Normal Daily Hair Loss Occurs In Shower?

/by William Rassman, M.D./3 /

Dear Dr. Rassman,

Thanks for taking the time to run this blog. It has been very helpful to me in understanding hair loss.

I’ve looked through the archives but have been unable to find any answers to a particular question I have. I know that it’s normal to lose between 100 to 150 hairs per day. Of course, the most obvious times for discovering this hair loss is when taking a shower (looking at your hands after putting shampoo in hair, seeing the hairs on the shower floor) or when waking up from a night’s sleep and seeing hairs on the pillow. By counting these hairs, I suppose it gives some indication of how many hairs one is losing, but hair must be falling out throughout the day as well. My question is what percentage, on average, of normal daily hair loss falls out during hair washing? It seems like I expend about 50% of my daily allowance of normal hair loss in the shower. What a amount of hair loss is normal when washing hair, in your estimation? I think knowledge of this might help alleviate some anxiety about whether the amount of hair loss I’m experiencing is normal. Since it’s difficult to know how much hair is falling out during other parts of the day, it would at least be helpful to know how much is normal during those times when hair loss is easier to guage.

Also, I know that you recommend a miniturization study to truly determine whether atypical hair loss is occurring, but, to my knowledge, I don’t have access to anyone who can do such a study anywhere near where I live. So, I’m hoping your response to this question will give me some indication about the normality of my hair loss.

Thanks for your time and efforts.

Hair shedding is uniform, but clearly when you massage the hair (in the shower) or abrade it on your pillow, the loose hair that is about to fall out, will fall out a few hours ahead of your genetic schedule. That is why we suggest that you do not really rub hard in the shower and use a wide-tonged hair brush for combing, as it does not pull on the hair. I am sure that if you paid attention to what comes off in the comb or on your fingers in the shower, you are seeing more for that period of time when compared to never washing your hair.

Tags: hairloss, hair loss, shower

Do the Corners Recede First in a Maturing Hairline?

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

hi doc.with regards to a mature hairline, do the corners recede first and the middle afterwards or should the hairline all recede at the same time? as the corners recede further than the centre i am assuming they recede first,is this correct?? Thanks

A maturing hairline is not related to balding. It occurs as early as in the teenage years to the early twenties and may complete as late as 30. It may start from the corners or from the middle or both. In general, the corners seem to recede or thin out slightly faster causing one to panic and think they are going bald. The Norwood Class 3 balding pattern does have corner recession as well. When I see these patients in my office for a miniaturization study, I find that most of the time the miniaturization of their hair is only limited to the very front (indicating that they are likely not balding) if it is just a maturing hairline.

Tags: hairline, hair loss, hairloss, maturing, mature

I Developed a Widow’s Peak

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

Hi there doc., I have developed a widows peak in the last 2-3 years (18-21) however I have had no recession of the temples and my hair doesn’t seem thin at all. My brother has had a widows peak all his life and DID lose his hair, I did not have a widows peak all my life… is it possible I just have maturing hairline? can it mature IN to a widows peak? I don’t want to start propecia unless I need it.

Thanks a ton

I am not sure if what you are describing is a widow’s peak or a persistent forelock. We can speculate on what is really going on and if it is a maturing hairline, but in the end you should see someone who is an expert and get a miniaturization study to determine if there is genetic balding that is creating some interesting ‘art’ on your head. Please send me a photo with your eyebrows lifted high and showing the “widow’s peak” so I can then give you a better opinion. Reference this blog post when sending.

Tags: hairloss, hair loss, widows peak, persistent forelock, forelock

I’m Advancing Toward a Norwood Class 6 or 7

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

I have been balding since the age of 18 and am now 29. I have been taking propecia and then dutasteride for 5 years and although the process is still continuing I’m sure I would be completely bald by now if I hadn’t gone on the medication. I can see I am am advancing to a 6-7 norwood. I have thick blonde hair which sticks up and has lots of body, when i had a full head of hair as a child the barbers all commented on how thick it was and it was a nightmare to style. I would say presently i have about 20-30 hairs per square cm, less at the front and the coverage still looks ok. could i achieve good coverage from transplant procedures with a naturally looking but thin hairline?

Look at the previous blog post titled, Difference Between Norwood Class 7 Patients. In that post, you will see a man (Patient BF) that became a Class 7 patient over 10 years. He started getting transplants in the front initially and then progressed to a Class 7 after the transplants were done. So yes, you can get a transplant and continue to maintain your look.

