Month: May 2006

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Conflicted About My Diagnosis – Hair Loss Information – Balding Blog

A couple of months ago, I began to notice the top of my scalp more prominently after getting out of the shower. Not balding per se, but certainly thinning. I finally went to see a PCP (who took a thorough history and performed the hair pull test) and he felt it was Telogen Effluvium and not MPB, but that we should give it six months and reevaluate then with a blood panel to determine DHT levels before prescribing Proscar.

I’m conflicted about this diagnosis. I did admit I had been feeling some anxiety lately, since my wife and I are expecting our first child in November, and that the stress may be triggering the TE. But on the other side of the debate, my father started experiencing his MPB around my age (my mother’s father left this earth at 90 with a full head of hair, however).

Is this a common approach for a PCP to take?Should I get a second opinion, possibly from a specialist, or should I attempt to be an adult and patiently wait the six months?

Thanks in advance for your time.

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I would recommend that you get a second opinion about your hair loss and in that second opinion, I would get your scalp mapped out for miniaturization, which will show if it is genetic balding as seen in your family line. A hair specialist and dermatologist are in a better position to diagnose your hair loss than your primary care physician, because they see men with the balding process all of the time. Assuming that you do have genetic hair loss, the earlier you get on Propecia, the faster you can save your hair. Time is of the essence and the stress of fatherhood may be a precipitating factor.

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HIV Positive and Hair Transplants – Hair Loss Information – Balding Blog

I have been diagnosed with HIV which is now under reasonable control. For a period of time I was very sick, but now with the proper balance of medications, I am healthy and active. The problem is that I lost a great deal of hair from the time I got sick 2 years ago to the present. I am 54 years young and I do not like looking 80 whic is what I feel I look like when I saw a recent picture of myself. Can I have hair transplants or does the my HIV status impact either my candidacy for surgery or the results of hair transplants? Will the doctors turn me down for surgery because I am HIV positive?

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A healthy person who is HIV positive may be a good a candidate as an HIV negative person. Your sickness probably caused the ‘expression’ of your genetic balding process on an accelerated timeline. At your age, I would be surprised if it continued to progress, but after mapping out your hair for miniaturization, I would go on Propecia to protect you hair from further loss and then be evaluated for a hair transplant if you want to change your look.

Under most state laws, doctors can not discriminate against someone who is HIV positive. Some doctors fudge on this and do what I call ‘closet’ discrimination where there are convenient reasons to turn down patients, but not only is this against the law, it is against the oath we as doctors are supposed to adhere to. If you are healthy, you can expect that you should be a reasonable candidate, certainly one worth evaluating. I perform hair transplants on many such patients each year.

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I Want To Undo My Plugs From 14 Years Ago – Hair Loss Information – Balding Blog

I was looking at your photos of the blog “Alas, Bald Again”. That is what I am considering. I have had about the same amount of hair transplants and in the same area. I want to have the transplants removed and not have any more work done. I was wondering if this could be done and be able to not have a bunch of scarring and divits left on my scalp? I had the work done about 14 yrs ago and wish I just would have went bald. Thank you.

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You’re referring to: Alas, Bald Again.

Each case is different. Scars, plugs, pits, color changes in the skin of the plugs, cobbling of the skin — all of these things must be analyzed. This type of question is not an easy one to manage over the internet. I have many posts on this subject and this one shows a long cure time and an expensive process. Based upon a direct examination, I might be able to give you advice.

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Ringworm and Hair Loss – Hair Loss Information – Balding Blog

Do I have Ringworm, that is scarry? Where are the worms? I looked very carefully for them and did not see them. Are they like earthworms? Here is a picture of what my doctor called Ringworms as the cause of my hair loss.

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Ringworm is a terrible term and I apologize for the medical profession’s use of it. A better term is tinea capitis and it is not a worm at all, but rather it is a fungal infection of the skin. For more info on this, please read:

This is one cause of localized hair loss that is relatively easy to treat and diagnosis is easy in the hands of a good family practice doctor or dermatologist.

Here’s a photo of what tinea capitis (better known as ringworm) infection looks like on the scalp:


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Nexium and Hair Loss? – Hair Loss Information – Balding Blog

Dr. Rassman,
Thank you so much for your answer concerning the two shoulder injections of cortisone!
I also have acid reflux,& had taken nexium, but stopped it after noticing hair loss more accelerated than usual. Are you aware of any hair loss associated with Nexium, as this drug seems to work best with GERD, & will regrowth occur after suspension? Also does regrowth generally occur with hair lost to seborrheic dermatitis, if treated? Thank you again for your prolific insight!

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Nexium can cause hair loss, though it is a rare side effect. Seborrheic dermatitis rarely produces hair loss unless you scratch it and produce traction alopecia by continuously pulling at your hair.

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Taking Propecia at Age 57 – Hair Loss Information – Balding Blog

  1. I am 57. Over the last 5 years I have suffered hair loss. I have consulted with three hair-loss experts. Two have said I should be on Propecia, one said at my age it will make no difference. Will it?
  2. I have four elevated liver counts. I do not drink or smoke, nor have I ever smoked or drank. Will taking Propecia have negative effects on my liver?

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The value of Propecia should be determined after you have a diagnosis in hand for the balding process. How much miniaturizationdo you have as compared to balding? Propecia works well if the miniaturization process is well underway, but the hair still should have substantial volumes. With regard to your liver, what is your diagnosis as the cause of your liver problem? Doses of Propecia must be reduced when people have liver disease. I do not like internet medicine, because I like to see and bond with my patients. That is why you need a good doctor first, then a Master Plan to determine what to do next. Propecia may make a difference in the crown hair, even in a 57 year old.

