Depression and Female Hair Loss

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

I’m a 21 year old female and I went through a serious about 6months ago deppression. I’m now loosing a lot of hair. I’m not taking any medication so, why is my hair falling, and what can I do to restore it? Thank you!

You need to get a good doctor who can map out your hair and scalp for miniaturization. There are many medical conditions that when combined with stress will produce hair loss. There are some blood tests that may have value as you need a diagnosis and then treatment. Please see my list of possible female hair loss causes here.

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

Propecia’s Effectiveness on Different Ethnicities

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

Hi, I am a 23 y.o. male and I have been experiencing steady hairloss since Jan 2005. Baldness runs in my dad’s side of the family. I have been on Rogaine for the past year and it hasn’t stopped the loss but only slighlty slowed it down. To be fair I have only been using Rogaine once a day for quite a while now. My hair loss seems to be even across the top of the head and I am not noticing too much of receding of the hairline just hair loss on top of the head. The loss has increased in the last three months ever since i started my new job and started getting a little more stressed. While the stress is manageable, hair loss is making me uneasy. I recently got a prescription for Propecia. My questions

  1. Will Propecia be effective given I have been using Rogaine for a while
  2. Does Propecia result in additional stress
  3. I am Indian – is Propecia known to be more/less effective on different ethinicities?

Thank you.

Here are the answers to your questions:

  1. Yes, Propecia is working through a different mechanism and will have additive effect if being used with Rogaine, and will be still effective if used after stopping Rogaine.
  2. I am not sure if I understand your question, but if you are asking about side effects of medications, it has been explained in several posts in this blog and emotional distress or anxiety is not one of them.
  3. Propecia was not exclusively studied on Indians, but there have been some variations in response to it in different ethnicities. The effectiveness of the medication on vertex baldness has been compared in different ethnic groups as below:
Hair number change in one inch (5.1 cm2) diameter (*)
  Propecia Placebo
Caucasians (1185 patients) +91 -19
Blacks (89 patients) +49 -27
Asians (17 patients) +53 -38
Hispanic (45 patients) +67 +5
Other ethnic groups (20 patients) +67 -15
 
(*) Source Merck
Tags: finasteride, propecia, minoxidil, ethnicities, merck, hairloss, hair loss, placebo

Contraindications of Strip Surgery?

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

Dear Dr. Rassman,

What are some possible contraindications in a strip surgery?

Also, is there any difference in the end cosmetic quality between FUE and strip? For example, would there be any difference in transplanted densities between the two?

Finally, if I were to get an FUE procedure done, would I most likely be able to shave my head later without noticeable “dot scarring”. I read on another forum that FUE creates a “confluence of scarring” where the tiny dot scars seem to merge into one another to create a big scar. Can you possibly clarify this?

Thanks

See the recent post, Is an FUE Procedure a Less Successful Hair Transplant?, which shows that if the quality of the extracted grafts are good, the end result will be the same for FUE or traditional strip surgery. Many FUE grafts are less than ideal, so there might be a difference if the extracted grafts are not perfect. ‘Dot’ scars may or may not be visible with a shaved scalp (razor shave). If your healing is good and the punch size is very small (0.9mm or less), the ‘dots’ may not be visible unless you look very closely. A short hair clipping (1/4 inch length) will not generally show ‘dots’.

Tags: hairtransplant, hair transplant, fue, strip, hairloss, hair loss, scar

Doctor for African Hair Type

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

I’m a Afro American 33 y/o woman who in the last year have been experiencing hair thinning ,sever hair breakage and dryness. Can you tell me where I should start? I am not aware of any doc that treat our kind of hair. I just want my hair back…and healthy.

Start off with a good dermatologist who may have insights into the hair problem and determine if you have hair loss developing. Speak with your stylist and see if the shampoos and conditioners you are using participate in the problem. If you are in Califormia, I would be happy to see you after your speak with the stylist.

Tags: hairloss, hair loss, african, black, dermatology, women, woman, female

Dramatic Change in Hair Texture

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


Hello Dr. Rassman, and thanks for your continuing work.

My “shedding” and permanent hair loss started in my early teens. Within about 5 years, my hair went from shiny, heavy wavy hair to coarse, brittle, curly hair (to this day). Everyone and my own mother too thought it was a perm.

What would account for this? I was diagnosed with hyperthyroidism, however, that was 20 years later after a baby and after enormous stress. My hair got even worse.

Could there be a connection between my teen hair loss and the hyperthyroidism in my thirties?

