February 2015 – Page 2 – WRassman,M.D. BaldingBlog

Beta Sitosterol and Propecia

Feb 16, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Hi Dr. Rassman , I have been taking one Tab. Beta sitosterol (375 Mg containing Total Plant sterols at 1000 Mg ) along with Propecia / Finasteride ( 1 Mg )every day daily , as I wanted to combine the Natural with the Prescription , Please note that I am taking Generic Finasteride .I have been doing this from the pat 4 months in the effort to Stop my Hair Loss , recently last few days I am Noticing quiet a bit of “Hair Shedding” in my shower , I am quiet Upset , Can you please tell me if the Beta sitosterol and Finasteride combo is Lowering the DHT Too Much and that is in effect worsening My Hair Sheds? OR do you think they both have No Connection with each other in terms of Action and Pathways of blocking DHT are different !? Can Too Low DHT cause the hair follicles to shed OR as Beta sitosterol Lowers Cholosterol also , Maybe the Lower Cholesterol is causing the sheds? Please Help me on this , I am in Real Distress !

According to WebMD, “Beta-sitosterol is a substance found in plants. Chemists call it a “plant sterol ester.” It is found in fruits, vegetables, nuts, and seeds. It is used to make medicine”. It is not a drug.

In general hair loss in men is genetic and there is no stopping it. There are medications such as Propecia (finasteride) to slow it down, postpone, or even grow hair in the short term, but in the long term the genetic predisposition will win out. This time course is variable for each individual.

I do not think drug interaction has much to do with genetic hair loss. Sometimes people try to explain or blame their hair loss with certain events or medications, but the most obvious cause is that it is just the way you were per-programmed when you were born with the genes. If you want to take this any further, the best recommendation is that you seek a doctor for an examination and possible treatment options.

Tags: propecia, Beta Sitosterol, finasteride

Scalp Micropigmentation If Patient Has Seborrheic Dermatitis?

Feb 13, 2015/by William Rassman, M.D./1 /Hair Loss Causes

I’d simply like to ask if a Scalp Micropigmentation procedure would doable despite a patients sensitive scalp due to seborrheic dermatities?

There seems to be no definitive answer I have on this so I ask on here.

Essentially my goals for hair restoration would be to fill in the frontal third + thinning midscalp portion of my head with a transplant procedure, and then either opt for Scalp Micropigmentation on the thinning areas moving forward – so I can maintain a buzzcut with texture and an illusion of density/hairs. This would be due to the fact that I would probably continue to lose more hair without medications (I’ve reacted very negatively to finasteride – lots of sides that I know aren’t smply in my head)

I am wondering if this would be achievable given the scalp condition w/ sebhorric dermatitis? I wouldn’t mind going for a scalp micropigmentation procedure with a respected clinic in order to create an illusion of a hairline with a buzz, but I want it to feel like it’s not simply flat skin, so I would combine it with some FUE.

Do you thing this is a realistic expectation?

Seborrheic dermatitis is an inflammatory skin condition. Many patients have successfully had a hair transplant and SMP with seborrheic dermatitis.

With respect to your specific condition and your expectation, I cannot comment since I do not know you nor have I examined you. Everyone is different and you won’t know the answer to your question unless you see a doctor face to face.

Tags: smp. scalpmicroigmentation, scalpmicropigment, seborrheic dermatitis

People Who Lost Hair In Later Years

Feb 13, 2015/by William Rassman, M.D./0 /Hair Loss Causes

As we commonly see that men display their balding pattern by their late 20s, it’s sometimes surprising to see how much hair was present in people’s old photos.

A most striking example is Mickey Rooney, who managed to appear in a very thick head of hair into his 30s, only to go Norwood 7 later in life. Richard Attenborough, who held quite a thick head of hair when he was 31, encountered a similar fate.

Then there’s nobelist Max Planck, who eventually went very slick bald, but only seemed to have a very persistent forelock in his 40s, Igor Stravinsky, to a less abrupt degree, and Eli Wallach, who… well, might have just worn wigs a few of times, after all.

What do you think, Dr. R? Are we seeing some of the more rare exceptions here, or is it time that we take a closer look at the pictures….

Most men (if they have the genes) will go through the hair loss pattern starting in their 20’s and 30’s. There are always exceptions to the rule. There are also wigs, make up, and creative hair styling that may confound the normal observation.

Tags: hair loss, hairloss, sickness, max planickm eli wallach, nobelist

Rubbing Eyebrows and Hair Loss

Feb 13, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Hi I really wanted to know whether gently rubbing your eyebrows while washing your face could do any damage to them in the long run and if I have been doing it quite frequently.

