I Have DUPA and Need a Specialist in Toronto

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

Dear Dr Rassman,

I just wanted to thank you for all the inspirational information you have provided for men and women that suffer from hair loss. I currently suffer from DUPA and I’m very concerned that I will not have the necessary donor hair in order to do a hair transplant.

I was wondering if you could let me know which doctors in the Toronto, Ontario Canada area provide miniaturization testing.

I have seen several dermatoloigists and transplant surgeons. However, my diagnosis from all of them have been a mixed bag: some say I suffer from telogen effluvium others say I have MPB. My blood work is normal. My hair loss is not just limited to the crown area but I am thinning from the sides and back of my hair severly at a tremendous pace!

Any help and/or suggestions would be greatly appreciated! I just need a straight answer in order to make an informative decision in regards to the necessary treatment options for hair loss.

Thank you again for your exceptional work and in keeping members advised of hair loss treatment options.

The straight answer is that there is no cure for diffuse unpatterned alopecia (DUPA), assuming that this is your correct diagnosis. I would recommend that you obtain a solid diagnosis of DUPA first (as it seems you may be self diagnosing this).

For a list of doctors in your area, you can try the physician search at ISHRS.org. I don’t have any personal recommendations in that area. Ask these doctors if they perform bulk analysis with the HairCheck instrument and miniaturization testing before you go and visit them.

Tags: dupa, hairloss, hair loss, diffuse unpatterned alopecia

Psychology Study Says Porn Causes Performance Anxiety

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

Hi dr. You often mention sexual side effects when discussing propecia but here is a recent psychology study that shows that there are often more reasons for performance anxiety

Link: Internet pornography destroying men’s ability to perform with real women, finds study

The report can be found at Psychology Today, and essentially blames online porn for libido problems in young men. I don’t know if there’s anything to this, but it certainly is interesting. The report suggests that in 6-12 weeks, the problem could be resolved by staying away from the porn and perhaps leaving your penis alone.

There was a large survey of Italian men published earlier this year that concludes internet porn causes “sexual anorexia” (see here).

Tags: masturbation, porn, libido

Should I Cut My Hair Shorter to Reduce the Weight?

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

(female)
I am 53 years old and wear my hair in natural locks. I have thinning hair in the crown an front hair line due to medication. Also the new growth is much softer than my natural texture. I understand that the hair should begin to regrow when treatment ends in a few months. Should I cut my locks shorter (currently shoulder length) to reduce the weight or cut them off and start over after treatment?

The weight of your hair shouldn’t have anything to do with its growth or loss, though if you cut your hair shorter you do reduce the risk of damage to weaker hairs you might have. If you would like to cut your hair to match a certain style or achieve a better look then by all means…

Tags: long hair, hair weight, hairloss, hair loss

Have You Tried NeoGraft Yet?

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

Hi Dr. Rassman,

I read where your colleague, Dr. Bernstein, recently decided to add the NeoGraft Unit to his office’s hair restoration offering – see his blog for more information. I was wondering if you have had an opportunity to try the NeoGraft and whether or not they have managed to overcome trauma to the grafts from “drying” and mechanical effects (during extraction and implanting)? I have read your blog concerning your (and Dr. Pak) device (hydro) and was really hoping that they might take a page from your book on this technique.

I did try NeoGraft on one of our known FOX negative patients and the results were not good, but comparable to what we would have gotten using our own techniques in such a patient. A quick aside, the FOX test means that we ran a small FUE test to see if they are candidates for a full FUE procedure… and FOX negative means we do not recommend the FUE procedure for them.

The NeoGraft system did what we would have expected it to do. I believe (without direct experience) that the ARTAS robot would have also produced damage with this FOX negative patient, but as most patients are not FOX negative, the test of the NeoGraft on this patient was not a fair representation of what it should do.

I have asked for a loan of a NeoGraft system to help me find a place in my practice for it. I know that Dr. Bernstein is getting an ARTAS system and I am sure that when he has a FOX negative patient, I will find out what his experience is with such a patient.

Tags: neograft, fue, hair transplant, follicular unit extraction

Is It Realistic to Expect Finasteride to Keep My Hair for Decades?

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

I recently went to my Family doctor and told him about my hair loss problem. He prescribed me proscar which he said I have to cut in quarters and take it daily. I asked him how long my hair would last on this medication. He specifically told me as long as I am taking the medication I can have my hair forever, till the day I die sort of speak. He told me he has had patients on proscar for 15-20 years that still have all their hair and are well into their 30’s and 40’s now.

I am 28 years old, so I am hoping my hair loss stops by the time I am in my 30’s, b/c so far my hair loss hasn’t progressed that much since I started to 1st notice I was losing hair. Do you think me having hair well into my 40’s and 50’s is a realistic goal with proscar?

I know how cliche this sounds, but nothing lasts forever and everyone is different. Propecia/Proscar (finasteride) is not a cure for hair loss. It helps slow down the process. Some patients respond very well to the drug, while others do not. I cannot predict how you will do with the medication.

