Why Is Surgery So Expensive?

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

Dear Dr. Rassman,

I really like this blog, and all the help you’ve given us, but I have a question (not a good one for you, I suppose). Why there are such exorbitant prices for hair transplants, making them available only for those rich guys?! Another question, which probably will make you think before answering the first: Do you think those diagnosted with leukemia, who need a marrow transplant, don’t have the right to live on because they don’t have 150.000 $ for the surgery?! Medicine shall not be business, but as we all see it is. Anyway, thank you for your time and I really hope in the future medicine will be as it should be, available for everyone! (just a teenager view)

Hair transplants are not just available to “rich guys”, but as you are a teenager with an interesting view on things, perhaps you consider anyone with a better-than-minimum wage job to be “rich”. Remember that hair transplantation is a completely elective procedure and not for everyone. If you buy a hair system and do the ordinary wig replacements and wig repairs, the cost will average $15,000/5 year time frame. Every 5 years the cycle continues. If you have a hair transplant, most people can get it for between $5,000 and $10,000. For me to do a hair transplant, I use a certified facility that is accredited (a process that is very expensive, but guarantees quality processes and sterility), I have a team of people working almost all day with the patient having the hair transplant, and I pay support staff, buy surgical supplies, and have rent, which is expensive. All of my staff are paid a decent living wage so that I can retain the best staff and they get medical coverage included in their employment. My overall costs are a fraction of what you would pay to have a surgical procedure performed on an outpatient basis in any hospital in the US (normally between $1000-2500 per hour) and our typical surgery runs 5-7 hours in length. And you’re always open to save a buck by using doctors who do not have my experience, many of them producing inferior results (or even worse).

By comparison, if you bring your dog into the veterinarian, the office visit often runs about $80, and blood work and any X-rays could run $1,000 or more. Your dog may not be cured in one visit, so repeat visits and repeat tests will drive up the costs further. He/she will probably get sick again another time. Another example: my son just had his timing belt replaced along with miscellaneous other things on his 11 year old Toyota car and it cost him around $2,500. I doubt it took a team of people 7 hours to do it. A good hair transplant, compared to a wig or a vet visit, is most often a one time cost that will probably not be repeated (if you take finasteride) in the lifetime of many people. Compare the value: a wig at $15,000 over 5 years or a hair transplant that will last your lifetime and will be less than the cost of a wig for 5 years. I think that comparing a bone marrow transplant is not appropriate here and your question about that is pretty ridiculous.

Tags: hair transplant, surgery, price, cost, hairloss, hair loss, doctor, physician

Are More Young People Losing Hair Now Compared to In Past Years?

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

In your experience, in the past few years have you noticed a higher percentage of young people (15-20 years old) losing their hair compared to years past?

Shaved headThere’s a couple ways to look at this —

  1. The shaved head look is quite common, possibly more so than in the past, so it’s difficult to tell who is doing it because they’re balding or who is doing it for style.
  2. The internet has changed the lives of many people, especially with regard to education. Balding impacts many millions of young men and women, and they can get educated and become more proactive because of what they learn about hair loss and treatment options. So if anything, I’d expect less young people would be losing hair compared to years past.

However, the answer to your question is that there is no more balding today than in the past.

Tags: hairloss, hair loss, history, teen, youth, young

Dr. Farjo’s Minoxidil Research

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

Dr farjo
i am aware that you have been doing research with Bradford university into the workings of minoxidil. i just want to ask if this research has shined any light on any potential improvements on minoxidil or even a better drug?

The following response is by UK-based physician Dr. Bessam Farjo:


Response by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

Our research has made a big breakthrough in discovering the precise mechanism of action of minoxidil, as far as its action on hair loss is concerned. We have shown that this is done via the potassium channels in the tissue, which are sort of like on/off switches that help govern various transmission of signals and chemicals. This was previously unknown. The significance of this possibly lies in higher efficiency of minoxidil action, but more likely will result in discovering new drugs that act through these channels that may show better benefits to hair than minoxidil.

—

Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

Tags: minoxidil, rogaine, regaine, hairloss, hair loss, farjo, bradford, university, medication

Cloning Eyebrows?

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

Is hair cloning only limited to the top of the head or are they also working on cloning eyebrows? Hence they grow at the same length and density or are they soley working on head hair because it is of more concern to the majority of people?

When hair cloning is available, it will have a genetic clock that should dictate the hair cycle for each particular hair, hence its length. But saying much about something that is not here now and possibly won’t be available for 10+ years, would be foolish for me at this time. It would be like having a long discussion about flying cars and the speeds at which they travel.

