How Natural Does Body Hair Transplantation Look?

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

What can you tell me about body hair transplants, where hair is taken from almost any part of the body and transplanted to the head? I found a place on the web that offers it and I am curious to know if it is a real possibility and how natural it looks. Thanks.

In the cases I’ve seen, body hair transplantation (BHT) does not look natural at all. A while ago I saw a picture in the National Enquirer that showed a person who had his head transplanted with pubic hair. The transplants kept their hair character in the transplanted process… and no surprise, it looked like he had pubic hair growing out of his head. I also saw a man in my office who had the entire top of his head transplanted with body hair… and it looked just like his chest hair did. It was anything but a lush, tight hairline look and it was thinner than a normal head of hair would be.

Those are just examples of the visual differences. I’ve also seen a few cases of BHT failures. Plus, there’s the problem of the hair growth cycle for body hair being different than scalp hair, meaning much of it is dormant at any given time and it will never get to any great length (which you probably would want for styling).

So as you can probably guess, I’m not a fan of BHT for a number of reasons. Further reading can be done here and here.

Tags: hair transplant, body hair transplant, bht, hairloss, hair loss, body hair transplantation

Dr Rassman, Did You Ever Do Hair Plugs?

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

In the early days did you ever perform a surgery like this? (hair plugs)

No, I never did the large grafts placed into holes (commonly called hair plugs). I started with my own practice in late 1992 and immediately went to large quantities of small grafts (at the time 1.5mm grafts into punch holes with each graft containing about 3-5 hairs each). I quickly reduced the size of the grafts to 1.25mm grafts, reducing the number of hairs per graft to about 2-4 hairs each and I used all of the single hair grafts in the front of the hairline.

At that time, the follicular unit was not recognized as the “golden standard” that is, until we published the classic article on follicular unit transplantation in the mid-90s (read it here). By 1994, we were using small grafts into slits and many of these grafts were follicular units. Our number of grafts had climbed to as high as 4000 grafts in a single session.

Tags: hairloss, hair loss, hair transplant, hair plugs, rassman, nhi, new hair institute

My Doctor Suggests that Finasteride Could Be the Cause of My Itching

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

Dear Doctor Rassman,

Once again thanks for this brilliant blog and useful service that you provide your readership with.

I’m 25, been on finasteride (1/4 proscar) since Sept. 08 and I have had no problems at all. My hair loss has stabalised and I’ve seen some thickening up around the top middle of my scalp so you could say I’ve reacted well to the drug.

However, around the start of July this year I’ve been experiencing really bad itching all over my body. I’ve been to my GP a few times with it (having trouble sleeping at night) and they have done some blood tests – everything fine except slightly lower than normal pottassium levels. The GP has suggested that finasteride could be the cause, but when discussing with my prescribing doctor he believes it is unlikely as itching is such a rarely reported side effect (perhaps 1 in 700 cases) and if I was to have an allergic reaction it would have shown itself within the first few weeks of taking the drug. I wondered what you thought about this.

My prescribing doctor also suggested that if i want to try and come off finasteride for 3 – 6 weeks, there wouldn’t be any long lasting hair loss and I would know during that period whether it was the finasteride causing it. Do you think that if it is finasteride, coluld it be one of those symptoms that goes away with continued use?

I haven’t found many articles discussing this issue specifically on the blog so I would be interesred to read your opinions.

Many thanks.

I think you are very well informed and I agree with your doctor that you should try to come off the finasteride to see if there is an allergy, but the likelihood of the drug causing of your itching is low. You might want to shorten the period you are off the drug to 2 weeks, though. Being off of finasteride for 2 weeks will have minimum impact, but keep in mind your itching may just go away on its own and there may be a false correlation.

If you’re taking generic finasteride, I also wonder if you’re now taking pills made by a different pharmaceutical company (perhaps without realizing it). There could be a difference in a filler ingredient that you’re allergic to.

Tags: finasteride, itch, hairloss, hair loss, propecia, proscar

Histogen in 5 Years?

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

What are your thoughts about Histogen? They were at ISHRS meeting and showed photos and data. They say 5 years.

You can read up on their progress in this article from a couple weeks ago at Biospace.com. Who knows where this will go? I certainly don’t have the answers. I would not wait for the breakthrough based upon where the company is in its research at this time. Maybe in a year we will know more and then be able to forecast to answer your question.

