4 months Combined Treatment (photos)

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

In these 4 months since starting dut/microneedling, I feel my hair is more dense, better quality, and I’ve noticed small vellus hairs on my temples.

Dut (0.5mg) 2x a week

Fin (1mg) 5x a week (on days I don’t take dut)

Foam minoxidil 2x a day (as per instructions)

1.5mm derma pen 1x a week

0.5mm derma pen 4x a week (immediately before applying min)

Nice improvement seen in just 4 months. I noticed that he did dermaroller 4 times a week. I see some fill in the forelock and also in the corners of the hairline.  Better photos with better views would help.

Can a Norwood Class 7 man get a good hair transplant?

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

 I’m 43 years old I’m a Norwood 6 is my Norwood 6 pattern fully developed? my hair loss genes won’t express anymore correct? Or will I develop into a Norwood 7? Thank you!

At the age of 44, you may stabilize at a Class 6 pattern. Hair transplants can work well in men with Class 6 patterns, even if your donor density is low. First you need to have your donor supply measured and your total lifetime graft availability determined. If it is average or above average and your hair is or a medium thickness or better, then a hair transplant will work well. If your donor hair is fine or your donor density is low, then please read this article I wrote on how to get a full head of hair in these situations: https://newhair.com/wp-content/uploads/2018/11/Combining_Follicular_Unit_Extraction_and_Scalp.98621.pdf which is being heavily read by plastic surgeons from around the world. We have a travel reimbursement program for people outside of Southern California.

Can bleaching hair cause thinning?

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

I bleached (at a parlor) my hair about 6 months ago and have noticed a noticeable thinning overall in my hair since then. My question is does bleaching cause permanent hair loss?

When bleaching is done improperly, there are chemicals in the bleach that can burn your hair follicles resulting in a permanent loss of hair. We see this at times in professional salons when either the person doing is new, or the person doing it did not follow a strict protocol designed to prevent such happenings. When the damage happens, it kills hair follicles at the root. Sometime, Minoxidil (Rogaine) may grow new hairs, but this is generally not a reversible thing. If it particular bad in a single area, then maybe a hair transplant can address it,

Balding without miniaturization

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

I think that there is no miniaturization in my hair but the hair seems to be sparsely separated.  Could that be true?

Hair grows in bundles called follicular units containing from 1-4 hairs each. When some people lose hair, the lose hairs within the follicular unit occurs so a three hair follicular unit might lose a hair and have only two left. Then in time, it will lose another hair and have only one hair in it.  Eventually that last hair may fall out as well.  This occurs all over the scalp in the balding areas in many men without miniaturization. The average human scalp has 50,000 Follicular Units of which 15,000 are in the rim around the back and sides of the head and 35,000 are subject to the patterns of balding you inherit from your family. The 15,000 follicular units around the side and back of your head are not prone to balding, keeping their hairs over your lifetime.

Horrible side effects from finasteride

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

I was 2 months into fin and then got horrible ED and horrible horrible horrible brain fog. I was eating clean, working out, staying fit, and yet the brain fog was horrible. I quit the fin the past month and it finally has gotten a little bit better with a shit ton of adderall. I don’t want to loose my hair but also can’t be brain damaged like I felt when I was on fin. Anyone have any recommendations or other alternatives to fin? I’m 22 btw.

Men like you, at the first sign of problems with finasteride, should get off the drug. Of course, a conversation with your doctor is just as important.

What do you think of my hairline? (photo)

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

What is bothering me a bit is that too many of the leading edge grafts have more than one hair in them. They should all be single hair grafts to make for a soft hairline.  In addition to this, the hairline looks rounded and it should be V-Shaped but the photo is inadequate to really ascertain the entire hairline reconstruction.

Sensitive to other people’s hair loss

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

Was hooking up with a girl and realized she also had hairloss. I think once you become obsessed with hairloss you notice it so much. Noticed that her hair part was wider and thinner hairs around there. Can totally see more scalp than most women. She is still hot so idc. But my point is once you know about balding you easily notice it. So many people have hairloss.

Yes, that is very true.  Ever since I entered this field of Hair Restoration Surgery 30 years ago, I look at other men and women to establish what is normal and what is not normal for hair loss.  From all of these observations, I have learned (especially at airports when I see many people walk by and have little else to do) what normal hair loss patterns are found in the general population. From this, I drew interesting conclusions which I speak about at medical meetings as I have identified patterns of loss that are not the patterns confined to the Norwood Classification.

Do we shed more at one time of day?

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

For almost a month now, I’ve been losing more hair during sleeping. Like 10-20 hairs. It’s happening out of a sudden. No changes in my life, diet, sleeping hours and I’m not on min or fin but I’ve been using Nizoral 2% one day a week for more than a year. I am not shedding more in the shower though, the same amount I’ve been seeing when I first discoverd my receded hair line. About 10-15 hairs, then few more hairs when combing. Thankfully no increase shedding in these two activites but it is kind of weird to me. Why am I shedding more only while sleeping? Other weird thing I’ve been noticing, all the sheds on the pillow don’t happen during the entire night, but in like 2-3 hours. Actually this has just happened to me that’s why I’m writing this post. Tonight, I checked the pillow every time I woke up for a piss or just turning to the other side. I swear every time I checked there were 0 hair. The bitch tricked me and really felt happy and confident, then I slept for 2-3 more hours and BAM almost 20 hairs on the pillow!

Seriously, what is happening? Should I be worried or this is normal? I know about the 50-100 hair per day, I don’t believe I’m losing up to 100 hairs but this is new for me.

We notice more hair loss when we brush, wash our hair, rub it against a pillow when we sleep. I believe that hair loss occurs 24/7 but when we are not disturbing the hair, the hairs we lose just hang-in with their brother-en until they can be set free with the actions I described above.

Should I ride out my Finasteride side-effects?

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

I’m 19 and I’ve been taking 1 mg of fin daily for one week. My libido has dropped and it takes forever to get an erection. I also have slight ball ache, watery semen, and possibly some headaches, but that’s probably just because I haven’t gotten enough sleep this week. I’m not paranoid to be honest. But will these side effects subside eventually? Should I try to ride them out? It’s mainly the low libido that’s worrying me. It’s unfortunate timing since I met a girl I really like recently.

If you have sexual side effect from finasteride and don’t reverse them by reducing the dose, then you should stop the drug. The risks for Post Finasteride Syndrome (if it exists) is high if you continue to take the drug. You should see the doctor who prescribed the drug to you for advice.

Finasteride with Testosterone Injections

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

I’ve been having to get some Testosterone injections for the past couple months due to low testosterone levels. I’ve been give a prescription for Finasteride to assist with some major hair loss. I had a couple questions:

  1. My understanding is that Fin can lower T-Levels, isn’t this kind of counter intuitive if I’m getting T-Shots?

  2. If you’re taking Fin, does it need to be long term or just around 6 months based on results?

  3. The side effects of Finasteride seem pretty scary, any thoughts on that?

Although finasteride blocks the DHT it is not a complete blockage. By adding testosterone to your system, you will increase your DHT levels as DHT is a breakdown product of testosterone and therefore increase your hair loss.