Month: May 2008

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My Leg Hair Just Disappeared — My Father Has the Same Condition – Hair Loss Information by Dr. William Rassman

Hello there,

I’m a 34 male. I’m a non-smoker, very moderate drinker, healthy in every respect. I have lost almost all hair on both of my calf muscles. I’m not excessively hairy, but I do have a full head of hair. This hair loss is the cause of some embarrassment. Now, interestingly my father (62) has the same condition, though a lot more advanced. His legs are totally almost bald! My younger brother (32) has no signs of such loss. But like my father he has experience a good deal of head hair loss. I’m puzzled. And help that you might be able to offer me, would be enormously appreciated.

Many Thanks.

It seems like you have inherited the same gene from your father. The process of apoptosis (cell death) is genetically programmed in hair follicles. See Wikipedia for more on this.

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I Want a Hair Transplant, But I Won’t Take Propecia to Maintain – Hair Loss Information by Dr. William Rassman

Hi, I have read before that you will only do HTs on men who agree to take propecia, and are hesitant to do it on young people. I am 22 and cannot take Propecia due to side effects, but I now have a prominent bald spot in the front of my head. The thing is, I would be happy to get a HT very soon, and I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar. It won’t look as stupid as being 22 with a bald spot at the front. This is the prime of my life, and I’m much more concerned with my physical appearance over the next 8 years than I will be for the rest of the years of my life. So why not do HTs on people like me? Of course I want an ethical doctor, but really your 20’s are when looks matter the most.

PropeciaAt the age of 22 (unless you are already completely bald) you would generally not be a good candidate for a hair transplant surgery, particularly with your attitude, which appears immature to me. Surgery can sometimes accelerate hair loss and you may look worse after a surgery. Hair transplantation is a permanent process. 10 years from now you will be 32 years old and you will definitely care how you look. Three of the contributing editors on this site are in their 30s and I don’t believe any one of them would agree with your comment, “I couldn’t care less if it looks stupid 10 years from now and I have a visible ugly scar“. Even at 64 years old, you will care how you look. Trust me. I have seen plenty of men with your mentality who regret having had a bad surgery in their early twenties and having had accelerated hair loss.

I am not saying you should absolutely not have surgery, because I do not know your specific situation and degree of hair loss, but there has to be some maturity and understanding and realistic expectations with a hair transplant surgery. You should start with a good consultation with a doctor you trust. If it seems that I have been harsh with you, it is because I’m not trying to make a sale, but I am absolutely certain that 90% of the hair transplant doctors out there would love to get your money.

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Crunching the Numbers: Propecia and Frontal Hair Loss – Hair Loss Information by Dr. William Rassman

My hairline had receded slightly over the years and more so on the corners but was in pretty good shape as of my 45th birthday. But over the past 10 months I’ve noticed a lot of thinning on the hairline and in the area behind it, which I know now is called the mid-anterior scalp. I went to see a local dermatologist/hair transplant specialist who told me that propecia wouldn’t work in that area as it was only effective on the crown. However, he did offer to restore my hairline with 900 grafs for $5,000.

Luckily, I found your site and later read Merck’s report on propecia’s effectiveness for frontal hair loss. After crunching the numbers it seems to me that it works just as well in this region as it does in the back, although it may not be as apparent. Here’s how I got there. At the start of Merck’s vertex study, the average patient’s hair count in a 1 inch circle was 876. After one year of use the average propecia user gained 86 hairs. If we assume that the pre-baldness count per square inch was 1,400 than the average guy restored 16% (86/(1,400-876)) of his lost hair. In the frontal study the average starting hair count per inch was more dense at 1,096. One year later there was a mean gain of 49 hairs so the percentage restored was 16% (49/(1,400-1,096), the same as in the vertex study. Doctor, am I overlooking something? If not, why do so many dermatologists continue to believe that propecia won’t work for frontal hair loss?

If you are thinning in the front (and have some hair there), Propecia is worth a try, but it is not as simple as crunching numbers, as you will still have thinning in the corners. I think you are on the right path of doing research on the matter. Just remember that even a hair transplant procedure will not completely give you back what you lost.

I always tell patients that going to a hair transplant surgeon requires a buyer beware caution. I’m glad that you’re taking charge and believe that Propecia is worth a try for the area you are focusing on before looking for a hair transplant. As to why many doctors believe Propecia will not work at all in the hairline, I’ve addressed this before in Why Is It Difficult to Regrow the Hairline?.

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Pain, Inflammation, then Hair Loss – Hair Loss Information by Dr. William Rassman

About a year ago I noticed I had some pain in my vertex. No itching. I went to my dermatologist who said it was seborrheic dermatitis – as my vertex was red and inflamed. It is uncomfortable to the touch, and touching the hairs there hurts. Since then it has come and gone, but I have started to thin quickly on the vertex, and see scalp now even when dry. I have no hairloss in my father or older brother, and I am 33. I know you’ll say get mapped for miniaturization, but my derm said the loss wasn’t bad, saw no MPB and would not prescribe propecia yet. He said MPB is not associated with pain. Still it is thinning quickly, and only in the spot it hurts – the vertex. So, 2 questions. Is it normal just to have pain on the vertex and be thinning there from just from SD? And in your practice, have you ever seen pain associated with MPB? I just want my hair back and the pain to go away so I can touch my scalp.

Thanks!

