We’re off today and tomorrow, but we’ll be back on Thursday.
I’ve had 2 procedures with a prominent surgeon for a total of around 3700 grafts. My first was at age 51, second 54. I felt I was a good candidate since the hair on the back and sides of my head was thick. My first procedure grew-in nicely but I had a lot of dry, itchy, flaking scalp issues. I began to notice thinning hair in the transplant area about 1.5 years ago. The 2nd procedure is still thickening up but I suspect it will thin as well in a year or so. I think this is partially due to my age since all my hair is getting thinner.
I’m not convinced HT’s last as long as the hype would like you to believe. I’m really concerned for guys in their 20’s going through this procedure expecting it to last a lifetime.
There are many patients who undergo hair transplant surgery in their 20’s and 30’s that still have a full head of transplanted hair in their 50’s. There is a small minority of patients who were never properly diagnosed and perhaps do not have genetic androgenic alopecia, but rather have another type of balding (such as diffuse unpatterned alopecia), that underwent hair transplant procedures that were not permanent. Or it’s possible the grafts were taken from a non-permanent zone.
When patients have transplants into thinning hair, the results are generally good for the first few years until their original non-transplanted hair starts to fall out (as they would have without the surgery) and those initial results become less impressive. This makes them think that the transplanted hair is falling out, as patients do not see (or were not properly informed) that hair loss is an ongoing dynamic process. Even with the native hairs falling out, the transplanted hair should be enough to provide a better overall look to the individual, as long as there was a proper Master Plan made.
Snippet from the article:
Cancer death rates continue to decline in the United States for both men and women. Experts say the four major cancers, lung, colorectal, breast and prostate, account for more than two-thirds of the decline.
In 2001, a routine PSA blood test helped John Nemeth, 77, of Glendora detect prostate cancer at a very early stage. Twelve years later, the cancer is gone after undergoing a minimally invasive treatment.
According to 2013 National Report Card on Cancer, success stories like Nemeth’s are on the rise. Deaths from the top four cancer killers are dropping.
From 2001 to 2010, lung cancer deaths dropped 29 percent, a faster rate than in previous years.
Read the rest — Cancer death rates drop 29 percent over decade
I want to rule out other possible causes for my hair miniaturization to ensure that it is definitely genetic since I am not aware of any bald men in my family. My iron and thyroid levels are fine. I read that a urine analysis will evaluate my nutritional state. Is there anything else I should get tested? Like hormones for example?
In general, genetic hair loss in men shows up as a specific pattern (hence the name “male pattern baldness”). That is why there are diagrams and pictures (Norwood) to show what these patterns look like. A fairly competent doctor can determine what genetic male balding is by merely looking at the person. If the hair loss is relatively early in the process you can look at the hair under a microscope to see if there is a miniaturization pattern or a bulk measurement that can give tell you if you’re thinning. You don’t need a blood or urine test for this.
Other types of hair loss, such as from low thyroid or anemia, will present as diffuse thinning with no specific pattern. There is a hormone test to check your thyroid levels, but there is no hormone test for genetic male pattern balding. This can be confusing because a hormone called DHT (dihydrotestosterone) is the cause for hair loss in men, but only if they have the genes for MPB. The quantity or levels of DHT will not determine if you will bald since the underlying issue is genes.
There is a genetic test for balding, but it is not a straight forward test to interpret since it only give you a probability score. The easiest way to test for balding is a good old fashioned physical exam. Finally, I must point out that the gene for balding can skip generations and there is no specific rule on how it is passed down.
Snippet from the article:
It turns out that when it comes to growing hair that’s stopped growing, and stopping hair from growing where people don’t want it, the same molecules in the human body are at play, according to a new study from the University of Pennsylvania School of Medicine.
Researchers writing in the journal Cell Stem Cell this month say that balding is caused by the protein inhibitor Dkk1, which stops the intracellular Wnt/Î²-catenin pathway from functioning properly. They further found that stem cells for dormant hair follicles are still maintained after balding begins. When Dkk1 is removed, the Wnt/Î²-catenin pathway resumes normal function, stem cells were activated, and hair growth is restored.
We are getting a better understanding of the balding process and potential solutions as described in this interesting article.
Can propecia cause platelets in the blood to lower. My platelet count was 125 and my doctor said its not anything to worry about. I know the normal range is 150-450.
please help doctor
I would listen to your doctor. I do not believe Propecia has anything to do with low platelet counts, but I did find a case report from 2002 in the medical literature that mentioned it. I haven’t seen more cases mentioned in the 12 years following the report, so I’d expect if finasteride does cause low platelet counts, then it is very rare.
