I’m 20, and My Hairline Has Matured More Than I’d Like

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

Hi,

I am a keen reader of your blog. I’m 20 years old (male), there is no balding in either my father/mother, or their father’s/mothers.

However, from early puberty, the corners of my hairline have “matured”, but a little too far for my liking. I understand that your general rule is not to perform surgery on young patients, however… if you are satisfied that there would be no further progression, would you “fill in” a young person’s hairline? .5-.75″ and also possibly lower the actual hairline down a small amount?

I know I’m in the UK and your offices are in the US, but I’ve not yet found what looks like a reliable, trust worthy, honest hair transplant surgery in this country! Approximately how many grafts/hours/sessions etc would the process take? I can e-mail pictures if required.

Thank you.

It is understandable that you do not like your current hairline, but even with no evident balding in your family, you may have genetic male pattern balding. It is difficult to tell how bald you may or may not be at such a young age. At the least, you need a miniaturization study, a good history, and exam — and then develop a good Master Plan for the future management of your hair loss.

There are doctors who are willing to transplant hair in patients who are in their early twenties with only slight balding or recession. However, I am cautiously resistant to the idea of lowering your hairline at this point, because I do not know if you will bald further as you get older. With that said, a hair transplant may accelerate balding and cause you to lose more hair, leaving you in a worse position than you are currently at. I would wait for perhaps at least about 5 more years before considering a hair transplant.

For more about the mature hairline, please see Maturation of a Hairline — Moving From Juvenile to Mature.

Tags: hairtransplant, hair transplant, mature hairline, hairloss, hair loss

DHEA and Hair Loss

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

Hi,

I have read confilicting information regarding DHEA supplements and Hair Loss.

  1. Can DHEA increase hair loss?
  2. Is this due to DHEA converting to Androstenedione then this converting to Testosterone and then on to DHT which causes the hair loss?
  3. Does DHEA cause direct problems to the hair follicles like DHT does?
  4. If you were to take a 5 alpha Reductase inhibitor like Finasteride would this help with any potential hair loss problems associated with taking DHEA? and if so would it be because it blocked the Testosterone (converted from the Androstenedione converted from the DHEA) from converting to DHT?

Thanks for your help

  1. Dehydroepiandrosterone (DHEA) does not directly cause androgenic alopecia (AGA), but may accelerate it.
  2. DHEA can potentially affect DHT levels, thus indirectly causing hair loss (via DHT).
  3. Dihydrotestosterone (DHT) does cause hair loss in men who are genetically susceptible to AGA.
  4. Finasteride is a prescription medication for men who have AGA. It is not meant for use with DHEA.
Tags: finasteride, hairloss, hair loss, aga, dht, dhea, dehydroepiandrosterone, testosterone, supplement

I Was Told To Sleep With My Head Tilted After a Hair Transplant

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

I just did a hair transplant procedure and I have been asked to sleep at a 45 degree angle with 3 pillows in order to prevent swelling. This is supposed to help the fluids drain. However, I find that this causes me to sleep with my head tilted forward. Will this cause stretching of the scar?

I know that I am not supposed to play sports or lift weights for several weeks (by the way how long before I can lift again?) because this can stretch the scar also. But wouldnt sleeping with my head tilted back be better? I am just concerned that sleeping with my head tilted forward would put additional strain on the donor scar.

You should be asking this question to your doctor. The instructions given to you post-op are relatively standard instructions. With respect to the stretching of your donor wound, some stretch is unavoidable. Head positioning after a hair transplant is less important after 3 days, as swelling is less of a problem.

Tags: hairtransplant, hair transplant, scar, stretching, stretch, post-operative, sleeping

Propecia and Zoloft

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

My question is about taking finasteride while taking an SSRI (Zoloft to be exact). Is there any interaction between these two medications that should be of any concern? I have been using Rogaine foam for a few months will little success (my problem is balding/thinning on the crown); and from everything I’m reading finasteride is a better, more effective option for the hair loss I am experiencing. I’m taking 50mg of zoloft daily, but for only 2 months now, for anxiety – the hair loss was going on way before. I am 38, and think what I am experiencing is somewhat normal for my age based on everyone else I know (who is my age), but if I can stop it that would be great. Thanks

As far as I am aware, Propecia (finasteride) does not have any interaction with other medications (including Zoloft). I do not know what you are experiencing and what type of hair loss you have. You should see a doctor if hair loss continues to be a problem and have a baseline miniaturization study to objectively document the progression of your treatment. There are rare reports of depression and mood alterations with Propecia so how this medicaion interacts with Zoloft is beyond my expertise. Discuss this with your prescribing doctor.

Tags: zoloft, propecia, finasteride, hairloss, hair loss, ssri, anxiety

I Have Hairy Knees, But Bald Shins

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

i am a 26 y.o. white male. I exercise regularly and eat a healthy diet and have no known health problems. I am embarassed by the unusual growth pattern of leg hair over the past 10 years. I have extremely hairy knees but almost no hair on my calves or shins. The skin on my calves is also very pale and thin and I am developing age spots. I totally avoid the sun in this area. Is there any way to improve this condition (with diet , medication, etc)and what may be the cause? I have no other symptoms. I would like to improve the skin on my legs at the very least.

