How Many Hours Does Minoxidil Stay Effective?

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

Hi Dr Rassman, I thought I recently heard you say on this site that minoxodil stays effective for 22 hours, did I hear you right? Because my thoughts are that I would like to cut down my use of minoxodil to once a day if it would have the same effect and save $ or did I misunderstand what you may have been saying? Thank you. Great blog.

Minoxidil is a twice daily treatment for best results. You might get benefit once a day, but why take it once if twice a day is better (and the recommended dosage). It is not a very expensive medication, so go for it the right way.

Tags: minoxidil, rogaine, hairloss, hair loss

5 Months After Transplant, Still Redness and No Growth

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

I had a transplant in late-May. I still show no results and it is almost November. I also still have redness on my scalp. Shouldn’t I now show some hair growth? Should this redness have subsided by now? Finally, is Tricomin shampoo supposed to speed up growth?

If the redness and the lack of growth concerns you I would follow-up with the doctor who performed your surgery. Not everybody reacts exactly the same to the surgery, but it is relatively rare to see redness continue after the first month. With respect to growth, it may take up to a year to see the complete results. I would not put much faith in Tricomin shampoo to speed up the newly transplanted hairs. After 8 months, if you do not have styling length hair, then you might have a failure of the transplant, but wait it out before drawing conclusions.

Tags: hairtransplant, hair transplant, surgery, redness, growth

11 Year Old Girl Has Gray Patch of Hair

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

My daughter is 11 years old. We recently noticed a gray patch of hair along with a pink spot on her scalp. What caused this? She had braids this summer and it was not there. Please help because shse is being teased at school now.

Sometimes it is normal to have patches of hair that is different in color. I doubt it had anything with having braids. You may want to have your daughter seen by a dermatologist if you are noticing something different on her scalp. There may be a medical condition that may be causing the change in her scalp and hair pigmentation (such as ringworm, which is common in children).

Tags: hairloss, hair loss, child, ringworm, gray, grey

2 Months Post-Operative Trichophytic Closure (with Photos)

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

I thought it would be nice to share a 2 month post surgical donor wound (still a bit light pink) with hair growing out of the wound from a trichophytic closure. By the 4th months, this wound will become virtually invisible.

For more information about the trichophytic closure technique, see Techniques to Minimize Donor Area Scarring.

Click the photos to enlarge.



Tags: trichophytic, closure, hairtransplant, hair transplant, photo

What Can I Ask My Doctor? Nobody Has Any Clue How to Help Me!

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

(female) I think the biggest frustration is the fact that we search sites and find answers like: You should ask a local doctor… but the problem is that doctors either don’t know or don’t take the time to find out. I have been “undiagnosed” for almost 2 years. Severe hair loss (50%) burning scalp after hair fall, outer eyebrow loss, fatigue, hair growth on arms, visual changes, etc. but no abnormal hormone tests, no thyroid issues. It makes no sense and I can’t just keep asking doctors because they truly don’t know. I need to find out if I had TE and I was genetically predispositioned to FPB and it is DHT I need to be targeting or whatever. It gets very old when you watch your hair fall with no hope of stopping it. Please let me know if there is anything else (disease) I can research. Thank you.

I am sorry to read of your frustration and its unfortunate that this isn’t the first time I’ve read or heard similar stories. Its quite often, in fact. Even as a hair specialist, I sometimes do not have all the answers as to what is causing the hair loss. Many times doctors are just acting like mechanics. They fix a problem without fully understanding the cause.

In your case, the symptoms of visual changes, hair growth on your arms, fatigue, and burning sensation are very troubling to me. You need to find a doctor (I realize that is the hard part) that can sit down with you and find what is going on with you and explore all possibilities from Lupis to Multiple Sclerosis to Sarcoidosis to other female diseases like Chronic Telogen Effluvium. Many of these conditions require a biopsy and the diagnosis can be made under a microscope. There’s little I can do via the internet without examining you, and I don’t have any local recommendations in your area. I wish there was more I could say to help, but at this point my hands are tied.

Tags: hairloss, hair loss, disease, doctor, physician

Is Propecia Stopping My Beard from Growing?

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

Dear Dr. Rassman
I’m 20 years old, and I’ve been using propecia for one year. I would like to know, if one side effect of propecia is stopping the development of my beard-hair. I’ve heard that DHT is responsible for the development of beard hair and finasteride stops the production of DHT. Is this right?

That is an interesting question. Beard hair develops as you go through puberty as a secondary sex characteristic and DHT is one of the agents that cause its growth at puberty and beyond it. I have heard reports from a few patients that beard growth has been slowed by finasteride as was a maturing hairline slowed. It would not be what I would expect and neither are reported as a known side effect of finasteride. When I started Propecia, it did not reverse my nose hair, ear hair, my beard (which I hate) or my excessive chest hair (although one patient did report to me that his chest hair went away with Propecia).

Tags: finasteride, propecia, beard, facial, hair

Too Much Chlorine and Hair Loss?