“Gently” rubbing eyebrows or just plainly washing your face and eyebrows (or any part of your body) should not damage the hair or cause hair loss. Habitual rubbing and pulling of hair over the long term such as in trichotillomania can cause permanent hair loss.

Tags: rubbing eyebrows, traction alopecia, trichotillomania

Advantage of Long Hair FUE

Feb 12, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Hello. What is the advantage of Long Hair FUE, don’t the transplant hairs fall out quick anyway? Is it to just avoid shaving? And can you not shave on both the donor and transplant site? Thank you.

One aspect of having a FUE procedure is that you need to shave the donor area. This can be a difficult proposition when you are having a discrete cosmetic procedure and have to go back to work in a week. Long hair FUE avoids shaving.

The recipient area does not need to be shaved.

Tags: long hair FUE, FUE

How Many Hairs Do You Need to Pull For a Hair Pull Test

Feb 12, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Dr William, in a hair pull test , If i gently pull around 60 hairs, so on how many hairs extracted out will the hair pull test be positive? I mean to ask if one pulls gently around 60 hairs so how many hairs will come out for the hair pull test to be positive?

Generally one does a pull test for the diagnosis of telogen effluvium. Usually pulling gentle on 10 hairs will yield a positive test if more than three of them come out.

Tags: hair pull test, telogen effluvium

Scalp MicroPigmentation Review of Hair Transplant Scar and Balding Areas (with photos)

Feb 11, 2015/by William Rassman, M.D./0 /Hair Loss Causes

This is a patient who had a hair transplant to the crown top areas at another doctors office. He didn’t get what he was promised : a full head of hair. Instead he was left with a hair transplant scar. SMP was used to add fullness to the hair line (a soft hair line) and provide even coverage to the thinning crown area. SMP addressed the linear hair transplant scar. You will always be able to pick up the scar in harsh lighting and at certain angles, but in general it is not as noticeable to the casual observer.

New Hair Institute Scalp MicroPigmentation

Tags: micropigmentation, smp, photos

Why Did I Become Almost Bald In Only 4 Months Since October Of The Year 2014

Feb 11, 2015/by William Rassman, M.D./0 /Hair Loss Causes

It is related to my poor dental condition : 7 teeth cured but 1 tooth was so ill that i had an horrible pain it was devitalized IN OCTOBER (i don’t know if this word exists in english but i can’t find any translation) and now i have got an infection below another tooth.

Please tell me. I have no more hair on the vertex just a little on the mid and front scalp but very thin. IN early October, i was very hairy but i was wondering if i was going to be bald because of my very first stage or maybe second of the balding scale.

No one seems to care about me, i’m a 28 y.o. man with no Girlfriend and i didn’t want to go through such a nightmare.

I am not sure how poor dental hygiene or cavities can cause hair loss, but probably wont help in attracting a girlfriend either. Certainly poor health and medical illness (such as “poor dental condition”) can cause stress to your body and thus hair loss; however the most common cause of hair loss in men is genetic balding where you lose the hair is a certain “pattern”. Men in their 20’s often experience this genetic Male Pattern Balding (MPB).

Tags: balding, poor dental condition, cavities

What Is The Value Of Follicular Units

Feb 11, 2015/by William Rassman, M.D./0 /Hair Loss Causes

What are Follicular Units?

In the picture below, the normal scalp hair that is being parted with the hand. Note how the hair seems to grow as single strands.

The hair in every person’s scalp grows in tiny bundles called follicular units. Although this had been recognized for some time by histologists (doctors who study human tissue), the existence of follicular units was largely ignored by physicians performing hair restoration surgery.

The follicular unit of the adult human scalp consists of 1-4 terminal (full thickness) hair follicles. In areas of the scalp affected by genetic balding, the healthy terminal hairs are gradually replaced by hairs of smaller diameter and length called “miniaturized” hairs.

In addition to the full terminal hairs, the follicular unit contains 1-2 fine vellus hairs, sebaceous (oil) glands, a small muscle, tiny nerves and blood vessels, and a fine band of collagen surrounding the unit (called the perifolliculum). The follicular unit is thus the hair bearing structure of the skin and should be kept intact to insure maximum growth.

The follicular unit is seen on the surface of the scalp as a tiny group of hairs that appear to be growing together. They are best viewed under a microscope where they are seen as well-formed structures in the skin.

The close-up view shows the hair actually emerging in small groups called Follicular Units.

With the hair clipped, the natural hair groupings are visualized on the surface of the skin at 30x magnification through an instrument, invented by Dr. Rassman, called a densitometer.

