Transplanting Wavy Hair

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

I am scheduled to go in for a consultation in two weeks for getting a procedure done. What I wanted to know, I have wavy hair but when it is short its not wavy. However, the wavy hair starts to come out on the top and front of my head first then the donor area follows a few week after. Wouldn’t that be a problem if I get a transplant b/c I will have straight hair in certain areas and then wavy hair?

Are most clinics required to develop a long term plan for future hair loss for a patient, and are they required to use devices to measure miniturization on the scalp for a patient?

You should always start off with a Master Plan, created by you and your doctor based upon his findings during your examination. If you have wavy hair in the donor area it will grow out as wavy hair in the transplanted area.

There are no requirements to measure miniaturization. It is something I stress in my practice and on this site, but many doctors do not do this, nor do they measure bulk of the hair in the various parts of the scalp in the initial examination.

Tags: hairloss, hair loss, miniaturization, hair bulk

Could Testosterone Replacement Therapy Cause Hair Loss?

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

Hello Doc,
I have recently been diagnosed with low testosterone levels and my doctor recommended that I start testosterone replacement therapy. Is it possible that once my testosterone levels reach “normal” or average levels that I will experience hair loss?

This is something you need to discuss with your doctor and express your concern to him/her. If you carry the genes for genetic androgenic alopecia (AGA) then testosterone replacement therapy can potentially cause hair loss.

Tags: testosterone therapy, hairloss, hair loss

I Am Bald in a NW3V Pattern, but My Hair is Thin in a NW6 Pattern

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

I am 40 years old. I have bald areas corresponding to Norwood 3 Vertex but thin (but stable) hair corresponding to NW6 according to two doctors. I am not taking Propecia for 18 months.

1. Can I still progress to a NW6?
2. If you (Dr. Rassman) were to transplant me, would you fix the NW3 regions or the NW6 regions or both?

Norwood 6Generally, when doctors assess patients with a Norwood scale, it is meant to categorize your eventual balding pattern. You may not look like a Norwood class 6 right now, but it seems two doctors that have examined you think you are going to eventually be a Norwood 6. This likely means you are not a Norwood 3V, but you have a pattern leading to a class 6.

Many men on finasteride may never lose all of the hair in the end pattern, but no one really knows. Best to get good baselines with bulk measurements along with some good pictures, and then repeat them serially year after year to know where you are actually going.

So a good doctor should recognize this and transplant the hair with both a short term focus to address your immediate needs and a long term focus leaving enough donor hair available to address the evolving situation as it unfolds. In short, this is what I always stress about on this blog and in my private practice. This must be a Master Plan for each patient before going forward with the first hair transplant in what may become a course you will follow over your lifetime.

Tags: hairloss, hair loss, norwood patterns

Why Do Some Men Lose Hair Much Later in Life?

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

doctor,
since we know DHT is a cause of hairloss, why do some people start showing sings of male pattern baldness later in life? I know a few family friends pople who have had extremely thick beautiful hair norwood 1, with no signs of balding in their 40’s and late 40’s. then in their 50’s they started get thin and crown balding. if dht is the cause then i’m sure these guys had dht in their body in there 20’s, 30’s, and 40’s. why all of a sudden in there 50’s the dht decided to choke the follicles?

Dihydrotestosterone (DHT) is the cause of hair loss when it is associated with the genetic disposition of male pattern baldness. The genes that cause hair loss are preprogrammed and often express themselves at different ages.

For example, some men and women get grey hair in their 20’s, whereas some never do. Most men with the balding gene will go bald in their 20’s and 30’s, but there are always exceptions to the rule as you pointed out.

Tags: hairloss, hair loss, dht, age

I’m Worried About This Shedding I’m Seeing After Starting Minoxidil

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

Dear Doctor,

I am 28 yr old male. I have been losing a few strands of hair here and there for the past couple of years. However, it aggrevated in the past six months or so, with visible thinning of hair on the crown and receding of temples. I consulted a physician and a dermatologist. My reports about anaemia, thyroid function and blood sugar levels are normal. I was informed that I am suffering from genetic male pattern baldness.

I have been prescribed Minoxidil 5%, twice daily, Propecia once daily with Nizoral 1% twice a week. I have been on the above regime for a month. However, I have observed dramatic hair loss in the past month. I am loosing about 300 hair everyday. The most worrying part is that there are times when I loose a bunch of two to three hairs with a single white bulb at the bottom.

I am told that the use of Minoxidil can cause such increased hair loss. From your vast experience, can you confirm if such increased hair loss is common in the first month of treatment?

Also, assuming that this increased hair loss is pursuant to initial reaction to Minoxidil – will the hair lost in the past month grow back to their original length and thickness or is the best case scenario that only small thin miniature hair will replace them?

