In the News – Breast Cancer Patients Find Strength in Hair Loss

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

Snippet from the article:

Kim Irish had just started a new job and was in California for a training session. She had her tests and was waiting for the results but had asked the doctor not to call her so she could concentrate on the training.

She was set to return to Indianapolis when she got the call from the doctor confirming she had Stage 2 breast cancer. “I was standing in the security line at San Francisco airport when she called me, and I can still see the people in line around me,” she said.

Irish had a lumpectomy followed by four rounds of chemotherapy and 33 sessions of radiation. “My doctor told me my hair would start to fall out three weeks after my first chemo. The moment he said it would start — it started.”

Read the rest (and watch the video) at USAToday.com — Breast cancer patients find strength in hair loss

Fair warning: The video automatically loads when you click that link.

Tags: breast cancer, cancer, hairloss, hair loss

I Was Diagnosed with PCOS Six Years Ago and I’m Losing My Hair!

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

I am 23 years old. I was diagnosed with PCOS when I was 17 and was placed on birth control pills. I started to take them regularly, but they started making me sick, so I quit taking them and didnt take them for several years. Just recently I went back the the practitioner who diagnosed me with this and she placed me on a slow-release iron tablet daily along with a new birth control that has iron in it.

I have started losing hair around the middle-back of my head mainly around the crown area. It looks like my part is getting a lot wider, and the part is spreading down to the back of my head. I used to have really thick curly hair but now it is getting thin around the top, and in some patchy areas.

At first, since I am a Registered Nurse, I thought stress was causing it. The last time I went to the doc, she said I was anemic with low iron levels, hence putting me in daily iron, so I thought my anemia was causing it. I’ve been on and off birth control, so I thought that could be another cause.

Am I too young to use a topical treatment such as Rogaine? or Sephren? Sephren is an oral and topical treatment for hair loss in women. What do you recommend? I feel like I am losing more and more hair by the day and it really stabs a knife into my self image and self confidence. I’m desperate for some answers. I wish someone would lead me in the right direction so I can start growing hair in those thinning spots. I don’t want to be bald by the time I’m 30. PLEASE HELP!!

Polycystic ovary syndrome (PCOS) causes hair loss in women who can also inherit the genes for balding/thinning. It is a very difficult condition to treat, as the treatment is often unsuccessful. Since you’re already under the care of a doctor, I’m not sure what I can offer. You need a good doctor/patient relationship.

Hormone therapy might help with the PCOS-related hair loss, though since you mentioned stress and anemia, those are other potential reasons for your thinning hair. I just have no way to know what is causing your loss, or whether it is a combination of things. You aren’t too young for minoxidil (also known as Rogaine, which is FDA approved to treat female hair loss), but the oral Sephren is just a vitamin supplement with no peer-reviewed published clinical evidence that it works.

There is a new cosmetic treatment that we’ve mentioned here called Scalp MicroPigmentation (SMP) which we offer to address the thinning problem in many women. One such patient can be found here.

Tags: rogaine, minoxidil, hair loss, hairloss, female hair loss

I Used Minoxidil for a Couple Years, But Then Got Severe Dandruff and Hair Loss

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

I am 25 years old and have used minoxidil for two years but around a year back I got severe hair loss along with dandruff. Now the condition is worse than it was 3 years back, when I had started the treatment.

Hair loss is progressive, so having the loss increase over time is not unusual. Minoxidil doesn’t block the DHT that causes hair loss, and many people get increasing dandruff from its use.

If you decide to stop the medication, you should realize that this could rapidly cause hair loss, as many people build dependencies on this drug when it works well. Have you seen a dermatologist?

Tags: minoxidil, rogaine, hairloss, hair loss

In the News – Survey Finds Baldness and Man-Boobs Are Men’s Biggest Concerns

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

Snippet from the article:

Men are fast catching up women when it comes to worrying about their appearance, according to new research.

A detailed look into the body confidence of 2,000 men and women documented a dramatic rise in appearance-related anxiety for both sexes. Results showed two-thirds of women feel under too much pressure to look good, claiming a rise in ‘perfect-looking’ women in the media has set unrealistic standards.

