Do swimming pools promote hair loss?

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

I’m not trying to suggest that swimming causes MPB or anything like that. I’m just wondering if the chlorine or other chemicals in the pool could be detrimental for those of us already struggling?

The chlorine in the swimming pool may damage your hair, but the growth mechanism is below the scalp, not reached by the pool water. There is a difference between damage to hair that has already grown and new hair that just emerges into your world. If you look at a long hair carefully, the part of the hair closes to the scalp is new and in its best shape, unless your have miniaturization associated with genetic hair loss

Well medicated to reverse miniaturization, but still not there

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

Compared to the pictures from past months, my hair looks improved a bit (I mean really a bit). But I still see short, miniaturized hair fall. My medication history: 10 months on fin 1mg, 5 months on dut 0.5mg, 4 months on oral minoxidil 5mg. Why do the miniaturized hairs remain?

Just because you are taking good medications for your hair loss, there is no guarantee that the progressive nature of your hair loss will reverse all of the miniaturization you have. Stay on the coarse, and time will tell you where you will be down the road.

Crown transplants and Swirl (photo)

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

The swirl area is always difficult because the hairs do not layer but rather draw one’s eye to the center of the vortex. The impacts of 4000 grafts depend upon the thickness of your hair shafts (fine, medium or coarse). The thicker the hair shafts, the better the coverage. I suspect that, looking at your result, your hair has a medium or medium-fine hair thickness. Please let me know if I am correct. The transplant was largely done in front of the swirl, but half of the upper swirl was included in the transplant. Note how difficult it is to get a tight swirl unless you put in more hair or have coarser hair.  This is a nice result. Rarely does new hair appear from a hair transplant beyond 9 months.  Congrats!

As an aside, look at my crown hair transplant, which was fine when it was done; however, when my hair thinned out with age, a see-through appearance showed my scalp.  I had SMP done and the change was dramatic, see here; https://baldingblog.com/i-just-finished-my-smp-on-my-crown-area-today-see-before-and-after-photos/

Does eating steak, reverse hair loss?

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

I stumbled upon a video a month ago with over a million views where a doctor talks about how to regrow hair, and the main conclusion seems to be that eating steak will fix your hair, delivered with just enough half-truths to seem convincing. I’m not even a vegetarian, but this carnivore cult stuff is getting on my nerves. Is there anything to this claim?

Steak doesn’t reverse the genetics and the chemistry of hair loss. The internet is full of misinformation, that is clear.

Failed Transplant from Turkey Clinic

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

Does this look like 5000 grafts to you?  That is what they said they gave me when I went to Turkey for the transplant. What can I expect in the future?

5000 grafts is well over half of your donor hair supply. You need to have your remaining donor supply evaluated by someone who understands the donor supply. After you have gone a year, the last of the growth will have occurred.  Then, look at where you are and have a good surgeon develop a Master Personalized Plan based on your remaining donor supply.  From that, you will know what you can do.  This is what I do: https://baldingblog.com/creating-a-personalized-master-plan-for-present-and-future-balding-photos/

Are Scalp Micropigmentation and Nanopigmentation the same technique?

/by William Rassman, M.D./0 /
A dog is a dog no matter what you call it. Many names have been developed for this technique for marketing purposes. Our group originally named it Scalp Micropigmentation as my group was the first to do it for clinical cases like surgeries, various scalp diseases, scars, etc. I always publish the things I do and have published many articles on Scalp Micropigmentation. I have lectured on it at many meetings worldwide, even last January in India. This is essentially a tattoo that appears like cut hairs on the scalp. To mimic the cut hairs, the dots must be very small, and the ink has to be permanent. The person using it must be artistic because otherwise, the look can be awful. Here are two examples of poorly done SMP: https://baldingblog.com/terrible-smp-3/ and https://baldingblog.com/what-do-you-think-of-my-smp-photo/ and https://baldingblog.com/terrible-smp/
The third link shows some poor victim who had it done by someone clueless. Don’t be a victim; do your research. There are many poor SMP operators out there.

I’m taking both oral and topical finasteride

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

I’m confused about the effectiveness of taking both oral and topical finasteride simultaneously. Please give me some insight into this practice. 

I don’t see a point in taking oral and topical finasteride simultaneously. The oral form is better as it reaches the areas the topical form can’t reach. The topical also goes systemic, so your systemic dose may be much higher than oral. The use of topical liposomal finasteride is different than the standard topical finasteride as it is designed to stay mostly in the scalp.  This liposomal preparation is used when there are side effects from the systemic finasteride. 

Plucking miniaturized hairs

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

Will Miniaturized hair that is under Finasteride Grow back thicker and longer if it is plucked?

Terminal (normal) hairs plucked once will always grow back. Miniaturized hairs that are plucked many times may not grow back. If you are under the influence of finasteride and the miniaturization is reversing, and then you plucked your hair, I suspect it would grow back. I would like to know why you are even thinking about plucking your hair. That makes no sense.

Finasteride growing some areas and not others

/by William Rassman, M.D./0 /
You mention regularly that different parts of the scalp have higher and lower probabilities of filling in on consistent Finasteride use, highest going to the crown and lowest going to the temples. I wanted to know, however, from your experience if it happens that one area can improve while another continues to regress. I’ve recently noticed some new hairs around my forelock. I don’t expect the temples to thicken up as quickly, or much, given the data but I would like to know what you think. It doesn’t make much sense that one area improves while another regresses, but I am very curious to know your thoughts given the amount of patients you have seen. 
For context, it’s been about 8 1/2 months since I started and am 32. Noticing any improvement at all the first year seems promising long-term. 
Anyways, let me know what you think if you have a moment.
Finasteride, from my experience and others, shows varying responses in different parts of the scalp, often age-related.  Young men under 25 get better overall responses than older men. In men over 50 good results are often seen in the crown, even when there is no new growth in the frontal hairline. I have seen men over 70 get good hair growth when they were treating their prostate problems; it is a welcome but unintentional benefit.  

After years, my minoxidil is causing itching

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

Ive been taking minox for about 4 years now, (fin too) and suddenly in the past month the area where i apply has become incredibly itchy. It also looks like im losing denisty and hair in those areas, even though im not actually getting any hairs loose when i put my fingers trough it. Hair is pretty long now so id notice. The few hair i do get out look very thin. I find myself half sleeping scratching the area , i cant help myself.ive started using ketoconazole every day now for the past 2 weeks, it hasnt gotten better yet. Its the same brand, same amount and same place i get it from.

You may be allergic to the minoxidil or the carrier within the preparation. Ask your pharmacist for a different minoxidil brand with a different carrier.

Is this DUPA

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

As you suggested, this is a photo using a hand microscope of the donor area.  What do you think?

My rule for diagnosing DUPA is to count the miniaturized hairs from the back of the head. If they exceed 20%, as yours does, then it is DUPA. You have some hair that is being lost and quite a few that are just miniaturizing. To be sure, I would want more extensive views of your donor area, as this is a disturbing diagnosis to be made with such a limited view of the donor area.