A question about the hair bulk measurement tool – surely it’s dependent on the person measuring having exactly the same length hair every time a measurement is taken otherwise it’s going to produce inaccurate results?

I mean, great if you know your hairdresser can cut your hair the same length perfectly each time you want to do a measurement but realistically that’s not going to happen unless you use clippers which most of us don’t want to do.

Or does it not work this way? Am I missing something?

If not, then I’d think that a camera would be a better way of judging hair loss.

For the bulk analysis, you need to have an adequate length of hair (maybe 2 inches in length) so that the hairs can be bundled up and the bulk can be measured. Any adequate hair length will work the same, even if it is 3 feet long, because the measurement is made at about one to one and a half inches from the scalp. Think of a person bundling up a long pony tail. If you have more hair, the bulk of the pony tail will be much greater. As the measurement is limited to a point about one inch from the scalp, the longer hair will not impact the measurement.

We take a baseline measurement at the same coordinates of the scalp each and every time you return (12 months). If you cut your hair with clippers with a buzzcut style, you cannot do a bulk measurement. If you have gel or other products on your hair it will give a higher bulk reading, so we ask that there are no hair products on your hair when you come in for the analysis.

If your hair is very short, then we can always use a miniaturization study, looking at hair diameters at a microscopic level. Bulk measurement is doing it at a macroscopic level. These are all our attempts to measure an objective (not subjective) value of your hair status. The subjective measurement can be a simple before after picture of your head/face. The picture can be highly variable depending on lighting and angles. At NHI, we try to keep the angles and the lighting and the camera model, lenses, aperture, and external flash location as constant as possible.

Tags: hairloss, hair loss, hair bulk, hair analysis

Hi DR Rassman. Thank you for providing this very informative blog.

I’ve wondering about this and trying to find the answer on the internet for ages – sometimes when I rub my head in the morning I see some slightly thinner hair than my normal healthy looking ones. I went to the derm and did a miniaturisation test and had less than 10% miniaturisation. The derm said I am not balding, however when I see these slightly thinner hairs I get worried…

So I guess my question is do these slightly thinner hairs (intermediate?) grow on a non balding scalp? They grow just as long as my normal hair and are same thickness throughout the strand.

Thank you

If you have less than 10% miniaturization and your dermatologist told you that you are not balding, I would stop worrying. Non-balding people shed about 100 to even 200 hairs a day. Perhaps you’re seeing hairs going through various growth cycles?

If there is any doubt, then have a bulk measurement of your hair done, which will show beyond any doubt if you are thinning or balding. If you have miniaturized hairs, those hairs will not grow at the rate or to the length of normal, non-miniaturized hairs.

Tags: hairloss, hair loss

How can you tell the difference between male pattern baldness and general thinning as you age? I am almost 35 and have no discernible signs of MPB other than a mature hairline (which appeared when I was about 19). However, I am convinced my hair is thinner than it used to be.

Simple answer: There is a pattern to MPB. That is why they call it male “pattern” baldness and this is the classic male genetic hair loss.

There are other diseases that cause general thinning, including diffuse unpatterned alopecia (DUPA), senile alopecia, etc. You can have that diagnosis made for sure by comparing the bulk in different parts of your scalp. A knowledgeable doctor will add value in examining you.

Tags: mpb, hairloss, hair loss, thinning

A few months back you had mentioned an upcoming trip to Europe. You also said that you planned to meet with Gho to discuss his technique or whatever. I am just following up to see if the visit ever materialized? Many people would appreciate a blog update on that situation. ALSO- many people would like you to be the first doctor to offer HST in the United States!

thanks for your time,
anonymous baldy

When I said “on my next trip to Amsterdam” I didn’t mean that I was planning on going there right away.

I was hoping to talk to Dr. Gho at the recent ISHRS meeting in Alaska, but he didn’t attend so we did not have an opportunity to meet to discuss what he was doing.

Tags: gho, hairloss, hair loss

Video: NHI on California Adventure TV

When we did this interview and video shoot for California Adventure TV, the host was very excited and she showed it in this piece. Can you imagine why we got excited?

And in case seeing a beautiful woman talk about hair loss treatments isn’t enough to get you to watch it, the video also gives a brief look at the Scalp MicroPigmentation (SMP) process.

