I Want My Head to Always Have a 5 O’Clock Shadow of Hair

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

Heres one for you: I wouldnt mind a shaved head if the shadow of existing thick hair wasnt so obvious around the donor areas. It’s like the top is your normal face color, and the donor areas white with potential hair. The shadow where hair grows is just so noticeable. My question is: is there a procedure where you can have implanted just tiny hairs as in a shadow over your balding? So it looks like you only shave your head?

5 O'Clock ShadowI suppose you can tattoo your bald area, but that’s not the recommended route. I have seen it done in a few patients with reasonable results, but they have done this because of some deforming surgery they had from older hair transplant techniques many years earlier. Alternatively, you can air spray the balding area to develop a subtle shadow. If you’re looking to transplant a “5 o’clock shadow” look to your head (like the facial hair style that became popular in the 1980s), it’s really not going to be possible without having visible scarring to some degree (even if minor from FUE) in the donor area.

In other words, to answer your question — no.

Tags: shadow, hairloss, hair loss, hairtransplant, hair transplant, shaved

I Used Both Finasteride and Minoxidil with Great Results, But I Want to Stop One

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

Hi! About 1 year ago I noticed a bald spot on the crown of my head, typical for Male Pattern Baldness. After reading up on the issue I decided to try the double approach of finisteride tablets (Proscar) and Minoxidil spray. My doctor told me that it was unecessary to use both, but I read a few postings on chat groups about success stories taking this double approach, so I decided on that route. Now, a year later, the results are absolutely fantastic! The untrained eye would probably not notice anything. So now I am considering stopping either the minoxidil or the finisteride tablets. If I did stop either of these, and notice a regression, would resuming the treatment again bring back my now great hair? Which of the two would you recommend stopping as a test? Thanks for your help!

I don’t know your age or the degree of balding you had. That would make my impression inadequate to help you, based on the scant information you supplied me. If you are young (under 29 years old), then Propecia should be more important than minoxidil. I would get miniaturization studies and map out your scalp accordingly so that if and when you stop minoxidil first, you can follow the results with scientific measurements.

Tags: finasteride, minoxidil, hair loss, hairloss

Laser to Break Down DHT?

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

I was contacted today by a person from the hair institute – www.thehairinstitute.com.au who claimed to have a breakthrough treatment for thinning hair. His description was of an “LSD Light Laser” which is applied to the hair scalp over a period of 6 months and breaks down the DHT in the hair follicles. He stated that DHT is built up over years and once it is gone it wont come back to the same extent. (he told me after 30 years old you don’t produce much DHT). He claims the results to be amazing, as shown here: thehairinstitute.com.au

Is this yet another scam?

Please help! I’m a musician!!

Lots of claims, not much basis. If this worked, there would’ve at least been discussions about this among the prominent people in this field. Unfortunately, I’ve not been part of – nor have I seen any discussions about this so-called DHT effect from lasers among my fellow physicians.

A cure for hair loss is essentially what this is claiming to be — and claims like those that are made on that site are worth potentially billions of dollars, if it worked.

Tags: laser light, laser, dht, hairloss, hair loss

Could Conditioner Applied 10 Days After My Hair Transplant Lead to Problems?

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

POST-OP CONDITIONER WASHING TECHNIQUE CAUSING GRAFT FAILURE?

Dr. Rassman,

After reading about using a gentle conditioner to aid in the removal of post-op scabbing in the recipient area after surgery on a popular hairloss forum, I applied a conditioner to my recipient area for 20 minutes on Day 10 post-surgery. (It was Haircylce Conditioner that I purchased over the Internet prior to my surgery!)

But, I foolishly applied the conditioner to my dry scalp, which made removing the conditioner nearly impossible!

Finally, after 20 minutes of constant rinsing with a cup of water, I was able to remove the conditioner by gently dabbing the area with my fingertips in between rinses. There was no bleeding or noticeable irritation afterwards. Is it possible that this constant rinsing could have damaged the grafts? Please advise because I am worried that my physician may use this information against me, if I have a poor result.

Thanks in advance

If you did not pull out the grafts in the process, I would doubt that any problems would have been produced by the conditioner you used after 10 days have passed.

Tags: hairtransplant, hair transplant, conditioner, problem, haircycle

How Much Dutasteride Could Make Me Sterile?

