DHT, DHT, and Another Thing About DHT

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

Hey, i’m just writing in response to a question that has been recently answered about DHT. I recall you said that just because that you’re hairy, oily skin (skin) and i’m assuming any other DHT physical signs, cited as byproducts of DHT, don’t indefinitely mean that you have alot of DHT. I guess I dont follow that notion, could you please elaborate. I only ask out of curiosity, considering any site that talks about DHT, describes these attributes as a indictive of DHT. Granted, I know that some of the “symptoms” listed definitely have alot to do with genetic blueprints. But, most men start to get hairy in their 20’s like the case of my father and others I know of. Then they started to bald around them. I’d hypothetically assume that since they didn’t have enough DHT to fill in their blueprints at the time. I know DHT only has physical characteristics if you’re genetic blueprint follows, but when you’re blueprint does and the DHT feeds it, wouldn’t that be indicative of DHT?

DHT causes many secondary sex characteristics after puberty, such as hair in different parts of the body (groin, underarms, chest, nose, ear, etc…). I really do not understand your questions. If by genetic blueprint you mean a balding pattern in your family line, then yes, you can inherit it. DHT is a byproduct of testosterone metabolism and all men who make testosterone will make DHT unless they have a genetic defect.

Tags: dht, testosterone, hair loss, hairloss, genetic, genes, hair

Minoxidil and Blood Donation

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

Hi Doctor,

I have been donating blood regularly. But I have hair loss and would like to try applying topical minoxidil on my scalp. Would my blood be safe to donate? Look forward to your kind response.

Best regards

Always reveal the medications you take when you donate blood. I doubt that a topical like minoxidil will be a problem for blood donation, as little of it gets absorbed, if any. I would suggest that you stop taking minoxidil for two days prior to the donation so that any of the drug that might be absorbed by your body will be gone before the donation.

Tags: minoxidil, rogaine, blood, donation, donating, hairloss, hair loss

Hairmax Claims They Formally Challenged Dr Rassman

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

Hairmax claimed that at the ISHRS they “formally challenged you on the issue and you were unable to justify the accuracy of your hair counts you presented and you therefore had to retract your comments.” Is this true?

I remember that we had some verbal interchange, but I never retracted any of my comments.

Tags: hairmax, lasercomb, laser comb, ishrs, rassman

Use of DermMatch for Managing Thinning Hair in Women (with Photos)

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

This patient has classic female patterned balding with hair loss behind the frontal 1/2 inch. The thinning is worse in the frontal area and is more manageable in the top and back, but still thin and see-through. I have given this patient DermMatch, which is a cosmetic powder that colors the scalp and sticks to hairs to make them thicker. The contrast between hair and scalp is lessened with this product and when combined with good styling, products like this (see also, Toppik) can work to make the transparency of the hair less so. The photos below show how big of a difference a topical camouflage can make.

The photo on the left is before, on the right is after DermMatch. Click photos to enlarge.

 

Tags: hairloss, hair loss, female, women, woman, photo, styling, toppik, dermmatch, dermatch, ludwig

Hair Transplant Tools — Choi Implanter vs Carousel

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

I have sent this question to this blog several times, however have had no response. I understand you have extremely high volumes of email, but i feel i might of had no reply due to the question its self as it may be considered that i am being purposely insulting. My question is as follows. The carousel i think is an extremely well designed implanter. And i imagine its results are alo very good, however i have seen in one of your replies to a question about the choi implanter were you said, ‘The Choi implanter is just a surgical tool. It makes some aspects of the transplant easier to perform, especially for those people who did not develop the difficult placing skills with the more traditional transplant tools used throughout the world.”

This to me seems a contradiction when the carousel is also an automated surgical tool, which also makes some of the transplant easier to do. I admit that the carousel could be considered to be better in the sense that it may harvest the hairs better, however its still like the choi implanter. One could say the carousel is a better evolved version of the choi implanter. The carousel and the choi implanter do the same job in almost exactly the same way. Please will you reply as i would find an explanation really interesting. Thanks.