Tags: hair cloning, eyebrows, eyebrow, cloning

Woman Developing Itchy Pimples on Scalp

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

I’m a african american female 27yrs old that is having terrible time with my hair & scalp for about the past 2yrs i have been developing bumps on my scalp mostly in the back the bumps come & get extremely sore &can be popped & filled with puss & then it get very itchy & pain alot.Have you heard of these symptoms before cuz am dying need.thanks in advance.

You need to see a good dermatologist. You may have a variety of conditions that are dangerous and will cause you to eventually lose hair. The internet is not a place to gamble the future of your hair and your health.

Tags: pimple, scalp, hairloss, hair loss, african american, female hair loss

How Many People Take Propecia?

/by William Rassman, M.D./10 /

I have several questions. I think it’s great that a doctor with your reputation and qualifications takes the time to offer feedback to so many curious internet users–it’s truly a great service.

I’m a 23-year old male with very slight hair receding and thinning at the front and temples (not noticeable to anyone but me, and two dermatologists said they might see the early onset of recession, but it was too early to tell). Out of 2 grandfathers, my father, and two uncles, only of the uncles has a receding hairline (and he is positive his did not start until he was in his early 30’s; could mine be due to a cause other than MPB?).

Searching through the internet and your blog, I’ve found an abundance of negative subjective feedback regarding Propecia–from long-term sexual side effects to long-term disruption of various endocrine system processes. Many say the side effects are more common than the 2-3% recognized by Merck. I know from your blog that you said, in your experience at your practice, the side effects are present in about 2-3% of patients.

I’m wondering: have you ever encountered a patient who complained of negative mental side effects? I discovered a few online users who claimed to have had their hormone levels drawn before and after taking the drug, and that the differences were substantial.

Also: how many patients, per your estimate, would you say are regularly taking this drug? I ask because I look at some of the forums for people claiming to experience long-term negative side-effects, and there are hundreds to thousands of users. So I’m wondering if this is 0.001% of patients ever prescribed propecia? 0.1%? 10%?

Finally: I truly just want to avoid having to have a significant hair transplant in 5 years. I’m using 5% minoxidil 2x per day, as prescribed. In your experience, is minoxidil less effective than Propecia? I’ve only been using it about a month; do you think it should stop my hairline? Finally, if I did end up requiring a hair transplant in 5 years, is it fairly safe to say the hairline could be recreated in a manner similar to the original?

Any advice or reply is much appreciated. Thank you so much for your time!

PropeciaThe potential market of 33 million American men who have pattern baldness is not close to penetrated. In an informal discussion with a Merck representative a few years ago, I was told that they sell more than 1 million prescriptions, but I do not know how the generic market has hurt the Propecia market. I don’t have any real numbers on how many people taking the name brand or generic, but it is sold in many countries and I’d estimate it is in the millions.

The forums are filled with spectacular statement about side effects of Propecia and if you read them, you do not get a fair and impartial view of these side effects. I’ve pointed out before that those with complaints (real or otherwise) are going to be the most vocal. You won’t see a whole lot of posts from the vast majority of users that have their hair loss stop or hair regrowing, because they have no real reason to go out of their way to write testimonials for a medication. If you think you’ve been wronged though, you’re more likely to voice your opinions. I can not tell you what the side effect incidence of people who stop taking the drug is after a week or a month, but it must be rare.

The one thing that I want you to take away from this post is that the half life of finasteride is measured in hours… and that means that most of it is out of your blood stream in a day or so. Some residual tissue presence might be in your system for as much as a week. What does this mean? It means that if you have side effects, you can stop the medication and be free of the side effects in a week or so.

Propecia (finasteride) is a better solution to balding for the young man than minoxidil, by a long shot. The best way to avoid hair loss (and a hair transplant) is to take finasteride daily and keep your fingers crossed that you started treatment in time and that your response is a good one. I wouldn’t expect the minoxidil to do much for your hairline, and recreating your hairline from a hair transplant is possible, but it really depends on what “original” hairline you’re talking about and how much hair loss you have (you might not want to focus all of the grafts in one area if you’re thinning throughout the scalp).

Tags: finasteride, propecia, side effects, forums, hairloss, hair loss

When Will I See Propecia Benefits… and Does Showering Cause Hair Loss?

