Is Propecia Worth Using If My Only Loss is At the Hairline?

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

Dear Dr

I currently have a norwood 2.5 shape hairline with moderate recession at both sides. I have been using minoxidil for over a year and while there hasn’t been any regrowth, there has been a definite slowing down of recession. My hair is very thick at the forelock and all over the rest of my head so my question is:

Is it worth committing to propecia when less than ten percent see a benefit at the front hair line? From the studies i have read, minoxidil has as much chance if not more than propecia of making a difference at the hairline. I don’t want to commit to a drug with until i have to, and would prefer to wait and see whether my hair loss will extend to the crown or won’t, but would appreciate your advice.

Many thanks

Without actually seeing you and examining you, I can not tell you what to do. Your assumptions about minoxidil and where it works best, are not standard thinking… but if it works to slow down your frontal loss, that seems to be what you want.

Many Norwood class 3 balding patterns will evolve into a class 3V (which includes the crown). Finasteride is good at stopping or slowing crown loss if there is miniaturization present. You should see knowledgeable doctor who can do a bulk analysis on your scalp hair, because that measurement will determine if the process has started in the crown.

If you really care about the future of your hair, why not get a professional involved in helping you make intelligent decisions? Propecia could make a difference in at least preventing further loss, but taking that medication is going to be something a doctor will have to recommend after an examination.

Tags: hairloss, hair loss, propecia, finasteride

About a Week After I Banged My Head a Few Inches Below My Transplant, The Hair Started Falling Out

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

I had a hair transplant four years ago on both temple areas. It has been growing perfectly for four years. About two weeks ago the left temple area just on the hairline looked a bit thinner and showing more scalp, also there seemed to be a few gaps were a few strands of hair usually grow.

Three weeks ago however I banged my forehead on the corner of a table three inches just below the left temple, but NOT on it. Is there a chance that the impact, even though it wasn’t on the transplanted area could have still caused there to be less hairs growing and it of shocked the hairs to stopped growing indefinitely? The other temple is fine, to a certain extent the left one is, but It is sprouting a few less hairs than usual and making it look thinner. Any suggestions. Thanks NHI team.

All the hairs that grew after a hair transplant are now a permanent part of your own body. It is just like any other non-transplanted hair. It goes trough the same hair cycles, sheds at times, regrows, and will even turn grey over time.

Since it has been FOUR years since your hair transplant, I don’t think banging your forehead (well below the transplant area) should have any impact on your transplanted hairs. Maybe you are paying attention to a particular area now and noticing the change.

Tags: hair transplant, hairloss, hair loss, trauma

After 2 Surgical Procedures, I Was Diagnosed with Chronic Telogen Effluvium

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

I think I’m suffering from CTE, without any obvious triggers. I’m 30 years old. Only on my fathers side is there a history of hair loss, which for all the males started after age 50.

A year ago I had two back-to-back surgeries, and several months later noticed shedding and that my hair was noticeably thinner. Thinking TE, I decided to let it run its course. 8 months later I decided to get an evaluation as although the shedding had abated, I wasn’t seeing visible improvement. Under a microscope the levels of miniaturization were found to be well under 10% across my scalp. However, the hair count on the top was noticeably less.

The hair-pull was positive (I had washed that morning) and I got an HMI reading of 84 on my vertex. The next month I saw a massive shedding increase and went in for another check. HMI then 59, exactly 2 months later – a 30% drop. Miniaturization was still found to be low. Neither that hair specialist nor a dermatologist could offer anything other than CTE. However, other than the dandruff I’ve had most of my life (which has been under control, although it flared in that 2 month period), I haven’t had any other stressors. I recently had blood work for iron, thyroid, CRP, and autoimmune markers: all clean. At the suggestion of both doctors I started minoxidil to help “kick start” the growth. However, the CTE (if it is) without an obvious trigger is worrisome.

Any suggestions would be greatly appreciated, as I’ve read there are several alopecias that can mimic both CTE and AG

Chronic telogen effluvium (CTE) has no cure. Sometimes minoxidil works and this is frequently recommended by many doctors. You may have to just wait it out.

