Doctors That Use the Densitometer

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

Dr Rassman
Do you have a list of doctors in the US that use and are skillful with the Densitometer?
Thank you

Go to the ISHRS website to look up doctors who specialize in hair diagnosis, treatment or hair restoration. Good dermatologists should also fall into this category. When you call their offices, before you make the actual appointment, ask them if they map out the degree of miniaturization on the scalp for quantifying the extent of balding or thinning. That is a better probing question than asking about an instrument I invented, since other doctors may not know it by the actual name I gave it. (FYI, the U.S. Patent I obtained for this was U.S. Patent #5,331,472 ‘Method and apparatus for measuring hair density’, issued July 1994).

Maturing Hairline at Age 21

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

Hi there. I’ve browsed around your site a little bit, and I’ve found some interesting information. However, to be honest, I am even MORE paranoid now about losing my hair! I am 21 years old, and I have always had a full head of thick hair. But within the past year I’ve noticed my forehead getting larger…or, as you’ve already deciphered, my hairline receeding. Nobody I know has noticed it because my hair is long, and its more on one side than the other. It is at the very beginning stages of receeding, but I wanted to see what kind of advice you had for me at THIS point. Should I already start taking propecia at 21? My dad and my grandfather on my mother’s side both have full heads of hair, but my mom’s brothers and my brother are balding. Are there any type of topical creams that are known to work at ALL??? or is it all just a waste of time and money?
Thanks for your time

Panic will not be productive. If you have a problem, you need to get a diagnosis in hand by a competent doctor and then you respond properly. A rising hairline does not mean that you are balding, as you may be transitioning to a mature hairline, which by its nature causes the hairline to rise about 1/2 to 3/4 inch from its childhood location. Whether you have genetic balding in your family or not, males develop a higher hairline between the ages of 17-29 (on average). This gives them that “distinguished” look that younger women talk about being attractive. This is normal (and actually desirable) and is not anything to be concerned about.

You should see a doctor and have a good microscopic evaluation of the scalp. If you only have a maturing hairline in transition, then there will be no miniaturization in the remaining parts of your scalp. Take charge, get a good doctor and find out if there is a problem before you jump to do something that you may regret.

Do Transplanted Hairs Fall Out When Washing?

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

Hello Dr. Rassman

You are really doing a great job in this informative blog, thanks a million for that. Have had a recent HT procedure for about 1500 grafts by strip excision method that were implanted along my temples in addition to the frontal hairline. So far everything seems to be going fine as i approach my 8th week post-op except for one slight problem. Just like any other HT, the grafted hairs begun to shed within the first 4 weeks & i was left with only about (20-30)% of the total amount, now i started seeing new hair growth of very fine hairs but the problem that these little stubbles-like hairs are easily fallen as i wash/shampoo my scalp, are the implanted follicles intact? will new firm hairs grow later?

With Regards

Thank you for your kind words.

Now that you are in your 8th week post-procedure, I would not worry about losing the transplanted follicles, as they will regrow over the subsequent 2-5 months. In general, a small percentage of all normal hair comes out when you shower, when you walk along a windy path, or when you comb or brush your hair. The same number of hairs start into anogen (growth) so that the total population stays the same (about 100,000 hairs). When your transplants grow, they will behave as your normal hair does and cycle the same way, some falling out while an equal amount will regrow. In the normal, full haired adult, about 100 hairs per day come out that way. If you have hair loss for any reason, be gentle with brushing and washing, as vigorous handling will negatively impact genetically ‘fragile’ hair.

