At What Age Should Men Seriously Consider Hair Transplants?

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

Dr. Rassman,

Right off the bat, I have to give my deepest appreciation and gratitude for everything you do here! I have 3 seperate questions for you. I don’t believe I have seen these specific questions on your blog before, so hopefully you won’t have to be repeating yourself!

  1. For anyone willing to send you pictures to publish with your comments (I am), what are factors should we keep in mind? For example, eyebrows raised are good, correct? What about wetting your hair vs. keeping it dry? Are pictures easier to dissect and faux diagnose if it’s longer or shorter? What about including older photos of yourself? Lighting, etc.
  2. I realize every case is different, but generally speaking, at what age do you think people should start seriously considering transplants for receding hairlines? I’m 27, and I realize my mature hairline may continue to recede until at least age 30. If that’s a good rule of thumb, is it logical to wait until approximately age 30 to consider restoring your hairline? (I’m sure the last thing anyone would want is to transplant your hairline too early, only for your natural hair to recede more, leaving you with a bald gap!)
  3. While I don’t quite understand why this occurs, I often see the immediate results of transplantation, which is often scarred and scabbed looking. How long does this look last? The reason I ask is regarding those who perhaps want to try and not let EVERYONE in their office (& life) know they had a procedure. If one were to take a week off work to let their scalp heal, would it look back-to-normal after 7 days? Then can you just wait for the hair to start growing in? I haven’t seen many week-by-week photo diaries online. Most tend to be more month-by-month, IF that.

I appreciate any detailed insight you might be able to give. Thank you, sir!

Old cameraIf you want a formal consultation from me, you can call (800) NEW-HAIR or send photos to this address and make time for a phone consultation. Sending pictures to BaldingBlog and having me comment on it will be just generalizations. I recommend taking the photos outside in daylight with some close-ups that wrinkle the brow so I can estimate where the hairline belongs. I also recommend taking some photos with the hair pulled back and even some with the hair wet if you think it will help me see what you want me to focus on.

I have performed surgery on men in their early 20’s to late into the early 80’s. There is no one age I would recommend. It all depends on what you are trying to do and your expectations and your maturity and understanding of what is possible (realistic expectations).

The scabbing after a hair transplant can last as long as one or two weeks, but it all depends on how well you clean and wash your hair. It can look “normal” after one day, and patients who have considerable existing native hairs in the recipient area often have their own coverage. In other words, if you already had some hair in the transplant area, you can use that to camouflage it. If you had no hair in the area at all, that wouldn’t work for you… so we often suggest changing your face by growing a beard or mustache to give a different look overall and detract from your scalp until the healing process is done.

Tags: hair transplant, hairloss, hair loss, surgery

Can Lasers or Home Remedies Thicken Hairs?

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

Hello Doc,

Thanks a lot for the blog. I’m 22 and I have a full head of hair, but all the hairs are very thin. Moreover, there is distance between my hairs. Also, I have a problem of small acne kind of thing which keeps popping all over my head. However, I have started using betadine scalp and skin cleaner which has resolved the problem but I have tiny round scars all over my scalp. The main problem is my hairs are very thin. When I make them long, it covers my whole head but it gives a see-through look. When I get a buzz cut, no body knows that im balding.

IN YOUR OPINION,

1.Is there a way that each hair of my head can be thickened? Is it possible for thick-hair-promising hair oils and home remedies (egg yolk, etc.) to penetrate the scalp and nourish the hair from the roots? what about lasers, i know they cannot grow new hair, but can they make thin hair thicker (many doctors on tv say they can)?

2. Any update from lexington? They said something like they were going to publish their results in the scientific journal?

LLLTYou can put styling products (pomade) to make your hair “feel” thicker. Medically, you can take Propecia (finasteride) to thicken the shaft size, but it is not a permanent solution. Herbal products and shampoos that claim hair thickening may accomplish this by adding water to the hair shaft. There is no scientific proof that Low Level Light Therapy (LLLT lasers) work in my experience.