Snippet from the article:
There’s more disappointing news about multivitamins: Two major studies found popping the pills didn’t protect aging men’s brains or help heart attack survivors.
Millions of Americans spend billions of dollars on vitamin combinations, presumably to boost their health and fill gaps in their diets. But while people who don’t eat enough of certain nutrients may be urged to get them in pill form, the government doesn’t recommend routine vitamin supplementation as a way to prevent chronic diseases.
The studies released Monday are the latest to test if multivitamins might go that extra step and concluded they don’t.
What the article reflects is the benefits directly to a multi-billion dollar industry (vitamins), with what is apparently little value received in return.
I am a very sporty and fit 39 year-old. I never get sick. Less than 1mth ago I was diagnosed with TB as well as being pregnant at the same time (almost 3mths) however before being diagnosed with both ‘conditions’ above I was suffering with very sore joints in mainly the hands and feet , sometimes the knees and back as well. This was over the course of about 2 mths. The joint pains generally got progressively worse and I was tested for all auto-immune related diseases, nothing came up in the blood tests. Then my hair started falling out and it was only a few weeks later that I was diagnosed with TB and was confirmed pregnant.
Why am i loosing all my hair? I have asked both GP, physician and gynae and neither can give me an answer? Is it a symptom of TB and/or being pregnant or neither? and will it grow back?
Sorry, I do not know why you are losing hair. I cannot diagnose your medical condition over the Internet.
Generally speaking, medical illness and stress can cause hair loss. Sometimes drastic changes in hormones (such as pregnancy, postpartum period, menopause) can cause hair loss in women. In those cases, the hair should grow back with in a year. If it has not grown back within a year then it is likely permanent and there is no specific cure for it.
It’s the holiday season, so we’re not going to post today or tomorrow like we would normally do. We’ll be back on Thursday!
There has been few questions troubling me concerning taking propecia.
1) Is there a chance that it could make hairloss even worse than without taking it? (and what exactly people mean by term shedding because of propecia)
2) My doctor and parents are worried because of a bad effect on the liver. How serious is that? What do you think of it?
1. Propecia a drug that is prescribed by a doctor after you had an exam that confirmed a diagnosis for androgenic alopecia (also known as male pattern baldness). It is a drug that slows down and sometimes reverses the hair loss process. If taking this drug will make hair loss worse, it would not be recommended by a doctor. Having said that, if your genetic predisposition is so overwhelming and you are destined to be a bald man, the drug will not have a significant benefit. In other words, you may still lose hair despite taking the medication. It is not the medication that makes it worse.
2. In general all drugs are either metabolized by the liver or kidney. Propecia does not cause liver damage, but if your parents and doctors are worried, then you should resolve that issue (valid or not) with your doctor and parents.
I had a face lift 4 years ago. I lost hair at the incision lines on my scalp and it has not grown back, which I expected. But 5 months ago, my hair began thinning all over my scalp, more so at the top. I have seen a dermatologist who diagnosed this as telogen effluvium
My question is could this be a delayed reaction to the face lift of 4 years ago, and if so, is the hair loss associated with a face left permanent? Why would it take 4 years to thin? My surgery went well, i was happy with the results and there were no complications.
A face lift can cause hair loss around the scar. If no hair has grown back in over a year, then it is likely permanent. I do not know why you are noticing scalp loss after 4 years, but if what you’re experiencing is telogen effluvium, it is unrelated to the face lift. The effluvium does cause overall thinning and this may be causing you to notice the hair loss around the scar that was always present.
Dr. Rassman / Dr. Pak,
If, after consulting with you and establishing a masterplan, a patient were to undergo SMP with the intention of having a hair transplant in the near future, are there aspects of the procedure that require particular consideration?
(a) Would the SMP hairline have to be positioned slightly further back than the original hairline to allow for the creation of a transition zone during an HT?
(b) Are the SMP dots used as a template for an HT?
(c) Would the integrity and visual effect of SMP ink be damaged or compromised by HT-surgery incisions?
(d) Do you advocate using a darker pigment to provide better camouflage to the scalp, or do you always match the ink to the patient’s existing hair colour, even if it’s greying/white?
Or is it advisable to have SMP after a hair transplant? Thank you.
