Hey Dr Rassman. i hope your day is treating you well. As i am a frequent reader of this ever informative blog of yours a few questions have sparked my interest over the last week. It is in regard to the new micro pigmentation service NHI is offering. Now in the past i have noticed you were quite the skeptic about this type of procedure. I recall reading a few comments made by yourself which made me think they were: wouldn’t the scalp still shine? The lack of a ”sandpaper feel due to there being no actual stubble on the scalp and hair is 3 dimensional a tattoo is not.

However I was doing some thinking and this came to mind. If a patient were to come and request to have as many grafts that their doner supply would allow then have the tattooing procedure done in between those grafts and also had the scar camouflaged in the back of the scalp wouldn’t it be nearly impossible to tell the persons head of hair from a non balding person ? It would eliminate all of those issues i previously mentioned. Like for those individuals with high donor densities if someone had 10,000 grafts placed on their scalp then had the micro pigmentation procedure done i would think they would be able to get close to their juvenile hairline back and they would also be able to grow their hair out to probably a number 1 clipper with out it looking to odd. What are your thoughts on this ?

as I presently support the shaved head look but my hairloss is progressing i like the look i would just like more coverage. I have been on finasteride for 3 years when i first started it i was 20 and an early norwood three now my hair is really thin through out the top half of my scalp. I totally anticipate being completely bald by the time im 25 whether im on the medication or not.

HeadlubeYour scalp can shine with the oil that your scalp produces, so scalp micropigmentation (SMP) patients often use matting products available at cosmetic stores. There’s various brands of shine control lotions for the scalp, including HeadLube.

SMP has a use with some negatives and some positives. There is a natural symbiosis between hair transplants and SMP in some individuals. SMP is far less expensive than hair transplants, but you can not have it both ways (SMP in part with a limited hair transplant) unless the Master Plan takes into account what is happening to you now and later. There is a balance between SMP and hair transplants, but I can not give you an opinion over the internet.

It sounds like you need a Master Plan (I know I talk about that a lot), because you are changing with regard to your hair loss. Whatever you do, it should fit into the life plan; if you do go really bald, you’ll want to have a plan for what you’ll look like in the future if you make decisions about today’s problem. Come see me.

Tags: scalp, shine, smp, pigmentation, hair transplant

What do you think of this published clinical study? Foltene study

They concluded that Foltene is an effective and agent for male pattern baldness, alopecia areata and seborrheic alopecia with pretty good results.

The study you referenced was published almost 25 years ago in the Journal of Korean Medical Science and included only 30 men, ten of which had male pattern baldness. That study is simply too small for me to seriously consider that the results show an effective treatment. Besides, if there was really something to this I would expect in the decades since it was published there would be more information and larger studies available. If they exist, I can’t find them. In particular, the study claims regrowth for patients with alopecia areata, and I know the alopecia areata community would’ve been all over this had it been real.

There’s a product sold in Europe by that name, but I’m not sure it has the same ingredients that the study mentioned. We’ve written about that Foltene before here.

Tags: foltene, hairloss, hair loss, mucopolysaccharides

Pfizer Inc. subsidiary Greenstone LLC recalled one lot of its Citalopram depression medicine and its prostate drug Finasteride because the wrong labels may have been put on the bottles, said the U.S. Food and Drug Administration.

Greenstone said in a recall notice that bottles of Citalopram, a generic drug with trade names including Celexa, may contain Finasteride, used to treat prostate problems and baldness in men. Finasteride’s trade names include Proscar, Propecia and several others.

PfizerRead the rest — Fear of Switched Labels Prompts Recall of Antidepressant, Prostate Drugs

The recall includes 100 count bottles of 10mg citalopram and 90 count bottles of 5mg finasteride. Both are generic, non-name-brand varieties (so you’re fine if you have Proscar; Propecia is not included in the recall).

The article does say — “Both have the lot number FI050058-A on the label.” So if you are taking 5mg finasteride, double check the lot number on the bottle.

Tags: finateride, citalopram, propecia, proscar, celexa, medication, greenstone, pfizer

Dear Dr. Rassman,

I am interested in your new SMP process. I have had approximately 3000 grafts in the past and am running low on donor area.

