I am just 15 and i am male. About 3 years ago i got nits and bought some conditioner for it. My scalp reacted with it and i got dandruff. My peers teased me about my dandruff and i started frantically rubbing my hair to get rid of it. When i was 14 it turned into pulling hair from the very centre of my scalp. i didnt want to pull my hair and get bald but i had an urge and got satisfaction out of pulling. i have now got a small circle of baldness on my scalp and have managed to stop pulling from there but now im pulling from the back of my neck and behind my ears and it is thinning out there. I require help and advice and want to know:if i leave it will it grow back to normal?

This condition is called trichotillomania, which is an impulse disorder characterized by the urge of pulling out hair from scalp, eyelashes, eyebrows, beard, nose, pubic area, or any other area in the body. It is most often related to obsessive-compulsive disorders. Surgical treatments for hair restoration are usually not indicated, and the best treatment would be through psychotherapy and behavioral treatment. You should be seen and treated by a psychiatrist. If you can stop pulling hair, it will usually grow back in a few months with no further treatments, but if you have stopped pulling out your hair and the hair does not return, then transplants are a relatively fool proof way of handing it provided that you do not go back to pucking out the hair again and again.

Dr. Richard Shiell wrote the following about this disease: “By far the most common of patients with this disease are children of both sexes and as trichotillomania is an OCD, where stress seems to play a role, most of the kids just “grow out of it” with no lasting problems. Success rate very high (probably over 90 %)

Some do not grow out of it however and a small percentage of the females go on to be chronic pluckers. They associate the plucking with episodes of stress but I do not know if this has been verified scientifically. Most of the cases I see fall into this category and have plucked each hair so many times that the follicles in the patch cease to grow somewhere along the line. In other cases, not so long standing, the hair is short , vellus-like and snowy white in the plucked area. It is this group of women who acknowledge the plucking (past or present) and who are seeking help that you will have some success after transplantation. I cannot give you a figure for success as I have lost contact with all of these patients over the years. Psychologists tell me that medication will assist those members of this group who find it difficult to refrain from plucking.”

Tags: trichotillomania, psychological, disorder, treatment, hairloss, hair loss, pull, pluck

Hi Dr Rassman, you recently responded to one of my questions with this reply: No, I am not aware of any specific ingredients in any supplements (when taken as directed) that could cause hair loss. Some of the supplements that may have steroid type effects cause hair loss. Keep in mind any medications, supplements, and food when taken in excess can be harmful to your body. My question is, can you tell me what ingredients may have a steroid type effect so that I can know what to look out for? Thank you.

There are several types of medications with steroid activities, and I believe the ones that you are referring to are anabolic or androgenic steroids. Androgens are steroids that control the development and maintenance of masculine characteristics. They are also the ones used for muscle building purposes. Testosterone is the most well-known androgen and is prescribed for male patients who don’t produce it regularly, such as patients with delayed puberty. There are several other androgens including Dehydroepinephrone (DHEA), Androstenedione, Androstenediol, Androsterone, and Dihydrotestosterone (DHT) with somehow similar effects. The anabolic steroids may also be ingredients of other commercial products. They are used for treatment of body wasting in patients with AIDS and other diseases with loss of muscle mass. Athletes and others abuse these steroids to boost performance and also to improve physical appearance. The side effects of anabolic steroids could be severe and are not limited to hair loss, and it is necessary for anyone who takes these type of steroids to discuss their potential side effects with a doctor.

Tags: steroid, anabolic, androgenic, hairloss, hair loss, dht

Hi, I’m 22/M and have had thinning eyebrows for the past 6 months. I used a product called Brow Boost “conditioner” from Billiondollarbrows.com that was suppose to thicken eyebrows and promote new growth. After using the product for a week I was seeing new hairs growing in and old hairs getting thicker. Then on day 8 my eyebrows started to fall out. I discontinued use of the product 3 days ago and I’m still loosing eyebrow hair and eyelashes as well. The manufacturer gave me no help they could only say that “its extremely rare to loose your eyebrows using our product”. Can you please give me some advice, short term and long term? How long am I going to keep loosing my eyebrows for?

Conditioners usually have one or some of the following ingredients: moisturizers, reconstructors, acidifiers, thermal protectors, glossers and/or oils. Some of these will add small molecules to the hair shafts. I don’t know what the contents of the conditioner you used on your eyebrows are, but they shouldn’t cause any permanent damage to hair. It is difficult to say whether you are losing hair due to this new conditioner or this is only prolongation of your baseline loss. If any doubt, stop the product and hopefully your eyebrows will grow back in a few months. A series of autoimmune and genetic causes may be responsible for loss of eyebrows. If your eyebrow doesn’t grow back in 8-12 months, you can consult a hair transplant surgeon. Hair transplantation works nicely on eyebrows, but it has the disadvantage of growing longer than the normal eyebrow hair (since it is moved from the back of the scalp) and the hair must be cut every few days.