Men now spend over three hours a week on average stressing over their image and feel the level of expectation placed upon them is rising. In fact, results also showed a rise in men dressing for their body shape, discussing their image with partners. One in eight men is even dieting in secret. Baldness and ‘moobs’ emerged as men’s biggest concerns.

Read the rest — Men stressed about beer bellies, baldness and moobs

The survey revealed that men had the most anxiety about being overweight, followed by yellow teeth, going bald, and growing breasts.

Tags: hairloss, hair loss, survey

Transplanting to the Hairline Corners Without Risk of It Looking Bad with Future Loss?

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

Hi Dr Rassman,

I am 30 years old and for the past four to five years have had some recession/thinning at the corners of my hairline. It is uneven (on the left side around a 6cm triangle shape in area) and on the right side around half that area. For years I’ve monitored the area (even went to see Dr Farjo two years ago who confirmed i had mild recession – not a mature hairline) and in terms of area of recession it has got no worse – maybe a little thinner in those areas but it has not spread.

The fact that I have a receded hairline REALLY bothers me because i have very dense hair in the middle and on top but it is thin on the sides making my hair very messy when i wake up etc. I would love to have it filled in slightly with a hair transplant to frame my face better and so I wouldn’t have to worry about styling it as soon as I wake. It consumes too much of my time/thoughts and I’d like to not have to worry about it so much. So here are my questions…

1) If my hair loss has been fairly stable for over three years is it likely that I won’t lose so much hair in future or does it not work like this? Dr farjo didn’t seem to think that I would not lose a great deal of hair in future but my dad is NW6 bald, My maternal grandfather was more NW3-4v in his later years with hair combed over.

2) If as I suspect it is just not possible to predict that I wont lose too much more hair in future, is there any way that I can have a hair transplant to the hairline corners without risking looking stupid in future if I do lose lots of hair behind it and can’t afford a future hair transplant or don’t have enough grafts left to cover it all (I have very fine hair by the way). What I mean is, is there any way for a HT surgeon to do a lower density transplant at the corners to stop it looking like the patient is looking like they have thick horns of hair left in future as they go more bald? By the way – I have ruled out the option of ever taking propecia as for me i can’t afford messing with my hormones (other health issues) and minoxidil never worked for me in this area (I sometimes wonder if it did more damage than good as it is when i used it years ago that the thinning progressed).

3. Finally… For someone with fine hair…what would be the density per square centimeter needed for a transplant at the hairline corners. I’d like to get an idea of how many grafts i might need if it is possible.

Thanks in advance for your help.

p.s. I realise my questions are quite specific and will of course go back to see a surgeon for an opinion but just can’t afford to at this moment hence my questions.

Dr. Farjo will give you good advice on these issues. If he thinks your hair loss won’t progress to your father’s pattern, I would plan for that. Ask you dad when he started to lose hair. I suspect he started earlier than you and accelerated more quickly.

That said, since we never know with 100% certainty what is going to happen to the hair loss over time, you need to make plans for now and then be able to maneuver to another step if the hair loss progresses. You should have a Master Plan created with Dr. Farjo if you have not done that yet.

Concerning a transplant to your hairline corners and having very fine hair, if you do opt for surgery, be sure to have it done right. Creating a thinning or balding look with this hair is not in your best long term interest.

Tags: hairloss, hair loss, hair transplant

Do I Have DUPA or Alopecia Areata?

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

29 years old, male. Around 1 1/2 year ago I started thinning all over, except for 3/4 of the neck area (the last inch), but even there i am sure it is somewhat thinner. I probably lost 50% of volume. I shed 50+ hairs just in the shower. We can call it DUPA. Blood analysis are ok: ferritin, diabetes, thyroid, hepathogram.

