Miniaturized Hair All Over, But Same Hairline As When I Was 16

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

I have miniaturized thinning all over my head (top, sides, back, sideburns and facial/chin hair does not seem as thick either) which began about 2-3 years ago. At the same time my thinning began it was accompanied by depression, fatigue. I have been thinning with every growth cycle and feeling depressed, fatigued ever since until this day. I have had my thryoid tsh checked 3 times (TSH- 1st-1.98 2nd- 2.28, 3rd- 2.36) I had testosterone checked 3 times as well (1st- 320, 2nd- 385, 3rd- 360…… ref 250-850) LH hormone levels were all on the very very low side when checked w/ all 3 testosterone testes. I had ferritin checked 105 (ref 22-322) I had knee surgery about 4 months ago (left knee bone graph w/ arthroscopy). Is there anything that is causing my total hair thinning/follicle shrinkage? Is it possible to have shrinking follicles/ thinning diameter hair that is not MPB related? I have absolutely no balding, no recession at all, my hairline is the same as when I was 16! whats the matter with me? should I use minox or propecia? I once tried saw palmetto when I first noticed my thinning about 2 years ago and it gave me ED! so I know I would probably have a tough time using prop or fin! thank you

Simply put, you need a caring doctor and a good doctor/patient relationship. That is the start of surrounding your problem. There is no easy way to get this over the internet.

Tags: hair loss, hairloss, hairline

Toppik Could Hide Skin Cancers

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

I have been using toppic for years and what I thought was a small mole on my scalp was actually a plug formed by the toppic. Now there is a small crater and I would like your oppinion on how to address it. It is now hard to use Toppic because the fibre fills the hole everytime I use it. Thanks Dr Rassman

Using scalp cosmetics like Toppik can be good, but not all good. Occasionally what you reported does happen. Toppik does successfully hide the scalp, reducing contrast between hair and skin. In doing so, however, it can hide things on the scalp (like folliculitis, skin cancer, various skin infections like ringworm). The best way to manage this is to wash it thoroughly at least once a week to get it all the cosmetic off of your scalp. There is no substitute in getting a good look at your scalp and you should examine your scalp periodically. For older men who run the risk of skin cancers, frequent self-examinations are critical. Cleanliness is the best way to prevent what happened to you. Another good scalp cosmetic worth looking at is DermMatch.

I am sure that some people will get a folliculitis and Toppik or DermMatch can be rubbed into any open wound creating a foreign body reaction. You might want to get a good doctor to look at you.

Tags: toppik, cancer, folliculitis, hairloss, hair loss

Propecia Dosage and Biotin

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

Hello Dr. Rassman,

I would like to know if there is any harm in taking one half of a milligram of Proscar a day instead of just a quarter milligram, reason being would it speed up the process? And, if I do start to take one half of a milligram until my hair loss is completely reversed, can I then step back down to taking just one quarter milligram of Proscar without any negative side effects? I want to be sure I don’t become dependant on taking one half of a milligram daily as this will cost much more in the long run.

Also, my dad suggested using a non-prescription drug, Biotin. Do you think I should take Biotin? Will it help, make no difference or be bad?

And I have started using hair gel again (daily), a small amount, will this be bad for the hair loss reversal?

And, is there a specific type of shampoo/conditioner I should use that will help my hair?

Thanks for your time

There is no major harm in increasing the dose of finasteride, except we see a higher incidence of decreased libido with higher doses. The higher dose does not, to my knowledge, have more value than the 1mg dose of finasteride for the treatment of hair loss. If you are cutting Proscar 5mgs into 0.5mg, then that is 10 pieces of a pill, something that is hard to do and regulate (produce a powder I suspect). A dose of 0.5mg of finasteride is reported to be 80% as effective as the 1mg dose. Now with all that said, either cut a Proscar 5mg into quarters (1.25mg) or take the full dose of Propecia (1mg).

Biotin will not hurt you provided that you take recommended doses, but it will be no substitute for the finasteride. I recommend no particular shampoo, conditioner or hair gel.

Tags: hairloss, hair loss, propecia, finasteride, biotin

3 Year Old Shedding Hair?

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

My son is 3 year old and has relatively long hair, however I have noticed that in the morning there must be around 20-30 hairs lying on his PJ’s or pillow, is this normal.

