Wife Losing Hair Daily After Stopping Birth Control 18 Months Ago

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

My wife has been losing handfuls of hair for about the last year, pretty consistently on a daily basis. About 18 months ago, she stopped using birth control, and we thought that might be the cause. However, now a year later, we don’t know what’s happening. My wife has very dark brown, thick hair, but it has thinned significantly. Some seems to be growing back, but not at the same rate she’s losing hair.

At first, I thought it might be a form of Telogen Effluvium Hair Loss based on what I read about it.

She’s been to a few general practitioners, gynocologist and dermatoligist. None of them have really offered any help. Based on this brief description, a) what do you think the issue could possibly be, b) what kind of doctor should we be looking for that can actually give some answers, c) are there any nutritional steps we can take that would make a difference?

Thanks

I would want to have her hair mapped for miniaturization, because this might tell us if she has genetic hair loss that was precipitated by the birth control pills. Before recommending what to do, I would want to know what her hair looks like in every part of her scalp. Some doctors in the field of hair transplantation will map out her scalp, so look to the ISHRS.org‘s physician search and call some local doctors to ask if they do hair mapping.

Tags: hairloss, hair loss, birth control, bcp, women, woman, female

Matthew McConaughey’s Hairline… Revealed?

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

I knew his hair looked too perfect for it to be real. I mean even a hair transplant wouldn’t bring back ALL your hair you had back when you were your teens. And Matt seemed to get ALL his hair back in such a short amount of time. So, it is safe to say matt is wearing a gold old hair peice. Matts hair looked to perfect for it to be his. If everybody could get hair like his through a transplants (assuming he had some work done), everybody would be getting a hair transplant and you would be on of the richest men in America. LOL. Am I correct? I am not saying transplants don’t work but I have seen people with hair transplants and they just don’t seem to cover up a whole lot. That is why so many people are probably just shaving their heads because they know you have to keep on spending a lot of money on transplants to get your so called “desired look” and even then there are still balding spots that are visible. And don’t get me started about propecia. I think it is honestly BS. E-mail me and let me know what you think. Please, post this on your web-site. The pictures at least.

Article at – PerezHilton.com

Matthew McConaugheySince this site’s first blog post on Matthew McConaughey, we seem to be taken up with all of the focus on his hairline. I am not into sensationalism, even though I have elected to share what has been sent to me. I do respect a person’s need for privacy, yet there seems to be no let-up on the probing about Mr. McConaughey’s hairline. Many women think that McConaughey is the best looking man in Hollywood and one would ask if that opinion would persist if his hairline was kept ‘au natural’. Some members of our culture do judge the book by its cover.

One of the local doctors here in the Los Angeles area let the word out that he had done McConaughey’s hair transplant. Was it because McConaughey has done such a good job at presenting the perfect hairline image? I even commented privately to my staff that the claim that this doctor did McConaughey’s ‘transplanted’ hairline could be believed because work of great quality is often done by the best hair transplant surgeons in the business.

Based upon the photographs at the link the blog reader sent, then compared to our first posting about this, there appears to be no change in McConaughey’s hairline from the mugshot taken in 1999. It would be in poor taste and a violation of the patient’s rights to even admit to performing the surgery without the express permission of the patient — not to mention that it would be outright fraudulent for any doctor to take credit for a stylist’s apparent hairpiece.

Update, Sept 29 2006: Another reader just sent this article that has apparently more recent photos of Matthew McConaughey, where his hairline can be seen (for those that are interested) — Splash News Online.

Tags: hairloss, hair loss, hair transplant, hairtransplant, hairline, mcconaughey, celebrity

Can Trichophytic Closure Technique Remove My Scar?

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


As you can see in the picture I have had 2 HT strip scar procedures. I always liked to cut my hair short with a 1# guard but after 2nd HT scar (top one) I cut hair with 2 guard and it’s still visible. Right now I don’t know if I should get another HT but I do want repair work.

If I go and get the Trichophytic Closure Technique can my old scars be removed? How can this be possible?

How about body hair transplants into my old HT scars?

Will I ever be able to cut hair close again with a 1# guard?

Thank you

No.

All cuts will produce a scar.

The worst doctor with the worst technique can operate on one patient and have a great result with minimal scarring. Likewise, the best doctor with the best technique (using Trichophytic closure, etc) can operate on another patient and have a poor result with wide scarring. In other words, everybody heals differently and some people are more prone to scarring.

