Cymbalta, Atenolol, and Female Hair Loss

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

Hi I’m a 24 yr old female, with some questions I would like to ask you about my hair that is thinning. About 10 months ago I was getting a haircut and the stylist had mentioned to me that my hair was thinning a lil at the crown of my head…It wasn’t very noticable, so I didnt think anything of it, and just went on with my life…I had started taking an Anti-depresent called Cymbalta, and a high blood pressure medicine called Atenolol, at around that time as well. Well in january of 2006 I noticed that my front part of my scalp, maybe from my hairline & back 2 inches was very thin. I couldn’t understand why, because it was an over nite thing, I would have noticed if my hair was thin, and i even look back at christmas pics from the month before and my hair was like usual, so I know it was a very immidiate thing. I had disconntinued my anti-depressent and blood pressure meds, like 1-2 months earlier, because I could no longer afford health insurance, so I had been med free for about a month when I noticed the thinning frontline. its now almost 3 months later and im starting to think the thinning is getting worse in this reigion only…i started to take folic acid and a prenatal pill, because I read folic acid helps with re-growth, but I dont know what to do..I cant see a Dr, for another month untill govt health insurance kicks in, but in the meantime what should I do??..i know I had blood test run before about 8 months ago checking for throid disease, but it came back normal, so could something medical cause this..because no one in my family has a balding problem, my mom is 47 and just started to thin, and thats only because she used many products in her hair for so many years. do you think my hair will grow back or get worse?…I heard it takes about 3 months for the hair growing process to start showing, but its been about that much time and i dont see any improvments…Ive looked through the internet and read some scary stuff that can cause hairloss…but im so down about this, becuase i am soooo young, and I dont know why my hair is falling out…please help me if you could, thanks alot and have a wonderful day.

You are in need of a good doctor and there is no substitute for what the doctor does. Problems like yours can not be managed well by a doctor through the internet, nor can you manage depression and high blood pressure combined with hair loss by yourself. Look through the many posts in this blog on female hair loss to educate yourself and then get a good doctor.

I Need My Hair To Be Colored…

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

I dyed my hair blackey blue about a month ago and it is in quite a dry condition. However the colour is fading there are now brown patches(my natural colour) becuase each time I straigthen my hair (which has been reduced to about twice a week)strips the colour slightly. This upsets me as my hair looks a mess and I do not know what to do. I have a school prom in three weeks time and would love my hair to look nice for it. However I do not really want to dye my hair again as the damage done to it will be awful and I do not know whether it is worth taking the risk again as the starightners will probably just strip the colour. Please help! Also my hair is starting to snap and becoming thin! Please, please get back to me!I will be grateful forever! xx

Sounds like you need the help of a good hair stylist, not a doctor. Have fun at prom.

I Don’t Like Having a Mature Hairline

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

I am 23 and notice I have a mature hairline. its a 2 on the scale. I dont like my hairline though and would like to get the hair around my temples back. Is there any procedure that can fix this? If so please tell me

I have transplanted the juvenile hairline back in some men, but I do so only under certain conditions:

  1. There is no evidence of advanced balding either on examination or in the family line.
  2. I want to get to know the patient and he must be mature and able to understand the ‘worst case’ scenario that could happen (in your age the worst case thing is advanced balding).
  3. I look at the value of the various elements of hair quality, skin color, hair density, and overall donor supply characteristics and connect it with potential demand considerations.

I have clearly done this more than once, but in my present memory the only ones I have done under 25 years old were professional actors, television soap opera sexy men, or models whose livelihood depends upon that ‘youthful’ look.

2 Years After Transplant, I’ve Lost My Original And Transplanted Hair

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

Hi Sir,
I’m 24 now (My birth Year 1982) had a transplant in august 2004 on my front portion but at that time i had hairs on my top left and right. Now in 2006 i have lost most of my hairs both my original and my transplanted. How can i have my hairs back. Im too worried, Please guide me what to do. Reply me soon.

Loss of transplanted hair generally means that the hair that was transplanted was not from the permanent zone (the wreath around the side and back of the head), or that the hair that you lost was really the original hair not the transplants itself, or the hair came from the neck rather than the scalp (hair from the neck is not really permanent hair), or that you might have another type of alopecia (most commonly Diffuse Unpatterned Alopecia – DUPA). You need to get your hair mapped out for miniaturization and that will clearly show the status of the permanent hair zone. If the permanent zone has miniaturized hair, that means that you might have never been a candidate for hair transplantation. This is the most common cause for what you are telling me about. Finasteride benefits this condition in about 50% of patients with DUPA.

Please get your donor area mapped out to be sure that the quality of the donor hair is good.

