My Donor Area is Thin, So Can I Have My Entire Beard Transplanted to the Scalp?

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

Hello,

I’m a 25-year-old male and I’ve been thinning since the age of 20, and I believe I might have stabilized the hair loss process as I’m taking medication and substances to stop the hair loss.

I’d like however to undergo a hair transplant, especially at the front of the scalp. The bad news in my case though is that my donor area is also thinning out, which means that perhaps 1500 grafts can be harvested.

My question to you is if it’s possible to harvest grafts from other parts of the body, say like the beard, arm pit hair and pubic hair, also the hair between the buttocks? Let’s throw in arm, chest and leg hair while we’re at it. Is it possible to transplant hairs from these areas to the scalp?

I wouldn’t mind if my ENTIRE beard was to be transplanted, because I have sebhorroeic dermatitis and my beard is just aggravating that condition. Is it possible to transplant the ENTIRE beard?

Grateful for a reply

I really can not answer your question properly. First, I have not examined you so I can not confirm what you are reporting.

Second, if you are losing your donor hair, then you probably have some condition that is not genetic patterned balding. Do you have diffuse unpatterned alopecia (DUPA)? It’s not usual to have the entire scalp thinning like you described.

Third, a hodgepodge of hair transplants from different parts of the body may give you a freaky, unnatural look and therefore, I wouldn’t be interested in doing a surgery like that. The hair from the beard is different than the underarms, the chest, the leg and so on. Body hair in general is different from scalp hair, as I’ve written about before (see here). Hypothetically speaking, transplanting the entire beard would leave facial scarring that wouldn’t be in your best interest.

Anything is possible and any hair can be moved from one area to another, but how it will look in the end is another entirely different matter.

Tags: body hair transplant, bht, hairloss, hair loss, hair transplant

In the News – Merck Updates Propecia Side Effect Warnings

/by William Rassman, M.D./8 /

Snippet from the article:

Warning labels for Merck & Co’s drugs for baldness and enlarged prostate will add notices of sexual side effects that continued after use of the medicines was stopped, U.S. health regulators said.

Labels will be revised for Proscar, which treats symptoms of enlarged prostate, and hair-loss treatment Propecia, the Food and Drug Administration said. The active ingredient in both drugs is finasteride.

The Propecia label will now include notification of problems with libido, ejaculation and orgasms that continued after use of the drug was ended. Proscar’s label will include notification of decreased libido.

Read the rest — Sexual side effect warnings added to Merck drugs

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

Clobetasol and Female Hair Loss

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

(female)
I have used clobetasol off and on for years. I have never been advised that this med can thin the skin or cause hair loss. Just about 1 yr ago my scalp psoriasis became quite aggressive and I spent every evening slathering my scalp with the med. My hair thinned to about 1/2 of its normal thickness. Is it possible to somehow regrow the hair that I have lost?

Clobetasol is a powerful topical steroid that can thin the skin, thin the hair, and produce a variety of systemic problems from steroid overdose. Withdrawal from this medication can be a problem and you may need to be managed by a good doctor for the withdrawal process.

With respect to hair growth, if it does not regrow within one year, it will probably never grow back.

Tags: clobetasol, female hair loss, hairloss, hair loss, steroid

I Was Told I Didn’t Need to Take Propecia, But I’ve Already Been Taking It

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

I am 25 years old, and weeks ago i had my first appointment with Dr Pak at your office.

He was very helpful and professional and gave me very good news, we took a look for miniaturization and bulk loss and everything was fine and there was no point for my to worry about.

Dr Pak told me that it wasn’t even necessary for me to take propecia (which i been taken for two years and 6 months), i havent stopped propecia so far, because even though Dr Pak didn’t classify me on the norwood scale, what worries me is the hairline, now i believe i am between norwood 2.5 and 3.

My question is, is it safe to stop propecia when the norwood scale is more advanced that 2?

Perhaps my pictures taken by dr Pak two weeks ago are available in the data, and perhaps you could classify my in the norwood scale.( i’m not ok with having them posted)

Anyway i want to thank you and Dr Pak, I plan to have an apointment once a year if everything stays the same without changes, and i also plan the possibility to have a hair transplant with nhi on the hairline when i hit 30.