Nizoral, Milk, Cows and Hair Loss

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

Hi Dr. Rassman,

I have a couple questions to ask you regarding my hairloss situation. First of all, im 21 yr old male. I recently began losing a lot of hair suddenly throughout my whole head at about 8 months ago. I have been on propecia for 7 months now. However, the majority of hairs that fall out(about 75%) has a white hard mucus substance that can be scraped off from the end of the hair. I lose about 150ish hairs and they are basically always all the same size hair. I also seem to have a lot of dandruff (im assuming, white mucus-like flakes) that fall off also with the hair.
I just went to a dermatologist the other day and had him look at everything. He looked and sifted through my temple region hairs with just his eyes but didnt really look closely at anything else (no magnifying or anything). When i asked him about the white mucus stuff, he said it was normal to have that. (For the record, i know that hair has little white bulbs on the end of a hair, but this isnt the case here. it is real scrapable stuff, NOT the bulb)I then asked him about taking a scalp biopsy and he told me that that wouldnt really show anything. I then asked him about measuring my level of DHT in my body to see if its really high and he said that also wouldnt show anything because it doesnt matter how much DHT we have in our system, it only matters how much the hair follicles react to that DHT. He then gave me a form to get my thyroid, iron, and blood glucose? tested, which i will do now.
He then concluded that the acne on my face that is deep down inside my skin (never been able to get rid of it) could have something to do with my scalp and the flakey-ness as well as the mucus on the hair pieces so he prescribed me Nizoral 2% shampoo as well as Nizoral pills to get deep down and clear out my face and anything in my scalp. He also believed that milk could be playing a part in my hair loss because of the hormones milk has and how it bypasses the DHT blockers in propecia. (I do consume a lot of dairy products) He was very adamant about it and said how americans are much more balder than other countries and how the US drinks much more milk than others, etc. and how he is planning on doing a research project on it with candidates, etc. So he told me to stop all intake of milk, cheese, ice cream, etc. and see if it improves in the 2 months when i see him for a followup appointment. I asked about the loss of calcium etc. and he said that i would be fine without it and the loss of dairy products wouldnt have that big of an effect. (i could get it from other food products, etc.)
What im wondering is if what you think of my situation and about the dermatologist. I was just a little taken back about how he didnt give me a scalp biopsy, or look in a magnified glass to see deep down in my scalp. I dont doubt his intelligence because he told me that he was one of the doctors that got the creation of Nizoral, etc. and he is very well known and popular. (takes 3 months to get an appt.) I was just wondering if you agree and what your thoughts are on what he said about the different tests and if the examination of me seemed correct because i really wanted a biopsy and DHT test since i heard it worked well. Also, what are your thoughts of the acne issue and besides the thyroid, iron, and blood glucose tests, are there any other tests or procedures done to see if my hair loss is normal. And lastly, what is your opinion on my hair loss situation and is this normal? If that white mucus stuff isnt normal, does that mean that as each one of those hairs falls out, does that mean that particualr hair will never grow back? (is that the hair follicle or something meaning permanent loss?) I will send you a picture of my hairs and of my scalp.
Thank you so much for your time in reading and replying to this, it means so much to me. Im really having a hard time trying to deal with this.

The tests that your dermatologist told you about are always a good idea, so he can be sure that you do not have other causes of hair loss (other than genetic male patterned balding, which is the most common). We generally lose 100-150 hairs per day, so seeing the hair come out does not bother me. If you are picking because of the scaling, then more hair loss with bulbs may be detectable. What I always do and think is important to do, is a thorough analysis of your scalp by region, looking for miniaturization, which is the hallmark for genetic balding and some other forms of balding as well. Any good long-term plan, which is critical for someone of your age, must have periodic follow-ups of the scalp, quantifying the degree of miniaturization and any changes over time. Without that step, there is no possibility that a diagnosis of genetic male pattern balding can be made. Hair falling out is normal, provided that your body replaces the same amount (usually between 100-150 hairs per day).

With regard to the milk focus that your dermatologist is referring to, I am not familiar with it, nor have I found that others in the hair restoration community have developed such focus. I was a dairy farmer many years ago, and I do not believe that we are allowed to use the type of hormones in these cows that would produce more hair loss, but it’s been many years since I’ve last milked cows. As for Nizoral, I’ve discussed this previously here: Nizoral Shampoo.

It sounds to me like you need some real assessment of the balding process by a hair specialist, like me. On the east coast, Dr. Robert Bernstein in New York (phone – 201-585-1115) would also be able to do such an examination for you as well.

Should I Be Proactive with Family History of Hair Loss?

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

Hello Doctor,
Thank you for your blog !
I have a few questions. I am 24 yr old male with no history of hair loss/thinning. But my dad started balding at 34. I have a full set of hair as of now but the chances seem high that I will eventually start losing/thinning. My brother is only 21 and he is already thinning. I was wondering if I should be proactive and start on propecia/minoxidil so as to delay/avoid the hair loss? What are the downsides to this (if any)? Will the fact that I take minoxidil or propecia even though I have full set of hair affect my hair in any negative way or initiate the process of hair loss ? Even if any of those medications grow further hair .. will I lose all that hair or even my original hair if i discontinue taking them? Please advise. Thanks!

