I Had My FUE Done Over a Year Ago and It Is Still Not Fully Grown

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

Hi Dr

I went thru my fue 15mths ago. Today i am still feeling some stubbles (transplanted graft) on the recipient area. These stubbles do not seems to be growing. Is there a possibility that newly transplanted graft stays as stubble – do not fall off neither grow out and become healthy hair? Or am i just a slow grower?

While it is possible, is highly unlikely that you will start finally seeing growth at 15 months. You should have seen most growth at about 6 to 12 months following your surgery.

More importantly, the new hair growth will not appear as coarse stubble (like a beard). It’ll start off fine and grow as the months go by. Sometimes the stubble can be remnants of the original hair grafts that never fell out, but are just stuck in its place. You can test this by having someone find these stubbles and pulling on them with tweezers… or if you can reach it yourself, you can do this yourself. If the stubble is a dead hair shaft (old leftover follicle from 15 months ago), it should slide / slip right out.

The implication of this is that the surgery may have been a failure. Have you talked to your surgeon for a follow-up since your procedure?

Tags: follicular unit extraction, fue, hair transplant, hairloss, hair loss, hair growth

I’m 16 and My Doctor Prescribed Propecia

/by William Rassman, M.D./6 /,

Hey, I am a 16 years old and I have started to notice that I am losing my hair. My doctor has prescribed me propecia and I have been on it for almost 2 months now. I have noticed that a lot of hair has been falling out recently but I have heard this is common with propecia. Is this true?

I was also wondering if you have heard of anyone of my age who has been successful with propecia, since it is meant for people who are 18 and older. I’m not really looking to grow more hair, I just want to keep the amount of hair i have now and hope that I wont lose anymore.

Propecia will slow the process down and sometimes provide some regrowth, but it won’t cure the loss completely. You will continue to lose hair at some rate, over time. I do not believe increased hair loss is common when you start Propecia use, but I have heard others mention it.

I would expect that a 16 year old will get a better response than a 21 year old with very early loss. We rarely see boys of your age go on the drug or have enough hair loss to warrant taking the drug, so I don’t have a wealth of past experience with teens on Propecia. Please follow up with your doctor.

Tags: propecia, finateride, teenager, hairloss, hair loss

Exclamation Mark Hairs

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

I know that you’ve addressed this before in a post a few years ago, where you suggested that exclamation mark hairs were a sign of a more serious infection. However, I was wondering if you could provide a little more information as to if it is also a sign of Is it a sign of traditional male pattern baldness?

Particularly if the thinning is very gradual down the hair shaft, only detectable if you bend the fallen hair so as to compare the top of the hair with the bottom next to the bulb.

If they get thinner towards the bulb and less heavily pigmented is this an example of the process of miniaturization? If not, rather than an underlying infection, could it be due to a lack of vitamins, or telogen effluvium?

If this smaller diameter is noticeable on all the hairs that are being lost, even from the side and back of the head, or even body hair is that the case where it is more likely to be as you originally suggested an underlying infection?

Hairs that look like exclamation marks can be a sign of a variety of issues, but alopecia areata is chiefly among them and often points to this diagnosis. Other possibilities include lupus, thyroid disorders, and some allergies. I don’t mean to get you alarmed, so see a doctor for an examination to get to the bottom of the problem.

I’ve written about this before — Is Hair Normally Thinner Towards the Root?.

Tags: hairloss, hair loss, exclamation point, exclamation mark, thin hair

In the News – Evolution of Hairless Humans

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

Snippet from the article:

Stand up straight! And do something about that hair!” Annoying? Sure. But such parental advice may have made humans what we are today. Because our upright stance, and relative lack of hair, may have enabled our human ancestors to run far and fast enough to capture their prey. So say scientists in the Journal of Human Evolution.

The idea that standing on two legs and shedding all that body hair might have helped early humans keep cool on the African savanna was first trotted out in the late 1980s. But those early models had our ancestors standing still in a gentle breeze. Scientists simply didn’t have the computational power to assess what might happen when those early humans had to up and chase down a meal.

Read the rest — Upright and Hairless Make Better Long-Distance Hunters

The above article is actually a transcript of a podcast. The published model can be found here.

