questions posed by people that write in. I think I post much more frequently though. I guess that could be considered similar, but I’d like to think BaldingBlog is much more than that. I do not consider this type of thing as a competition, because this is simply my blog / journal site. I’ll sometimes post random hair-related info or videos, to mix things up from the question/answer style posts. Information provided here should not to be used for any medical treatments or judgements or diagnosis or endorsement. I offer my opinions, but the bottom line is that it is a blog site that I enjoy maintaining as a hobby (and I do like helping people). I have posted over 1350 blog entries in the last year, mostly because I am a crazy and passionate man. Well, maybe not that crazy — but passionate, certainly. I try to be objective and I love what I do I will on occasion refer to NHI if readers want to contact me on a professional basis. Sometimes, if I feel that my services could be of use in a more professional type setting (such as when someone wants to set up an appoinment with me to discuss private medical issues, I will make that time available. I have met a few of baldingblog’s audience since I started the site and their comments on baldingblog’s value have more than stimulated my desire to continue it. The newhair.com site was put together over the course of 10 years and contains writings in many scientific journals that I have contributed to, along with the most extensive patient photo gallery on the web.

Another good resource for hair loss info is American Hair Loss Association.

Tidbits: Prostate Cancer – Diet, Genetics, and Finasteride

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

Israel Medical AssociationIt is important for our largely male readership to understand that we will all confront prostate cancer if we live long enough. We can modify our genetics by a dietary focus (e.g. vitamin D & vitamin E may reduce the risk of prostate cancer while diets rich in fat may increase the risks), and the use of such medications as Aspirin (they call this in the class of NSAIDs), and finasteride (we use it as Propecia or Proscar) daily will clearly impact risks.

The following article may will shortly be published in the Journal of the Israel Medical Association: Harefuah. 2006 Jan;145(1):47-51, 76-7. Related Articles, Links [Nutrition and pharmacological treatment for prevention of prostate cancer], Article in Hebrew, by Segev Y, Nativ O., Urology Department, The Bnei Zion Medical Center, Haifa. Isreal.

Here is an abstract of the article:

“Prostate cancer is the most common neoplasm and the second cause of cancer death. It is an excellent target for primary chemopreventive strategies for the following reasons: it is highly prevalent and has a long latency period, there are identifiable risk factors and a precursor lesion and it produces a biochemical marker (serum PSA) which can serve as an intermediate end point in chemoprevention studies. The goal of primary prevention strategies is to prevent development of clinical life-threatening neoplasms in asymptomatic patients with no evidence of clinical disease. Identification of populations at risk for developing cancer is the cornerstone of chemoprevention. Well-established risk factors for prostate cancer include African-American race, older age and family history. Data on diet and obesity are less clearly defined. Since high grade prostatic intraepithelial neoplasia (PIN) is an early predictor of prostate cancer, preventive strategies focusing on men with high grade PIN are being explored. It was demonstrated that finasteride could significantly reduce prostate cancer in asymptomatic men with normal PSA and no abnormalities on rectal examination. Elevated prostaglandin levels, and upregulation of cyclooxygenase-2 (COX-2) are found in prostate cancer cell lines. There is some epidemiologic evidence that regular use of NSAIDs, which inhibit COX-2, may be associated with a lower risk of prostate cancer. In the field of nutrition, data from prospective large-scale studies demonstrated that increased consumption of lycopene-rich tomato-based foods referred to a reduction in the risk for prostate cancer. Vitamin E was also found to reduce prostate cancer risk. Prospective data showed that vitamin D has an inhibitory effect on prostate cancer development while increased calcium consumption, independent from dietary intake, might increase the risk. Dietary fat intake, particularly from animal sources, may also increase the risk for prostate cancer. Whether this effect is strictly due to the already identified compounds or to other compounds, remains to be explored. Further study will hopefully help to establish a core set of nutritional and dietary factors that can positively or negatively affect prostate cancer development, as well as a set of pharmacologic agents that can reduce the risk of prostate cancer development and/or progression in selected patients.”

