April 2010 – Page 8 – Balding Blog

April 12, 2010

Density – FUE Versus FUT – Hair Loss Information – Balding Blog

One aspect puzzles me. In FUT a strip is removed and closed so a part of the scalp vanishes and is replaced by a thin scar. The areas adjoining the scar retain their hair density and very often with trichophytic closure hair grows out of the scar, again with no reduction in density.

In FUE follicular units are harvested individually. No large scar is generated but hundreds (thousands?) of tiny ones. However (and this is my main point), donor area density is reduced because the scalp from where the hair is removed does not vanish and is essentially now a tiny bald spot.

Does this mean FUE thins out the donor area in return for not creating a long FUT scar? Is that the trade-off?

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Thanks for asking, as this can be a bit abstract.

When you remove a strip of hair (say 1/2 inch wide by 4 inches long) you are effectively removing skin and pulling the scalp from top and bottom. This in effect stretches the scalp/skin along with the hairs. So if you have a very, very precise measuring tool of hair density before and after the surgery, then you will definitely see a decrease in hair density after the surgery… but this reduction in density is very low and not perceptible to the naked eye.

When follicular unit extraction (FUE) is performed, many hundreds and thousands of hairs are taken out (and never grow back on that spot) so it is easy to see how this would also reduce the donor density.

April 12, 2010

Is Actor Josh Hartnett Losing His Hair? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

First off, thanks for your site- very helpful! Now for my question- I’ve recently encountered photos of Josh Hartnett in which his hair seems like it might be thinning diffusely on top. I am attaching links to those photos:

Photo 1 and Photo 2

I was wondering if you could give your opinion on those photos. Could this be due to fine hair and harsh lighting or flash? In some other photos, his hair seems ok. I’d be glad if you could answer this question. Thanks in advance

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Sorry, I can not tell a thing about his hair from those photos. In people with fine hair and harsh lighting conditions, a see-through look to the scalp is not unusual. This is especially the case if the hair is dark, skin is light, and the hair is straight… which appears to be what Josh Hartnett has. Plus, it appears that his hair could just be messy or wind-blown.

April 12, 2010

Is Taking 0.2mg Every Three Days as Effective as 1mg Daily Finasteride? – Hair Loss Information by Dr. William Rassman

Dear Doc,
Just read that 0.2mgs of finasteride taken once every three days is just as effective as 1mg daily at this site: hairloss-research.org

Is this bollocks?

That is just the opinion of one doctor, and I am also aware of similar opinions regarding low dose finasteride (though taken daily). I generally prescribe and recommend the standard 1mg treatment dosing to treat hair loss. From some research I have read, lower doses of finasteride 0.5mg and 0.25 mg will have an impact on DHT, but less of an effect can be expected from these lower doses.

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April 12, 2010

I Have to Take Medication That Causes Hair Loss – Balding Blog

A bit complex. I am a 47 y/o male. In good shape. Been slowly balding on the top of my head for 8 years.

Had a kidney transplant 4 months ago. Not related to diabetes. Donor was Brother. Take Prograff 2mg 2x a day. Started Testosterone thereapy 2 months ago. Very low levels. started with Androgel 5 mg. daily. Stopped that…Now on Testosterone Cyp 200mg every 21 days. The Testosterone does make me feel much better. I would rather not stop taking it. And the Prograf, I cannot stop… Hair is falling out fast for the last 2 months!

A side effect of Prograf is hair loss. A side effect of Testosterone therapy is hair loss. Is there any way to combat this? Would a hair transplant work or would it just fall back out again from the medications that I take? Any help you may be able to offer is greatly appreciated.

Kidney transplamt As a male, it is possible that the impact of testosterone may be offset by Propecia (finasteride). Propecia may also have some beneficial effects on the general genetic balding process, but you need to discuss this with your doctor before doing anything.

Hair transplants may help if you have patterns of distinct balding, as the transplanted hairs (which do not have the genetic components of balding) may be able to resist the hair loss caused by the anti-rejection medications taken for your kidney transplant.

April 12, 2010

Dutasteride Injections to the Scalp? – Balding Blog

Dr Rassman
I have read about avodart injected into the scalp with good results. Can you tell me how it would work without getting into the blood stream first. Here is the link:

Mesotherapy using Dutasteride-Containing Solution in Male Pattern Hair Loss
(PDF file)

Inject The results are interesting, but the sample size was very small and the length of the study was only a few months. This might be worth exploring with further research, though. The paper is almost 2 years old, so if there’s a follow-up study I’d love to see it.

This paper says there were 28 patients that completed the study, with 14 having received an injection of “0.05% dutasteride containing solution” and 14 receiving a saline placebo. Hair growth was noted in most of the 14 dutasteride-treated patients, and all of the placebo patients did lose hair. This is promising, but since the study only went on for 12 weeks (I realize it was just a pilot study), a longer study should be established in the future to address safety concerns. Growing hair is great, but if you end up risking your health it negates the cosmetic benefit of your hair. Also important to note — this doesn’t appear to have been published in a peer-reviewed medical journal, which means it wasn’t subjected to any scrutiny by those experienced with this medication and method of application.

