Hashimoto’s Disease in Women

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

I am a woman, 40 years of age, and having a hair loss problem for over 18 years. I used to have very straight and thick hair, but now very thin and fluffy. I tried too many kind of shampoos, vitamins and programs. One of them, 101product, was no help. I have had an autoimmune disease called HASHIMOTO for 16 years. I’m taking medication and everything is under control. My doctor told me after he did all kinds of tests that i don’t have any physical problem causing my hair loss. My question is what do you think could help me? My sister has the same problem and she doesn’t suffer from anything physically.Your replying back will be appreciated.
Thank you

You may have both female genetic hair loss plus Hashimoto’s Thyroiditis and your sister may have the genetic element, which tends to run in the female line in particular families. The existence of Hashimoto’s Thyroiditis or any auto-immune disease can precipitate hair loss. Medications that treat these autoimmune problems often have hair loss as a side effect. Woman’s hair loss is extensively discussed here and I suggest that you and your sister read my many answers to questions which will contain many bits of insights for you here.

Transplanting Females with Diabetes, High Blood Pressure, and Glaucoma

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

Hello I have several more question I need answers for before I consider a transplant procedure. Can you preform this procedure if you have diabetes or high blood pressure and glaucoma and if not do you have another kind of treatment for a candidate like me. Is there a medication in a different form? I am female.

I am assuming that the hair transplant is appropriate and you are concerned about the existence of the medical problems. These problems are not contraindications for hair transplants which are performed under local anesthesia. I have my diabetic patients continue to eat and take the same medications that they would normally take. I would expect that the blood pressure is under good medical treatment and that the glaucoma is also well controlled. In people like you, any problems have not been different than in people without diabetes or high blood pressure.

Hair Loss After Chemotherapy

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

I was diagnosed with small cell lung cancer in July 2005 and began chemo and lung radiation shortly after that. I lost my hair after the first month of treatment. After my chemo, my hair started to grow back, only for the doctor to tell me that I needed to do a 3-week round of brain radiation as a percautionary measure since the lung tumor was gone and there seemed to be no other organs affected. I finished these treatments about two weeks before Christmas 2005. I totally lost all of the hair that I had grown back, yet again. Well…here it is February 19, 2006 and still no sign of any hair growth at all. My question is this: How long before I should consider this a permanent condition? I’ve basically already given up hope and kissed my long blonde hair goodbye. I would just like to know how long I should wait before I consider the fact that I might not be growing back any hair ever. Thank you.

I am sorry to hear that you have small cell lung cancer. After cancer treatments, hair can go into a dormant phase for many months. You may have to wait up to 6-8 months for hair to regrow. Some people will have all of their luxurious hair grow back once the effects of chemotherapy have gone. Let’s hope that this is in your future along with a healthy body.

Alopecia Areata Doctor Recommendation

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

Dear Doctor,
About four years ago my sister’s hair started to fall out in chunks, expecially in the back. She has very large bald spots all along the back, and the top hair is very thin. At first nobody wanted to treat her, but then a doctor told her she had an auto-immune disorder – alopecia – and that there really was not any cure. She has tried steroid injections in her head, all sorts of topical solutions, and is now doing Chinese herbs. She is in her early 30’s and I know the hair loss has really taken an emoitonal toll on her. Do you recommend any doctors in the San Diego area who specialize in these types of problems, or any solutions?

Thank you very much.

It sounds like she has Alopecia Areata. This is a difficult disease to treat. One doctor at UCLA has specialized in this, Dr. Richard Strick, and as you are in southern California, I would try to make an appointment with him. He has developed special protocols for this disease and I have sent a few patients to him who have achieved remarkable results. He is also on the National Alopecia Areata Foundation medical advisory board, where his contact information is toward the bottom of this page: NAAF Scientific Advisory Council 2005/2006.

I’ve Had Alopecia for 15 Years

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

I suffer from hair loss for more than 15 years ( I am 36 years of age, female). I have been to a specialist here, in Uk, just to be told that I suffer of alopecia (no reason for it)and there is no treatment for it. Hence i never tried anything…But in the last 2 years the situation has worsen and I became desperate. Could you give me an advise, please?