Tags: evolution, hair, hair loss, hunter

Finasteride and Cognition?

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

I am a medical intern working 80+ hour week. My hair loss is probably due to a combination of stress and Androgenetic alopecia. Would taking finasteride impair my cognition? Are there any studies that test congition and finasteride use? Should I take HairDX Genetic Test before starting on finasteride?

Thanks

If you are medical intern you should know to look up these types of questions on PubMed. I have yet to come across any studies or valid reports that taking finasteride will impair cognition. There is a study that suggests finasteride can inhibit hippocampal neurogenesis in mice, but there’s another study that say sleep deprivation can cause the same thing. Plus, we don’t know how this translates to humans.

I’ve heard cognition mentioned by patients who find abstract information on the Internet, but I really do not know what to make of it. I don’t recall having patients tell me about any personal experiences with memory or concentration issues after starting finasteride, though.

With respect to the HairDX genetic test, I do not have a strong opinion. Genetic balding is diagnosed by a physical exam and the treatment is based on an individual case by case basis. The best test for the presence of hair loss is mapping the scalp for miniaturization and measuring hair bulk.

Tags: finasteride, propecia, memory, hairloss, hair loss, cognition

Actor Kelsey Grammer’s Hair

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

Hi Dr. Rassman.
I wanted to ask your opinion of Kelsey Grammer’s hair – maybe it’s my imagination but he seems to have more hair lately than he used to. Do you think he may have had a transplant? If so, how many grafts would you estimate?

Recent photo and Older photo

Kelsey Grammer

The comparison photos do look like Kelsey Grammer (known for his work in sitcoms Frasier and Cheers) has more hair in recent years, but I cannot determine if he had a hair transplant.

But assuming that he did, if I had to make a guess of how many grafts he may have received to attain the look in the photo… I’d say more than a 1000 but less than 3000. Yeah, sort of a wild guess. The photos I’ve found make it difficult to really see his hair perfectly without image compression or different lighting conditions.

Tags: actor, celebrity, kelsey grammer, frasier, hair transplant, hairloss, hair loss

Temporary SMP?

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

Hello, I read your blog everyday and wanted to thank you for the information you provide. I am a 40 year old male and been on propecia and minoxidil for over 15 years with pretty good results. I find now my crown is getting pretty thin and wondering if SMP would be an option for covering up the crown for my hair which is a light brown/sandy blond .Is there such a thing as temporary SMP that might only last a few years?

Thanks

Scalp MicroPigmentation (SMP) should be considered permanent. If you want a temporary solution, I would suggest you research topical camouflage products such as DermMatch or Toppik.

Tags: smp, pigment, toppik, dermmatch

If I’m Taking Propecia, How Do I Know If My Loss Has Stopped?

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

i was just wondering if i was on propecia for the last three years and my thinning hair has ceased, how do i know if the drug is still at work or my hair has done all the thinning its going to do on its own in my life and i dont need the drug no more. im 54 yrs old.

thanks

Propecia is considered a life-long medication. If you stop taking Propecia you may lose the hairs that it was maintaining.

I just saw a 40 year old man who stopped taking Propecia 8 weeks ago. He reported that his hair started to fall out in handfuls. This is what I call “catch up” hair loss. We have written about this phenomenon numerous times on this site. He asked me if he could reverse it again by starting the drug today and wanted to know if it would work on him now. My answer was to watch the change in his bulk measurement and if he came back in 3 months, this test should show if the hair loss process is reversing or if it just stopped the hair loss. Since everybody is different, talk with your doctor regarding your specific situation and your options.

Tags: propecia, hairloss, hair loss

Can Finasteride Stop Further Hairline Recession?

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

I’m aware that fin isn’t as effective on thickening hairs at the hairline, but is it effective at halting further recession, as it is at stopping general thinning?

Finasteride (Propecia) may halt further hairline recession, but hairline recession is usually not reversed with this drug. It’s also usually not a permanent phenomenon, so over time you can expect more hairline recession even if it stops the recession initially.

In other words, even if you take Propecia every day without missing a step and have good results, you could eventually start seeing the loss start again. It’s not a hair loss cure, though some patients have been on the medication for over a decade while still seeing good results.