My question is, will the SMP damage the hair that I have already had transplanted? The purpose of SMP in my case is to make the hair look thicker when it grows out.

The SMP (scalp micropigmentation) process works really well for this problem (low on donor hair), provided that you have enough hair to take advantage of the reduced contrast between scalp and skin color. SMP will not damage the previous hair transplants or any naturally growing hair that is present.

Tags: scalp micro-pigmentation, micropigment, hair transplant

Time to say good bye to propecia …

after 3 years on propecia, all this venture end with a gynecomastia surgery ! According to my surgeon the breast gland size was like a lemon…

He also said to me that finasteride drug is also gives to men who want to be a female (transgender…). according to the drug compagny, gynecomastia is a rare side effect… Now i think it is more a common side effect but impossible to really know at least at the beginning of taking this drug… like me….

Anyway this is my own story, i simply want to warning those guys that might thinking of taking this drug…PLEASE READ TWICE THE SIDE EFFECT SECTION, ESPECIALLY THE “RARE SIDE EFFECT SECTION” BEFORE ENROLL TO PROPECIA.

TootsieWhile I’m not entirely familiar with medications transgender patients might take, consider this — most male to female transgender patients do not want male pattern baldness, so finasteride is a good choice to prevent that. Propecia is not a medication to make you transgendered. In other words, transgender people do not take Propecia to make them “more” transgendered.

One of the potential side effects of Propecia is gynecomastia. This side effect is rare (my recollection is 1 in 300 or 500). Most of the time it is reversible, at least in my 14 years of experience… and most men will complain of breast enlargement when it is early, way before their breast turns to the size of a lemon.

In general, for older men (not taking Propecia) the prevalence of gynecomastia is 24-65% (source: eMedicine). But statistics aside, if it happens to YOU it is 100%, right?

Drugs other than Propecia that can cause gynecomastia are:

  • Cimetidine (Tagamet), ranitidine (Zantac), to treat heartburn
  • Nifedipine (Adalat, Nifedical, Procardia), to treat high blood pressure
  • Spironolactone (Aldactone), to treat high blood pressure and heart failure
Tags: propecia, finasteride, lgbt, transgender, tg, hair loss, hairloss, gynecomastia

Dr. Rassman,
I know you have written about demodex mites on this site in the past. A quick search of the blog revealed two times you discussed it with readers and the possibility that it could lead to hair loss when mites multiplied in great numbers. I for one agree with you… my derm not so much. She like many doctors in the field, believes that it s just a myth and that they do not lead to hair loss, rosacea and acne (in some cases of course, not all).

I have strange hair loss and papules that have appeared in my brows for over 12 years now and steroid creams have only exacerbated the condition. I believe I might have a mite infestation (as I have researched the topic extensively through various medical journals) and although my symptoms are rare, there have been documented cases much like mine. My problem is my derm doesn’t believe it’s even a factor. She says even if we do a skin scrape test to look for mites (by my insistence of course) and she finds them in increase numbers it doesn’t mean anything and furthermore that there is no known drugs to treat it. What are your thoughts? I wanted to know if you could recommend any derms that might be open to recognizing/treating demodex? I reside in the near the LA area.I mean after all is demodicidosis just a made up condition? Doesn’t add up!

It seems you are insistent on proving your dermatologist wrong. Maybe you are right. I haven’t personally treated any one with demodex mites. I did write in past that it may cause localized hair loss if there’s an abundance of mites around the follicle, but that is more of my educated guess. In general, demodex mites are considered benign and it do not cause hair loss.

If you really believe you have the mites on your eyebrow and you are not satisfied with your doctor, find a doctor who will listen. If you really want to know, find someone who can diagnose your condition with skin scrapes, etc (as you state). At least you will know. I don’t know if there is a definitive treatment, but I am sure you are savvy enough to search out on the Internet for resources.

Tags: dermatologist, demodex, mites, hairloss, hair loss, demodicosis

I would like to know if rogaine (5%) is contraindicated for use in type 2 diabetics, if so then why? thank you in advance.

(BTW the site is very well done, nice to see doctors who are in touch with technology.)