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

hi dr Rassman,

i have a few questions i havent seen an answer to on here,

  1. how long does it take to see results from propecia? is 6 months the normal time it takes or can it take longer?
  2. when do u think cloning will be made available to the public? ( i know there is no way to tell)
  3. i used to spray rogain 5% on my hairline, however around 2 weeks back i switched and started using a dropper which probably meant im putting on my minoxidil than when i was using a
    sprayer, the areas i have been applying it to have thinned out, could this be because im using more minox now with the dropper?
  4. Does showering everyday cause or worsen hairloss? what temperature is best?

thanks

Shower knob

  1. For Propecia results, I’d say 6-12 months. Benefits could be just halting the hair loss, not necessarily regrowth… so keep that in mind when you’re looking at results.
  2. Getting hair cloning to be effective and reliable is the first step. Making it available to the public is quite another. Maybe it’ll be ready in another decade or so, but nobody knows. I’m not sure how you haven’t seen me answer a question about hair cloning before. I’ve probably written the same thing over a dozen times already.
  3. Why did you switch from the Rogaine sprayer to the dropper? It could be that you’re not covering the same area. Using more minoxidil in the area shouldn’t cause hair loss, but using less might.
  4. Showering daily won’t cause hair loss, though if you’ve already got weak hair on its way out, be gentle to your hair when shampooing. Actually, you should be gentle regardless. Use whatever temperature is comfortable.
Tags: hair cloning, propecia, finasteride, rogaine, minoxidil, hairloss, hai rloss, cloning, shower

I’m 18 Years Old and Can’t Cope with My Hair Loss

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

I went to the dermatologist this week to confirm that I had male pattern baldness, which he did confirm. I am only 18 years old, and since I am so young, I am not dealing with this very well. I cannot find much information on people close to my age balding, so I assume it is relatively rare. I am currently on 1mg of propecia a day and will start rogaine shortly. I just do not know how I am going to cope with this. I am so young, and it feels like balding will hinder my social life. I haven’t hung out with friends since I realized I was going bald. I don’t know how they will react of if they will treat me differently. I don’t know how I am ever going to get a girlfriend now. Do you have any advice on how someone as young as me can cope with the feeling that my life has been devastated?

Most of the young men I treat, like yourself, get great response from Propecia (finasteride) and do not show any balding when picked up early. I have even seen men of your age reverse the balding process. Make sure that what you are seeing is not the maturing hairline, because the drug will not reverse this. Speak with your parents and the doctor who prescribed Propecia. This isn’t a death sentence and you do have options. You should be commended for the courage to start the correct treatment early and I’m hoping you will be spared the balding problem for years.

Tags: propecia, finasteride, youth, young man, hairloss, hair loss

Is Finasteride Suddenly Giving Me Hives?

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

Dear Doctor, I have been taking 1mg propecia for almost 5 months and have noticed an improvement to my hair. However, just a few days ago hives began breaking out on my legs and arms as a side effect. Would reducing the dosage by half by splitting the pill reduce the effectiveness of the drug? Thank you very much.

It could be from the medication, but it could be unrelated. If you are really having an allergic reaction you need to stop the medication. What other causes could you have? See your doctor and let him/her investigate what is happening to you. It is better than having me blindly make your diagnosis via the internet without an exam or medical history.

Tags: propecia, finasteride, allergy, allergic, hives

Transplanting Pubic Hair to the Temples?

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

Can I use my pubic hairs as donor hair for my temple?

If you want curly hair in the temples, it can be done… and done successfully. I would question your motives, but upon examining you I can answer questions about the character of your head hair that will allow me to judge the appropriateness of such a request.

Tags: pubic hair, pubes, temple, hairloss, hair loss, bht, hair transplant, body hair

Long Term Benefits from Rogaine?

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

i know that many people have written to you about how after a few years they start to see their hair thinning even though they take propecia daily..Ur response has always been that the drug doesnt prevent hair loss but only slows it down and after a period of time genetics will win out over the drug and you will start to see hair loss.. You also say that you shouldnt stop taking propecia otherwise the hair loss will be much more..i think you refer to it as catch up hair loss..

But one thing i havent seen here is people writing in to say that after using rogaine for several years they are now seeing hair loss..I get the impression that the long term effects from rogaine are much much better then the long term results from propecia. Of those people who are no longer benefiting from propecia how many of them are also using rogaine? I bet not many!

I myself use both rogaine and propecia and things are pretty stable..It may very well be that the propecia isnt working but the slack has been picked up by the rogaine..I would never know. The one basic difference between the 2 is one is something you take internally and the other is something you use externally. Could you tell me ur thoughts about this? I would imagine another reason that rogaine is probably doing a better job long term is that phizer switched from a liquid to a foam for better penetration into the scalp as well..

Yes, there’s no medication that will stop hair loss forever. And yes, if you take both Rogaine (minoxidil) and Propecia (finasteride) at the same time you may never know which medication is doing the trick, though perhaps both are doing their own unique thing to treat your hair loss. Many of my patients do use both medications together, though some only use one or the other. I don’t have any polling data that shows what percentage of Propecia users also use Rogaine, so your guess is as good as mine. Just as with Propecia though, if you stop using Rogaine you’d also be subject to the catch-up hair loss.