One of my favorite patients has been on finasteride for 14 years and it completely reversed his crown loss, which is still the case today. So it is possible that the medication can help for a long time… but I have no idea if that will be the case for you.

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

I Lose Spots of Hair That Regrow White Before Changing to My Normal Color

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

Hi doc

Im 51 and for many yrs now, i some times lose my hair. its always in a circle, in different spots on my head. Now it always grows back in white at 1st then it changes back to my normal color..why does it do this ????

You may have a condition called alopecia areata, as the stigmata of this type of hair loss is (as you describe) in circular patches that eventually regrow over time. I haven’t heard of the changing of hair color, though. Follow up with a doctor for a diagnosis, as I am taking a wild guess here.

In any case, the diagnosis of this disease is by biopsy of the area around the lesion. If it does happen to be alopecia areata, you can find more info here — National Alopecia Areata Foundation.

Tags: hairloss, hair loss, bald spots, alopecia areata

I’m Seeing Shedding a Couple Months After Starting Minoxidil

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

Dr.Rassman

Although I started noticing small vellus hairs growing at my hairline when I started taking minoxidil. I thought everything was working out perfectly, but then I also started noticing hair loss a couple months after I started taking minoxidil. Is this normal, I thought most of the shedding would happen earlier on like within the first month not after that?

I’m surprised you saw hairline regrowth from using minoxidil. There are some reports that the short term use of minoxidil will cause shedding of hair and that this is a reversible process once you get out 3 months from the time you started it. If you are not seeing this, go to a specialist on this.

Tags: hairloss, hair loss, shedding, minoxidil

Do Doctors Track Transection Rates in Hair Transplant Surgery?

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

I was curious if you know if any doctors track the survivability of the grafts? I know that there is quite a bit of information on transection rates for different surgeons but was wondering if anyone monitors this metric? If they do – how might the survivability be determined outside of just counting the grafts in the recipient area a few weeks/months after the surgery? Thanks

This is a great question. We track transection rates when we perform FUE surgeries. The transection can vary from 5% to 50%. I believe 5 to 10% is an acceptable number. If there is a high transection rate then we will abort or never recommend surgery. This is the reason why at NHI we always pre-test all potential FUE patients, but I realize other clinics and doctors may not do this.

The data for other clinics and doctors is not available or well published in studies. I believe mainly it is directly linked to business. No one would publish poor results or high transection rates, as it is not good for business. As unfortunate as it may be, the consumers and patients are left to do their own due diligence and trust their doctor, probably by contacting patients who had it done by that doctor. One way around this would be for patients to ask about seeing actual patients in person or seeing their own surgical records of how the grafts were tracked (if it is done at all). In theory, the transection rate should be documented on the day of surgery, but I realize not all doctors will keep this record (as it is not mandatory) and some may refuse to show it to their patients. I can say this because I have heard these issues come up in consultations with some patients that have had procedures done elsewhere previously.

I know of one doctor who promotes and reports 96% good FUE grafts (4% or less transection), yet I have see many of his patients and found a high degree of failures in those of his patients who came to me for a second opinion. This is a buyer beware business. Sometimes you can expose poor practices through reports by the chamber of commerce or the courts in the areas where the doctors practice. I’ve also been asked to post the names of doctors to be weary of, but if I were to speak up and identify those who may not be honest in their representation, I would become a target for slander. I have better things to do than take up residence in the court system.

Tags: transection, hair transplant, surgery, hairloss, hair loss, fue

What’s the Difference Between Rogaines?

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

Hello, We’re wondering about the difference between Rogaine for men, & Rogaine for women. Also, it would seem that by now something would be developed that you wouldn’t have to use twice a day, also something less sticky…

In today’s world of hi-tech advances (Latisse is one, & what a blessing for men/women who have had surgery), that something would come along that grows hair much easier.Just wondering…
Thank you

RogaineRogaine is a brand name for a topical formulation of a generic drug named minoxidil meant for topical application to the scalp (for hair growth). It comes in 5% strength for men and 2.5% strength for women and is available without a doctor’s prescription (over the counter). I’ve written about the ingredient differences before here.

Some formulations are very sticky, as you imply, and others are not. It all depends on the preparation of how it is mixed and packaged. The brand name Rogaine also comes in a foam and it is not sticky at all, but I believe it is slightly more expensive. In summary, there is consumer choice available to each of you and some experimenting with what is available maybe a good idea. All drugs have their limitations.

Tags: rogaine, minoxidil, hairloss, hair loss

I Chemically Relax My Own Hair and See Hair Loss

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

Hello. I am a 42 year old black female that is experiencing hair loss. I am wondering if this is due to me chemically relaxing my hair myself. I do have a low thyroid condition that I take medication for daily. Could this be contributing to my hair loss. It seems to be getting worse. I recently permed my hair but I burned my scalp pretty bad. Will my hair grow back? Could you give me any suggestions of products to use that might help? Thank you

Chemical damage and thyroid conditions can both contribute to hair loss, and there’s no way for me to try to pinpoint the cause via email. Try stopping the chemical use on your hair and give it a year or so to see if there is improvement. The hair could regrow, but it depends on the severity of the burn. At this point, all you can really do is wait it out to see.

