Female Hair Thinning

Hello sir,
I am an Asian female and I am 24 years old.About 3 years ago, I noticed that my hair had started thinning. That was a period of time when I was under a lot of stress and used to hav a bad diet as well. So I thougt that was the reason for my hairloss and also thought it would come back in time. I have lost hair mostly from the front region of my head.But am not loosing much hair now.My hairloss kind of reduced on its own about few months ago and I also see few hair coming.

So does that mean that I am gonna get back my lost hair? Was the damage irreparable? Should I take treatement?

My mom had lost a lot of hair at a young age,my dad is 60 years old ,but still not bald. Could you please let me know more about my hairloss and whether it will come bacK or not.I would be extremely grateful sir.I am undergoing a lot of pain because of my hair.

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You are not alone. Since I started this blog, I have gotten quite a few questions from women about their hair loss problems. Here is a link to the similar questions and answers. The first thing you need to do is to see a physician who can examine you and order tests to make sure that there are no underlying medical reasons for your hair loss. Some of the reasons for female hair loss are: anemia, thyroid disease, connective tissue disease, and various gynecological conditions. These laboratory tests may be useful if underlying medical problems are suspected: CBC, Chem Screen, ANA, T4, TSH, STS, Androstenedione, DHEA-Sulfate, Total and Free Testosterone.

If it is determined that there are no medical reasons for your hair loss, I would suggest that you visit a hair loss specialist. Since you are in New Jersey, I can highly recommend Dr. Robert Bernstein in Fort Lee- his phone number is 866-576-2400.

Minoxidil and Retin-A

I have been taking Propecia for sime time and I recently ran across a site that talks about a combination of 2% Minoxidil and Retin-A. Should I switch?

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Propecia works at the cause of hair loss, by blocking the action of DHT on the genes that impact hair loss. Minoxidil is a drug that has a side effect: growing hair. The side effect of a noticeable growth of new hair occurs in between 3-15% of the Minoxidil taking population. Minoxidil does not block DHT, so its action is very different than Propecia. Retin-A is an acid which produces a burn to the skin. I generally look at burns negatively; why burn the skin? The burn causes increased vascularization and therefore allows a higher absorption of the Minoxidil. Retin-A also has it’s own side effects and warnings. Retin-A possibly may make the Minoxidil more effective, but at what cost to you and your skin? That is the question!


Hi Dr. How much biotin should I take a day for hair loss???

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Biotin deficiencies can cause hair loss, so many people may include biotin in their vitamin regimen. However in healthy people it is almost impossible to have a deficiency of biotin. A biotin deficiency is therefore extremely rare in the United States. When it does occur, it may be associated with disease conditions of the gastro-intestinal digestive tract. An adequate daily dosage for biotin is 30-100 mcg for the adult male.

Running Out of Donor Hair

I’m an existing patient of yours and had great results on the front of my scalp with the last session 2 years ago. I’m starting to get a little thin on the crown of my head and a little forward of that. If it stopped where it is now, I wouldn’t be concerned but continued loss would be unnerving.

My issue now is that I’m pretty much out of donor hair. Has any progress been made with something I read about a couple of years ago called hair cloning? Also, I have a few old fashioned plugs that could be thinned and dispersed I suppose.

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Nice to hear from you. Please look at the other comments in this blog on hair cloning. There is nothing new that would apply to you. As you are near our Northern California office, visit me there and I will personally assess your balding pattern. You are correct that taking hair from old plugs works, but the problem is total supply versus need. We would have to determine whether there is enough supply from all sources to meet your need for coverage.

Propecia, When to Start

Lots of Propecia questions this week…

I am 21 and notice that my hairline is going. Should I start taking Propecia?

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There are many important elements to your question and like all good questions, the answer may be more complex than you were expecting. There are many reasons for the hair line to move, the most common reason is the transition from having a youthful hairline to acquiring a mature hairline. This frontal change in the hairline occurs in 95% of young men and it is not reflective of the balding process. I can not tell you if Propecia will stop or slow this process down, but I suspect that it might considering that this is probably a DHT induced manifestation.

With regard to early genetic balding, I would get a good doctor to examine your hair looking for miniaturization of the hair shafts. The finding of miniaturization is an absolute sign of genetic hair loss, If you have it, Propecia is recommended to be started at the earliest appearance of genetic hair loss in the post pubescent male. Since genetic hair loss is a progressive process, the earlier you get a good diagnosis, and begin Propecia, the better your chance is to keep your hair for a longer period of time.

The Problem of Popping

I would very much apreciate it if you could explain what “Popping” is all about. As I understand it, it limits the amount of hair that can be successfully transplanted.