CaouselPractically speaking, the Carousel and Choi implanter are similar in that both make a recipient site directly into intact skin and then place a follicular unit into such sites. Mechanically speaking, the way they place the follicular unit in the site is different. The main limitation of the Choi implanter is that you have to load one follicular unit at a time, make the site with the implanter, place the FU in the site and load it back again before you can continue. For the Choi, a single hair graft is pulled into the instrument by a hair (being backed in). The advantage of the Carousel implanter is that it holds 100 follicular units, making the process smoother. The discussion is moot, however, because the Carousel is not currently on the market and can not therefore be used by any surgeon.

Note: The image to the right is of the Carousel implanter.

Tags: carousel, choi, implanter, automated, hairtransplant, hair transplant, tool, hairloss, hair loss, surgical

Hypothyroidism and Hair Loss

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

Good day doctor, I was reading a short article about hypothyroidism, and I was left with a few lingering thoughts. Perhaps you might be able to answer my questions:

a) Would you say that hair loss due to hypothyroidism is a common or a rare incidence among those who suffer from hair loss?
b) Or, among the various symptoms of hypothyroidism, is hair loss a common or rare occurrence?

I understand that there may not be good statistics to answer these questions, but perhaps you might be able to shed some light, based on your experience.

Hair loss is one of many symptoms of hypothyroidism, but the frequency of it is not reported. Patients suffering from hypothyroidism usually have other symptoms along with hair loss, including weight gain, cold intolerance, fatigue, weakness, constipation, and depression. The diagnosis of hypothyroidism is made through blood testing for the level of T4 (the main thyroid hormone) and TSH (thyroid stimulating hormone).

Most of the patients in our practice suffer from male pattern baldness (MPB). Patients concerned about hair loss should have a miniaturization study to determine if the pattern is consistent with MPB or if there is an underlying medical condition causing the hair loss.

Tags: hypothyroidism, hypothyroid, thyroid, hairloss, hair loss, mpb

Dissecting Cellulitis of the Scalp

/by William Rassman, M.D./302 /,

I am a family medicine resident finishing up my last year. I unfortunately have a condition which I discovered doing my own research called Dissecting Cellulitis of the Scalp. It is horrible!!! This is a rare condition that usually affects black men in their 20’s. It is a very painful, cosmetically disfiguring disease that I have dealt with for about 4 years now. I have tried all of the antibiotics and medical treatment that you can think of and have seen many dermatologists that in my opinion, are not really aware of how tough this is to treat. I have read some studies that state that Laser therapy has been used with some success and others that state that complete scalp excision is successful. Of course, I don’t want my whole scalp taken off, but I am willing to try Laser therapy if it really has good results. At this point, I am really ready to try anything. If you are familiar with this or can even refer me to someone who is, I would really appreciate it.

This is a rare condition and as you said it is very difficult to treat. Before going as far as having surgical excision of your scalp, I found a case study in which they had success in treating recalcitrant dissecting cellulitis with Nd:YAG laser. The study was published in Dermatologic Surgery in August 2004, Volume 30 Issue 8, and was written by Eric C. Parlette MD, Nathan Kroeger, EVictor Ross MD — Laser Treatment of Recalcitrant Folliculitis Decalvans.

Unfortunately, I can’t post the text here and the publisher charges a fee to view the text, but it may be worth looking into. Good luck.

Tags: folliculitis decalvans, laser, dissecting cellulitis, dcs, hairloss, hair loss

I Had Several Hair Transplants — Will Testosterone Therapy Cause Hair Loss?

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

I am a 53 yr old male who is considering have testosterone therapy. I have male pattern baldness and had several hair transplants,including one in your office in Fort Lee, NJ and one from your colleague in Fort Lee, NJ My hair looks fine now and have had no significant hair loss for years. Will low doses of testosterone cause me to have hair loss?

