How Understanding Are Hair Transplant Doctors to Patients with Pre-Procedure Anxiety?

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

Hi, I had two HT’s done previously by FUE. I am one of these people that gets the ‘white coat syndrome’ just going to the doctors so going for a HT twice was very hard. I am a fit and healthy 38 with a good BMI and when they took my blood pressure i could feel myself get anxious both times which caused adrenalin to raise the heart rate and give a slightly higher B.P reading but once I got in the chair and had a valium I was relaxed and felt good and it was better than the dentist. the surgery went well and I had no bleeding. I will be needing another small procedure in the next 12-18 months with a different doctor and the worst part for me is the pre-procedure nerves that only last from the time I enter the clinic to getting in the chair. Have you seen this before in your patients ? and are HT doctors generally understanding of the healthy people like myself who have low risk of complications whos blood pressure is raised only before a procedure because of temporary anxiety and excitement, not a medical condition that requires treatment? I would appreciate your opinion on this. The actual surgery is the easy part for me. thanks for your time.

Any doctor who is worth anything at all, must be compassionate and caring. I would stay away from doctors who are not that way. Most of my patients are anxious when they come in for the hair transplant and many will have elevated blood pressure when there is no history of high blood pressure. The rise in blood pressure is the result of anxiety and calming words and some good jokes go a long way to calm my patients down. Good drugs also work to accomplish the same effect.

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

I Stopped Propecia and Now I See Sperm in My Urine!!!

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

Sex: Male
Age : 25

I have been using Finasteride for the past 7 months. I have seen some improvement in hair regrowth during the coarse of the treatment. I stopped it suddenly 2 months back. As soon as i stopped sperm got released in my urine and with out my control it was leaking so many times. but after some 20 days this problem goes off. now no issues. Since i stopped the treatment hair started falling again. Is it advisable to go for the treatment again?

This is the first such observation in my advanced medical history. Perhaps stopping Propecia made your eyesight so fine-tuned that you’re now able to see sperm with the naked eye? I’m kidding — that isn’t possible. If you’re seeing a weird discharge in your urine, you should see a urologist. I couldn’t advise you whether to stop or start the medication, particularly since it sounds like you have other medical conditions that need to be looked at first and foremost.

Tags: propecia, finasteride, semen, sperm, urine, hairloss, hair loss

Should I Stop Propecia After 6 Years? I Never Saw Any Regrowth

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

I have been taking Propecia for 6.5 years. I was wondering should I continue. Will the effects fade after 6 years? Will my body get ammune to it. It basically stopped my hair loss, I got no gains.I don’t know if it actually works on me or my hair just reached a point and stopped or slowed loss. I am 46.

If you stop taking the medication, you will lose any benefits you’ve had. If you haven’t seen gains in hair, that doesn’t mean the drug hasn’t worked — it could’ve retained hair or slowed the process down for you (as you noticed). Stopping the Propecia will result in “catch-up” hair loss, where your hair will fall out at an accelerated pace to get to the point that you would’ve been at had you never taken the drug at all.

Tags: propecia, hairloss, hair loss, finasteride, catch up hair loss

Can Propecia Keep Miniaturizing Hairs at the Temples from Falling Out?

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

My temples receded from my highest wrinkle brow to 1.75 inches. You said a mature hairline temples are up to 1.5 inches away from that wrinkle. So I’m slightly more which is fine by me. But around those corners there is a piece of short hairs, they seem to have the same thickness as a lot of my front hairs but they look like they will fall of since I assume they are miniaturized. After that my temples will be about 2-2.2 inches receded which will be too much. I just began Propecia and am almost 22 years old, can Propecia stop those hairs from falling out and even help them grow normal again? But I’m also taking Propecia because I have frontal and mid anterior probs as well but early stage.

Propecia will slow or stop the hair loss in most men of your age. Consider sending me photos (will be kept private) and I will give you an opinion, but you should consider getting your hair mapped out for miniaturization to determine if these hairs at that exact location are really miniaturizing.

Tags: propecia, finasteride, hair loss, hairloss, miniaturized

If I’m Class 3V Now, Will It Stabilize and Then Progress More? How Does it Work?