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

I take dutasteride (generic avodart), I think its 0.5mg or 1.0 mg…either way its one pill. Will this potentially cause sterility or would I need a much higher dose?

I doubt that doses of 0.5mg or 1mg would have any certainty with regard to sterility. The information on this complication is presently not very plentiful.

Tags: dutasteride, avodart, hairloss, hair loss, sterile, sterility

Histopathology of Non-Scarring Alopecia

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

Hi Dr. Rassman, I was wondering if you knew the histopathology of non-scarring alopecia in a 21 year old male? My dermatoligist said I had diffuse hair loss and non-scarring alopecia and prescribed me Propecia; I am also taking Rogaine. Additionally, what do you think of spirinolacatane as a topical treatment as an anti-androgen for this type of hair loss?

Thanks

MicroscopeThe histopathology of non-scarring alopecia is just as it states — When you look under a microscope of your scalp biopsy there is often cells seen that reflect some autoimmune disorder, but no scarring where there is hair loss. Examples include anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia.

Of the list above, the most common non-scarring alopecia is genetic balding (otherwise known as androgenic alopecia — AGA; otherwise known as male pattern baldness — MPB). And since your dermatologist prescribed Propecia for your non-scarring alopecia I would guess that your dermatologist thought you had MPB. It probably would’ve been much easier if you were just told that you have male pattern baldness. If you have diffuse unpatterned alopecia (DUPA) then the donor area behind your head would have substantial miniaturization. Speak with your doctor about how he/she arrived at the conclusions.

Finally, spironolactone has anti-androgenic properties, but clinically there is little good evidence that it helps with MPB.

Tags: alopecia, hairloss, hair loss, propecia, finasteride, spironolactone, rogaine, minoxodil

I Just Got Married and Finasteride is Giving Me Libido Issues!

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

Dear Doctor,

I have what seems to be a desperate situation – I was married just 2 months ago, and am having serious libido issues. I have been on Fincar (generic for Proscar) for about 9 months. I have experienced positive results, BUT ALSO the often reported side-effect of reduced libido, which really snuck up on me, and hopefully, is not a permanent condition, though this has been reported. I just begun taking PassionRx to counter the effect.

Should I discontinue the drug and live with the hair loss? (My assumption and hope is that my libido will return).

Or, is it possible to maintain positive effects but through a reduced blood-level of the drug vis a vis taking it less often, or cycling on and off and allow for return of libido at the same time?

Put another way, given the 3-6 month time-frame for “catch up” hair loss, can I cycle my use of Fincar, retain benefits, and restore libido?

MarriedYou need a doctor to talk with, one on one. There are many causes of libido issues, and although finasteride may be the reason, you should not just assume it.

I often tell my patients to stop the finasteride for a week, the go on a half a Propecia a day (that would be 0.5mg of finasteride) and see if the libido issue was solved in the week off of the drug. If it is, maybe half a pill will work for you as it is 80% as effective as a full 1mg tablet. If you’re taking a full 5mg generic finasteride, you’re taking more than the 1mg recommended hair loss treatment anyway.

Tags: finasteride, proscar, fincar, propecia, hairloss, hair loss, libido, wedding, married, marriage

Does Dying Gray Hair Lead to Faster Graying?

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

How true is it that when you color your grey hair, you will grow more grey hair faster than not coloring. I have been getting different answers from the web. I need your opinion. Thank you.

DyeIt’s not true at all.

Hair color is the result of pigmentation due to naturally occurring chemicals (primarily melanin). These chemicals are present at different levels, thus giving hair its distinctive color. The more melanin present, the darker the hair; the less melanin, the lighter the hair. Hair color changes as we age, going from their natural color to gray and then white. The color change occurs when melanin is no longer produced in the hair root and new hair grows without pigment. Coloring the hair has no effect on the rate of graying and on the deposition of melanin in the hair shaft — it just affects the hair above the skin.

Tags: gray, grey, hair color, dye, greying, graying, aging

Is My Son Losing Hair from LSD or MDMA Use?

