My Hair Appears to Be Thinning All Over, Not in a Pattern

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

Hi,

About 6 months ago i noticed i was shedding hair. i had low B12 a few months ago, but have been taking vitamins since (my B12 is now normal). now, as far as i can tell my hair is thinning, but not receding. since at every hair loss site i look there’s the NW scale for hair loss, which shows the hairline receding gradually, i’m wondering – is overall thinning a form of MPB? could this be something else?

You are asking two different things here. MPB stands for “male pattern baldness” and just as the name implies, the hair loss would be seen in a “pattern”. Diffuse hair loss would have no pattern. Either form can be genetic, but the diffuse loss may be caused by diet, vitamin deficiencies, or many other conditions.

I assume you saw a physician for your B12 deficiency diagnosis, and I would suggest you should see a doctor that can make a diagnosis for you about your hair.

Tags: hair loss, hairloss, thinning, diffuse

Maximum Amount of Grafts That Can Be Extracted with FUE?

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

Hey Doctor
Thanks for the website. In a person with average hair denisity, what is the maximum number of grafts on average that you would believe could be extracted over time using FUE (i.e more than one procedure)?

I really do not know the maximum and I would be just giving you a theoretical number. In practice, I believe we may have done about 4000 grafts over several procedures using only FUE.

Tags: fue, follicular unit extraction, hair transplant, surgery

After I Started Medical School, My Hair Started Thinning Greatly

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

Hi Dr. Rassman,

I’m writing you to ask whether significant hair loss over the course of a couple months can be due to just MPB? Last august, I had a nearly full head of hair, but I admit it was a little thin on top. THEN, I started medical school and my hair is now thin both in front (along the hairline) and even more so at the crown. Did the stress, lack of sleep and not-so-great diet I’ve been eating simply exacerbate the balding process, or could there be another problem?

I’ve actually already seen a dermatologist regarding my hair-loss, but he didn’t ask me about the time frame whatsoever, so I figure there’d be no harm in asking you for a second opinion. He recommended I start taking finasteride and using minidoxil daily, which I’ve been doing for about a month now. Excuse my complete lack of medical knowledge on this, but I’m just a first-year, so we haven’t touched upon it yet.

All the best

TwinkiesThere was a story I remember learning when I was in medical school, that a few years before I attended one medical student practically lived off of Twinkies and junk food. He developed scurvy from malnutrition. That is an extreme form of poor diet and I will assume your diet is a bit healthier.

With respect to my recommendation, I really do not have one to give you other than to follow your doctor’s advice. You need a medical diagnosis and a treatment plan and someone to follow up with you to see if that treatment plan is working.

In general, stress may accelerate the genetic process, but it is not a direct cause and effect type of relationship. I don’t know how old you are, but it could be quite possible that the timing of your MPB starting is coincidental to the start of your schooling.

Tags: stress, hairloss, hair loss, malnutrition

Combing Hair in the Opposite Direction

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

Hello, I am a 21 year old male, and I don’t have any dramatic balding, but I am noticing my hair is thinner than it used to be when I was younger, but perhaps I am just being paranoid. I am a Sikh, and part of the religion is to keep uncut hair tied neatly in a topknot. I do not tie this topknot very tightly, and I leave a lot of slack between the knot and the root to make sure I am not putting any unnecessary tension on my roots. I wash my hair every 2-3 days depending on how greasy it gets.

My question is: does combing your hair in the opposite direction (as I must to bring my hair in the upward direction to tie the topknot) lead to any sort of increased hair loss? I comb, not vigorously, all the hair at the back and sides of my head “up” in order to tie the knot, meaning I run my comb from the top of my neck to the top of the crown, and I am scared that this is the cause of thinning hair.

SikhCombing your hair “against the grain”, so to speak, wouldn’t cause hair loss.

Tightness can cause tension hair loss which sounds like something you are now experiencing. This hair loss in the front and sides is very common amongst Sikhs from what we call traction alopecia. It is caused by a tight turban which pulls against the healthy hair.

Image source: Wikipedia

Tags: sikh, hairloss, hair loss, combing, brushing

In the News – Follica Gets Another 7.5 Million in Funding

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

Snippet from the article:

Follica has raised more money for its quest against hair follicle disorders like male pattern baldness. The biotech startup, which is developing drugs that could spur the formation of new hair follicles, has raised $7.5 million in equity financing, according to an SEC filing.

FollicaRead the rest at Xconomy.com — Follica, the Biotech With Potential Drug Against Baldness, Nabs $7.5M Venture Financing

Follica is still in the development phase, so there’s no telling if this will end up working as well as many folks on the internet hope. The company’s policy is to not comment on their research and development, but the article at Xconomy.com does provide more insight into the venture capitalists that are funding it.

Tags: follica, hairloss, hair loss, funding

Diabetes and Diffuse Thinning?