Rogaine (minoxidil) works in about half of the women who use it. Try it, but apply it twice a day and keep on it for at least 6 months to see if you get the benefit.

Hair Loss and an Enlarged Prostate

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

Sir: I am 60 years old with enlarged prostate. I am taking the following: 5mg proscar, 5mg avodart, 4 gel caps saw palmetto, 81 mg aspirin, also terezin for blood pressure. My urine flow is back to normal, however I have not noticed much hair growth in 3 months on these drugs. I have typical male pattern.What do you recommend?

Many men with hair loss, when starting the types of medications you have, will grow hair as a side effect of these medications. The converse of your presentation is also common. In patients we start on Propecia, they get improvement on their prostate problems and their urinary retention improves with the hair treatment. In your case, if the medications failed to grow hair, then only hair transplantation may solve your problem.

Folliculitis Decalvans

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

Hello Doctor,
I am a 22 yr old African American that has been diagnosed of folliculitis decalvans. I am losing my hair at my crown area at an ernomous pace through scarring. I have had this for several years (8yrs). I have been on several medications but they only seem to have an impact in the beginning. Please is there anyway of aggresively treating this disease as well as recovering my hair in the scarred regions. If you have any dermatologic recommendations around the Tri-state area i would be grateful. Thank you.

This is a difficult problem and you must find a doctor with a particular interest in this disese as well as the training to deal with it. Check with the American Academy of Dermatology for a referral channel for this problem. If the dermatologist is uncomfortable with this, then he/she should refer you to an appropriate expert.

Inflamil and Hair Loss

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

Ive read articles indicating that inflammation of the scalp is a contributor to hair loss. What are the effects of scalp inflammation? If inflammation affects hair loss can anti-flammatories such as Inflamil help?

Yes, certain types of an scalp inflammatory conditions can cause hair loss but it is not a diagnosis, but a symptom as I believe that you are using it. They may include auto immune diseases, dermatitis, eczema, psoriasis (with a great deal of scratching) and infection in combination or alone. Inflamil, according to info I found on the web, has the following ingredients: 10% Feverfew, 10% Thuja Occidentalils, 10% Epibolium, 5% Green Tea Extract (see green tea catechins) and 1% Mentholum verum. It may work but you would be treating something blindly with a series of ingredients that does not have documented safety and effectiveness clearly defined. In other words, you will not know what it is that you are treating nor what effect these ingredients are having. I would doubt that auto-immune disease will not be impacted by these ingredients nor will some of the other problems that cause scalp inflammation. Again, the diagnosis of an inflamed scalp is only a symptom of something that may be going on. You need a diagnosis.

Lichen Planopilaris and Hair Transplantation

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

I am a 55 1/2 yr old female. I have been diagnosed with “lichen planopilaris”. I am tired of scalp injection. My doctor said the next step is probably 3 hair transplant. There seems to be no information on this disease. Is there anything else that can be done? In addition, I am on a generic rogaine formula. April will make 1 yr. on this product.

Any advice? Also, I know the cost for a transplant vary with different results.

See DermatologyChannel.net for more information on this disease. The problem with transplantation is that if the disease is active and is autoimmune in etiology, then a hair transplant may be doomed from the start. Inactivity of Lichen Planopilaris in the autoimmune arena must be determined before starting the costly hair transplantation process. If you and your doctor believe that it is under control and inactive now or sometime in the future, a test hair transplant with a limited number of grafts (about 10) taken with an FUE approach will tell you if a larger hair transplant procedure will work. Either these grafts will fail to grow (indicating that the disease is still active from an autoimmune perspective) or they will grow (indicating that the disease has become inactive). It should take 5-8 months to determine success or failure of the transplant. For those people who have an autoimmune cause, reactivation of the process is always an added risk.