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Popping is a technical term referring to a problem with placing grafts into the recipient sites in the balding area in a hair transplant. The grafts are placed and then do not stay in place, ‘popping’ out of the site. In the early days when we didn’t trim the grafts as closely and the recipient sites were larger, the bulk of the graft was so large relative to the surrounding tissue, that the graft would not be held in place. When the surgeon placed another graft next to the one that was only a couple of millimeters away, the ‘mass’ from the graft into this next site, pushed the last graft that was placed out of the wound. You can imagine a cascade effect, you place one graft and then another and the first pops out. Then you finally get both the first and second secured and place a third when the first two then pop out. That was the way it used to be.

Today things have changed. When we introduced the microscope in 1994, it was evident that smaller and more accurate dissection meant better results than dissection with other less powerful magnification tools. The grafts are smaller and can be more carefully dissected, so that the bulk of today’s follicular units is less than the old minigraft. The recipient sites are much smaller today, we use needles in the 0.8 – 1.0 mm range to make the sites. The results of the smaller site is that the ‘hole’ that is made tends to ‘hug’ the graft and the ‘bulk’ of the graft is of less consequence in the hands of an expert graft placer. Today the best surgeons have staff whose skills have built over years, allowing the grafts to be placed without disturbing the last graft placed. So, popping which was a major problem when we were getting the number of grafts from 500 up to 2000 in 1993, became less of a problem as we moved into the 3000-4000 grafts per session size.

To conclude, your question of popping is more of a historical question than a problem today. What is still relevant today, however, is that surgeons who use larger sites (greater than 1.2mm in size) to manage their grafts, are still practicing older techniques and popping (which is not a problem for us) still remains one for those less skilled in the art of today’s techniques.

Hair Density in Scars

How many hairs can you transplant into a square centimeter? I have a scar, and I want to fill it in. I am trying to find a doctor who can fill it in with just one surgery. Is this a reasonable question?

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An excellent question! The calculation is one that is used in the industry as a benchmark measurement. The average person with 100,000 hairs on his head has 1250 hairs per square inch or 193 hairs per square centimeter.

But what is the number to use in determining the correct density for a hair transplant? Some doctors use high density numbers to define how good they are. However, there is a balancing act between maximizing density at the time of a transplant surgery and maximizing growth months later. Experienced doctors are the key.

The reasonable upper limit of density numbers from a transplant perspective is up to 120 hairs per square cm. This type of density, however, requires supple skin that still has elastic properties. Scars do not have this characteristic. Also scars have an abnormal blood supply when compared with normal skin. Much of the infrastructure and microcirculation in the vasculature is not present in scar, so transplanting very high densities may not produce good growth.

You need to be examined by a hair transplant expert, who has the experience to give you a reasonable answer to your specific need. While I understand that you would like to have this completed in one surgery, that may not be in your best interest. Only your doctor will be able to advise you.

Cheap & Discounted Hair Transplants

When you buy a cheap airline ticket and you are flying American Airlines, neither the airline nor the seat is shoddy. But when you buy a cheap hair transplant, you may not be getting a ‘legacy carrier’ doctor. Cheap hair transplants means that it is highly possible that you will get the pluggy doll’s hair look, inexperienced surgeons, poorly trained teams of people working on you, and an absence of quality control. I know of one of my former technicians who did a hair transplant on a friend on his dining room table. The procedure was done outside the United States and his friend would have bled to death had he not gone to a hospital to stop the bleeding. On a more local level, I have seen many patients over the years who were enticed by a new doctor who wanted to build his experience by offering discount prices. Sadly, they now needed an experienced and ethical doctor to undo the damage. Fundamentally, I can recommend if you are committed to going to the cheapest place for a hair transplant, that you do your homework. Make sure that you extensively research their medical licenses, how they were trained in hair restoration, how long they been performing hair transplants, what techniques do they use, their board certifications and in what field, are they active members of recognized hair medical societies (like ISHRS), and what do their results look like – because you will usually get what you pay for.

I’ve touched on this before in a previous blog entry, Bargain Hair Transplantation.

Propecia vs Proscar

Can doctors legally give someone a prescription for proscar when they just need propecia?

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Yes, doctors can prescribe whatever is in the best interest of their patients. With regard to Proscar versus Propecia, they are both exactly the same medication, but Proscar is a 5mg dose of finasteride while Propecia is a 1mg dose. The two are exactly equivalent if you can cut the Proscar 5 mg pill into fifths. That is a problem for some patients, because the cutting process is not easy.

Stress Induced Hair Loss

I am a 57 year old male. Recently I have been under a lot of stress. Have been taking a topical testosterone ointment off and on, HGH injected of and on. Have noticed a great increase in hair loss lately. Have been taking Saw Palmetto as a DHT Blocker. Would I benefit from beginnning Propecia or am I too old to benefit from it. I am going to get a Hair transplant with NHI in the future but now just want to stop the hair loss. Thank you.

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It appears that you have many reasons for hair loss (stress, testosterone, HGH injections). Clearly a good DHT blocker like Propecia will be far more valuable than Saw Palmetto which is very weak, if effective at all. Still, the combination of contributing factors may not be enough to stop the hair loss. Visit me and let’s talk.