Dr Gho Patient Diary

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

Hey Dr R.

i jave a question about your opinion on Gho. Recently there has been a very well documented case from a patient, with obvious donor regneration.

Link: Hairsite

I think that this is the real deal because this patient has no incentives to lie and he provides close up donor pictures.

He was also said by other clinics that he has only around 2500 available grafts. Gho extracted already 1400 and the next time this patient is gonna get 1400 additional Grafts extracted.

Also this patient has scarring alopecia.

Oh, I can’t wait to see some of the vitriol that is sent my way for this one. These pictures are confusing and do not tell the full story of what was done. I am sorry, but what is presented here does not move me to believe anything had occurred other than a nicely done FUE with healing. When I watched Dr. Gho do his thing (on video) at the Amsterdam ISHRS meeting, I thought he was performing a partial FUE, leaving some of the hairs behind.

He obviously has supporters (I received basically the same email half a dozen times), but this doesn’t change my opinion as previously stated.

Tags: gho, fue, hairloss, hair loss

What is a Norwood Class 3?

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

NW3What are some of the characteristics of an NW3, is the pointy triangle shape of the forelock or is it how far the corners have receded back?

Compared to a mature hairline, a Norwood class 3 pattern has further frontal recession and deeper recession at corners.

You can find explanations of the rest of the Norwood classes on the Assessing Hair Loss page of the NHI site.

Tags: norwood, hairloss, hair loss

Pro Hockey Player Dion Phaneuf’s Hair Loss?

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

Hi doctor Rassman, can you please tell me what norwood class pattern this is? This guy is a pro hockey player for the Toronto Maple Leafs.

Photo 1, Photo 2, Photo 3, Photo 4, Photo 5

in your opinion do you think this is just a mature hairline? do you think he should take propecia or not?

Based on the photos, he appears to have an advanced Norwood class 3 pattern of balding. It is hard to see if his central hairline is impacted as well.

Tags: dion phaneuf, maple leafs, nhl, hockey, hairloss, hair loss

I Saw Amazing Results from Medication, But Quit and Saw Massive Loss

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

Hi, I had a hair transplant a year ago January 2010. I had a thinning crown and little hair on top. I had 3000 follicle transplant and use Minoxodile and 1.25 tab of finisteride daily. Wow. 6 months later I was so happy with the results.

Then in November due to published side effects of propecia I quit everything and now am experience a massive hair loss. I hate even washing my hair seeing all the hair on the shower floor. I can lose 50 hairs just by brushing in the morning. My hair is finer than it used to be and when I walk outside without a hat I feel the cold on the sides of my head like never before. I’ve started everything(finesteride and Minoxidle) back up about two weeks ago in hopes of reversing this. What should I do and can I expect some or most to regrow? Thank you

You have experienced what I’ve called “catch-up hair loss” which means that the full benefits of finasteride and/or minoxidil may be lost within a few months of stopping the drug routine. Your hair loss then catches up to the point you would’ve been at had you never used any medications.

I can not tell you what you can do, but just wish you luck. It’s possible you’ll see some benefits restarted in a few months, but I have no way to know if you’ll regrow what was lost. The wild internet postings about side effects from finasteride that persuaded you to abandon your successful treatments may have unfortunately lead to more hair loss, even though you didn’t mention seeing any side effects yourself. The reality, of course, is that if you were to have developed sexual side effects from finasteride (about 2% of men), you would have seen them within the first month of so of starting the medication.

Tags: finasteride, minoxidil, hairloss, hair loss

Cutting Proscar and Even Distribution

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

Dear Dr. Rassman,
Congratulations on the new NHI site. Very nice and user-friendly. I noticed however in the frequently asked questions section on Propecia you recommend against doctors prescribing 1/4 Proscar, as it is not certain that the active ingredient is distributed evenly. In past posts you have referred to the use of 1/4 Proscar without mentioning such risks. Would it be possible to clarify this? Thanks for your insight

For treating hair loss, the daily finasteride dosage should be close to 1mg when you cut the Proscar (5mg finasteride) tablet into quarters. Finasteride fixes (attaches) to the tissues, so blood levels which are relatively short (under a day) will not be impacted by varying the dose from (let’s say) 0.75mg to 1.5mg/day.