There is an old American saying “If it ain’t broke, don’t fix it”. That fully applies to you. You are correct to be slightly concerned at this time, so the best way to find out what will happen to you is to obtain a good hair doctor’s examination and get yourself followed yearly to detect the very first signs of miniaturization. You should not start treating it now, but if or when the process begins, then Propecia will probably be the best approach to preventing or slowing the process down, that is, unless another better drug comes on the market by then. It is not infrequent for generations to be skipped, so please do not obsess over the balding prospect.

The Medical Science of Hair Loss

/by William Rassman, M.D./12 /, ,

What constitutes a good way to follow genetic balding? So far it seems to be a vague art that varies between doctors, and not something that will give an intelligent person an understanding of what is happening to them.

Miniaturization occurs in men and women who are balding. Miniaturization is the process where a normal thickness hair shaft becomes thinner and thinner over time due to the genetically determined effects of aging and/or androgenic hormones on the terminal (normal) hair follicle. The process of miniaturization is a slow process in genetic balding. Hair shafts may lose 10% of their diameter, then 20%, then 30% and so on. Each degree of increased miniaturization reflects further progression of the genetic balding process. The instruments that measure miniaturization were invented (and patented) by me in the early 1990s and they are in wide spread use today. Socially detectable hair loss is not evident until more than 60% of the hair has been lost and as a result, many men do not seek out expert help until they see some evidence of balding (which they too often deny).

When a doctor views the scalp hair with high magnification, the degree of miniaturization and the location of the miniaturization are both critical to establishing (1) the diagnosis and (2) the rate of the process, which progresses over time. Because miniaturization is a relative measurement at any one time (comparing finer hair to the thickest hair), it takes substantial experience before this measurement can be useful to the individual clinician. In our experience, from examining and following thousands of patients with the Hair Densitometer, we have found that assessing the degree of miniaturization has useful predictive value when evaluating the risks of hair loss and in establishing hair loss patterns. The amount of miniaturization in each section of the scalp tells the physician just how far the balding is progressing or has progressed. In men who show more and more areas of miniaturization over time, the genetic balding can be considered active.

Read more

Marketing and Ethics

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

On October 31, 2005 you wrote a piece and appeared to criticize the marketing of some of the companies that you mentioned. You are high and mighty with your condemnation of these companies, yet you did the same thing by calling your company NEW Hair. Why are you any different than they are?

You are referring to my blog entry, Recapeen, FUE Plus & Lasers for Hair Loss?, in which I discuss the word “NEW” used in advertising. I may not like the tone of your question, but I relish tackling the answer. Marketing is not a bad word. The business community looks at marketing as the sum of product research (or service research), development of products and process, public education and advertising, and sales. The scope of what falls into marketing reflects the value of a product or service as it impacts the consumer.

You seem to be angry about my exploitation of the word NEW in our market branding for a hair transplant medical group. Well, putting aside the clever exploitation of a proven adjective in marketing, sales, and promotion of our service, I believe that the term NEW is appropriate for our business and the massive publications that led the world of hair restoration. I would direct you to the Medical Publications page on the New Hair Institute website, where we have posted the papers that originated much of what was NEW in hair transplant standards and now have become the standard of care today. Few terms would be more appropriate for our many contributions in this industry. We even pioneered an outspoken position on medical ethics, which was not a popular position to be in at the time. Please read Comparitive Shopping for Hair Restoration, Doctor Availability, and Low Laser Light Therapy, which I feel are all relevant to my answer.

Your Rights as a Patient

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

I thought I purchased a hair transplant session and paid for 3000 grafts. I counted the hairs on my head (now one year later) and I do not believe that there is 500 new hairs there, and that is a generous quess. What might have happened? Could I have gotten 3000 grafts and they failed to grow, or was I cheated, sold one thing and received something else? How do I tell the difference and what are my options if I were cheated? Are their ethical standards amongst the doctors?

Since I can’t see you to tell for myself (email and digital photos are no substitute for real life in a case like this), there are several things which you might consider;

  1. Check the photos: The first thing you should do is to follow up with the surgeon who did your transplant. These are good questions to ask your surgeon and he should respond with a sincere concern and answers that appear targeted to your questions. Visiting with your doctor to compare your pre-operative photographs with your current hair growth can sometimes be an eye-opening experience. If your doctor’s office is equipped with a 50 power video microscope, you can often use that to help see the grafts next to the native hair (although if follicular units were transplanted it can be difficult to tell the difference in certain cases).
  2. Be patient: Realize that sometimes growth can take up to 18 months. Most hair docs quote a year as the time period to have the final results (90% of the growth in) but it can take longer. I would want to know more about your post-operative course. Did you have difficulty healing? Are there other medical problems or skin conditions which you have that might delay growth?
  3. Inquire at the source: When you speak with your surgeon, ask how the surgery went! If there is a problem with growth, most ethical doctors will not only back up their work but also want to know about it so they can pinpoint potential problems and make things right.