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

Hello doctor,

My building water supply has too much chlorine in it in the ‘hot’ water. I have to take head bath with luke warm water so I have to mix hot and cold.

Is this the cause of my increased hair loss and thinning on the crown since moving to this building?

Does your opinion agree with traditional Ayurveda on this?

SwimmerChlorine in our tap water and hot water should not cause hair loss or increase your hair loss. It is an urban myth. If it was true, a disproportionate number of professional swimmers would be bald, as they are in a chlorinated pool all day long.

For readers that aren’t familiar with Ayurveda, it is a traditional, holistic treatment of medicine from India. From Wikipedia — “Ayurveda deals with the measures of healthy living, along with therapeutic measures that relate to physical, mental, social and spiritual harmony. Ayurveda is also one among the few traditional systems of medicine involving surgery.”

So if you’re asking if I agree with Ayurveda that chlorine is causing your hair loss — no, I do not.

Tags: hairloss, hair loss, ayurveda, chlorine, water

Any Danger to Grafts From Humidity 4 Days After Surgery?

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

Hi Doctor,

i Had hair transplant surgery in Thailand. First day was a rest day. Second day i went to his clinic and washed my head. third and fourth day I went shopping in thailand and nowadays the weather is quite humid there.

My question is When I was shoping (3rd and 4th day after surgery I had light exercises and in the hot climate in Thailand I began to sweat because of the of humidity. SO i quickly reached the hotel room and cleaned my scalp with baby shampoo as the doctor advised. my question is , is there any danger to the grafts because of this humidity and sweating?

After the second day, your hair transplant grafts should have firmly set in and humidity/sweating should not affect them (even light exercise). For more on physical exercises after surgery, please see Resuming Physical Activities After Surgery.

Tags: hairtransplant, hair transplant, surgery, activity, physical, exercise

Healthy, Thick Hairs Are Falling Out

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

Hi Dr. Rassman and Dr. Pak,

I am 29 years old male, taking Propecia for about 4 months now, and have 10% miniaturization, hair loss is not really noticeable. Also I am using a shampoo called Nioxin. But I see that a lot of hairs fall out when I am taking showers, combing my hair and just generally during the day. The hairs that fall out are healthy, thick hairs, but there are a lot of them, 200, maybe more! My questions are:

  1. Why is this happening? And is there any way to stop shredding so much hair?
  2. Another question I have is that, in recent years, my hair density seems to be thinner at the top of my head compared to the sides and back, even though the hair strands themselves are of same thickness. Is there a method to increase the density besides just taking Propecia?

Thanks very much!

You need to see your hair stylist for compounds that thicken the hair. Many of these compounds add water to thicken the hair as it is hydrophilic (water loving) and substances that cling to the hair follicle will increase the value of what you have. Usually, miniaturization of less than 10% is not really the classic miniaturization that we see in balding conditions. These miniaturized hairs may actually be the normal vellus hairs that are part of the follicular units in everyone. You should not be losing 200 hairs per day. If that keeps up you need to be evaluated by a hair expert as there may be a reason for that degree of hair loss. You say that the hairs that you are losing are healthy, thick hairs — well, healthy, thick hairs that fall out will not fall out in that quantity. There is a hair pull test which can be performed by an expert that will define if you are really losing hair at the rate you think.

Tags: hairloss, hair loss, miniaturization

Nourkin and Toppik

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

Are Nourkrin and Toppik ok to use together?

I’m female aged 23 and have been suffering from hair loss for 3 years. I have been using both products for a few months so far.

Nourkrin is a food supplement which contains marine based extract of proteins and polysaccharides, Vitamin C, Silica, Horsetail, and IgG. It is mostly used in UK. Toppik is a topical medication and contains Keratin, Ammonium Chloride, Silica, DMDM Hydantion, and Iodopropynyl Butylcarbamate and it is in particular (fiber like) form that sticks to the hair follicles to make them look fuller. There should be no negative impact with using them both, but you need to always remember that even these simple substances have risks at some level.

Tags: hairloss, hair loss, nourkin, toppik

Topomax and Lamictal Causing Hair Loss?

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

I am on Topomax and lamictal for epilepsy and have been experiencing hair loss problems since starting the topomax that seem to be worsening. I have been told it is a side effect of Topomax. Will this stop on its own? Is there anything I can take or anything I can do to mitigate the impact of topomax on my hair?

This is a subject you and your neurologist need to discuss. Many of these medications do cause hair loss. Drugs like minoxidil may work for men and women, and if you are a man, then Propecia may also help, but when the medications are working away at your hair as a side effect of the drug, then alternative drugs may be worth trying. This is a difficult problem, but you can not sacrifice your health for your hair.

Tags: hairloss, hair loss, medication, drug, topomax, lamictal

Scarring in Donor & Recipient Area, Body Hair, FUE

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

Hi Dr. Rassman,

I’m considering going in for a FUE hair transplant and I understand that there is minimal scarring involved. I was reading up on the New Hair Institute web site and noticed there are many “mini” scars. Will these scars be only in the donor area or where there is transplanted hair?

