Do I Have Premature Balding?

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

Well I’m 17 years old and i have a few questions. My hair is completely different both in color and in type from my mum and Dad. My dad suffers from baldness yet my grandpa from my dads family tree didn’t suffer from baldness. My Mother’s family doesn’t suffer from baldness at all. Lately I’ve noticed some thinning in the crown of my head, but i don’t know if i suffer from premature baldness, I blow dry my hair every day, and i wash it everyday I hardly ever comb it, I also touch my hair alot which might make it oily, could all of this be the reason for the thinning or is it really premature baldness?

Genetic balding can start in the teenage years. I can’t say for sure whether you’re losing hair due to genetics as I haven’t seen you, but if your dad has balding you could’ve gotten the gene passed from him. It can come from either side of the family. Also, oily hair isn’t a cause of loss, nor is the lack of combing.

My suggestion is to do a miniaturization mapping of your scalp hair and find out if you are balding. You can learn how to do it yourself if your doctor can’t / won’t do it — click here.

Tags: teen, teenager, hairloss, hair loss, genetics

In the News – ISHRS Says Hair Restoration Patients Up 26% in 2008

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

Snippet from the press release:

Despite the worldwide economic downturn in 2008, more people continued to seek treatment for hair loss, according to statistics released today from a recent member survey conducted by the International Society of Hair Restoration Surgery (ISHRS) — the world’s leading medical authority on hair loss and hair restoration. The extrapolated worldwide number of hair restoration patients treated in 2008 was approximately 811,363 (236,468 surgical patients and 574,894 non-surgical patients) — up 26 percent from 2006.

Read the rest at Marketwatch.com

These are some interesting statistics. If you’re considering a hair transplant, you’re obviously not alone. Hair transplants have never looked better, and with fees drastically reduced now is the time!

Tags: hairloss, hair loss, hair transplant, hair restoration, ishrs

It Seems Doctors Are Seeing More Gynecomastia from Propecia

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

Dr Rassman,

I’m in my mid-30s and have been experiencing hair loss for the past 5 years. I feel like I’m at the stage where I need to decide if I want to take finasteride or not. My biggest concern is the side effects.

It seems that more and more I hear (both on the news and from friends who are doctors) how doctors are seeing a greater prevalence of male gynecomastia. The often sited reason for this is due to the increased use of finasteride (both for prostate treatment and hair loss treatment). Of course, it could just be that gynecomastia in men makes for an interesting story on a slow news day…

My question is, do the number and types of side-effects experienced by your patients on finasteride agree with published studies?

In reading this blog you do make mention of how some of your patients experience side effects, but you’ve never made mention if the number of side effects you’ve seen clinically are more, less, or the same compared to the numbers posted by Merck.

I’ve had 2 patients in the past 2 years that had gynecomastia. Both stopped finasteride and it went away. Most of my patients are on Propecia/finasteride. I would tend to agree with the statistics published by Merck.

Tags: merck, gynecomastia, side effects, propecia, finasteride, hairloss, hair loss

Hair Transplants for 20 Year Olds?

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

do you do procedures under the age of 25 im 20, because for some reasons other surgions like bernstein wouldnt……also is there another alternative other than propecia that doesnt have side effects to prevent further hair loss?

At 20 years old, you’re likely not a candidate for surgery unless there is obvious recession and you are realistic in your expectations. When Dr. Bernstein turns down a 20 year old, I generally follow his lead as we both are very concerned about your long term prognosis. Hair loss is progressive, so transplanting you now without planning for future hair loss is a bad idea, particularly if your future pattern is uncertain. You have a finite amount of hair that can be transplanted, so you don’t want to use it all up now and then continue to bald years down the line without enough reserves to follow the hair loss. There are many doctors eager to get your money, so you can find other doctors willing to transplant a young man of any age.

As for Propecia’s (finasteride) side effects — they are overblown. Propecia is easily the best medication for those men with early hair loss. The only alternative I recommend is minoxidil (Rogaine), as it is also FDA approved to treat hair loss. Minoxidil will not prevent hair loss in the same way that Propecia will, and has it’s own issues with side effects. Remember, each and every medication has the potential for side effects (look at Tylenol, for example), as each person is different and will respond differently to it.

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

Reader Checks in with His Thoughts on the Latest LaserComb Study

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

LasercombI reached out to a reader/writer/commenter that has previously sent in some great insights about FDA trials to get his thoughts on the latest Lexington HairMax LaserComb study that was released (read the abstract of the study here). He wrote back with a great overview, and although lengthy, it’s a worthy read for those interested.

Here’s his reply —

—————-

    Dr Rassman

    I am a physician-scientist (MD-PhD) with long-standing experience in the clinical development of drugs, trial designs, and interaction with drug regulatory agencies, and am also an avid reader of baldingblog. As such, I have been critical of Lexington in the past for failure to release clinical trial data in a peer-reviewed journal and in a timely fashion. I have also mentioned that their responses on your blog to questions by your readers (and information posted on their own web site) appear more likely written by marketers than scientists.

