Why Is There a Dormant Phase After a Hair Transplant?

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

Hi Dr Rassman

I was just wondering if you could explain why grafts enter a dormant phase immediately after being transplanted, and only start recovering after 8-10 months?

I’d also be interested to know why they initially grow back much finer, and then thicken up later. Essentially the follicle itself hasn’t changed, so why does the hair diameter it produces fluctuate in this way?

Many thanks

I do not know why there is a dormant phase after a hair transplant. To put it simply, when you have hair transplant surgery, your follicle was removed from your body, handled, cut, manipulated, put in solutions, manipulated some more, and put back into another new location on your body. If I was that follicle and I survived all of that, I’d be traumatized and go dormant for awhile. In all seriousness though, I do not have a professorial explanation.

The simple fact is that most follicles go dormant (telogen) and start to regrow in a period of 3 to 12 months. Most patients see results starting on the 6th month to 12th month. Some lucky minority of patients (< 5%) see results within a month! This is what we have observed over the last 20 years in thousands of patients. [tags]dormant phase, hair transplant, hairloss, hair loss, telogen, hair cycle[/tags]

Losing Crown Hair While Maintaining a Juvenile Hairline?

/by William Rassman, M.D./2 /

Hello Dr. Rassman,

Is it possible to start balding in the vertex area and scalp area while still maintaining a juvenile hairline? I noticed that I still have hair under my furrowed brow, but the overall thickness of my scalp hair has dramatically decreased. I am 22 years of age.
Thank you.

Yes! You can start balding from the vertex (crown) area while maintaining a juvenile hairline. Those patients are a subset of the normal Norwood hair loss patterns with a persistent frontal hairline.

In rare instances, someone with this type of hair loss may even continue to have his juvenile hairline for the rest of his life, even though his crown has become bald.

Tags: hairline, hairloss, hair loss, vertex, crown

Force Scalp Sebum Production?

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

Is it possible to permanently damage the Sebaceous gland to where it is not secreting any sebum? Two yrs ago i used a re moist intensive hair treatment and left it in my hair for several hours and every since then my hair has been brittle and dry.

I know that sounds crazy but my hair just hasn’t been the same. While i might be wrong about the product that i left in my hair causing my brittle, dry hair, one thing i do know is that (all of)the hair on my head is very unhealthy. Im debating to see a doctor about it but im afraid to waste my money to just be told to use a deep conditioner, which i have been.

Is there any thing that a doctor could do about very brittle, dry hair? Or is there any way to get the body to produce more sebum?

Maybe it is probable, but I do not really know. Some people just have dry and brittle hair, and it can change during one’s life. I do not know of any way to increase sebum production aside from perhaps washing it regularly.

Tags: sebum, dry hair

Article Suggests Hair Wax Can Make Hairs Stop Growing?

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

Just wanted to send you a link to this silly article. One of the claims is that petroleum-based waxes can block hair follicles.

Link: Worried you’re going bald? Eat nuts and have a fried breakfast

Thanks for the find. Yes, it is a silly article. Journalism isn’t what it used to be. Even the title of that article suggests eating a fried breakfast will somehow stop your hair loss. That’s ridiculous.

Tags: hair wax, hairloss, hair loss

When Will Dr Rassman Retire?

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

Hello dr Rassman,

I think you are 68-69 years old.Does that mean that you are going to retire soon?If yes what will become of baldingblog?I hope you are going to be with us for another 5-10 years.

Dr RassmanMy grandparents lived well past their 90’s and longevity runs in the family… and since I love what I do, I suspect I will be doing this for a very long time. In fact, I am very involved with Dr. Pak in the engineering process of new hair transplant instruments and we will be testing a new FUE extractor and implanter in the next month!

Besides, even if I do eventually retire, I only need a computer and Internet for BaldingBlog, right? With respect to what you read on this site, Dr. Pak and I equally share contributing to the posts without the reader knowing who answered what. So even if I am gone for a long vacation, BaldingBlog will continue on. But in general, before any content is posted, both Dr Pak and I cross check and edit each other’s answers.

But just to make it clear, I am not planning on retiring yet.

Tags: rassman, retire

When Does a Scalp Wound Result in Permanent Hair Loss?

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

Hello Doctor

How bad does a scalp wound has to be in order to mean permanent hair loss in the area ? I bleeding or crusting afterwards na indication for bye bye hair ?

Any cut on the skin will produce a scar, and on the scalp no hair will grow on that scar. Even with follicular unit extraction / FUE (advertised as “scarless” surgery by some) will produce a round punctuate scar.