Tags: finateride, propecia, hairline, hair loss, hair loss

How Often Are Mice Studies Actually Successful?

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

I see that mice are often used in studies for medicine before they are tested on humans such as this article posted recently on this site in regards to balding (here). I am not sure if anyone would have this information readily available, but how often is medicine that is successful in mice also successful in humans? I am curious to a percentage of a success/fail rate.

Thank you for your very informative site!

Animals such as mice, dogs, monkeys, etc are often used in medicine. In general, it may take many years for the study to leap from animal trials to human trials. With respect to the success and failure rates of such studies ever making to human trials, I would wildly guess that there are way more failures than successes… but I don’t have precise figures to satisfy your curiosity.

Tags: animal studies, medical studies

How Long From Healthy Hair to Miniaturization?

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

Hi Doctor,

I know everyone is genetically different in their balding patterns, speed, etc. but how long does it generally take for miniaturization to turn a healthy hair folicle into one that can’t grow any hair? Weeks? Months? Thanks!

You are right — everyone is different. The hair you see on top of your head reflects about 1/2 inch per month of growth. Miniaturization can take months or possibly even years to appear.

Tags: miniaturization, hairloss, hair loss

Why Not Take 2 Propecia Doses Daily?

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

Hi Dr. Rassman,

If Finasteride has a half-life of only 5 hours, how can it be so effective at stopping hair loss? If we take 1 mg or 1.25 mg of it, it would be pretty much out of our system before the end of the day. Does only a small amount of it prevent DHT from being created? Is it’s efficacy only dependent on a miniscule amount being present? Why is taking 2 doses per day not more effective than 1? And also, what are your current thoughts on what time of day to take it?

Just because a drug’s half life is 5 or 6 hours does not mean you need to take the medication according to its half life. Although half of the drug is out of the blood stream in 5-6 hours, some of the drug remains in the tissues for as long (possibly) as a week or so. Doubling the dose was not shown to be effective for better response in the original tests for Propecia.

In addition, the drug has been tested at different intervals and different doses, with trials determining that taking it once daily was just as beneficial as twice a day for treating hair loss. The best time to take Propecia is when you can remember to take it on a consistent basis.

Tags: propecia, finasteride, hairloss, hair loss

Finite Number of Hair Cycles?

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

Is it true that human hair has a predetermined number of cycles? If someone experiences TE or chronic TE are they using those cycles prematurely and causing their hair to thin earlier than it would have?

It is true that life of a hair determines the number of hair cycles you will have. I was bald in the crown by the time I was 45, so my hair there died… and then I had transplants to correct it.

If your hair cycle (from telogen to anagen) is 3 years and you have 10 cycles genetically programmed for that hair, then that hair will die at the age of 30. Although I am making this example sound simple, it is certainly not that simple… but male pattern baldness does probably follow that rule. I do not believe that telogen effluvium changes the hair cycle’s length, but just the telogen phase of that cycle.

Tags: hairloss, hair loss, hair cycle, telogen effluvium

Genetics or Coincidence?

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

Is it a coincidence or not that both my father and my grandfather (his father) went bald, or is it because of the similarities? My father has an overbite (his top jaw is more in front of his bottom jaw), as did his father. My grandfather and father went bald at about the same age, which was their early 20’s, although my father said he noticed hair loss at around the age of 18-19.

My brother who does not share this bite similarity is now 26 has his hair, but has an asymmetric pattern which has been this way since his late teens, and has maybe matured/receded more since then, but he has a healthy head of hair.

I guess my main question is: since I also have this overbite like my 2 bald family members, does this put me at more of a risk of balding because I have a facial feature more like them, or is balding simply not relateable whatsoever to minor facial similarities. I guess my concern is inheriting genetics.

Thanks.

I wouldn’t expect facial features and hair loss to have relation. You can get tested for the balding genes with HairDX and that will give you an idea if you are carrying the gene for balding. It won’t tell you if that gene will express itself (or to what degree, or when)… but it’s something to go on if you’re concerned.

Tags: genetics, coincidence, hairloss, hair loss