Month: June 2006

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My Hair Loss Became Aggressive Quickly, Follow-Up – Hair Loss Information by Dr. William Rassman

Doc,

I wrote in a few days ago about receding hairline: “My Hair Loss Became Aggressive Quickly.” I gaurantee I have what is “minimization.” I can see like at least an inch deep into my hair in the front but not on the sides. I am dirty blond like you asked, but I cannot imagine it is 90% gone. 50% maybe. Now I am on day 10 of Propecia. So according to the literature, from here, I have ~80 days before I see any “changes,” if I see any at all. From what I’ve read about Propecia, the more hair you have there, the better it works. So, say I go from 50% to 60% (for instance) by the time this stuff really starts being effective (the 80 days), are my chances of getting my full thickness back LESS than if i started a month ago? Two months ago? Could it be happening that quickly? I mean I started with propecia when it was 50%, right? Which number matters, the number now or the number later? Is propecia really working this whole time, but its just not “noticeable” for 3 months? Or should I assume things will continue to get worse (thinner) before they get better?

Thank you.

If you keep counting down the days for Propecia to take effect you’re going to lose your hair out from the shear stress. Remember, Propecia will take at least 8 months to see the benefits of it working. More importantly you may STILL lose your hair even on Propecia. Propecia may help by slowing the rate of your hair loss. I have no way to tell how fast or how much.

It seem you are very concerned and perhaps even obsessed with your hair loss. You may consider seeing a dermatologist or even a hair transplant doctor for your questions and concerns. Make sure that no one sells you a surgery without, in your case, waiting out the results of Propecia. Having a quantitative (not just your estimate) measurement of your hair by mapping your scalp for the degree of miniaturization may help you and your doctor in documenting the efficacy of your Propecia therapy.

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Is Missing Facial Hair a Side Effect of Rogaine? – Hair Loss Information by Dr. William Rassman

I have been using Rogaine 5% topical solution regularly for about 6 years now. It has worked marvelously for preventing the thinning of my hair at the back of my head.

Just recently I noticed two large, circular patches on my chin and neck where facial hair no longer grows. I grow a goatee and didnt mind the two empty patches but now another small, circular patch has developed in my goatee area. Could this be a side effect of using Rogaine?

Thank you for any assistance you can offer.

I would worry more about alopecia areata or fungal infection as a cause, which require a good doctor to make the diagnosis. I would doubt that this is a side effect of Rogaine.

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Did My Using Minoxidil Mess Up Propecia Benefits? – Hair Loss Information by Dr. William Rassman

In October I noticed slight thinning on the vertex and purchased 5% minoxidil. I applied this twice daily to the vertex for 2.5 months at most. I did not see any change at this time, but was tired of applying minoxidil twice a day and switched to propecia. I have now been taking propecia for 4.5 months and there is noticeable thinning on the vertex. I am also shedding quite a bit more than I ever have which has been going on for almost 2 months. I know that Propecia can awaken follicles and increase shedding, but how long does this last? Also, even though Minoxidil did not regrow any hair for me, can it have a negative effect on Propecia possibly reversing hair loss on the vertex even though I used it for only a short period of time and it did not produce any hair regrowth and thickening? Basically, did I screw myself by using minoxidil before Propecia?

No.

You may subjectively notice thinning and changes in your hair. However, it is impossible to tell what is working or not working. Consider the fact that you may be just progressing to losing more hair and taking those drugs may be slowing the process down (even if it does not seem to be). In other words it can be worse, but not because of Propecia and minoxidil. You may also consider seeing a doctor who can examine your hair under a hair densitometer to see its miniaturization pattern and quantitavely track the effects of what Propecia is doing.

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Taking Propecia May Increase A More Aggressive Form of Cancer? – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,
I met with you last month at your office in L.A. and am planning to have a procedure this summer. You recommended that I take Propecia before and after my surgery to, 1) prevent “shock loss” and, 2) lower my risk of prostate cancer over the long term. As to the second issue, I’ve read the studies on the internet and they seem to say that while taking Propecia does reduce one’s chances of getting prostate cancer in the first instance, taking the drug may increase one’s risk of suffering from a more aggressive form of the cancer. How do you view these studies in terms of balancing the risks and benefits of taking Propecia over the long term?
Thanks

There is no doubt that Propecia will play an important role in preventing shock loss from a hair transplant surgery.

With regard to the cancer issue, the study that I am aware of shows what appears to be a more aggressive cancer with people taking Propecia, but that conclusion is based on the interpretation of the cancer by the way it looks under the microscope. The pathologists usually review the microscopic slides to determine how mean a cancer looks. The pathologist scores prostate cancers and classifies them based upon criteria establishing a Gleason Score, which tries to predict prostate cancer’s aggressive nature. The patients who had the high Gleason Score were followed since the diagnosis was made in 2001 and the cancers did NOT behave more aggressively than the cancers that were present in the placebo group studied at the same time. Anything can be agrued and this is just what is happening here. Two camps are squaring off so any absolute final word has yet to be written.

