Transplanting a Norwood Class 2

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

Dr. Rassman,
I am 21 years old and I have been losing my hair since I was 16. I am now a solid norwood II and I am getting to the point where my hairloss is a cosmetic issue. I started using propecia, but I experienced the side effect of gynocomastia which fortunately subsided when I stopped using the product. Unable to use propecia, I feel a hair system or a transplant are my only options. Am I a candidate for a transplant considering that my hairloss will have to be chased across my head with multiple and frequent transplants? Thanks for your site. It offers a much needed service.

There is a need to establish a good solid relationship with a good doctor for someone like you. Having tried Propecia and developed a side effect, clearly you are doing the right things. A good baseline for miniaturization needs to be mapped on your head. Both you and your doctor must be able to command just what is happening to you and project what might happen and when. With that relationship in hand, you will be in a better position to analyze your situation. I personally think that if you start off with a hair piece, you will absolutely accelerate the hair loss process. Again, get a good doctor and work with him/her before undergoing something as radical as a hair transplant at your age. With that said, anything is possible if it is well planned out with a good Master Plan for your future in hand.

Circular Spot on Back of Toddler’s Head

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

My 4 year old has developed an almost circular spot on the back portion of his head. It seems almost bald. What is it?

There are many causes of such balding, including genetic factors such as alopecia areata (or variations of this), fungal infections, etc. You need to take your 4 year old to see a dermatologist specializing in children and/or hair loss.

First Step for Teen with Thinning Hair

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

Hi doctor, I have been recently been encountering certain problems with my hair over the past 5 months, I am 16 years old (male) and currently starting my first year of college. First signs of change were with the texture and build of the hair, as it started to become much drier and thinner. Then the amount of hair that started to fall out naturally started to drastically increase, although I have naturally thick hair the changes that I am experiencing seem too unnatural, one example is the fact that I never really used to be able to see my scalp, now I am really feeling concious about it. I have great foundations of friendship in the school that I go to and the worry of acceptance isn’t preying on my mind too much. I have asked my best friend about it and she seems to see no difference in the appearance of my hair, but I still believe there is something wrong.

My grandfather had troubles with baldness as a teenager and was completely bald on the top of his head at age 20. Confident self image is something that I always like to pursue, I style my hair using straightening irons and using gel based products, which I have been widely recognised at school for, for the past two years. A balding head it something that is not really seen around my social groups, and I’m not quite sure how my friends would react. I haven’t consulted my doctor about it and I would really like some impartial, friendly advice on what to do next, whether I should consult my family or keep it quiet and hope it will go away. I would really appreciate your help in this matter as I have only spoken to one person about this and I haven’t been able to research it myself much. Thank you

Go get your head mapped out for miniaturization, which will show if you are in the early phases of genetic balding. Especially at your age, it is too important to guess or work the answer blindly through the internet.

Treating Alopecia with Acupuncture

/by William Rassman, M.D./4 /, ,

hi dr. rassman! i came across your website and i found it to be very helpful. im a 14 year old girl and about a month ago i was made aware of a bald patch at the crown of my head about the size of a 10p.a few days ago,i noticed that it had grown to about 2inches by half an inch. this is the only patch that i am aware of. im only 14 and i am sooo soo depressed about it and am constantly crying about my hairloss. ive been to see several doctors and i know there is no cure accounted for. today i went to a chinese health practice and went for a consultation with a chinese doctor, i was asked many questions about my diet and health and then acupuncture was suggested to me. i was very shocked and scared but went ahead with the acupuncture session there and then. and i was given a selection of herbal remedies to help with the alopecia also. what i would like to know is, how effective is acupuncture for the treatment of alopecia as i am extremely confused and scared as whether or not go ahead with regular acupunture. i am absolutely terrified of needles and i know i will be crying the whole way through, but if there is that possibility of my hair growing back again, i would definitly go ahead with the treatment. please please give me any advice you can im very scared that i will lose more hair and im confused as to what to do about it! please help im desperate

Acupunture should not help hair loss. Patches of hair loss are often caused by alopecia areata and this should be one of the diagnoses to consider. It sounds like you need a competent medical doctor to examine your case. It is impossible for me to make the diagnosis without seeing you, but if you send me digital photos to the address on the Contact page, I might be able to make a suggestion in the differential diagnosis.