In general, if the injury or wound is significant there will be permanent hair loss. Even a scratch could cause bleeding, but that doesn’t necessarily mean permanent hair loss will result. Only time will tell if your hair will grow back. This time frame is around one year. If you see no hair growth after one year, then it would be safe to bet it is permanent hair loss.

Tags: hairloss, hair loss, scalp wound, scar

I Stopped Finasteride Due to an Increase in Body Hair, But Now My Scalp Is Thinning

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

Hi Doc. i’ve been on finasteride 1mg for 3yrs without major sides just an increased in body hair. i quit for 2yrs and now my hair has thinned so much that i’ve started fin again. now will i get sides this time? or should i expect the same.

Increased body hair from finasteride is not a common side effect I have seen, but I have been asked about it before. I have seen decreased body hair in a couple patients over the years.

If you restart the medication I cannot say if you will get the same side effect. You should follow up with your doctor.

Tags: finasteride, propecia, body hair

Shouldn’t I Try Propecia and Rogaine At the Same Time?

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

Dear Dr. Rassman,

I found this blog a very interesting read, and I appreciate you taking the time to answer questions online like this. It has been a wonderful resource in coming to terms with the somewhat shocking discovery of my hair loss.

I am about to start treatment with propecia for my thinning top, but there’s something that has been nagging me:

I want to heed this blog’s earlier recommendation and wait until after a year on propecia before trying Rogaine. But isn’t it “the earlier, the better” even with propecia working in the background? Wouldn’t this delay risk my potential for improvement? Wouldn’t it risk killing miniaturized or dormant hair?

It is my hope to completely eliminate the visible thinning with medical treatment. I realise my odds aren’t super great, but I also feel it wouldn’t take much improvement to achieve this. My hairline has receded to mature levels but seems stable. I will be 25 this year and I only noticed my thinning a month ago.

Propecia
Rogaine

Generally, when I recommend a medical treatment for androgenic alopecia (AGA), I only have two proven medications I can recommend: (1) Rogaine (topical minoxidil), and (2) Propecia (oral finasteride 1mg). While you can start taking both treatments at once, it would be difficult to assess which medication had more or no benefit. So I usually give the patient a choice on one medication and they use it for 6 to 12 months to assess how it is helping their hair loss issue before we add on the second medication.

Also, in practical (real world) terms, it is a hassle for men who are not used to taking any medication to stick with the regimen of taking a pill every day (Propecia) and putting on a topical medication twice a day (Rogaine). Before they know it, most patients get lazy, forget to take the medication, or forget to resupply the medication when they run out. I find that in a good percentage of time, the failure of a medication is related to the poor compliance issue. This not only applies to Propecia, but many other medications.

So yes, while starting both at the same time allows you to potentially see your maximum benefits begin sooner, it’s a lot for most men to keep up with every day. And who knows — since you just noticed your thinning, only one of the meds might be all you need.

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

Finasteride and Tamsulosin

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

I take 5mg Finesteride daily and also used to take 0.4mg Tasulosin. My doctor ‘s PA took me off Tamsulosin with no reason given.

Is there a reason?

Thanks

The reason can be found by asking your doctor or your doctor’s assistant. Finasteride 5mg (Proscar) is used to treat the symptoms of an enlarged prostate. Tamsulosin (Flomax) is also used to treat the symptoms of an enlarged prostate. This is a site focused on hair loss issues, not prostate issues… and I have no insight into why your doctor did or didn’t prescribe certain medications to you.

The recommended dose of finasteride is 1mg a day for treating hair loss, and taking more will not make things better with respect to hair. Tamsulosin is not (and has never been) used for to treat male pattern baldness.

Tags: tamsulosin, flomax, finasteride, proscar, prostate

Can I Just Have a Lot of Smaller Transplants Over the Years Instead of Waiting for My Final Pattern?

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

Hey Doc,
You have a great site going. Thanks for all you do. I am a 20 year old male and my hairline is receding at the corners. The only family history of balding that I have is my maternal grandfather who was completely bald by the time he was thirty. I am currently on finasteride, but I was wondering about a transplant.

Would it be a bad thing to have smaller transplants over the next fifteen years instead of just waiting until you’ve reached your final pattern? For example, could I have one to fill in the corners, and then another in ten years to fill in whatever else is thinning or gone? As of right now, I am about a NW 2.5 with no evidence of thinning in the crown.

Not everyone has the exact same goal, and some patients have transplants to keep ahead of their thinning. This issue is up to both you and the doctor to plan out the Master Plan. Generally, most patients do not wait until they are completely bald… but in your case at 20 years old with early loss, you would likely not be a candidate just yet.