Now, the thing is that some months ago I had Exclamation-mark hairs. I would see that most of the shorter and thinner hairs in the shower were even thinner at the root (say 30 or 40% thinner). The Average hair was 3 or 4 cm long (1 inch and a half) and this tapered hairs 1 to 3 cm (0.5 to 1 inch). I thought it was just miniaturizating really fast. But now i know they can be a sign of alopecia areata. I don’t have them anymore. Now the roots are thicker than the distal end as it should be in a normal hair. They disappeared after a diet (no dairy, sugar, flour) or by coincidence. I thought I was improving because of that and because the dandruff decreased. But i still shed many hairs and I am still getting worse (maybe at a smaller rate, only maybe).

Is it just DUPA? Can I have DUPA with Tapering hairs? Could be areata? If not, what else should I check for? Considering that i dont have Tapering hairs anymore (maybe some long ones, but it is really not the same), would a scalp biopsy help to know?

Diffuse unpatterned alopecia (DUPA) and alopecia areata are both very rare in men, but I can not tell you what is going on without seeing you. An examination is necessary, so you should see a good dermatologist in your area who should be able to tell the difference.

I wish I could provide more info, but this isn’t something that can or should be diagnosed just based on your description.

Tags: dupa, alopecia areata, hairloss, hair loss

FUE vs Strip — A Technical Analysis (Continued)

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

A couple weeks ago, we wrote a post titled: FUE vs Strip — A Technical Analysis. In it, we discussed how the anatomy of SOME follicular units in SOME patients get disrupted, stripping off the fat from the lower part of the hair follicles.

We had two patients this week that provided some good examples we can delve into —

1. Patient #1 had a strip surgery, and we harvested two 2-hair grafts and two 3-hair grafts for this example. Note that all of the anatomy is present (sebaceous gland, fat to the bottom of the hair follicles) as shown in the photo below (click to enlarge):

 

2. Patient #2 had FUE performed, and if you look carefully, the bottom of the grafts have some missing tissue on them. This resulted when these grafts were pulled from the scalp after the FUE was cored. Parts of the end of the graft (surrounding the bulb) are devoid of the capsule and fatty covering that can be seen in the strip grafts. The photo below shows 7 follicular units extracted by FUE in a FOX negative patient (click to enlarge):

 

From the left, grafts #1-3 had loss of fat with intact follicular sheath (glistening membrane surrounding the hair follicles). These grafts should grow well; however, no studies on such grafts have ever been done.

Grafts #4 and #6 showed that some hairs were pulled apart within the follicular unit, probably when it came out of the scalp (a common occurrence in FOX negative patients). The missing parts of the lower half of these follicles were probably not transected with the punch instrument and will not produce hair; however the remaining follicles should grow. Again though, no studies on such grafts have ever been done.

Grafts #5 and #7 show intact follicular sheaths; however there is some mechanical “fracture” at the end of the intact hair shafts. We do not know if this will impact graft growth, but these changes are not uncommon in the FOX negative patients. These grafts should grow well, but… well, no studies on such grafts have ever been done.

 

Read more

Did Taking an Acne Pill Cause Provillus to Stop Working?

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

I started with the 6 month trial offer of provillus after noticing a thinning hair line. I was skeptical at first with the knowledge that hair was still falling out while using the product because the product was pushing out dead hair to grow new strands. But about four weeks in I had great results with a filled in hair line. The product continued working so well for months and I decided to grow my hair out a little longer than my usual buzz cut.

I eventually stopped using the product as much,skipping applications certain times but not too often. One day I noticed my hair was the longest it’s been in a while so I decided to buzz it again to about a #2 short length. When I did this, that is when I noticed my hair line had began to thin again some where along the line, which I could not see under the longer hair. I then began to make sure I didn’t skip any more applications day or night.

During this week my results with the product began to change for the worst. My scalp began to get irritated and flakey with heavy dandruff and even small scabs appearing. I noticed that my hair was very weak and fragile at this point, and it began falling out the same way it did before I started provillus. *about a month prior to this bad result period, I began using an acne pill called acnepril to treat my acne symptoms.

So my question is: do you think my taking this acne treating pill has any correlation to why provillus stopped working for me? Or is there any other reason it may have stopped working??

