Your hair loss questions, answered daily.

 

As a writer focusing on men’s health issues I would be interested in your comments on two areas of my research.

  1. I have read a number of reports that suggest that hirsute men (those with a lot of body hair on chest, shoulders etc) are more prone to lose hair from their heads.
  2. I have also seen reports that the American Red Indian does not suffer from hair loss.

I do not believe these issues have been dealt with by you before.

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I too have seen claims that men with heavy populations of body hair have more balding than their hairless or less hairy counterparts. I can say that in my medical practice, the balding men routinely say: “I wish you can take it from my chest or back”. But then again, I do not have the type of interchange with non-balding men to probe the same issue. There is generally a belief that DHT (the evil hormone that ‘causes’ hair loss), also brings on the body hair, the nose hair and the ear hair along with the balding on those genetically inclined balding men. I believe that in the discovery of Finasteride, the people who ingested large amounts of this drug through their dietary intake of a food stock from the rain forest, did not bald, nor do the men born with a genetic defect where they can not make the enzyme that produces DHT. I recently probed a large number of doctors asking if anyone has found evidence of a reduction of body hair, nose or ear hair with Propecia. Everyone liked the question and told me that although they believed it might just do that, there is no evidence that Propecia or Proscar actually blocks or reverses these less than ideal hair locations.

With regard to the American Red Indian, I am fully aware of this observation. His ancestors came from the Alaskan bridge and they had the balding trait, so it is strange that this particular ‘race’ (the great grandchildren of the migrating Alaskan ancestors) is unique amongst all humans as they do not have balding. Of interest, I am not aware that these people are missing any enzymes for making DHT. Could it be that a primitive people actually wiped out balding genes in their brothers in a relatively short time frame of less than a couple of thousand years?

 

I have a hair system and it smells. I am compulsively clean and I used to wash my hair once or twice daily. Now, with the hair system on, I can not wash frequently. A close friend told me that the colognes I use do not help hide the smell, so when I heard this, I was devastated. Now I think that everyone is smelling me, my dates, the ladies around the office and strangers I meet, but I am so embarrassed that I do not know what to do. Any suggestions?

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Just in case you weren’t sure, the term hair system is another term for a toupee, a wig or in local slang, a rug. Systems have been around for centuries. They have been found in Egyptian tombs, on frozen mummies from Alaska’s Eskimos, and on your late night TV showing quick fixes for hair loss. My saddest story reflects a less than ethical wig-salesmen (only some are bad folks), who introduced a 21 year old with early frontal balding for a free trial. Before he knew what was happening, his head was shaved and then a ‘mop’ was put on this poor soul’s head, glued to his shaved scalp. Of course, he could have walked out and not purchased one, but alas, with the front of his scalp shaved bald and the back of your head with long luxurious hair, he knew he was going to look kind of funny walking into the office in the morning. So, like a few fixes of Heroin, he got hooked on a ‘system’ and found it part of his persona for years. Worse still is the hidden reality that these systems promote hair loss from traction, accelerating the genetic hair loss and promoting the addiction even further. Hair piece cripples are created and they live their hell almost every day.

When a poor self image is perpetuated in the mirror every morning, the smell may be less of an issue. This emaiiler’s main point is the smell. To deal with the smell, the only satisfactory solution is to have a series of wigs, use clips to attach them so that they can be taken off at night and then wash the wig often. Daily washing of the scalp is not a problem when the wig is off the head. Washing the wig will cause it to wear out sooner and the result will be more frequent replacements. The use of clips are not promoted by those who sell these systems. For reasons I can not fully understand, glues and tapes are more popular, and weaves are gaining in popularity. These last three fastening methods keep the soap and water away from doing a proper cleaning of the scalp, despite what the wig salesmen say. If you can’t wash the scalp with the system off, the scalp will smell and if you do not wash the wig, it will smell. I have rarely seen a person in my office with a system that does not smell, but sometimes I can not tell if it is the system or the patient. Does it matter what smells?

Today, the cost of a hair system properly fitted and maintained in a 5 year period of time will often run more than the cost of a hair transplant procedure.

 

HI Dr. William Rassman. I read in many places that propecia can make the frontal hairline/temples recede. Is it true or is it a myth? Coincidently my temple was a NW 1.5 2 month before propecia. Now it’s diffusing in a strange way. thanks

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I am unaware of any reports that Propecia will accelerate temples recession. I am assuming that you are a young man (Norwood 1.5-2) and one of the things that you must recognize is that 95% of Caucasian young men (also true of other races but a smaller percentage) will change their hairlines as they mature. This maturation process certainly moves in the direction of a Norwood 2 – 2.5 range. This is not balding, but normal maturation which occurs between the ages of 18-29 in men. The other 5% or less of Caucasians are like Bill Clinton, where they keep their childhood hairline and remain as they were at 12 years old. Best to be sure that you understand the difference between normal maturation of the hairline as seen in your genetic family connections and the balding process itself.

