We’re taking a day off for an extended New Year holiday weekend, but we’ll be back on Monday in 2011!

Happy New Year

What do you think of the comment in the side box, “Do blonds have more fun ? No – but they do have more hair. People with blond hair have more hair on their head than people with brown or red hair“.

Link: KidsHealth.org – Taking Care of Your Hair

That’s wrong, Isnt it?

Blonde hairI don’t know that there is a significant difference in hair densities between blondes and those with darker hair, even though it is recorded in various places on the web. I’ve seen pages like this one, but can’t find a source for their information. I have made a point to check the hair densities of the blondes who have come into the office to see me over the years since I started the hair practice nearly 20 years ago, and I couldn’t find any real difference.

However, there is a difference in hair densities between different ethnic/racial groups. Caucasians have the most hairs on their head. African/black hair types have the least amount of hair on their head. Asians fit somewhere in the middle. The reason for this difference is not clear, but Caucasians probably need the most hair on their head because their hairs are the finest. This fine character requires more hair to look like the equivalent of say, Africans, who have the least amount of hair, but their curly hair makes up the volumes. Asian hairs are often coarse, so they may make up for the less numbers that way.

Tags: hair color, density, blonde, blond, red head

I just saw a commercial for the Minoxidil applicator brush. Do you(or your patients) have any experience with this product. Do you consider it an advancement in terms of effectiveness or ease of use?

Link: Ultra-Mox Applicator Brush

Minoxidil brushI haven’t seen this one before. So from what I gather, you load the brush with the minoxidil and then comb it through your hair to dispense the medication. It’s a clever idea, but I don’t really consider it any advancement in the drug arena or a game-changer in the effectiveness of minoxidil. If it’s worth $100 to you to not apply the minoxidil with your hand, I suppose this is an item you could use.

So while I don’t have any experience with this minoxidil brush product, I wish the makers well. It is a free economy. For the record, I also don’t own automatic tie rotating hangers or other extraneous late night TV gadgets. Any readers out there use this applicator brush? If so, we’d love to hear your thoughts on it.

Tags: minoxidil, brush, hairloss, hair loss, ultramox, minoxidil comb

I recently purchased an issue of mens health and they were discussing shampoos for various hair types. They listed Bosley Professional Strength Nourishing shampoo as their shampoo of choice for thinning hair. The website for Bosley describes the shampoo as saying:

Gentle, sulfate-free cleanser that helps to recondition hair and rejuvenate the scalp. Cleanses and removes toxins such as DHT, a primary cause of thinning hair and hair loss, from the hair and scalp. LifeXtend complex contains Saw Palmetto extract to help promote healthy follicles. Pentapeptides help stimulate production of root-strengthening Keratin Protein. Soy Amino Acids help restore strength, thickness and volume. Vegetable Protein helps fortify hair shafts. Plankton Extract helps protect from photo-aging, frequent washing & damage from brushing.

Is there any benefit to purchasing this shampoo for around 20 bucks a bottle or is everything claimed false. Thanks!

Men's HealthThe claims are extensive and suggestive, and the various elements in the shampoo have never been proven to treat thinning hair any better than other shampoos. If Men’s Health feels that the Bosley Pro is a good shampoo, it may be worth a try… but I truly doubt that it will treat hair loss in the way that balding men may hope.

Also, I have no idea if this was just a paid product placement or if there is some study the magazine conducted that lead them to the conclusion they made.

Tags: hairloss, hair loss, shampoo, bosley, men’s health, magazine

Snippet from the article:

There’s little doubt that the placebo effect’s real, but it has always been argued that a person feels better because they think the pill is the real deal. But what if it works even when you know it’s a fake?

According to Ted Kaptchuk at Harvard Medical School and his colleagues at least one condition can be calmed by placebo, even when everyone knows it’s just an inert pill. This raises a thorny question: should we start offering sugar pills for ailments without a treatment?

In the latest study, Kaptchuk tested the effect of placebo versus no treatment in 80 people with irritable bowel syndrome. Twice a day, 37 people swallowed an inert pill could not be absorbed by the body. The researchers told participants that it could improve symptoms through the placebo effect.