Merry Christmas & Happy New Year!
Each and every patient is different and there is no rule. You can have Scalp MicroPigmentation (SMP) first and a hair transplant later. Or you can have the transplant first and SMP later. I have had patients who had SMP on a completely bald scalp and later had a small FUE surgery to add texture to the hairline.
The hairline for SMP and a hair transplant is placed in the same proportionate height according to what the patient and doctor agrees on. If a patient ever considers having a full HT later on in life they should let the doctor know of this possibility so the SMP hairline can be placed slightly back to make room for some transition zone… but in my experience (in practice) this rarely happens, because most bald patients who are undergoing SMP will never consider a full HT since it will never give them complete full hair coverage. Most bald SMP patients would rather have a good hairline and later consider an FUE option for added texture (not fullness).
I do not advocate darker ink for better camouflage. I advocate a specific shade of ink that matches the complexion of skin and hair combination. If the patient’s hair turns grey later on in life, the SMP shade will make the roots look dark. If you apply SMP all over the scalp it would not matter if the hair turns grey, because there is a base SMP color. Many patients with grey hair have SMP and it actually makes their hair look less grey and they look a little younger. If there is ever a drastic mismatch where your hair turns completely white (not grey) like Santa Claus, then I suppose one must consider dying their hair. Completely white hair will not work with SMP unless you shave the white hair.
I am a 22 year old male with mildly active Crohn’s Disease and in the next few weeks I hope to be going on Humira. I know that both the disease and the Humira can cause hair loss.
My question is this: Does hair loss from drugs and disease miniaturize and fall out in the same fashion as MPB? I would like to know if there is a difference, because if it’s the disease/drugs, I can’t do anything about it and no need to waste money on it either. Thanks for reading.
The biggest difference is that in male pattern baldness, there is a pattern to the hair loss, as seen in the Norwood classification chart (see below). Drug induced hair loss is usually generalized loss all over the head without a pattern.
Snippet from the article:
“The suggestion that bald men are more virile than their well-thatched contemporaries is probably an old wives’ tale, but it must be conceded that old wives are likely to be unusually authoritative in this matter.”
So said the esteemed British dermatologist John Burton back in 1979 when the topic was first explored in the medical literature. Burton was notably balding at this time.
Since the time of Hippocrates it has been known that eunuchs do not go bald. This link between masculinity and baldness was confirmed by the anthropologist James Hamilton in the 1940s when he studied the hair patterns of prison inmates in the United States. He was particularly interested in the sex offenders who had been castrated by the authorities as part of their sentence.
Read the rest — Are bald men more virile?
So are bald men more virile? Spoiler alert — The answer is “no”.
Dear Dr Rassman,
I know you’re probably sick of hearing questions about this but here goes… I read in one of your more recent posts that ‘a mature hairline is usually about one finger width above your highest forehead wrinkle.’
Doesn’t this seem to contradict earlier measurements which suggest it can rise as high as an inch and a half in the corners? Or in this post are you referring to the center? If the corners receded by only a finger width (which is like half an inch) wouldn’t that be more like a NW 1.5?
The problem I am having with my hairline at the moment is that the sides are moving up (probably by just over an inch) but the center isn’t really moving. This is creating a weird angle. I actually want some of the middle to recede to even it out!
I have seen you describe this as ‘persistent forelock’ — but is a persistent forelock a greater indication of MPB than maturation?
In fact, the part of the center which persists actually seems to be more to the right, and the whole right side of my hairline is still thicker than the left. So maybe this isn’t a persistent central forelock and actually indicates the point remaining which still touches the highest forehead crease should fall out?
Just on a side note it seems as though a lot of males have a juvenile hairline whose central point is actually higher than the corners, kind of like David Schwimmer from Friends. So when their hairlines mature some of the corners recede and their hairline still looks straight. However, my central point was probably a tad lower than the corners (furrowing my brow shows a slight ‘dip’ in the middle’) and I still have hair touching the lowest line in that dip.
This really is not that complicated. If you think you are losing hair and you want to do something about it, see a doctor. Even if you have a juvenile hairline or a “weird” hairline and you are bothered by it, you can address it with hair transplant surgery. If you can live with it, then leave it alone. If you think it will get worse, then have it examined by a doctor.
There is no point breaking straws and going over a definition of a juvenile hairline or a NW 1.5 versus NW 1.75 versus NW 2, etc. Nobody has a perfectly even hairline.