Balding On One Side More Than Other

/by William Rassman, M.D./4 /

Dr. Rassman
I am 21 years old my grandfather on my father’s side is Bald my father however is not bald his brother is, I got my mother’s side of the hair which is very thick and wavy and alot of hair. My concern is that i shaved my head recently and I noticed that My Left side near my forehead is kinda thin compared to the left side. I can notice it. The left side is thick and strong. My father is not bald he has a receeded hairline but at age 47 I think thats as bald as hell get. I am concerned I may be at risk for balding, even though my grandfather on my mothers side isnt bald nor is anyone on that side of the family. My uncle my father’s brother however is bald. I heard a freind say that everyone naturally has a thin side is this true? or should I start buying rogain right away so that I can stop balding early.

It is not uncommon for one side to bald faster than the other. The other side will catch up, unless you are treating your balding process with Propecia.

21 Year Old Female with Thinning Hair

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

Im a 21 year old female and have been noticeing my hair getting thinner since december of ’04. I figured it was just shedding and did not relieze a more drastic hair loss until september of 05. I went to two different dermatologists and both said my sclap was fine and to take vitimans. I had bloodwork done and everything came back normal. My mom is 52 with very thick hair and has been double processing it since she was in the 8th grade and my fathers side does not have any hairloss problems either. Im very confused and am worried to loose even more. It started in the front of my head now its March of 06 and im now loosing alot more in the back as well. The doctors said it could be stress .. but i would like to get to the bottom of it before it gets any worse. Is there anything else it could be?

Without seeing your hair loss pattern, I cannot comment on the etiology of your hair loss. You may have genetic female hair loss that has symptoms similar to yours, or other conditions. As you indicated that you are in New York I recommend you see Dr. Robert Bernstein, a hair transplant doctor who happens to be a dermatologist on the Columbia Medical School faculty.

For more information, look up female hair loss in the search engine on the front page of this site and you can read the various questions and answers that will align to your questions. Remember, the more you know when you see a doctor, the more value you will get from the questions you pose and the doctor answers.

Why Did I Start Balding at Age 15?

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

Dear Dr. Rassman,
I am a twenty-seven year old man, and I began to lose my hair at age 15. I went to several doctors when I was younger but they all told me the hair loss was male pattern baldness and not the result of any health problem. I am already as bald as my father, who is thirty years older than me.
When someone begins to lose hair at the age I began to lose mine, will the baldness progress until all of my hair is gone? Will I ever be able to use a hair transplant system? And what the heck would cause my male pattern baldnes to start so early anyway?
Thanks.

Don AmecheAndrogenic hair loss or male pattern hair loss starts as males enter puberty, as their testosterone levels increase, bringing on voice changes and pubic hair and other male sex characteristics. Although it is usuual to start the genetic process at 15, the DHT is clearly working on young men of that age. There is an issue of ‘gene expression’, which means that the trigger for the gene may have started early on you. Unfortunately, some men have the gene that causes male pattern hair loss to trigger earlier, while others do not see this until later in life. For example, Don Ameche, a popular old-time movie star in the 1930s and 40s known for his perfect hairline and good looks, started to bald after the age of 50 (late onset trigger for gene expression) and was almost completely bald when he was in his mid 70s (and starred in the movie Cocoon in 1985).

Hair Loss Around Donor Scar After Hair Transplant

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

Dear Dr. Droctor,
I am 3 weeks out of a hair transplant and just experienced a telogen effluvium episode(shock loss) on the area surounding the scar on one side of my head. The affected area is about 2-3 square inches. Have you ever heard of such post traumatic patchy hairloss? is this common? and is all the hair automatically back after a while? same thickness?
For this particular case, would you suggest a treatment?

Thanks in advance for your answer… I’m a little bit worry.

You should ask your doctor first. Hair loss after a transplant in balding men in the recipient area is often not reversible, but if it happens in the donor area it will frequently return in 2-5 months. Good before and after pictures will help make the assessment for the recipient area. If you are young man (under 35), then you should have been on Propecia which does protect against the hair loss induced from surgery in the recipient area.

I am assuming that what you are talking about is hair loss around the donor wound. When this occurs, it is often the result of wound tightness with the surgical closure, but it can happen to almost anyone. You must wait out a period of between 2-7 months before you will know. Returning hair growth may occur over a long period of time.

2 Weeks After a Hair Transplant (with Photos)

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

I have some hair in the frontal area but it is thin. I want to know how would I look after a transplant? I must be in the public view within 2 weeks. Is that possible and still be undetectable?