There was a study published in Journal of Cosmetic and Laser Therapy last year that an insightful BaldingBlog reader wrote a response to — Reader Checks in with His Thoughts on the Latest LaserComb Study. I can’t seem to find the actual study online anymore though.

Tags: laser, lllt, hairloss, hair loss, thickness, hair oil, hair lasers

If I See Finasteride Side Effects, Do I Need to Consult a Doctor?

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

I took Proscar (1/4 of pill per day) for 2.5 years for my hair loss problem .I haven’t seen a clearly any side effects in the past 2 years but lately I read that Proscar causes erection dysfunction so I stopped using it three days ago and I tried to masturbate but I ejaculate quickly and before that my penis get rigid enough(I ejaculate before get hard) but just last week my sexual life was normal but now I have difficulty to achieve a correct erection . I still have nocturne erection while sleeping and in the morning so do you think this problem is caused by Proscar or just due to stressful situation after knowing that Proscar could causing irreversible sexual disabilities .

are the sides effects of Proscar irreversible? do I have to consult a Doctor? how much time I need to take a ride of the side effects(testicles pain,libido,ED.. ? can I take other medicines to heal theses sides effect are they effective ?

This seems more like a psychological problem rather than an effect of the finasteride. You took the medication for quite a while without issues, then after reading about possible side effects you suddenly developed them. Ever hear of the power of suggestion? That’s what is sounds like to me.

At any rate, this is a prescription drug… so definitely see your prescribing doctor if you feel you’re having issues with libido or any pain and let him know of your recent issues.

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

Is Skipping a Shower Bad for Your Hair?

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

Hello, I have a question about the shower and hair loss.

My question is, is it harmful to your hair if you do not shower daily, or sometimes go a few days without showering? Does not showering daily or showering every other day cause hair loss/is it bad for the hair to not shower often? Thanks so much!

You do not need to shower or wash your hair daily. There are many people all over the world who do not have access to water and they have the same frequency of balding that we see in countries that have the luxury of lots of water for frequent hair washes. I think a nice shower just feels good.

Tags: shower, hairloss, hair loss

Some Men Look Just Fine Bald

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

i don’t think that every body looks bad bald. i think that everyone looks better with a full head of hair, but men who are taller than 5’10, have masculine facial features, are muscular e.g bushy eyebrows, chiseled jaw, large cheek bones, big intimidating eyes can actually pull off looking okay bald.

The funny thing is I think that when Kelly Slater and Kurt Angle both had full heads of hair, Kelly looked way better, now that they are both bald, Kurt looks better. Both men looked better with full heads of hair and I’m not trying to tell you that being bald doesn’t reduce your looks, it does, but some people have the facial features and head shape to carry the bald look well. let me emphasize this, Kurt Angle DID NOT HAVE MODEL LOOKS WITH HAIR AND HE DOESN’T NOW EITHER

Here is an example of Kurt Angle. The photo is good, but not superb and he is BALD AS A CUE BALL, NO HAIRLINE.

Kurt AngleI guess your point is that some men can pull off the bald look just fine, and I agree with that. You just need to have the right head for it (I’m sure we’ve all seen someone with a weird head shape that could probably be improved with hair).

Many readers might not know who pro surfer Kelly Slater or pro wrestler Kurt Angle are, but the bald look can work for a variety of men. For action stars like Vin Diesel or athletes like Michael Jordan and Kurt Angle, it can even provide a more intimidating “tough guy” look. Kurt Angle was losing his frontal hairline in a classic example of male pattern baldness, so just shaving the head provided a quick fix of sorts to that aging look with the deeply receding hairline.

Hair restoration surgery isn’t for everyone, and the reason some celebs (actors, athletes, politicians, etc) decide to just shave their head could come down to personal preference. There’s nothing wrong with that, of course. For others though, hair transplant surgery can restore the hair and confidence that many men want… and again, there’s nothing wrong with that either.

Tags: kurt angle, wrestling, wrestler, hairloss, hair loss, shaved head, celebrity, athlete, bald

Impotence After a Few Days on Propecia — Is it The Drug or Anxiety?