Thank you Dr Rassman

I did review your file and it seems your hair loss issue started when you had a long hospitalization stay from your illness (considered stress-related hair loss). You noted hair loss after being discharged from the hospital and since then it has grown back.

There is little harm taking Propecia if there are no side effects; however, if after bulk analysis, miniaturization mapping, and observing your frontal hairline, it still indicates that you are not balding, then taking the drug is unnecessary.

Many men worry that they have frontal balding and often classify themselves as having a Norwood class 2 or 3 balding pattern, but they are really just seeing the appearance of a mature hairline. We often do not agree with their classification, but the final decision about taking Propecia is obviously yours and I can justify the drug in your particular case.

Tags: propecia, finasteride, hairloss, hair loss

How Long Will My Testicular Pain Last from Propecia?

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

I’m a 24 year old male. I’ve been using Propecia for about 40 days and just started getting testicular pain. Everything functions as normal, but I have pains and my libido seems down about 30%, although it could just be from the pain. I can deal with some libido loss as I really want to keep my hair. It’s unlikely to be caused by anything else. Will symptoms likely fade and how long should I wait before discontinuing treatment? Also, I take the generic, Finpecia 1mg.

Testicular pain can be a serious medical emergency. Before dismissing it on a side effect of a medication please contact your doctor or get yourself to the nearest emergency department. This is not a place to get a diagnosis for your testicular pain issue or self treat a potentially serious medical issue.

In the last 10+ years I remember only two of my patients who had testicular discomfort (not pain) reported as a possible side effect from Propecia, and both of them found that their symptom was gone (best of my memory) in less than a month.

Tags: testicle pain, propecia, finasteride, hairloss, hair loss

Tell Me What Prescription Medication to Use!

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

Hi, I’m 22-years-old (111 lbs) and started to diffused thin when I was 17. At the time, I was under severe prolonged stress and eating turkey with wheat bread for every meal for 7 months due to digestion problems, and using Nizoral to treat dandruff.

Since then, for the past 5 years, I have kept most of my hairline, excluding the receding area around my right-temple.

Most of the thinning is near the crown and on top of the scalp. The left-temple still has its shape but the hair quality is noticeably thinner than the rest of the hair on the sides.

I have been on-and-off Minox 5% for the past 3 years; Finasteride 1 mg for 16 months; miconazole nitrate cream for 6 months; and Folligen since the last month.

Overall, I have been trying to convert my vellus hairs into terminal ones, but so far I have not been successful. Should I drop Finasteride and go for either Dutasteride (? mg) or RU58841?

Thanks and looking forward to your response.

Sorry, I am not your prescribing doctor and can’t tell you what medication you should take. Dutasteride’s proper dosage is still undetermined, it isn’t FDA approved for treating hair loss, and as it is a much stronger medication, the side effect risk is likely greater (and longer lasting). As for RU58841, the last I remember it was some experimental lotion that was tested on macaques years ago.

You sound desperate to try anything, but with severe stress and malnutrition, your hair loss should be one of the last concerns you have.

Tags: dutasteride, hairloss, hair loss, finasteride

Why Is It OK For Women To Talk About a Man’s Balding?

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

Dr. Rassman / Dr. Pak,

Oops… faux pas! Why is it considered socially acceptable for women to openly discuss a man’s balding pate, often at some length and in excruciating detail, but should a man happen to discreetly mention to a woman, ‘Your butt looks a bit big in that dress’, he can confidently expect to be crucified?!

Good humour might not be the panacea but surely it’s a constituent.

Happy Easter!

Redesigned NHI website is excellent!

I’m not going to claim to completely comprehend why some topics are more socially acceptable to talk about than others. Perhaps men are expected to be less sensitive and able to take criticism of their appearance. Any sociology majors out there have a theory to add?

Your observation about men and women is noted. And thanks for your kind words about our redesigned site.

Tags: hairloss, hair loss

My Transplanted Hair Is Darker and Curlier Than My Native Hair

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

Hello Doctor

Last year I underwent a hair transplant. Seven months have passed and I am very happy with results, the regrowth is quite fast. I have noticed one thing I’d like to ask about, though. The color and the texture of the transplanted hair differs from my native hair. The transplanted hair grows darker and it’s somewhat kink and curly.