Your dermatologist is correct in stating male pattern baldness (MPB) is not associated with pain. It seems you have some sort of inflammation on your scalp and I would follow up with your dermatologist to treat the underlying problem. You may have some hair loss and have seborrheic dermatitis (SD) at the same time, though if you do, the SD may not be the cause of the thinning hair. If it is not related to the MPB, your hair should grow back. The mapping of your scalp tells the health of the hair in the crown, something that you should want to know.

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My Doctor Told Me I Needed to Take Propecia to Make My Hair Transplants Grow – Hair Loss Information by Dr. William Rassman

I just had a hair transplant (2 procedures) with a total graft count of about 4100. The area in the crown and just above it only grew partially. My Dr. told me to take propecia to see if it would help. The question is, if it does help and the new transplanted hair begins to grow, will i need to continue the propecia because that hair is “genetically programmed’ to last? Is there any reason that the transplants in that area didn’t grow?

Propecia (finasteride 1mg) will not do much with the transplanted hair. It may help with preventing the shock loss associated with a hair transplant and keeping your native (non-transplanted) hair from falling out, but the story that you need to take Propecia to grow your transplanted hair is just not true. You need to ask your doctor about this and have him/her explain to you WHY it is being recommended. Maybe you misunderstood your doctor’s advice.

If transplants in an area fail to show any growth after a year, there was something terribly wrong with the surgery. As always, I am flattered you would ask me, but having had surgery twice, you should have a good relationship with your doctor to ask questions pertinent to hair growth.

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If Propecia Can’t Stop Progressive Hair Loss, How Can it Regrow Hair? – Hair Loss Information by Dr. William Rassman

If Propecia eventually can’t stop the natural hair loss progression, then how does that explain it growing hair again in people who take it?

Every drug has limitations. Propecia (finasteride 1mg) has its greatest effect in the first two years, but it’s important to note that it still works even after those first two years by slowing the hair loss. The drug may reverse hair loss in younger men, particularly if the loss occurred within the past couple of years.

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Hair Coloring and Propecia – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I have used “Just for Men” hair coloring in the past and am starting on a treatment of finasteride. Could you recommend a hair coloring product, “Just for Men” or any other, that will not damage my hair or that has ingredients less likely to cause damage

Hair coloring will not affect genetic balding or damage your hair as long as you use the product as directed and it is a commercial grade product purchased from a reliable source. Taking finasteride and coloring your hair are unrelated. I don’t know much about coloring agents to advise you further.

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Sodium Lauryl Sulfate and Hair Loss – Hair Loss Information – Balding Blog

Dear Dr Rassman,

I am a regular reader of your blog, so first of all let me congratulate you on the highly informative and useful resource you have created.

I am a 21 year old male with thinning at the crown and right-had side of the scalp. My question regards shampoo and hair loss.

I came across this article which describes the alleged effect of Sodium Lauryl Sulfate (SLS) found in most commercial shampoos nowadays. Apparently due to the acidic nature of the chemical, it could be blamed for accelerated hair loss.

First of all, I’m not suggesting that MPB in men is caused by this chemical, otherwise we’d all be bald! The bit of the article that interests me is the part which suggests that it (SLS) can cause damage to hair follicles which have just shed their minaturized hair due to MPB, thus accelerating the balding process.

All in all, I’m simply seeking your medical opinion on this issue and asking if you think it’s worth trying an SLS-free shampoo.

Keep up the good work

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ShampooBased on the article link you sent, sodium lauryl sulfate (SLS) does not look like a safe additive in shampoos, BUT by using the powers of the Internet (*cough* Google search), I have found that this is nothing more than an urban myth. Yes, it is true that SLS is used in de-greasers and yet is also found in shampoo (and toothpaste), but it is found in the personal hygiene products at much lower levels than the stuff used to clean your garage floor. If you have very weak and miniaturized hair, you can try using an SLS-free shampoo to see if that makes a difference. I don’t have an answer one way or another, and if you are concerned, using SLS-free shampoo shouldn’t be a problem. There are a number of shampoos that do not contain SLS, marketed perfectly for people that buy into hysteria. However, I think it is way overblown and wouldn’t concern myself with it.

You can find much more information about SLS at Snopes.com, a great site for debunking myths. Also, HairSite.com has a good point / counterpoint breakdown showing both sides of the argument. Even the American Cancer Society has spoken out on how the SLS rumor is completely false.

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Pantogar and MPB? – Hair Loss Information – Balding Blog

I’m a 27 year old male with slight receding hairline and hair loss on the top of the head which already has slight balding. Currently i’m taking Pantogar for around 2-3weeks, although it’s stated i need to wait for around 3 months for results but instead of seeing some improvements it seems to have a reserval effect instead. Is Pantogar really suitable for all? Is it suitable for someone of my age? If not, what is? Preferably without side effects please. Seek your kind advise on this please.

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PantogarPantogar is a supplement made by German pharmaceutical company Merz (not to be confused with Merck, the makers of Propecia). It does not offer anything that taking chicken soup won’t cure. In other words, I don’t see anything in Pantogar that will treat your male pattern baldness. The active ingredients of Pantogar, according to the product’s website, are vitamin B1, calcium D-pantothenate, vigar-yeast, L-cystine, keratin, and para-aminobenzoic acid. None of those will regrow your hair or halt your hair loss if you have male pattern baldness.

Propecia (finasteride 1mg) and minoxidil are the only medications I’ll recommend for hair loss treatment, as they are the only products FDA approved and proven to treat hair loss. Side effects do not occur in everyone, and Propecia is a prescription medication so you should see your doctor about this.