Tags: eyebrow, hairloss, hair loss, conditioner, browboost, brow boost, billiondollarbrows

I am sending this message, wondering about scar revision surgery on the scalp. I have extensive scarring from a surgery when I was younger. I was born with a hairy nevis on my head and had to get it removed…all this happened before I could remember. I now have been living with the scars ever since. The doctor who did the surgery did a great job because the scarring isn’t terribly bad. It’s probably about a 1/4 inch (maybe smaller) in size and runs pretty much the length of my scalp forking off in the front and back, with the front fork being considerably smaller than the back one. I am 20 years old now and have been wanting to have something done about this ever since grade school when kids would make fun of me when i got my hair cut short. I know it’s not possible to completely remove the scar but after all the strechting that has been done to my scalp is there anyway to “hide” it better with some sort of surgery/hair transplant??? What about z-plasty???

ALL surgical cuts will leave a scar (as it did on your case). A Z-plasty is an elegant approach to reduce the size of the scar, but you will still be left with a Z-plasty scar. In either case, a hair transplant procedure works wonderfully when transplanted into such scars, but before I point you in that direction, you need to have an expert look at the scars and examine your head. Please send pictures and I would be happy to review your case (please reference this blog posting when sending the photos).

Tags: scar, surgery, repair, z-plasty, hairtransplant, hair transplant

I started to loose some hair. I decided to buy some shampoo against hairloss and i found one at the pharmacies called ecrinal. On the box it says that it contains ingredients of lipidic nature that come from a gland located at the base of horses’ mane…tricholopids and A.N.P. So i’m wondering if this shampoo may actually be effective?

Mister EdFirstly, please see my previous post about Mane-Tail-Groom. There appears to be considerable support for this product in Europe. But that product is for horses and some humans use it on themselves — what you’re asking about is a shampoo for men and women that has an extract from a horse mane, right?

Dr. Pak first reviewed your question and in researching it, it was obvious that he knew nothing about this family of products and he wrote: I do not know of any “tricholopids” or “A.N.P.” (I don’t even know what that stands for). Furthermore, I am not a veterinarian and don’t know what relevance a horse’s mane has to do with human hair growth. I am curious what would make a horse’s mane better than that of a lion, perhaps? Or what about a hairy monkey? More importantly, how did they get these “glands”? How many horses’ glands were sacrificed for the sake of hair? I wonder what Pamela Anderson would say as the spoke person for PETA.

I think Dr. Pak has a humorous writing style, so I thought I’d try get a smile from you by posting his response. The serious answer to your question is — I have no idea.

Tags: horse, ecrinal, hairloss, hair loss, lipid, shampoo

I am a male, 24, and experiencing thinning on the crown of my head to the point where other people are saying “are you going bald?” and poking the thin area. Real nice. I tried a 5% minoxidil safeway knockoff and began to get redness and irritation on my scalp. I discontinued use but now have no idea what to do about my hair loss. Was this reaction due to the cheaper safeway brand? Should i try finasteride/propecia? What type of doctor should i see about the persciption pills? Dermatologist? please help I’m single and balding!

What you are describing sounds like classic male patterned genetic hair loss. You need to see a good doctor who will map out your scalp for miniaturization and then, assuming I am correct, put you on Propecia (finasteride 1mg). If the balding spot is the only sign of balding, then you have an excellent chance of reversing it with Propecia. It sounds like you had a bad reaction to minoxidil, but minoxidil is not the best medication, assuming that I am correct in the diagnosis (difficult without an examination). Some people experience irritation of the skin when using minoxidil (might be brand independent). A good dermatologist will do the right thing, but so can your family doctor. Make sure that no one even tries to suggest a hair transplant, as there are some less-than-ethical doctors that might recommend one for you.

Tags: hairtransplant, hair transplant, propecia, finasteride, hairloss, hair loss

Is it true that iron deficiency in women can cause hair loss that may appear to be AGA? If so, does supplementation actually help?

Also, do you know if oral birth control pills (Ortho-tricycline lo) can cause progressive hair loss while on them. I am not refering to hair loss after discontinuing but progressive loss over time.

Iron deficiency with or without anemia has been reported as a cause of hair loss. Hair loss seen in iron deficient patients is typically more diffuse. In patients who are prone to male pattern baldness, iron deficiency can speed up the hair loss process.

Birth control pills or medications that manipulate the estrogen balance can cause hair loss as well. Although any medication containing estrogen may cause hair loss, the opposite also occurs and in some situations estrogen may be protective. Excessive hair loss (telogen effluvium) could be often seen in withdrawal from estrogen, or in postpartum phase and can last about a year after the baby is born.