Tags: value, follicular units, normal scalp

Scalp MicroPigmentation Review From A Happy Patient (with photos)

Feb 10, 2015/by William Rassman, M.D./0 /Hair Loss Causes

It’s been over a year since my first SMP procedure and I scheduled a followup procedure for 02/05/2015. I really feared showing up (driving the 2 hours at 4am) and Dr. Pak saying it looks fine and there really isn’t much to do here. For the most part it looks to me the same as the day I got it.

However, Dr. Pak and his staff examined my head with a critical eye and definitely saw the fading that happens from exposure to exfoliation and UV. Now that I see the new final result, my jaw again drops to the floor. It looked good before, but now it looks amazing. One of the big things that I noticed is the difference that occurred in the camouflage of the scar. It’s very hard to see the fading that occurs when you see your own head day to day.

The touch up procedure went the as smoothly as the 4 days of initial application. This one started at a little before 7am and ended at 2pm. The day started with gas and lidocaine. A few booster shots shots over the day to keep the “numb buzz.” The lidocaine really seems to fade for me when eating lunch. Christine and Len worked on me continuously for that time except for the lunch break. I feel asleep multiple times as the tattoo needle is almost a pleasant vibration once you have the lidocaine and I woke up at 4am to get there. FYI, Len is a new addition to Dr. Pak’s staff (as of last April) and just as pleasant and diligent as Christine.

I brought my daughter (aka car pool lane buddy) again. We were both amazed at the kindness and service at Dr. Pak’s office. We both smiled at looked at each other when each of 5 different people (including Dr. Pak) offered us a beverage when we started. They bought my daughter and I lunch (Burgers from The Counter) and served it to us in the chair. Then there is the ice cream dessert and candy bowl to boot. We watched some YouTube and Netflix during the procedure when I wasn’t sleeping.

As an update on me, personally. I have never looked back at hair. I don’t think I have had it longer than three day’s growth over the past year. My hat collection is collecting dust and I have a nice collection of sunscreen to replace it. There is always something, eh? On other people detecting the work, I have dated a few women over the past year, all ask about the scar, but none know about the SMP. I end up explaining it just for grins.

I highly recommend Dr. Pak and his staff; they are diligent, hardworking and are continuously looking to make the procedure as pleasant as possible. Now (a year later) I realize the value and foresight that Dr. Pak provides by allowing his clients a simple and easy way to maintain the SMP look.

NHI Scalp MicroPigmentation

It’s always good to hear from our patients. The entire staff takes personal pride in what we do and we form a close bond with our patients. Thank you for sharing your experience!

Tags: scalp micropigmentation, SMP, happy patient, patient testimonial, photos

I’m 24 Year And My Father Is Balding – Will I Also Bald?

Feb 10, 2015/by William Rassman, M.D./0 /Age, Hair Loss Causes

I am 24 and my father has a receding hairline and there is balding on his side of my family. Will that happen to me?

I see many young men like this man with a what appears to be a full head of hair. He was concerned that he may inherit his father’s pattern and does not want to go bald. He wants to be proactive on the use of drug. When he asked me about the drug finasteride, I originally told him I would not prescribe it unless I was certain he was balding. From what I saw on my first impression, I did not think so, but when I did bulk measurements of his hair, I found that despite the visible full head of thick hair that I saw, he actually lost 45% of his frontal and crown hair. With that knowledge, I prescribed the drug finasteride and he was very grateful.

Many readers routinely send photos for me to diagnose their hair loss condition. I cannot do this with photos alone. I would never have thought this patient was balding by just looking at him. It was the measurements and examination that made the diagnosis.

At the age of 24, his future is uncertain with regard to hair loss, but with thinning in the top and crown of his head at this time, he does run a risk of a more advanced balding pattern over time and this test shows clearly the value of early diagnosis to try to prevent his probably outcome or at the last slow it down. Early diagnosis is best done in the doctor’s office who offer a ‘hair bulk analysis, which can identify hair loss before it becomes visible to the naked eye.

Tags: bulk test, balding, father, photos, hair bulk analysis

I Would Have FUE If I Did Not Have To Shave And Stop Exercising

Feb 10, 2015/by William Rassman, M.D./0 /Hair Loss Causes

I love the idea of FUE but I don’t want to shave my head. IS there a way around shaving my head like a strip surgery without the pain.