Thanks

I’ve had some emails over the years of reporting on this site from people asking about minoxidil shedding. I’ve written about it here.

I can’t say for sure how long it’ll persist or if those shed hairs will regrow, but it seems to be a temporary thing that lasts about a month in those that see this initial shedding and the hairs usually do return.

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

Since I Had Shock Loss Before from Hair Transplant, Would I Be Likely to Have it with SMP?

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

I have had several large hair transplant procedures. Subsequent to my last 2 hair transplant procedures I experienced a good deal of shockloss from existing hair which took months to grow back. I am interested in having SMP and was wondering, if because of my previous shockloss experiences from the last 2 hair transplants, would I be suseptible to shockloss from the SMP procedure?

Thank you

If you are considering Scalp Micropigmentation (SMP), you would need to arrange a consultation with us. Shock loss after SMP is rare, but is a risk you should consider.

Tags: smp, pigment, shock loss, hairloss, hair loss

Free Testosterone Declines with Propecia Use?

/by William Rassman, M.D./9 /

Dear Dr. Rassman,

I am a 31 year old male who has been on Propecia for 5 years. After getting bloodwork done, it was discovered that while my Total Testosterone was high, the percentage of Free Testosterone was proportionately low.

Then, I discovered an article from an Egyptian medical journal entitled “Effect of Oral Finasteride on Serum Androgen Levels and Androgenic Alopecia in Adult men”, which found that all men in the experimental group experienced a decline in free testosterone after taking Propecia relative to no change for those taking a placebo. Were you aware of this? Does this not add to the growing body of literature showing how dangerous Propecia really is?

The main point of why Propecia (finasteride 1mg) works is because it changes DHT hormone levels. DHT is the result of testosterone catabolism (it is a byproduct of testosterone metabolism). So to say Propecia affects testosterone in some way is valid, but I cannot say what this really means. The study you refer to included only 30 men and it does not go on to state what the implication is or what the significance is of the findings.

For those interested, the study can be found here (PDF file).

These are the type of articles that can cause confusion and add fuel to the never-ending debate on Propecia depending on how you parse the information presented. Anyone can quote articles and infer what they want, but the real meaning or significance is unclear. At least this is interesting reading. Let the debates begin… or rather, continue!

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

I Need Minoxidil Without Propylene Glycol

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

Doctor,
Took Dr. Lees 5% non PG formula for years. After FDA shutdown switched to Minoxidilmax non PG form. After ran out of that tried Rogaine Foam and had a terrible shed in within 10 days. I know you don’t see much shedding in your practice, but why would I have such a dramatic shed switching from one 5% formula to another? Could it be the other formulas weren’t the real formulas? People swore by Dr. Lee so its possible Minoxidilmax wasn’t the proper formula. i just can’t handle PG. Even the women’s 2% form have PG.

I’ve read doctors who say stay the course during a shed, but if minoxidil is causing dramatic frontal shedding and the general wisdom is it doesn’t regrow hair in front, Seems like a losing prop to keep going. Would it shed hair that it doesn’t regrow?

Have to try something soon before I’m off minox too long.. Already on Propecia..

Thanks..

I would not know what is going on with your hair loss. It could be a problem with the formula, or maybe there’s another ingredient in there that you’re having an allergic reaction to, or it could be that the Dr. Lee product you used was stronger than 5%. Without an examination and follow up it is just a guessing game.

Typically it is my understanding Rogaine Foam is better absorbed than other formulations and does not contain the propylene glycol, so to have an opposite reaction is strange.

Tags: propylene glycol, rogaine foam, rogaine, minoxidil

How Can I Find Out If My Doctor Will Prescribe 5mg Generic Finasteride?

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

I’ve read back 30 pages, but could not find a former instance of my question. Apologies if it is a chronic repeat.

I’ve been taking Propecia for one year, and recently accepted a lower-paying job. As such, I am interested in switching to the quartered 5mg generic Proscar method. I would like to know that the doctor is willing to prescribe the 5mg prior to scheduling an appointment – is there a way to politely obtain this information?

Thank you in advance for your response.

I can’t tell if your question is about another clinic or doctor at NHI. If it’s elsewhere, just call the doctor and ask. Most patients we treat with finasteride at NHI are prescribed the 5mg dose to save costs, and they are instructed to take 1/4 pill a day.

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

In the News – A Year After Wayne Rooney’s Transplant, His Hair Looks Very Thin

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

Snippet from the article:

He could be tempted to scratch his head over why he spent the money – but on this evidence that might not be the best of plans.

Exactly a year after Wayne Rooney paid £30,000 for a hair transplant, his new thatch is showing signs of thinning.