Generally a Trichophytic closure technique will benefit 1mm of the scar margin. So if you have a 5mm width scar, a Trichophytic closure technique will make it look more like a 4mm scar. It is obvious that the wider the scar is, the less benefit will be obtained by the Trichophytic closure.

At NHI, we offer free scar revision to our former patients. Sometimes we are able to achieve an improvement, but as stated earlier, there will always be a scar.

Body hair transplants are not considered a standard of care in my opinion and are still controversial because of their long dormant stage and growth cycles.

Tags: hairloss, hair loss, hair transplant, hairtransplant, scar, trichophytic

DHT in Sebum

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

I think its been scientifically proven that sebum contains DHT. Based on that fact I have a few questions

  1. Can you explain the difference of DHT in sebum vs. the DHT that causes MPB is genetically senstive follicles and why DHT in sebum would not cause MPB? Im asking because I was the one who posted about worries of not washing my hair/scalp consistantly, could have caused hairloss. Its possible in a 4yr period I went up to a month w/o washing my hair with shampoo, although I did take a shower daily, so the hair/scalp did get wet.
  2. Also I have a fairly hairy body and was wondering since I really only washed my face consistantly because of compulsions namely acne on my face,by not washing away sebum on my body caused more hair growth that I would had experienced if I washed myself well during this time? Im using the basic concept that DHT promotes hair growth on the body and hairloss on the head.
  3. Finally is there a definitive correaltion between hairy body and MPB? I was wondering because you always talk about the differences between maturing hairlines and actual MPB, would it then be your recommendation to males to wait taking propecia or any other med for MPB until you see definite thinning on the crown and vertex vs just some recession and minuaturization along the hairline?
  4. How common is it to see males have really prominate recession (NW2-2.5) in their 20’s but then just stabilize and not have any thinning on the vertex and crown? I think of Bush Sr. if you pull up a pic of him in his 20’s, he had definitive recession but then it just stablized and now about 50 yrs later, he basically has the same hair although alittle thinner due to aging.

Your post is a bit troubling to me.

How did you go four years with only washing your hair maybe once a month with shampoo? That sounds like a hygene issue.

I believe your logic is a bit flawed. Male pattern balding is associated with DHT, but DHT is NOT the only cause of male pattern balding. In other words, just because it is cloudy on a rainy day does not mean it will rain if it is cloudy. Thus, DHT is only part of the puzzle in the cause of male pattern balding. That is why finasteride (Propecia) does not always work on all patients. The cause of male pattern balding in its entirety is still not completely understood.

I do not believe there is any scientific proof that DHT in sebum is the cause of hair loss. Even if was true, it would not be the ONLY factor in hair loss. Thus the basis of your following questions is subject to a false assumption (sorry).

The difference between a maturing hairline (normal) and receding hairline (male pattern balding) has to do with the location of the recession and how far the recession goes with respect to basic proportion of an individual’s face. Keep in mind that everybody’s face is unique and there are subtle variations. To be more scientific (for an individual case) more detailed examinations (including a miniaturization study) and a complete history of the hair recession would be appropriate.

Increased body hair does not correlate well with MPB.

Tags: hairloss, hair loss, sebum, dht, mpb

Using Body Hair for Eyebrow Restoration

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

(male) I have a question regarding eyebrow restoration. All of the websites I’ve been to for doctors who specialize in eyebrow restoration describe the procedure in the same way. They all talk about using donor hair from the scalp. Is there any alternative way of obtaining donor hair, i.e., from a different location on the body, so as to eliminate the issue of transplanting hair that may or may not have the same characteristics as eyebrow hair, and hair that will continue to grow unless trimmed periodically for the rest of a person’s life? What about using arm hair, leg hair, or chest hair? Also, is it possible to obtain donor hair by extracting, rather, plucking, existing eyebrow hair? Can the follicles be extracted that way?

Body hair has a long sleep cycle. For every body hair that you transplant, less than 4 out of 10 will grow at any one time because of this long cycle. Hair from different parts of the body have different sleep cycles. I’ve answered this before a few times, most recently here.

Your thinking is good, but the cycling of the hair makes this approach not practical. I would be reluctant to moving eyebrow hair around. There is a possibility that if it is move, it may not regrow, so I avoid this solution. All hair can be extracted using the FUE techniques that I have pioneered (see Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation).