See Through Hair and ‘Towheads’

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

Hello Doctor. I am a 20 years old and I had suffered from thin hair all my life. Since I was young, it was noticiable that I didn’t have a full set of hair, and as I grew older, my hair just mantained the same volume. There is no actual hairloss, but there is just not enough hair. Something maybe like half of the density it should have. I’ve been taking Propecia for 2 years now, and although the hair seems to be thicker, there is no hair regrowth at all. I’ve always wonder is this is something different from baldness, given that I dont lose hair; i just never had enough hair to look normal. If so, what are my options.
Thank You so much

I believe that your see through thin hair is just your genetics. Now that you are getting into the dating scene, you are more sensitive to your see through hair than you were before. We used to call people like you “towheads”, which implied see through hair. When I was young, people would always rub my hair for luck because it was thick, gorilla like and non-see through.

First, you need to have baselines made with good measurements for miniaturization, as I have talked about in many previous blog answers. It is critical to know if you are actually losing hair or just have thin hair and a changing view of your hair situation. This will give you comfort, at least, for knowing. If by chance that I have guessed right and you are a “tow head” and have no balding, then this is a situation that can be adequately address with hair thickening agents, of which there are many on the market today.

And yes, “towhead” is a real word. Here’s a link to towhead in the dictionary.

Going Gray and Losing Hair at 14

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

Hi,
I’m only 16 years old and i’ve noticed I’m losing alot of hair, more then the 100 hairs a day that is “normal”, probably about 400+ a day. My hair has been going gray since I was 14 years old and I’ve died it a few times using the same product each time so I don’t think thats the problem. Since it started (or maybe a day before?) it was VERY itchy, and has been since. Is there anyone you can recommend going to see? or anything I can do myself? As its obviously far from normal losing hair/graying at 14-16yrs old.

You have an interesting problem which is not common and so your first step (based on your symptoms) should be to go to a dermatologist. You should expect that they will want to get some blood tests and possibly do a scalp biopsy. The dermatologist will likely advise you to stop using the hair dye at least until a diagnosis is established since dye in itself can cause itching and hair loss in some cases.

Before you go, there is one thing you can do – perform a hair count. Here is how you do it:

  1. Clean your brush and shower drain of all hair and change your pillowcase.
  2. For one week, collect all the hair that falls out and place it into an individual baggy marked with the day of the week.
  3. At the end of the week, sit down and count EACH hair in EACH baggy — keep a tally.

If your hair loss is less than 100 hairs per day (and some experts say 150 hairs), this is considered a normal amount of loss. When you go to a doctor for this problem, this will also be useful information for them so you might consider making a copy of the tally or bringing the hairs in so that they can be examined under a microscope. Whatever you collect, the actual hair loss will be higher because hair falls out everyplace you go, so if you count 100 hairs/day, it is possible the actual loss might be double that number. You will want your scalp mapped out for miniaturization to determine if you have premature genetic balding.

Hope all goes well!

Risks and Pain in Transplanting a 50 Year Old

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

I am considering a hair transplant of 2200 grafts and am 50 years old. I am in good health and I have plenty of donor hair. I feel that this would make a tremendous difference in my hairline and appearance. What are the risks and pain involved for a man my age and with that amount of micrografts? How long would it take to heal? thank you

2200 grafts is a moderate-sized surgery that would likely take about a week to heal in the donor area. The risks for someone of your age if you are in good health are roughly the same as those for most other ages – to be more precise, there are surprisingly few. As with any surgery you risk the possibility of scar formation, infection, and possible adverse reaction to anesthesia or other drugs are very, very rare. These are the big ones we worry about and incidences are very uncommon in a proper surgery center and with a trained and experienced doctor and team. There is also no excuse for this elective surgery to be any more painful than a mild dental visit. Good pain medicines and effective techniques are available, well known, and should be used.

To be completely honest, your biggest risk is in the choice of your surgeon and the team they use. Choose a surgeon with a good reputation whose hairlines you like, and make sure they are willing to let you meet their patients and evaluate their results for yourself. Check the facility and ask the surgeon who is on the surgery team. An experienced staff makes all the difference in the world both in your experience that day and in your final result because of the way the staff members treat the grafts. Lastly, choose someone with whom you feel comfortable. Many of my patients who come in for corrective work had a less than good feeling when they went to their doc or they chose them solely on price. Remember, you are the one who gets to live with the permanent results after all, so be a little picky.

17 Year Old with White Hairs

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

I am a 17 year old male. I started noticing that I was losing just a little bit of hair when I use shampoo. I know its normal to lose a little bit of hair. I also started using a hair dryer to style my hair. I noticed that I was starting to grow white hair. I have only a few white hair right now. Is this normal? Does this mean I will be losing hair??

