I Wonder If My Forelock Will Remain

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

I wonder how persistent the forelock is. My father – 55 now, has a receded hairline (V) shaped. It has thinned in the frontal region in recent years, but no real crown thinning.

My question: I’m 24, and already have a deep V shaped hairline, but I wonder how permanent it will remain? Or, whether the forelock can be expected to disappear as well.

Also, what extend does baldness proceed? Who makes it to a norwood 7 pattern?

You need a good diagnosis, including miniaturization mapping and a solid measurement of the hair bulk in the top and crown of your head. The same can be done for the forelock to let you know if you are actually losing hair in the forelock now. As a generality, if the forelock remains strong by the time you are 30 years old, then you may keep it into the years to come. As for percentages of men that make it to the advanced balding stages, see here.

At 24 years old, you need good metrics that should be repeated every year, and with what you report (your deep V hairline) you should consider finasteride. Talk to your doctor, as it is a prescription medication.

Tags: hairloss, hair loss, forelock

Astressin-B

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

Does anyone think the new drug called astressin-B has any possible benefits to regrow hair? I am surprised no one has asked any question about the new finding made last month. Researchers claim that mice grew hair when injected with the drug astressin-B, how far is this true and how long would it take for the treatment to be available.

Thanks

Actually, we did write about this last month.

Quick recap — researchers discovered that a compound (astressin-B) that blocks the action of a stress hormone called corticotrophin-releasing factor (CRF) was able to regrow hair in genetically altered mice. There isn’t enough information available to discuss anything beyond what was published. It is all hopeful, but the FDA process will take years before safety and effectiveness is proven in humans.

Tags: astressin-b, stress, mice, hairloss, hair loss, mouse

Hair Growth Listed as HGH Side Effect?

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

Dear Doctor,

Really Love the website. I wanted to know, I have read up on HGH and some of the positive side effects which were listed, are hair growth and thickness on the scalp. I was wondering these method hasn’t been used to treat hair loss.
Thank u.

Human growth hormone (HGH) is not something that should be taken lightly. I have met many men who have elected to take it and it is definitely effective at making the person who takes it feel more energy, younger, and have more vitality. While HGH may have many benefits (including some reported hair regrowth), there are also patients that suffer heart attacks. The final conclusions on safety are not out as far as I am concerned.

I am not religious so take what I’m about to say as my logical mind in action, but I believe that if we were intended to have the energy of a 20 year old when we are 60, then our bodies would continue to secrete growth hormone late into life. Since I believe in Darwin’s laws, older men with vigor would probably compete better for women, and survive in the bush better as they would be more stealth, but alas, that is not how we are built so I suspect that there are plenty of down sides. I am not an expert on the subject, so read on the various sites for HGH and interpret what you want.

A recent article I read in the LA Times a few weeks back discussed negative side effects of HGH, which can promote cancer. With the hype of Propecia and its side effects, HGH would not be recommended. Remember, there is always a risks and benefits of any drug use. My point is HGH is not a bad drug. It has its purpose and use. I just wouldn’t recommend it for treating balding.

Tags: hgh, hairloss, hair loss, hgh, human growth hormone

iGrow — A Hair Laser Hat… with Headphones!

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

Snippet from the article:

The latest in laser-based hair rejuvenation is the iGrow, a stylish new wearable device from Apira Science that packs 21 laser diodes and 30 LED lights. According to the company, that matches the output of most clinical hair lasers, and it should result in “thicker, fuller and healthier” hair in just a “few short months.” But that’s not all. The iGrow also includes a remote that has been programmed for both men and women, and it has a built-in set of headphones that you can use with your own iPod or MP3 player

iGrowRead the rest at Engadget — iGrow promises to regrow hair with lasers, accessorize any wardrobe

And it looks so classy! Any regular reader to this site knows how I feel about the laser hair therapies that make big claims with little to back it up, but this one goes a step further by including headphones and an Apple computer style iPhone/iPad/iPod naming convention.

CNet also points out that the maker of this product is covering their tracks by adding the fine print on the bottom of their site for their other laser product that states, “The REVAGE 670 has not been cleared by the FDA for medical use and any references are purely investigational.” I’m sure the iGrow falls into that same category.