You are safe with the 5mg dose divided into four pieces. The information you found on the NHI site about not cutting up the generic finasteride is outdated and we will update the old reference. There’s more recent info about this here.

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

Nanogen Serum VEGF

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

What are your views on the new Nanogen Serum VEGF, and the (very big!) claims it makes?

I read about it in a magazine and wanted to yawn, but sucked my yawn back in when I saw the excitement of some of its supporters…

Link: £30 serum goes on sale to beat baldness

Reason tells me it will not make hair transplants redundant…but what about minoxidil? If not, is it worth adding to one’s arsenal of hair loss products?

I have no experience with Nanogen’s Serum VEGF, but the notion that increasing blood supply to the scalp increases hair growth or reverses balding is wrong, illogical, and not scientific. The link you sent looks to be a press release disguised as a news article.

To me, it sounds like yet another product in a long line of products that try to dangle a carrot in front of balding men in hopes that they chase it. In other words, you can try it out if you’re curious, but I wouldn’t expect it to regrow hair.

Tags: nanogen, serum vegf, hairloss, hair loss

Is There Any Link Between Weightlifting and Hair Loss?

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

I have read your past answers on weightlifting.

I understand that you don’t believe there’s a proven link between hair loss and weightlifting – but do you think there is any risk whatsoever? If there is even a minuscule risk, I’d rather not weight lift.

There could be a connection if your body increases its testosterone levels in response to prolonged extreme exercise. Most people who exercise normally should not increase their testosterone levels. Some professional weightlifters take steroid-like drugs that accelerate the genetic hair loss process.

Tags: weightlifting, hairloss, hair loss, exercise

Any News of the Avodart Clinical Trials?

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

doctor rassman
whatever happened to the fda trials with avodart? we all know avodart is more effective but when will it be cleared by the fda for hair loss? are their trials still going?

We know that dutasteride (Avodart) works when used to treating genetic hair loss. Some reports suggest that it may work even better, but the safety issues in young men, the sexual side effects and other side effects, and the long term issues related to sterility are not known.

The last I remember, there was a Korean study being done… so I looked up the ClinicalTrials.gov site and found this post about recruiting 900 Korean men for a dutasteride post-marketing study by GlaxoSmithKline (makers of Avodart). It was updated just a couple of weeks ago, though I’m not sure which part was updated, and appears to be concluding in July 2013 — AVODART Alopecia Post-marketing Surveillance (PMS).

The FDA will weigh out the safety issues before any application for use in hair loss is approved. So at this point, we’re still in wait-and-see mode.

Tags: dutasteride, avodart, hairloss, hair loss, korea

My Daughter Has Alopecia Areata and High Fever

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

My daughter was diagnosed with Alopecia areata 2 months ago just recently the bold spots that looked like the size of a quarter are becoming bigger and bigger and its only in the back . I took her into the emergency room 4 days ago due to her high fever at 105 104 and she’s been having a recurrent fever every other day our the whole day just observing her.

I’ve been with 3 different pediatricians and none if them can answer me why? Where do I have to go to get answers? ; Who do I have go with? Is it an internal capability? Why the fever? Why the Vomiting? I just need to have some kind of answer

thank you.

I understand that you have a sick daughter who needs medical attention, but I am a hair transplant surgeon. Alopecia areata is not likely related to your daughter’s overall problem, which sounds serious. Vomiting is related to possible treatments that she might’ve been given for the alopecia areata, but I have no idea if she was treated with anything.

A good internist or pediatrician (if she is under 16 years old) is the doctor you might consider consulting. The doctors you have seen may not have a definitive diagnosis, but they should be able to assess and treat your daughter and answer your immediate questions.

Tags: alopecia areata, hairloss, hair loss, illness

Will I Eventually Have My Father’s Pattern If I See Some Hair Loss?

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

Hello Dr.

Question: When hair loss is hereditary, is it always the same type of hair loss pattern? I believe my father suffered a Type V hair loss, and my hair loss has been at a Type 3A for about 4 years now. Will my loss eventually become a Type V over time?

-Thanks!

I do not know your age, I have not examined you for miniaturization or bulk analysis, and I essentially know nothing about you other than a connection to hair loss by one side of your family (father). As you know, there is a 50/50% chance of getting his pattern if we blindly guess using available statistics.

Tags: hairloss, hair loss, genetics

I’m 39 Years Old and Norwood 1 — Could I Still Develop Hair Loss?