As we all know, testosterone is converted to DHT, which is the main culprit in male pattern hair loss. There is always a risk, maybe low, that testosterone will cause hair loss since. It may help knowing if there is miniaturization in the remaining hair along the edge where the transplants were placed. Miniaturized hair may be affected by testosterone and DHT.

Tags: testosterone, dht, hairtransplant, hair transplant, therapy, hairloss, hair loss

Topical Finasteride Research

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

Hi Dr. Rassman,

As I scour the internet for information about new developments in the treatment for balding, just thought the readers might be interested that it appears some effort is being put into
researching/developing a topical version of finasteride to treat hair loss:

PubMed – Development of liposomal systems of Finasteride for topical applications: design, characterization, and in vitro evaluation.

Take care.

Seems like interesting research. Thanks for bringing it to our attention. The next step, with regard to the hair restoration field, would be to determine if it is equal to or better than oral finasteride in the treatment of hair loss. Clearly more work is being done for the formulation, as that is not finalized yet.

Tags: finasteride, oral, topical, propecia, proscar, hairloss, hair loss

If Hair Loss Is Not From Environmental Factors, Why Does Hair Only Fall Out On Top?

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

My question is that when men are bald why is it usually only on the top of the head? it seems as though environmental factors should be considered as a cause. Sun, wearing hats, showering etc.

Now i understand that most causes seem to be genetic but it just makes me very curious why it would not be the whole head.

The sun, wearing hats, showering, etc. will not impact hair loss. It is all in the genetics. If I knew the answer to why genetic hair loss only impacted the top of the head (not counting diseases like alopecia universalis), I could be a rich man. Unfortunately, the answer is not known.

Tags: hairloss, hair loss, sun, environment, genetic, genes, hats, showering

Do You Have An Opinion on Individual Doctors?

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

Do you have any insight on Dr. [name removed]? As in do you think hes skilled and ethical? Please would like your advice

Over and over again I am asked such questions. I just can not answer them, because I could be at legal risk if I thought badly about a particular doctor and voice my opinion over the internet… and there are many doctors in this field who I might not speak highly about.

There are some websites that claim to be consumer advocates and give such information to potential shoppers. Some of them provide a service and some do not. It is important for the readers to understand that many of these websites charge doctors a fair amount of money for an endorsement. That may not mean that if a doctor is not endorsed on the website, he/she is not a good doctor; it means that they do not want to pay thousands of dollars a year for such endorsements.

This is a buyer beware market, a theme I proclaim over and over again. In this blog, I tell consumers how to find a good doctor and I do not charge for any of that advice. So why do I add content to this blog day and after day addressing such questions as how to select a hair transplant doctor? The answer is that this is part of an overall philosophy I have to educate the public and to let the public know that there are many good doctors out there who perform quality hair transplants. Today’s modern hair transplant creates results which are indistinguishable from a person who never had a hair transplant and is blessed with a good head of hair. At our Open House events every month, many of our patients come in to help me illustrate that very point. I stress ethics in the field, tell the consumer how to hold a doctor responsible for their work and warn the consumer that this is a buyer beware market and the burden is on them, as a buyer, to do his/her research to get a quality job done.

For more information on doctors — what to avoid, how to find a good one, what some don’t want you to know — see:

Tags: doctor, doctors, physician, surgeon, hairloss, hair loss, hairtransplant, hair transplant, advice, referral, opinion

Merck’s Site Doesn’t Say Anything About Initial Shedding from Propecia

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

Dear Doctor,

Great website !!

Re: Propecia and Minoxidil – The reality please

I am been sending you several emails regarding the following questions which I very much appreciate if you could answer:

– Propecia and initial shedding: Several comments on the internet mention that this medication may cause increased shedding at the beginning of the treatment (3 to 4 months). However, nothing thereupon is mentioned in the Merck product description. Moreover, this does not correspond to the timeline for results indicated in the propecia website (www.propecia.com). This website indeed indicates that one may on the contrary expect reduction of hair loss within 3 months and some regrowth within 6 to 12 months. Similarly, several dermatologists to whom I spoke indicated to me that this initial shedding my occurr with Minoxidil (which acts as a growth stimulant) but not with Propecia. What is your experience in this area with your patients. What is the reality please ? If initial shedding was a common effect of Propecia I am sure Merck would have mentioned it in the product description just like the makers of Rogaine did for Minoxidil ?