 

Hi Dr. Rassman.
First I would like to thank you and Dr. McClellan, for doing such a great job. It has only been a week since my surgery 1,700 grafts. 5 Years ago I had 1,100 grafts. Healing is occurring quite rapidly, and I feel the positive results around the corner.

I have somewhat fine, and curly hair age 38. Auburn brownish is my natural color. Redhead when I was younger. My father grayed heavily in his thirties, as did my brothers & I. I use either “Grecian Formula”, or “Just for Men” 5 minute hair coloring. (Light Brown to get as close to my natural color as possible). About a month prior to surgery, I had my hair highlighted bleach blonde, and the results were fantastic. I looked a lot less bald, with wonderful full blonde curls, and my brown underneath. It looks so natural and subtle that everyone thinks I have just been in the sun for a week. I am very pleased with this coloring. Because I only highlighted, the brown color treated area remains, its brown status.

The main question becomes at this point, is when can I use the “Grecian Formula”, or the “Just for Men 5 Minute Hair Coloring again as my base?

And, when can I “bleach” highlight again?
A) My regular area.
B) Donor, and Transplanted area.

Thanks again to Dr. McClellan for doing such a great job last week.

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Thank you for your kind words! I am hesitant to post this for fear that readers may think this is a ‘planted’ question, but you do raise some issues that have not been addressed in this blog. You can begin to color or bleach your hair once there is no more scabbing present and the skin is smooth. This usually happens within the first after surgery (in some people in days). I generally advise people to dye their hair immediately prior to the surgery so that there is no significant disruption to their schedules.

You also bring up an important point on the value of hair coloring. Lightening the hair always adds the look of fullness. In a question posed to me on April 21st (see: Platinum Blonde Patients), the question of blonde hair came up in a different context. That question has bothered me since it came in and as I looked through hundreds and hundreds of patient photos, fewer blondes were in my hair transplant group than non-blondes. Then I realized that the lack of blondes in my database of photos came about for two reasons:

  1. There are fewer blondes in the population (estimated at less than 10%). We are led to believe that the actual number is higher because there are many, many blonde women. Could it be that because ‘Blondes have more fun” women are becoming blonde far more frequently than men are?
  2. A platinum blonde man can lose 85% of the hair on the front, top and crown without knowing that he is going bald. This is because of the low color contrast between hair and skin color and that the shiny hair platinum blondes have makes balding less prominent.

In conclusion, men who are balding should think more like you and consider taking charge of coloring like some of the women out there are doing regularly. Maybe, just maybe, coloring can solve the hair thinning problem without a hair transplant for those who are not quite bald yet.

 

Just wondering if it is known why Propecia is often not effective around the front/sides ? Is there any hope for a new drug in the works that may address the front/sides?

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When Propecia works, it works where the hair loss is relatively newer. The frontal area is often the first place the hair loss starts but often it is not noticed until the hairs are fully miniaturized or lost and at that point Propecia is not effective. Propecia can work well in preventing rapid hair loss in the frontal areas when the drug is started early enough. There is clearly a difference between frontal balding and crown balding, which tends to start later, in the way the genetics are expressed.

 

A female reader asks…

I have Hashimoto’s Syndrome and diagnosed alopecia areata. The hair on the crown of my head is not diminishing as fast as that around the face and all around the back of my head. What options do I have? I feel I will shortly have to wear a wig permanently. Is there anything that can be done?

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Hashimoto’s Syndrome and diagnosed alopecia areata are autoimmune diseases which are attacking the hair follicles in your situation. If the disease can not be controlled, then the hair will continue to fall out. Sometimes, these diseases are self limiting, but your doctor will be in a better position to judge this for you.

 

Hello,
I’m considering hair transplants, but my wife saw a talk show recently with a hair expert. In the segment, the expert said that a significant number of transplanted hairs fall out in both the short and long terms following the procedure. He said figure five years before you return to your original look.

How is loss of transplanted hair measured, and is the permanency guaranteed in some way?

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Most transplants fall out within a month of being put into their new location. The new hair goes through a rest phase and some 2-5 months after the transplant was done, they start to grow and will continue to grow for the rest of your life. Hair grows at about ½ inch per month so you can calculate the hair length from the point the hair starts to grow multiplied by the number of months the hair has been out. The hair growth is not like a horse race, where every hair starts to grow at the exact same time. The growth comes in waves, some earlier and some later. We generally expect that 100% of the hair that is transplanted, will grow. Some if it may start immeciately, some in a month, two or three, and some may not start to grow for 6 or more months. Good growth reflects a skilled surgical team who does this all of the time. Less than a skilled team may take a toll on less than 100% growth.

