Adding Density to My Existing Hair

/by William Rassman, M.D./7 /

Dr. Rassman, I have a question regarding a statement you made on your Q/A blog. You said: “I wouldn’t allow any doctor to transplant into an area that has not fallen out under the excuse that there’s anticipated hair loss (behind the leading edge of your loss), as this will only accelerate the thinning. Some doctors do this, and it isn’t in your best interest, only serving to put your money in his pocket.”

I have had in-person consults with Dr. Pak in the San Jose previously. During the consult when discussing what I’d like done and the procedure itself, Dr. Pak has mentioned that he has to consider my future hairloss when he’s doing a procedure. He said he would work within my current frontal hair to add density to what I have.

So when considering what you stated in the above quote, how does that comport?

Thanks

Almost everyone we transplant has a zone between the bald area and the balding area. We allow the transplant to ‘spill’ into the balding area just in the areas that are evidently in the balding process. We never go back behind it into the area where the hair is normal and not miniaturized.

What I see often is someone with an early Norwood class 3 balding pattern who has some minimal miniaturization behind it (let’s say 25% miniaturized hairs). I might transplant hair about 1/2 – 1 cm behind the posterior bald edge, but not far into the area where there is 25% miniaturization.

Unfortunately, many doctors will transplant 1-3 inches or more behind the bald area, suggesting that it would be to prevent future balding, and it is that process that I warn about. I have recently seen a patient who needed about 800 grafts for corner balding in the frontal area, but his doctor put in 3500 grafts to prevent the balding from spreading. Not only did that cost the patient a bundle of money, but it also almost certainly damaged hair in the normal areas that got the grafts and did not need them.

Tags: hairloss, hair loss, hair transplant

I’m Still Confused About Propecia Efficacy in the Long Term

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

Hi Doc

I’ve been reading that forum for quite a time, and i am still a bit messed when it comes to long term propecia (finasteride) efficacy. In one of your last posts you wrote ‘The problem is that many people who see it stop may find that it picks up again years ”

when you say ‘many’ i guess you take it from your practice over the years, do you keep firm statistics about that like what percentage of your patients is that. Another important thing is when you say ‘picks up’ does it mean that there are people who went completely bald while on finasteride or they just lost some small percentage of their hair? thanks

The quote you’re referencing is from this post, which wasn’t about finasteride. I was answering a question about final hair loss patterns. So what I was talking about was that for those men with hair loss that has seemingly stopped on its own, they may see additional hair loss as time goes on.

I don’t have firm statistics to share regarding my patients that have seen their hair loss halt and then eventually start again while they maintained finasteride use over years. Not every patient comes back in for follow-ups. As I’ve written before, you can look at it like a tug-of-war between finasteride and your genetics. Eventually, the genetics will win out. To what degree and when, I have no idea. If you stop finasteride, the tug of war will end faster in the direction of more balding.

Tags: propecia, finasteride, hairloss, hair loss

Likelihood of a Significant MPB Treatment Breakthrough in the Next Decade?

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

Hi Doctor,

Thank you for the great blog. I was curious about your big-picture opinion — do you think it is possible/likely that a significant breakthrough in treating MPB will come along in the next decade? I was wondering about your perspective on this, based on your experience and what you hear from colleagues / journals / etc.

We can hope that this will happen. Knowledge is increasing logarithmically, so whatever breakthroughs we have seen in the past 10 years should be 10 times that number. There is work going on in cloning and the financial rewards are certainly there to make the required breakthrough. This means to me that something will happen sooner rather than later. But if I had cancer, I would not wait for a cure while it grew in my body. I would treat it when I made the diagnosis. The same applies to hair transplants — you could wait until it all falls out or you can treat it with drugs (like finasteride) or surgery (like a hair transplant).

Tags: hairloss, hair loss, breakthrough, prediction

Did a Hair Transplant Help Soccer Star Wayne Rooney’s On-Field Performance?

/by William Rassman, M.D./4 /,

Dear Dr Rassman
Im a keen reader of your website and user of Propecia. Interesting article in the Daily Mail UK.

Link: How Wayne Rooney’s hair loss cure could help boost your performance

I’m not sure about the extra muscle mass but the other effects apply to me. Though as the article suggests they could be psychosomatic.

Best Regards

Increased confidence and self-esteem in oneself is probably the most common result of a hair transplant or a successful reversal of hair loss with drugs like Rogaine and/or Propecia.