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

I really have to give a shout out to the balding blog: YOU GUYS ROCK!!

Ok, i was wondering if you can explain (in a nutshell) how the balding progression works. Specifically of interest to me is how I, currently diagnosed as a 3V pattern can seem to be moving towards a 4 pattern, while. I know it sounds kind of silly, but i don’t understand how i can go from thinning in the crown to stabilization and now thinning on top. What do i have to look forward to? 5 pattern? 6? Please help me understand

I really cannot answer your specific problem, because I have not examined you or diagnosed you. In general, if you have the genes for balding, you will bald in a certain pattern as depicted in the Norwood chart (as follows):

Norwood scale

You may look like a class 3V, but depending on your age, miniaturization pattern of the hairs on your scalp, and even family history, you may eventually progress to a class 4 or a 5, etc. Some men will stop with a 3V pattern while others progress to a 4 or 5 pattern. There is really no way to generalize and doctors are not fortune tellers to give you a prediction of what you will look like in many years to come. Drugs like Propecia (finasteride 1mg) can and usually will slow down this progression. Nevertheless, with a good examination and follow up you can generally get an idea of what your hair loss pattern resembles and by mapping out your hair for miniaturization you can follow the progression before it become apparent with the naked eye.

Tags: hairloss, hair loss, norwood

Topical Steroids and Hair Loss

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

Dr. Rassman,
Thank you for writing this blog. It’s very informative. Also, nice job on TLC.

Anyway, my question deals with Topical Steroids, Topical Antibotics, Rogaine and hairloss. I’m 32yrs old and have been using Propecia (7.5yrs) Rogaine(4yrs) and have maintained my hair pretty well until recently. Over the years I’ve also had a red inflammed scalp with what looked like bumps or pimples, and itch. I went to hair specialist/ dermatologist in my area and they gave me lidex and diagnosed it as Seb Derm, that was about 3 years ago. The steriod took some of the itch away but my scalp was still red and bumpy. This past April it seemed to get worse after a trip to Cancun so I began using the Lidex everyday approximately 2-3 times a day and made an appointment with another Derm.

The New Derm diagnosed it as folliculitus and gave me a prescripton for EvoClin. So far I’ve been using that for about a month, 2 times a day along with my Rogaine. The New Derm said to stop the steriod. The Evoclin has stopped the itch but a few bumps and mainly the redness remain.

My question is I feel that my hair has thinned dramatically from Mid April til now. That was around the time I increase the use of the steriod. If the overuse of the steriod caused my hair to fallout will it grow back? It’s one thing to be balding but the way my scalp looks I can’t even buzz my head because my red scalp will show. Will the redness ever disappear?

Thanks for the time and keep up the good work.

With respect to your scalp condition, it seems you’re on the right track with your dermatologist. Establish a good communication line with your doctor and discuss your concerns with him/her. I really cannot comment on your state of hair loss.

If you are using Rogaine (minoxidil), I am assuming it is because you are thinning or balding. Instead of focusing on the details of what you are doing with steroids, try to get the big picture: The most common cause of thinning or balding is genetic androgenic alopecia (male pattern balding). While steroids may (or may not) contribute to some degree, I doubt it is the main reason for your hair loss but it is clearly possible. With the steroids not chronically used, the offending element from it should be obviated.

Tags: hairloss, hair loss, rogaine, minoxidil, steroid, steroids, dermatology

Is Minoxidil Shedding Age-Dependent?

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

Dear Doctor,

I am 19 years old and my hairline has receded a bit at the front and a bit more at the temples starting about a year ago. I am considering using rogaine to halt the loss but I read on the website that it could cause a significant increase in hair loss during the first stage of use. my questions are:

  1. is it safe to assume that because I am relatively young, my hair wont fall out as much during this stage?
  2. I read that rogaine does not work for everyone. If I experience the initial excessive hair loss, then stop using rogaine, will most of that hair grow back?