You asked about measurement of hair. I invented and obtained a patent for a device I called the ‘densitometer’ over 10 years ago. This invention covers almost all of the measuring devices presently used today. What it allows is the direct visualization of an area of scalp. If you cut the hair (an area about the size of a pea), you can actually measure hair densities by counting hairs in the cut pea sized area. This measurement is performed on every patient we analyze prior to a hair transplant. This measurement tells me what the total supply of hair is in that particular patient (hairs per square mm) or the overall thickness of each hair shaft in the field of view. Caucasians, have the highest densities, African hair is usually the lowest and Asian hair is somewhere in between Caucasian and African hair. But within the races, there is a wide variation of densities so there is no substitute to good measurements. After a transplant is done, the same measurement process can be performed to reassess the donor area or even the recipient area. It is, however, impractical to take such measurements in the recipient area because it would require shaving too much of the scalp (a pea sized area may not be representative of the entire recipient area). The judgment of a good honest doctor and the results that you saw on other patients may be your best guide to determine what the yield of the transplant procedure actually was.

The 5 year statement you asked about is difficult for me to answer as whoever gave this opinion may have been looking at a very advanced balding pattern and looking at the native hair in the recipient area, not the transplanted hair.

Since you are in Northern California, I would suggest you and your wife may want to come to our Open House (at our office on Wednesday, May 18th in San Jose) where you can see a surgery and meet former patients. They will share their experience with you. There is no substitute to meeting patients directly.

 

I am considering getting a hair transplant, however, I read a comment you made that hair transplant can accelerate hair loss if the process of hair loss is active? what does that mean? So what’s the point to get hair transplant? Maybe I didn’t understand what you said.

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Every person who has genetic hair loss continues to have hair loss throughout their lifetime. Hair loss is accelerated as time moves forward and as we are stressed. A hair transplant is another stress. If you are a young man and in rapid hair loss, the added stress of a hair transplant may increase your genetic rate of loss for a few months. With women it is different. With drug protection (Propecia in men only) you can slow down the rate of loss that is programmed into your genetic clock. Those over 30 are less reactive to the stress of a hair transplant (less likely to get telogen effluvium, the medical term for stress loss) than are those under 25. The hair transplant (1) in the right patient performed (2) by a good doctor (3) with the proper modern procedure (4) placed in the right location (5) in the best distribution (6) adjusted to your hair color (7) hair character (8) hair shaft thickness (9) hair density (10) balding pattern (11) with a proper plan catered to your individual needs diagnosis, age and (12) adjusted to meet your financial situation may replace some of those already lost hairs. I could keep going on and on, but I hope that you understand that there is more to getting a world class hair transplant than just having a doctor put holes in you head and then plugging those holes with hair. All hair transplant doctors are not equal, nor is each hair transplant patient. The drug Propecia generally protects men from surgically induced hair loss, so we use that drug with great frequency.

 

I am a 26 year old male, who has had two hair transplants in my frontal area. The density of hair in my transplanted regions is much lower than that of my natural hair, and hence looks a bit unsightly. I want to know if there is a limit to the number of FU grafts one can transplant in order to improve density. If so, what are the dangers of exceeding this limit?

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The normal hair densities of non-transplanted hair are measured at 193 hairs per cm squared (97 follicular units per cm square). A transplant doctor can put in densities of half of that in a single session. If you have thinning hair, then your density is not up to a level adequate to appear full. There are no inherent dangers in dense packing the hair in a transplant surgery provided that the doctor’s team is able to do it.

Dense packing, a technique we defined in 1993, makes for less surgeries and more fullness. If the wounds are over a particular size (more than 1.7mm each) then the risks start impacting the patient, for example, with regard to blood supply. If the wounds are smaller than 1.7mm, then the risks of dense packing of the grafts all but go away. We use wound sizes of about 1mm (the size of the wounds vary with each patient). The smaller the wounds, the faster the healing. Healing in this context means that the wounds on the skin become almost impossible to see, something that usually takes a day or two on most of our patients. Wounds greater than 1.7 mm, tend to show for longer periods. Some transplant patients in the old days saw wounds measuring 3-4 mm each (the old plugs), and they were visible for weeks after the surgery.

 

My original blog entry (found here) detailed a reader’s thinning hair, possibly due to taking Accutane when he was a young man. The following is my response to him along with one of his photos, which I was given permission to post.

Thanks for sending your pictures. I am using one of these for the Balding Blog to make good reading for our audience, showing only a top down view without anyone able to identify you. What I see in this photograph along with the other you sent, is that you seem to have miniaturization throughout the Norwood Class 6 pattern. The frontal hairline looks stronger than the area behind it (a good surprise), suggesting that the frontal line has different and stronger genetics than the hair behind it. I can not determine the amount of miniaturization that is there, but a good baseline is needed to determine change over time and any response to medications. Also, the donor area around the back and sides needs to be assessed to determine if you have a condition called Diffuse Patterned Alopecia, a diagnosis that is important to make prior to considering what to do about your problem.

With such an extensive area of thinning, your donor supply, skin laxity, and varying hair characteristics need to be determined before any treatment recommendation can be made. You may be a good candidate for Propecia and/or Rogaine. The pictures help, but I would think that you need to be managed by a competent doctor before going forward from here.



 

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