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Hair Loss InformationI Had 4 Scalp Reductions And My Donor Area is Depleted – Hair Loss Information – Balding Blog

Have you considered, or would you consider body hair transplants to the scalp? I was a patient of yours once, but my donor hair is depleted. And since I have had 4 scalp reductions, you could not do the FOX (I believe its called) procedure on me because the folicals were stretched or deformed from the stretching of the scalp. I have resorted to having to wear a hair “system” because even if I shaved my head, the scarring from the donor area would be quite apparent.I am hoping for cloning or multiplication, but these seem to be far in the future, and I am not getting any younger. Do you have any ideas, or have you ever planned to experimetnt with body hair?

Thank you.

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Body hair transplants have problems, including the long sleep cycles of body hair. That means that up to 80% of transplanted body hair is sleeping and not present at any one time. Body hair transplants therefore give you efficiency factors, possibly in the range of 20% — in other words, they do not provide much value. Before you go into way out treatments, come see me in Los Angeles, as Phoenix is not that far away.

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Taking Estrogen Blocker with Propecia – Hair Loss Information – Balding Blog

I had a transplant done 2 months ago at a hair transplant office. Right now I’m in the waiting period to see any growth. I’m also on propecia for one month. I love working out, but I have some preexisting gynomastica (not sure how to spell it). I have ordered and estrogen blocker to help prevent anymore possible gyno. I was wondering if taking this product will at all interfere with any propecia results or results from my transplant? Any info would be greatly appreciated. This estrogen blocker also acts as a testosterone booster as well. That is what makes me wonder the most. Thank you for your time.

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The permanent hair from the donor area is usually not affected by hormones, so I would expect that it would not impact your hair transplant, but it might impact the other hair in the vicinity (the original hair is at risk here). Any testosterone booster will work against your goal and contribute to more hair loss. Get in touch with your doctor and get his guidance.

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Distributing Minoxidil Evenly On Scalp – Hair Loss Information – Balding Blog

Hi Dr Rassman!

I’m 27 this year and my hair has been thinning since I was around 20 years old.
Just a couple of questions for you:

  1. Could you tell me whether minoxidil has any success in slowing down the rate of hairloss and if so – what is the best way to apply it? Can you buy a cap that distributes it evenly on your head? I realise Propecia is more effective at achieving this aim – although I’m not keen on the sexual side effects (I’m quite a suggestive person!)
  2. Do you know of anywhere in the UK that offers hair mapping for miniaturisation? I have tried a handful of dermatologists to no avail.

Thanks once again for this blog – it is so refreshing to find such an informative and unbiased database of facts all in once place!

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  1. Minoxidil is not the best approach to genetic balding and you have too much to lose if you go that route. Propecia does have possible sexual side effects, but the percentage is very small (less than 1%). You may want to try it first and see. You may want to check a hair salon or beauty supply store for a cap to cover your head when applying the Rogaine if you’re concerned about that.
  2. A good hair transplant physician should be able to map your scalp for miniaturization. You can try checking the ISHRS site’s physician search to find a doctor in your area.

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Hair Loss InformationDoctor Blasted the FUE Technique – Hair Loss Information – Balding Blog

Dr. Rassman,

Thank you for your fantastic website and exciting blog! I am currently looking to find the best way to address my hair loss situation. It appears that I am, on the Norwood scale, a Type III vertex. At this time, I am seeking to have the FUE procedure done, however, I continue to find all kinds of conflicting information on the Internet, and was hoping you could give me a breakdown of what are the most important things to look for when choosing a clinic/doctor to do the procedure.

Additionally, I am confused by the various FUE methods, such as the FUE plus, FUSE, etc. I just don’t understand much about the differences and what is best for me.

Furthermore, I read an article in 2002 (http://www.hairlosstalk.com/newsletter/article181.htm) and found that Dr. Limmer, the creator of the Follicular Unit Method, blasted the FUE technique saying that it is “the equivalent of looking like you were shot in the back of the head with a shotgun.” This obviously is pushing me to reconsider any procedure since I will not consider the FUT. Please help!

Note: If possible, please e-mail me your response as well. Thank you!

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There is much on this blog about FUE and I would suggest that you take a look at the FUE category to see what I wrote here in great abundance. Follicular Unit Transplantation was first introduced by our medical group, not Dr. Limmer, but with that said, Dr. Limmer made wonderful contributions on the value of the microscopic dissection which led us to the discovery referenced here. I have great respect for Dr. Limmer, but it takes time to change and adapt. He originally did not like the megasession and made statements against them — now he does them. He waits until the technology is well tested and safe before jumping on to any new bandwagon and I agree with him that it may not be the best approach for many doctors doing this work and their patients who might look like their head was exposed to a shotgun. But with that said, I do not think that in good hands, this will be a problem. You are rightfully confused, because the doctors who push these techniques often promote rather than educate, inventing marketing terms to claim notoriety for themselves rather than teach and all of this just confuses people. I am a little guilty of this myself, as I did create the name FOX Procedure as the type of FUE technique that I use — but at the time the name was coined, there wasn’t all of these various terms out there because I was the first. Although I also coined the term FUE procedure, when you sound it out, it sounds terrible, so to make the name more respectable I came up with FOX. But, to clear up some of the confusion, I use the term FUE on this blog to hopefully make it clear to people looking for information. This is a wonderful procedure in the right hands by honest doctors who have mastered the procedure. The patients who I have performed FUE surgery have loved it.

Read, read, read what is on this blog and you will learn what you need to know. We show patients off at our open house events who had the FUE procedure to help assure people like you see that you will not look like a leaking, sinking lifeboat.