March 2009 – Page 11 – Balding Blog

March 6, 2009

Hair Loss Information » Would Zinc, Magnesium, and Vitamin B6 Counteract Finasteride? – Balding Blog

Dear Doctor,

i started using ZMA, a supplement which contains zinc, magnesium and vitamin B6. It is considered to be helpful for athletes, as it increases muscle strength. It is also claimed, that it increases testosterone levels. Since i take 1/4 proscar daily,i would like to ask you if it is possible possible to counteract with finasteride.( dht etc)

i thank you in advance.

With a good finasteride block and your adherence to daily use, the supplements you are talking about should not impact the value of the finasteride.

March 6, 2009

I’m 19 and Want A Nice Hairline Now with Hair Transplants – Hair Loss Information by Dr. William Rassman

Hi Doctor Rassman and Staff, thank you for this informative blog. I am 19 years old and I was wondering if you guys would consider filling in temples and creating a lower hairline for a person my age. I know you say you do not do this because of future balding, but I would rather have this done so I can have a few years with a nice hairline, than have no years at all. I am in college and I am forced to wear my hair long and for the most part no one realizes I am starting to bald. I just want to be able to have a short hair style again.

Thank You

Before I could give you an opinion, I would need to see you and probably even meet you. I would then be able to determine if you are just experiencing a maturing hairline, which would be likely at your age, or actually have male pattern baldness. There is no substitute for an in-person examination, and over the internet does not meet my needs as a doctor. Some of the doctors in this business would want to rush you into the surgery even if you are just evolving into a maturing hairline. Any doctor too enthusiastic about performing a surgery on you might not be honorable.

Whoever you take on as your doctor, make sure that they are not just doing it to make a buck. Think long term! The great majority of 19 year olds aren’t candidates for a hair transplant because most are experiencing changes of the maturing hiarline, and there are dishonest doctors who will prey upon someone with cash in hand… like you, who may not want to accept the maturing hairline. A young man with a maturing hairline can cut his hair short, so first find out what is going on with you before you jump into a life time of hair transplants chasing what you may never catch (your 13 year old hairline).

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March 6, 2009

Get a Free Second Opinion Before Your Hair Transplant! – Hair Loss Information by Dr. William Rassman

Rassman It is unfortunate in these times to see the profiteering by some hair transplant doctors who:

Create fears of balding in young men
Perform unnecessary surgery on people who are gullible and believe what doctors tell them without question
Charge for grafts that they will not deliver (see this previous post)

For nearly 5 years now, BaldingBlog has been a site where you’ve been invited to ask questions about a variety of hair loss topics, and some have reflected upon the honesty of their doctor’s calculations and indications for surgery. As a surgeon, I think I like those questions the best… and to continue this path, I am volunteering the services of myself and Dr. Pak to help you not get caught in the quagmire of inappropriate surgery or recommendations that will not help you.

What does that mean, exactly? Well, have you gone to a doctor or clinic and were told you were a perfect candidate at 19 years old? Or do you have a Norwood Class 2 hair loss pattern and were told you needed 3000 grafts in the frontal hairline? Or maybe you’ve never actually met with a doctor, but a man in a white lab coat (a salesman getting paid to sign you up) shook your hand and booked you for surgery? There are so many ridiculous moves like those examples that I keep hearing about, and I’m drawing a line in the sand!

Call to action!

We’ve given you the information to help you research before a surgery… now it’s time to put it to use. If you think something is fishy with your hair transplant doctor, we’re going to help you. Dr. Pak and I are honest people… and it’s time someone called out the shysters. These hard times are driving some doctors to abandon whatever integrity they may have had just to make a buck and some patients have a poor understanding of what is happening to them. If you may have sought consultation with a doctor who (1) wants to find out how much money you can spend, (2) wants to know that you can get the money, (3) identify your credit cards to cover the surgery and determine the number of grafts based upon how much money you have, then the number of patients recommended for surgery goes up along with his/her income, (4) sell you substantially more grafts than you need (very common practice), putting grafts into areas that do not need them. Many people do put money aside for a hair transplant or use credit cards to cover the costs, but sharing this information should come after you and your doctor bonded, you understood the plan that you doctor put before you and have developed realistic expectations that the hair transplant will achieve your goals. I would rather tell a patient that a hair transplant is something that should be postponed because he does not have the money, than to get him to go into more debt to save his look. I’m personally sick and tired of seeing people getting ripped off for unnecessary surgery or hearing that a doctor or his sales staff promised you a full head of hair. Let me help you. You can consider this a free second opinion in the case you are doubting that what you are being told is really in your best interests. There are many honorable doctors who do not engage in such practices and if you are comfortable that you found one of these doctors, then you will not need to take advantage of a free ’second opinion’.

Get a 2nd opinion!