This may be his normal. Thirty hairs is not a concern unless you think that there is a real ‘bulk’ problem with thinning. People (children are people too) cycle their hair and lose about 100 hairs per day. These will be seen in the drain or on the pillow.

Tags: hairloss, hair loss, child, children, youth

Follicular and Lymphohistiocytic Infiltrate

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

I’m a 34 yo white healty male. When I was 30 (2 mts before I turned 31) I noticed a lot of hairs on my pillow and when I ran my hands through my hair. My hair was extreamly thick. When I was 32 I went to a local Dr. that is a hair specalist. He did a biopsy said 2 vellus hairs to 25 total hairs. Had mild follicular and lymphohistiocytic infiltrate. He says I dont have AGA.

Fast forward two years to today, Im 34 hairs still come out same rate(been on propecia 2 yrs) biopsy says I have 3 velous hairs out of 23 total hairs. My family has little to no MBP (only mothers brother and her father a little) I see zero frontal recesion, no balding in the crown. No change in the way my hair is around my head other than its getting thinner everywhere, sideburns,sides, nape of neck, crown, vertex,all thinning at the same rate. What are your thoughts?
Thank you

Biopsies should not be done to rule in the androgenetic alopecia (AGA) diagnosis. They should be saved for special forms of alopecia which require the microscopic analysis and staining techniques that show cellular details. When doctors find lymphohistiocytic infiltrate, they often look to classify other cells in the area of biopsy which should not be present in large quantities, for large quantities of lymphocytes, eosinophils, etc, may point to infection or auto-immune diseases. The diagnosis of AGA is better made with a video densitometer (see Miniaturization: Critical to the Master Plan for Hair Loss), as it is non-invasive and simple.

Tags: hairloss, hair loss, follicular, lymphohistiocytic, infiltrate, lymphocyte, androgenetic alopecia, alopecia, aga

Avodart Has 50% Better Regrowth Rate Than Propecia?

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

According to https://www.hairlosstalk.com/research/men/treatment1men.htm, Avodart is said to have a 50% better regrowth rate than Propecia. If one were to choose between staying on Propecia and achieve a lower regrowth rate or to switch to Avodart, what would be the pros and cons? Thanks.

Avodart is not currently approved by the FDA for the treatment of male pattern baldness (MPB). Propecia is the only oral medication approved by the FDA for MPB. Comparisons of Avodart with Propecia are conjecture by those who make such statements. It may be fair to say (without putting a percentage to it) that Avodart is reported (by physicians who use it regularly) to work better on some patients who are not getting good responses to Propecia.

The only real reservation I have about Avodart is that it has a very long half life in the order of WEEKS versus Propecia, which has a half life in the order of HOURS. A half life of a drug is the time it takes for half the drug to be cleared from your blood stream. This does not account for the drug cleared from tissue. The point is that Avodart is a strong medication and its full effects are not known. In my practice I do not generally recommend Avodart unless there are special circumstances.

Tags: hairloss, hair loss, avodart, dutasteride, finasteride, propecia

Taking Grafts From Side of Head for Small Scar Repair?

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

Hi, I was wondering, since my procedure only requires 50 grafts [scalp scar repair], do you think it would be okay for my doctor to make the incision to the side instead of in the middle of my scalp? Because I don’t want any scar to show when I have pig-tales or something. I forgot to ask this at my consoltation, although I doubt you would really be able to see it even if the incision was in the middle of my scalp, because the incision would be so small, and my doctor is using a trichophytic closure, so I doubt it would show anyways, but I just want to be on the safe side. Is the outcome any different if the incision is in the middle of the scalp or to the side?

Most people with a small number of grafts get an FUE harvest so that there will be no easily visible scar, no matter where the grafts come from. Alternatively, you could take the harvest with a strip from the sides, so that it could be parted in the middle without showing a scar. The FUE approach may be better. If you had your consultation here at NHI, please feel free to call 800-NEW-HAIR to schedule another consultation.