Tags: histogen, regenica, hairloss, hair loss, hair stimulating complex, hsc, wnt proteins

Vigorous Weight Training and Finasteride

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

I’ve been on finasteride for about 18 months–great results!

During this time, I’ve been loosely weight training, but mostly doing cardio and aerobic, which I know to be good for reducing stress and keeping testosterone levels steady, but this is my question:

If a person started training more vigorously with weights, would the consequent spike in testosterone levels impact the effectivness of finasteride? Or put another way, would the rise in testosterone translate into a rise in DHT, thereby overwhelming the capacity of the finasteride already working in one’s system?

Thanks Dr’s

Vigorous weight training will not have an impact on your balding. Your body will take care of itself. I think you are over-analyzing the issue. The workout will not make finasteride less effective, as many people seem to believe.

Tags: finasteride, propecia, dht, exercise, workout, hair loss, hairloss, weight, training

In the News – Combing Too Often Means Hair Loss?

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

Snippet from the article:

Put that comb back in your handbag — a study by an Israeli dermatologist has found that too much combing of the coiffure leads to hair loss, the daily Haaretz reported on Monday.

During a test 14 women recorded their daily hair loss and combing habits, with those combing more losing more hair, the research found.

Read the full article — Don’t brush with baldness: put down that comb

BrushThe Internet is full of useful information, but as I’m sure you all know, some of it can be deceiving. The article states that an Israeli dermatologist studied just over a dozen women and came to the conclusion that women that comb their hair twice a day have far more hair loss. The study went on for just a month, but what is unknown is the type of hair the women have, their ages, health condition, type of brush used, plus various other factors that would be important to note in a study like this. In fact, I found the original article published in Israel, with a quote from the dermatologist that conducted the study. He says, “It’s a very simple experiment, very primitive, you could say, not high-tech.” I’d have to agree with that. It seems to be pretty incomplete… but it sure makes for a good headline in the news.

Bottom line, if you are rough with the comb and your hair is long and you pull on it when you comb it, it may just fall out eventually. Men with genetic balding and miniaturization have a more fragile hair that is easily traumatized, so I always suggest that people are careful when they comb their hair and not be abusive to it. Gentle combing done very frequently will not cause hair loss.

Tags: combing, comb, hairloss, hair loss, female hair loss, brush, haaretz, israel, kiderman

Problems After Switching to Generic Finasteride

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

I started using Propecia 5 years ago at the age of 25. I wasn’t sure if my stress level was affecting it (went through a really horrible breakup) or if I was having genetic hair loss. So I started to take it and all was fine. 2 summers ago I stopped taking it thinking it was probably just stress and 2 months later, I noticed the hair was indeed falling out. So I started up again. Until 2 months ago i was taking propecia but then just decided to switch to finasteride as many of my friends and clients (I’m a hair stylist) swore by it and so I switched.

I’m noticing my hair has thinned as if I stopped taking it altogether. Is this possible? I have the 5mg finasteride and cut into quarters.

Also, I was reading online about symptoms of testicles/penis “feeling cold” and shrinking frequently is related to the propecia/finasteride usse. I have had A LOT of that and am wondering if it’s related since the prostate is directly involved.

I appreciate the time you give in reading and answering my questions. Thank you.

Taking generic finasteride 5mg and dividing in to quarters is the same as taking Propecia (finasteride 1mg). There should be no difference at all between the two, except for cost savings and the requirement of cutting the 5mg generic pill.

I might just be under the wrong impression, but from the brief description of your history, it seems you are not being followed by a doctor and almost blindly treating your hair loss issues with medications that may or may not be right for you. You really need to see your doctor and discuss these concerns with him/her, as you may have other medical issues not related to finasteride use. Shrinking testicles and a cold feeling are not usually side effects of taking finasteride. Even in the remote chance that it is, you cannot afford to not get it checked out. You may have a medical condition causing your problems. See your doctor, please!