While 35 per cent of the patients who had not received any treatment reported an improvement, 59 per cent of the placebo group felt better. “The placebo was almost twice as effective as the control,” says Kaptchuk. “That would be a great result if it was seen in a normal clinical trial of a drug.”

Read the full story at Gizmodo — Placebos Can Work Even When You Know They’re Fakes

I am certain that the placebo effect also applies to side effects. If you hear you may get erectile dysfunction from taking a drug, how many people will report the side effect from taking the placebo?

Tags: placebo, medication, drug, side effects, medical study

Hi Dr Rassman,

Fantastic site, and I’m really enjoying your cautious matter-of-fact coverage of the new A-Cell technology!

I’m a 28 year old male, slowly but surely experiencing diffused patterned alopecia. So far it’s not visible except when wet, but miniaturisation mapping shows I’m probably headed for a NW7.

I’m interested in whether you think it’s possible in theory for a surgeon to insert A-Cell treated hairs into the balding areas, thus gradually replacing the DHT-affected hair with permanent hair, and ensuring coverage “continuity”. Obviously this will depend on whether the A-Cell hair is in fact permanent.

Also, I believe you indicated in a previous post that finasteride is recommended to prevent shock loss. Do you believe this will be an ongoing necessity? i.e. assuming the new hairs take root and are unaffected by DHT, would a patient need to remain on finasteride indefinitely or only for the months following surgery?

Perhaps you need a good diagnosis of what you have. Do you have diffuse patterned alopecia (DPA) or androgenic alopecia (AGA)? I suppose you can have both, but that would be rare. It’s important to determine the proper diagnosis, because diffuse patterned or unpatterned alopecia is generally a contra-indication to a hair transplant surgery. The donor hair area is questionable in its permanence in those cases.

Thus, even ACell technology would fall into the same uncertainty. In other words, the hairs transplanted with ACell may not be permanent if the donor hair is not permanent. The technology is so new that I do not have an answer for you.

Finally, Propecia (finasteride 1mg) is recommended for men with androgenic alopecia (AGA). Patients who take Propecia need to take it indefinitely if they wish to slow down or keep the hairs that are at risk from falling out. Many doctors (including us) recommend Propecia to decrease the risk of shock loss. For practical reasons, patients who do not want to be taking Propecia indefinitely (but wish to decrease the risk of shock loss), usually take the medication for about one year. Once they stop taking the Propecia they risk the same ‘catch-up’ hair loss phenomenon. The main thing one needs to understand is that Propecia is an OPTIONAL medication and the only thing that we (doctors) can do is to recommend it.

Tags: propecia, finasteride, acell, dpa, alopecia, hairloss, hair loss, shock loss

Hi Dr. Rassman,

Many thanks for the detailed and trustworthy information you offer your readers. It is a true resource amidst the unreliable heresay elsewhere.

I am a 29 y.o. male — I started Propecia 1mg 4 years ago and it worked great until this summer when my hair started falling out quickly. My doctor increased my dosage to 1.67mg, which I filled with generic finasteride at Target(thank you again for pointing out the great deal there). It has only been a month, but I am hopeful it will work again.

Recently, my regular dermatologist (not the prescriber) asked whether the pill I am taking is scored and evenly distributed. I inquired with the pharmacist who said it was not scored and likely not evenly distributed. He knew of no generic finasteride that is.

What are your thoughts on the effectiveness of taking 1/3 of a tablet that I am not sure is evenly distributed. I looked in the archives and was able to dig this up, but it seems like the answer was inconclusive at the time and I am wondering if anything changed. It also dealt with Proscar, not generic finastertide.

Thanks so much

I am not an expert on drug mixing, but I believe that the various ingredients are homogenized, so as it is made into a pill there’s no irregularities in the mix. If the ingredients were irregularly mixed at a pill level, then in theory it could be irregular from pill to pill… and I’m not sure if the FDA would allow that. I’m not well versed in pharmaceutical manufacturing policies, though.