Angry Emails About Hair Products

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

it would seem to me, if it worked as good as you say on TV, all the news media, talk shows, and anyone reliable else, would be backing this product. An infomercial is paying the TV. If It was as good as you say, you wouldn’t have to pay to have is broadcast. Remember, just because you say it’s so, doesn’t make it so.

Where do I begin? I was able to determine that this email came from someone that found the BaldingBlog by looking for ScalpMed on a search engine and just assumed that I was the one responsible for promoting this product. This is sadly not the first email I’ve received like this. Some people just seem a little angry about the ScalpMed product. I’ve never seen the TV commercial and I’ve never claimed ScalpMed is good. In fact, I haven’t promoted myself or my company in almost 10 years and I’ve never promoted a hair loss product on TV, ever. Folks, just because you found this site by searching Google for something you saw on TV, it doesn’t mean I made the commercial promoting it or had anything to do with the company or the product. I understand there is anger over products out there claiming to do things that you have not experienced, but your anger is misplaced if it is directed towards me.

I do agree with the writer of the above email though — if a product is as miraculous as they each believe is more than hinted at being a wonderous cure or treatment for hair loss, you would see as much information EVERYWHERE as you surely did when Viagra was made available to the public. Stop to think of the Viagra marketing launch and try to apply that to any magic bullet pill advertised to treat hair loss. Viagra was everywhere, and a topic like sexual dysfunction is far more embarassing for many people to talk about than hair loss. So if a miracle pill for hair loss did exist, I would think you’d see it even MORE than Viagra. You’d be getting 50 spam emails a day (with multiple misspellings) talking about selling it at a discount. You’d see it on the cover of Newsweek. You’d certainly would see it in magazines and newspapers. Hair loss is a big deal to many people.

With nearly 50% of men losing their hair, the market for a wonder drug that claims to do it all for your hair is wide open. I do recommend Propecia, because I’ve seen it work and it is FDA approved. The same recommendation goes for minoxidil, although to a lesser extent — but again, it is approved. Propecia doesn’t work for everyone all the time, and minoxidil has its faults as well. As a physician, I have a hard time recommending any product that I am not convinced works. I have no experience with ScalpMed, but there does seem to be a very polarized group of emailers who do not take a positive view of their experience with this product. If you are included in this group, could you take a few minutes and write down your experience and let me know if you were happy or unhappy, and why? I will be happy to share rational people’s emails with the readers of this blog.

Hairline Regrew with Meds

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

I’m a 27 year old with recession to a NW2 pattern, but thinning over a NW5 area. I’ve been using Propecia, Minoxidil and Spiro for roughly 1 year, and I’m noticing pigmented hair starting to sprout around my original NW1 hairline. However, the density on the top of my head appears to have gotten slightly worse. Maybe it’s a shed, I don’t know.

With success continuing on the hairline regrowth standpoint, do you think the thinning on top is just taking longer to grow in — or could it be possible I’ll end up with a NW1 hairline, but with a thin NW5 pattern? I understand that hairlines usually come back in (if at all) AFTER the crown and vertex have filled in…? It just seems odd to me to be having regrowth success in the one area people have a lot of trouble with, but be lagging behind in the areas that are meant to respond best to treatments.

My father has a NW4 recession/NW6 thinning pattern at 55, and my hair loss seems to be following the same pace and pattern as his did at my age. In the scenario that I don’t achieve desirable density on treatments in the next 12 months, is FUE an option to fill in the density of the thinning pattern? On that same note, if I were to have FUE done in the next 1-2 years, would it still be possible to pursuse Hair Multiplication when it became available? I can’t remember where I read it, but someone mentioned that previous HT patients would not be suitable candidates for HM for some reason. Or maybe I misunderstood/misread…?

Call it vanity or risk, but I’d rather have decent hair in my 20s and 30s, and the confidence that goes with it, and worry about my 40s onward if/when I get to them. What can I do NOW to achieve my goals, even if they’re temporary fixes until the next great drugs/procedures come along?

Thanks

Norwood Class 2

Norwood Class 1

I am very impressed with your questions, particularly the way you distinguish the difference between the way to classify recession and thinning patterns of hair loss. You are correct to assume that the impact of medication is different between the front and the top/back of your head. I do not understand why the treatments you are having are impacting the juvenile hairline (Norwood Class 2 pattern moving to a Norwood Class 1 pattern).

With regard to filling in a thinning pattern — that would depend upon many things. There are many doctors who would gladly sell you hair to fill in a thinning pattern, but there is always the really important question to ask: Will the gain off-set any loss from the transplant? Many unscrupulous doctors would like to tell you that this is preventive hair transplantation to stop the balding. When I hear that statemen (preventive hair transplants) I know that the doctor has ethical problems and $$$ are getting in the way of his/her judgment for good patient care. To get a proper answer to that question, you MUST find an ethical doctor who will answer it from your perspective. Judging that you are focusing upon a Norwood Class 1 pattern, I might think that you are overly worried. If you choose to have an FUE or a conventional strip procedure, that is an independent decision to having a transplant in the first place.