Rogaine (minoxidil) is not contraindicated for diabetics. Rogaine is for hair growth and has nothing to do with insulin production or diabetes.

Always check with your doctor before starting or stopping any medication as BaldingBlog is not a source for personal medical information or recommendations.

Tags: rogaine, minoxidil, diabetes, diabetic, hairloss, hair loss

Hi Dr. Rassman,

I’m a 22 year old Caucasian male who has experienced some recession due to maturation of the hairline (I hope so anyway). As a teenager I wore my hair long, and I now have long hair again. My question is, is it normal for my bangs to look and feel thinner since there is a higher hairline, and hence, less hair to drape down? And if so, is this a commonly reported phenomenon? Thanks!

This may reflect the miniaturization at the leading edge of the hairline, the first findings for hair loss. If your hairline just got higher due to maturation, I wouldn’t expect your bangs to appear tin. It’s tough to know what you’re seeing without examining you, though.

Tags: hairloss, hair loss, hairline

Hello, I am now 17 and I’ve noticed my hair loss (or receding hairline) about a year ago. The strands of hair around my hairline are uneven with the rest of my head and I knew it’s not gonna last long.

I’ve tried Procerin for the past 3 weeks now (since it seemed like the “safest” way for treating it) but I still shed the same amount of hair than before I started taking it. So much for that.

Then I started to read about stem cell treatments that might come in the next few years, and it sounds promising. Do you think I should wait until cell injection treatments are available? Or am I just fooling myself and should I go with treatments like Rogaine?

ProcerinAt 17 years old, I wouldn’t be surprised if what you’re seeing is a maturing hairline. Have you seen a doctor or are you just treating yourself with over the counter supplements? You might not be experiencing male pattern hair loss, but rather, the maturation of your hairline (a totally normal part of getting older when your hairline goes from juvenile to mature). For more on that, see here.

Procerin is essentially saw palmetto (an herbal that hasn’t been scientifically proven to stop hair loss, though many people on the internet swear by it) with a fancy label and some added vitamins. You can learn more about Procerin here. You’ve only used it for a few weeks, but I wouldn’t expect it to do much for your hairline regardless of how long you used it. Rogaine is proven to regrow hair, but I wouldn’t expect much in the hairline from that either (works best in the crown).

Future treatments are just that — future. There’s no timetable for them to actually make it to market. We’ve been hearing hair cloning would be popular by now, yet it is still in the early stages of trials. We’ve been hearing the cure would be available by now, yet there is no such magical elixir, pill, or lotion available. It’s up to you to decide how long you want to wait for something to maybe become available.

Tags: procerin, saw palmetto, hairloss, hair loss, teenager, teen

What is your opinion on TRX2?

L-Carnitine, nicotinic acid, Potassium … $ 50 .. 90 capsules. is it a scam?

TRX2I would not say it is a “scam” per se, just that it is a buyer beware market. Everyone needs to understand that male pattern hair loss is a genetic trait. There is no product or drugs you can take to stop hair loss or grow it back completely.

We wrote about Trx2 a couple of years ago when it was first announced, and there’s still not much solid information available. I’ve not seen any peer-reviewed studies or even photos of results. Their site says there’s a 60 day money back guarantee, but I’ll leave the decision to try it up to you. Anyone have experience positive or negative with this supplement they’d like to share?

Tags: trx2, potassium, hairloss, hair loss

Hey there.have you ever heard of a product called Prorestora? Claims to be fda approved. Thanks alot, really helpful site!

ProRestora isn’t by itself FDA approved, but it probably contains minoxidil (I couldn’t find a list of ingredients, so I’m just speculating). There are only two FDA approved hair loss medications — minoxidil and finasteride. Finasteride requires a prescription, minoxidil does not. Minoxidil is otherwise known as Rogaine/Regaine (depending on country). There are a lot of products that include minoxidil as the active ingredient since it is proven and available over the counter.

Either that… or it could be a scam. Even the bottom of their site says “All statements and information on this website have not been evaluated by the Food and Drug Administration“.