As for taking the 1.67mg finasteride, if that is what your physician prescribed you, I’m not going to argue with that. There have been times where I’ve increased the dosage recommendation for individual patients if they notice hair loss accelerating after being on Propecia for years.

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

Hey. I’ve had brain surgery back in 2000 and an additional one in 2004. I have a scar on the front of my scalp going from my right side of my head to the top of my forehead. Its not from left to right but almost there. And I have some kind of missing spot on the back of my head. I dont know where that came from. But I was wondering if u had any suggestions on getting hair to grow inside my scars so I have no noticible scars?

We (NHI) have been treating scars of all types on the scalp with hair transplants (especially brains surgery / craniotomy scars). The process is as simple as a hair transplant on the scar itself.

The entire process may take more than one procedure to fill in the scar, as hairs are transplanted directly on the scar and may not fully grow. Whether or not the scarring remains noticeable will remain to be seen. I wouldn’t want to make any wild promises without seeing you.

Tags: brain surgery, scarring, hair transplant

Snippet from the non-hair article:

UCSF researchers have identified an existing medication that restores key elements of the immune system that, when out of balance, lead to a steady decline in immunity and health as people age.

The team found that extremely low doses of the drug lenalidomide can stimulate the body’s immune-cell protein factories, which decrease production during aging, and rebalance the levels of several key cytokines – immune proteins that either attack viruses and bacteria or cause inflammation that leads to an overall decline in health.

The initial study, which was designed to define the dose range of such a therapy in a group of 13 patients, could lead to a daily pill to boost immunity in the elderly, the researchers said. Data will appear in the January issue of the journal Clinical Immunology.

Read the full story at ScienceDaily — ‘Fountain of Youth’ Pill Could Restore Aging Immune System

This is all great stuff with the research done at UCSF medical school. Worth a read!

Tags: fountain of youth, ucsf, health

Hello doctor,

My question is regarding weather and hairloss. I know in canada it gets really cold sometimes even -50, and i believe it effects my hair. I find my hair thinner and more brittle during winter and it becomes more straighter then usual (i have wavy air by the way and i would be a good candidate for a HT because i know i have frontal thinning but because of my wavy hair it covers the balding up) but during the summer it feels thicker and more brighter and wavier. I was just wondering if there are any studies showing weather and hair loss and texture or if its just a myth.

If it is just a myth then why am i experiencing all these hair characteristics during winter. I personally believe hair thins out during winter and becomes thicker during summer.

Thanks for your time. All the best.

Cold weatherThere are no studies that I am aware of that look at a relationship between hair texture and weather. I think it is more of something we take as common sense that when the weather is cold and dry, our hairs and skin may be affected.

If your hair is dry in the winter months, then try using moisturizing shampoo. If your skin is dry and lips are chapped in the winter months (like many people) use moisturizing lotions and lip balm (Chapstick, for example). I don’t know if there is study that looks at dry skin and chapped lips in the winter/cold months, but I don’t think you need a study to prove that point either.

Scientifically, in cold months, the humidity in the air is much lower than warm summer months. That contributes to dry skin, chapped lips, and texture changes of your hair. There have been reports over the years from readers about thinning hair at different seasons, but I’ve got no medical reason for this.

Tags: hairloss, hair loss, seasons, weather, cold air

What are your thoughts on Dr. Gho’s partial extraction stuff? There’s a new study in the Journal of Dermatological Treatment:

Link: Donor hair follicle preservation by partial follicular unit extraction.

We are aware of this and I believe I’ve commented on partial unit extraction before. Similar work has been done by others with very different results, so I am a little skeptical. First of all, only five individuals were used in the study and between 100-150 grafts were harvested. The results look very promising, but I do not understand how you can achieve a success rate over 100% (104.1%) like is mentioned in the results.

It is also difficult to understand how one could keep track of where the 100 to 150 grafts were harvested from to see if they regrew hair. Think about this. Unless you make a clear mark (like a circular tattoo) around where you harvested the grafts, how can you say the hairs grew back? In the end, with all due respect to Dr Gho, I remain a bit of a skeptic.