Any transplant you *or any person having them) might have will not interfere with the advances in hair cloning or hair multiplication that may come up in the future. You are worried about what you will look like in 13 years, but I would ask you to have you scalp mapped for miniaturization and if you really are thinning in the patterns you discussed above, then the drug of choice is Propecia/finasteride and that could do more to fix the thinning problem than any hair transplant you can do.

Should I Try Rogaine?

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

Hello Sir,

My age is 23 and like many people around the world i am also very much worried about my receding hair line (from the centre of my crown till my temple ). The density of my hair has become very less from past one and half years after i started to work for a call centre. Most call centre jobs in India are out sourced, which means i work mostly at night.

I do have read a lot of blogs on your wonderful website about hair loss and treatment. But i really wanted to know whether is it okay if i start using minoxidil for retaining my remaining hair or you would suggest me to visit a trychologist and then get the prescribed medication.

Also can a hair transplant will show the same density as normal hair..after the transplnt has been done..

thank you

If you are balding at 23, you should buy finasteride and take 1mg of this drug daily. In India, there are generic versions of this drug on the market and this is the best drug to stop, slow down, or reverse early hair loss in a young balding man. I can’t vouch for the authenticity of the generic versions available though. Minoxidil (Rogaine) is not the best first choice for a drug in a young man, as it is not reliable and it does not block the balding process from happening. Transplants should not be considered unless after a year on finasteride you still show significant balding. Doctor selection is a real problem in most countries, and I am sure that a trip to the United States may be out of the question, but take great care in selecting a doctor there for hair transplants.

ScalpMed and Hair Growth Rate

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

Hello Dr. William Rassman. I have heard that scalpmed supposedly thickens your hair but what I want to know is does it speed up the rate of hair growth as well? For example if my hair normally grows a half an inch in a month, could scalpmed make it grow an inch or more in a month?

Nope. The ScalpMed people are promoting their product very heavily and the claims that seem to be coming through internet chatter is unsubstantiated. There is nothing in that product that can make hair grow faster, because in fact, there is no drug anywhere that will make hair grow faster.

My Crown Looks Like It Is Thinning

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

Hi, I’m a 23 year old asian male with a norwood 2 hair pattern, I have been since I was 19. I was born with less hair on the crown than most, there’s a small hole there. I was wondering if an HT can cover that up and if it was safe to do so in say 2 years time? Is it also possible that I’m more ‘prone’ to hairloss because of it? I also wondered whether it was alright to have an HT to straighten the hairline? It’s only for cosmetic reasons I guess but I feel quite stupid with my hairline so I’m forced to put my hair out in the front. Thanks

If your hair is very straight and strong, what you are describing is the swirl in the back of your head. In Asians with strong, straight hair, the swirl will show. The swirl is created by the change in direction of the hair in front to the sides and behind it. Like water going down the drain, the swirl emphasized the hair flow and the eye can follow the hair shaft to the scalp. In most Asians, the light skin and dark hair make the swirl area look balding, when it is not actually going bald. Here’s a photo of the crown of our own Dr. Jae Pak, M.D. He is not balding in the crown, but what looks like balding is the result of (1) Asian straight hair that does little to cover the crown, (2) black hair on pale skin, and (3) low density hair, typical of Asians. In some Asians with hair that stands up on its own (like the spiked hair style that is popular today), there is the perception of thinning hair in the front, when that is actually not the case at all. The most difficult areas to get to be full looking therefore are the crown area (particularly in the center) and the frontal hairline where the light penetrates into the hair and the scalp (and when the skin is light and the hair is dark, the background lights up). As you may ascertain from what I have said here, there is a real ‘art’ to doing hair transplants, because the surgeon must understand the blend in color and contrast, hair thickness (like the brush strokes of a painting), the waviness of the hair, and the number of hairs available to fill in the balding area being transplanted. Like a portrait painting, you need to have a good artist doing it for it to look real, that is, unless you like the Picasso look.

If you wish to fill in the crown and make it fuller, you need to find a good hair transplant surgeon, one that is ethical and will be able to meet your goals without risking you to hair loss or deformities created by poor planning.

Anyway, here’s a photo of Dr. Pak’s crown, as mentioned above. Click the photo to enlarge.


Analytical Questions From a 21 Year Old Balding Man

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

Respected Sir,
I am very happy to see the service you are providing. My name is nabeel hussain .My age is 21.5 years. I have started getting bald when I was of eighteen. Now on THE NORWOOD/HAMILTON SCALE I am at 3V position. I have met a dermatologist he recommended me genesis and minoxil2%. I was told that initially I will lose hair + I have to use these medicines for whole of my life. Sir please answers my following questions I will be highly thankful to you.