Thanks, and God Bless.

Female changes in hair texture that follows medical problems like hyperthyroidism will combine with your genetics to create a new hair (something different than what you had as a child). There may be a connection.

Tags: hairloss, hair loss, texture, hyperthyroidism, hyperthyroid, female, women, woman

FUE Robotics

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

You recently responded to a question on the balding blog that FUE will soon incorperate robotics. I’m trying to picture how this would work…. Will patients be required to wear a certain helmet of some sort so that their head remains completely still? Do you think that general anesthesia and paralysis would be necessary?

R2D2As you do not want to have a mobile robot like R2-D2 chasing the patient around a room, there must clearly have some head immobilization apparatus to hold the head steady. A smart robot will be programmed with enough pattern recognition to be able to adjust to slight movements. Heavy sedation (not general anesthesia) for the long, arduous process will also be needed. There will not be a helmet because, again, the robot needs to be smartly programmed. I have seen this robot in action. It looked like a scaled down version of the robots used in industry today (e.g. car assembly).

Tags: fue, hair transplant, hairtransplant, robotics, robot

Why Do All Young Hollywood Actors Have Great Hairlines?

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

Hi!

Do you think that it is common that young and famous persons take propecia prior to any experience of hairloss?

The reason for my question is that I am so astonished that rather young people in hollywood (say between 20-40 years), all seem to have a full head of hair! I cannot even come up with almost any names of young actors with an obvious receding hairline (as they get older), except Jude Law!

If they do not use propecia, how could this kind of luck of a full head of hair even excist, when balding is such a common problem amongst “ordinary people”??

There is no difference between vulnerability of Hollywood actors to keeping hair and the normal population. If there was, I would imagine all balding men would be taking acting lessons to get the positive benefits of that profession. I think that those men blessed with good hair have better opportunities for acting than balding young men. Once they make it, they do what they need to maintain good hair. That might include wigs, transplants, or Propecia.

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

Psoriasis in Donor Area

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

I have psoriasis (as know, non-curable) in a part of my potential donor area. Does this rule me out as a candidate for a transplant from that location? Is it possible to use other parts of the donor area since I have good overall density?

Psoriasis does not move, so it stays where ever it originally was (in the donor area in your example) and will not be transplanted to the recipient area. The psoriasis needs to be under good control if one is to use the skin from impacted areas for the donor site. One could be selective where the donor is taken from, but this will reflect supply and demand relationships for the donor supply and the size of the bald area.

Tags: psoriasis, donor, hairtransplant, hair transplant

Dermatologists Specializing in Alopecia?

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

In one of your comments you noted that there are certain dermatologists that specialize in the treatment of alopecia areata. Could you please provide the names of any that you are aware of (particularly those on the east coast as I live in the DC Metro area). Thanks.

You need to go to your family doctor and ask that question. Each doctor in each city has worked out the referral patterns for their patient’s best interests. I have a good doctor referral that has built a reputation — Dr. Richard Strick at UCLA in Los Angeles. You might check with the National Alopecia Areata Foundation for other sources.

Tags: naaf, alopecia, dermatologist, hairloss, hair loss, doctor

Maturing Hairline Questions

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

Hey, thanks for taking my question. I’d like to know if I’ve got a maturing hairline or if I’m going bald. I’m 20 years old and I’ve recently noticed my hair is thinning away around my temples, and that on the right side of my head the hairline is beginning to rise a little bit higher than it is on the left. The rest of my hair is as thick as ever. Just a few questions:

1. Is this probably a maturing hairline? I’ve read other questions and I noticed you said it develops between 17-29. Seeing as I’m on the younger end, does it make a difference how long it takes? Meaning, if you develop one at 17 do you start continued balding faster than a person who develops it at 27?

2. Do hairlines mature symmetrically?

Thanks!

Hairlines often do not mature symmetrically. If you do not have balding, then the maturing hairline will develop when it develops. No two people develop it at the same rate. My youngest son took 9 years to evolve, yet others will evolve it in a matter of a year to two. I do not know if Propecia will slow it down, but it is logical that this could be a side effect of Propecia.

Tags: hairline, mature, hairloss, hair loss, propecia, finasteride

My Grandfather, Father, and I All Have the Same Mature Hairline

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

Hi Dr,
I have a mature hairline (since 15) , and my dad and his dad both have the same hairline. No one on my mom’s side has/had a mature hairline. Is this an indication that I will take after my father?(he still has lots of hair)

Sounds like it. Is there balding in the family on either side? That could impact what will happen to you if there is.