Is a texture change something that happens in the early phase of regrowth after transplant? When should my hair return to its normal state? Is this something I should worry about?

Thank you

Changes in hair texture are somewhat common, though kinky hair occurs less frequently. Usually patients that experience a characteristic change see their straight hair get more of a wave in the transplanted hair. It’s possible that you’ll need to wait out a full hair cycle (2-4 years for the average male) to see if the kinky change disappears.

The transplanted hair should replicate the native hair in the donor area and most changes in color reported reflect a comparison with miniaturized hairs in the recipient area when compared to the transplanted hair in the recipient area. I do not believe that transplants themselves influence changes in hair color, other than maybe accelerated aging issues like early graying.

One patient from 2006 showed changes from blonde to brown which is a process of color change that many blond people go through as they age. My three sons (born with blonde hair) saw their hair change from blonde to brown by the time they got into their late teens. So what you’re describing is unusual unless it is in the aging genetics that you have triggered ahead of schedule.

Tags: hair transplant, hair color, hair texture, hairloss, hair loss

Use of PRP and ACell in the Hair Transplant Process?

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

Im inquiring if dr rassman is treating people with thinning hair with acell and prp as a standalone treatment? (and if so can you give me some more info). Im intrested in this procedure before undergoing any surgery, i didnt see anything on the website but his name popped up on a web forum saying he does this?

Thanks kind regards

I do not use platelet rich plasma (PRP) or ACell prior to a hair transplant. There is no evidence that either of these produces value for the patient having a hair transplant. I’ve written about some doctors offering PRP, and we did try ACell for hair multiplication to no avail.

What gives value is a very high growth rate, which is produced by experienced surgeons with experienced, well-seasoned teams working under strict quality control conditions.

Tags: prp, platelet rich plasma, acell, hairloss, hair loss, hair transplant

Why Aren’t DHT Treatments Working for Some Men?

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

Drs. Rassman and Pak,

I’m a 23 year old man with fairly extensive loss. I was on 1mg Finasteride for over two years with no success (I know, of course, it’s impossible to tell how quickly my loss may have progressed had I not been on the drug, but the rate of loss while on the drug was certainly no slower than it had been prior to beginning the medication.) Finally giving up, I relucantly sought, and obtained, a Dutasteride prescription, and have been on 0.5mg for some considerable time now, again with little to no discernible success. Not least thanks to warnings issued on this blog, I’ve finally woken up to the fact that my health is more important than my hair, and that, especially given its apparent ineffectiveness in my case, Dutasteride is not worth the risks. I’m about to stop the drug and let nature take its course.

As someone who has had little to no benefit from two treatments widely known to be effective in most patients, my question is this: do you or any of your colleagues in the field have any thoughts on why the two major oral DHT blockers aren’t effective in some men? Is it simply that in some men they somehow fail to block the DHT, or is it rather that some men have so much DHT that the drugs, though they may reduce it by a massive amount, still leave sufficient DHT to impact upon the hair. (I wonder if this scenario might be true of young men with aggressive balding patterns, like myself?) Or, alternately, is the fact that DHT inhibitors aren’t always effective in treating androgenic alopecia evidence to suggest that there are factors other than DHT at play in the hair loss game?

Just a theoretical brainteaser really, but I’d be interested to hear your thoughts. Lastly, you have my thanks: whilst it’s unfortunate that, at my age, my ‘baldness journey’ ends with sanguine acceptance that for me there is no realistic ‘fix’ for my hair, and that therefore I’m to be a bald man pretty soon, the calm, well-informed and often witty advice you continue to offer here has over the years helped me greatly in coming to terms with my situation.

Read through the HairDX Test for Finasteride Response site and you will see some reflections on why some men do not respond to finasteride. Minoxidil is still another story.

You need to establish a good doctor-patient relationship and get the opinions of a good doctor who might help you. Sometimes, it just is what it is. I know it sounds cliche, but I don’t have all the answers and drugs do not solve all problems. Life isn’t that simple.

Tags: hairloss, hair loss, finasteride, dht

Are the Baldness Gene and Hair Characteristics Unrelated?

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

Dad and his family have been diffuse balding since his early 30s. He has super fine, thin hair. I have the same super fine, thin hair, though luckily no signs of balding yet. A cousin on my dad’s side has pretty severe diffuse balding, the other also has diffuse balding but not as severe.

