Physiological Difference Between Crown and Hairline Balding?

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

Dear Dr. Rassman,

My question is regarding the non-approved use of minoxidil for frontal balding. In your response here your thoughts were that it might work to some degree. My question is whether there is a physiological difference between balding at the hairline and on the crown? If not, is there some other reason why minoxidil might be less effective at the hairline, or is it simply the case that Pfizer didn’t test it there, and if not, why not as it would surely increase sales.

The drug PI in fact specifically says not to use it for receding hairline, do you believe that it’s possible that it may have negative effects? Further, is there a likelihood that minoxidil use by a man who in fact wasn’t balding but only having a maturing hairline would have negative effects (other that normal drug side effects)?

Many thanks

You raise an interesting question, but no one really knows why minoxidil or finasteride work better on the crown area. There may be a physiologic difference of hair follicles in the frontal area versus the hair follicles in the crown area, or it could be that hair loss in the frontal area is more rapid and medication works better when the hair loss is earlier with more miniaturized hairs. I do not think there is a danger or negative consequence of using the medication for the frontal area, though. In fact, many of my patients do use these drugs for the frontal area with some success.

I really do not know why the drug companies did not study the effect of the medication on the frontal area of the scalp. My cynicism would tell me that their initial results were very weak and they’d rather not publish poor results, but I actually believe that it was too complex for a good science study to show the type of results seen in the crown.

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

New Study – Body Dysmorphia Due to Visual Processing Abnormality

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

From the study abstract published in the Archives of General Psychiatry:

Results: Subjects with BDD showed relative hyperactivity in the left orbitofrontal cortex and bilateral head of the caudate for the unaltered own-face vs familiar-face condition. They showed relative hypoactivity in the left occipital cortex for the low spatial frequency faces. Differences in activity in frontostriatal systems but not visual cortex covaried with aversiveness ratings of the faces. Severity of BDD symptoms correlated with activity in frontostriatal systems and visual cortex.

Conclusions: These results suggest abnormalities in visual processing and frontostriatal systems in BDD. Hypoactivation in the occipital cortex for low spatial frequency faces may indicate either primary visual system abnormalities for configural face elements or top-down modulation of visual processing. Frontostriatal hyperactivity may be associated both with aversion and with symptoms of obsessive thoughts and compulsive behaviors.

Read the full abstract — Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder

Body dysmorphia is a problem for a few patients that I have seen with balding. At times I make this diagnosis so I found this particular study very interesting. CNN also just published an article based on the same study here, which might be a little easier to digest than the study abstract.

Tags: bdd, body dysmorphic disorder, body dysmorphia

Using Toppik to Provide More Density After a Hair Transplant

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

If you don’t have enough density to cover a full Norwood 6 with a transplant, what is your opinion of doing light coverage and then using Toppik and/or other concealers (for life) in order to give the appearance of more hair?

ToppikI’ve posted a couple cases about this. Those with very fine hair will have a harder time obtaining coverage, and the use of concealers with the transplants can work quite well. So yes, I absolutely think it’s a good idea if you want to use these camouflaging agents.

See these posts for some good examples:

  1. Use of Concealers (with Photos)
  2. Can a Class 8 Person be Transplanted? (with Photos)
Tags: toppik, dermmatch, concealer, hair transplant, hair loss, hairloss

In the News – Fake Doctor Claimed He Could Cure Hair Loss

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

Snippet from the article:

Timothy Syed AnderssonTimothy Syed Andersson billed himself as dermatologist to the stars. Andersson, known to his patients as Dr. Syed, had a wall of photos at his home office in San Francisco’s Lakeshore district, showing him with actress Julia Roberts and actress-model Elizabeth Hurley, Nobel laureate Linus Pauling and other notables.

His Web site boasted of his research that had led to cures for everything from stretch marks to hair loss. San Francisco prosecutors say it was all a lie.

Read the full article at SFGate –Fake doctor fleeced patients, prosecutors say

As the article points, this guy was a con man with fake credentials, Photoshopped images, and was indicted in Sweden before fleeing to the US 14 years ago. He set up shop here and he was able to bilk people out of thousands of dollars each for treatments that were total BS. Shameful.

Tags: fraud, con man, hair loss, hairloss, syed andersson, syed

Releasing Clinical Trial Results, Follow-Up

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

FDANote: One of my favorite contributors to this site is a reader (that wishes to remain nameless) that has provided wonderful insight into areas like LLLT (hair lasers) and the FDA. I’m admittedly not an expert in everything (no matter how much I wish I was), and he’s corrected my initial thoughts about companies publishing ongoing clinical trial results. His email is as follows:

Dr Rassman,
As someone who has worked in the drug development industry, I try to keep your readers updated with accurate info on how this process works. One of your readers asked whether “Aderans…would send out an update on their Phase 2 trial data……..and whether there are rules requiring such info to be confidential.”