As I do not professionally think that Provillus works any better than generic minoxidil (Provillus is just a boutique combination of minoxidil and some herbs), I can not tell you how your Provillus interacted with your acne medication. From what I just read about Acnepril, it is just a multivitamin.

If you’re serious about treating your hair loss and acne, I would consult with a dermatologist… not tinker with so called “all natural” herbals.

Tags: acnepril, provillus, minoxidil, hairloss, hair loss

Have You Ever Seen a Case of Hair Loss Contained to a Just One Small Bald Spot?

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

Has a case ever occurred where a non uniform/asymmetrical form of hair loss had say thinning/hairloss centralized in a small area say 1inch x 2inch and the rest of your hair remained intact for the rest of your life?

Yes, there are inherited patterns like you mentioned and there are a variety of diseases like ringworm and alopecia areata that can do this. If that is a problem, see a dermatologist who can tell the difference for you upon an examination of your scalp and hair.

Tags: hairloss, hair loss, bald spot

I’ve Got Stress, My Wife Finds Balding Men Sexually Repulsive, and Now I’m Worried I’m Losing Hair

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

Hi,

I am 36yr old male and have just had a baby as well as a herniated disc which incapacitated me for 3 months (this was on top of an interstate move and loss of my job). I received an epidural steroid injection to minimize the pain. I am now on the road to recovery, however my hair is falling out at an alarming rate, I would estimate a 30%-35% loss but have not noticed my hairline receding. I am noticing many hairs on my computer keyboard, pillow in the sink etc etc. I also have pretty bad dandruff at present.

I have always had VERY thick hair as does my father (he’s 74 now and still with a full head) but my uncle and grandfather on my mothers side are bald. I think i am noticing small re-growth hairs on my hairline but read that this is actually the hairline receding. I am very worried as my wife has always told me she finds balding or bald men kind of repulsive (sexually). I of course went to my docs who took bloods and found everything was normal so i asked for a referral to a dermatologist but the only clinic in Portland OR cant see me for 4 months. I find myself in a catch 22 cycle of worry, please help.

My questions are as follows….,

May i be experiencing stress related hair loss and if so will the hair that has fallen out grow back?

If i shave my head now will that affect regrowth if it indeed occurs or will it just speed up the process of my ‘losing everything’?

I have read that Rogaine does not work on the front of the scalp, is Propecia my ‘best bet’?

Best Regards

You might be experiencing stress related hair loss. If you have the genetics for losing hair, stress induced loss might become permanent. Otherwise, it should hopefully be a temporary hair loss. Try to get your stress under control and have some patience that your hair may regrow within a year.

If you shave your head, you will have a shaved head with the same amount of hair follicles which will grow out to the same status as you are now, unless you are losing hair. Shaving the head doesn’t speed up hair loss or induce hair growth.

Before you make a decision on going on any hair medication, do two things:

  1. Send me photos of your head from various angles and with your hair pulled back and your eyebrows lifted high. Reference this post when sending.
  2. Find a doctor in your area that can provide a hair bulk analysis with the HairCheck instrument which will absolutely let you know where you hair is being lost, if at all.

I wait anxiously to hear from you, as it sounds like you are coming into a personal crisis.

Tags: hairloss, hair loss, balding, stress

Sebum Contains DHT, Which Is Why Women Don’t Go Bald?!

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

I receive oddly angry emails from time to time, and this one had the subject “WRONG!!!!” that appears to be in response to a post from 2007 — Does Sebum Build-Up Produce More DHT on Follicles?.

Actually the sebum in men contains DHT because it is caused by Testosterone in males…which is why women dont go bald..u should know that,

I think that you are confused. Here’s an article that discusses the relationship between dihydrotestosterone (DHT) production and sebum. Yes, the sebum contains DHT, but it is not the sebum that causes hair loss.

The androgens produced in the human body heavily impact sebum production (more about sebum can be found here). Women with conditions that cause ovarian cysts (PCOS) get balding just like men, but to a lesser degree.