I will tell you about a man I transplanted some years ago. He was a very successful man who made millions of dollars taking over troubled companies and turning them around. He presented as a Norwood class 4 pattern balding patient who had two hair transplants over a one year period. He was a happy camper after his hair restoration. If you put him into a room with 100 men (even before his hair transplant) his dynamic personality would project so well that people would gather around him hoping that this charisma would rub off. That part of his career did not change after his hair transplant, as he was (and still is) a dynamic person.

One day, some two years after his second hair transplant, his wife was in Los Angeles on a family trip. She stopped by my office to see me. She told me how adamant she was against her husband having a hair transplant, and how they fought about it up until he had the first procedure. I remember her saying something to the effect of, “I told him that I loved him with or without hair and that having a hair transplant was foolish. I really did not think that he needed it and he was handsome with or without hair. Now I am here to tell you what I never told him, that I was wrong about my stance against the surgery. He changed after his hair was restored, and the man I married, the man I fell in love with, returned. I just want to thank you for what you did for us.”

Hair loss impacts our psyche in many ways. Over the years I have done transplants on thousands of men, and some of these men had successful careers after their transplant. Many of these men are household names (CEOs, celebrities, heads of state) and some of them have even given me credit for launching or resurrecting their careers. While I have been honored by that, I am certain that what happened to these men is that due to their self-confidence significantly improving, their ability to tackle their careers was unhampered by the energy they used to spend focusing on their hair loss.

So is this the case with Wayne Rooney? It sure sounds like it.

Tags: hair transplant, footballer, football, wayne rooney, confidence

Does Botox Prevent or Reverse Hair Loss?

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

Any news on the use of Botox in treating hair loss? I read something a couple years ago about it and saw it advertised recently. Thanks

We addressed a press release we found back in 2009 that Botox was being used to reverse hair loss. Since then, there’s been a pilot study of 50 men, but nothing I can find beyond that.

The rationale for using Botox as a hair loss treatment is that when the muscles are blocked, the blood flow in the scalp increases and bathes the damaged or thinning hair follicles. If this catches on, there could be a rush to get Botox in the scalp by some of the many balding men and women. I do not endorse this treatment at this time without more convincing evidence that there is value in the use of Botox for this purpose.

Tags: botox, hairloss, hair loss

If I’m a Norwood 4A Now and Have a Hair Transplant, Will I Have Sufficient Hair for Later Procedures?

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

Hey doc,

you mentioned in a previous post -“The Class 5A pattern does not evolve into a Class 6 or 7 pattern”. does this mean even if I am 23, norwood 4a, and I were to go for a hair transplant at my young age, I should have sufficient hair for full coverage in later years?

thanks doc!

If you are a true Norwood 4A pattern balder, then you should not progress to anything worse than a 5A pattern (not a 6 or 7 pattern). Most Norwood 5A pattern men can get a transplant to manage the entire balding pattern reasonably well. Talk to your chosen surgeon about your candidacy, as I don’t know how the density of your donor area is. At 23 years old, your final pattern may not yet be known.

Norwood 4A
Norwood 4A		 Norwood 5A
Norwood 5A		 Norwood 6
Norwood 6
Tags: balding, hairloss, hair loss, norwood

Pudendal Neuropathy and Propecia

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

I read on one post that Propecia caused someone to have pudendal neuropathy which caused both sensory and motor dysfunction in the genital tissues. Is this a Post-Finasteride-Syndrome? Is pudendal neuropathy a side effect?

The term “neuropathy” means damage to a nerve… so “pudendal neuropathy” is damage to the pudendal nerve. I cannot imagine how Propecia can cause damage to this specific nerve. Damage to the nerve is usually from mechanical injury (bike riding, falling on your buttocks, etc) or inflammatory issues (infection) or chronic medical conditions that damage your nerve, such as diabetes or multiple sclerosis. Propecia is a drug that that partially blocks the conversion of testosterone to DHT. If someone is going to claim that there is some special DHT relationship to a pudendal nerve, we might as well be blaming Propecia for our economy or the color of the sky.

Stating that a drug (Propecia) caused a neuropathy to the pudendal nerve is questionable, because there is no difference in the pudendal nerve to a nerve that innervates your thumb. The pudendal nerve is one of many nerves in your pelvic area (for both men and women) and one segment of it innervates your penis or clitoris. I believe many readers may have heard of sciatica when doctors refer to certain back pain caused by the sciatic nerve. The pudendal nerve is a distal branch of a sciatic nerve. Patients with back problems or pelvic area problems/trauma/tumor/etc can have pudendal nerve issues. Pudendal nerve damage can cause erection problems, but it will also cause perineal numbness or pain (see here).