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

Hi

I’ve just started on finasteride, and I’m wondering if it is possible to see side effects (impotence) after only a couple of days on the drug. I’m not sure if it’s just my anxiety and over-analysis causing the problem, or if it’s actually the drug itself. I’d really really appreciate a private answer.

Thanks!

(24 year old male)

What you’re experiencing may be due to anxiety and what I generally tell my patients is to continue the medication for a month and try to ignore the erection problem if it is there. I do not know anything about you. I would need to get to know you to assess the anxiety element. The power of suggestion could certainly be in play here.

If you got the drug over the internet, this means that there is likely no professional guiding you on your problem. Consider seeing a good doctor if you do not have one… or if you do, then go back to him/her and ask the questions you posed here.

Tags: propecia, finasteride, erection, impotence, hairloss, hair loss

Dad and Brother Are Losing Hair, So I’m Worried About Myself

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

Greetings,

I am nearly 25 years old and am concerned about going bald. My 60 year old father is bald and my 31 year old brother is visibly balding. My mother’s father also experienced hair loss. At this stage I cannot see any signs of hair loss and still have a full head of hair. So my question is will I go bald/should I be concerned?! If so what preventative measures should I take?

Thank you in advance

Taking hair loss medications now could end up backfiring, so there’s really nothing preventative you should be doing if you don’t see any hair loss. The genes can skip generations, meaning you might not experience any thinning. It’s not uncommon for one child to have visible hair loss while another has a healthy head of hair. You can get a HairDX test to find out if you even inherited the genes for balding or not.

If you’re convinced that you’re destined to follow your family and lose hair, see a doctor and have a miniaturization mapping done of your scalp. Then repeat that again in a year to compare the results.

Tags: hairloss, hair loss, genetic, family

Recurring Rash Following a Hair Transplant?

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

I had a hair transplant 7 months ago. I have had a re-occurring rash which first appeared about 4-6 weeks after the surgery. Is this a side effect, based on hormones? I have no idea what else it could be related to.

This rash is not something that usually occurs following a hair transplant, so I don’t have a clue what it is without seeing you. You should be asking this question to your surgeon.

Tags: rash, hair transplant, hair loss, hairloss

My 17 Year Old Son Has Been Taking Finasteride

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

My son is 17 and he has been receding and thinning significantly on top for the past 12 months. We took him to our derm and he rxed propecia which he has been on for 7 months today. Not only has he not seen any re-growth but has lost even more hair. We put him on generic finasteride because its cheaper. Should we move him to brand propecia?

Do you have someone in Utah that you would recommend we take him to? And last…how do we know if his hair loss is from MPB or accutane? He was on a low does of accutane for 12 months and that is when his hair loss became noticeable. His derm said MPB but I am skeptical.

PillsIn the U.S. generic finasteride is only legally sold in a 5mg dose due to patent laws, so the pill must be cut into pieces to get close to the proper dosing found in the 1mg Propecia. Aside from the difference in size (1mg to 5mg), generic finasteride has the exact same active medication as Propecia. Changing to brand name Propecia will likely not solve your son’s hair loss issue. It just may be that your son has genetic male pattern baldness (MPB) and it is running its course. Remember that there is no cure for MPB, and medication only goes so far. Having a HairDX Test for Finasteride Response may have value in that this genetic test will give insights into his overall sensitivity to the drug.

Sometimes Accutane (isotretinoin) can precipitate hair loss, but Accutane alone is not likely the cause. If there is a “pattern” to his balding, then it is likely to be MPB. The various patterns can be found here.

I don’t have any Utah-based physician recommendations, but you can try the physician search at ISHRS.org to find a doctor in your area. These are going to be transplant docs, but they’ll know hair loss. At 17 years old, no doctor should be even suggesting surgery anyway.

Your son should have his hair mapped for miniaturization, as the microscopic view will point one way or the other to the cause of the hair loss. Mapping the hair will give you the opportunity to follow any progress (or lack thereof) as it extends the science to measurement of the miniaturization process.

Tags: hair loss, hairloss, accutane, finasteride, propecia, proscar, hairdx, teenager, teen

Female Hair Loss from Chemical Relaxer?