Tags: hairline, hairloss, hair loss

Any Speculation on Worst Case Scenario of Dutasteride Side Effects?

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

Ok I know you can’t give me a complete answer for obvious reasons, but based on your currently knowledge and educated speculation, what do you think are the most likely possible side effects from using Dutasteride in the worst case scenario? Would it simply be a case of Finasteride x 10 (i.e. loss of libido)? I really wouldn’t mind just hearing your speculation, as i’m well aware that it hasn’t been fully tested yet.

Also would it be a simple case of getting a prescription from my local GP?

Dutasteride is a selective inhibitor of the type I and II isoforms of 5-alpha-reductase, the intracellular enzyme that converts testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison, finasteride acts as an inhibitor of only type II 5-alpha-reductase, and as a result, it is more specific, target oriented, and has less side effects.

If you are taking dutasteride for other indications, keep on taking it and you may get some hair growth as side effect. Based on current evidences, I can not recommend dutasteride solely for the prevention of hair loss, because:

  1. It has not been well studied for this purpose and as a result is not FDA approved for hair loss treatment.
  2. The optimum dose of dutasteride for hair loss prevention is not determined.
  3. The side effects of dutasteride are much more compared to finasteride.
  4. And finally, if you are considering its cost effectiveness, this is not in the picture anymore with new price reduction of finasteride (thanks to generic 5mg).
Tags: dutasteride, avodart, hairloss, hair loss, propecia, finasteride

Cortical Steroids and Effects on Hair Loss Medication

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

I have been reading that many skin problems, such as seborrhoeic dermatitis, may be associated with hair loss in balding males. For instance, the scalp can become itchy/flaky in regions of the hair thinning/loss. The application of cortical steroids (Luxiq, etc.) are often given to ameliorate the symptoms of the dermatitis, however can they have a deleterious effect in furthering your hair loss?? Do you know if these cortical steroids act to aid or hinder the effect of typical hairloss medications, such as Propecia?

SnakeYes, steroids can be a cause of hair loss in some people. Hair is a skin organ, but hair is only part of the skin elements. When the surface of the skin turns over faster than normal (we shed skin slowly and uniformly on a daily basis and replace from below, what is lost on the surface). Compare this to a snake, which sheds its skin all at once and replaces it before the shedding occurs. When skin is shed more rapidly, it builds up flakes of skin and some people call this dandruff. When it gets bad, it is called seborrhoeic dermatitis. It can be caused by external factors such as infections and fungal diseases as well. Steroids work well to control the autoimmune elements of the seborrhea, when it occurs, and antifungal agents or other treatments are needed (for example) when infections are present.

Many people think that seborrhea or dandruff is associated with hair loss, but this is not true unless the person picks on the skin and produces traction alopecia. When a scalp becomes balder, it becomes dry more easily. When there is hair present, flaking builds up in the forest of hair, so that when the skin turnover occurs more rapidly, the dandruff becomes a real social problem. For those interested in the chemistry of the relationship between cortical steroids and hair loss, please see:

Tags: hairloss, hair loss, cortical, steroids, effect, finasteride, propecia

Ulerythema Ophryogenes and Hair Transplants

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

1.I have a condition called Ulerythema Ophryogenes, i was thinking of getting hair transplants but i was wondering would they just fall out.

2.Also how often do eyebrow hairs usually fall out and regrow

Thank you for your help

According to eMedicine: “Ulerythema ophryogenes, a rare cutaneous disorder, is characterized by inflammatory keratotic facial papules that may result in scars, atrophy, and alopecia. This disorder has been described in association with other congenital anomalies such as Noonan syndrome, Cornelia de Lange syndrome, or Rubinstein-Taybi syndrome.”

Unfortunately, this is a rare condition that not many doctors (especially hair transplant doctors) have significant experience with. That being said, if you have this condition and also have genetic androgenic alopecia (or male pattern balding) your donor hair (in the back of scalp) should be considered permanent hair. There is no reason for me to believe that a hair transplant may not be successful. There may be a slight increased risk of scarring or discoloration on the recipient area.

With respect to the eyebrows that may be lost with this condition, a hair transplant may also work, but with the same caveat as outlined above. The growth rate (or the cycle rate) of eyebrow hair is different than that of scalp hair and it follows a one to two month cycle.

Tags: hairtransplant, hair transplant, ulerythema, ophryogenes, hairloss, hair loss, eyebrow