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

hey doc,

just wondering, does diabetes have a role in hairloss? the worst person in my family was my grandfather who was a norwood 3 in his mid thirties and then lost it all. interestingly he had diabetes, and i noticed from pictures of him that he had diffuse thinning everywhere. when i looked it up on the internet it seems than diabetes causes diffuse thinning, is this true?
thanks

Diabetes is a disease that affects multiple organ system. While not common, it can cause diffuse hair loss, particularly if it is not well controlled. It is important to understand that stress in people with the genes for hair loss, induces hair loss. I must believe that a diabetic who inherited genetic balding and doesn’t control his diabetes well, must be stressed enough to lose hair.

Tags: diabetes, hair loss, hairloss, thinning hair

Propecia and Avodart on the FDA Safety Probe List

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


Dear Dr Rassman,

First off let me say what a very informative website you have, it’s allayed a lot fears I have had about Propecia which my Doctor in the UK is unable to answer. I’m a Propecia user and have came across this article when browsing Reuters.

Link: FDA probes risks of HIV, prostate, other drugs

My questions are: Has Propecia ever been on the FDA’s List of Safety Probes before? What’s your view on Propecia being put on the list?

Must admit I’m surprised, I’d read a few things on the web but dismissed them as they weren’t certified medical opinion. I look forward to your reply.

Best Regards

FDAThis is the first FDA safety probe relating to either Propecia (finasteride) or Avodart (dutasteride) that I’m aware of, and it is looking into a link between male breast cancer and 5-alpha reductase inhibitors. Any FDA probe certainly is in the best interest of the public, but as the article points out, “Merck spokeswoman Pam Eisele said the prescribing instructions for Proscar and Propecia already mention cases of male breast cancer seen in clinical trials.” No relationship has been established though, so we’ll have to wait to see what is discovered in the FDA’s investigation.

In my opinion, Avodart and Propecia are both safe medications when used as directed (for their intended purpose) under the supervision of a physician. Avodart is a similar type of medication to Propecia, but it has a much longer half life, which is the time it takes for half of the drug to be cleared by your body. Avodart’s half life is in the order of months, whereas Propecia’s half life is in the order of hours. In other words, if you have side effects from Avodart, it’ll take a while to get rid of them. Plus, Avodart is not at this time FDA approved for the treatment of hair loss.

Tags: propecia, avodart, finasteride, hairloss, hair loss, fda, probe

Is Accutane Hair Loss Permanent?

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

Hi Dr. Rassman,

Thank you for maintaining this site, it is by far the most informative hair-loss site on the net I have come across.

When I was 22 I noticed that my hair line was starting to recede and I had a little bit of thinning in the crown. When I was 24 I went to see a doctor and was prescribed Propecia. At that point my hair loss was still in the early stages and was probably only noticeable to me. In January 10′, after about a year and a half on the drug… I felt like my hair-loss had stabilized, was thicker than my hair had been in a long time, and I was genuinely happy with the results.

This brings me to my problem. Along with suffering from hair-loss, I have also been fighting acne for over 10 years. In February I finally decided to take accutane to hopefully put an end to it for good. I am currently in month 4 and my acne has cleared and is continuing to get better. Unfortunately I feel my hair is in the worst condition it has been in years. The hair is overall brittle and thin. The hairline has receded in the past few months, and the crown has thinned considerably.

My question is this: If I was to assume that the accutane is what is having a negative affect on the hair…once the drug is stopped, will my hair improve? I have heard that loss while on accutane is temporary but in some cases accutane speeds up MPB. Have I done myself a huge disservice by taking accutane after having been on Propecia?

Accutane (isotretinoin) does work well for treating acne, but unfortunately one of its many side effects is hair loss. I suspect hair loss from Accutane is temporary, but it may accelerate the male pattern balding process. Only time will tell. I really do not have much experience with patients taking Accutane (nor do I prescribe it), so you should talk with your doctor as he/she may be a little more versed.

Weren’t you given all the warnings and waivers before a doctor prescribed you Accutane? I mean, have you read all the other side effects of Accutane? I know this isn’t doing much to boost your morale, but my point was to illustrate to all readers that things should be put into perspective and take medications with an informed decision. Always weigh the benefits with the risks of any drug you take.

Tags: accutane, hairloss, hair loss, propecia, isotretinoin

How Fast is Catch-Up Loss if I Stop Propecia?

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

Hey Doc. Does the catch up happen straight away though – or does it slowly fall out at the pace it previously was falling out at.

If you stop taking Propecia it might take around 3 months or so for the loss to “catch up” to where your hair would have been if you’d never taken the medication in the first place. Then again, some men have reported to me that it took 6 or more months before they saw anything noticeable and others have reported they see the start of the loss within weeks. Each hair is in a different part of its cycle, so I suspect that each hair that is prone to genetic hair loss will react differently. This does not mean that by taking Propecia you made your hair loss worse, but for those who experience catch-up hair loss when they stop the drug, it can be dramatic to a point where I have seen men cry.