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

I am a black (African American) woman in my mid thirties, and in the top of my head and on the right side, in the front around my ears, my hair is continuously thinning and no new hair is growing so the area is getting bald. I chemically relax my hair, and when the straightened hair grows out and the new curly hair grows from my scalp, I notice that in the area with thin hair there is no new growth.

How possible would it be for me to get a hair transplant to that area of my hairline, that extends to my right ear, and about two inches back from my forehead?

I suppose it might be possible, but this isn’t something I could agree to doing without a consultation. You might not be a candidate for surgery. I don’t know how long you’ve been waiting for the hair to regrow, but it could take a year or two.

There’s just too many variables to be able to give you a yes or no about having a hair transplant without seeing you in person. I’d meet with your doctor to find out if this is chemically related loss or if there is something else at play like a series of autoimmune diseases which can cause localized hair loss. You should try to figure out why you’re losing hair before you try to surgically correct it.

Tags: hair transplant, female hair loss, chemical relaxer, chemical damage, hairloss, hair loss

Can a Blood Test Determine Genetic Hair Loss?

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

Hi,
I’ve been having some pretty severe anxiety over potential hair loss over the past few months. I went to my primary care doctor, barber, and mother who have told me that I just have fine, blonde hair and a high forehead. I specifically asked if there was any receding or balding, and each said no. Hoping to get closure,n I went to a dermatologist that I randomly found on the internet. This dermatologist has only been in practice for two years, so I’m a little skeptical when he said I had early hair loss by running his fingers through my hair a few times.

That’s where this blog comes in. I feel you’re a pretty trustworthy source of information, and hopefully you can help. My primary doctor actually did bloodwork, specifically DHT and testosterone, and they came back fine. This dermatologist almost disregarded the blood test and said he saw things as a dermatologist that no other doctor would see. Now I’m not sure what to think. So I have to questions.

1. Can a blood test determine genetic hair loss?

2. Is it possible that I just have fine, light hair? It’s darker and a bit thicker around the sides, but my maternal grandfather has the same hairline and fine hair as I do, just looks a but thinner as his is gray.

It may also be of note that this dermatologist said I had mild hair loss, and then was somewhat eager to prescribe Propecia. He also assured me that once on Propecia, it would not stop working and I would be fine and keep what I had for the rest of my life.

Sorry for the long inquiry, but hopefully you can set me straight. Thank you in advance.

A blood test can determine a “probability” for genetic hair loss based upon your carrying of the gene, but carrying it does not mean that it will be expressed. More importantly, any good doctor can tell you if you have genetic hair loss without a blood test by simply mapping out your hair for miniaturization, which shows genetic effects well before the naked eye will show it.

Yes, it is just possible to have fine, light hair or just a high forehead that may look like hair loss. In any case this seems to bother you. If you want to find out more, see a hair transplant doctor who can see your hair under a microscope to see evidence of some pattern of balding.

Tags: hairloss, hair loss, blood test

Propecia and Diflucan

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

Hello – I’m curious about the possible interactions or side effects between propecia and diflucan (fluconazole). Would diflucan hinder propecia’s absorption or cause it to become ineffective in any way? Also, how common is hair loss as a side effect to diflucan? Is it fairly normal? Thank you.

DiflucanThere are no interactions I am aware of between Propecia and Diflucan (an anti-fungal treatment). I do not believe it is common to have hair loss from Diflucan, and the medical literature lists that side effect as “incidence not determined”.

There was a small study from 15 years ago that looked into the connection, but I am unable to find any larger study or anything that definitively links Diflucan and hair loss.

Tags: diflucan, fluconazole, propecia, finasteride, hairloss, hair loss

My Trichologist Said I’m Not Balding But Likely Will in the Future!

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

Hi doctor, I was involved in a car accident four years ago where amongst much more serious injuries I lost a section of hair at the back of my head approximately one inch long and half an inch wide. Because of this I had to visit a hair loss specialist local to me who is an expert in trichology, she thinks it is alopecia but this hasn’t got any worse over the four years post accident.