Tags: igrow, i grow, hair laser, lllt, laser hat, revage, hairloss, hair loss

Why Did My Body Hair Thin Before on Propecia, But Not This Time?

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

Hello Dr., I took Propecia a few years ago for a period of 8 months and had good results, but also had significant thinning of body hair (legs, arms, chest, & back). I quit taking it because of financial reasons, but 6 months ago I got back on generic finasteride (1.25mg) and now have no perceptible body hair loss, maybe slight thinning on my back. How could I have such a different response this time? Should I assume that the generic finasteride is not working? (I got it from my local CVS pharmacy.) Thanks

I have heard on rare occasions that for some men that take Propecia (finasteride 1mg) their body hair thins out. This isn’t a usual side effect, though. I am not denying that you have noticed a relationship between Propecia and body hair loss, but that does not mean the drug is or isn’t working. If you are splitting the finasteride 5mg into quarter sections to make it 1.25mg, that is nearly equivalent to Propecia (finasteride 1mg), and there shouldn’t be a significant difference.

I have no way to explain the side effects (or lack thereof) that you’re seeing. The presence or absence of side effects do not indicate if the drug is effective.

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

Is There Anything a Woman Can Do for Alopecia Universalis?

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

i am a 62year old african american and i have universal alopecia. I am a female i was wondering if there is anything out there that could grow my hair back or could i get a hair transplant. I haven’t tried anything for it, i only wear wigs.

For men, I might recommend scalp micro-pigmentation (SMP), as this can give the appearance of a closely cropped traditionally male hairstyle… but for women, unless this type of style is an option for you, I wouldn’t recommend it. There is unfortunately nothing available (aside from wigs) today. You couldn’t get a hair transplant, as you have no hair to move.

Tags: alopecia universalis, hairloss, hair loss, wig, smp

Auditing a Hair Transplant?

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

Hey Doc,
I had an FUE procedure last week of 2400 grafts. The procedure lasted 9 hours (10 if you include lunch, etc.).

My question is as follows: How can one verify that the doctor (a well respected FUE doctor)actually gave you the number of grafts that you paid for? The work seems fine, but it just doesn’t seem like there are 2400 scabs on my head representing the number of grafts, and im now skeptical that i really got that amount. I do not have much of a way to verify my hunch as its too difficult to count.

I know the obvious answer is to pick an honest surgeon. But beyond that — any thoughts, tricks or advice for those of us whose eyeballs seem to underestimate the number of grafts on our heads? Is it tpically more or less than it looks like to the human eye?

Thanks!

Magnifying glassIf you feel the need to verify that you got what you paid for or what the doctor represented to you in regard to the follicular unit extraction (FUE) transplant, then you can get a second opinion. I have done that on a number of patients, but if the transplant was more than a week old, my accuracy in counting them is compromised. What I do is count the wounds (holes) on the back of your head.

If you had 2400 grafts, then you should have 2400 holes reflecting the FUE extraction sites. If the doctor charged by the number of follicular units, sometimes a single FUE site can have more than one unit if the doctor used a large punch or if your density is very high. Or maybe less than 2400 were taken, but the grafts were split (see here for more on that). I am not saying this is what happened, but I am giving you a skeptic’s point of view, reflecting your uncertainty.

Finally, if you trust the doctor ask for your surgical records and count sheets, which may show the doctor’s actual numbers (where the technicians keep track of all the “successful” FUE grafts pulled out and all the “unsuccessful” FUE grafts pulled out). This is what we do on every FUE case.

Tags: audit, hair transplant, fue, graft count, hairloss, hair loss, follicular unit extraction

Does Frontal Hair Loss Respond Differently to Medication Because of Something Other than DHT?

/by William Rassman, M.D./11 /

According to clinical studies, finasteride generally works primarily on the vertex, much less well on the midscalp, and not much at all on the front of the head. I’ve seen suggestions that this might be so because the processes that result in frontal hair loss are different than those at work in the crown. (That is, perhaps it’s something other than DHT, or in addition to DHT, that drives hair loss in the frontal and midscalp portions of the head.) Do you think there’s anything to this theory?