Tags: propecia, finasteride, hairloss, hair loss

Before Selecting a Hair Transplant Doctor, Do Your Homework!

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

Dear Dr. Rassman,

I wanted to share my thoughts with your readers concerning the selection of a HT doctor. I had several transplant sessions in the mid-1990’s. After many years, I find myself in need of a hair tune-up and will be scheduling surgery with Dr. Rassman this Fall.

I cannot stress enough that people do their homework when selecting a doctor. You only have so much donor area. When it is gone, it is gone. No amount of money can bring it back.

Through my research concerning HT doctors I have come to two conclusions. First, see a doctor that has been awarded the Golden Follicle award. This is voted on by their peers. Secondly, see a doctor whose primary specialty is hair transplantation. There are even winners of the Golden Follicle that practice other forms of cosmetic surgery. My reasoning is that I believe that HT is both surgery and art. The more a doctor performs quality HT, the better your results![/bq]

This is good advise. And you are correct in that hair transplantation is as much an art as it is a surgical procedure. This is a cosmetic procedure, afterall!

For more tips on choosing your surgeon, we put together a checklist of sorts that I encourage people to check out — Selecting a Hair Transplant Doctor.

Tags: hair transplant, doctor, hairloss, hair loss, surgeon, surgery

Why Can’t We Move the Entire Permanent Zone to the Front?

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

Hi Doctor,

My understanding is that when you remove hair from the permanent zone, you want to leave enough so that the permanent zone does not look “thin.”

But what about sacrificing the permanent zone, especially in the back of the head?

Why not remove most of the hair there — so that the back may indeed look thin — while moving it to the top front and crown as desired by the patient?

Bad faceliftI suppose you can do anything you want if you find a surgeon willing to cause you tremendous scarring in the back/sides of your head. I can’t say I know of any patients that would want to be the first candidate.

Doing what you suggest would leave a patient with a very wide and long scar on the back of the scalp as the scalp became tighter and tighter, stretching the scalp skin in the area of the excision. Even if the surgeon used follicular unit extraction (FUE), it would still not look natural, as the donor zone will be very depleted and look unhealthy (not to mention the tiny pinhole scars all over that may be visible). I have seen many patients with depleted donor hair, as too much hair was used by their surgeon for the front and top. These patients are not very happy with how their donor area (scalp) looks.

Keep in mind the entire point of doing any cosmetic surgery is to look natural (like there was no surgery done), meeting the enhancements and goals that the patient desires. Doing something extreme as you suggest is like an overly done facelift surgery, where it looks like someone is pulling one’s face back.

Tags: donor area, hairloss, hair loss, hair transplant, extreme

When The Hair Loss Cure Comes, Wouldn’t Transplant Doctors Be Out of Work?

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

Dear Doctor,
If they do infact find a cure for baldness, would’nt you and your fellow comrades be out of work?

thanks

That same logic could apply to anyone that specializes in something. Like, what would a cancer treatment specialist do once cancer is cured? What will tire companies do once the flying cars are developed? I mean, there’s just so many possible outcomes that it’s not worth getting into in an in-depth way… but if there was a cure for hair loss developed, who do you think would be prescribing/administering it?

Are you assuming a cure for hair loss would have to mean regrowth of all hair and not just cessation of future loss? Suppose the “cure” just makes it so future generations don’t lose hair, but those with hair loss still need options. To answer your question, the good doctors will likely be able to adapt their businesses, but we’re still a long way off from the elusive hair loss cure.

Tags: hairloss, hair loss, hair transplant, doctor

Alopecia Barbae

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

Doc,

Great Forum..Is alopecia barbae reversible? I came across a number of forums that mentioned that the use of cortisone shots in the affected region to be an effective treatment regimen for such syndromes…Do you concur with this?

Thanks

Alopecia barbae is a variant of alopecia areata, but where alopecia areata refers to spots on the scalp, alopecia barbae would be similar spots in facial hair. This disease has its course, at times may spontaneously reverse, and sometimes can be modified through various treatments (including variations of cortisone placed into the impacted areas).

See the National Alopecia Areata Foundation for more about research and treatment options.

Tags: alopecia areata, alopecia barbae, beard, facial hair, hairloss, hair loss, bald spots

Is My Mind Playing Tricks or Has Propecia Worked in Just a Month?

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

im 24 year old male, started balding around the age of 21. the crown started thinning about 2 years ago. ive been taking propecia for about a month. would it be uncommon for me to see results now? or is it just my mind playing tricks!

thanks for all your help!

I guess it depends on what you’re seeing. As much as I do believe in Propecia, I would doubt that you’d see much in just a month. Hair grows at a rate of about 1/2 inch per month so that the most you might see is better hair growth from the new hair that appears. This generally gets better over time. Most people can see an almost immediate improvement in daily shedding from genetic balding causes. But I am happy to hear your are doing well.

Tags: propecia, finasteride, hairloss, hair loss