Tags: hair transplant, hairtransplant, body, eyebrow

DUPA and Propecia

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

Hello Doctor,

Do men with DUPA respond to Propecia? Will it work on the area behind the hairline?

Thanks

For the classic DUPA that I defined in the literature, in my experience, some patients will get some benefit from Propecia. If Propecia (finasteride) failed to work in a 12 month period, it might be worth trying Avodart (dutasteride), knowing that it is not FDA approved for hair loss.

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

Female Hair Loss After Plastic Surgery

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

hello,
i’m a 25 year old female and little over 2 months ago i had a plastic surgery where i was completely asleep. Since then, my hair has been falling out more then it typically does. last month i got bronchitis and was given amoxicillin which did not work…the sickness progressed into pneumonia and now i am taking doxycycline. My hair is falling out much more rapidly now, but not in patches like alopecia typically does. The only visible area is at the front of my forehead. It is not very noticeable to others now, but my husband and I notice it. today i bought prenatal vitamins to help the issue but need some kind of idea whats going on. Is my sickness causing this to happen? will it grow back afterward? your advice is appreciated. thanks.

To understand what you are talking about, I would want to know what type of plastic surgery you had. Was it facial or brow surgery that could impact the hair and scalp on your head? Some people have surgical stress, which may induce genetic hair loss in those who are prone to it. I really need more information and the opportunity to examine you as well. Generally, hair loss may return after being lost in about the time it takes to cycle hair (4-8 months). See a good dermatologist and speak with your plastic surgeon, who is probably the best source of information for you that will be specific to what he did with you.

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

I Have an Itchy, Bright Red Scalp

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

(female) I have had an extremely itchy and bright red scalp for about 5 months. Now recently, it burns too. My hair is falling out. Looking back on pictures, I have about half the hair volume that I used to 2 years ago. My scalp is extremely oily also. I am a natural red-head, but now my hair is almost blonde in color and very brittle. I haven’t colored my hair at all. What could it be? I had blood tests done and they were all ok. I’m desperate for some answers! Please give me an idea and will my hair grow back?

There is no crystal ball. I can not tell you what is happening to you without examining you. If you are out of the California area, see a good dermatologist for an evaluation. There is no substitute for a good doctor and a one-on-one assessment in person. If you are in California (or are planning a trip out here), I have offices in Los Angeles, San Jose, and Newport Beach, and would be happy to provide a free consultation.

Tags: hairloss, hair loss, scalp, burn, oil, female, woman, women

High End Wigs

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

I did recently hear about a company that offered “high-end” wigs attached by some kind of inverted preasure. Do you know anything about this?

I do not know what you are referencing here. There is one company that offers ‘high end wigs’ for a starting fee of $50,000. They use small clips to attach the hair system to the hair that is still there, one by one. There is a great deal of maintenance as the hair grows, the attached artificial hair must be advanced one by one to the growing hair to make up for the growth. If you want a referral to this high end wig maker and can afford $50,000, call my office. This company has offices in Beverly Hills, New York and Paris, although I do not recommend them as a rule.

If you send me more information on the ‘inverted pressure’ attachment system, I will give you an opinion.

Tags: wig, hairpiece, hairsystem, expensive, hairloss, hair loss

So Where’s the Generic Propecia?

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

Dr,
Any word on generic propecia getting to the market yet? I know some company has the patent and that you would keep an eye on it, but I havent heard anything.

  • Propecia is a brand name for finasteride 1mg tablet. Propecia (finasteride 1mg) is still under patent protection and is not available in generic formulation.
  • Proscar is a brand name for finasteride 5mg tablet. Proscar (finasteride 5mg) is now available in generic (less expensive) formulation.

There has been some confusion on websites that Propecia (finasteride 1mg) will be available in generic formulation, but it is my understanding that it is not the case. I know it has been pointed out here that 1mg finasteride was listed on the US FDA website, but it being listed as approved for sale is different from it being on sale (which in my understanding would be in violation of Merck’s patent rights). This applies to countries where US patent laws and treaties exist.

Since Propecia and Proscar are both the same medication in different strengths (1mg vs. 5mg), some patients prefer to save money and take generic Proscar (finasteride 5mg) and use a pill cutter and divide it into 1/4ths (which makes about 1.25mg). When a pill cutter is used, it often is not exact and there is a tendency for the pill to break apart so that you have to estimate what is about 1mg. I personally do not think that there is a difference if you are slightly above or below the recommended dose.