/by William Rassman, M.D./5 /,

Hello
My son is 21, he believes that his hair is thinning at the crown and at the hairline. He has also been complaining about an itching, tingling, burning sensation on the top of his head. I personally do not think that it is thinning as both sides of the family have a long line of full heads of hair. He has a long history of depression and chronic anxiety, he is also a hypochondriac. However about a year ago i discovered that he had taken large amounts of estradiol, in the form of my estrogel, a month or so prior to me discovering it missing. He stopped after i confronted him about it. Approximately six months later he took LSD while at a friends, then he took MDMA, overdosed and had a seizure. My question is could his hairloss be due to either of these? I am very concerned about him, he has always been depressed and lossing his hair would be a huge blow on his self esteem.

LSDI can understand young men experimenting with drugs, as illegal and harmful as they may be, but it is strange that a young man would knowingly be taking female hormones. Does he have gender identification issues?

Hair loss can be a source for depression for many young men, but I would be less concerned about your son’s hair loss when there are potential life threating issues such as: depression, anxiety, illicit drug abuse, seizures, etc. Your son sounds like he needs help and I do not think hair loss ranks near the top of the list.

Tags: mdma, lsd, hairloss, hair loss, ecstasy, estrogel, estradiol, estrogen

My Dermatologist Prescribed the Following for My Female Hair Loss…

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

For the past several months, I had noticed my scalp progressively showing through just behind the crown of my head. During this time, I had not noticed excessive hairs falling out, in my hairbrush or in the shower. I’ve been doing my hair in a ponytail for the last 2-4 years. I first went to see my GP a few weeks ago, she did my bloodwork and referred me to a dermatologist. At the time of the appointment, the dermatologist had not yet received the bloodwork results. He spent a few minutes with me and prescribed the following:

  • Rogaine 5% for men daily at night
  • DHS Free and Clear shampoo daily for 6 days per week
  • Salex shampoo 1 day a week
  • Betamethasone valerate cream after shampooing.
  • Appearex Biotin 2.5mg daily
  • Vicogen 1 daily (a multivitamin)

A few days later, I received my bloodwork results which are all in the normal range. I am a 44 year old female. I am not sure if I should start this treatment plan or not. My GP had mentioned that the dermatologist may do a biopsy of the hairs, but he did not talk about that and when I mentioned it, he said it was not necessary.

Please advise, thank you so much!

It looks like he’s just throwing everything at you and hoping something will work. Ask him directly and try to find out:

  1. What his diagnosis is
  2. What his expectations are for your use of these medications

I do not know what your dermatologist’s line of thinking was.

Tags: hairloss, hair loss, dermatology, dermatologist, female, women, woman, appearex, biotin, vicogen, rogaine, salex

I Had My Eyebrows Partially Removed with IPL — Will They Grow Back?

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

I had IPL on my eyebrows 1 year ago – only 2 sessions. I now only have the medial part of my eyebrow on both sides because she removed too much hair. I was very upset and she assured me they would grow back. They haven’t. Will they eventually?

Essentially, the person that did the hair removal on your eyebrows screwed up and got rid of too much hair. If you haven’t seen any regrowth after a year, it is likely that they may not grow back on their own. If they do not grow back, hair transplants into the eyebrow will work well. For those curious about IPL, see the intense pulsed light listing at Wikipedia.

Tags: eyebrows, eyebrow, ipl, intense pulsed light, laser, hairloss, hair loss

I Stopped Taking Finasteride for 10 Days While On Vacation!

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

I stopped taking finasteride for 10 days while on vacation and believe my hairline receded as a result. Does that seem right or is 10 days too short a time to see any hair loss after taking the product for years?

There is tissue fixation of the drug that may last up to a week. I would doubt that you’d see a major impact from the 10 day finasteride-free vacation, but you should do better planning next time.

Tags: finasteride, hairloss, hair loss, vacation, holiday

Heavy Metal Music and Hair Loss

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

My question is in regards to the hairlines of many rock musicians which I have noticed over the years. I’ve been big into heavy music for many years and i’ve notived many of them seem to have slightly receded hairlines which have never gotten worse. Some examples are

Dez Fafara from the band Coal Chamber (now Devildriver), Bass guitarist Oliver Reidel from german heavy metal band Rammstein, And in particular Pogo, once keyboardist for Marilyn Manson who has retained i’d say what’s inbetween a 2 and 3 on the scale for many years.