The pictures below are from 13 days after this patient’s hair transplant of 2,710 grafts in the frontal area. He also had some hair present, just as you asked. This photos below show typical healing with small wounds, good post operative care, washing any scabs off within the first day or two and good overall planning. Your doctor should tell you what to expect, as each doctor’s work differs on the post operative course.



Scalp Itching

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

I have experienced pruritus mainly to the crown since I was a teenager. I have used all types of products, prescription and OTC, including Nazoral, Neutrogena products, etc. The only one that I have found to be efficacious has been Neutrogena T-Gel. It stinks (literally), it produces sun sensitivity, and it dries my hair. Do you know if continuous daily use of this product will impact my health? I have heard that chronic exposure to coal tar may cause cancer. I do appreciate your professionalism and your desire to help those of us who have issues with the prospect of balding.

You might try hydrocortizone cream (0.5%) applied two or three times a week to the scalp. It should not be used more frequently than that, because it could be absorbed with high doses. If you keep its use down to two or three applications directly to the area every 12 hours for 2-3 applications, you might find that the problem will disappear. What you are calling Pruritus may actually be other conditions, and a dermatologist might give you the diagnosis you need.

Woman with Chronic Telogen Effluvium

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

Hi I am a 44 year old female with chronic TE and a positive hair pull. I had 2 brief incidents in my 30s but this latest one has been continuous for 18 months and I have lost a significant amount of my hair with little or no visible regrowth. All of my hormone tests are normal including thyroid, FSH, LH, estrogen, my testostone is even slightly below normal and my ANA is negative. The only issue I have is low ferritin and I have been taking iron for about a year but can’t seem to get the levels above the low end of normal.

My condition continues to deteriorate despite rogaine and topical steriods. I don’t know where to turn. Any advice would be welcome.

Thanks

There are people who specialize in this. Please let me know where you live and I will try to find someone in your area. For more information see Telogen Effluvium by Elizabeth CW Hughes, MD.

Trichophytic Closure Photos

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

I read your article about the Trichophytic incision. Do you have photos of what this looks like?

The pictures shown below are of a patient who had a trichophytic incision on half of his wound and on the other side had a non-trichophytic closure. The side with the trichophytic closure has hair growing in the actual wound, making it less obvious. These pictures were taken 5 months after surgery, so the scars have not fully matured and a slight pink color still remains. The photos below are both from the same patient (right and left are exactly the same image), except the two on the left are unedited and the two on the right has a yellow highlight showing where the actual scar is, so that you can see clearly that hair is growing through it. I apologize because some of the hair from below the scar is obscuring the trichophytic set of photographs, but I believe if you look through the line of hair that is combed upward from below you will see the hair growing directly from the wound. I will replace these with better photographs from the next patient that comes in to the office. Click the images to enlarge.



The below photos show the non-trichophytic side.



For more information about Trichophytic closures, please see Techniques to Minimize Donor Area Scarring

Color of Donor Scar 2 Weeks After Procedure?

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

I am 2 weeks post-op a 2400 FUT.The surgery was performed by a very reputable Dr. and so far I am very pleased with the results.The recipient area has healed well but I still have a very pronounced dark pink line at the donor site from ear to ear.The scar itself seems only about 1 or 2mm wide but the dark pink line is about 4 or 5mm wide and very noticeable.I went back to the clinic and the Dr. told me I wasn’t being aggressive enough with washing the donor area and advised me to use olive oil to soften the area and lift off the secretion.Is the secretion causing the wide pink line and when can I expect this to look less noticeable?

After two weeks, what you are describing is not abnormal. Some people keep a red/pink color to the surrounding wound. This will become better over the next few weeks. Sounds like you doctor is giving you reasonable advice.

Propecia and Body Hair (with Photos of Hair Transplant)

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

This patient had a very nice result from one hair transplant procedure. An interesting item to me was that he reported that when he started to take Propecia, the hair from his chest and back (which was very heavy) returned to his barely hairy 18 year old body’s hairless appearance. In addition, he also reported a reduction of nose and ear hair. So this patient shows not only the benefits of a good hair transplant, but also a rare but good side effect of Propecia (I have rarely seen been made aware of this loss of body hair). I only have photos of his head, as I didn’t think people needed to see photos of the inside of his nose or ears (and so I didn’t take any).