  1. I don’t want to do this hectic and frustrating job of using medicines. As it is temporary and as I will stop using them my hair will lose more rapidly. Apart from that they have side effects also. Am I right? Will medicines have some negative effect on my donor area?
  2. I want to go for hair transplantation. but one doctor told me that doing so at an early age of 21.5 is not a good option because I will continue losing my hair and I will be again bald at a age of 30.and the previous transplantation will become fruitless. Is it right?
  3. I want to transplant hair because I have a concern about my donor area that it might not diminish if I postponed my transplantation. Is it could be the case?
  4. Can we take hair from the side of our head as donor hairs?
  5. What is period of complete bed rest after transplantation?
  6. At what age should I go for transplantation?

I have asked you a lot of questions but I hope and am certain that you will answer them all as you are very co operative.

Kindly recommend a better solution for me.

  1. If you are balding from genetic causes, then there is a good reason to be using finasteride 1mg (marketed as Propecia), which you must take for the rest of your life ( that is, until a cure for balding is discovered).
  2. The doctor who told you that you are too early for transplants is probably correct, but I have not seen you so I am drawing this conclusion based upon no objective findings, just the average 21 year old who is in the early stages of the balding process.
  3. Hair transplantation may not be the answer for you because you do not know how bald you will become and if the supply of your donor hair will meet the demands of your eventual balding pattern. You could end up depleting your donor hair for the short term gain at the expense of your long term look without a Master Plan for hair loss in your hands.
  4. The donor area is on the side and back of the head as you indicated.
  5. Hair transplantation does not require any bed rest after the surgery. You can walk around and within 5 days, even run a marathon.
  6. Generally, balding patterns are clearly evident by the age of 25-26. The later you can delay the decision, the more mature the hair loss pattern will be.

You are asking good questions. Take the advice of the good doctor you have already seen.

Shedding Hairs Get Thin At Root

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

Hi Doc, I’ve been on propecia for 4+ months. Ive started the infamous sheds about a week ago. I would say 90% of the hairs I shed are extremely thin. The ones that look like they are about dead. What’s weird about it, and what worries me, is that so many of the shed hairs seem like it thins out at the end (closer to the root). What trips me out is that my hair is about 4 inches long, so I get to see the trend of hair thickness from before propecia to now. And the fact that it looks like my shed hairs gets thinner at the roots gets me a little paranoid. Are shed hairs, whether affected by MPB or not, usually meant to thin at the end? Or is this a classic sign of MPB attacking my hair? Thanks Doctor!

What you are seeing is the shedding of the miniaturized hairs. Some physicians believe that the shedding impacts these miniaturized hair as they are forced into the hair cycling. The hair on the scalp follows three life cycles:

  1. Anagen
  2. Telogen
  3. Catagen

Once the hair falls out, I would expect that it would be replaced by a new, stronger hair coming into its Anogen phase.

Shakespeare’s Hair Loss

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

Shakespeare How did 16th Century playwright William Shakespeare lose his hair? I’m sure you find yourself pondering that question every waking day of your life. Well, perhaps not. At any rate, I stumbled upon this year and a half old article that has an interesting take on why Shakespeare possibly lost his hair. The title of the article gives away the punchline, but enjoy…

Ouch.

Hair Transplant and Propecia Combination Results (with Photos)

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

This patient had a hair transplant a few years back with me, which filled in the front and top. He has been taking Propecia for the crown. The combination is awesome. In just ONE surgical session of 2,626 grafts, he now has a strong frame to his face and filled in much of the frontal hair. The back of his head gained just enough hairfrom the Propecia to take away the heavily see through look and all of his sensitivity to being the balding man we see in his before pictures. Photographs were taken from eyebrows up only. Click the photos to enlarge.

Before:



After:



Comments from Transplant Patients

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

People are so worried about detection of their hair transplants. A patient who sent me this comment is a few months out of surgery. No one detected he ever had a transplant, and after his last transplant, he gave me the following update:

“Like last time, no one noticed as far as I can tell — although my sister-in-law (who’s sly-as-a-fox) caught me off guard last week when she said that my hair looked fuller. I responded that I hadn’t had a hair cut in awhile (true), and that I was taking Propecia. (I am taking Propecia as you directed, and will continue doing so).”

Another patient who was bald just 9 months earlier, came to dinner at his daughter’s home with a reasonably full head of white hair. His daughter commented that he looked foolish with that wig on, so she insisted that he take it off. He told her it was not a wig and allowed her to pull on his hair. Surprised, she asked where it all came from and he commented that he started taking Rogaine 8 months before. She was a nurse and replied: “I never knew Rogaine grew hair like that.”