All of the males in my mother’s family have very thick hair, and none of them are balding even though they’re well into their 60s.

Since I have my dad’s fine hair, does it mean that I’m more likely to have his balding gene? Or is the gene completely separate from the hairs’ characteristics?

Hair characteristics are unrelated to the genetic hair loss process. So just because you have fine hair from your father, doesn’t mean you’re guaranteed to have his hairline.

Tags: hairloss, hair loss, genetics

Patient Results – A New Hairline in 2926 Grafts (with Photos)

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

Here’s an awesome hair transplant result I want to share. This patient had one procedure of 2926 grafts, with the photos taken just under a year after his surgery.

He said that almost no one noticed the hair growth, but family members and friends that he hadn’t seen for a while did detect a change in appearance. Some people thought he lost weight, some thought he had a face lift, but a few did notice that he had hair that was not there the last time they saw him. He isn’t shy, so he’s allowed me to post his photos and I am appreciative that he agreed to share this remarkable change.

Click the photos to enlarge.

After (1 procedure of 2926 grafts):

 

Before:

 

Tags: hair transplant, hair restoration, surgery, hairloss, hair loss

I Think I’m In the Early Stages of a Norwood 6

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

Dr. Rassman –

On March 13, you wrote:

“Men in the process of losing their hair in a Norwood class 6 pattern may not be thinning uniformly. They may be losing more of the frontal hair faster, yet have the overall pattern of a class 6 that may or may not become complete. Some men who take finasteride will arrest much of the class 6 pattern thinning, especially in the top and crown of the head, but their frontal balding could actually be advanced.”

Could you explain this in more detail? Are you suggesting that finasteride might accelerate frontal balding, beyond what would have occurred without medication? Or are you just saying that finasteride might have relatively minor efficacy in the front?

I’m a 26-year-old caucasian male, and most male relatives on my mom’s side have Norwood 6 or 7 patterns. Like the guy who wrote on March 13, I appear to be in the early stages of thinning towards a Norwood 6 pattern. My own loss is heaviest in in the vertex, with some loss also in the middle and front (although I have a strong forelock). About three months ago, I started taking 1.25mg of finasteride daily. At my checkup a week ago, my dermatologist noted new growth in the vertex (hooray!) and agreed that my corners were a little worse.

I’m interested to hear your thoughts on how finasteride might impact my ultimate balding pattern, both in the front and back. And I’m interested in a clarification and elaboration of those comments from March 13! Thanks for all your work. Your blog is a great read.

Sorry if I wasn’t clear in my prior post.

A simple way to think about this is that Propecia does not stop hair loss completely, and it works best at the top / crown area. So if you are balding in a Norwood 6 or 7 pattern, Propecia will slow down the hair loss on the top / crown area while the front area will have faster hair loss than the top / crown.

Eventually, you may reach the Norwood 6 or 7 pattern, but if Propecia thwarts the hair loss process, you may be able to delay this for 10+ years if the drug works that way for you.

Tags: propecia, finasteride, hairloss, hair loss

In the News – Hair Loss in the UK

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

Came across this article about hair loss in the the daily mail. What are your views doctor rassman?

How a £30,000 hair transplant can still leave you going bald

That’s a nice looking transplant result in the first photo set in the article. The article goes over the various treatments that are available, and warns about scarring and shock hair loss following transplant surgery. Nothing new here that we haven’t written about dozens of times before on this site, unless I’m missing something. It appears to just be a general hair loss treatments article for the UK audience with a punchy headline to grab readers.

Tags: hair transplant, hairloss, hair loss

ACell Plucking from Harvested Grafts?

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

Doc, I understand Doctor Cooley is still doing plucked hair procedures but found they need to be done with grafts harvested from FUT or FUE.

What’s your comment on this

It is not considered plucked hair when you are using follicular unit grafts. That sounds like a regular hair transplant procedure. The pulled graft/hair will not grow back from its ‘plucked’ place. It is no longer considered hair multiplication.

If one believes that adding ACell to a hair transplant procedure for better growth, it needs to be studied and proven.

Tags: acell, hair multiplication, hairloss, hair loss, hair transplant