In addition, I would be more than happy to have your opinion on what path of treatment I should take

Shedding from minoxidil use does not occur for everyone and should be temporary, and there is no connection between this shedding and your age. See Hair Loss Worse After Rogaine for more.

You’re focused on Rogaine (minoxidil) and at 19 years old, your hair loss most certainly will be genetic. Propecia (finasteride) is the best choice for genetic hair loss in a 19 year old, without a doubt. Get your hair mapped out for miniaturization, have your doctor make a diagnosis, and then get him/her to think through a Master Plan with finasteride (Propecia) in it.

Tags: minoxidil, rogaine, regaine, shedding, hairloss, hair loss, age, teen, propecia, finasteride

Propecia and Tinnitus

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

Hi Dr. Rassman,

i am following up on a previous message i sent. I am wondering if you know of anyone who after taking propecia(finasteride) found the following symtoms- tinnitus with an overall feeling of pressure in the head. I only took the drug for two weeks and then stopped after these symtoms appeared. I am still suffering with this six months later. I had these same symtoms five years ago, (but was not taking propecia at the time) which lasted for one year and am wondering if the propecia could have triggered this again as it is used as a blocker, or might it just be a coincidence.

Hope you can answer this for me, thanks!

I do not know what may be the cause of your problem. While many drugs can cause tinnitus, it is relatively rare. More importantly, tinnitus can potentially be a sign of serious medical problems and suggests to me that you have some medical issue which needs to be addressed by an expert in middle ear problems. I personally have not seen any patients in the last 10 years with tinnitus as a side effect of Propecia. I’ve been asked about this once before, a couple of years ago — Propecia Causing Tinnitus?

Tags: ringing, tinnitus, hearing, ear, hairloss, hair loss, propecia, finasteride

8 Year Old with ADHD and Hair Loss

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

My question is I have an 8 yr daughter she has ADHD and has hair loss she right will be almost bald, then that will grow back and her left side will fall out. Could this be caused but her anger? or ADHD. or the medication she is on? Her dr. has tried different medications to see if it is the medication. She is a little girl who wants to have ponytails so bad.

Hair loss that comes and goes may be related to pulling out of the hair (most common cause in young children). Also included in the differential diagnosis would be chronic telogen effluvium, ringworm, and medications (it is a rare possible side effect of Ritalin, for example). This is not meant to be an inclusive listing. She clearly needs to see a specialist.

Tags: hairloss, hair loss, adhd, add, child

I Overplucked My Eyebrows and Had Them Tattooed Back On, But Want a More Natural Look

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

I overplucked, then had to have them tattooed because they wouldn’t grow back. With the tattoing, of course, they didn’t regrow either. It’s been years and I would like a natural looking eyebrow, one that doesn’t fade and frames my face. What would you recommend?

Hair transplants into the eyebrows is the answer and it works wonderfully. Here’s an example of a female patient that had eyebrow restoration — Patient BG. For more info about eyebrow transplants, here’s an article from a few months back that I was quoted in — Women who pluck too much turn to eyebrow transplants.

Tags: eyebrow, hairtransplant, hair transplant, eyebrows, tattoo

Taking Propecia a Few Weeks Before Surgery to Prevent Shock Loss

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

I have FUT surgery scheduled in late late July. I started taking propecia early July..so would have started about 3 weeks before surgery. Is this long enough before to help reduce chances of shock loss?

The longer the better, but 3-4 weeks should cover you. Stay on the medications until all of the results are achieved and then consider staying on the drug for life. Talk with your doctor about this.

Tags: propecia, finasteride, hairloss, hair loss, shock loss, hair transplant, hairtransplant

Measuring the Mature Hairline

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

I know you explained how to measure the mature hairline with the wrinkled brow but you didn’t say how exactly. Do I need to put a ruler in the middle of my forehead and measure that way (this way it shows my corners are 2 inches receded) or can I put in highest corner of my temple and measure downwards if I do it that way I get 1 1/2 inches but my hairline is only 0.4inches away which is good. I believe I’m on a NW2.

Also around my temples I have a chunk of short hairs but there thickness is pretty much the same like other hairs. My hair is kinda longish you know. But what worries me that they will fall off and then my corners will be quite big. Is this all normal?

