Coversyl and Propecia

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

I have been on propecia for about 8 years, so far so good. Recently I am on “Coversyl 4mg” to control my blood pressure. I understand most of the high blood pressure drug will cause hair loss. If this drug does, can propecia reverse the effect? I am worried cause it takes me 8 years to maintain reasonable “amout” of hair. Hope to hear from u soon. Regards

Many drugs have the potential side effect of hair loss and antihypertensive drugs are amongst them. If your hair loss is from the side effect of a drug, then it will not respond to Propecia. Speak to your doctor about this drug. Is there a one-to-one relationship? I mean, did the hair loss start exactly at the same time as you started to take the new medication?

Tags: propecia, finasteride, hairloss, hair loss, drug, coversyl

Losing Weight And Losing Hair — Any Way to Prevent This?

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

On a recent visit to my hair dresser, I was informed that I was loosing some of my hair and she stated that it could be from the weight loss I have had. I have been on Weight Watchers since Sept 23, 2005. I have lost about 35 lbs and would like to loose about 10 more pounds but not more hair. Is there anything I can take or wash my hair with that will prevent the hair loss? I also take a one a day vit., potassium, B-12, and calcium. I take Estroven at night before I go to bed as well. I am 51 years old, female.

Congratulations on your weight loss. While a medically starving state and rapid weight loss may be a factor in hair loss, your weight loss was gradual for over a period of one year (which is a healthy way to lose weight). The key is good nutrition and slow, methodical weight loss. You may want a medical evaluation to pursue any medically treatable causes for hair loss and should get your hair mapped out for patterns of miniaturization which are typical of female genetic hair loss.

Tags: hair loss, hairloss, weight loss, weight

Major Hair Loss After Depo Shot

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

I recently got my first shot of depo and it has been going good until now. I started losing ALOT of hair. I have naturally thick hair and have never had an issue with it falling out. I fill the drain in the shower then fill a brush after the shower. It started happening about a month ago and i can feel the differance in it already. I have read that it happens with the depo but will it come back and how long will it keep falling out like this?

If you are talking about depomedrol, it is a steroid and it is a know cause of hair loss. In men with genetic hair loss, it may precipitate permanent acceleration of the hair loss. If you stop the steroids and possibly take Propecia (assuming you are a man), then it might take a few months before you may see new hair growth once the offending agents disappear.

If you are a woman and are talking about Depo-Provera, then birth control pills are known causes for hair loss in women. If you stop the Depo-Provera, chances are that the hair loss will reverse in a number of months. Be sure that your doctor is managing the process and is checking you out for other causes of hair loss. Ask your doctor about alternative birth control to this medication.

Tags: hairloss, hair loss, depo-provera, depo, depomedrol

Shen Min, Hair Loss, and Foolishness

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

hi ..im 25 yrs old and have started taking an herbal hair growth supplement called Shen Min …100% all natural …ive been on it for about a week and notice my hair is falling out more..especially when i wash it i have more hair end up in my hands..i read in some posts that this is normal…but man i dont wanna lose all my hair if it’s not normal….should i stay on it ??

First, let me say that losing hair may be normal for you. What you want to do is postpone what is happening to you as long as you can and reverse it if that is possible. Clearly what you are doing is not working, right? With that as a focus, read-on!

I’m speaking here as a physician in the United States, so my comments are based on regulations (or lack thereof) in the USA.

Herbal supplements are not regulated by the US government or health agencies, because they are not medication. And because it is not a medication, it should not make medical claims. When it comes to herbal supplements, it is a “buyer beware” market. Shen Min is making medical claims that have no basis that convinces me that it has any more value for growing hair than rubbing grass on your head.

No matter how many times I write about the many unproven products out there for hair loss, there seems to be a neverending barrage of people looking for magical cures for things that have no magic to it and is only a shortcut for disasterous hair loss. What surprises me is that men will do anything possible to avoid really solving their hair loss problem. Every day that a balding man loses in addressing his hair loss properly, is a step he’s taking to becoming balder and balder and balder and balder… until there is permanent balding. I sometimes grow frustrated with saying the same thing over and over again, but I will persist because it is important to educate people. Get a proper diagnosis by getting your hair mapped out for miniaturization , and then if there is genetic balding, finasteride is the only FDA approved oral solution for stopping or reversing it. As a hair transplant surgeon, I make my living putting hair back in the bald man, but if you think this through, why would I tell you the way to avoid my transplant option? The answer is clear to me — it is best for the patient. I even mapped out the hair on one of my sons and put him on Propecia because I knew, I absolutely knew, he had genetic balding. Much of the hair that he was losing reversed and unlike the person who asked the question about Shen Min and got sold a bill of goods, my son got what he wanted — his hair back.