There are no rules to keep trial data confidential. The sole reason why data from an ongoing Phase 2 trial is not released is because it is not available. That is, no data is available to a sponsoring company until a drug study is complete (or in rare cases, when an “interim analysis” is done). When a company begins a trial the data (and identity of the participating patients) is kept secret from the company during the conduct of the trial. This is to ensure that no data is manipulated; extraordinary safeguards are put in place. Intentional violation of such safeguards with hiding of the act is a form of scientific fraud and would result in failure of drug approval and public sanction of the company by regulatory (and other)
authorities.

The FDA (and regulatory agencies, in general) have no jurisdiction of when a company reports data to the public (and do not care). However, public reporting of inaccurate data can result in sanctions from both regulatory agencies and, if the company is public, the US Securities and Exchange Commission (SEC). The latter relates to how public release of trial data typically affects a public stock (good data raises the stock price, bad data lowers it).

Nearly all public companies release Phase 2 clinical trial data (regardless of positive or negative) on trial completion for 2 reasons: (a) to communicate results to the scientific community, and (b) to communicate the results to shareholders. Withholding such data from shareholders can be perceived as having “inside information” of results that are considered “material” (i.e. important for shareholders to make decisions on purchase or sale of the stock). In cases where a company is private (rare when a company is at the stage of Phase 2), trial data is usually released to encourage future investors (positive data) or explain why a program is not moving forward (negative data).

Bottom line: Aderans can not send out a trial update because the data will not be known until study completion and analysis (the FDA has nothing to do with this). There are no rules to keep trial data confidential when a study is completed and, in fact, there are many reasons why public companies are required by the SEC to divulge these results. In fact, the SEC has brought legal action against some companies that they feel have not released “material” clinical trial data in a prompt fashion.

Tags: fda, aderans, clinical trial, hair loss, hairloss, sec

A Heath Website Says Over-Masturbation Causes High Levels of DHT

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

Here is a quote I just found on a health & fitness website:

“Over-masturbation or over-ejaculation converts too much testosterone into dihydrotestosterone(DHT). High levels of DHT overload the body causing baldness and possible prostate enlargement. Reducing the frequency of masturbation or ejaculation will help maintain low levels of DHT and avoid hair loss.”

So should I really believe this stuff and, well, ‘keep it in my pants’? I’ve never heard of ejaculation elevating DHT before, so any comment would be appreciated.

Older studies show masturbation cuts prostate problem risks, but a more recent study shows that it could possibly increase prostate troubles for younger men. Yet the study suggests that older men should have frequent sex or masturbate more frequently. Some male health experts believe that men should either have sex once a day or masturbate once a day, but the evidence is really not scientific.

Every man has DHT, yet not every man loses hair. For those that are susceptible, DHT is a cause of hair loss. But even if ejaculating caused a DHT increase, you’d have to be genetically inclined to lose hair for it to actually cause hair loss. Why does this not make sense to people? Masturbating doesn’t cause hair loss. Genetics does. If you never masturbated or had sex in your entire life, you could still lose hair.

Tags: dht, ejaculation, ejaculating, hairloss, hair loss, masturbation, sex

Does 2mg Finasteride Help Once 1mg Finasteride Effectiveness Levels Out?

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

Hello Doctor,

Firstly I’d like to thank you very much for maintaining such a very informative blog.

I have read that in cases where 1mg finasteride has lost its “effectiveness” in patients over the years you have prescribed 2mg instead of avodart. In the majority of these cases do you see a halt to hair loss, or no change from 1mg. Thanks for your time.

I haven’t seen much difference in results for those men that take 2mg finasteride from the start compared to those that take the recommended 1mg. I’m still not clear if it helps to take 2mg when 1mg seems to not be as effective as it once was (generally after years of taking it). I occasionally do advocate the double dose for those situations, but there isn’t actual evidence that this helps. There’s been only a small handful of patients that I’ve recommended this to within the past year, too soon to get a follow-up. In other words, there is no objective data on the results of changing the dose.

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

Scratching Out FUE Grafts a Month After Surgery?

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

Hi Dr. Rassman,

I’ve had a hair transplant a month ago. Is it still possible for me to scratch my implanted FUE out?

Thank you

I would usually say no, but I have seen some strange results and methods of hair transplants over the years. Not all FUE (follicular unit extraction) is the same and not all hair transplants are the same. If you are able to pull out a graft one month after surgery, then it was never going to grow anyways. Under most circumstances though, the graft has already taken hold by then.

Tags: fue, hair transplant, hair loss, hairloss

I’m Losing Hair Before I Can Even Grow a Beard!