White hair has nothing to do with hair loss or the shampoo you select unless there is a bleaching component in the shampoo, which could bleach your hair. Some people genetically grow gray/white hair earlier than others. It is normal to lose up to 100 hairs per day. Excessive blow drying may affect your scalp and hair by making it more brittle, thereby leading to hair loss.

Advised To Not Take Propecia?

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

HI Doc,

Im a 20yr old male and have just noticed that my hair is thinning out and im losing it. My hairline has been reduced and in the middle and back ive lost a significant amount of hair too. I can see through my scalp now in many parts. Also, in the front you can see through my scalp and actually count the hairs that are in front! I look at my pictures from last year and even this summer and im seeing a huge difference! im really getting scared.

Im using rogaine now, started a week ago. I want to take propecia but been advised not to. i ve also looked in getting FUE or FUT! Please let me know what you think? And also do the hairs extacted from the donor area grwo back or not?

Thank you very much for this amaizng service!

Propecia is only for male patients treating male pattern baldness and it is the ideal drug to prevent or possibly reverse your hair loss.

I would say that you are too young to consider any type of hair transplant. At the very least, you should try the medications and then develop a Master Plan for your future with a good doctor. You need to be evaluated for miniaturization. I am the physician who helped shape the Follicular Unit Extraction (FUE) procedure, which extracts 1 follicular unit at a time using special instruments leaving very minimal scarring. The hairs are moved from the donor area — so no, they can not grow back into the donor area.

More information can be found at the links below:

18 Year Old With Hair Falling Out in Clumps

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

I’m only 18 years of age and have started to lose a lot of hair within the last 6 months. I’ve never really had a high hairline or anything. I’ve always had thick bushy hair at the front. I don’t think it can be androgenetic because everybody in my whole entire family, whether it be my parents parents or just my parents, all of them have a full head of hair. My brothers all have a full head of hair too and no sign of receding.

I was reading on the internet about hair loss and how it can be linked with cancer. I have found a lump and I was wondering if this could be anything to do with it. I have seen the doctor and he’s also bald (doesnt give me much hope) and had a blood test. It’s really depressing to find clumps of hair faling out each day and not growing back. If there are any solutions for regrowth please could you let me know. Thankyou!

If you are concerned that you have some disease, then first address this as your highest priority with a good doctor. Assuming that you have no medical problem, then you need to be managed by a doctor who can make the proper diagnosis (assuming that you have genetic hair loss) and then mapping out your head for miniaturization.

White or Gray Hair at 23

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

I have male pattern baldness and choose not to take medicines for it because im comfortable with my balding. But, my beard hair and some hair on my head is turning white /gray. i’m 23. what to do?

Dye your hair, as that is the only possible solution to color change and it is an art that has been around for years. Get a hand on how to do it for yourself, once you get it done by a professional if you are cost conscious. I have seen young men with black hair and white beards, so they keep their beards closely shaven, successfully hiding it from everyone.

Hair Loss at 19 from Vitamin Imbalance?

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

Hi, i first noticed that my hair was thinning when i was 17. Around the same time, i got this weird rash on the back of my head due to poorly cleaned clippers at a barber shop. Now i’m 19 and it’s really noticable that i am going bald. I can now see my scalp and my hair line has receded at least an inch and a half. I am very young. I believe it has to be a vitamin inbalance. Right now i’m taking ULTRA HAIR, which is filled with Biotin. I’m too scared to take rogaine or propecia, becuase i read that propecia can stop a man’s erection. What should i do? Who should i talk to? And do you think the rash has something to do with all this? The rash is still there. Thank you

If you review the Age category of this blog, you will learn that 17 year olds can get male pattern genetic hair loss. Assuming that you are male and receding, that is the most probable diagnosis. You need to get a diagnosis; you should have your head mapped out for miniaturization and attempt to get proper control of the hair loss with a drug like Propecia. If you have lost the first 1 1/2 inches of hair line, then you will go bald if you do not take a real proper action and get control of your hair loss. Playing with vitamins when you are losing your hair like you described, is like looking for fleas when a herd of elephants are chasing you. You should be running for you ‘life’ (and by that, I mean ‘hair’).

Propecia side effects have been covered on this site before: here, here, here, and here.

Would I Hate Myself If I Had a Transplant at Age 26?