Tags: chemical damage, hairloss, hair loss, female hair loss

Do I Need to Wash Off Concealers?

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

Hello Doctor

Is it necessary to wash off concealers ( such as dermatch or toppik ) daily or is it safe to use them daily but keep a 2 – 3 washes per week schedule

Thank you

You don’t need to wash off these camouflaging agents every day. I’ve seen patients who keep these concealers on for 2 to 3 days (since they wash their hair that often), but it’s up to you. Concealers will not damage your hair or cause hair loss, even if you keep them on for a few days.

Tags: toppik, dermmatch, shampoo, washing, hairloss, hair loss

What If You Have Unavoidable Hair Loss from Chemo After You Have SMP?

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

Dr(s),
Regarding the use of SMP for creating a thicker look in those with existing, thin transplants and limited remaining donor hair….are you still creating simulated follicle “dots” or are you “painting” the whole scalp. If the latter is required for reasonable cosmetic difference, it seems like a really poor choice in terms of any unavoidable future hair loss (say, chemotherapy induced, etc).

The way we do SMP (scalp micropigmentation) is by creating individual “dots” that mimic a shaved scalp and an end view of the follicles. We don’t “paint” the scalp.

If you should lose your hair from chemotherapy or further hair loss should develop, it should not matter because SMP can be performed over the entire scalp. In some men, shaving the head is a good option and allows you to exploit the shaved look that SMP offers. If a man lost his crown hair, we do not just put the pigment over the bald crown, because that would look strange (it would look like a person shaved the crown and left the rest of the hair long). For women who keep their hair longer, if they go through chemotherapy but the recovery only has a partial return of their hair leaving it thin, then we may consider doing SMP to make it appear thicker in the areas where thinning is a problem.

Since there is definitely a limitation of SMP (mainly the life-long shaving of your scalp in men who want that look) we are highly selective on the clients we choose for this. There must be maturity and a clear understanding of the limitations of the process. For those who have had chemotherapy, SMP may be an option to make the hair appear thicker, but the decision to undertake this process must be clearly understood. There are more details on the SMP process: here.

Tags: scalp micro-pigmentation, pigment, smp, hairloss, hair loss

What Class Is My Boyfriend’s Hair Loss? (with Photos)

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

Hello Doctor,

My boyfriend is rather paranoid about his hairloss, personally, I don’t see a problem… but I pointed him out to your website as I feel it’s a great source of information! My boyfriend has agreed to post some pictures so you can help determine his Norwood class, and he would also like to know if propecia and/or rogaine would be suitable to help him with his receding hairline! Thanks for your help! We look forward to hearing from you!

This is a Norwood class 3 pattern. I can not recommend how to treat him without seeing him. Generally neither Rogaine nor Propecia will reverse this pattern, but Propecia may prevent its progression to another more advanced pattern. Your boyfriend needs a good doctor.

I’ve posted the photos below. Click to enlarge.

 

Tags: propecia, finasteride, minoxidil, rogaine, hairloss, hair loss, hairline

Does the Age You Start Balding Affect the Final Pattern?

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

Hi Doc,

Two-part question for you: Does genetics determine what age we get MPB (for example, was I destined to start losing my hair at 21), and also, how does a mans’ age at which he begins balding affect his final pattern, if at all?

Norwood 4AThe start of hair loss is mainly genetic (according to our general understanding), but recent studies suggest that diet, lifestyle and other factors such as stress, will also impact the start and rate of balding. It is believed that our final pattern is predetermined. That means if it is meant to be a Class 4A (see image at right), then the variable will be the rate of achieving that final pattern. A Class 7 will not evolve out of a Class 4A genetic pattern if the genes are not lined up that way.

Tags: hairloss, hair loss, mpb, patterns

I Want to Use Cream to Remove My Scalp Hair, But Not Permanently

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

Hello Dr. Rassman,

I’m a young man experiencing MPB, and I’ve decided I want to embrace it. I’d rather not shave my head since I find razors irritate my skin. My question is this: Do you know of any hair removal creams that are safe for use on the scalp? I’ve read varying reports that indicate Nair can damage the scalp. Furthermore, if I later choose to have a transplant or other hair restoration procedure done, would the earlier use of hair removal cream alter my hair’s regrowth in any way once I cease using the product?

Thanks for your informative site and the time you devote to answering all our questions!

There seems to be many warnings on using depilatories such as Nair. The warnings suggest chemical burns and damage may result from their use on the scalp. It appears that your options are limited to shaving. Try different razors or shaving creams to see if that helps reduce irritation.

Tags: hair removal, scalp hair, nair