Tags: chronic telogen effluvium, cte, hairloss, hair loss, stress

My Shiny Blonde Hair is Regrowing Dark Brown and Dull After 3 Months of Minoxidil Use

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

Hi doctor,
I am a 21 year old male. I began using minoxodil about 3 months ago as a last resort since I could not handle any amount of finasteride. Since I started using it I am seeing some regrowth, yet my hair, which is usually shiny and blonde in different tones, is coming in almost dark brown and dull. Friends have even commented on the colour change and said it looks very strange and doesnt match my complexion. I guess I can not complain as I am not rapidly balding like many others, yet is this a normal change to occur or should I go and see my doctor?

Thank you so much for your blog.

Minoxidil can, at times, cause a change in hair color and texture. I don’t have an explanation for the color change, and it doesn’t happen in most cases that I’m aware of. I guess there is a choice to be made — hold on to your new brown hair or stop the treatment and lose your newly regrown hair. You can go to lighten your hair going back to blonde if you decide to dye it (just be careful to not cause any chemical damage).

My three sons had blonde hair as children, but as they aged their hair color started to change. My oldest son was a platinum blonde and today he has the darkest brown hair of the three. Maybe your hair was changing color already and you’re just now so focused on your hair that you’re noticing it?

Tags: minoxidil, rogaine, hair growth

If I’m a Norwood 1 in My Late 20s, How Likely Is That to Be My Final Pattern?

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

Hello,

I am curious about something. I have read several of your blog entries where you write something like “if at this age somebody doesnt look like pattern X, fully advancing to pattern Y seems unlikely”. I would consider myself looking like Norwood 1, perhaps a bit from 2. I have to completely pull back my hair to notice a tiny hint of a corner recession, and I have had that since I was 17 (I am 29 now). Men from the mother’s side all have full hair, men from the father’s side tend to start balding. However, my father started to bald at something like 23, and never had hair as strong as mine. On top of that, I can still see a few (rather thick) hairs left from what used to be my juvenile hairline (which was really low).

Now, I know a definitive needs to be done with scalp mapping and bulk measurement, but statistically, with the hair status I have, how likely is it that my final pattern will be norwood 3 or higher?

At the age of 29, I can not tell you what is going to happen to you over the next 10 years. It’s possible the tiny bit of corner recession you see is actually just a matured hairline. Without photos, I have no way to know what you’re seeing. I don’t have a statistic to give you, but it is possible to remain a Norwood class 1 for years.

The best way to estimate what will happen to you is to look at your family pattern. If neither side has balding and you are presently a Norwood 1, then it would be likely that you will remain without any significant loss for years. But since your father’s side has some balding, you very well could have the genes. That said, I wouldn’t worry about unless you start to see some thinning.

Tags: norwood, hairloss, hair loss

So Is BHT for Very Short Hairstyles a Good Idea or Not?

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

Dear Sir,
I read the Q&A titled “If I Want to Have a Very Short Hair Style Forever, Can I Use BHT?”

I could not figure out what your view is about this. I think the sender’s idea sounds good but I would like to have your view as to what you think of Body hair transplant in this scenario if one wants to nearly shave his hair or cropped hair look.

Best Regard

Hair transplants from the scalp are far superior to body hair transplants, even with the short haircut you want. That is what FUE offers. I don’t recommend body hair transplants.

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

I Switched From Finasteride to Dutasteride And Now Have Shedding All Over the Scalp

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

Hello Dr. Rassman. First, a huge thank you for this great site. It is an island of real medical information amidst the sea of misinformation of hais loss.

I have a question I believe has not been asked before. Can the switch from finasteride to dutasteride cause catch up loss?

After 4 years on 1.25mg of finasteride, 3 months ago I added 2.5g of avodart daily for two months, lowering the dosage to 0,5g daily after that. I mantained finasteride for the first month of avodart and stopped taking it since about two months ago.

As of now I am experiencing massive shedding all over the scalp (including the sides and donor area), with the characteristic white bulb of a telogen effluvium. Could this shedding be catch up loss from not taking finasteride, causing permanent damage, or does avodart “picks up” that protection and is just normal shedding from switching medication? Is it reasonable to expect my hair to grow back? I discussed this with my doctor, but he simply does not have your knowledge. I returned with my daily 1,25 of finasteride a few days ago, just in case, and will maintain a low dose of avodart for extra dht suppression.

Thanks for your time!

Changing many factors makes an analysis extremely difficult. I haven’t heard of a switch between medications causing catch-up loss, but I’m not sure why you were taking both medications and changing doses so much. Did your doctor prescribe this method?