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

Dr. Rassman:

I am 39-years-old, and while there’s no advanced balding in my family tree, the Norwood 3v pattern is very common, slightly more so on my mother’s side. As a result, I’ve been very vigilant through the years for even the slightest signs of hair loss.

Even still, I recently visited a hair loss specialist who told me that I am still a Norwood 1. She took pictures of my scalp and analyzed the hair follicles, and informed me that the hairs seem uniformly thick and there’s no significant miniaturization.

What are the chances that I could still develop a Norwood 3v pattern showing at this point?

It would be highly unlikely that you inherited any balding if it has not shown at your present age, your hair is thick without miniaturization, and there is no frontal recession.

Tags: hairloss, hair loss

Why Would Prince William Be a Surgical Candidate?

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

Thank you for running a great site. I’ve found it immensely helpful in learning about this condition.

My question is – earlier last summer, you mentioned that Prince William would likely be a good candidate for a hair restoration procedure. I am curious though why that is the case. I had always been under the assumption that a young man with an aggressive pattern like the Prince would not be a candidate. Am I mistaken? If so, what particularly sets someone like Prince William apart? Is it the fact that he is a diffuse thinner rather than a receder?

Prince WilliamIn general if a person has male pattern baldness (like Prince William) and has good donor hair and scalp laxity, they WANT and DESIRE a change, and they have REALISTIC expectations of what is possible, they can be a candidate for a hair transplant surgery.

I have never met Prince William and my answers were just based on the reader’s hypothetical questions. Perhaps Prince William does not want a hair transplant surgery and is fine with his hair and the possibilities of eventually going completely bald in the Norwood class 6 pattern. I do not know if he has (a) fine, medium, or coarse hair, or (b) what his donor supply looks like or how it would measures out if I checked his hair density in the donor area.

From his overall pattern, I would suspect that he might benefit from Propecia (finasteride) based upon his age and overall pattern. Many class 6 patterned individuals who are young and go on this drug, may notice increased coverage, reflecting the thickening of the existing hair shafts or even new hair growth.

Finally based on pictures alone, I do not think he has a disease like DUPA, as it appears that he has good hair on the sides and back of his head.

Tags: hairloss, hair loss, royal family, prince william

Am I Losing Grafts 4 Months After My Transplant?

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

Hello
i had a FUE transplant last december, everything seems ok, but sometimes i feel a little itchy spot and when i scratch it, a hair (seems like it is one of the transplanted ones) comes out of the scalp attached to a bit of something looking like hard sebum, almost looking like when cleaning a black head blemish or an ingrowing hair. Is that normal? is that the follicle coming out? if so does this mean that i’ve lost one of the transplanted hairs?

thanks

These are really questions for your doctor. If you pick (or vigorously scratch) at your hair, you run the risk of losing the hair. Picking causes hair loss, infection and associated skin problems. For hair transplant patients, they should always have their doctor check out what is going on with their head.

I would doubt that you’re losing grafts at four months after your surgery, but I couldn’t tell you what is causing the itch. Maybe it is an infection, but this is clearly not something for an Internet-based diagnosis. Please call your doctor for a follow-up exam.

Tags: hair transplant, hairloss, hair loss

Switching From Propecia to Finpecia

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

Dear Dr. Rassman,

Thank you for your very informative blog. I have been on Propecia for nearly three years with good results. For cost reasons I am thinking of getting Finpecia when I am next in India. Do you believe switching from Propecia to Finpecia would have any effects for a good responder like me? I will only do it if the transition can be seamless.

Many Thanks

Assuming Finpecia is 1mg finasteride, I do not expect there to be an issue. Propecia is just the brand name for 1mg finasteride, and the generic form is sold by a variety of different names outside of the US (where it is not legally available until late 2013 due to patent laws).

There might be some differences in the manufacturing process, but chemically Finpecia (made by Cipla) is the same as Propecia (made by Merck).

Tags: finpecia, propecia, generic, hairloss, hair loss

Taking Propecia with Liquid?

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

doctor rassman, this question might sound stupid, but does taking propecia with a glass of water make it less effective? or should it be take wuthout liquid at all?

I’d assume most people take Propecia with water or some other kind of liquid. Water doesn’t change the efficacy. Just avoid taking it with grapefruit juice.

Tags: propecia, finasteride, water