Would My Slow Hair Loss Rate Prevent Me from Having a Transplant?

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

This may sound like a weird question and it might not really happen. If an individual is 29 years old and is on propecia losing hair at a slow rate initially, and then all of a sudden starts to lose it a rapid rate, and then goes back to losing it a slow rate what is the cut off age for you to perform surgery? I ask this questions because I am in a similar situation and I feel that my hair loss at a slower rate is preventing me from getting a surgery right now. I have minor thinning in the front which is noticeable in certain lighting, but still enough to cover it up for the time being.

I am afraid if I get surgery done right now, the shock loss will for sure kill those hairs I have in the front. And if I am losing hair at a slower rate it will be hard to determine when I will reach my final hair loss pattern, so by me getting a surgery will be pointless because I will always be losing hair, albeit it a slower rate. Please help!

If you want to have a hair transplant, taking Propecia (finasteride) in advance and through the process beyond 8 months, should reasonably be expected to prevent shock loss from the transplant. This has been my experience. Hair loss is progressive, and taking this medication should halt or slow your continued loss so that you’re not just chasing your loss with transplants.

As for your surgical candidacy, that is up to your doctor to determine. You’re not disqualified from surgery at 29 years old, though.

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

Is Polysorbate a Hair Loss Treatment?

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

Doctor,
Is polysorbate an ingredient (in a cosmetic creme or lotion) which could temporarily increase the diameter of thin & regular size hairs? If so, how long would the effect persist after a single application? And assuming no commercial product is available could it be compounded by any pharmacist?

I am asking these questions because years back a commercial lotion, supposedly from Norway which (falsely) claimed to be the solution to baldness incorporated polysorbate (I can’t remember if it was polysorbate 20). An employee of a pharmacy who told me he was using the product stated that he had noticed an apparent increase in hair density over a short period of time which could not be from new hair growth. I did not try this product after reading critical comments. But I wonder if one could safely use polysorbate or for that matter other products to improve the apparent hair density.

Thanks in advance

I have no experience with this approach for using polysorbate (80 or 20 or any number) as a hair regeneration treatment. If it really worked, I would suspect I would know about it. I will, nevertheless, keep an open mind and probe it with some of my colleagues.

Tags: polysorbate, hairloss, hair loss, hair growth

Viibryd and Hair Loss

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

Is Viibryd more likely to accelerate MPB than other SSRIs? Thanks Drs

Vilazodone (also known as Viibryd) is an antidepressant medication and I have seen in my research that there has been hair loss reported with its use. I have no way to compare one medication to the other concerning hair loss.

Tags: vilazodone, viibryd, hairloss, hair loss, ssri

Suicide in Young Man with Gynecomastia

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

This isn’t hair loss related, but it’s something I wanted to write about…

Bullying is one of the evils found in schools, and the spotlight has been placed on this topic as of late. When a young man develops adolescent gynecomastia, he often become the target for bullying and peer ridicule. This is common and often not a subject of focus between parent and child. I have just become aware of a suicide in a 16 year old boy who was the target of bullying when his peers found out that he had breast swelling. His parents did not recognize the social impact on his psyche.

Here’s a post on a gynecomastia forum that serves as a heart-wrenching example of the feelings of a man with breast enlargement, which may be a silent epidemic.

The good news for parents and men with gynecomastia who might read this post is that there is a simple surgical cure for this cosmetic defect. If you are so impacted, look to your communities for doctors who offer treatments.

Tags: gynecomastia, breast enlargement

I Stopped Finasteride Because of Decreased Libido (Which I Had Before I Started the Drug)

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

I took finasteride for two months and then stopped because of decreased libido. However, I am not sure they were because of the drug. I had low libido even before I started to take it. It just got worse, but it might have been just in my head anyway.

Now, my libido is back to normal so I am considering starting propecia again. My question is, if I already have taken propecia without permanent side effects (because everything is fine now, those side effects were clearly temporary) does that mean that I will surely not have adverse side effects if I get back on it again? That even if I do have the side effects they will be temporary?

I think the key is that you had low libido even before starting Propecia (finasteride 1mg). You should speak about this with your doctor and consider further testing of your hormone levels. If you took Propecia and you believe it caused side effects, you can try a lower dose (such as 0.5mg). A lower dose may give you no or lower side effect profile, and is about 70 to 80 percent as effective for treating your hiar loss. In all my years in practice I have never seen irreversible side effects or even heard of them from short term use (2 months or so).

Tags: hairloss, hair loss, finasteride, side effects

Intense Stabbing Pain and Heat From My Scalp — Is This Aggressive MPB?

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

Dr. Rassman,

I’ve had intense burning scalp pain for the past 10 months. It all started during a particularly stressful point in my life so I initially attributed it to that. Unfortunately it persisted so after a month I went to see my general doctor then 3 dermatologists, all whom said my scalp and hair looks fine (albeit slightly pink at times). One of the dermatologists did a biopsy in the spot that hurt the most and came up with nothing indicating why I would be in such excruciating pain. I was prescribed topical steroids which I used and did nothing.