Tags: hairloss, hair loss, scar, fue, follicular unit extraction, repair

My Girlfriend Has an Itching, Burning Scalp That She Picks At

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

please help – my girlfriend is suffering from itching and burning on the top of her head – and she has little red bumps in that area. she picks at them until they peel or flake off – and now she is seeing her hair fall out in little small circles in this location. what can she do and what is causing this??? just some information: she is 50 y.o, in menopuase and has had this condition for about 3 months now. please help.

If she continues to pick, these bald spots may become permanent. The red areas you are looking at may be traumatic in origin from the picking. This is an obsessive condition called trichotillomania. She needs to see a good dermatologist to lock in a differential diagnosis and pick up therapy from the recommendation of the dermatologist. The signs of trichotillomania are very characteristic on an examination of the scalp, so a good doctor will easily identify this as a cause if it is what is happening to her.

Tags: trichotillomania, hairloss, hair loss, picking

Using Minoxidil At 15 Years Old

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

Hey Doc, your site is awesome. I have a question. I am a 15 year old Indian male, and I recently discovered my receding hairline. For a week or so I thought it was a mature hairline since everyone in my family has one (noone is bald though). Anyway I went to see a dermatologist and she said it’s male pattern baldness because of the recession on the sides. She prescribed Minoxidil 5 % for 12 months. I just wanted to know if you think I should take Minoxidil at such an early age or get another opinion. BTW, when I raise my eyebrows my last fold of skin is 3/4 inch away from my hairline. And the recession of my left and right sides are an inch away from my hairline.

I do not have the benefit of examining you in person and this site is not intended for personal medical advice and second opinions. From what you are describing, your hairline may be advancing from a juvenile hairline to a more mature hairline, albeit a bit prematurely. This is generally not considered male pattern hair loss. To be more certain, you should have your scalp hair evaluated for miniaturization with a hair densitometer.

Also, I am curious as to what you mean by “recession on the sides”. Are you saying the the sided temple prominences are a problem as well? If that be the case, then there is more here than meets the eye.

Tags: hairloss, hair loss, minoxidil, mpb

Robotic Controlled Hair Transplants

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

There’s a doctor in the bay area that is claiming to do hair transplants with robots. What is this about? Robots??? Can you tell me more about this?

Robot“Restoration Robotics, Inc. (Mountain View, CA) is a company using image-guided robotic technology to perform hair restoration by emulating the FUE technique. The robotic technology is in development. Currently, it is not approved by the FDA and the technology is not for sale”, said a company spokesperson when I contacted them. I also found this press release about Restoration Robotics from 2003, here.

I can imagine the scene of a movie with robots doing hair transplants, starring 3-CPO from Star Wars. I am sure that we will be hearing more about robotic-assisted hair transplants in the future and I doubt that it will be as frightening as I just made it sound. This is an exciting conceptual solution to the Follicular Unit Extraction (FUE) quality problem.

There is also the Medicamat Punch Hair Matic, first announced in late 2004 in this press release — Punch Hair Matic rescues baldies — which says: “Medicamat of France will be launching its new robot for hair transplantation”. I have been familiar with this company, which purchased the technology from a long term friend in the mid-1990s, Dr. Pascal Boudjema, one of the brightest inventors that the hair transplant community has ever had.

Their press release goes on to say: “The Punch Hair Matic (which is patent-protected) is a robot using micro-instruments to remove follicular units, which makes surgery simpler, faster, and less debilitating for the patient, with more convincing aesthetic results.” They report a very fast surgical time (2 hours to do 700 grafts) for the transplant (appears to be an FUE technique).

In many ways, Medicamat has been doing small punch grafting longer than I have, considering that they have been using smaller and smaller punches for many years. The evolution to smaller punches has been slow and methodical.

Today, the shoppers for FUE transplants pass through a mine field (a ‘buyer beware’ business for sure) where doctors from all over the world (with little or no training) are using manual techniques with varying degrees of success. Regardless of their expertise, they are telling the public that they specialize in FUE and are experts in the technique. At least, the robot approach promises to standardize the technique and the quality of the output. So we have a horse race now between two companies offering what may turn out to be competing technologies. Only the public can benefit here, so I sincerely hope that one or both of these companies succeed in making the business for automated hair transplants work.

Tags: hair transplant, robot, robotics, hair restoration

Masturbation! Hair Loss!!!