Tags: new hair institute, california adventure, nhi, rassman, pak

I was just wondering if I sent you a few pics of my hairline do you think you could give me an answer to if I’m going bald or not?

We do not diagnose people on BaldingBlog, as that would be a poor practice of medicine. If you want to send in your pictures for me to post and comment on, feel free. If you want a virtual consultation, you can send good photos, I will look at them, and then established a dialogue with you over the phone.

In general, hairline pictures do not tell me much with respect to predicting the balding process. It’s kind of like sending a picture of your hand and asking me if you will have arthritis later on in life. I am not a fortune teller (or misfortune teller).

Tags: hairloss, hair loss, hairline

About four weeks after getting a large hair transplant I had a bit of a major shock to my business which caused a good deal of panic. A lot of adrenalin rushes, flight/fright, etc., off and on for a few weeks. Pretty constant. The worst has passed, but I am wondering if these adrenalin surges hurt my new implanted grafts’ growth chances. I know it is a vasoconstrictor, but assume that the grafts were secure and alive after 10 days or so.

I don’t have a definitive answer, but I would guess that your emotional stress would have no significant impact on your hair transplants particularly since it occurred a month after your surgery. It’s going to be a case of wait and see.

Tags: hair transplant, stress, surgery

What would you say the average age is for men to develop MPB? I know there is a wide window, but what is considered to be the norm? (Any pattern of MPB)

Most people lose (or start to lose) their hair in their 20s. A few people have started it as early as 14, but that is unusual. I have seen others start losing their hair into their 50s or 60s.

Tags: hairloss, hair loss, age

Hello Doctor,

Thanks for maintaining such a great blog.

I am a 20-year-old student who started taking Propecia about a month ago. Since then, I’ve broken out in hives about once every two weeks. The breakout lasts for about 3 days.

I have three questions for you:
– Do you think that this is an allergic reaction to Propecia?
– If I am indeed allergic to Propecia, do you think that it will be less effective?
– I have experienced a noticeable increase in shedding since starting Propecia. The Internet tells me that this could be a good sign, but we both know there’s a lot of misinformation out there.

Again, thanks for the great blog.

First of all, if you are breaking out in hives I would see a doctor. This is not a place to get a medical diagnosis or treatment. Any medications can cause a reaction or side effects, but I do not know anything about your medical history or health or habits to even guess why you are breaking out in these two week intervals. Are you doing something different every two weeks?

In general, patients do not shed after taking Propecia. Patients lose hair with or without the medication from natural genetic causes. The “increased shedding” people refer to is very abstract and hard to quantify. This is one of the main reasons you need to see a doctor before you start Propecia and have some form of documentation of where you are starting from (such as a picture of your hair, miniaturization study, or even a bulk measurement). Without anything objective to compare to, it is just anyone’s guess.

Finally, I would guess there are people who are allergic to Propecia, but I have not met anyone face to face at my medical practice who have these allergies people write about on the Internet.

Tags: propecia, finasteride, allery, hives, hairloss, hair loss

Snippet from the article:

As if the heartache of divorce wasn’t hardship enough, it appears that women enduring marital break-up may also have to deal with hair loss.

New research reveals that, genetics aside, the next strongest predictor of midline (central) hair loss among women is their marital status, with the loss of a spouse (through either divorce or death) raising the risk for thinning hair above that of married or single women.

Read the full story — Could Divorce Trigger Hair Loss in Women?

The study looked at sets of identical twins and determined that excessive alcohol and smoking increased the risk, in both men and women. The study also revealed that sun exposure is also believed to be a factor in hair loss, as those exercising outdoors or didn’t regularly wear hats (sun protection) saw increased thinning. One of the keys the article focuses on is divorce, which can bring about a lot of stress… and it isn’t surprising that stress can lead to hair loss. Overall, it’s interesting stuff and worth a read.