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

Hi Doc

I am a 22 male with fine blond hair, and ever since I can remember I have always had fine hair (used to be able to pull out chunks of my hair) however since the age of 16 I have become obsessed with my receding hairline. Don’t get me wrong, I accept the fact I’m going bald and just waiting for the day to come where it becomes TOO noticeable so I can get the clippers on them. What I don’t understand is …. why now? I cant even grow a beard.

Surely it cant be normal for my hair to be falling out and I cant even grow a proper beard? I got stumble on the chin and upper lip but nothing else….. I am starting to think maybe I have a underlying illness that I don’t know about. Could it be because I am a smoker and that why my hair is falling out? Is it normal for someone to be going bald that hasn’t properly finished puberty yet? or maybe I am just being paranoid? I don’t know.

Any advice would be greatly appreciated

Kind Regards

Sorry to hear of your hair loss. It seems you have accepted that inevitable. Unfortunately, if you are destined to go completely bald (Norwood 6 or 7) it usually starts very early, possibly as you described.

Growing a beard has nothing to do with scalp hair loss. It is in itself a genetic trait (like balding). Some men just never grow a beard. Also, smoking is bad for you (hey, I’m a doctor — what did you expect me to say?).

Tags: facial hair, beard, hairloss, hair loss, age

Propecia Year 10 Estimates?

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

Dear Dr. Rassman,

Could you talk a little bit more about what you see over long-term with results with Propecia? Let’s start with the assumption that nine of 10 patients will have not lose hair from baseline at year 5.

At year 10, what percentage of patients would you say have a very noticeable decrease in hair, what percentage have a modest decrease in hair, and what percentage do not have any visible decrease in hair? I, for instance, have modest diffuse thinning–just barely visible to the naked eye. It has been diagnosed as MPB. I started on Propecia and minoxidil a few weeks ago, and am just looking for rough probabilities that 5 and 10 years from now, I will still have reasonably good hair coverage.

I know there are no hard and fast numbers and no clinical studies beyond the 5 year point, but any rough estimates would be great.

CalendarYour assumption that 9 of 10 patients will not lose hair from baseline is incorrect. Almost all patients will lose hair from baseline, because Propecia is not a cure! The rate of hair loss will be slower, but you still continue to lose some hair. Some will lose more hair and some will lose less hair, as it mainly depends on their genetic predisposition. That’s why I always tell folks here to get their miniaturization mapping done so that you have a baseline status at different regions of your scalp. This way you can track the progress of hair gain/loss.

As you know, the actual study was for only a 5 year time period, so I don’t have the data to be able to make any realistic estimates beyond that. A few years ago I posted a 10 year projection estimate here, just as an example. I really cannot give you probabilities on how good your results will be, just like I cannot predict the weather a year from now. If you have modest diffuse thinning on your front, top, and crown, I can expect the worst and say you may be an early Norwood Class 6… and that means you will likely go bald sometime in your life. With Propecia that will hopefully buy you a few years or maybe even a decade or more of good hair. But really, I haven’t examined you and I don’t know where your loss pattern will go.

Tags: hairloss, hair loss, propecia, finasteride, estimates, progression, hair count

How Can Events Trigger MPB Onset?

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

Hey Doc,

This is such a great site and I learn so much from here. I had some questions for you. I see you mention that certain events can cause an onset of MPB. Can you elaborate on this, as far as how certain events can cause an early start of MPB. Also, is it possible that a person may never have developed MPB even if he has to genes for it, if that person would have never engaged in an activity that that you say can cause an onset of MPB.

Last question, I asked you once about perscription meds causing hair loss. You indicated that a women should regain her hair back with in a year if the hair loss was caused by the meds. How long would it take for a male to regrow hair that was lost due to perscription drugs?

Thanks!

No one really knows exactly how it happens, but stressful events (such as a major illness) can start a process of genetic hair loss. It can also be such that the genetic hair loss was in progress all along and that the stressful event just made the hair loss more evident (with rapid hair loss during the stressful times), but I doubt that it’s possible to avoid MPB by avoiding these stressful events.

Prescription medications may cause hair loss, but that may be the last item on the list of possible reasons for your thinning hair. For both men and women, one year is a good, safe rule of thumb to wait for regrowth of hair that was caused by medications. But in the real world things are not so simple and there may also be other factors involved for the hair loss.

Tags: hairloss, hair loss, medication, trigger, stress

Alopecia Areata and Cyclical Hair Loss

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

(female)
i have alopecia areata and my hormone levels are up the creek . i am growing new hair , however why does it get so far and then fall out again ?

I do not know what you mean by your hormones being up a creek. Which hormones and what creek?

I am glad to read that you are growing new hair, which is to be expected for those who have alopecia areata. But it also may fall out again, also to be expected for those who have alopecia areata. This is something that happens with this disease, where it may spontaneously reverse and at times recur. For more info about alopecia areata, see the National Alopecia Areata Foundation.