/by William Rassman, M.D./9 /

I started masturbating when I was 12 and I continue to do now at 19. All in all, I’ve averaged 3-4 ejaculations a day, all this along with a diet that is strictly based on meat. My baldness is unlikely to be genetic since all my have have kept thier hair. So is masturbating a lot along with a poor diet the reason for my hair loss ?

I’ve gone over this before, but simply put, masturbation will not cause you to lose hair. This is an “old wives’ tale” to stop what nature pushes men to do. If masturbating would cause hair loss (even 3-4 times a day) then the vast majority of men would be bald.

Poor diet can cause hair loss. You must have a balance of the proper daily recommended foods to get a good diet. Even a daily dose of ‘fast food’ should be able to get you the balanced diet to keep your hair.

Tags: hairloss, hair loss, masturbation, masturbating, diet

Bald Spot Occurs Every Other Year, Then Regrows

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

I have an occipital baldness. My family thinks that I have pulled it out. In actuality, my son has the same weak spot. My dad had this circle shaped baldspot on his occipital scalp. I noticed that when I shave/taper this area. It will grow back. Sometimes long sometimes short straight hairs will protrude.. At any given rate, the baldspot on the occipital area will occur every other year. Why does this happen?

I would have to render a guess. This is the first time I can remember having this question put to me. Synchronous hair cycling is something humans are not supposed to do. It is possible that your hair in this area has a shorter geneticaly programmed hair cycle than the surrounding hair. This would produce a bald area in the hairs that have a shorter hair cycle, but I would doubt that it would be a complete bald spot — rather, a thin spot. If you are near one of my offices in California, I would agree to map out your balding spot and compare it to the surrounding scalp. A study of the hair shaft thickness may demonstrate the answer to your question.

Tags: hairloss, hair loss, bald spot, hair cycle

As Accutane Treatment is Ending, Propecia Stopped Working!

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

Help! I’m a 36-year-old who has been on Propecia for about 8 years. Over the past couple of months, I have noticed a dramatic thinning of my hair. Interestingly, the thinning appears to have started just as I ended a 6-month Accutane treatment. What is happening? What can I do now that Propecia has stopped working? Am I a good candidate for Avodart?

I’ve written you three times on this matter. Please answer. I’m desperate!

You could have thinning secondary to Accutane build-up. Stopping Accutane may help. Avodart, as I have said over and over again, is not FDA approved for hair loss. Although it is used by some doctors, I have only prescribed it once and am not about to start going ‘off label’ for many reasons that I do not wish to discuss here. Simply put, safety and effectiveness have not been demonstrated for Avodart in the long term on young men with hair loss. I am not your doctor and you need to have a doctor who is vested in your condition. Between you and your doctor, you need to build a Master Plan to deal with your hair loss. You need to have your hair mapped out for miniaturization to see if the thinning you are seeing is ‘patterned’ or not. Pattern analysis of miniaturized hairs may help you distinguish the difference between genetic hair loss and Accutane effects. Give it some time and see what happens in the next 6 months.

Tags: hairloss, hair loss, propecia, avodart, accutane, dutasteride, finasteride

Going Off Medications Causing Female Hair Loss

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

Hello Doctor!
I’m not unique, but have a specific question regarding female hair loss & regrowth. I am slowly going off of Topamax (w/Dr. supervision), and have recently gone off my birth control pills. I have extensive hair loss, to the point of clogging the shower drain daily (frightening!). I’m using topical Rogaine 5%, but have only done so for a month. How long does it take for hair to grow back? I’m confident mine will once my body adjusts to all of the medication changes. And does hair typically continue to fall out post-medication use? Please advise? Thank you!

Your question has a number of moving parts. You have recently stopped oral contraceptives and are tapering down on Topamax (both known causes of hair loss). Also, you have decided to start using Rogaine 5% for your hair loss, which if tolerated well, can only help. The standard time for hair to grow back once it has fallen out and gone into a ‘sleeping cycle’ is about 4 to 8 months. If your hair loss is due to medication, it should hopefully grow back once the medication has been stopped. Given that you are under the supervision of a physician, I suggest getting a full medical workup to rule out other causes of hair loss.

Tags: hairloss, hair loss, female, woman, women, rogaine, topamax, bcp