Lastly, there ARE ethical standards in the industry, such as those set by the ISHRS, in addition to those which encompass all of medicine. If you suspect a problem with your results, your first option for recourse is to deal directly with the doctor who did the work. Before you jump in to a legal battle, be sure to know where your previous doctor is coming from, then write back to us here and we can write the next chapter for you.

Lyme Disease and Hair Loss

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

I have had Lyme disease and taken massive quantities of antibiotics. I am also 57 and taking a small amount of estradiol. I also recently (over a six month period) lost 12 pounds on a diet prescribed by my endocrinologist which eliminated foods I was allergic to (wheat and dairy). my hair has been falling out for about four months now. I thought it was due to the antibiotics, but I quit them three weeks ago and the hair loss is as bad as ever, particularly when I wash my hair–a handful! I am down to half my normal head of hair (and have also lost it on other parts of my body). Do you know of a good Alopecia doctor in Los Angeles who could help me. And, of course, what are your thoughts?

I am in Los Angeles, so I’d like you to please pay me a visit. I can add other doctors to the mix that have the specialties to deal with some of the problems we identify. It sounds like many of the elements you discussed can contribute to your hair loss. Medications, hormones, weight loss, and some types of allergies all are known factors that by themselves can produce hair loss, but first, you need to have a good, caring doctor who will look at you as a person first, and with a desired head of hair second. I might not be the right one for the entire management, but certainly I am good to have on the team.

Call my office at 800-NEW-HAIR to set up an appointment with me. The consultation is free.

Changing Hair Characteristics

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

hello i am 19 and i noticed that me hair was thining last year while i was a freshman in college. i also started to notice that the hair on the side of my head and in the back some wouldnt grow as fast and became very curly and dark.i was wondering if this would have somthing to do with the thinning. it was just kinda weird to have 2 differnt kinds of hair on my head. i started taking propecia about 4 months ago and started to notice results within the first 2 weeks, no more hair falling out. i was wondering since the hair loss was so sudden as was the curly black hairs if this could have something to do with a chemical inbalence of somekind. i was thinking maybe thyroid or somthing. if u have ne advise i would be happy to hear it. thanks

It sounds like you are experiencing male patterned genetic hair loss and the Propecia has started to reverse it. Wait for a full 8-12 months and you may find that the hair will return to your normal thickness. Get a working diagnosis from a doctor with a good microscopic assessment, so that you are not blind to the things that are going on. You will want some ‘metrics’ (numbers) on the amount of hair miniaturization you have before the Propecia takes full effect, so that you can gauge the changes over time. You should have a Master Plan for the many years you have in front of you, so that as you age and your hair loss problems progress, you will have a better idea of what your options are. For more information on a Master Plan, see the NHI Master Plan page.

Family History of Hair Loss

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

Hello doctor. Thanks for your time. I have medium length wavy hair. I have notice recently a lot of hairs coming out in the shower and sometimes on my pillow. My fringe feels thinner and i feel a little bit thinner on top, but my hairline does not appear to be very receding. I’ve also had an itchy scalp of late. My brother suffered hair loss aged only 21 and my uncle also lost most of his hair before he reached 30. This would make me believe it is hereditary hairloss but my hair doesn’t appear to follow the pattern that i’ve read about. Could there be another reason? Thanks.

You need to be examined by a good doctor and the diagnosis of genetic hair loss needs to be made with objective criteria. A close microscopic examination of the scalp (all over) will show indications of patterned hair loss common in the genetic cause of hair loss in men. Please, before you jump in and start taking drugs, let’s make a diagnosis and map out the full impact of the genetic balding now. Then, knowing what you have in store for you, Propecia would be a good drug to combat your hair loss (assuming you are a young man) and a repeat microscopic examination of the hair in different areas of your scalp will show the areas that are most improved with Propecia.