Tags: hair transplants, hairloss, hair loss

I Want My Hair to Fall Out Faster So I Can Get a Transplant Sooner

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

I am currently taking finasteride and it has been helping me in slowing down my hair loss but not stopping or regrowing anything. If I am losing hair still, wouldn’t finasteride be a bad thing for me to take because I would want my hair to fall out faster so I can get a transplant right away instead of waiting to see my final hair loss pattern.

Wouldn’t this also avoid me risking shock hair loss if I get a transplant in areas I still have a bit of hair in which was being saved by finasteride?

Love the website.

Oh boy. Why in the world would you want your hair loss to progress faster?! Please read about building a Master Plan.

If you are ready for a hair transplant, I would think you would want your existing native hairs present as long as possible for a better result. Shock loss may be an issue, but that is something you discuss with you surgeon for its risks in relation to the aforementioned Master Plan.

Tags: hairloss, hair loss, hair transplant

Spironolactone for Treating MPB?

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

Hi Dr.Rassman, what are your opinions regarding the safety and effectiveness of topical spironolactone? Is it a safe alternative to proprecia or does it pose harmful side effects?

It does work for the treatment of balding, but the side effects are significant and far more common than Propecia, including the scope of side effects.

Spironolactone causes an increased risk of bleeding from the stomach and duodenum, gynecomastia, and testicular atrophy (kills off the testicles or makes them smaller and less effective). Erectile dysfunction would be common and it can cause a serious rise in potassium in the body (hyperkalemia). The side effects and complications go on and on.

It should never be used to treat the benign condition of male pattern hair loss.

Tags: spironolactone, hairloss, hair loss

Micro Extensions?

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

Is there anything else other than finasteride I should consider to help with my hairloss?

What is your thought on micro extensions?

Finasteride and minoxidil (Rogaine) are the two drug treatments I will recommend, as they are FDA approved to treat hair loss.

Micro ring hair extensions do not use glues or sewing, but while I haven’t had it done myself (I prefer my hair short), the photos I’ve seen show me that it will probably run the risk of causing traction alopecia (more hair loss) due to the tight pulling on the scalp.

Tags: micro extensions, hairloss, hair loss

2006 Study Says Saw Palmetto Doesn’t Improve BPH Symptoms

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

Dear Dr.

Link: Study Shows Saw Palmetto Extract Does Not Improve BPH Symptoms

It says: There is no different between Saw Palmetto and Placebo. if it’s correct, then maybe there is absolutely no benefit for inhibiting 5-alpha-r/DHT? Please tell us your comment. thank you.

I believe if you search BaldingBlog over the years, we have always maintained that saw palmetto is just an herb and there is no scientific proof of its efficacy (for MPB or BPH). Informal studies, differing dosages, and duration of use have all been issues with clearing up once and for all if saw palmetto does anything to treat hair loss.

Regardless, as I have said too many times here, “Buyer beware”.

Tags: saw palmetto, hairloss, hair loss

When All Else Fails, What Can a Young Man With Hair Loss Do Besides Give Up?

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

Hey, I just want to take a second to thank Dr. Rassman for all of the time that he puts into this blog in helping young men as myself in looking for solutions to hair loss. I just want to explain something for a second.

First of all im 20 years old, have been losing my hair for some time. For all the time I put looking for answers to stop my receding pattern, people like me seem to be just wasting their time. I have been on finasteride for two years, and from the looks of my head, it seems as if I have no more options. I come to this blog out of desperation to hopefully find a “miracle cure” that will hopefully one day regrow the little fibers of youth that have slowly destroyed any bit of self confidence I once had. Im afraid that I have put countless hours a week researching baldness and still can find no answer in how to stop this.

How do people like me… when all fails…deal with this situation?…because it seems to me like the answer that makes the most sense is to just give up. It is most certainly wrong that young men, barely out of high school, will not face judgement and humiliation from this. In my case, I am embarrased to say that this little problem has turned into one big life crisis. A couple of years ago I was a pretty good looking kid. Now I cant jump into a pool without my scalp showing for everyone to point fun at. Two years ago I was happy…now im just depressed

If I’m going on a little rant here im sorry, but im just desperate I’m afraid. In reality, is there any hope for the guys like us, who seem to see thier youth crumbling, and confidence fading?

You’re not alone in feeling this way. Unfortunately, we don’t have all the answers and there is no cure for hair loss. It’s possible that a hair transplant could be in your future… but you need to find a caring doctor who can work with you on a Master Plan addressing hair loss possibilities.

Tags: depression, hairloss, hair loss