Tags: finasteride, propecia, proscar, generic, hairloss, hair loss

Propecia and Minoxidil Combo Questions

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

I am a 26 year old male who is experiencing early signs of balding on the crown and around the vertex. I have been to a trichologist who suggests that I use a combination of propecia and minoxidil to try to stabilse and hopefully regrow some hair. My question is; if I stop using one of these hair loss treatments would my hair loss accelerate quicker than if I never took them? Would you recommend a combination of the two drugs? Does stopping one have more of an effect that the other? And finally, what can I expect from this sort of treatment and if it is successful how long can I maintain my hair at its current stage? Many thanks

For a 26 year old, I do not recommend the use of both Propecia (finasteride) and minoxidil for the following reasons:

  1. Propecia goes to the root of the problem (assuming genetic hair loss is present).
  2. Minoxidil confuses the situation and does build dependence if there are benefits from it.
  3. If you stop taking minoxidil and there is dependence, you only know by stopping it (bad way to find out).
  4. In most young men, minoxidil is of little help.
  5. I recommend minoxidil only after Propecia fails to work to meet the expectations of the patient. The incremental value of minoxidil will be seen 8 months after starting it, so at the least you will know if it is working.

If you stop minoxidil or Propecia, you will not lose more hair that you would have normally lost without having taken it in the first place. Lastly, I can not tell you what will happen to you from an email inquiry like this.

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

Women and Propecia

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

I am 49 year old female with very thinning hair, primarily in the crown. Can women of non-childbearing years take Propecia? Have any studies been done on its effectiveness in women?

There are women who take Propecia (finasteride) and it has worked for them. That being said, it has not been well studied in women and it is not recommended for women, because the long term effects on female cancer risks (ovarian, uterine, breast) are just not well known.

There’s a good overview written earlier this month about female hair loss options — Treatments Available for Female Hair Loss

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

Ephedra and Hair Loss

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

You recently answered a question about amphetamines causing hairloss in which you stated it can. Amphetamines are a CNS (central nervous system) stimulator that suppress appetite, increase energy, etc… Would Ephedra which also happens to be a CNS stimulator cause the same hair loss effects as amphetamines would? Basically, wouldn’t amphetamimes and ephedra physically stress the adrenals of the body? I have used ephedra for almost 3 years daily to help with workouts and during this time is when I noticed my hair thinning/miniaturizing…….

You seemed to have answered your own question. Yes, ephedra can cause hair loss.

Tags: ephedra, hairloss, hair loss

Father Went Bald at 19, I’ve Still Got My Hair at 21

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

Hi! My father started balding, according to him, when he was 19, and from there it progressively got worse. Now, only a horse shoe of hair remains on his head. I’m 21, and my hair is very thick, and it continues to grow without stop. Moreover, it seems like, genetically speaking, i didn’t inherit his side of the family, i look nothing like him, and my appearance looks like family members who have had thick hair for all their lives. Does this mean, taking into consideration that i have a thick set of hair, that i didn’t inherit those genes?

Norwood Class 7Your father sounds like a Norwood Class 7 patterned hair loss (see image at right). Usually if you are going to inherit this pattern, you would already have signs of it as that pattern usually starts showing miniaturization at your age. These very advanced hair loss patterns are nearly complete by the mid-20s. That is, of course, no guarantee, but it does sound like you have inherited your hair genetics from some other person in the family.

Until you reach around age 26, you will not know if you are going to have genetic balding (possibly a balding pattern less severe than your father’s pattern), as most men show some signs of hair loss by that age if they are going to develop genetic balding.

Tags: hairloss, hair loss, genetic, miniaturization

Losing Hair from Coumadin (Warfarin)

/by William Rassman, M.D./10 /

Why can hair loss occur after having been administered Coumadin? What causes this? Do the majority of Coumadin patients experience this? Please offer any information regarding hair growth after.

There are many medications that causes hair loss as a side effect. Coumadin (Warfarin) is one of those medications that may cause hair loss. Nobody really knows why this occurs.

There are two important points patients should understand:

  1. If you are on a medication under the care of a doctor, you should NOT stop the medication on your own just because you believe it has an undesirable side effect. You need to address your concerns with your doctor and explore other options TOGETHER. Your relationship with your doctor should always be thought of as a partnership.
  2. The relationship between your hair loss and a specific medication may just be a coincidence.
Tags: coumadin, warfarin, hairloss, hair loss