Hair Loss InformationFemale Hair Loss – Hair Loss Information – Balding Blog

I am 25 years old and I have thinning all over, I’ve been to two dermatologists and both of them just tugged on my head and told me to use Rogaine. I want to know how to find out what the cause is and if there might be an underlying health condition. I have never taken ANY medication including birth control but I may have some other symptoms, only slight but possible indications of something medical or hormonal. There is also no baldness in any women on either side of my family, but there are men on both sides. This is absolutely destroying me and I just want to figure out how to get some answers because Rogaine is not working, I’m running out of hope. Do you know where I can go or what I can do? Thank you for your time and consideration to my question, I would appreciate any suggestion you might have.

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There is not a great deal understood about women’s hair loss. First, many women have hair loss secondary to a medical condition. You need to be check out by a competent doctor to rule out the conditions that cause hair loss. Thyroid disease, for example, seems to have hair loss associated with it. In addition to thyroid disease, hair loss can be a sign of a medical problem from anemia, connective tissue disease, gynecological conditions, polycystic ovaries and other androgen stimulating hormones. While you do not currently take any medications, some medications can cause hair loss including: oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone so at any time in the future, this awareness may have significant value to you.

The treatment of women’s hair loss with hair transplantation must be approached differently than men’s hair loss, as most women rarely develop patterned hair loss and it is much more widely distributed. In fact much of the hair remains, but the thickness of the hair shaft is smaller than normal hair and the areas that get impacted by this process can be localized or generalized. This reduction of hair thickness (miniaturization) causes the hair to appear thinner. Because a relatively large area has been subject to this thinning, for hair transplants to have any value it is important to place the hair in areas where it is cosmetically most significant and where it can augment a specifically “defined” styling plan to increase the appearance of fullness. Also, the ‘donor’ area might also be impacted so careful measurements of the donor density and distribution of miniaturization in the donor area is important before a transplant decision is made. For this reason, we generally confine the entire transplant process in women to a localized part of the scalp such as behind the “frontal hairline” or “along the part” in a plan that fits the way the woman combs her hair.

Since hair will be transplanted into a part of your scalp that is thin, but not completely bald, there is a risk that some or all of the original hair in this area may be lost. This process is called “telogen effluvium” and is usually (but not always) reversible in women. In addition, if the donor area continues to thin, then the transplanted hair will also thin over time, since it came from the same area. The progressive hair thinning may be improved by subsequent procedures, but with significant loss, there is a limit to the improvement that can be achieved. In hair transplantation, as in all surgical procedures, it is important to balance the potential gain against the possible risks when making a decision to go forward with the treatment.

Once you rule out a medical problem, then a doctor with knowledge about hair transplantation may be considered. The problem here is that too many women are so desperate for hair that any doctor wanting to offer a hair transplant to a balding women, set up a woman as an ‘easy mark’ for a sale. You must find a doctor who understands who can be helped and who can not be helped; a doctor who is honest and has a good reputation. There is an easy test to give to a doctor. Ask him/her, “What is the percentage of women patients who get hair transplants in your medical practice?”. If he reports significantly more than 5% of patients are women, you can generally assume that he is doing more transplants on women than he should be doing. Some doctors claim that half of their patients are women and that puts me on an alert that this doctor may doing more hair transplants on women than he should be doing. Women have different aesthetic challenges than men, so patient selection is critical and when a doctor elects to do a woman’s hair transplant, he/she has to fully understand the art. The thing that makes women’s hair loss different is that their donor area is frequently not healthy and the recipient area is very diffuse. Moving bad hair to another area just moves the problem around without helping, unless the goals and expectations reflect the reality of that woman’s particular problem.

Hair Loss InformationFemale Traction Alopecia – Hair Loss Information – Balding Blog

I have a full head of hair which is shoulder length. However due to many years of wearing a pony tail, I have developed a mild traction alopecia around the neck line and slightly behind the ears. Because of this, I am not able to wear my hair up, or side swept which limits my hairstyles. I was wondering if I may perhaps benefit from follicular hair transplant?

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Tight pony tails or ‘pig-tails’ can cause traction alopecia (hair loss from constant pulling). Of interest, the ‘falls’ that women use to add fullness to hair are a frequent cause of hair loss in women who use them to make their hair appear fuller. The more the use, the thinner the hair gets and the cycle of more use to treat thinner hair produces more thin hair.

With that said, the traction alopecia may not be permanent, that is, if you stop putting the traction on it. To find out, you would need to stop using a ‘pony tail’ for at least 6-8 months. What hair does not come back is probably permanent. There is a difference in the hair at the nape of the neck (which often has a different genetic ‘permanence’) then other scalp hair. Hair in the nape of the neck is generally more fragile and can be lost with stress (like traction).

We have extensive experience with treating temple hair and hair at the nape of the neck. The neck transplants were usually secondary to scarring from flap procedures which were surgically induced. The temple hair has been done in many, many patients wanting to move the temples forward or replace them from thinning. Send some pictures to me and I would be happy to give you an opinion. My email address is on the Contact page.

Hair Loss InformationHigh Hairline in Women – Hair Loss Information – Balding Blog

Hi I am a 24 year old blonde female. I am not experiencing hair loss, but I was born with a weak/receded hairline. Is it possible to correct something like this? I have very fine hair in two spots on either side of my hairline but you can’t see the hair unless you look closely. Let me know if there is any hope. Thanks

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High hairlines in women or thin hairlines are very common. Many women who have them would like to have them fixed, but not many come to people like us who have the expertise that might apply. Without discussing which one is better, they are:

  • Moving the entire hairline forward with a surgical procedure, similar to a brow lift but with a focus to bring the hairline down. This gives a very fast result and healing is fairly fast as well.
  • Transplanting the hairline. This has great value in many cases, particularly when the hairline is weak in an identified area as you seem to be describing. This may be one of the most popular hair restoration procedures we do in women.

Send pictures in digital format to me via email and I can give you an opinion.

Hair Loss InformationHirsute Men and Head Hair Loss – Hair Loss Information – Balding Blog

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?

Smelly Hair System – Hair Loss Information – Balding Blog

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.

Accelerated Loss from Propecia? – Hair Loss Information – Balding Blog

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.

Hair Loss InformationHair Coloring After Transplant – Hair Loss Information – Balding Blog

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.

Propecia’s Effectiveness in Front and Sides – Hair Loss Information – Balding Blog

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.

Hair Loss InformationFemale Alopecia Areata – Hair Loss Information – Balding Blog

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.

Hair Loss InformationHow Is Loss of Transplanted Hair Measured? – Hair Loss Information – Balding Blog

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.