I am sorry that I can’t offer much help, but that is just the way you are. You can try Rogaine (minoxidil) on your shins if you want to grow hair there, as it may work. On the bright side, at least you don’t have hairy palms.

Tags: hairy, knees, bald, shins, hairloss, hair loss, rogain, minoxidil

Take Propecia With or Without Food?

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

Dr. Rassman, first off, just wanted to thank you for making your skills, experience and educated opinions available to everyone around the world through such a fantastic site.

Quick question: is it better to take Propecia along with a meal or to take it on an empty stomach followed by a normal meal about 2 hours later (from an absorption point of view)?

Thanks again!

Take it any time with or without meals… whatever it takes for you to remember to take it every day. Some doctors recommend taking it in the morning when the testosterone level is the highest and I like that recommendation personally, as that is what I do.

Tags: finasteride, propecia, food, testosterone, hairloss, hair loss

I’m an Athlete, and Finasteride is Banned — How Can I Take It But Not Test Positive?

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

I am currently a college athlete taking 2.5 mg/daily of finasteride. I just noticed that it had been added to the NCAA’s list of banned substances. I do not take any performance enhancing substances. How long would I need to be off finasteride in order not to test positive? Any suggestions? I would usually know of the test a half day in advance. Thank you.

NCAAFirst of all, you do not need to be taking 2.5mg of finsteride for the treatment of male pattern hair loss. 1mg is the ideal dose.

Second, the half life of finasteride in your blood stream is 4-5 hrs. So it should be out of your blood stream within a day, but it may still remain in the tissues. When I say it is out of your blood stream after a day, you can calculate how much remains by taking off half the impact with each successive 4 hour period. For example, at 4 hours 50% is gone from the blood stream, at 8 hours 75% is gone, at 12 hours 87.5%, etc. This does not necessarily mean it will not be detected after a day, because they may not be testing for finasteride in your blood stream and I do not know what they are really testing for. In other words, without knowing more about the testing process, I don’t know what to tell you. I will research this further and repost at another time.

Although I do believe Propecia (finasteride 1mg) to be the best FDA approved treatment for hair loss currently, in your particular case it might be smarter to stick to the NCAA guidelines and stay away from this prohibited substance to maintain your athletic career. It is up to you.

Tags: proscar, propecia, finasteride, ncaa, banned, substance, test, blood stream, athletic, athlete

Plastic Surgeon Specializing in Facial Scar Repair?

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

I trust your opinion and was wondering if you could recommend me a Dr. that deals with scar revisions on the face or a publication that might rate plastics surgeons who do this type of work.

Kind Regards.

All plastic surgeons can perform facial scar revision surgery. On a simple scar, it is a relatively easy surgery. I do not know of any specific ratings of doctors based on scar revision success.

You need to please keep in mind that all cuts on the skin will result in a scar to some degree. Thus, a scar revision surgery will still produce a scar. While the goal is to minimize the scar as much as possible, this is limited by the individual patient’s propensity to heal well. In other words, scar revision is not solely dependent on the surgeon’s skill or expertise.

Tags: scar revision, scarring, plastic surgeon, surgery, cosmetic surgeon

Women Taking Avodart (Dutasteride)

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

I am an emotional wreck about my hair loss, just down the road from suicidal. When I look in the mirror, I see an attractive, fit 47 year old female with thinning hair. I found a website yesterday, a female blog about hair loss and read everything I could. Most of the visitors use medications some in combination with Rogaine and have hair regrowth. The one medication frequently mentioned is Avodart but is considered to be harsher then others. Reading this gave me hope– that there is something I can use to stop the loss. Also, I am a type 1 diabetic (for 35 years) and believe some of my hair loss may be a result of poor diet and uncontrolled sugars. Can you tell me what tests I should have a doctor do to rule things out and if you might happen to know a dermatologist willing to do these tests in DC? Thank you for your site.

The use of Avodart (dutasteride) or Propecia (finasteride) in women is not FDA approved and has no proven value. With that said, more and more doctors are prescribing it, possibly because in some women it may work. There are a series of studies that have been discussed here (see Treatments Available for Female Hair Loss), which are valuable to review. There are risks that are not clearly defined so safety of the drugs have not been defined in women.

As for tests, see Female Genetic Hair Loss is Different from Male Genetic Hair Loss. Sorry, I don’t have a dermatologist recommendation in Washington DC.

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

Woman Hates Her Widow’s Peak

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

I am a 22 yr. old female with a terrible widow’s peak, and I have hated my forehead for my entire life. Some people think that widow’s peaks are unique, but trust me–mine is ugly and awful and makes me feel bald. It is very prominent and severe and it makes me feel like I have a man’s receding hairline more than anything else. I would do nearly anything to have a round, even hairline like most women do. I have considered methods such as rogaine and hair transplants. Is there any hope for me to ever have a normal hairline?