Tags: birth control, iron, anemia, hairloss, hair loss, estrogen

I am 54 years old and had a total hysterectomy 1.5 years ago. I started HRT right away (premarin), but it gave me migraines. Three months ago my Dr ran blood work and started me on HRT natural cream, by prescription, which contains triest, testosterone and progesterone. I noticed within the last 2 months that my hair has gone from VERY thick to very thin. Now I am noticing that the top front of my head is looking even thinner, perhaps balding. I also take 1 mg of Adavant daily since my hysterectomy, and 300 mg of neurontin for night
sweats/heat flashes. Can any of this be causing my hair loss?

Many of the things you mention, including the surgery and the medications, can be the cause of your hair loss. You need to meet in-person with an expert on the subject to (1) stop what is happening to you, and (2) try to reverse it.

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

I am a male in my early 20’s and I just came across your website. I have been on propecia for maybe 3 years and I have a feeling it is loosing it’s power. More so in the front of my scalp. What is another option? I received a book from a dermatologist and in it he lists some other medications. I don’t have the list handy but I would like to send you the list so you can let me know what you think.

I want to know about telogen effluvium. How do you know if you have it or if you are going bald? I read on the net that for telogen effluvium there is an overall thinning of the scalp but not baldness and that the hair comes back. But how long before the hair comes back? I am guessing if the hair doesn’t come back within a year then you are going bald I guess.

congrats on the site once again. Really helpfull.

It would be hard to judge about the efficacy of Propecia. You don’t know how you would look if you were not taking it. It is true that some patients experience better results than others, but your hair loss may get even worse if you stop taking it now (by catching up to the point of loss you would have experienced if you’d never taken it at all).

As discussed here before, the effect of Propecia on the frontal area is not completely studied. Current studies on Propecia indicate good result on crown and back of scalp. Other options are minoxidil and hair transplantation. Propecia and minoxidil are the only FDA approved medications that should be used for treatment of hair loss.

Human hair is in growth or anagen phase most of the time (between 3-6 years), and following that enters to a resting or telogen phase (about 3-6 months). The hair loss that we experience on a daily basis is due to shedding of hairs that are going into telogen phase (10% of our hair population at any one time). Telogen effluvium is triggered when a physiologic stress or hormonal changes cause a large number of hairs to enter to telogen phase at one time. Telogen effluvium is characterized by diffuse hair shedding. It is usually caused by a metabolic or hormonal imbalance or medications. Typically, recovery occurs within 6 months without any treatment. If your hair didn’t come back after 6 months, you should see a dermatologist for further evaluation and to rule out the other causes of hair loss.

At your age, with frontal balding, I would expect that you have genetic hair loss. The diagnosis is made by mapping out your scalp hair for miniaturization. This will show regional miniaturization weighted to the frontal area as you are describing. If the diagnosis is telogen effluvium, it will not show that pattern and it will be more generalized beyond the frontal area into the permanent zone.

Tags: hairloss, hair loss, miniaturization, propecia, finasteride, telogen effluvium, telogen, effluvium

This is a follow-up to a post from a month ago, How Can I Convince My Transplant Doctor to Refund My Money?

Hi i wrote to you in October about my bad hair transplant and i would like more advise from you because everyday i suffer from it. its making me hate my life ever since i had the procedure done. Here is the message that i wrote to you and you responded.

[note: see link above for full message and reply]

I would like to also add that when i tried to speak to the doctor he did not let me finish what i was saying. it was like he already knew what was on my heart and on purpose shut me up. Im not a cruel person so i did not argue back i just listened to all his rude remarks and hung up when he was done making me feel stupid. Every day i look at my hairline and it just hurts me deeply. I have spent over $7.000 and when i look at before and after pictures i still look the same. When i lift my hair up i can see that my left side looks like it has plugs and the right side is noticibly higher then the left. It has been 7 months and i still look like NW class 2 hairloss. im just tired of feeling depressed and feeling stupid. I dont know what to do anymore. im so frustrated with this. Im tired of waking up and falling asleep with the same though on my head. Im tired of seeing all the people in my college class with much better natural hairlines and feeling stupid that even after spending over $7000 i look worse then them. If theres anything you can do please help me

Now that you have waited the 7 months I suggested the last time you wrote to me, I would suggest that you get another opinion. If you can see me in Los Angeles or San Jose California, I will be able to render you an opinion and even offer to help you once I know what the problem is (in medical terms at the least so that I can frame the process). This does not seem like a comfortable problem you have, not just because of the lost money, but your perception of poor work. Call my office and let’s start off with a conversation. You can reach me at 800-NEW-HAIR (or 310-553-9113) and ask to speak with me (Dr. Rassman). Please reference this blog posting when you call. My heart goes out to you and I would like to see if I can help.