Tags: prorestora, minoxidil, fda, hairloss, hair loss

Yes hi, i’m 20 years old (male). i went to get a hair cut a few months ago and i noticed a bold spot on the side of my head. it has a little bit of thin hairs but you can totally noticed that i have a bald spot. its the size of a quarter. its been a few months now and the hair hasn’t grown back. can you help me with my problem?

thank you

You may wish to see a dermatologist. If it’s just a single spot on the side of your head, there could be a variety of reasons for it to occur — anything from stress to disease. There isn’t much else I can provide without an examination.

Tags: bald spot, hairloss, hair loss, stress

Hello Dr. Rassman
This man who died last year had hair 20 feet long. How did it ever reach this length, i thought anagen phase was only 7 years. Or is it just fallen hair dreadlocked to attached hair. here is the link — OddityCentral.com

Tran Van HayIndeed, that is odd. One explanation is that Tran Van Hay (the man with the longest hair) was stuck in a castle waiting for a prince to rescue him.

Another explanation is that while the anagen phase may last as long as 7 years (rate of hair growth at 1/2 inch/month) and produce approximately 4 feet of hair length, if the hair at the catagen/telogen phase (when the hair disconnects from the scalp) was intertwined with the hairs that remain in anagen (growth phase) the hairs will add length. This would create a dreadlock of sorts, but each strand will stay intertwined with the growing hairs. Note that in the photo at the right, that isn’t a hat he’s wearing.

My 114 year old grandmother (she actually lived to 114) had hair that was many feet longer than the 4 feet limit discussed above. I wasn’t yet a doctor when I saw her hair taken out of the bun she had it in. As a hair specialist today, I know that 6-8 feet hair length is not possible. Her hair was washed on rare occasions. When it was washed, it was a festive event when granddaughters worked to unravel her bun and let the hair fall to the floor. The hair was washed with soap and water (not shampoo or conditioner) and rung out by hand, but it was never brushed or combed. In hindsight, I believe I witnessed the hair “dreads” that formed from the failure to brush or comb the hair, where the hair that was growing had meshed with the disconnected loose hair. I remember that her hair was never aggressively combed or brushed, just washed and rung out and then allowed to dry on its own. Those were the days before hair dryers were common in the home (I remember this was in the 1960s, when she was already in her hundreds).

Tags: long hair, dreadlocks, hair cycle, tran van hay

I would first like to thank you for this very informative site. My question has to do with post operational side effects. Specifically, I had FUE/FUT 1.5 months ago. Unfortunately I have something my doctor called histamine positive skin. As a result there is redness in the recipient area. My first question is related to that.

How long would it take for such redness to fade away and what can I do to reduce that amount of time? Additionally, in the donor area, there is a significant amount of redness and the hair growth appears limited. Is this to be expected? And what is the time frame for full recovery of the donor area? My doctor is quick to say it will all be fine in a few months but I wanted a second opinion as well as anything I should keep an eye on to better facilitate the recovery of that area.

This was my first surgery and I only had 1000 grafts transplanted.

If your doctor was helpful enough to explain a histamine reaction to you, how is it possible that you were not told how long it would last? I often do a scratch test to the scalp or forehead to preselect those patients who are histamine positive. In general, every patient is different and the redness can last several weeks to months. 1 to 2 months would seem on the long side.

Unfortunately this is not a place for second opinions as I do not know what you are really experiencing. All hair transplants are not the same, especially FUE, as there are many variables such as size of punch, techniques of extraction, the drugs you take, the allergies you have, etc, etc.

Tags: histamine positive, redness, hairloss, hair loss, hair transplant, surgery

Hi DR, I have two questions: is it possible to get any heart disease by using topical minoxidil? And if I have chest pain what exactly is happening inside my body?
Thanks for your answer

If you have chest pain, you need to go to the Emergency Room or call your doctor right away. Topical minoxidil does not cause heart disease and I’ve addressed the chest pain before. Minoxidil (when taken orally) is a blood pressure lowering drug and was originally used to treat high blood pressure, but it was not very effective or consistent. Side effects of topical minoxidil can include dizziness or palpitations, but this is rare (especially if you are using the recommended 5% solution).

Tags: minoxidil, rogaine, regaine, heart, chest pain, hairloss, hair loss