Tags: hairloss, hair loss, divorce, female hair loss

I recently had a motorcycle accident about a month and a half ago. unfortunately i was stupid and wasnt wearing a helmet causing a minor injury on my head. i went to the hospital and was told by the doctor that i would need plastic surgery to make sure my wound closed. however throughout the whole process of taking care of paper work and insurance to cover the plastic surgery my wound closed out perfectly fine. even the doctor told me i didnt need the surgery anymore.

however i have a scar about the size of a quarter, a little bigger id say, and i have no hair there. but people say i am gonna grow hair being that everything closed out normal no stitches or anything. i just wanted to clarify that. thanks

I would wait about 6 to 12 months to see if hair will regrow. If not, you can have that scar dealt with, either by having the scar revised or perhaps hair transplanted into the scar. At this point, you’re going to have to wait and see, and if the hair doesn’t return you can meet with your doctor to determine the next step.

Tags: accident, wound, scar, hairloss, hair loss

Finasteride lowers type II DHT while Avodart lowers both type I and II. Does the amount of type I DHT have any effect on hair or it is only type II that may cause hair loss?


We answered this years back here. Short answer — it’s been proven that type II is linked to MPB, but type I hasn’t been linked.

Tags: dht, hairloss, hair loss, dutasteride, avodart, finasteride, propecia

Hello. I needed to know if you have any high resolution before and after photos for male patients who have had transplants at NHI to restore their juvenile hairline with a high density. I was trying to find some on the newhair.com site, but couldn’t. I know that this is not a common procedure in men as many guys do not commit to taking propecia early on in the balding process and come in when the hair is only restorable to the mature position, but I’m sure juvenile hairline restoration has been done as for certain modeling/acting careers the thick Juvenile hairline is the aesthetic-standard.

The mature position is unacceptable for some of us, especially with how the aesthetic standard is becoming more stringent in 2011 due to many popular icons who lack the balding genes. I am considering doing hair transplantation for my career at your practice and was recommended to have FUE by my doctor (if I really wanted it). I do not have advanced balding or miniaturization beyond the hairline.

In general, we do not restore juvenile hairlines or any hairline with high density, especially with one surgery for most patients… perhaps with the exception of young male actors or models that have careers dependent on a specific look. You probably will not see these patients at our website, because many are convinced that their hairline will put them at risk for recognition if shown online. We don’t force patients to sign a photo release, so we can only post what we have permission for.

We don’t recommend transplanting a low hairline in men, because you are setting yourself up for disappointment if you develop a more advanced balding pattern over time. More specifically, I do not know what your expectation of “high density” and your desire for a “juvenile” hairline is.

If you want to see examples of hairline density, just attend one of our open house events in Los Angeles and see some of our patients in person. A few of them who regularly attend do have high density, and meeting them to see for yourself in person is a great way to get an idea of what can be done. Our next open house event in Los Angeles is this Saturday the October 1st, and you can find our upcoming free open house events listed here.

Tags: juvenile hairline, hairline, hair transplant, density

Have you ever transplanted grafts along a non balding person’s hairline not to lower, but to thicken the hairline so that they could grow a fuller fringe if they had fairly fine hair?

In dealing with hairlines, transplanting a normal hairline just to thicken it is not advisable, as the transplant could damage the existing hair. I have fixed defective looking hairlines on male actors and models who need perfect frontal hairlines for their careers, so I have worked to keep their juvenile hairline intact.

For women who have normally high, non-balding hairlines, these can also be addressed with either frontal hair transplants to bring the hairline down or hairline lowering surgery. Many women have these procedures done.

Tags: hair transplant, hairline, mature hairline, juvenile hairline

Hi Doc,

I suffer from tinnitus due to tension in my neck. I am unable to figure out anything about it besides that when I am nervous or I am slouching for a long time, it comes.

My question is – Is there any swelling in the neck area or behind the ears or in the sinuses from a hair transplant? If so, would there be anyway to avoid it? Have you heard of a transplant causing tinnitus? I’d like to get a transplant but the thought of it worsening my tinnitus makes me nervous!

I’ve never heard of a hair transplant causing tinnitus. Tinnitus generally has to do with the inner ear problems or even certain brain pathology. I would follow up with a specialist.

With hair transplant surgery, you may have swelling of the neck and ear area. I would follow up and raise these concerns with your doctor before having any surgery.

Tags: hearing, tinnitus, hair transplant, hair loss, hairloss