Tags: doctor, refund, hairtransplant, hair transplant, opinion, hairloss, hair loss

I’ve been using Propecia for about 3 months now and my testicles are extremely soft and sensitive. Should I continue using it? Will this condition worsen to where I may become impotent?

Although testicular pain and tenderness are sometimes reported by patients who are on Propecia (finasteride 1mg), the rate of this side effect is the same as those on the placebo. Impotence is not one of the documented side effects of this medication and I would doubt any permanent side effect like this would occur from taking Propecia. My advice to you is to stop Propecia for a few weeks and see if the pain goes away. You may also cut the dose of medication to half a pill each day (after stopping it for a week or so to see if the symptoms go away). Some of our patients had good results by cutting the dose of medication. If you continue to experience the pain, stop Propecia and discuss it with your doctor.

Tags: finasteride, propecia, testicle, teste, pain, tender, hairloss, hairloss

Hi Dr. Rassman. I recieved two hair transplant procedures in the late 90’s with micro/minigrafts. I just recently had them removed with lasers. It took me 11 sessions but i got there. I proceeded with 3 micropeels. I’m sad to say that I’m really not satisfied with the results. I want to know what your opinion is on permanant make up on the scalp? I really don’t want to proceed with anymore surgeries…You’re feedback would be greatly appreciated. Please note if you’ve ever seen permanant makeup on a hair transplant recipient ..thanks so much

I have seen quite a few people who had their scalp tattooed. I would suggest that this may not be the best approach for you. I will assume the the peals left you with discolored skin and the transplants that were lasered also gave you a less-than-normal looking scalp. Your situation is a complex one to solve since you have gone through all of the things (number of surgeries) you had. I would be happy to see you, but a face to face meeting is the only way I might be able to help you or anyone in a situation similar to yours. I have always said that the good and the bad news about scalp and hair surgery is that these are permanent procedures. You can try to undo what was done, but the results will never quite be 100% to where you once were. This is why researching your doctor is important and this is certainly why understanding what you are getting into is extremely important — before you ‘dive in’ and that goes for any procedure, cosmetic or otherwise.

Tags: scalp, tattoo, makeup, hairloss, hair loss, hairtransplant, hair transplant

I’ve been using a salve of the comfrey root and its flowers on my head for the last four years, it has stopped my hair loss and has regrown hair in my residing hairline. I did this experiment on myself based on the fact that comfrey contains a chemical compound called allantoin which is a cell rejuvenator. My barber will testify.

This appears to be a product with extensive claims that run the gamut — gum disease, hair care, hair damage, hair growth, hair loss, halitosis — and have no basis. If you believe in this product, I would suggest that the readers take notice of my slogan. Let the buyer beware.

There is generally interesting information about comfrey root, its history and much about its growth and use at Wikipedia. Many, many herbs are used for various conditions and when they work for one of these conditions, the person becomes an advocate. This type of advocacy is not scientific. We only know the successes and not the frequency of failures, because advocates do not talk about the failures. For the advocate, it may reflect their pride of authorship and an individual’s need to contribute to the welfare of fellow human beings, but as a clinician, if I recommend something (even an herbal type of product like comfrey root) I want to have evidence of its effectiveness and its safety.

Tags: hairloss, hair loss, comfrey, root, herb, flower

I am just wondering if you have heard of Adenogen, a hairloss product by Shiseido, one of the biggest cosmetic company in Japan. What are you thoughts on it? Do you think it is likely to work?

Here’s yet another product that costs quite a bit ($85) for a 5 oz supply and is claimed to be a “quasi drug” for some possible benefits of treating hair loss. My guess is that for that kind of money, I would think that it better work. I did find this forum topic on HairLossHelp.com that discusses Adenogen, if that helps any.

Anyone out there that has tried this product, please feel free to comment or let me know via the Contact page.

Tags: hairloss, hair loss, adenogen, shiseido, japan, cosmetic

I have had patches of sebhorrheic dermatitis on my scalp since I was little but since I started using Monoxidil for my hair loss it has spread over my entire scalp. My doctor perscribed the strongest medication that she could prescribe (clobetasol propionate) and it isn’t working at all. I just started using the monoxidil 3 months ago and was wondering if my scalp will eventually adjust and stop itching and flaking as bad?

It sounds like you are reacting to the minoxidil, which can increase the flaking of the scalp. You are probably not a candidate for minoxidil, so try stopping it for a week or two and see if the problem goes away. When people react to this medication, it usually does not get better and may actually get worse. Long term use of topical steroids are risky, so be careful.

Tags: dermatitis, minoxidil, steroid, hairloss, hair loss, clobetasol