Email your story along with clear, concise photos to secondopinion@baldingblog.com and we’ll do our best to get back to you as soon as possible.

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March 5, 2009

Hair Loss InformationI Heard My Surgeon Discuss Mistakes Made During My Surgery! – Hair Loss Information – Balding Blog

hi Dr,
i just had a FUE procedurefor 1500 grafts a few days ago. I am very worried now because of some mistakes that took place during the surgery. I overheard the surgeon making comments like ” How come i insert in follicle with 3 hairs, but 1 hair is left outside?” Eventually, the problem is caused by her assistant failing to insert the graft properly into the special insertion tool. I think the affected grafts are quite an an amount cause she took some time to find out the cause of the problem. I dont dare to question her as i am scared she might be offended. I also didnt know if the surgeon did took out the “wrongly inserted” grafts and reinsert it back properly. If that is case, how much will it affect the grafts survival rate??

Thanks a million!!

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It sounds like the team used the Choi Implanter, which is as instrument that makes the recipient site and puts in the hair at the time the instrument is withdrawn (see image at right). It requires proper insertion of the graft into the instrument and it takes considerable dexterity to do this. These instruments are used throughout Asia and Europe, and in the hands of many doctors, the grafts often do not grow for a number of reasons, including:

Improper insertion of the hair graft into the instrument
Placing the grafts too deeply into the recipient area
Trimming problems in preparing the grafts for the instrument with removal of the hair growth centers
Graft drying, as it may be in the air for more than the 10-20 seconds it takes to kill the graft

I have seen a fair number of failures in this technique. I never understood why the surgical teams in these countries did not develop the ‘manual’ skills used in the United States, where the results may be more predictable. This instruments work in the hands of a few who developed the needed skills to overcome the above problems, but the use of these instruments suggests to the novice doctor that placing grafts into the recipient site is very, very, very simple.

I always say that doing a hair transplant is conceptually simple, but getting a successful hair transplant whatever technique or instrument the doctor uses will be seen in 8 months when the results are evident, one way or the other. A successful transplant is the sum of a whole ‘lot of steps and techniques’. The picture of the instrument shown here suggests simplicity, but by the time 8 months have gone elapsed and if there is poor graft growth, the doctor has your money and the rest can be just a nightmare of dashed hopes.

With regard to your other points, you can be meek and take the failures that may occur, or you can be proactively aggressive and let the doctor know of your dissatisfaction or your concerns. Be direct with your doctor and his/her answers should likewise be direct and to the points of your concern. In California, the state medical board or the courts protect patients. You indicated that you live in Singapore, and because I’m not familiar with the laws there, I don’t know what recourse you have.

March 5, 2009

Why Does Catch-Up Hair Loss Occur When Stopping Propecia? – Hair Loss Information by Dr. William Rassman

Hey Doc.,

I have a question regarding the shedding after quitting propecia. Why is it that when one quits propecia the shedding occurs much more rapidly then the natural progression of hair loss? That is, why don’t we go through the same “minituarization” that normally occurs with hair loss?

You cannot escape genetic balding. Hair has a normal life expectancy (see this post) so when the Propecia is withdrawn, the apototic process kicks in. Medications such as Propecia slow this process down by preserving or strengthening the dying miniaturized hairs (the hairs that are genetically programmed to die and fall out). When you no longer take the medication, all the genetically predisposed hairs that should have fallen out naturally will no longer be supported by Propecia. As such, they will fall out. That is a simple way of thinking about catch-up hair loss. In other words, you didn’t stop the time line of genetic hair loss by taking Propecia.

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March 5, 2009

Natural Radial Inclination? – Hair Loss Information by Dr. William Rassman

I have a NATURAL RADIAL INCLINATION of my hairs and i’d like to “fill” some low density areas. Could it be a problem with a transplant or any skilled doctor should be able to match the inclination of my hairs?

I am not sure what you mean by a natural radial inclination. The only place where one has hair that points in a radial type of direction is the crown or vertex area. If this is the case you need to have a Master Plan of what you want accomplished with hair restoration surgery. If the area of low density is only in the crown area you may benefit from Propecia or minoxidil and may not need hair transplant surgery initially.

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March 5, 2009

Laser Assisted Hair Transplants? – Hair Loss Information by Dr. William Rassman

Need your comments on laser assisted hair transplant: http://www.hairscalplaserclinic.com

I had an opportunity to review this technology and in my opinion it is a bogus technology looking for Star Wars type recognition. This also reflects comments on the website for stem cells doubling hair somehow magically achieved from the donor area.

In his video on the website he talks about stem cell for doubling hairs with limited donor hairs. Need your thoughts about that.

There used to be a laser sold which made holes in the head for graft placement and most competent doctors have abandoned it. I never used it because it produced more damage than benefits. The procedure that is defined at the website you linked to, defies medical common sense. Seems to be more science fiction than science fact. As far as I’m aware, there is no such thing as laser assisted hair transplantation and certaintly I am not aware of any competent doctor who uses the laser.