Tags: hairloss, hair loss, shenmin, shen min, herbal, supplement, finasteride, propecia, hair transplant

Low Hormone Levels and Hair Loss

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

Thanks for all the insights. I began worrying about how loss at 21. 6 years later, it’s no longer a fear. It’s a certainty. In the past years I’ve spent researching hair loss, I’ve found your site provides the most honest and reliable advice and information anywhere. It might not always be comforting, but at least I know it’s backed by experienced professionals.

A while back ago I saw a physician after hearing hormone levels may affect hair loss. I learned my testosterone levels and HGH levels were extremely low. This doesn’t suprise me, because I can probably still pass for a 16 year old.

But if this were the case, DHT shouldn’t be the cause of my thinnning hair, right? I’ve read HGH therapy can grow thicker hair, but I’ve also read the opposite.

Also, my hair isn’t thinning in the same pattern as most of the pictures I’ve seen online. It’s thinning equally from front to back. Is this normal, and do you think hormonal therapy might be a viable option to regrow hair in a case like mine?

– Thanks again

HGH (Human Growth Hormone) therapy is a known cause of hair loss. I think that you are looking for therapies, solutions, and causes in the wrong places. I do not have the luxury to examine your hair loss pattern, but you may not have a typical male pattern hair loss. If you are concerned about hair loss and a definitive diagnosis, you need to see a good doctor who can view you scalp hair under a hair densitometer and map your scalp for miniaturization patterns. It is impossible to give you a medical opinion on the cause of your hair loss without a proper examination.

Tags: hairloss, hair loss, hgh, hormone

Shaving Donor Area for FUE

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

Hi, I am scheduled for a minor FUE procedure to fill in a scar on my scalp, (non-transplant). My hair is very long, and I found out that the back of my head would have to be shaved. My question is, how much of the back of my head will be shaven if the procedure only requires 100 grafts? Would I be able to hide this shaven area will the rest of my hair while it’s still short like that? And also, about how long would my hair take to grow to a normal lenghth again? How many inches does hair grow in a year? And for my final question, to bypass this whole shaving back of head thing, would it be possible to retrieve these hair from another part of my body since there is such a little amount to be extracted?
Thank-you so much

These questions should have been addressed between you and your doctor. If not, you should call him or her and ask these questions. I think that the actual answer can be seen by looking at the creative way we extracted grafts with FUE. Generally, for a 100 graft FUE procedure, your hair would not require extensive shaving and what shaving was done should not be detectable (the photos below show how well the FUE shaved sites are covered when the hair is left long).

Normally your hair grows at 1/2 inch a month (so 6 inches a year) on average.

There are doctors who do body hair transplants on the scalp. However, these are not proven or widely accepted techniques. More importantly, body hair has a short growth phase and long sleep phase which makes it a poor transplant source.

Tags: scar, hair transplant, fue, female, woman, hairloss, hair loss

How Will a Patient Know if They Lose a Graft?

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

Hi Dr. Rassman,

How does a transplant patient know if they have lost/dislodged a graft? Will a lost or dislodged graft always be associated with bleeding and/or pain, or is it possible to lose grafts and be completely unaware. I think for many of your readers who have recently had transplants, it would be helpful/reduce the stress in the interim between grafts falling out and regrowing months later to know what may indicate a lost grafts versus the expected shedding that is supposed to happen. Thanks, as always, for your time and help.

After the first day (the first few hours by the time you get home) your newly transplanted grafts will have set in and they should not dislodge. If you see something that looks like the pictures on this page, then it is a graft. It would be highly unlikely for these to come out after 3 days post surgery, unless you pick them out. To be a graft, all of the elements of the anatomy should be there.

Some people mistake the hair follicles that come out at about day 7-12 with hair and some surface skin (even with a bulb) as grafts. In a published paper we wrote, the grafts are clearly locked in place at the worst case 10 days after the transplant, or as soon as 3 days after the surgery, provided that all scabing is gone.

Tags: hair transplant, hairloss, hair loss, grafts

My Doctor Told Me Propecia is a Feminizing Drug

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

A dermatologist prescribed propecia to me, telling me it looks like I have MPB, but my GP told me that I shouldn’t take it because it’s just a “feminizing” or “demasculinating” drug. I have hesitated using it out of fear of both the reported side effects and the limited long term studies done on this hormonally-influencing drug. Can you comment on these concerns? What is your advice? Where can I go to get a thorough and proper examination? And about how much does that cost?

I do not like using the word “ignorant”, but according to the Merriam Webster Dictionary, your GP is “lacking knowledge or comprehension of the thing specified”.