Tags: alopecia areata, hairloss, hair loss

Is a High Forehead on the Norwood Scale?

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

Excellent blog – dispelling the myths and hysteria around the web. For that, I thank you.

I have a question about the classification of hair loss – i.e. the Norwood Scale. I have a high forehead and temples, I have always had a high forehead even as a child and my temples developed into an adult hair line in my late teens. Looking at the NHI site my hair line is similar to some of the Norwood class 3s. However, I know for a fact that it hasn’t changed in at least 10 years (i have photos) and I am pretty certain it is the same as when I was 20 (give or take a few hairs). I am now 33. The thickness has not obviously changed either. But according to Norwood I am losing my hair. Any thoughts?

Thank you in advance

If you have a hair hairline, it does not mean that you are balding. High hairlines are genetic in both males and females. If you wrinkle your brow, the highest crease is where your hairline was when you are 12 years old, but in the mature hairline, the mid-point rises about 1/2 inch in the mature hairline and that is not balding on the Norwood scale.

Assuming that you have balded to a Norwood class 3 and stayed there, it does not mean you are going to progress from a class 3 to 4 to 5 to 6. It is merely Dr. Norwood’s description of how men look.

Tags: high forehead, hairloss, hair loss, norwood

Catching a Pharmaceutical Counterfeiter — A Must Read!

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

Snippet from the article:

On May 25, 2007, Kevin Xu logged into his Gmail account and found a startling message from a man who could have been his biggest client.

From an office suite on the 28th floor of the Plaza Royale in Beijing, the baby-faced businessman had gone from selling shark cartilage and penicillin to Chinese hospitals and clinics to cashing in on the high-profit margins of the European and—he hoped—US pharmaceutical markets. Xu kept a list of 29 brand-name drugs he could deliver at cut-rate prices, from the baldness remedy Propecia to lifesavers like the antileukemia drug Gleevec.

Read the full article — TheScientist.com – The Counterfeiter

The article goes on to show how Kevin Xu was ultimately caught and convicted, but also delves into the fake pharmaceutical business. The rate of drug counterfeiting has gone up substantially in the past few years, and just goes to show how this stuff is more widespread than most believe. A fascinating read! Thanks to the reader that sent me the link!

Tags: pharma, pharmaceutical, counterfeit, medication, propecia, drugs, finasteride

No Growth 7 Months After from My Hair Transplant (with Photos)

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

Thanks for the informative site! I’ve searched for similar questions and answers, you’ve addressed delayed and no growth from transplants before, so hopefully this isn’t repeating too much from others. I’m 29 and had a hair transplant with a reputable IAHRS doctor seven months ago. 2400 grafts total were used, placed in the front 1/3 of my scalp to thicken my front and fill up my hairline.

It’s been seven months and the only growth that has occurred are a couple or so dozen hairs that didn’t shed during the two weeks following surgery. Those started growing further at about 3 months and are still growing, but it looks as though nothing else has even begun to pop through. The only possible explanation I can think of is concerning ridding my transplanted area of scabs post-op. 14 days after surgery, the scabs started to raise up and I went through with the balls of my fingers and gently rubbed them off, in some cases gently picked them a bit to rub them off (a few also peeled like dead sking does). There was no sign of trauma and with the scabs came the small hairs. So I shed about 90% or so of the hairs at 14 days. I discussed this with my doctor and he said there shouldn’t have been graft damage and any grafts coming out would’ve been followed by bleeding.

Is there any explanation(s) for this delayed or potentially little growth from my transplant? I’ve read articles about some transplants having delayed growth for up to a year due to different types of hair cycles. Could the rubbing and slight picking off of scabs after 14 days taken the grafts out or traumatized them to lay dormant longer? I’m sending before and after photos. Thanks!

You sent a lot of photos, but unfortunately most of them were from a distance and poor quality, so they don’t help me see much. The two best photos are shown below (click to enlarge) — the left photo is from 1 day post, the right photo is from 7 months post surgery. There does not appear to be any growth and I would expect that something should have shown by now.

 

Sometimes transplanted hairs can take up to 12 months before it grows, but usually there is some growth by 7 months. You should see some results between 5-6 months post surgery. I would give it up to a few more months, but definitely follow up with your hair transplant surgeon. I really do not like the unusual zig-zag hairline the doctor placed, as evident in the 1 day post-procedure photo.

There are MANY factors that go into a successful hair transplant surgery. Each and every hair graft/follicle can easily dry up and die if not handled and transplanted by a professional medical team. That is why choosing the right doctor and the right medical group is very important. In other words, it is not like buying a car from a dealer who can get you the cheapest out the door price. Despite what the consumers may think, not all hair transplants are equal (even if they advertise the latest techniques).

Tags: hair transplant, hair growth, surgery, hair restoration