I’m almost 22 years old and my temples started to recede slowly since late 17s but in the past year just jumped up fast.

A maturing hairline is a generalization of how a young male will have a slight recession of his hairline in his teenage years or early 20’s. If you follow this “rule” (it is actually my rule) then there are three elements of it. A mature male hairline exists when:

  1. the middle of the hairline is about 1/2-2/3 inches above the highest crease of the furrowed brow
  2. the shape of the hairline is convex
  3. the sides of the hairline will rise about 1.5 – 2 times higher than the middle of the mature hairline

If you continue to recede beyond this area then there may be a genetic component of androgenic alopecia. This presence of genetic causation can be seen by mapping out the hair for miniaturization and looking for miniaturized hair substantially behind the leading edge of the mature hairline. And not to confuse anyone, but even though I call it a “rule”, there really is no specific rule to this. You cannot go by an exact set of measurements, such as 0.4 inches. If you are worried about this matter, I would see a doctor for a good microscopic examination (miniaturization study) of your hair to determine if there is a pattern developing.

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

Bald Spots on the Sides of My Head Hurting My Self Esteem!

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

I am a 22 year old female that since i was 14 years old i have been having a bald spot on the side of my head, it use to be the size of a quarter and as time has gone by it has grown bigger, i have also started balding from the other side as well. i am very scared of having alocepia. i have not tried any medication like rogaine for women or have not gone to a dermatologist because i am embarrased of this problem because i am soo young to be worrying about balding. this balding issue has affected my self esteem. i just want to receive some sort of answer before facing a dermatologist. i sent some pics of my problem you can use them for your site just please make sure my face is blocked and i remain anonymous. thank you for your time

First off, thank you for give us permission to use your photographs. I like being able to offer visitors to this site a chance to see precisely what they’re reading about.

It appears that you have a condition called triangular alopecia. This is a genetic condition which can be treated with hair transplantation very successfully. There is no need to suffer as you are. I would be happy to see you for a consultation.

 

Tags: hairloss, hair loss, triangular alopecia, alopecia, temples, photo

After About 2 Years on Propecia, I’m Seeing Sudden Shedding

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

Dear Dr. Rassman,

I’m 24 and I’ve been using Propecia since Dec 2006. It worked very well to slow down my hairloss but in the last 30 days I’ve been seeing more shedding. I work at my computer and I’m seeing more and more hairs on my keyboard and desk. I’ve been using Propecia for 2 years (almost) – is this the normal timeline for the hair cycle? Dormant for 2 years and then shedding for a couple of months? Is my shedding a sign of more balding to come?

Thanks!

If you had been my patient from the beginning, I would have a reference map of your hair and scalp for miniaturization and I would be able to look at the change over time. By starting from point zero and looking at the measurements two years into it, it will help show what occurs over the next two years, but will not help you now. This could be caused by a normal acceleration of the genetic process, or you can be misinterpreting what you are seeing. You should go back to the doctor who put you on the Propecia and ask him to examine you and give you an opinion.

Tags: propecia, finasteride, hair loss, hairloss

Hypothyroidism, Hyperthyroidism, and Hair Loss

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

Hi Dr. Rassman, can you explain why people with hypothyroidism and hyperthyroidism often suffer from hair loss? I was diagnosed with hypothyroidism last summer(TSH of a little over 8.8), and since then my endocrinologist has changed my dosage of thyroid medication twice, most recently in April. I have been experiencing a lot of hair loss since I have started the medication. Could propecia possibly be beneficial to my situation? Thanks for the great website.

Unfortunately, I do not know the exact mechanism of why people with low thyroid can experience hair loss from it. As the saying goes, it is the “practice” of medicine and not the “science” of medicine, and as such, medicine can be a descriptive and observational discipline.

Propecia will not be beneficial for hair loss associated with thyroid conditions unless there is an active genetic component to it. Propecia is a medication for androgenic alopecia.

Tags: thyroid, hypothyroid, hyperthyroid, hairloss, hair loss, propecia, finasteride