If there is an erection issue, the most simple test is a nocturnal penile tumescence (NPT) test. Imagine a roll of stamps wrapped around a flaccid penis and taped. If you get an erection, the stamps will stretch and break at the perforations. I assume there are better devices out there and better tests, but this test can sometimes be a good starting point to help delineate if erectile issues are psychological or physical. Normally, men will have involuntary erections during sleep (aka “morning wood”). It would be interesting to see if the 70 or so men that reported permanent erection problems can achieve nocturnal (involuntary) erections and if they ever underwent these tests, But from my reading I believe the erection issues were self-reported and no subjective testing was performed.

In matters of medical health, the Internet is not a place to self diagnose medical conditions or become armchair physicians. But alas, it is what many readers will continue to do and the urban legends will propagate.

Tags: propecia, finasteride, dht, nerve damage, pudendal neuropathy

Any NeoGraft and Artas® Robot Alternatives?

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

What other “automated” or similar hair restoration systems are available besides Neograft and Restoration Robotics?

The follicular unit extraction (FUE) technique is a simple and elegant technique conceptually, but it is highly variable or difficult in practice. Since I published my FUE article in 2002, hundreds of doctors have adapted their own automation and instrumentation. I encourage this, as one superior technique or machine may emerge. But as of 2011 it has not.

There are handful of doctors who have invented their own technique in some form or another. NeoGraft and the Artas® robots are just commercial adaptations. Both Dr. Cole and Dr. Harris have developed instruments which are diametrically opposed as to how they work. There is also Dr. Boudjema in France (one of the brightest and most creative people in the hair business) who first invented an FUE automation machine back in the mid-1990’s called the Calvitron (which is similar to NeoGraft). He always has a new approach and just recently talked with me about his most recent innovation (brilliant as always).

Real inventing requires ‘out-of-the-box’ thinking, but most of what is out there are just minor variations of each other. There are powered punches that vibrate, twist one way and then the other way, that are slow in RPMs, that are fast in RPMs, that claim sharper punches or duller punches as the key to best results, etc.. The Artus system uses sharp followed by dull punches and the Neograft uses very sharp punches. Each doctor will likely say ‘his’ instrument is the best.

Tags: neograft, calvitron, artas®, fue, hairloss, hair loss, hair transplant

Mixing Rogaine Foam and Brylcreem?

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

I dislike using both versions of Rogaine foam and solution. As I could always feel some drops on my eyebrows, eyelash and gradual hair growth on my forehead, nose, ears and neck. I thought about mixing a bottle of %5 Rogaine Foam with a hair growth cream or brylcream even. Could you suggest a ratio of Minoxidil to cream to create such homemade mixture. Would that minimize the benefits of Minoxidil?

Thank you

You’re saying that even the Rogaine Foam is too messy to apply, leaving you with drips and drops on parts of your head that you’re not intending to apply it to? I haven’t heard that complaint before with the foam, though it was more common with the liquid. Perhaps you’re not rubbing it into the scalp areas enough, or you could use a wet rag to wipe down your forehead, nose, ears, etc after applying it.

I don’t have experience with homemade mixtures of any medication, so I cannot and would not recommend this practice.

Tags: minoxidil, rogaine, mixture, hairloss, hair loss

Prostatitis and Hair Loss?

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

Hello Dr Rassman,

I am a 29 year old male who recently noticed that my crown was thinning. My hairdresser confirmed that she only noticed the thinning very recently. Over the last year I have also been battling a severe and stubborn case of what the urologist told me was prostatitis.

Are these two problems linked. I have read that a swollen prostate will produce more DHT then a regular size one. Is that accurate?

I would doubt that prostatitis will increase DHT, as the prostate itself has nothing to do with DHT production. DHT is a metabolic derivative of testosterone which is made in the testicles, not the prostate. The prostate is a target organ that is impacted by DHT and that is why blocking this DHT with finasteride or dutasteride will reduce the enlarged size.

Tags: prostatitis, prostate, hairloss, hair loss, dht

Dermatologists I’ve Seen Just Say They Can Tell If There’s Hair Loss By Looking

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

Dr Rassman,

Is hair bulk analysis a commonly performed test by dermatologists or hair transplant surgeons? I’m from the Uk and the dermatologists I’ve spoken to say ‘it’s easy to just tell with the human eye’.

The thing is, I also have really OCD (particularly with my hair) and it would ease my mind to know exactly how things were progressing rather than just questioning myself in the mirror every morning for an hour on end.