Tags: gho, partial unit extraction, hair transplant

Hello Dr. Rassman,
I have been having eyebrow loss for over ten years now. It started after a period of overzealous plucking as a teen (I am now 29). The hair grows out and then after a few weeks to months it gets very weak and limp and falls out. This has been going on for years. My primary doc said it was age and possibly alopecia (though I have no problems on scalp and hair loss is diffuse not patchy). my dermatologist said seb derm but my symptoms are not that similar and the meds he prescribed didn’t help. Any ideas what it can be? And am I a candidate for transplant surgery? Please help! Thank you.

I really couldn’t make an attempt at an answer to what you are asking without examining you myself. So I’m not sure what it could be. If it is indeed seborrheic dermatitis, treatments are usually limited to antifungal shampoos. You didn’t mention which meds you were prescribed, so I’m kind of at a loss there, too.

As for whether you’re a surgical candidate, again, that’s not something that can be determined without an exam. A hair transplant into the eyebrow will reflect the thickness of the hair in the donor area where it is taken from (back of the head area).

Tags: eyebrows, hairloss, hair loss, eyebrow loss

i had a hard impact injury to the top of my head after 5 or 6 weeks after transplant surgery. I had a big bump on top and a small amount of bleeding. I was wondering what the chances of damage to the implants. Do you think I should be that concerned about this accident? Thanks so much for your comments and advice on hair transplants.

Since the injury occurred 5-6 weeks after your hair transplant, I do not think that it will be any risk to the grafts. Of course, if you have concerns and are able to make a follow-up appointment with your surgeon, that would be the best thing to do (at least for peace of mind).

Tags: injury, hair transplant, post-operative, grafts

Hi, I’m a 20 year old Caucasian male, and for the last few months I’ve been concerned about my hairline. I had never paid much attention to it before, as I’ve always had thick wavy long hair that mostly hid it, but after getting it cut short I realized that the corners extended a little bit higher than I’d like them to. The left only extends a little bit above my juvenile hairline, but the right corner is a little bit higher than the left. In both corners above the juvenile hairline mark I have short dark vellum hair.

I’m worried because I have more of this hair on the left than the right. The left almost hits my juvenile hairline while the right does not… Any advice you can give me would be much appreciated.

I give all permission to use these photos.


Thanks for allowing us to post your photos. Click them to enlarge.

You shouldn’t worry about having more hair or less hair on left or right corners of the hairline. Many people have asymmetry, so what you’re seeing isn’t uncommon. With respect to hair loss, I cannot give you a diagnosis at this stage since you’re only 20 years old and anything is possible. This could just be a case of the hairline maturing, but honestly, it is impossible to tell how/if your hair loss will progress just based on looking at photos. There needs to be more hands-on examinations of the hair.

My advice is that if you are concerned about hair loss, see a doctor. First, get an objective measurement — miniaturization studies and bulk analysis of hair on different parts of the scalp). Then get a diagnosis and a suitable Master Plan that will follow you for the years to come.

Tags: hairloss, hair loss, hairline, mature hairline

Hi I am a thirty year old African American Female. From my early childhood, I have been exposed to tight ponytails, braids, weaves and chemical services applied incorrectly. Surprisingly, I still have a head full of hair with the exception of my thinning hair line. My hair is currently chemical free and has been that way for over seven years. I normally wear wigs as a protective style. My hairline is still thin. Is surgery my only option?

Norwood 4AUnfortunately, there’s no medication that can restore a hairline and surgery might be the only option. Hair transplants for the frontal hairline work well, even in African Americans. Unfortunately, many African American women I’ve seen with traction alopecia have lost much of their frontal hair, even the hair that goes into the temple peaks on the side, creating a concave look similar to a Norwood Class 4A pattern (see image at right). The problem is that the larger the area, the more hair it takes to get a thick result.

African Americans usually are born with less hair than Caucasians (about 65% by hair count) so the supply is often more limited. In your case, if the hair loss is just in the frontal 1 1/2 inches, you may be able to get it back. A good examination is important, especially when made by someone who has considerable experience capable of giving you realistic expectations.

Tags: african american, black hair, african hair, hairloss, hair loss, traction alopecia