Minoxidil 12.5 + Azelic Acid 5 % in the form of a cream: I have been advised by a clinic in London to combine the use of Propecia with this cream. However, I am 36 years old and I have JUST started to thin (on the crown but not on the temples and hair line). Do you think that addition is necessary or would propecia be enough.

Age concern: I hear that propecia best works for men under 30. However, if I have just started to thin (since a year) at 36, does this mean that the medication will have little effect.

Many thanks

I have never actually seen a patient with shedding from Propecia (finasteride 1mg), but I have read many such complaints through this site. Maybe I just get the unusual bad news. Maybe there’s some commonality (outside of taking the Propecia) that isn’t being said. That is a problem with getting one email from a random reader that I may never hear from again. I don’t have enough medical history to really know what to make of it all. I can not comment on adding the combination of minoxidil 12.5 and azelaic acid 5% cream, but the acid does irritate and may cause increase absorption of the minoxidil (that is the theory, anyway).

You are correct that the best results from Propecia are in younger men, but I have seen many men in their 30s get wonderful benefits from the drug. It will be what it is and it will be better results than not trying the drug at all.

Tags: propecia, finasteride, minoxidil, azelaic acid, hairloss, hair loss, shedding, rogaine, merck

After Taking Propecia for 2 Years, Suddenly I’m Shedding

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

Hi,
Love your site. I am a 37 yr old male and I’ve been on propecia for about 2 yrs (with very little shedding). I’ve recently started shedding quite a bit, almost like the propecia stopped working. Is this normal??? Please help!!!!

Propecia (finasteride) does not cure hair loss. When your genetics ‘push’, then Propecia becomes less effective. Please note that I said less effective. If you were to stop the drug, then you would be on a wild ride to hair loss. As I am not your doctor, it is difficult for me to tell you what I would do. I might consider Avodart (dutasteride) under certain situations, but if I did, the dose would be high and sexual side effects may become evident. Sterility may be a price, as it has been reported (with reversal not clear). The Master Plan may include a hair transplant, but that would depend on many factors. You need to have a good relationship with your doctor.

Tags: propecia, finasteride, avodart, dutasteride, hairloss, hair loss

FlutaGel

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

What can you tell us about FlutaGel?

Flutagel is a gel that contains 1% flutamide as the active ingredient, a drug that is used to treat prostate cancer. It acts by inhibiting the uptake and/or binding of dihydrotestosterone (DHT) to the target cell receptor. To date, no clinical studies have been done to prove its efficacy in MPB. In theory it sounds great, but this does not always translate into the clinical arena. It needs to be studied further to evaluate its safety and effectiveness.

The website for this is at Sinere.com if you want to try to find more info.

Tags: flutamide, flutagel, hairloss, hair loss, flutamin, eulexin, gel

Reader Says John Travolta’s Hairpiece Is Not Costly

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

The hair like Travolta wears is NOT costly as mentioned in the article.Also not required to go into a salon to have it attached.There are a number of sites on the net that sells this type of quality piece for less than 200 dollars.I have 2.Also Hollywood hair web site shows John`s hair for 159.00

Thanks for the information. It seems like you’ve done your research… or perhaps you’re just selling something. These type of hair systems can go for thousands of dollars, but there will always be a cheaper company there to undercut the more expensive model. Plus, I assume that like many celebrities, John Travolta would have a personal stylist, adding to the overall cost. Judging by the photos (see here) though, perhaps his stylist got the day off.

Tags: travolta, hairloss, hair loss, hairpiece, wig, hair system, hair piece, actor, hollywood