Tags: hairloss, hair loss, hairtransplant, hair transplant, norwood

Wearing Sunblock and a Hat Weeks After Hair Transplant

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

I just had a transpant operation 2 weeks ago and am going to the beach in 2 weeks. My doctor told me it is okay as long as I wear sunblock and a hat, for longer times. I really don’t want to mess up the follicles or the entire transplanted area or the donor area for that matter. What’s your advice?

My advice would be the same as your doctor.

Tags: sunblock, hairtransplant, hair transplant, hairloss, hair loss, sun block, sunscreen

Donor Scarring, Suture vs Staples, and Other Hair Transplant Questions

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

Hi, Dr. Rassman.
Some more issues:

  1. Your book says the Monocryl suture can produce a fine surgical scar superior to metal staples and is less painful and more convenient to remove (since it doesn’t have to be removed…) If this is the case, why would stapling even still be used? Is it a matter of closing the wound as fast as possible?
  2. Regarding scarring of the donor site, if scalp laxity can be measured before hand, why do people even end up with donor sites that cannot be completely closed?
  3. Do you always remove a 1 x 15cm strip, and use all the FU’s, however much that turns out to be? Somewhere it is written that if I leave the session open-ended, more hair can be harvested. But don’t you close the donor site before proceeding with the transplants?
  4. Tell me some more about the risks and the rates of complications. What percentage of the grafts transplanted at NHI typically grow? How much variability is there?

I am, as you would say, “doing my homework…”

Good questions!

  1. I have changed my mind on the use of staples. The Monocryl did produce some reaction in some patients which may have increased scarring. With regard to laxity measurements, there is presently no instrument available that will measure it (other than one we are presently testing) and laxity is often a judgment call by the experienced surgeon.
  2. The size of the donor strip depends upon the number of grafts you need and this is a math calculation based upon the density of the hair (see Patient’s Guide — How Many Grafts Will I Need?).
  3. I tell people to keep it open ended if possible so that a more generous strip may yield more grafts and then we can place higher densities.
  4. With regard to the risks of any transplant surgeon, I wrote a book on this and can not replicate that book here. Our informed consent document defines those risks for our surgery patients in enough detail to manage what MIGHT happen, not what probably will happen. Most, if not all, of the grafts should grow after a transplant with a good surgeon and experienced transplant team.
Tags: hairtransplant, hair transplant, suture, staples, donor strip, surgeon, surgery, hairloss, hair loss

Are Propecia or Rogaine Preventing Me From Growing a Beard?

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

Hi,

I am a 23 year old male. I began using Rogaine 2% approximately 3 years ago when I noticed a steady increase in balding on my hairline. I didnt have a full beard when I first started using it. Only a mustache and some hair around the chin area.

A year after using the Rogaine without any results I switched to Propecia. My beard at this stage hadn’t formed yet.
2 years later I still have just a few hairs around my cheeks and the rest hasnt grown tremendously either.
Do you think this could in part be due to the DHT-blocking affects of the Propecia/Rogaine?

If so, can you recommend any way of potentially trying to ‘inspire’ the cheeks to grow hair if there is still a chance?

Some men can never grow beards. Some men can never grow a moustache. Some men become bald. This is all in their genes. It is not related to Propecia (finasteride 1mg) or minoxidil.

That being said, anecdotally DHT blocking drugs such as Propecia may have some impact on beard hair or chest hair growth, but I doubt that Propecia is the sole reason why you cannot grow a beard. Minoxidil (Rogaine) is not a DHT blocker.

Tags: finasteride, propecia, facial hair, beard, moustache, mustache

Direction of Hairs Grown from Intercytex’s ICX-TRC Procedure?

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

Dr.Rassman any new updates about intercytex? anyway i’ve visited the website and there is this FAQS page where its says:

—
Would new hair grow in the same direction as the old?
In the ICX-TRC procedure we are not transplanting hair follicles, instead we are implanting cells into the skin which induce new hair growth, so there is no reason for these hairs to grow in a different direction from before.
—

they are cloning or multiplying the cell from the back which is not affected by DHT right? then as they have said implanting it to the bald area how come they say that it wouldnt grow in different direction since it came from the back of the head then putting it infront? i just dont get it.

do you support intercytex?

and another thing.. if you think that this technology is far to be available, and no advances are still made but propecia, what can u suggest for the people who suffers from hairloss and propecia for them is wearing down or loosing its effectiveness? because iv read alot of problems like this on baldingblog. what’s next for them if they dont have the money for hair transplant or HT is not indicated for them(poor donor site)? what you have told me before is Avodart or Dutasteride but not yet approved by the FDA for hairloss treatment. I just really can relate myself to the people here who suffers from early hairloss since its impact really takes you of your youth. it changes your life, the way you carry yourself and the way you used to mingle with other people. thank you. i hope you can give new advice on this