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

I’m a 25 yr. old guy. I visited [a well known doctor] and he told me that if I had a hair transplant procedure, I’d “hate myself for the rest of my life.” Pretty harsh. I appreciate his honesty, but am disappointed that this is not an option for me. I’m confused! I would be more than pleased with the results that I have seen on various good physician web-sites. I’ll be 26 shortly, and am wondering what my options really are if the best results are so bad that I’d hate myself for the rest of my life.

You can always get a second opinion. If the doctor is well respected, there are a number of questions I first would want to know about you, so seeing a photo/meeting with you and speaking with you would be invaluable. Things that may make the doctor have hesitatations with transplanting a man of your age would be:

  1. Unrealistic expectations (which is why we don’t do computer imaging)
  2. Body Dysmorphic Disorder (see BBC News: Health)
  3. Poor donor supply (possibly from DUPA)
  4. Too early
  5. Unable to face the consequences of progressive balding
  6. Psychiatric problems
  7. Financial problems

Many times when I want to point a patient to a psychiatrist, they resist. After all, I am a hair transplant doctor and not a ‘shrink’, so it is not often that I give a special speech on this subject, and certainly not like the one the doctor you discussed gave to you. If you do not communicate with your chosen doctor, that would be one way for him to get your attention. Remember, you do have options, and if you are not comfortable with what you were told by one doctor, you are free to see another.

Tests to Run for 13 Year Old Girl Losing Hair

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

Dr. Rassman, my 13-year-old daughter (caucasian) has been experiencing thinning hair these past few months. Her dark wavy hair in the past had always been pretty thick. Her pediatrician ran anemia and thyroid tests which came back normal. We then saw a dermatologist who ran free testosterone and DHEAS–these too came back normal. The next step we are doing is seeing a endocrinologist (appt. not available until February). Are there some other tests that ought to be run in the interim, or should we see a hair specialist (do you know of any in the Metro Detroit area with a female (teenage) hair loss specialty?)

Her diet is fairly balanced, she has not experienced any stressful episodes, and she feels fine physically. I have recently been giving her Women’s 1-A Day vitamins since this problem has occurred. In the Spring of 2005, she began taking Cephalexin (Keflex) for acne. The dermatologist gradually reduced her intake, and she has recently stopped taking it entirely. Another note is we visit the Islands every February (during the past 7 years) whereby she has her hair braided. She would generally keep the braids in for a week, which looking back must have caused a lot of stress on her hair, but again, that would be 8 monts after the fact that the problem began. Thank you for any insight you may be able to provide.

-Very concerned parent

You daughter can go through periods of shedding hair and then reverse and regrow the hair. It is normal to lose up to 100 hairs per day. Now, if she continues to lose more than 100 hairs and she begins to show bald spots or more scalp, then it is a concern. There are many causes for hair loss in women as you outlined she is or has been evaluated for. The list includes: hypothyroidism, alopecia areata, telogen effluvium, androgenic alopecia, repeatedly over plucking, surgery, trichotillomania, stress, chemotherapy, radiation, cancer, eczema, seborrhea, scleroderma, lupus, hormonal imbalance, psoriasis, parasites, fungal, autoimmnune disorders, poor diet, poor nutrient, burn, trauma, leprosy and drugs. The common medications which may cause hair loss are beta-blocker, coumadin, oral contraceptive pill, antibiotics and chemo-medications. Braiding hair could cause permanent hair loss if it is kept for a long period of time and especially when a person has sensitive/weak hairs. I believe visiting a hair doctor in your area is a got start. A full analysis for miniaturization with a good microscopic evaluation of the scalp hair is critical in understanding the process. Continue with your present course and get the scalp mapped out as well.

18 Year Old Female with Thinning Hair

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

I am an 18 year old female college student and I have been noticing for about 3 months that right at my bang area, my hair is thinning and I can see my scalp. It not real bad, I mean you cant look at me and say your going bald.I am the only on that notices it. So yeah its not in horrible condition to where it is noticable. I just see it because of cousre I am a girl and look for things like that. What could it be: stress, diet, dying my hair? How can I help my problem? Please help me it bothers me so much even though its hardly noticable except by me when im staring at it…HELP!!

There is a typical female pattern of hair loss just behind the first 1/3 inch of hairline, in the area of the forelock. Whatever you have, you need to see a doctor who can evaluate you in person for miniaturization and determine if you do have female genetic balding. For your peace of mind, you should know that there are things that can be done for it. Overall testing of women for a variety of conditions are well discussed in this blog (see Female Hair Loss category).