Tags: finasteride, generic, propecia, prostate, side effect, hair loss, hairloss

I’m Asian and My Facial Hair is Spotty

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

Dr. Rassman, Dr Pak

Hi, I’m a 23 year old Asian Male. I was wondering some areas on my face does not grow facial hair at all. For an Asian, I grow facial hair pretty fast and it’s thick (for instance, under the chin). But there are spots on my cheeks that don’t grow facial hair at all, which keeps me from growing a full and even looking facial hair. The spots are literally the smoothest skin on my face. Is this because of my genes? What can I do to grow a full even set of facial hair rather then only certain areas of my face? I appreciate any help or advice you can give me. Thank you

Pat MoritaIt is your genes. Asian men do not usually grow full thick facial hair (some can, but they generally have less facial and body hair than most). What you describe is normal. If you want a full beard you can consider a hair transplant procedure to the beard area, but I would suggest that you wait a few years and see what grows in first. Full beard growth occurs between the ages of 25-30. Many men have actually had transplants with great success.

At right, an image of the late Japanese-American actor Pat Morita (from the Karate Kid) sporting a goatee.

Tags: facial hair, beard, asian, hair growth

Finpecia is Fake?

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

This is regarding your blog entry titled “I Don’t Think I’m Responding to Finpecia”

I had been taking Proscar for a year and my hairloss stopped completely. Because I was trying to save money I decided to switch to Finpecia. After 3 months on Finpecia I started noticing a rapid hairloss. I immediately went and got a refill of Propecia at CVS. I’ve been back on Propecia for about a month and the hairloss is gradually slowing down. I think Finpecia is fake. Please tell that poor student to throw that stuff away.

The above is an opinion of one of our readers. I’m not going to tell someone to throw away their medication that I didn’t prescribe and I’m unsure is even a problem.

I’ve written about Finpecia before here and here. There are a variety of 1mg generic finasteride made in other countries (not legally available in the US), and you can see some of those listed here.

Tags: finpecia, finasteride, propecia, generic, hairloss, hair loss

In the News – Fish Oil Benefits for Cardiovascular Disease Confirmed

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

This is a general health posting, unrelated to hair loss.

Snippet from the article:

Fish oils are so effective at helping protect against heart attacks, they should be taken daily by everyone, say doctors in a new review of the effects of omega-3 fatty acids.

The doctors say their review found that there is now “compelling” evidence that the omega-3 fatty acids in certain fish and other sources not only prevent cardiovascular disease, but may even help treat it.

The study, published in the Journal of the American College of Cardiology, reviewed data on four trials involving almost 40,000 participants that showed the benefits of omega-3 fatty acids in the prevention of cardiovascular disease, in treatment after heart attack and, most recently, in heart failure patients.

Read the rest of the article — Fish oil’s heart benefits overwhelming, say docs

Being bald is OK, but dying from heart disease should not be in your cards.

Tags: cardiovascular, heart, disease, fish oil, omega-3, heart attack

Am I Losing Hair Because I Switched to Generic Finasteride?

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

Hello,

About 3 months ago I switched from Propecia to the generic Finasteride 1 mg manufactured by a Thai pharma company (bought overseas). Also, for the last 4 weeks I have trouble sleeping and irregular sleeping patterns due to international travel (ie. jetlag, time difference etc.). Lately I am noticing excessive hair loss in the bathroom sink (about 3-4 times my average) after a shower. Should I attribute that to the lack of proper sleep or to a potential ineffectiveness of the generic Finasteride? I had been on Propecia for over 5 years before I switched, which represents an “investment” as you can imagine.

Thank you.

Hair loss is genetic. I doubt jet lag or proper sleep has anything to do with what you are describing, but stress might.

Generic finasteride and Propecia (finasteride 1mg) are the same medication, just marketed differently. Unless you are getting your finasteride from a shady Internet site (particularly the sites that sell prescription meds without a prescription required), I doubt it has any clinical significance. Keep in mind there are many reputable overseas drug manufacturers, but I don’t know which maker or brand you ended up with. In the end, if you are unsure of the validity of your medication, share your concern with your pharmacist or your prescribing doctor. The ultimate decision of going back to brand name Propecia is up to you.

For the record, I routinely prescribe finasteride in two ways:

  1. Generic: Available in 5mg strength, with instructions for the patient to take 1/4 pill a day (generic 1mg finasteride isn’t sold legally in the US due to patent laws).
  2. Name brand: Propecia, which is already the 1mg dosage that is FDA approved to treat male pattern baldness.

I leave the decision up to my patients whether to take a brand name versus splitting a generic. I do not see any difference with respect to clinical results; the only difference is financial saving. If you are worried about the generic finasteride, then go for Propecia and then there should be no doubt.

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

Does Dr Farjo Endorse the Scalproller Like It Suggests in the Press Release?