Propecia (finasteride 1mg) is a drug that inhibits testosterone from being converted to dihydrotestosterone (DHT). DHT is responsible for male pattern hair loss. Propecia will not make you into a woman or produce changes that are characteristic of women. Some of the side effects of Propecia are an increase in libido (possibly is frequently 1 in 10 people in the first few months of treatment as the testosterone rises) or decrease in libido (1 in 100). The long term (5+ year) studies done on Propecia shows benefit for male pattern hair loss, thus it is the only FDA approved drug for that purpose.

If you need further information and an evaluation of your MPB diagnosis, I would be happy to see you and answer all your questions in person at my NHI office in Los Angeles. Just reference this BaldingBlog post when you see me.

Tags: propecia, finasteride, hairloss, hair loss

How Many Follicles Required to Fill in This Scar?

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

Hi, I was just wondering about how many follicles would be needed to fill in an inch long and a few mm wide area of scalp?

Tootsie PopHow many licks does it takes to finish a Tootsie Pop? In other words, I couldn’t tell you how many grafts would be required just by the simple question you asked. It depends on what you mean by a few millimeters — two, three, five?

It would also depend on:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

Generally you can achieve a good cosmetic effect with about 20 to 40 follicular units per square centimeter, but that number does not reflect the local skin dynamics or how the surrounding hair may lay.

Tags: scar, hair transplant, hairloss, hair loss

Woman Losing Hair and Possibly Her Husband

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

Hello,
I’m a 26 year old female. I have been losing hair for the past 10 years and tried many things to improve it. AFter researching extensively about hair loss I’m now taking Biotin and B-Complex supplements. But I still have not seen any result. My husband has lost interest in me because of this. I don’t want my marriage to break because of my hair loss. Is there any way to prevent hair loss . My mom and my brother have a similar hair problem. is it hereditary? Is there any medication to improve my Hair loss. Please Help.

There are many causes of female hair loss. Before any treatments, you must find the correct diagnosis. More importantly, you must rule out any treatable medical causes of your hair loss. You may want to see a medical doctor who can do blood tests and/or evaluate your hair for any miniaturization pattern. I realize that in our society hair loss is a very emotional process for men and women. We identify much of our sexuality with our hair. It is not normal to lose a husband so I suspect there may be deeper relationship issues and that hair loss is not the sole cause of that problem.

Tags: hair loss, hairloss, female, woman, women

Bald at 3 Years Old

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

I am most pleased to contact you from Tbilisi, Georgia. I am male, 24 years old.

I would like to tell you about my problem which occurred at the age of 3 when my hair started falling out (circumscribed alopecia) which has resulted in full baldness and continues till today. It should be noted that a genetic factor is absolutely excluded as far as no one in my family have ever had similar pathology. My parents associate this disease with a strong stress and fear. The treatment which I have undergone over many years in my country yielded no result and therefore, I am kindly asking you to assist me.

I learned about your clinic a week ago and I was greatly delighted as after many hopeless years, I am filled with strong hope. Please advise me if you are able to cure me at your clinic and let me know terms and conditions of treatment.

Thanks for attention! It is interesting to me, what result have been received at treatment total alopecia(circumscribed alopecia) in your clinic. Whether in my case probably treatment in your clinic and what result will be received? How many will manage the treatment in your clinic?
Thank’s for your attention

I believe what you are describing is a condition we call alopecia universalis. There is a population of people who have this condition appear at about 3 years old. The hair falls out in clumps and takes less than a year to complete. The end results are bald children and the condition is not curable. Please send me pictures of yourself now and if you have pictures of you at 3 years old, that might be helpful.

Tags: alopecia, hairloss, hair loss

What Procedures Has Dr Rassman Had?

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

Hi Dr. Rassman,

I’m wondering if you could tell us a little about what you’ve personally gone through? I’ve managed to gather, based on reading about half of all your entries (i’m aiming to get through all of them!) that you’ve had a full transplant and that you’re currently on Propecia, but I was wondering if you could elaborte.

Cheers

In the early 1990s I had three scalp reductions for balding in my crown. I realized after the third (about 8 months had passed) that I was worse off after the three surgeries than before I had them done. Worse off because:

  1. my bald spot returned larger than before I started the first procedure
  2. the skin was fragile, bleeding easily
  3. the scar looked like a Mercedes emblem on my head

I was not angry with my doctor because he had done what others were doing, practicing a standard of medical care that was sub-standard. What angered me was a phone call I had made. I called the authority on this surgery, explained what happened to me and found out that it was a common outcome for many patients. I remember clearly that when I asked him one simple question: What was this outcome not published? His answer was: It would be bad for business. I was sickened. I had personally performed 8 of these surgeries myself, one of them on my first cousin. He was the only one who had the complications of scars and the emblem on his head. We joke about it today and he never loses the opportunity to be dramatic about the impact of the scar I gave him. I transplanted his crown three times to try to make amends, and although he now has great results, he still teases me over his suffering.