    I am presently reviewing for your readers the recently published article that summarizes the clinical study supporting the safety and efficacy of the HairMax LaserComb (Leavitt M, Charles G, Heyman E. Clinical Drug Investigation. 29(5):283-292, 2009).

Read more

Will Female Donor Hair Fall Out?

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

Is it true that female donor hair that is transplanted does not become permanent and may eventually fall out of the transplanted area whereas male transplanted hair will never fall out?

Whatever happens to the donor area will happen to the transplanted hairs in their new location. Female genetic alopecia is often diffuse and when it progresses, it impacts the donor area with miniaturization that is progressive, so you will see that impact in the recipient area for donor hair as the miniaturization progresses. In most men, the donor area is spared from miniaturization, so when this hair is transplanted into the recipient area it reflects that stability seen in the donor area and is not lost. In other words, men have that ring of hair around their heads (often called the permanent zone), whereas women aren’t going to necessarily have that same permanent area.

Tags: female hair loss, hairloss, hair loss, donor hair

Nicotine and DHT

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

I am a current smoker (10/day), who has for months been in a constant battle of giving it up and starting it back again. Aside from the obvious health risks, I’m feeling a kind of burning pain in my scalp where my hair is thinning, and I am wondering if this burning might be precipitated by the nicotine. I’ve read studies that purport nicotine can increase the levels of DHT.

My questions: 1) Is the burning in my scalp a sign of hair loss. 2) Could this burning be related to the nicotine’s effect on DHT levels?

Sidenote: During periods of intense smoke, the burning in my scalp increases, primarily where I’m losing my hair. Conversely, the burning subsides whenever I lay off the accursed habit for more than a week. Any thoughts?

SmokingYou just answered your own question, as you show clearly a relationship between your smoking and your symptoms. What can I add in the face of such a clear association? Scalp burning isn’t necessarily a sign of hair loss, but if you’re seeing your hair fall out while you feel this sensation, it might be connected.

For further reading, check out this NY Times article — The Claim: Smoking Can Cause the Loss of Hair

Tags: smoking, cigarette, nicotine, hairloss, hair loss

Can the Sauna Damage Hair?

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

Hello,
I would like to know what you think about the sauna. Average 80°Celsius (170° Fahrenheit). Some say it can damage hair follicles. Some say this is good for blood circulation system, helping the flow of blood to the scalp. Who to trust?

Thank you in advance. All the best.

Hair is above the scalp and it is dead when it appears from the skin. “Damage” is a relative term, because while you could dry out your hair and lose the luster that the oils bring to it, a sauna will not impact the hair that has not grown out through the skin yet.

Tags: sauna, hairloss, hair loss, damage, heat

Hair Loss from HGH

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

Hello,

Does the hair loss associated with HGH reverse with continued treatment or with discontinuation of treatment? That is, does the hair grow back? I just started using only 1IU of somatropin every other day, and 5 shots into it I am noticing some hair falling out when I’m styling it.

Thanks!

I suspect that the genetic hair loss you have has been accelerated and is likely not to return. Men without genetic balding should not develop hair loss from HGH.

Tags: hgh, hair loss, hairloss, somatropin

How Can I Tell If My Finasteride is Real?

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

Let me start by saying this is a great site. I have gotten so many answers from here. I am 21 years old with a receding hairline, and excessive shedding. I also think my crown is getting thin, but nobody else seems to think so. Anyways I started taking generic finistride about 4 months ago. I order through a discount website, and I have heard that some websites send out placebos labeled as finistride. Being as how I have been taking it for 4 months and I still haven’t noticed any difference I was wondering if there is a way to tell if my pills are the real deal or just placebos..

Thanks alot

DrugsHere’s the best way to tell — buy it from a reputable pharmacy. Seriously though, I don’t know of an easy finasteride test you can run on your medication to authenticate it. Generic finasteride 5mg tablets cost about $20 from Costco or Walmart, which brings the cost down to about $5/month… so why buy it from an unknown source? If you’re not in the US and don’t have access to either of those stores, I’m sure your pharmacy has the generic finasteride at a pretty decent price. Have your doctor prescribe the 5mg generic and then cut the pills into 4 pieces to get the same benefits of Propecia.

Those various “discount” websites that sell prescription drugs (in many cases without a prescription) aren’t high on my list of things I trust. Sure, the price might be great… but at what real cost? It could be real finasteride that you’re getting, but is it worth the risk of losing your hair if you’re just getting a placebo in foil wrapping? I just found an article from late last year that might be of interest — Fighting Fake Drugs in India.