Read the rest (and see the photos) — Wayne reveals more scalp in training session

I wrote about his transplant looking thin months ago. As to why his hair looks so much thinner now, I couldn’t say. To really comment on the actual results, I would have to run a comb through his hair.

Tags: soccer, football, wayne rooney, hair transplant

Connection Between Early Balding and the Risk of Parkinson’s Disease

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

The authors of a recently published article show that a specific genetic locus was identified on Chromosome 20, which is associated with Parkinson’s disease, that is also a susceptibility locus for early-onset genetic balding. The study was conducted in 12,806 individuals of European ancestry who had early-onset genetic balding. There was a high degree of confidence in the reported statistics.

The suggestion is that individuals with early onset genetic balding have a 6 fold increase in the risk for Parkinson’s Disease (7,664 cases of Parkinson’s Disease was studied). This data was published in Public Library of Science, and you can read it here.

With the advent of wide scale genetic testing, we are now finding relationships between the genes we carry and various diseases that run in family lines. I registered on 23andMe some time ago. When you register on this site, you send saliva samples along with the registration. From this, the company compares you with an expanding database of people and their genetic make-up. Risk of disease is sent to you and as new genetic testing is developed, you can see your ever-changing risks of various diseases. What this means is that, for example, you have a higher risk of heart disease than the average person, you can take steps early in your life to mitigate that risk. I would suggest that you may find it interesting to look at the 23andMe site.

Tags: genetic, testing, chromosome, parkinsons, hairloss, hair loss

2 Months After My Hair Transplant, Should I Be Doing Anything?

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

I had a hair transplant 2 months ago. Should I be taking any medication to encourage growth or retain native hair? My surgeon said it was not necessary, but I an concerned about losing transplanted and native hair thanks

I do not think I can impart any more wisdom that what your surgeon has already told you. If the surgery went well, it should grow in 6 to 8 months. The native hairs may fall out as it depends on your genetic fate and if you were taking Propecia, you might be protected from the shock loss that occurs after a transplant. Just be patient and take good care of yourself.

Tags: hairloss, hair loss, hair transplant, aftercare

Sometimes I Lose a Lot of Hair for a Few Days and Then None for a Few Days

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

Hello Doctor

You often say that normal hair loss is asynchronous, meaning that one loses about 100 hairs per day on average and there are periods with more shedding and periods with less shedding . I often notice those periods to be extremely small. I might shed lots of hair for three, two or even one day, and then not at all for the next two or three days. And after a few days it starts again.

Now, would that qualify as a normal asynchronous hair shedding pattern? Let me tell you that i wash my head every day .

Yes. Asynchronous means not everything is the same every day or on every part of the scalp. Over the long run it will average out. If you lose more and more hair over the long run, then it means you are losing more hairs than growing new hairs (thinning / balding).

Tags: hairloss, hair loss, shedding

Case Study – Dutasteride Plus Finasteride Saw Dramatic Increase in Hair Growth

/by William Rassman, M.D./22 /

Australasian Journal of DermatologIn a report in the Australasian Journal of Dermatology published last week, a case was presented of a 47 year old man who did not see the same hair density after 4 years on finasteride. The doctors added 0.5mg/week dutasteride to the treatment plan and there was a dramatic increase in hair growth.

There is a problem for what is called “poor responders” to finasteride, and the focus of this article was to add a low dose of dutasteride weekly. There was no significant sexual side effects with this particular patient, but of course, the issue remains that sexual side effects could be significant in other patients. Dosage is a problem, as some doctors have prescribed 5 times the dose of dutasteride at 2.5mg/week, or even daily use. The dose increases the costs for the patient and no one really knows the recommended period that a patient should take this increased dose nor the time to obtain the therapeutic response. Worst case, we do not know if dutasteride acts as a carcinogen that can cause a high grade prostate cancer, as the story is not in yet on the full extent of the safety of this drug over time.

In no way am I recommending you add dutasteride, but you can talk to your prescribing doctor about your case. The above is just a single case study presented, but it was worth posting here to get your always fascinating feedback.

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

Can SMP Cause Shock Loss Like a Hair Transplant?

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

Does SMP scalp micropigmentation cause shock fallout or shedding, similar to the shedding that occurs after hair transplant procedure? Does the shock or trauma caused by SMP have any negative impact on thining hair? If it does, what area is likely to shed the most? Thank you.

Yes, there is always a risk of shock hair loss with SMP, but we have not seen any significant hair loss in our experience (I recall one female patient, but it was minimal). Most people who choose to have SMP are already balding and made the decision to shave their head. We are very selective on who we recommend SMP to.

With respect to long term effect on thinning hair, in my opinion SMP should not be a factor. People with thinning hair in the long term lose their hair — that is why they choose to have SMP or a hair transplant or take medication.

Tags: smp, pigment, hairloss, hair loss, shock loss