Shock Loss

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

Here’s 2 related shock loss questions…

I have been on propecia for 12 months. I had a transplant at the frontal hairline 2 months ago. Since the transplant I have noticed thinning in behind the grafts and complete baldness at the graft area. My doctor tells he this is shock loss but the hair will re grow due to the fact I am on propecia. Is this true? Also, how long can shock loss occure after surgery?

Is it possible that native hair (in the recipient region) can go into shockloss well after the HT procedure, say 6 months or a year?

As a general rule, shock loss with a man on Propecia has a high possibility of reversal. Shock loss usually occurs in the first 3-4 months after a transplant and reverses in 5-7 months. Hair loss after that time may be from other causes, including acceleration of the genetic process. Time will tell you what your fate is. I would need to see your progress over time if you want more opinions from me. Take good pictures and keep a good library of your progress.

Scalp Testosterone?

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

Dr Rassman

Can you please tell me the role of scalp testosterone (not serum) in hair loss/growth?
Thank you

The scalp does not make testosterone, but it does metabolize it with the enzyme 5alpha-reductase, the same enzyme that Propecia (finasteride) blocks. During the metabolism of testosterone in the scalp, 5alpha-androstane-3beta-17beta-diol appears to be formed and the formation of androstanediol (a steroid byproduct created by the hair apparatus in the metabolic process) has some effect on the functioning of the sebaceous glands, as well as (possibly) accelerating the hair loss. It probably impacts the sweating and the sebum production. We really do not know this for sure so I would consider what I said here as an intellectual logical exercise (taken from what I read which incidates that much of this information is based upon experimental work from in-vitro research studies).

On a practical level, I think that you may be thinking about the length of time it takes to block DHT production. The answer here may be in the duration of action of the particular DHT blocker you are using. Propecia has a 5 hour half life, Avodart has a half life in months and other claimed DHT blockers do not have a clearly defined life of action. It is better off sticking with known drugs that are fully researched by standards established by such bodies as the FDA.

Frontal Hair Loss

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

I have a receding hair line, similar to my fathers’. As of right now if i were to lift my bangs up, the two ends of my forehead are pretty far back(much like the shape of an M from a top p.o.v.)How can i grow this hair back before it’s too late? And will i ever loose the thin hair that is slightly covering this hairline?

Assuming that you are older than 24/25 and you have genetic balding, then it would be reasonable to assume that you will probably not get your frontal hair back with anything short of a hair transplant. Take a look at this celebrity with a similar sounding problem to yours. We performed a hair transplant on Steve Hartman, a CBS sports correspondent with his own radio sport show every day in Southern California. He had a single hair transplant session of 1,895 grafts to accomplish his goal of restoring the hairline (see Steve Hartman feature for photos and details). You should also be on Propecia, a drug that can stop, slow down, and on rare occasions can regrow hair.

I’ve written previously about Steve Hartman on this blog. For more info, please see: Where Are the Celebrity Transplant Photos?

Is One Hair Type Better Than Another?

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

Why does hair vary so much with people? Does coarse hair or kinky hair have an advantage over fine hair?

I remember a television piece done by CBS News’ 60 Minutes where they tracked what was claimed to be one of the original 12 tribes of Israel deep into the African continent through genetic testing on the Y Chromosome. In the few thousand years since the migration, the physical characteristics of the African became evident in these people with bigger lips, a wider nose, and kinky hair. I think that thermal regulation has a lot to do with the kinky hair, which allowed better cooling as a person chased an animal in the savannas of Africa during the hunt. Wide nasal passages allowed better air movement for breathing as well. The scalp is a major releaser of heat by preventing overheating in the summer, especially when heat generation adds to climatic conditions. On the other side, we know that when the French invaded Russia in Napoleon times, the winter killed more Frenchman than the battles. We also know that the bald men died during the retreat at a much higher rate than those with a full head of hair. Conservation of our body heat in the cold is another function of hair. In your question, you suggest that there is a better hair type; but better for what? Those with thin hair that sticks to a sweaty scalp may insulate better than a person with kinky hair, but not with coarse hair that lies flat. Also, there are no kinky-haired people outside of the original African population, indicating that kinky hair had an evolutionary advantage, so it evolved as the people adapted better to their geography and climate. If everyone originated out of the middle east, then we should look to our cousins there to see where we may have started from. This could be interesting topics of conversation for those of us who believe that one type of hair/person is better than another. When we put esthetics into the formulae for your question, then culture and vanity act as modifiers that go well beyond the influences of climate. Thanks for the insightful question. I always enjoy the wide variety of questions posed in this blog.