Scalp Psoriasis in Women

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

I have been diagnosed with scalp psoriasis. I use a variety of topical ointments to keep it under control and it seems to be doing much better. However, I have lost a lot of hair because of this condition and now have a very thin area on the side of my head near my part. My question is, will using a hair growth product like rogain for women help “jump start” new growth in this area? And I also wonder about what I have read that once you start using Rogain, you have to use it forever or the hair will just fall out agian? Thank you so much for any advice you can give me

First, a doctor should determine if you have other causes of hair loss since psoriasis, by itself, rarely causes it. Most people with hair loss and psoriasis either scratch the skin constantly, pulling out hair and that can cause traction alopecia or they may have another condition that may be the cause of hair loss.

For women, you need an accurate run down on your hormones to rule out other diseases such as thyroid disease, etc. Make sure that you are not on a bizarre diet, as weight loss is a cause of hair loss. Both men and women need to have their scalp and hair checked out for miniaturization, looking for genetic hair loss causes. Other autoimmune and inherited conditions can contribute to this as well. Never assume the obvious, for the price is too costly in non-reversible hair loss.

For information about using Rogaine with psoriasis, please see: Psoriasis and Rogaine.

Thinning Hair Since High School

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

Hi, Im 21 and I have had thin hair since atleast 9th grade. It has gotten progressively thinner since high school, but my hair line is not moving. Rather, I experience a general thinning all over like you see in old women. I know i get it from my mothers side because she also has really thin hair while my father has a healthy head of hair. What is my best option to stop this gradual thinning?? My dad is a doctor so he prescribed me Propecia which i used for 5 months with pretty much no results. I feel that most of the products on the market are aimed at male pattern baldness while there is nothing for men like me. Could you please recommend a course of action. Thanks alot.

You need to get a proper diagnosis. Get your head mapped out for miniaturization and determine if you have Diffuse Unpatterned Alopecia (DUPA). This is a condition that is similar to female genetic hair loss, except that it occurs in men of all ages. Rather than write a book on your management, I suggest that you get your doctor (father) to connect with us. Have him start by reading the article I wrote titled Follicular Transplantation: Patient Evaluation and Surgical Planning?” and find DUPAwithin the text of the article.

DHT, Hair Lasers, Chemotherapy, and Finasteride

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


I have a few questions about androgenic alopecia and I’d be very happy if you could answer them for me:

1. What is a bigger factor for hairloss the quantity of DHT in the serum or in the scalp? If the scalp had levels of DHT at 0% would this stop hairloss? If that is the case is there a topical drug like Rogaine with finasterid instead of minoxydil and would it decrease scalp DHT levels better than oral tablets?

2. What is your opinion on the Lasercomb device that uses lasers to improve blood circulation in the scalp? Since minoxydil also improves blood circulation and is supposedly ineffective on the frontal area of the head would this device have the same downside?

3. Father of a friend of mine had cancer and had to undergo chemotherapy. My friend told me that chemotherapy improved his hair and even made it grow darker than before. Could there be any truth in this?

4. With propecia losing its effect over time I often see that people increase the dosages of finasteride up to 5mg per day. Would these higher doses really help or are you just putting your health at risk?

This is not really a question just observation on my part: everytime I see the after and before pictures of hair transplants the comparisons aren’t realy fair since the before picture usualy has more intensive lighting and hair combed straight forward or back and is often greasy while after picture has less intensive lighting and different position of lights and hair is combed to the side and it looks like it has just been washed. It would be nice if all pictures would be made with people having wet hair combed straight forward or back so people could really see the difference.

Thank you for your time and answers.

Whew! You need a whole hour-long cosultation with a hair doctor to answer all of these questions, but I’ll try to give you some short answers in the meantime.