What you are looking for, I am afraid I can not help you with. I don’t know enough details about Intercytex to comment beyond what I’ve already written. My present thoughts are that it may take years to prove and then have approved for clinical use, the final treatments that Intercytex is working on. I am a bit skeptical on the schedules that are projected (maybe not the final outcome), but I frankly don’t know nor do I believe everything I hear or read. DHT will not impact hair that is not genetically impaired, so if the hair that Intercytex is such a hair, then it will be resistant to the impact of DHT.

Tags: intercytex, hairloss, hair loss, hair cloning, hair multiplication

My Hair Falls Out After Dying It

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

I have died my hair brown to black and when my roots came back I died it black again and now everytime I take a shower or brush my hair some of it falls out. I cant afford to go to a salon and have it done. What do I do?

Dying hair should not cause hair loss unless your skin develops reaction to the chemical components of the dye or you are damaging the hair. Any skin reaction or inflammation of the scalp can cause hair loss or precipitate the underlying genetic hair loss process. Make sure you are using a good and reputable brand when you want to dye your hair. If it is an allergic reaction it may happen with any brand. If your hair loss is due to a reaction to dye, you should grow it back in about 6 months unless you burned the hair root (then it would not grow back).

Tags: hairloss, hair loss, hair dye, allergy, allergic

Lost Hair in Left Side of My Hairline — Now It’s Just Growing Back

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

Post #4000

Hello Doctor,
I am a 26 year old male. Recently, I have lost hair around the left side of my hairline. My hairline has risen on that side dramatically. Now it seems small/thin hairs are starting to sporadicly regrow in their place. Does this typically happen when a mature hairline is transforming? Does hair often fall out for no apparent reason and grow back sporadicly?

Symmetry is the key ingredient in the perception of beauty. Unfortunately, most of us are not perfectly symmetrical and it is not unusual for the tranformation to a mature hairline to be unsymetrical. Your eyes, nose, ears, teeth, and even hairline is never perfectly symmetric. When one start to lose hair from MPB or even a maturing hairline it will likely be more pronounced on one side and the other side may play ‘catch-up’ when it takes its turn falling out. You may be seeing the hairs going through their natural cycles, but you need a good examination and a miniaturization study for that assessment to find out if you have genetic balding in the frontal area.

Tags: hairline, hair loss, hairloss, maturing hairline, symmetry

Topical Insulin and Growth Hormone to Treat Androgenetic Alopecia?

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

Doctor,

I think you’re really going to like the following study that verifies the use of topical insulin and growth hormone in the treatment of AGA:

Comment: This article titled: Pilot Study of a Novel Treatment for Androgenetic Alopecia Using Enriched Cell Culture Medium: Clinical Trials taken from Dermatology Online Journal and posted on 04/25/2003 was of great interest. The authors were: Lindenbaum ES, PhD, Feitelberg AL, MD, Tendler M, PhD, Beach D, MSc, Gamliel-Lazarovich A, MSc, Har-Shai Y, MD, Hirshowitz B, MD

According to the abstract: a group of 48 people with known genetic hair loss had a novel treatment where a topical solution/gel that contained (a) a cell culture medium supplemented with insulin, (b) thyroxin and (c) growth hormone (CCM) was applied to a frontal balding pattern. This was a scientific study performed with good scientific methodology that concluded “a randomized, vehicle-controlled, double-blind trial of 6 months duration. Under occlusive cover the gel was self applied for at least 3 hours daily.” Hair loss stopped in 2-6 weeks and after a period of four months, hair counts were higher in the treated group. The treated grour got even further benefits at 6 months. This treatment also slowed or stopped hiar loss, increased the rate of hair growth and the appearance of new hairs. There were no side effects reported.

I found the link you are referencing at Medscape. This was an enlightening article and worthy of follow-up. Thanks for sending it in.

Tags: medscape, insulin, growth hormone, alopecia, hairloss, hair loss

Using Rogaine for 15 Years — Just Developed an Allergy?

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

Hi Doc,

Taking Rogaine for 15 years. Have had a lot of shedding the last year. I stopped the rogaine for a week and noticed a definate decrease in shedding almost immediately. Could Rogaine be irritating the scalp and cause shedding? After so many years would Rogaine still be effective? If it does become less effective over time is it safe to stop without more loss?