Since you’re going back to your finasteride routine that worked for you before, I’d give it some time to see what happens. I’m not sure why you experienced a massive shed, and it’s particularly troubling that it occurred in the back and sides of your scalp. If your doctor isn’t knowledgeable about treating hair loss, you should try to find one that does. You should have your scalp examined and baselines measured so that you can know for sure what any treatment is doing (good or bad).

I said this many times, and it may not be something you want to hear, but in the end your genetic predisposition will win out. It is really not about total DHT suppression.

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

My Entire Family Is Losing Hair and I Think It Could Be Environmental

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

Im a 25 year old female and I started to notice that i was losing my hair about a year ago. About six months ago my husband started to notice the same hair loss. What really scares me is that now my 4 and 6 year old kids are losing their hair too. The hair loss is diffused throughout the head and sometimes we all get scalp pain as well. Ive seen Dermatologists and Endocrinologists and all the tests that have been done have come back negative, so all I can come up with at this point is that its environmental because this has been happening ever since we moved to our current home.

Please what could this be? What could I have my family tested for as far as toxins among other things?

Thanks in advance!

If you, your husband, and your children are all losing hair, an environmental cause sounds like it is the most logical reason. It could be something in your home, in your food, in your water, etc. Are you just seeing hair loss and some scalp pain, or is there anything else that your family is experiencing (like nausea, skin issues, seizures, etc)?

I wish I could provide you more, but this is outside of my field of specialty. There are government agencies that can check the environment in situations like yours. I would probe that direction.

Tags: environmental, hair loss, hairloss

I Noticed Regrowth In My Hairline 2 Months After Taking Melanotan!

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

Melanotan and hairloss

some background info: Male, mid twenties, taking propecia for about 1.5 years.

Some time ago I stumbled across this thread

I thought it’s just an illusion, because the drug makes your hair a few shades darker. But recently, I’ve also noticed some regrowth in my hairline after 2 months of taking melanotan. It’s not dramatic, just a few follicles at the corners, but clearly visible. I doubt it’s finasteride since I’m taking it for 1.5yrs now (not taking any additional drugs).

Hope you find this interesting

It is interesting. Thanks for sharing. You should have taken before and after pictures to have some visual comparison at the very least, otherwise it is just one of many anecdotal observations that get reported about a variety of treatments.

Tags: melanotan, hairloss, hair loss

Could a Traumatic Experience Cause My Transplanted Hair To Fall Out?

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

Have you ever had or known in your experience of a man having a hair transplant and everything was going wonderful for the first six or seven months and then a traumatic event reversing things? My age is 62 and I was doing well until I started having severe stomach pain at about 6 months after the procedure.

I guess I passed out and was taken to the hospital unconscious. I had to have a transfusion of a small amount of blood. I had a stomach aneurism and almost died. I had to have some metal clips placed in my stomach so I had to have general anesthetic. Could this event have caused me to lose a lot of my transplanted hair? I seem to be losing more all the time.

I’ve been taking iron pills because I’ve been told that I’m anemic. Is it possible that the implanted hair could be coming out due to this incident? If that is true do you think my transplanted hair will ever grow back again once I regain my full health again? I have asked my surgeon these questions but feel like I’m gettin the “run around”. My surgeon has recommended that i start taking propecia or rogaine. I did take propecia for at least a couple months before my surgery and about 5 months afterwards. I did have some sexual side effects with the drug so was told that I had taken it long enough.

It has been 10 months since my surgery and I am feeling like I went through all this and may not end up with all the hair I had after about 5 months after the HT. Could you give me your thoughts and feelings on my story because I read your column frequently and I do respect your opinion. I would be willing to have another HT if you think that would be the answer to this mess. I had 2400 implants the first time. Thanks for your opinion.

It sounds like you are lucky to be alive. We do know that stress can cause hair loss and I guess it could delay the growth of your new hair for 10-12 months, so all may not be lost.

Most people who lose hair after a traumatic event, will lose their non-transplanted native hair, but I have heard and have seen some patients lose their transplanted hair some 3-5 years after the transplant was done. We say that transplanted hair is permanent, but that is a general rule… and all rules can be broken.

Your hair growth is clearly delayed, so I would wait out another few months and see if the Rogaine helps. I am assuming that your transplant doctor knows what we/she is doing and generally gets good responses from the transplants he/she performs.