First and foremost, you may have a widow’s peak that you do not like, but it is a “normal” hairline. If you want to remove the widow’s peak, you can try laser hair removal, which is fairly successful. There is a patient of mine who had his widow’s peak removed with great results. Unfortunately, he changed his mind a few years later and had a hair transplant to put it back. He decided he liked it after all, because it changed his appearance too much for his liking. Your other option is to have a hair transplant around the widow’s peak to round out your hairline. So, you do have options!

Tags: hairtransplant, hair transplant, widow’s peak, widows peak, hairloss, hair loss, hairline

Scalp Is So Itchy, It Feels Like Something Is Crawling in My Hair

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

My scalp is very itchy like is something is crawling in my hair. I am loosing hair very rapidly. I had a biopsy of my scalp done about 7 months ago where nothing was found wrong. I don’ know know what to do next. I have use most over the counter and RX shampoos and nothing has helped. Please advise. Thank you.

Maybe you have dandruff? I really cannot tell you what is wrong. It sounds like you need to see a dermatologist. Aside from the biopsy, have you checked to see if something is really crawling in your hair, like body lice? There is no substitute for a good, thorough examination by a caring doctor.

Tags: lice, dandruff, itch, crawling, hair, scalp, biopsy

BBC News – Braiding Can Lead to Hair Loss

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

Popular modern hairstyles which tightly braid the hair at the scalp can lead to permanent bald patches, say experts.

“Corn rows” and other styles, like extensions, which pull the hair are to blame, particularly if combined with hair straightening chemicals.

This is very interesting reading. Full article here — BBC – Braiding ‘can lead to hair loss’

Tags: traction alopecia, braiding, bbc, hairloss, hair loss, alopecia

I Was Told I Should Stop Minoxidil Use 2 Months Before a Hair Transplant

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

I was told that one should discontinue minoxidil 2 months before hair transplant as it can adversely affect outcome. I was told it can be started again two weeks after the procedure. Is this medically sound or is someone trying to create a more obvious gap between before and after pictures?

I have never heard of this. There is no medical reason why you should stop minoxidil 2 weeks or 2 months prior to a hair transplant surgery. Furthermore, stopping minoxidil may cause the loss of hairs that have built dependence on the drug.

Tags: minoxidil, rogaine, hairloss, hair loss, hairtransplant, hair transplant

Drinking Beer and Taking Propecia

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

Hey doc, I have just recently started to lose some of my hair and my doctor prescribed Propecia. He warned me against drinking too much while taking the medication and told me to keep it to 3 or 4 beers during the weekend. Seeing as how I am still in college, I see this as a potential problem. Ignoring all the other health related issues with binge drinking, what could happen if the two were combined? I haven’t been able to find anything on the web that warns against this.

Also, is there any chance of my insurance covering this? I don’t see myself paying $60/month for this.

BeerAs far as I know, insurance companies do not cover any drugs for male pattern hair loss, since it is a cosmetic issue from their point of view.

If you are concerned about the cost, you can ask your doctor for a prescription for generic finasteride in 5mg strength and then split the pill in four to five pieces, taking each piece daily. Propecia is a brand name for finasteride in 1mg strength (the recommended dose for the treatment of male pattern hair loss). Currently there is no generic finasteride in 1mg strength legally available in the US. Taking more finasteride per dosage does not mean it will work better.

Binge drinking is never good and keeping to 3 to 4 beers a weekend is good medical advice. This may conflict with your college lifestyle, but I do not see any physicians condoning excessive drinking. With that said, using Propecia in the morning and drinking in the evenings should not cause you any problem with the Propecia.

Tags: alcohol, beer, hairloss, hair loss, finasteride, propecia, proscar

My Doctor Says High Calcium Pantothenate (Vitamin B5) Can Reverse Premature Graying

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

Dear Dr,
I am 27 years old. I started going grey @ age 18. Now, I’ve spotted a few white hairs on my beard. In total panic I consulted a few doctors and was told that a daily high dose of calcium
pantothenate can reverse hair premature greying. I want to know if this works?

Calcium pantothenate is also known as vitamin B5. Vitamin B5 has been associated with hair pigmentation changes in mouse models deficient in vitamin B5, but it is EXTREMELY RARE to be deficient in vitamin B5. I personally doubt a high dose of vitamin B5 (calcium pantothenate) will reverse or slow they graying of hair. For more on vitamin B5 / pantothenic acid, see Wikipedia.

This may not be most relevant, but a chemical known as Retinol (also known as vitamin A) is associated with healthy vision. However, taking large amounts of vitamin A does not mean your eyesight will improve. On the contrary it may be harmful — too much vitamin A (toxicity) can cause hair loss as one of its many overdose side effects.

Tags: vitamin b5, calcium pantothenate, hairloss, hair loss, grey, gray, premature, vitamin