Any way my actual reason for messaging you is that I asked her if I was suffering from any kind of male pattern baldness and after being examined she said that I am not balding nor displaying any type of MPB at present but it in all probability it is extremely likely that I will later in life which concerns me. I am 25 years old, my father has a full head of hair at 55, his father died at 89 with a full head of hair and my father has 6 brothers with full heads of hair. My mothers father died at 40 with a full head of hair. My mothers brother is 55 with a full head of hair. The only bald male in my family tree to my knowledge is my mothers uncle.

If I have a full head of hair now at 25 with minimal balding family history how could she say that in all probability I will go bald later in life? I have always had very fine hair and quite a high hairline but this has been the case since I was a very young child. Please reply!

Regards

LotteryMaybe your trichologist has a side job of being a fortune teller. Ask her to pick the winning lottery numbers for you!

If you have hair loss from a serious injury following a car accident, this is obviously not genetic pattern baldness, particularly in the area you describe. Simply looking at family balding history isn’t a way to guarantee whether you’ll keep or lose your hair (it can skip generations)… but even if it was, it would look favorably to you since hair loss isn’t common in your lineage.

I have no idea how your trichologist came to that conclusion, but I’d probably meet with an actual doctor if you’re worried about this. Most trichologists are not physicians.

Tags: trichology, trichologist, hairloss, hair loss, injury

Understanding Shock Loss

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

Hi,

I had been on propecia for 5 months and after suffering from a lack of erection I talked to my doctor and told him of my fear of being on this regime. We decided best that I shall have a hair transplant once it gets really bad.

I would like to know – if after hair transplant the patient MUST take propecia ? What will happen if the person does not take that pill. Will it cause the transplant operation to fail ? Could you shed more light on taking Finasteride after a hair transplant o/p ?

Thanks

Taking Propecia either before or after a hair transplant means simply that the hair loss will slow and possibly stop. If you do not take it, then whatever is normal hair loss for you will happen on your genetic clock. Shock loss seen in young men who had a hair transplant and are not on finasteride, just means that the hair loss process accelerates from what it might have been without the drug.

Propecia isn’t a requirement following a hair transplant, but you’re running the risk of the transplant causing accelerated hair loss around the transplant area, basically leaving you with a similar thinning problem following the surgery. Talk to your doctor about possibly cutting the dose if you’re considering a transplant.

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

My Cut Proscar Is Stored Improperly

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

Hello Doctor,
I am a 30 year old male who has been taking propecia and/proscar (2 months propecia and 10 months 1/4 proscar) for a year. My partner who is a physician first noticed my hairloss when I was sitting down about a year ago. It is only in the Crown, so I was a bit shocked because I could never see it. I went on the medication and within a few months my partner noticed an improvement (looking back at pictures, I had been thinning in the crown for at least five years before). I also tend to blow dry the spot as it fills the hair out more and is barely noticeable.

Questions
1. At about 11 month mark, I noticed about 5-7 hairs on my pillow in the morning of mainly longer length (about two inches). I’ve also noticed that when I shampoo my hair in the shower on the top back, I have about 5-10 hairs come out. They are longer but not super thick – I don’t have really thick hair anyway. Does this fall under the definition of “shedding”?

2. If so, is it a sign my genetics are overtaking the medication?

3. I’ve been under a lot of personal stress over the past few months as well, the weather has gotten considerably warmer and I haven’t been storing the cut proscar properly (just realized this) – I’ve been cutting like 6 pills and leaving them cut in the pill cutter in the cupboard (no pregnant women or children nearby), could this be impacting the effectiveness?

Thanks

Stress does accelerate hair loss, and improperly storing your cut Proscar pills could limit the drug’s effectiveness. You need to have a good relationship with a doctor you can trust to answer your questions. Hair loss does, at times, accelerate. The drugs do not always work to stop the loss and that is why you need a good doctor who can perform a miniaturization study, get a baseline on the loss process with a measurement he/she can compare as finding like yours appear without explanation.

If you’re seeing a few hairs here and there, that may reflect normal hair cycling, not frank hair loss.

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