From Wikipedia — “in modern science the term ‘theory’, or ‘scientific theory’ is generally understood to refer to a proposed explanation of empirical phenomena, made in a way consistent with scientific method.”

Unfortunately, there really isn’t a scientific theory to explain the difference in hair loss in the frontal region and crown of mens’ scalps. Your hypotheses, which are theories that are not considered to have been satisfactorily tested or proven, may have some merit… but I do not know for sure.

In the end, it is genetics that cause male pattern baldness. That much we know. That theory is solid. At this point, I do not know why DHT (for those men who have the genes) affects mostly the crown. For that matter, I do not know why the back of the scalp in men are always spared from balding. Maybe there are other hormones involved.

Tags: theory, hairloss, hair loss, dht

Could Lawsuits Against Big Pharma Prevent Them From Working on a Hair Loss Cure?

/by William Rassman, M.D./8 /

Dear Dr. Rassman,

I’m very concerned over the article regarding the law suit being launched against Merck. I’m 31 and have been using Propecia for the past two years, which reversed crown thinning and has maintained a mostly full head of hair for me. I stay hopeful however that a better medication or procedure will come along for maintenance/regrowth over the next decade. Do you think that law suits like this are going to kill the efforts, funding, and motivation to continue research for creating more options for hair loss sufferers?

Thanks for your time

WorldThere’s around 7 billion people in the world, about half of those are men… and in general, hair loss affects about 50% of the male population to some degree. So with such a huge potential market measured in billions, if there is opportunity the drug companies will likely work it. These companies are in the business of making money. Lawsuits won’t stop them from their research and development.

We live in a very litigious society and a lawsuit against Merck does not mean they’re guilty or at fault.

Tags: lawsuit, legal, merck, hairloss, hair loss

Chemo and Hair Cycles

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

When you have chemo what happens to the hairs that are in the resting state after chemo finishes?

The hair starts to regrow as new hair buds enter the anagen phase of hair cycling.

Tags: hair cycle, chemotherapy, chemo

Does FUE Mean Less Total Donor Hair Available?

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

This analogy on the subject of FUE really hit home:

…Your donor is like a grid of marbles. FUT is basically a line through the middle (strip) which is closed up leaving the grid uniform and balanced but when using FUE, you are removing marbles at random from all over. It is much harder to keep the grid “balanced” with FUE…

So Doctor…..when a patient elects the FUE procedure to restore their hair, is there considerably less total donor hair available?

I have heard only half as much as with FUT. Say it ain’t so!

“It ain’t so!”

I suppose your donor area can look patchy with little white dot scars if you have 3000+ FUE grafts extracted. This occurs when your original density was average or less than average. People with high density hair often will not show the white scars (dots) at all. Even with 1000 FUE grafts, you will notice these patchy white dot scars if you shaved your scalp, but in general, even with 3000+ FUE grafts, the scars and the less hair volume will be hard to notice (depending how close you cut your hair).

Remember — not all FUE or FUT (strip surgery) is the same, and not all patients are the same with healing. I have seen awful FUE scars and great FUT scars and vice-versa. Each and every patient needs to talk with their doctor and understand the unique advantages and disadvantages along with the risks and benefits of the surgery. This may sound like generic advice, but many patients who seek out FUE choose to go ahead with a FUT procedure after understanding the limitations of FUE and FUT.

With regard to your main question about which procedure will get you more hair (strip vs FUE), I think that the answer is probably strip surgery. Many doctors now doing FUE surgery actually get the hair outside of the fringe area, which means that the hair is not permanent. Some doctors (who think about $$$ above all else) will push the FUE harvest area to meet the projections given. The donor area has about 20,000 hairs in it and if an FUE procedure harvested 1/3rd of the available supply (assuming average density of the hair in a Caucasian male), that would be about 6,500 hairs or 3,200 grafts on average. All of the higher number we are reading about reflects, most probably, non-donor (non-permanent) hair.

Tags: fue, hair transplant, donor hair, strip procedure, follicular unit extraction

Growing Hair from Body Fluid Injections to the Scalp?