  1. DHT and genetics are the biggest factors in hair loss. DHT is a hormone that is present in your blood (which flows through the scalp but does not reside there). There are no topical formulations of Finasteride (the molecule is too big). Any topical medication for hair loss would need to be a small enough molecule to penetrate the skin and have an effect. Minixodil does penetrate – which is why it works. Rubbing Finasteride on your head will not help and it will waste the Finasteride.
  2. Do a search for “laser” here. To reiterate, there is no conclusive data on the effectiveness of laser therapy for hair growth.
  3. Chemotherapy can occasionally change the character (color, curliness, thickness, etc) of hair in addition to many other unusual side effects. However, the idea of taking chemotherapy just to improve your hair is ridiculous. Chemotherapy drugs can kill you, they are used when the alternative is death. Hair changes post chemotherapy are absolutely the truth, though.
  4. Propecia may lose its effectiveness over time (the data presently now goes out only 7 years), and some patients continue hair loss, hopefully at a slower rate. There is no evidence that higher doses will reverse this, but neither is there evidence that higher doses of finasteride pose an increased risk to health.

Finally, your observation is correct – there are methods of taking photos which will give the misleading impression of increased hair density/thickness/coverage. To really compare, similar photos need to be taken in similar lighting conditions with duplicated angles and styles. Wetting hair before and then showing dry hair after is an especially obvious tip-off that the comparison is invalid!

Discoid Lupus and Hair Loss

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

Female. I was diagnosed with Discoid Lupus Erythematosus about 4 years ago. It started out as a little bald spot, now most of my hear on the top is gone. I am not sure what to do, I have at the cortizone shots, I have used the clobex shampoo,noting is working. I am constatly getting new bald spots it appears to always be active. Is there anything I can do to slow down the hair loss? I have kept my hair short for almost 20 years. I am tryin to let it grow back enough to be able to push the front part of my hair back to cover up the spots.

Autoimmune diseases are a known cause of hair loss and a difficult problem to control. To get control of the hair loss means getting control of the autoimmune disease. This requires the expert hands of a doctor specializing in such diseases, such as a dermatologist with a particular interest in this.

Hair transplantation works if the disease in the scalp has been inactive for a number of years and this is best determined by biopsies along the edge of the bald area where normal hair may exist. The presence of inflammatory cells may show active disease (from your history this is your case) so a number of areas must be biopsied (must wait until the disease becomes inactive). When the disease become inactive in the scalp (it may remain active elsewhere), biopsies will show that it is inactive. With inactivity present for at least 2 years, a series of test hair transplants will show if the skin will support hair transplant. Representative areas must be selected for the test transplants and FUE can be the source of the transplanted donor hair. Before embarking on this process, however, a supply/demand assessment must be made with goals clearly defined. With a disease only 4 years old, it is probable that you will have to wait some time before undergoing any type of restoration assessment and hopefully when it reverses, you will see some hair return in the affected areas as an indication that inactivity in the scalp may be on the horizon for you.

I have successfully transplanted a series of patients with inactive alopecia areata with nice results. I would suspect that you might be a candidate some day if you are fortunate enough for the process to stop progressing in your scalp. I have no other suggestions for the moment other than continue with your treating physician and have hope.

Hair Transplant After Alopecia?

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

I have several bald spots at the back of my head.I went to see an MD and a blood test was done all are normal and MD said that i am having alopecia. What is the approximate price of hair transplantation? i am only 26 years old / female and i don’t want to be bald this early in life. please respond. thanks

There are many types of alopecia. If you have one of the autoimmune causes of hair loss (that is what it sounds like), then hair transplantation does not work until the disease has burned out (generally you must wait for at least a couple of years and be certain that the autoimmune process has ended often requiring a biopsy). I need more information on the type of alopecia you have. See the Female Hair Loss category for the answers to your concerns that may have already been written.

Hair Loss After Adult Chicken Pox

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

When i was i think 19 i had chicken pox. i had a fever for about two weeks. after i recovered, one day when i woke up i saw my pillow had many hairs on it and when i combed my hair, many hairs fell out. before i had chicken pox my hair was very thick and long, but now is not so much bald but the thickness is gone. my hair in front of my head is in the shape of an M. and my hair in the top is not very thick now. im 22 now.

What you describe is very common. Significant illness or stress to your body can precipitate a “telogen effluvium”, also known as a “shedding phase” which is transient – it grows back. Now, several years later, the “M” shaped hairline you describe is consistent with male pattern balding – another common condition. These two conditions are likely unrelated. Hope that helps!