All of these artists seem to have retained around a 2 and 3 class pattern and has never gotten any worse. I guess it’s possible they all have gotten hair transplants at one point. Any knowlege on this? Is it possible for someone to have they’re hairline recede like that and just stop? I mean it happened to both my uncles who had they’re hairlines recede a bit around my age (19) and now in they’re late 30’s hasn’t gotten much worse. Thanks and hope to hear from you!

Norwood Class 3You are correct to look at the genetics of your family for the answers. Many people stop at Norwood Class 2 or 3 levels. I actually believe that the Norwood Class 2 pattern of balding is not real balding, but just the appearance of the mature hairline. That being said, I am not Dr. O’Tar Norwood and do not know if he recognized the mature male hairline as a normal transition for a maturing man when updating and devising the Norwood classification system that we use today.

As I’m sure you could likely assume, I’m not a big heavy metal music fan, and didn’t have the foggiest idea who the people you specifically mentioned are. I asked someone on my staff to hunt down these folks, and their photos are presented below:

Musicians

 

I don’t see any hair loss in the gentleman on the left, Dez Fafara, as the photos I’ve seen have his long hair covering any pattern that may be present. The other two guys, Oliver Reidel and Pogo aka Madonna Wayne Gacy (thanks Internet!), each appear to be Norwood Class 3. It is completely possible that they stopped at their current levels and did not require any hair restoration, but I have no first hand knowledge about that (and if I did, I couldn’t say).

Tags: heavy metal, music, metal, manson, coal chamber, devildriver, dez, pogo, rammstein, hairloss, hair loss

How Long Is The MPB Process?

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

How long can MPB take?

My hair kind of leapt into a widow’s peak during 2003/04 and is now considerably thinner than it has ever been in my life. So this is about 5 years maximum – i thought MPB took on average 15 years or more?

What happened?

Once you know you have male pattern baldness (MPB), it remains a progressive process until the day you die, but in reality most people slow down the loss in their late 30s or 40s. There are always exceptions to the rule, but most people are destined to develop a pattern and that pattern is not always a class 6 or 7 pattern (see Norwood Chart below). They may stop at a class 3… but of course, each person is different.

Norwood Chart

 

Tags: norwood, mpb, hairloss, hair loss

48 Year Old Woman with Hair Loss and Thyroid Problems

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

Dear Dr. Rassman,
I am writing to you because I would greatly appreciate your opinion as I have read much about you in the past and know you have a wonderful reputation when it comes to hair loss. I am a 48 year old female who has been around the block for several years dealing with AGA since my twenties. I know I carry a predisposition to it, (Dad, brother, Grand dad all went bald early) but assume it was aggravated by the high androgen birth control pills I took for several years as well.

I have tried everything under the sun including avodart for the past two years (which did not work for me, and therefore I went off a month ago) and since December have been using rogaine 5% foam twice a day on most days, the hair max laser comb 3 times a week, taking a hair vitamin containing saw palmetto and other hair friendly vitamins, and trying to eat a well balanced diet. I also was diagnosed with hypothyroid and am currently taking “synthroid” for the past couple years for an underactive thryroid, which I can’t tell if it is making the hair loss worse or not, even though it is suppose to help treat hair loss. I have been taking yasmin now for at least 5 years which is suppose to be a more hair friendly bcp.

(my questions are as follows: Is it worth it for me to see an endocronologist to conduct more tests other than thyroid, and iron levels (normal) at this point in my life? I went to a supposed expert dermatologist here in Boston several years ago who basically took a quick look and said genetic, and dismissed me telling me to try minoxidil..( I never did at that point). I would like to know if you think I have all the basis covered since at 48 I will be entering menopause soon, and can’t afford any more hair loss!

I was told I was not a good candidate for hair transplant, too much hair, and too thin all over and the results would not be any better than what I already have.
I really would appreciate your feed back.. Thank you so much.

You have a double combination of low thyroid and genetic hair loss. In women I have seen, when genetic hair loss is present and low thyroid precipitates more, even correcting the thyroid does not often help. Seeing another doctor may have value, but I am not hopeful. The appearance of menopause adds the third negative, which may or may not make you worse. The use of Rogaine Foam is a good choice and you will have to wait 1-2 years to see the benefits of this treatment. Sorry I can’t be more helpful. I am waiting for some drugs to be introduced or better research which may show us better what is happening to folks like you.

Tags: thyroid, synthroid, levothyroxine, hairloss, hair loss, women, woman, female