Tags: finasteride, propecia, medication, drug, proscar, pharmacy, hairloss, hair loss, counterfeit, authentic

Pricing Out a Hair Transplant is Not Feasible Without an Exam

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

I’m on Norwood III vertex scale. The hairs on my crown are very thin so that the circle is noticeable already. Can you do transplant on this case even there are still thin hairs, or just prescribe me with either propecia/minoxidil? Honestly, I don’t want the latter because I want a permanent solution. I can only pay cash. How much is your estimate for my case?

CalculatorWithout pictures I can not really tell you what it would take. If your donor density is low, fixing the crown may not be in your long term interests so pricing it out is not the way to go. Have you mapped out for miniaturization to try to determine the degree of balding you may find yourself with down the road on other parts of your head? Assuming that you do not have frontal balding now (could be age dependent) early crown loss can be treated successfully with finasteride (Propecia) alone. In the young man, the crown loss can reverse after taking the medication for a year or so, so maybe you can get away without a hair transplant.

Too many men just want the problem fixed, as that is a man’s way to manage a problem. Why would you not fix a broken car once and for all? But your head is not a broken car and hair loss is progressive in all men, so there may not be such a thing as a fix for the problem. Most important is that the hair donor supply is limited, so you must keep an eye on your donor supply as you receive more and more transplants. I have seen too many men just run out of donor hair with poor planning. Pricing out a transplant therefore, is a balancing act between short term needs and long term planning.

The frontal component for hair loss varies, depending upon how far advanced it is. Grafts for the front can range from 800-4000 in numbers, depending upon the findings on the examination. Pricing is usually done by the graft for most hair transplant surgeons.

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

In the News – Possible New Prostate Cancer Treatment?

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

Snippet from the article:


Two prostate cancer patients who had been told their condition was inoperable are now cancer-free as the result of an experimental therapy, the Mayo Clinic in Rochester announced today.

“We were all pretty shocked,” says Dr. Eugene Kwon, an immunologist and urologist at Mayo and leader of the clinical trial in which the experimental therapy was being used. “These results were far beyond anything we ever envisioned.”

Read the rest — Mayo reports dramatic outcomes in prostate cancer study

It’s not hair news, but prostate cancer treatment is probably more important to report on anyway. And in a related story, the pharma company that makes the aforementioned experimental therapy had some good news of their own — Medarex shares up as prostate cancer drug shows promise.

Tags: medarex, prostate cancer, cancer, mayo clinic, kwon

Platelet-Rich Plasma (PRP) Safety is Really a Concern?

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

This is in response to Since When Does Platelet-Rich Plasma Need FDA Approval? —

This tone is alarmist and feels competitive. I appreciate the scientific method you’re supporting, but do you really think there are SAFETY issues with putting your own blood back into your body (or parts thereof)?

This may be a new trend that will catch on more over time. I have not used the technique yet, but at the ISHRS meeting next month, this will be a subject that is going to be discussed. I will form opinions when I meet with those who are using PRP.

The following article is a good overview that shows the “simple” side of the PRP story — nwoms.com.

Tags: platelet rich plasma, prp, hair transplant, fda

Hair Loss and Lupus of the Skin?

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

I’m a 43 year old African American female. I’ve used hair products all my adult life. In addition, I wore weaves from braiding and sewing tracks on my hair to gluing tracks on my hair. To braiding my hair as well. I used extensive heat from flat irons to hair dryers. Everything has come to a halt. The top portion of my hair is bald in the crown area of my head in many large spots. I had a small spot for years smack dead in the middle of my crown area and never thought anything of it. Well a month ago my hairstylist noticed the small spot is no longer there. There are huge spots now that is red and is tender. For years my scalp always felt irritated very strange… Even when I brushed my hair my scalp would hurt. I recently got rid of all the hair products that contain Sodium Laurel Sulfate and Sodium Laurel Lereth Sulfate. I purchased all natural shampoos and conditioners.

Well I went to see a Dermatologist. He kept saying something about a band…? Dead hair follicles that will not grow back. Well they did the Biopsy and now I wait. He thinks it might be Lupus of the skin…. WHAT !@&^*()(*_( What is that… My first cousin has Lupus (enternal). I’m stumped…. I am wearing wigs because my hair is not long enough to cover the bald spots… What a mess…. Your thoughts Doctor?

You will know more when the biopsy comes back. If you don’t have Lupus, you have many causes for hair loss all listed in your first paragraph of your email to me. This is a complicated problem that will have to be evaluated with you sitting right in front of me and my obtaining the biopsy from your dermatologist. For more info, look to the Lupus Foundation of America‘s Lupus of the Skin page.

Tags: lupus, skin, cutaneous lupus, hairloss, hair loss

Repair Scars from Plugs in Donor Area?

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

can anything be done with plug scars from transplants in 93? scars in the back of my head. i mean im desperate for short hair but i know the scars will notice. i dont have time for make up and that might make more paranoid than i already am…

Scars in the donor area vary by person, surgeon, and the amount of transplanted hair you had. Some of them can be repaired or reduced, but I would have to see you to make such a determination.

Tags: repair, plugs, hair transplant, hairloss, hair loss