The first set shows his before photos. Click the images to enlarge.




And this set shows his results after one hair transplant procedure of 2,073 grafts.




Moved to New Country and Hair Is Falling Out

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

Hi Dr.Rassman,
I been bothered by this problem for almost a year now and couldn’t find way of solving it .I been reding magzines and testimonials about this but need more explaination. I come from the Philippines but residing here in Dubai, U.A.E because i am working here now.I am here for 2 1/2 years now in Dubai.Back in the Philippines i have a healthy hair means shinny and bouncing but my nightmare came to me when I am here now in Dubai my healthy hair becomes lifeless, dull,dry,and i experience hairloss too plus my sclap is very itchy to been trying different medication about it but i don’t seem to see the results.

Admittedly, as a person I easily gets depressed and one year back i did experienced a total depression due to some personal problems. I also heard some stories that one reason of hairloss hair in dubai is the water and the harsh weather of this country .Also, I am quiet afraid of the reality that my mom had a thin hair and i suspect i may have hereditary hair loss.But , I am only 24 to experience such problem, that is why i am consulting you this problem because i really want to know the mean reason of my problem if you could elaborate some of the theory you may have for this; and also could you give a solutions or advise on what should i do .

Thank you very much and I would really appreciate everything if you will send me a reply on my e-mail as soon as possible.

I do not have an answer to your problem. Your depression should be addressed, but being away from home surely adds stress to your life and stress can change the character of hair in some people.

How Does a Doctor Get FUE Training?

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

I see that many HT docs are offering FUEs and claiming how great they are. Where did they learn this and how can the consumer know what we’re getting is really quality work and not just a publicity scam?

It is best to ask to see the doctor’s patients and meet them directly. Do not accept photographs alone, for they may not be what they appear to be. FUE is becoming the ‘hip’ thing to offer patients to start to build a practice. It takes about 8 months from the time of the surgery until the results are known. For the dishonest doctor, that could become the ‘funding’ for a new venture and claims of expertise are easily made throughout newspaper ads and internet websites. Training is almost impossible to obtain unless you have a large hair transplant practice and are willing to practice on a dozen or so FUE grafts on every patient you perform a strip surgery upon. That is how I learned how to do them, 1-2 at a time per patient over 9 years. The main difference between me and others is that today’s self proclaimed expert can reference the standard I set and published. For me it was more complex than that, because I never knew it was really possible to obtain consistency until I had been doing it for years. The question you did not ask is about claims of success are measured. Self-proclaimed success in harvesting is clearly dependent upon ‘self reporting’ without audits. Trust is everything and integrity is at the core of the surgeons being. I can not advise upon this point for the buyer has responsibilities to research it heavily (please see The Truth About Cheap Hair Transplants for more info). As I always end these types of comments, let the buyer beware.

Hair Follicle Cells Growth Stages

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

My son will be 12 this August, I have been noticing lately on his pillow in the morning, there is some lose hair on it, I would say about 12 strands. I have never noticed this before and I would like to know if this is normal or something I should be concerned about. I was wondering if this could be related to puberty, his voice is starting to change or if it is coincidental? Thanks for your time.

It is normal to lose 100 to even as many as 200 hairs a day. Furthermore hair grows in cycles (see below) and you may notice more hair falling out at different phases and seasons of the month. In other words, hair growth and hair loss can be a cyclical phenomenon. Other factors certainly contribute to hair loss such as hormonal changes, malnutrition, etc. While your son’s hormonal changes of puberty may be coinciding with the hair loss, it is my opinion that 12 strands a day is perfectly normal.

Hair follicle cells have three phases of growth:

  1. Growth phase (Anagen phase) which lasts anywhere from 2 to 6 years. This is the phase where your hair is actively growing at approximately 10cm per year. 85% of hair is at this phase at any given time.
  2. Transitional phase (Catagen phase) which lasts about 2 weeks. This is the phase where the hair follicle shrinks and prepares to enter the resting phase.
  3. Resting phase (Telogen phase) which lasts about 1- 6 months. This is the phase where hair does not grow but stays attached to the follicle. Some hairs are shed at this phase, but at the end the hair follicle re-enters the growth phase to start the cycle over again. 10-15% of hairs are at this phase at any given time.