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March 5, 2009

I Have Alopecia Universalis, But Also Have 3 Faint Tufts of Hair On My Scalp – Hair Loss Information by Dr. William Rassman

Hey,

I have alopecia universalis. My doctor stated that alopecia universalis makes every hair on your body fall out, however on my head i have spikes all over it and about 3 tufts of hair, not noticable by the eye but by touch. I was wondering if anyone out there has the same question as me, is this a good sign?

I have just this week begun being treated with Topical Immunotherapy but i havent started with it being placed on my head, i have it on my arm to get me allergic to the stuff before i have it put on my head. Has anyone recovered from alopecia universalis who had the same questions as me? with the little spikes of hair all over my head. If there is anyone out there who knows something about this, please answer !

Thanks

Alopecia universalis is extremely rare (less than 1% of all cases of alopecia areata), and unfortunately I’m not an expert on the disease or the treatments. I will forward your message to anyone that I know that could possibly help. If any readers have anything to add, please leave a comment below. You might be able to find more information at the NAAF.org site.

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March 4, 2009

Hair Loss InformationI’d Think A Trained Eye Would Be Necessary to Determine Miniaturization – Hair Loss Information – Balding Blog

Doc

If a layperson tries mapping out their scalp for miniaturization are they really going to be able to tell the difference from a hair in a certain stage of miniaturization and a new hair growing in? Or from a miniaturized hair getting thicker. I would think it would take a trained professional eye. Especially if someone has already started treatment.

Thanks.

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If you follow the tutorials on mapping your own scalp (see BaldingForum) some of this information is not difficult to get as long as you have the proper tool. Using a video microscope, you take photos of various areas of your scalp and compare those photographs a year later at the same location. Then it will be easy to see what has happened to your hair. You do not have to be a rocket scientist to do this, just a motivated victim of hair loss.

That being said — yes, I can tell much more because of the years of experience I have. I was one of the first ever to do this and it reflected my invention (U.S. Patent 5,331,472), which defined the process for measuring hair density and observing the appearance and thickness of the hair. I then published the same process in various articles written since 1993 (see my CV for a list).

March 4, 2009

Why Will The Propecia Libido Problems Will Subside? – Balding Blog

Hi Doctor,

I’m a 23 y/o male with hairloss beginning from the age of 20.

I’ve been on Generic Propecia (Finpecia) for aboout 4 months now and have noticed a gradual depletion of my libido to the point now where it is at absolute zero! There are a lot of sources saying that I will have difficulty regaining any form of sex drive for quite sometime (years!?) and obviously your response ‘that it should subside within several months’. I understand you’ve answered this question before, however you haven’t given a medical explanation as to why it should subside and considering I’ve had a gradual decrease in my libido for several months I’m simply not sure what I should believe.

Loss of libido at such a young stage of life is obviously very concerning to me and to many of your readers. I beg you to shed some light about this problem.

There is no medical explanation to why you will have a prolonged (several months?) residual side effect after stopping finasteride. Finasteride lasts in your blood stream for about a day. After a couple of days, it is essentially gone, but there is some tissue fixation which may keep it in some of your body tissues for about a week or so. The short duration for blood levels is why you need to take it every day for it to work. So if you had a side effect, it will likely subside within a few days (not months or years) after stopping the medication. Of note, side effects can go away even if you continue taking the medication.

I realize people write about libido issues related to finasteride (Propecia) and post concerns on the Internet. While I believe these people are having libido issues, I have a hard time believing that there is a direct correlation between finasteride (Propecia) and its long term side effects on libido. As a physician, I have followed and seen many patients over the last 10+ years who have been taking finasteride (Propecia) and I do not see the long term libido problem that people write about on the Internet. Yes, a small percentage of my patients (1 to 2 percent) may complain of sexual side effects, but the side effects usually go away after a few days or weeks (not months or years) and it is not permanent and a few canm not tolerate the drug for this reason. If there was such a long term or permanent problem with Propecia, I am sure I would have seen at least one patient in the last 10+ years describe this to me, and that has not been the case.

I strongly urge you to talk to the doctor that prescribed you the medication. The most important thing that people do not consider is that it may NOT be the medication that is causing a low sex drive. Many men (even in their 20’s) have sexual problems, but there’s not a great percentage of them that would admit it. While it may be easy to just blame the problem to a side effect from a drug, it can be a sign of a serious undiagnosed medical condition (such as high blood pressure, diabetes, depression, low testosterone, the presence of other diseases, etc). So although I appreciate the overall confidence many people have in me because I listen to (or read) what they are saying, you need a doctor willing to take you on as a patient — someone to meet with in person, not just communicate via email.