I suspect there’s not a wide discussion about long-term Rogaine use, because it is available without a doctor’s prescription and it is not a hot topic like Propecia. I also don’t have data on long term benefits of Rogaine compared to those of Propecia, as it either isn’t available or just isn’t something that’s been presented to me (if anyone has it, please feel free to send it my way). The drugs have more differences than just oral vs topical, as Propecia actually blocks DHT (one of the causes of hair loss), whereas the reason for Rogaine’s hair growth isn’t known.

Tags: rogaine, minoxidil, propecia, finasteride, hair loss, hairloss

I Had Shock Loss, So If I Start Propecia Now Will I Lose Even More?

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

Dear Doctor,
i have undergone hair transplant 3 months back,and i had a Shock loss and i had lost tremendous amount of hair so much so that i could literally see my scalp starting from my hairline all the way up to the vertex. I have started using minoxidil 5% for the past 2 and a half months and have started getting my hair back.

My question here is that if i start using Finasteride now along with minoxidil (which i am currently using) will i have hair shedding again (as mentioned on various forums about hairloss on 11th and 16th week when using finasteride?)

please please kindly request your kind help as i am confused about starting finasteride and having hair shedding AGAIN. thanking you in anticipation

Shame on your doctor who should have insisted on you taking finasteride before the surgery to avoid the shock loss. You probably will not grow it back, but the hair transplant you had should offset some of the problem. Time will tell, as you’re still some time away before your transplant grows in. If you have another hair transplant within a few years, it will probably not happen again (no guarantees though), but going into such a surgery without finasteride on board will not be in your interests.

Let’s just hope that the shedding is over. Some people experience the finasteride shedding, though many do not. I can not predict what will happen to you as I do not know what you looked like before the surgery, how many grafts you had done, and I must know your age (the younger you are, the more at risk you will be).

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

Part of My Hair Transplant Looks Invisible a Week After Surgery

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

Dr. Rassman,

I had 1600 grafts transplanted to my hairline, filling in about 1/2″ below its current level. It has been exactly one week and I am a bit worried about the left side. The center and right side look like they have solid coverage, but the left temple area looks sparse, with empty spaces. Is it possible that the grafts aren’t visible, or that they may have fallen out?

I certainly am not in a position to tell you what is going on, but the doctor who did your surgery should be the first place to go to find this out. I wish I could offer more, but I didn’t perform your surgery and I don’t know what was done in the operating room or how many grafts were placed in each area. You just had surgery a week ago, so definitely have an open line of communication with your surgeon to alleviate any of your concerns. There should be good photos of you immediately after the surgery so that you can see the coverage you got on your troublesome left side. Good luck.

Tags: hair transplant, healing, hairloss, hair loss, grafts

Is PRP Safe and Will it Interfere with Future Hair Transplants?

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

Dr. Rassman,

Thank you for maintaining this blog. It is very informative. Although you have made a number of posts about the use of platelet rich plasma (prp) as hair-loss treatment, I was wondering if you could maybe elaborate on some questions I had.

By way of background, I am a 27 year old male with thinning in the crown. I seem to be exhibiting the same pattern of hair loss as my father. (He lost hair in the crown, but has a strong hair line). I am currently using both propecia and rogaine (7 months).

I am considering having the prp treatment. I realize it is in the early stages, but from what I have read (1) it is safe and(2) does not have affect other treatements, such as propecia and rogaine.

Do you agree with these statements? Do you think it may be effecive? Is it safe? Will the use of prp in combination with other treatements (propecia and rogaine) affect that treatment? Will the use of prp affect a patient’s ability to get future procedures (i.e., a hair transplant)?

Thanks in advance.

I do not believe that a PRP (platelet rich plasma or protein rich plasma) treatment will impact a future hair transplant procedure. You can read about this therapy here. It should be a safe procedure, but I do not understand what is being done to you. Are you doing this yourself, is a doctor or someone else doing it for you, and what do you expect from this unproven technique with regard to returning your hair or stopping its loss?

Tags: prp, protein rich plasma, platelet rich plasma, hairloss, hair loss

Can I Take Finasteride with Coffee?

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

CoffeeDear Dr. Rassman,

I take finasteride (1/4 Proscar pill)daily first thing in the morning with a glass of water on an empty stomach. However, shortly afterwards, I start to sip on my morning cup of coffee to get my caffeine fix going. I typically don’t EAT anything until at least an hour or so after taking finasteride.

Are you aware of any interference coffee/caffeine would have with the absorption/digestion of finasteride?

Thanks for your time and assistance

You can drink coffee (hot, cold, iced, warm), tea, milk, water, juice, and even Green Eggs and Ham. It won’t change the effectiveness of the finasteride you’re taking. The only food or drink I know of that you shouldn’t take with finasteride is grapefruit and grapefruit juice (see here).

Tags: finasteride, coffee, tea, hairloss, hair loss, propecia, grapefruit