Over the course of the 10 months the areas that are burning have begun to shed hair and not regrow them, where once I had an incredibly thick head of hair it’s started to noticeably thin (top, back). There is a point towards the back of my head to the left of my whorl that I have been told is hot to the touch, and that is the spot that hurts me the most. The best way to describe the pain there is as if someone is jabbing a hot poker into my skull. The rest of the pain in the top and back is like someone poured gasoline on my scalp and lit a match. The pain is so bad that sometimes it wakes me up and I end up throwing up due to the agony. It’s at its worst when I wash my hair, regardless of the shampoo.

Is this some sort of insanely aggressive MPB? Neither my father nor my mother’s father has any history of MPB. I am a 37 year old male and up till 10 months ago had no hair issues. Thanks for any advice/guidance you can give.

I’ve never heard this complaint before, about the scalp being hot to the touch (hypersensitive skin) as some sign of MPB. I always call on my experience with taking detailed histories from my patients. Sorry!

It could be something like trichodynia that you’re experiencing, which hasn’t really been studied all that much.

Tags: trichodynia, sensitive scalp, hairloss, hair loss

I’m Shedding Different Length Hairs Daily

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

I’m currently 19 and my hairline has matured within the normal boundaries of the measurements that you have given and as far as I can tell my hair is not thinning as I am not losing an excessive amount of hair a day. However, I have noticed some shedding of shorter hairs from all over my scalp and I was wondering whether it is normal to shed some shorter hairs along with hairs of my normal length (about 2 inches long). Any advice as to what this maybe or what is causing it would be much appreciated.

I suspect that we all lose different lengths of hair in our daily hair loss experience. You should be examined by a good doctor if you are losing hair so you can determine what is happening to you and hopefully stop counting your daily hairs in the drain.

Tags: hairloss, hair loss, hair length

SMP for Younger Patients?

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

I understand that younger patients may be denied hair transplants due to the fact they may lose more hair. If this patient gets scalp micro pigmentation as well and is happy with a shaved head if he loses too much hair, is there really a problem with running out of donor hair? I’ve actually seen results of men who get the procedure who still have somewhat of a hairline, and it looks much more realistic overall.

The desire to have Scalp MicroPigmentation (SMP) seems to be more common in younger men. The choice to do SMP reflects what may be a lifetime decision.

Let’s say, for example, that you have SMP done with your existing juvenile hairline at the age of 20 and then you progress to some hair loss pattern. You would then be stuck with your juvenile hairline even if you were to evolve into a Norwood class 6 or 7 pattern. You would not look normal, as you would have what appears to be a shaved frontal scalp and hair behind it… unless you shaved your entire head. Rarely can a class 7 patient be transplanted to cover the entire balding area (not enough donor hair), and in this scenario, if a 20 year old should let his hair grow out, the frontal leading edge (the SMP treated hairline) would not match the rest of the scalp unless he continued with a shaved look for his entire life.

So let’s say a young man decides to have SMP to address his frontal hair loss and is now stuck to shaving his entire head for the rest of his life. He then decides to do a hair transplant in the same area where the SMP was done, allowing him to then his hair grow out or shave it, and either way, he is covered (unless of course he loses more hair — let’s say in the class 4A pattern). Now the frontal area is covered with hair and pigment, and the back area may or may not be covered with pigment, but the problem now is that between the transplanted frontal area with SMP and the top/back of the head (in front of the leading edge of his natural hair in class 4A pattern), he would have developed a space which now almost certainly will be addressed with more hair transplants, or just SMP. With more hair transplants, he can let his hair grow out, but if he elects to fill the space with SMP alone, he is stuck once more needing to shave his entire scalp to remain looking normal.
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My Hair Has Miniaturized All Over My Scalp, Face, and Body

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

Hi great blog, my hair is neither falling out or receding but it has thinned/miniaturised completely as well as my facial and body hair !

Is this MPB or another health issue ? Any information or recommendations would be greatly appreciated thank you.

The best information I can give you is that you need to have a full history and physical examination by a good doctor and tell him of your concerns. Searching for your medical issues and trying to self diagnose your symptoms on the Internet is not a good way to start.

This is not meant to brush you off or not answer your question, but I would not know where to begin without taking a full history and examining you in person. I can tell you that when we refer to male pattern baldness (MPB), it is the patterned hair loss on the scalp. Body or facial hair loss is something else.

Tags: hairloss, hair loss, body hair

My Doctor Assessed My Hair from Across His Desk

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

I recently visited a hair specialist in my area to address some concerns over hair loss. I am 33, have been taking propecia for about 7 years and have had what i would call minor hair loss or perhaps the loss is indicative of a maturing hair line. The doctor stated that I am not really losing my hair and made this assessment from looking at me from across his desk.

My question is can a doctor really make this assessment in such a way as it seems to me a closer inspection would be needed and expected given the hefty consultation fee? Further he is recommending meso injections which seems strange to me given that he thinks the hair loss is minor. Is there a possibility that I am being sold treatments which i do not need to make extra money or would meso therapy seem like a reasonable preventative treatment?

I know Superman had X-ray vision, so it would be more logical to ask me if this doctor was actually Clark Kent and really had Superman-type powers. He should have measured your miniaturization and hair bulk and by not doing even the basics, I would run from any recommendation he would make.