Shaving your head is no longer necessary with our ‘Long Haired’ FUE (Follicular Unit Extraction) technique. That means we pioneered and mastered a new technique to keep the hairs long while still giving the benefits of FUE. With this technique (limited to under 1000 grafts), you can have a hair wash the next day and even go to work in a day or two after the procedure. As you know, FUE has the advantage of mostly being painless after the surgery unlike the strip where you can feel some discomfort after the surgery. Also with FUE, there are no exercise limitations within a few days of the surgery. This is particularly good for professional athletes who need to keep up their exercise program after the procedure (see: HERE).

Tags: fue, shaving, long hair fue

Can Rogain Cause An Elevated Red Blood Cell Count?

Feb 9, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Hello Dr William, I m using minoxidil 5% spray and recently I had a cbc and found elevated red blood cell counts. Could it be a side effect of minoxidil 5%?

Throughout the years of answering BaldingBlog, I often do not understand how one correlate one phenomenon with another. Elevated red blood cell count can be due to many causes and Rogaine use is not among them. In fact a rare side effect with the oral use may be a slight DECREASE in the red blood cell count which returns back to normal.

Taken from the MayoClinic website:
A high RBC count may occur because:

Red blood cell production increases to compensate for low oxygen levels due to poor heart or lung function
Red blood cell production increases to compensate for lower oxygen levels at higher altitudes
The kidneys release too much of a protein (erythropoietin, or EPO) that enhances red blood cell production
The bone marrow is producing too many red blood cells
The oxygen-carrying capacity of red blood cells is reduced
The loss of blood plasma (the liquid component of blood), often due to sodium and water depletion, results in the appearance of higher levels of red blood cells

Anabolic steroids, which stimulate red blood cell production
Carbon monoxide poisoning
Congenital heart disease in adults
COPD
Dehydration
EPO doping (injections of erythropoietin (EPO) to enhance athletic performance)
Heart failure
Hemoglobinopathies (conditions present at birth that impair the oxygen-carrying capacity of red blood cells)
Kidney cancer
Kidney transplant
Living at a high altitude, where there’s less oxygen in the air
Other types of heart disease
Other types of lung disease
Polycythemia vera
Pulmonary fibrosis
Sleep apnea
Smoking, which may result in low blood oxygen levels

Tags: rogain, rogaine, blood count

Did You Ever See A Completely Bald Man Grow His Hair On Finasteride?

Feb 9, 2015/by William Rassman, M.D./0 /Hair Loss Causes

Did You Ever See A Completely Bald Man Grow His Hair On Finasteride?

I say a man who at the age of 73, went on Proscar for a Prostate blockage (Benign Prostatic Hypertrophy) who grew hair on the front and top of his head within a year or starting the drug. I knew personally, and he was proud to show me what he grew on his own without a hair transplant. Another doctor reported a patient named ‘Joe’ who was around 58 when he first met him 1990. His entire U-shaped scalp (Class 7 pattern of balding) had been totally shiny bald for the previous 20 years and was such when that doctor examined him. Eight years later, he got a letter fromn the patient saying that his urologist had put him on finasteride 5mg a day for his prostate and he was amazed at all of his hair grew all over the crown. The doctor received pictures which validated these claims.

So to answer this question, I would rather ask Urologist just how often they see this phenomenon. It is clearly not totally rare.

Another Doctor Adocates Taking Avodart For Hair Loss, What Are Your Views?

Feb 6, 2015/by William Rassman, M.D./0 /Hair Loss Causes

I have read other doctors views on Avodart: Taking Avodart every other day will lower your DHT 80% and taking it daily will lower it 90%. The reason for taking either finasteride or dutasteride is to lower the DHT levels to a point where male pattern baldness is stopped. For 85% of men it only requires 1mg finasteride to lower the DHT 66% to accomplish this goal. For those men who continue to lose hair I advise gradually lowering the DHT by first taking the 5mg finasteride daily as you did, to lower the DHT by 72% and then to add Avodart once a week for a month, then twice a week for a month and then three times a week the third month.This gradual decrease of DHT rarely causes any more side effects than were noted when the patient was on only the 1mg finasteride. I think all men should respond better to dutasteride than to finasteride. The dosage will depend on the level of suppression you need to stop male pattern baldness and not have any side effects. I do not know of any source of topical spironolactone and would be wary of any absorption of it as it blocks all androgen receptor sites. I’d advise continuing with your plan to add dutasteride to the point of taking it every other day alternating with finasteride. That should lower your DHT nearly 85% What are ur views on it?

Many doctors prescribe Avodart for hair loss. I generally do not believe it adds much benefit. Everyone is entitled to their own opinions and practices. In my opinion, although Avodart blocks more of the DHT than finasteride, it does not block 100% of DHT (probably 80-85%) will likely still cause genetic hair loss once it has started.

Tags: avodart, finasteride, dutasteride, spironolactone

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