Tags: hair transplant, trauma, hairloss, hair loss

How Can Necrosis Occur After a Hair Transplant if Antibiotics Are Used?

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

Dear Doctor,

i would like to ask you about necrosis and skin infection. Since each patient is given a post-op course of antibotics, how can this happen?
i thank you in advance.

There is no connection between necrosis (this is a vascular problem to the skin) and infection (this is something that can happen after necrosis occurs, or can happen without necrosis).

If you have necrosis, tell me a bit more about it: When after the surgery did it happen? What was the size of the necrosis? Where was it located (donor or recipient area)? Did you have FUE of FUT. Without this information and some good photos, there is little help I can offer.

Tags: necrosis, hair transplant, surgery, antibiotics

Is Propecia Redundant If I’m Taking Spironolactone?

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

Hi

I started taking Propecia some years ago and now I’m also on Spironolactone. My question is: Is taking both these medication at the same time redundant since the Spironolactone already reduces testosterone?

Sincerely from a trans-Woman.

I would think that the reduction of testosterone is different than the blocking of testosterone’s conversion to DHT, so taking both medications may have value in your case. Of course, you should discuss any and all concerns with your doctor.

Tags: testosterone, spironolactone, finasteride

Scalp Micropigmentation (SMP) and Anesthesia

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

I called a few clinics doing SMP and there seems to be various approach in terms of anesthesia for SMP into a scar. Some don’t give anything, others say they apply an anesthetizing cream an other give injections. Which is the best approach to reduce any discomfort to a minimum ? I would not do it without any anesthesia and I am not sure applying a cream is enough. Can you comment ?

Thanks

A topical cream anesthetic might work on other parts of the body where skin absorbs the medication (like your mouth), but it does not necessarily work as well on thick skin and scalp. Many tattoo parlors use numbing cream, but I do not believe it would work well on the scalp.

Some places that offer SMP do not provide any medication, because they are non-medical clinics, and do not have a licensed physician that can administer the medication.

In our practice, we use local anesthesia so there is no pain or discomfort. We also offer light sedation and laughing gas (nitrous oxide) to minimize any discomfort or anxiety.

Tags: smp, scalp micropigmentation, anesthesia, sedation

I Have Below Average Density and Great Laxity

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

Hi Dr Rassman

What is your advise for patients with below average density and great laxity ? I got a hair transplant a month ago but it turns out my density of hairs is 60 hair per square cm and above the ears it was only 40 hair per centimeters. Am I still an acceptable candidate for a hair transplant ?

The Dr managed to cut a strip which went over the ears yet it only gave a total over 2660 grafts in the end. Since my hair is thick and wavy it appears like I have more hair than I really do. I come from an Indian background, but my density is even lower than Indian and in fact its lower in comparison to the Chinese society as well. The Doctor then transplant 30 grafts per centimetres per square using the FUT method.

The magic formula is balancing the supply that is available with the demand for hair (Norwood Class). A Norwood class 3 patient will not be impacted by low donor density, while a class 6 or 7 patient may not be able to meet his goals. Good laxity helps offset the lower density in donor yield, but the eventual supply will be restricted.

Did you ask your doctor for an estimate on how many hair transplants you would need to achieve your goals?

Tags: density, laxity, hair transplant

Can Happiness Levels Have Anything to Do with Hair Loss?

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

Dear Dr Rassman

I am a 19 year old who has had temple recession since the age of 17. I am a norwood 3 with a strong window peak (My right temple has a larger bald surface area than the left). I have the following questions.

1) Do happiness and relaxation levels have anything to do with triggering hair loss?

2) I am very conscious of my hair thinning, and sometimes have slight sensations in my head when I think my hair line is receding, is this possible or could this all be triggered by anxiety?

3) My hair line is definitely not symmetrical. If someones balding is only a norwood 3 and not higher, does it have to be symmetrical, or can people stabilize at norwood 3 have unsymmetrical hair lines for the rest of their lives?

thank you for your help

Stress is a cause of hair loss. So if you’re stressed, you’re not going to be relaxed. In that sense, they are related. As for the sensations you feel at your hairline, I’d guess it was probably anxiety.

The fact that your hairline is asymmetrical indicates that the lower side will rise to the level of the higher side eventually. The higher side may also rise.

Tags: hairloss, hair loss, happiness, stress