Mesotherapy is one of the fringe areas of this field.

Tags: hairloss, hair loss

Does Increased Testosterone Increase the DHT?

/by William Rassman, M.D./5 /

Hi,
I just have a quick question, does increased testosterone levels increase dht levels? Say if you take testosterone pills or shots does that increase dht levels? Thanks for your time

Yes. Dihydrotestosterone (DHT) is a metabolic bi-product of testosterone. If you have the genetic predisposition for male pattern androgenic alopecia, increased DHT will accelerate the balding process.

Tags: testosterone, dht, hairloss, hair loss

I Stopped Seeing Hair in the Drain After Being on Propecia

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

I’m 25yo and been on generic Fin 1.25 (get it from walgreens) for nearly for 4 years! I have early frontal hair loss confirmed by Dr.Bernstein. Before Propecia I had tons of hairs in the shower plug and I have medium long hair so that would make it more obvious. Ever since starting Propecia my hair remained exactly the same at least to my eye.

After about 1 or so the hairs in the shower stopped. I would have little or none at all! From time to time I see hairs there again but not much. Now for the past week I see hairs again. Every time it happens I’m worried. Why does it happen? Is my MPB just accelerating during those times or is it just some shedding?

The average person loses 100-150 hairs per day in the normal daily hair cycle (these hair fall out as they go through the catagen phase). That means that every year we will lose 35,000+ hairs and regrow the same amount from new hair cycles that start up in anagen.

As I’ve written before, Propecia doesn’t stop the normal hair cycling… so is it possible that you had some styling product in your hair that trapped these cycling hairs from falling out until you took a shower? Or did you wear a hat that trapped some hairs? Or was it particularly humid, causing your hairs to stick to your scalp?

I really have no true explanation for what you’re seeing and I could make a dozen guesses, but I suppose it is something you should monitor if you’re concerned. You should also consider paying a visit to Dr. Bernstein for a follow-up examination if it’s been some time since you’ve seen him.

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

Would You Restore a Mature Hairline to a Juvenile One?

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

Greetings, Doctor. I’d like to ask a couple of questions if I may!

How unique can hairlines be, in your experience? Can the hairline position at a young age predict hair loss?

How do you feel about restoring a juvenile hairline, if the person that comes to you has a perfectly fine mature hairline?

I’m asking this because most of the pictures from the hair transplants I’d seen on your website and others have had people’s hairlines restored to a ‘mature hairline’ and not a juvenile one. Am I wrong?

Thank you very much for taking the time to answer!

ReaganMany men into their 30s have juvenile hairline. For example, Ronald Reagan had one for his entire life (see photo at right)… and he was well past 35 years old at the time he died.

If a man developed a mature hairline and had no signs of balding (with good measurements), I might restore the juvenile hairline if I thought the patient was mature and level-headed. I have rarely restored the juvenile hairline, but I have repaired some that have had erosion and an incomplete migration to the mature hairline.

Tags: hair transplant, mature hairline, juvenile hairline

It’s Been 7 Months Since I Chemically Burned My Scalp — When Will I See Regrowth?

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

I am a 25 year old black female and I recently permed my hair. I burned my scalp pretty badly. But there are no bald spots or scabs, or anything. My hair started to fall off, not everything though. Will my hair grow back. It’s been seven months. I haven’t seen any hair growth. And I usually see hair growth within 2 or 3 months of perming my hair.

Wait out a full year to see if there is regrowth. When a person has a bad burn from chemicals, the results are often permanent hair loss. Transplants can help and might be considered an option at the 1 year point if the hair hasn’t grown back.

Tags: hairloss, hair loss, chemical burn

In the News – Tissue Engineering and Follicle Regeneration

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

Snippet from the article:

A hair-raising trick may lead to better hair transplants. Engineered hair follicles patched into skin can be coaxed to connect to surrounding tissue and to grow hair in an organized way, a study in mice finds.

Unlike current hair transplant methods, which simply move existing hair follicles from one area of the scalp to another to cover a bald region, the approach would spur the creation of new hair follicles from existing cells.

Read the rest — Engineering better hair transplants

Progress moves slowly and consistent in the direction of solutions that will eventually allow doctors to produce the entire hair organ, essentially producing new hair. These articles are very exciting. To quote from the Nature Communications article: “Concepts in current regenerative therapy include stem cell transplantation and two-dimensional uniform cell sheet technologies, both of which have the potential to restore partially lost tissue or organ function” such as hair. The article demonstrates “fully functional orthotopic hair regeneration via the intracutaneous transplantation of bioengineered hair follicle germ” (i.e. stem cells).

In the discussion, the author Koh-ei Toyoshima et. al. states: “In this study, we successfully demonstrate fully functional bioengineered hair follicle regeneration that produces follicles that can repeat the hair cycle, connect properly with surrounding skin tissues and achieve piloerection. This regeneration occurs through the rearrangement of various follicular stem cells and their niches. These findings significantly advance the technological development of bioengineered hair follicle regenerative therapy.”

Tags: mice, mouse, hair transplant, nature communications, bioengineering