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

I heard of a technique where your own bodily fluid is injected into the male pattern balding spot and is supposed to grow hair. Can you tell me what you know about this treatment? Is it for real, is it permanent, is it for the frontal part of the scalp etc.?

I don’t know of injecting body fluid (???) in your scalp to grow hair… but I do know some clinics offer platelet rich plasma (PRP) into the scalp in hopes it will provide faster healing after a hair transplant. Some dentists use it for faster healing after a dental procedure. I asked a few dentist friends, one of which is a professor at UCSF, and she believes PRP is controversial even in the dental field.

In the end, this method has never really been proven to grow hair on a bald scalp. If anyone can find a well controlled study for hair growth from PRP, please let me know. Some doctors charge hundreds or thousands of dollars for PRP, but I remain a bit skeptical. The patients we’ve viewed in the office haven’t had the results their doctors promised.

Tags: body fluid, prp, hairloss, hair loss

I Was Prescribed Beclomethasone Dipropionate

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

I had gone to dermatologist for the hairloss problem. He prescribed Finasteride along with Beclomethasone Dipropionate lotion. I want to know how does this Beclomethasone lotion function. Any side effects of it and for how long it has to be taken ?

Finasteride 1mg is for traeting androgenic alopecia (genetic hair loss in men). Beclometasone dipropionate is a corticosteroid that is used to treat skin disorders, like eczema or psoriasis… and is not usually used for treating androgenic alopecia. Do you have a skin disease?

Perhaps you should ask your doctor, since he/she is the one that prescribed it to you. I can’t give you advice on how much or how long to use a prescription medication, as I didn’t prescribe it and I don’t know what you’re treating.

Tags: beclometasone dipropionate, hairloss, hair loss, finasteride

Years After a Chemical Burn, Hair Is Still Patchy and Skin is Sensitive

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

I experienced a chemical burn from a relaxer almost seven years ago and a section in the front of my head is still thin and patchy from the hair loss. It is also still pretty sensitive and itchy. I saw a dermatologist/trichologist and she recommended fluocinonide, which only irritated it further. She was not at all helpful, or professional, and she is supposedly one of the top in the industry. It really bothers me to look at it and I just wear weaves to hide it though it isn’t terribly noticeable. Is there anything that will regrow the hair? Should I try rogaine or hair transplant surgery? I really can’t afford to continue throwing good money after bad! Any advice is greatly appreciated.

You should not treat yourself. If you weren’t satisfied with your dermatologist, get a second opinion! I’m sorry I don’t have a clear cut answer for you, but this isn’t something I can make recommendations for over the web. A good dermatologist in your home town is the person to see.

Tags: female hair loss, hair loss, hairloss

Transplanting Nape Hair at the Hairline to Soften the Look

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

A prominent HT doctor recommends using transplanted nape hair at the hair line to soften the look of the hair transplant and make it look more natural. This seems to make sense as often hair transplants look like the hair strands are too thick where transplanted and not natural. You mentioned that nape hair is not permament. Does this mean it might fall out over time and even if it does is it still worth it for the cosmetic effect in creating a more natural hairline?

I recently saw a patient in my office who asked me this same question and asked about the doctor. In case you are the same person, my answer was as you correctly state — nape of the neck hairs are not permanent. Some patients actually come to have hair transplants to the nape of the neck, as they are completely bald from below the ear level.

Thus, your nape of the neck hairs that are transplanted elsewhere may fall out over time and it is not worth the surgery. More importantly, even with the FUE technique there will be scarring that may show at the neck with white pale dots if the nape hair falls out over time. If you are considering this type of surgery I would ask that doctor if you can meet with a patient who has had it done to see what it looks like. When the donor area is from the nape of the neck with strip surgery, most of the time the scars are prominent and wide. Scars like these are not amenable to repairs and even with FUEs placed into them, they can not really look normal.

If you want a softer hairline, regular donor hair should be sufficient if done right with single follicles that are finer and grow naturally that way. If the staff and the doctor are good, they will pick out the smaller caliber single follicles for the very front.

Tags: hairline, hair transplant, nape of the neck, hairloss, hair loss