My conclusion (as well as many experts in the field of cancer) is that the Gleason Score is not reflective of the agressiveness of prostate cancer and that people who are taking Propecia are not at risk of developing an aggressive cancer more than the control group (made up of people not taking Propecia). For that reason, one of my sons and many members of my family are taking the drug.

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Shock Loss in Donor Area After Transplant? – Hair Loss Information by Dr. William Rassman

I had a transplant procedure 2.5 months ago—I am experiencing very little if any growth of the hair located below the donor scar area—my doctor assures me that this is related to some type of shock caused by the procedure and that in time it will regrow—-Is this normal??

This is not normal, but not a reason to worry. Wait it out and the hair around the donor wound should return about the same time that the transplanted hair will start growing.

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My 16 Year Old Daughter Has A Small Scar – Hair Loss Information by Dr. William Rassman

I was wondering if I could bring my daughter in for a consoltation, because she has a small scar on her scalp that she would like to get filled in, and we were just wondering what kind of treatment options there are. It is a very small scar, but it seems to bother her a lot, and I just want her to not worry about it anymore. She is only 16 but she is begging me to set up a consoltation. Would this be okay, or is she to young?

She is not too young and I would be happy to see her. Hair transplants work very well for scalp scars. The FUE technique works well here. That means that there will be almost no pain for the transplants or after the transplants are done.

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Less Body Hair After Propecia Use – Hair Loss Information by Dr. William Rassman

BigfootHi Dr. Rassman, just a quick question. Upon starting propecia 7 months ago i noticed a definate decrease in body hair. Have you come across this in your practice and what would you make of it.

Many thanks

Yes, through people that have written in to this blog, I have heard that this is a side effect. I have had one patient of mine who (like you) reported reduced body hair with Propecia use. I just wish it would have done that for me because at times I feel that I look like the picture on the right.

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Fibrosis, Atrophic Scalp, Insulin – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

I don’t believe there is anyone in the field of hair research/restoration today as qualified, knoweldegable, and practical as you – and it is for these reasons that I have come to your blog to ask my questions.

It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in ceullar atrophy, and of course the dreaded perrfollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and THE reason propecia does not work for extensivly bald men.

1.)What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good?

2.) If bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations) simply because the new scalp can’t accomodate it?

Finally, this last qustion may be of particular intesrest to you, becuase it tackles the baldness issue from a whole new perspective: Recent studies have suggested that insulin resistance, heart disease, and AGA are all part of one big happy family. My father is a research cardiologist and is CONVINCED that if we treated prematurely balding men with insulin drugs as if they were diabetic, that we’d indirecty be adressing the baldness problem as well. Is there any merit to this? If so, we’d love to get in touch with you and discuss things further.

I would be VERY interested to hear your response, and I thank you for giving this invaluable service to us. God bless.

In your first paragraph, you mostly defined the way the balding process impacts the scalp. The loss of blood vessels and the development of atrophic changes along with the fibrosis is the result of the disappearance of hair. Without the rapidly growing hair ‘organ’ there is no need for the infrastructure supplied by (for example) the blood vessels. So the blood vessels just disappear, because there is no end organ to feed. I believe that the fibrosis is more a reflection that something was there before (hair and support infrastructure) and not there now.

When the transplant is done, it brings with it stem cells that command the body to bring in the infrastructure to feed the new hair cells to grow into a normal hair. The stem cells induce infrastructure building. You can look at it as if the hair transplant (in addition to bringing in hair) is really a stem cell transplant with fatty and glandular tissue. For the hair to grow, it needs lots of blood vessels and therefore it commands blood vessel growth and the building the complete new hair organ infrastructure.

As your father is a research cardiologist and is convinced that some relationship exists between balding men and insulin deficiency, then he knows far more than I do on this matter. I would love to learn more about his thesis. I would like to know what he thinks should or could be done that is safe to address the balding problem. Please have him send me more information here.

Thank you for your kind words.

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Dr. Kabaker’s Hairline Lowering Procedure – Hair Loss Information by Dr. William Rassman

I am considering having my hairline lowered by Dr. Sheldon Kabaker in Oakland, California. What do you know about this doctor’s work in this area?

Thank you!!

I generally do not comment on a doctor’s ability on this website, because if I do not know or I think negatively about him/her, I do not want to put myself in dangerous territory. I will make an exception in this case. Dr. Kabaker is a master of the hairline lowering procedure and taught it to me.

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