Can The Horseshoe Pattern of Hair Loss Eventually Bald?

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

Dear Dr. Rassman,

I will try to keep this simple: Once a man with hairloss can make out his “horseshoe” pattern, is it possible or common for any of the “horseshoe” hair to bald at a later point?

I am 26 and, while I don’t have any bald spots, the hair on top of my head is thinner and more limp than the hair on the sides and back of my head. My “horseshoe” hair goes all the way up the sides of my head, and does not dip down low at the back of my head. Given that this hair has remained unaffected for the past 8 years since I’ve been thinning, is this indicative of hair that will remain unaffected for the remainder of my life?

The thinning in a young man at 26 years old which can produce an apparent horseshoe pattern, may be stable for years in the horseshoe itself. I have seen men that have a horseshoe pattern which is much more narrow than most Class 7 pattern patients. I often classify them as a Class 8 pattern to reflect the narrow band.

The normal height of the posterior part of the horseshoe is somewhere between 2 1/2 and 3 inches high (not counting neck hair). If this Class 8 patient was to have a hair transplant to cover his entire head (assuming the Class 7 pattern) he will likely have moved some of his non-permanent hair in the procedures. With the strip method of harvesting, the scars can be vary bad for cases this large. I have unfortunately seen this type of pattern with the scars produced by overly aggressive surgeons, and each one is a real challenge.

I couldn’t tell if it’ll dip down further as the years progress, but measuring the bulk of the remaining hair should be able to tell you if that area is continuing to thin.

Tags: hairloss, hair loss, norwood, advanced balding

Switching from Propylene Glycol-Free 5% to 2% Minoxidil

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

Doc..

I can’t take the PG in minoxidil formulas and the foam seems to get more on my hair than my scalp. I have been taking 5% non PG Formulas from Dr. Lee who is now out of business. How much hair can one expect to lose going from a 5% formula for years to 2%.. which I’m assuming has less PG. is that a correct assumption?

You can get 2% minoxidil from the drug store without propylene glycol (woman’s version of the product). I can not predict what the effect of reducing the dose would be, but I might suggest more frequent use than just twice a day as you ‘crank’ down the dose. As everyone is different in their response to minoxidil, I really can’t tell just will happen.

Although this isn’t a prescription medication, talk to your doctor about changing dosage, as there may be other effects that can occur based on your medical history.

Tags: minoxidil, rogaine, propylene glycol, hairloss, hair loss

What Happened to Merck’s Propecia Website?

/by William Rassman, M.D./10 /

Hi,

I have been advised by a doctor to begin taking Propecia, and have been researching it A LOT. I have read both horror stories and great success stories and agree that people should stop scaremongering. Just because you happen to have been taking Propecia does not mean all your ailments were caused by it! I bet 100% of those things happen to people who do not take it too.

My only concern is that the Propecia website has been all but closed down. Do you have any idea why this is? It is now the only thing stopping me from going ahead with the treatment. It just seems a bit strange? It makes me wonder, what if Merck were to go out of business and Propecia stops being made. What happens to all those people who have been taking it for years?

Thanks for all your great responses, this is a great place of understanding and comfort, when it seems nobody else does!

Your guess is as good as mine. Initially, I thought it may have to do with the Propecia patent expiring, but that doesn’t occur until November 2013. Once that happens, you wouldn’t have to worry about Merck going out of business (which I doubt would happen anytime soon, regardless).

Hair loss message boards have speculated about why the site was pulled down, but it’s just that — speculation. I really have no idea.

Tags: propecia, merck, website, hairloss, hair loss

SMP and Hair Transplant Combo for Men with Norwood 5+

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

Dr. Rassman,

I was wondering if you could shine some light on this in effort to give hope to NW5+ men. I think a great option for high NW men would be to obtain a low density (30/cm) transplant and supplement it with SMP.

What do you think? Also, with this strategy, would it be possible to keep hair at a 2 guard without it looking funny/weird?

Thanks!

A low density hair transplant with SMP (Scalp MicroPigmentation) in the scalp may or may not be enough to achieve a fully normal appearance. There is certainly a threshold where where too few transplants will not be adequately augmented by SMP.

Tags: pigment, smp, scalp micro-pigmentation, hairloss, hair loss, hair transplant

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