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

I saw that Dr Farjo was quoted in this press release for some scalp roller. The link is here: Breakthrough Therapeutic Tool Presented to 400 Leading Hair Loss Surgeons.

It also says “Furthermore, the latest research on behalf of Intercytex by Dr Bessam Farjo, and pioneering studies by Dr George Cotsarelis provide evidence that Scalproller therapy may produce new hair growth independently of any other treatment.”

So is Dr Farjo endorsing this tool?? Thanks!

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


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

Pangaea is a company I have known for about 10 years which started out making a scalp fibres camouflage product called Nanogen which we sell on to some of our patients. They have become involved in a variety of other hair products over the years, but earlier this year they approached me after the Intercytex data suggested scalp ‘stimulation’ made a positive difference to the hair counts. They showed me their Scalproller device and they suggested it could help stimulate hair growth on the principle of causing scalp injury, and they also speculated that it would significantly aid minoxidil absorption into the scalp. They discussed a number of other interesting ideas and projects and I agreed that the principles behind their Scalproller suggestions are scientifically plausible. We are currently in discussions about writing appropriate protocols for clinical trials. I can not endorse the Scalproller device itself until further clinical research is at hand.

—

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

Tags: scalproller, nanogen, scalp roller, hairloss, hair loss, farjo

Does the Entire Follicular Unit Miniaturize or Just Individual Hairs?

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

Doctors say follicular units contain 1,2,3, and sometimes even 4 hairs per unit. My questions is, when miniaturization occurs, does the whole follicular unit get affected at the same time or does the individual hairs within the unit miniaturize at a different pace and time frame? Hopefully my question is clear.

Best regards! I know you keep busy with the blog and practice!

When miniaturization occurs, each hair within the follicular unit seems to have its own time clock, but the follicular unit itself will miniaturize in the patterned area at a different pace, area by area. Often in young men, the frontal hairs will miniaturize faster than the hairs on the top of the head, about 4 inches behind the hairline. As the hairs within the follicular unit miniaturize and it progresses, one hair at a time may drop out and die before another one within the follicular units takes its genetic course.

Tags: hairloss, hair loss, follicular unit, miniaturization

Does HairDX Tell Me How Much Finasteride I Should Take?

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

Using HairDX to help understand if continuing Propecia is appropriate

I’m 29 with a full head of hair, but it’s a bit thinner than it used to be. I started Propecia six months ago after having some miniaturization detected on the front and top of my scalp. I have yet to notice any positive impact from the drug, but feel Propecia might be affecting my sexual performance. Whether I’m imagining side effects or not, I have been thinking about decreasing dosage or stopping Propecia altogether — I’d rather not have to be on a ED drug in my 30s, especially if Propecia isn’t helping me.

Would it be worthwhile having the HairDX test done to help me weigh the costs and benefits of continuing Propecia? Furthermore, does HairDX offer any insight into how hair loss might progress over time, the degree of hair loss that might occur, or the minimum Propecia dosage I might respond to?

HairDXThe CAG repeat test from HairDX (marketed as “Finasteride Response Test“), will tell you if you may respond to drugs like Propecia. Start from there and then discuss the findings with your doctor. To my knowledge, there is not direct quantification of the HairDX test for CAG and the dose required of drugs like finasteride.

The standard HairDX test won’t tell you how much hair loss you’ll see in the future — just whether you have the genetic markers for hair loss.

Tags: hairdx, hair dx, finasteride, propecia, hairloss, hair loss

Diffuse Hair Loss, Brittle and Yellowing Nails

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

I have been experiencing heavy diffuse hair loss for about a year now. My nails are very dry, brittle, have long vertical ridges and split very easily. My big toenails are yellow in color and have been falling off their beds with new ones growing under, for the last 5-6 years. My skin is also very dry. My skin is very dry too.

My scalp is itchy, and when I scratch it I have grainy, sand like white stuff in my nails. Could you please tell me how this hair loss can be controlled? Is it fungal in nature? Or is something else going on inside the body?

Thanks.

Generally, it does sound like you have a fungal problem (onychomycosis), but please see a dermatologist so that he/she can make that diagnosis and provide a treatment path. This isn’t something I can do over the Internet. Your hair and nail conditions could be completely unrelated, but I’d need an examination to determine that.

Tags: fungus, fungal, nail, hairloss, hair loss, onychomycosis