Tags: sebum, hairloss, hair loss, dht, testosterone

I Read That Balding Comes from a Mixture of Genes from Various Relatives

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

Hi Dr,
In school we studied how MPB is autosomal and sex influenced, not X-linked. I also read that balding is mixed penetrance. Does this mean there is a possibility that an individual can get a mixture of hair/balding, from various relatives? For example if ones father has no hair loss but his maternal grandfather does.

Thanks for your time.

You are correct. You can inherit balding from either family lines and the genes may not express in your father or mother, but it may express in one or both of their parents. You could be a victim of these genes when you are old enough.

Tags: hairloss, hair loss, genetics

My Doctors Just Glance at My Hair and Say It’s OK, But I Know I Have Hair Loss!

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

Hi doc, I’m a big fan!!
I saw a post where you mentioned the importance of consulting a doctor before taking meds for hair loss but what is your take on people self diagnosing and self medicating? The doctors I go to don’t do miniaturization test or bulk analysis. Instead, they just glance at my hair and tell my hair is okay. But I am sure I’m having hair loss although my hair looks full.

I could find many miniaturized (thin and lifeless) hairs mostly among the MPB regions. They pull out easily. The density of hairs in the MPB regions is very less compared to the permanent zone. I could scratch my scalp and easily find fine unpigmented hairs with dandruff flakes. Also the MPB region alone is super oily.

I would classify myself as Norwood 1.5 with very minor crown loss. I have been researching online for more than five years. I already bought a strip of Proscar and am waiting to take it.

BTW I’m 25 years old from India. I wish I could come and consult at yours. Sorry for the boring post, but your opinion sure will mean world to me!

The ability to check for miniaturization is in an easily available electronic hand microscope. Place the microscope against a small pea size area of scalp, and look at it. Count the hairs that are thick and then those that are thin. Miniaturization is present when the percentage of thin hairs exceed 20% of the total.

An alternative would be to have one of your friends do it for you with a non-electronic hand microscope. There can be purchased in the US for about $7, but I am sure they are also available in India.

If you’re under a Norwood class 2, I wouldn’t consider that to be hair loss. That said, there could be a good reason for your doctors to not prescribe you the drug, and I would not suggest taking a finasteride (Propecia / Proscar cut into 4 pieces) without a prescription.

Tags: hairloss, hair loss, miniaturization

Does Good Laxity Prevent Large Strip Scars?

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

Does having good laxity prevent large scars ? I see a lot of people with small scars, and a lot of people with large scars where the situation is so bad that many are implanting beard hair to cover those scars. I’m thinking about getting a second hair transplant, but I am afraid after the second transplant I might get a big scar which is hard to cover up. The doctor said I have above average laxity, but below average density. My density again is only 60 grafts per square centimeter. Can you give me some information about what causes a bad scar ?

Generally, people with very high laxity (loose scalp) may have a higher incidence of scars than those whose scalp is tight; however, the looser it is the more grafts can be extracted with any given hair density.

Scalp scars can be very easily treated, if they occur, with Scalp MicroPigmentation (SMP). An example patient can be seen here.

Tags: scarring, scars, hair transplant, hair restoraton

In the News – Can Hair Loss Drugs Cause Injuries to Athletes?

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

Snippet from the article:

Arsene Wenger has warned that professional footballers looking to cure baldness with hair loss products could be putting their careers at risk.

The Arsenal manager made the shocking claim when discussing the nature of injuries in his weekly press conference ahead of Sunday’s game against Everton.

Wenger, who revolutionised the English game when importing new fitness and preparatory methods following his arrival at Arsenal in 1996, says some players are leaving themselves open to problems if they use products to reverse the process of balding.

And according to the Gunners boss, vanity could lead to injury.

Read the rest — Wenger warns stars over hair loss products

He says hair loss medications can lead to liver problems, though he doesn’t specifically say which medications he’s concerned about. As far as I’m aware, finasteride (Propecia) does not have any adverse effects on the liver.

Tags: hairloss, hair loss, soccer, football