I saw a trichologists who said she could see miniaturised hairs at the crown but I have no idea what that means in terms of when I will have a bald spot. I want to stay away from drugs for as long as I can really but if it’s the case that I will be noticeably bald in two years then I might consider it.

thanks

You can tell if someone’s hair is thinning just by looking at them under a bright light, but the process of quantifying it is very difficult. Not many doctors perform miniaturization tests or hair bulk tests using the HairCheck device, which is highly accurate at detecting hair loss in its earliest stage.

I don’t have a list of clinics that perform these tests, but I know I’m not the only one that uses them. Best to call around and ask. I perform these tests at my clinic, because it gives me and my patients a certain metric or a quantitative value of what the state of one’s hair is in. We use these tests as a baseline to compare over a one year time frame to see if the treatments we use (Rogaine or finasteride) are working.

To be blunt, patients with obsessive compulsive disorder (OCD), particularly those who have seen other doctors and were told they are not losing hair, usually do not need help with hair loss. Their main issue may be the OCD, and the best help might be finding a treatment plan for that.

Tags: ocd, obsessive compulsive, hairloss, hair loss

Hashimoto’s Disease and Female Hair Loss

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

my daughter was diagnosed with Hashimotos in 1998. she has been suffering hair loss since then and it is now quite serious. She went to a dermatologist who told her that her hair loss was genetic and unrelated to the Hashimotos. That is hard for me to believe. She is very resistant to getting further help so I don’t know what to do to do and where to send her. She is at Stanford and there is a Dermatology Clinic with a specialty in hair loss but I keep thinking the problem is the autoimmune disease. Can you give me some advise about what to do.

While having a diagnosis certainly helps with finding a treatment, for women’s hair loss there is no definitive treatment. If you treat the thyroid disease the thinning may slow down, but it is unlikely that after treatment the loss will reverse. I have never seen it revert back to the original fullness. Even for genetic women’s hair loss (just like men’s genetic hair loss) there is no cure. If the hair loss issue is from an autoimmune disease, there is really no cure either and many doctors are suggesting that genetic hair loss may actually be an autoimmune process, not uniquely genetic alone.

At best, you can treat the Hashimoto’s disease and the hair loss may slow down. I am sorry for the bluntness, but at this time there is no medical cure for genetic hair loss in men or women… and unfortunately, we seem to know far less about treating female hair loss than we do with male hair loss.

Tags: hashimotos disease, female hair loss, hair loss, hairloss

My Daughter’s Hair is Processed and There Are Bald Spots

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

13 year old african american daughter having continuous hair loss for several years. Hair is processed and has several bald spots especially in back. Suffers from excema if that helps. Please HELP! Beautician just sews false hair in her head but has yet to get it to grow. Can you please tell us where to start.

It sounds like your daughter is having chemical problems with the things that the stylist is using. Hair loss is common when chemicals are applied to relax the hair. I am wondering what you mean that the beautician is sewing false hair into her head, though.

Tags: hairloss, hair loss, daughter, teenage hair loss

Doctor Prescribed Finasteride to a 20 Year Old Woman

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

Hey. I am a 20 year old girl suffering from androgenic alopecia. My doctor prescribed Finasteride for me and after researching a little, I am a bit wary of it’s usage. Should I be taking it?

Thanks.

Women, especially those of child bearing age, should NOT be taking finasteride (Propecia). Period. I would find a new doctor.

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

Can Propecia Cause Blood Clots?

/by William Rassman, M.D./14 /

I am hearing Propecia is now associated with DVT or thrombophlebitis. This is a life threatening thing. I can understand erection problems can be a major downer, but a blood clot can kill me!

For those not familiar with the term, “thrombophlebitis”, it reflects inflamation of a vein causing or related to blood clots in the inflamed vein. Clots that form, for example, in the leg, can be dislodged and then head to the heart and lungs producing a life threatening condition.

Propecia is a drug that blocks (though not completely) the conversion of the testosterone hormone to another hormone called dihydrotestosterone (DHT), meaning the drug reduces the action of DHT on various target organs in your body. If someone is going to claim that there is some special DHT relationship to a blood clot in your leg, I think we are going a bit overboard.

From a physiologic perspective, children (pre-puberty) have low DHT and men with hypogonadism or castration have low DHT and low testosterone levels. These people do not usually get blood clots. However, men that are treated with testosterone (which will also increase their DHT) show that there are a few case reports of blood clots. My point is that if anything, Propecia should have the opposite effect.

I want to make clear that these are my opinions based on my medical knowledge and years of practice, but I am not your doctor and you should not take this as a medical consult. Please speak with your doctor about your concerns. The Internet is a horrible way to self treat and you will be lost in a sea of information that is impossible to validate.

Tags: blood clots, vein swelling, propecia, finasteride, hairloss, hair loss