I’m also considering using body hair as a viable source for donor hair. I’ve seen a few surgeons doing this. Have you personally performed such an operation? I would love to hear your thoughts on this procedure.

Best regards.

Follicular Unit Extraction (FUE) produces very small scars in the donor area, usually less than 1mm (there are 25mm to an inch). The only way most people could see these scars is a complete shave of the head (not a short hair cut, which probably would not show any of these scars). In the recipient site, the grafts are always trimmed (in our office, anyway) to cut away the unnecessary skin so that these grafts should not produce any visible scar in the recipient area. My understanding from the recent ISHRS meeting in San Diego, is that most surgeons doing FUE do not trim the grafts and therefore may get very small recipient area scars.

I have commented on body hair transplants before, but I’ll recap the biggest problem with them. Due to the short growth cycle, body hair will not show up very well (quantity) because for every body hair that is transplanted, less than half of them will be in growth phase at any one time. That means that less than 50% of the hairs will grow according to what you can see. At the meeting in San Diego, one doctor who does a lot of body hair transplants showed two patients who had them done. The growth in numbers was far less than 50% of what the two patients and the doctor reported was put in at the time of the surgery. The only good news about what I learned at the meeting with regard to body hair is that the length of the hair does double to what the person had in the chest or back (natural position). I would want to have a face to face meeting to understand your focus on the body hair, why you wanted it, and to see what else was available to meet your needs.

Tags: hairtransplant, hair transplant, fue, body hair, bht, bodyhair, hairloss, hair loss, scar

Anticoagulants and Hair Transplants

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

What if your on coumadin, do you have to wait until your off the medication? I am told yes.

Just to clear it up for the readers out there, I believe you’re referring to waiting until you’re off coumadin before having a hair transplant.

It is wise to reduce or stop coumadin (an anticoagulant) prior to having a hair transplant. I have had the misfortune to do a hair transplant on a number of patients on coumadin (it can be reversed with Vitamin K) and on Plavix (can not be reversed). There was very mild bleeding from the recipient site the night of the surgery. The surgeon must understand why a person is on these medications and weigh out the safety of stopping them or staying on a lower dose of these medications. Each case is medically evaluated independently.

Tags: hair transplant, hairtransplant, coumadin, plavix, anticoagulant

Bald Spot Just Appeared on Back of My Head

/by William Rassman, M.D./31 /

I am a 21 year old Male who up until a few months ago had no problem with balding. I was getting my hair cut relativly short and my hair dresser noticied I had a bald spot on the back of me head about the size of a quarter. I kinda ignored it figuring it would grow back but it has been about 5 months now and my hair is longer but the bald spot is balder then bald and seems to be getting bigger according to other people (as I cannot see the back of my head). I was just wondering what the cause for this is and if it can be anything serious or just stress related possibly? Thank You very much.

Send me a photo of the spot you’re talking about so I can see what you’re referring to. At 21, you are relatively young for crown balding. I have some important questions for you:

  1. Is the spot in the center of the head where the swirl is located or is it off to the side?
  2. Is there still some hair present in this bald spot?
  3. Is there any balding or thinning any place else on your head?
  4. Do you have a family history of balding in the crown (back) of your head and if so, at what age did it happen?

A good doctor may be able to diagnose a possible cause, such as ringworm, alopecia areata, etc. There is not substitute to a good doctor’s examination for you. If this is genetic balding, you would want to get your hair mapped out for miniaturization as well as getting a HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/) as genetic hair loss has patterns of thinning which appear before developing a bald spot. The HAIRCHECK test will tell us if you have any balding elsewhere that you can’t see.

Tags: bald spot, baldspot, miniaturization, crown, hairloss, hair loss

My Dermatologist Stopped Prescribing Proscar for Hair Loss

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

I’m a male, age 27. When I began seeing a dermatologist 4-5 yrs ago, he prescribed finasteride 5 mg and had me cut it into quarters.

That went on for about a year or so, but then he said that there was some sort of regulation restricting physicians from doing this. Since then, I’ve been paying the higher cost of the daily 1 mg tablets. Was the doc telling the truth? I understand that the clinical indication calls for a 1 mg tablet, but are doctors really not allowed to prescribe the higher dosage with the understanding that the patient will do his part and cut the pill into the appropriate size?

thanks

Many doctors prescribe medicines for off label use. Proscar (finasteride 5mg) is a medication marketed for benign prostatic hypertrophy. Propecia (finasteride 1mg) is a medication marketed for androgenic hair loss (male pattern hair loss). They are the exact same drug with different strength dosing. That being said, if someone (or a computer, such as your insurance company) sees that you have been prescribed Proscar, they may think you have a prostate problem even if you were prescribed it for the intention of using it for hair loss. This is a story that is told by my Propecia drug representative – so there is obviously a bias there and I am not sure how true this story is — but it is plausible.

I give a choice to all my patients and do not favor one or the other, because they are the same medication in different dosages.

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