Thanks

There is no way to tell with anecdotal accounts. It may just be coincidental. Generally, I would doubt Rogaine has been causing hair loss, but you might have developed a skin allergy to the drug. Generally speaking, some drugs may lose its effective clinical value over time, but it should not lose all of its potency.

Tags: rogaine, minoxidil, hairloss, hair loss, allergy

G-Spot and the “Designer Vagina”

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

Note: This post isn’t related to hair loss or balding, but interesting and worth posting nonetheless.

On my recent trip to the Canadian Rockies, I read an article in the Globe and Mail newspaper about the “latest in sexual enhancement: a collagen injection to swell the elusive G spot”. This was the sub-heading and it caught my attention, not only as an interested reader, but as a physician who practiced some gynecology (as part of my general surgery practice) many years ago. Essentially, a shot of collagen is injected into the spot in the vagina where the G spot is supposed to be, thereby enlarging it and making it less elusive (read the article for the details — link below). This is supposed to produce a “trigger” for the female orgasm. The ‘G shot’ was patented in 2002 by Dr. David Matlock, a gynecologist and plastic surgeon in Los Angeles. The article discusses, in detail, the need for other treatments related to plastic surgery for the vagina “that shorten the plump labias, tighten vaginal muscles, shrink the skin covering the clitoris and reconstruct hymens”.

Many men think that libido and sexual dysfunction are problems that are unique to them, but this article provides some insight into the needs of women, a ‘black box’ for most men whose ignorance on this subject may be helped by reading this article.

Full article: globeandmail.com — Hit me with your best shot

Tags: vagina, g-spot, gspot, g shot, gshot, matlock, globeandmail

Various Hair Loss Products Are Well Reviewed Online

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

I am from Boston. I am 25 years old. I have been taking propecia for roughly 4 years. The side effects started bothering me so my doctor told me to get off of it. Everytime I try to get back on it my body does not tolerate it. Since being off of the drug my hairloss has rapidly begun again. Just sitting at work today there were tons of hairs all around me. It is very scary to start losing hair this fast. I can actually feel the hairs falling on my face. I have been doing some internet research and it looks spencer david kobren gave revivogen a thumbs up. I was also noticing procerin and provillus got excellent reviews. What are some alternatives to inhibit DHT besides propecia or to stop the hair loss for that matter. Now that I am not tolerating propecia am I destined to lose my hair quickly. I truly appreciate your help.

Reading reviews online is a good first step, but take everything you read with a grain of salt. It is good to be wary and to not just believe marketing hype and slick graphics that make claims to work without any scientific proof to back it up. Trusting your source is critical, as there are many fake reviews out there made by the sellers of various products to try to convince you to fork over your cash.

I only know for sure that finasteride, dutasteride, and minoxidil work (though only finasteride and minoxidil are FDA approved for treating hair loss — dutasteride is in clinical trials). Dutasteride may produce even more side effects than finasteride (Propecia), so I believe you do have a problem and an uncertain hair loss future. I, like many others, am awaiting the results of the FDA dutasteride trials for hair loss treatment.

Tags: finasteride, propecia, dutasteride, hairloss, hair loss, revivogen, procerin, provillus

My Face Isn’t Balanced When I Pull My Hair Back

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

Hi, I’m a 19 year old female and have been VERY self conscious about my forehead for as long as I can remember. Growing up my mother always made sure I had bangs and so it has been that way my whole life. For once I would like to not hide being hair. I know I have a pretty face and I’m satisfied with how I look. It’s only when I pull my hair back that I feel my face isn’t balanced correctly and it throws my whole views off completely. First I was wondering if there are any surgeons located in NY that provide this procedure. Second, are there any forums specifically for females who are considering a hairline advancement procedure? It would be greatly appreciated for any information on this. Thank you so much!

Having an unbalanced hairline is not as uncommon of a situation as you might think. Lowering the hairline could be a good option, particularly for women who have a high hairline to start with. This procedure is done by some plastic surgeons and some hair transplant surgeons, though it is not a hair transplant. In New York, you might check with Dr. Robert Bernstein (offices in NY and NJ) to see if he has any suggestions. Also, take a look at the site of Dr. Sheldon Kabaker (office in Bay Area, CA) for more information on the hairline lowering procedure.

As for the second part of your email, I am personally not aware of a forum that is only focused on female hairline advancement procedures, but if any readers our there know of any, please feel free to comment and I’ll update this post.

Tags: hairline, hairloss, hair loss, lowering