Like him, I had hair transplants performed into the scar in the back of my head. I no longer belong to Mercedes and am a free man with a good head of hair. My crown (1600 grafts later, see below) is still slightly thin, but few people notice it unless I call their attention to it. I use a comb-back and the hair in front of the thinning hair covers the bald spot reasonably well.

 

Click the photo to enlarge.

Because of the scalp reductions I had, it was not reasonable to replace the swirl in my crown so I accepted a change in hair positioning for each of the grafts to enhance the comb-back styling that I had gotten used to. I often do this in people who have a supply/demand mismatch, where the supply is short and demand is high. On some patients where there is no demand mismatch (like with Patient CL and Patient OR), we can replace the swirl.

Tags: hair transplant, hairloss, hair loss, crown, rassman, photo

My Transplanted Hairline Was Too Low

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

im 22 and had 500 grafts done in my receding temples about 6 months ago. i experienced severe MPB at 18-19 and hairloss had been stable since then. the hairline was carefully marked by myself before the surgery so i cannot blame the doc, but now i feel it could have been 1/2 further up. the hair are very fine and not very dense, just as i wanted them on temples(not too dense, just enough to cover). in the future can these be moved 1.2 up??

Not really. It is very difficult to move transplanted hair. I tell patients that transplanted hair is always permanent and that is why it should be done right the first time. If removal was to be attempted, it would have to be done with a Follicular Unit Extraction (FUE) technique. You can have a brow lift which will give you a higher hairline, moving the transplanted hair upwards, but that is fairly radical surgery for someone of your age.

I am disturbed that some doctor would transplant a 22 year old and that the hairline would be placed low. The fact that there were only 500 grafts also disturbs me, because it indicates that the balding is not severe. Were you on Propecia? If not, then there is clear malpractice here. You need an expert to assess your situation.

A hair transplant is for life. That is why I constantly emphasize the Master Plan in hair restoration. To achieve the maximum cosmetic benefit from hair restoration surgery, a personalized Master Plan should combine the best information available with a realistic assessment of what your future hair loss may be. It is an integral part of the patient-doctor relationship.

Tags: hair transplant, hairline, hairloss, hair loss

Chemical Burn from Foil Highlight

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

A customer is claiming she recieved a chemical burn in my salon but I don’t think it is the correct diagnosis. She claimed that several days after she recieved a foil highlight with bleach she noticed a bald spot in her hair. She was not burned on the skin and the hair is not broken off but a bald spot is present. She felt nothing unusual during the service but insists it is from the foil. Is it possible we are responsible even with no scalp irritation or does it seem more likely there is another explanation.

Your question is a delicate matter in terms of liability and almost certainly will have legal implications. All chemicals and or medications may have a potential for side effects. It is impossible to know the cause of your customer’s hair loss without examining her scalp and hair. We all look for a cause and effect relationship, but sometimes the two may not be related and be serendipitous in terms of cause and effect. It is possible that the bald spot was there at the time of the bleaching (and not noticed) or that it would have developed, even without bleaching. Unfortunately, this person has control over what they will do about the bald spot. Aggressive lawyers may see $$$ while a doctor may look for a diagnosis like alopecia areata. The decision on her response is clearly out of your hands. In conclusion, there may or may not be a relationship with the bleaching she underwent. Even if there is a relationship, you may have done nothing wrong.

Tags: chemical burn, damage, hair, hairloss, hair loss

15 Year Old Losing Hair From Sides and Back of Head

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

For the past year I have been noticing my hair loss, and it is getting to the point where I can’t hide it. The part that scares me is that I am only a 15 years old male. Could this be male patterned baldness at 15? It is not just falling off the top of my head but also falling out the sides and the back. Is any of this normal?

While it may be normal (but rare) to be affected with male pattern hair loss at the age of 15, it should not affect the sides and the back of your head. You may consider visiting a medical doctor who can evaluate you for any treatable medical causes for hair loss, because your hair loss may be secondary to a medical issue. If you had a ‘typical’ case of genetic hair loss, there will be patterns of miniaturization seen in the distribution patterns typical of those defined in the Norwood chart. Mapping your head and scalp for miniaturization will show this if that is the case. Otherwise there are rare conditions such as alopecia areata or diffuse unpatterned alopecia (DUPA) which are generally not easily treatable conditions.

Tags: teen, hairloss, hair loss