I appreciate you bringing this to my attention as it is quite interesting, but I wouldn’t suggest anyone rushing to have this done though. Besides, taking a pill sounds a whole lot easier and less painful than injections in the scalp — not to mention that dutasteride still isn’t even FDA approved for use in treating hair loss and anything injected into the scalp (which is very vascular) will see fast absorption into the body 100% of the time. The paper itself concludes, “As is often the case with previously untested new techniques, this study raises more questions than it answers.” Indeed.

April 9, 2010

Female Hair Loss and No Family History to Look At – Hair Loss Information – Balding Blog

Hello,
I have been losing my hair for the past 2 years. It started falling out in droves when I was on Ortho Lo and started taking Bupriprion, then Lexapro then back to Buproprion for 2 years. I as well was getting my entire hair dyed for about 5 years. I am Korean but don’t have any genetic history to go off (am adopted). Am at my wits end. Supposed to go to Kaiser dermo soon. Do you think all the above contributed to rapid hair loss?

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Sometimes a certain pattern emerges which could point to genetics, and other times it may be a medical issues or medications issues. There are many reports online that bupropion (Wellbutrin) causes hair loss, and I’ve previously written about Lexapro and hair loss. Many anti-depressants have hair loss risks… and depression itself could be a cause. Among the possible side effects of Ortho Tri-Cyclen Lo, I see “loss of scalp hair” listed. So really, there’s a number of things that could be the cause, or it could be completely unrelated to medication.

Female hair loss can be difficult to pinpoint a cause, as there are many potential reasons for the hair thinning in women. Some of those reasons include anemia, thyroid disease, connective tissue disease, gynecological conditions, and emotional stress. For more, you should read Female Genetic Hair Loss Is Different From Male Genetic Hair Loss.

April 9, 2010

What If I’m Already Taking Anti-Rejection Medication for an Organ Transplant? – Hair Loss Information – Balding Blog

Dear Dr Rassman,

You’ve written before that hair transplant from another person or the dead are not possible because it’d mean the recipient needing to take anti-rejection meds and the risk being much greater than the benefit.

But what if a potential hair transplant patient has already had a previous heart/liver/lung etc transplant, and so is already committed to a lifetime of anti-rejection meds, would it then be possible (even if only theoretically) ? If so, has it ever happened, and is it something you yourself would be ethically comfortable with and technically confident of getting a natural looking result with ?

Thankfully, this is not a situation I’m in myself but presumably there must be some small percentage of your patients who this would apply to and it’d be interesting to know. Thanks!

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What you are asking is theoretically possible. However, one of the many side effects of anti-rejection medication is hair loss.

In the last 15 to 20 years of my practice, I don’t recall seeing a heart/lung/kidney transplant patient nor have I met someone willing to donate their hair to someone else. I think people may be more willing to donate one of their kidneys than their hair… which says something about how important hair is to most people, eh?!

April 9, 2010

Would Drinking a Lot of Water Impact Propecia? – Hair Loss Information by Dr. William Rassman

In a recent post (Propecia and Coffee) you mentioned that some people believe that the increase in urination from drinking coffee and/or alcohol might diminish the impact of Propecia.

I currently drink about 1 gallon of water a day and because of this I urinate a lot. Could this prevent me from seeing maximum results from Propecia? Should I drink less water?

Water With respect to the post you are referring to, I never stated I believe in the theory that urination will make Propecia less effective. People write about these things on the Internet and the speculations get propagated (as I have probably contributed). So no — I do not think drinking and increased urination contributes to less efficacy of Propecia. I wouldn’t worry about it.

But, isn’t drinking a gallon of water a day considered excessive? I’d be concerned with possible water intoxication or hyponatremia.

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April 9, 2010

Why Don’t Transplanted Hairs Grow at the Same Time? – Hair Loss Information by Dr. William Rassman

Dr Rassman

I have a query that has always interested me but I have never quite found the answer to. Why does newly transplanted hair grow at different timelines to each other (either scientific or theoretically). For instance I had a hair transplant nearly 6 months ago. Today I could see a couple of new hairs popping through, yet my first good initial growth that I could visibly see was just before the 3 month mark. I find it amazing that there can be such a time buffer between growths, yet all the transplanted hair was inserted in my head within a 4 or 5 hour timeframe!! Surely all the hair should grow back within that timeframe??

Thanking you for your time.

I do not have a good answer for you, but I can offer some speculation. Some hair follicles remain dormant longer than others, but it has nothing to do with the time it took to place the grafts in your scalp. All of the hairs on the head are growing at different and overlapping cycles. So naturally the transplanted hair would behave in a similar way. It may have something to do with the time in the cycle the hair was in when it was moved.

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April 9, 2010

I Don’t Want to Invite Breast Cancer by Taking Finasteride! – Balding Blog

Dear Dr,
My dermatologist has suggested me “Finax” (Dr.reddy’s Lab) 1 MG and 2% minoxidil and Aminexil topical lotion (Since Iam allergic to 5% it causes itching in my case). Now I went through this web site: MHRA

It explains the possibility of breast cancer in men with Finasteride(5 mg). I dont know whether you have answered this question previously or not. Now After purchased finax for 3 months (90 tablets) what am I supposed to do? I dont want to invite the risk of breast cancer for the sake of hair. And have you seen any cases of male breast cancer which I think is very rare compared to female.

Finax Dr. Reddy’s Finax is generic finasteride and sold in 1mg and 5mg doses. I believe that their production in India is an FDA approved facility, but sale of the generic 1mg in the US would be a violation of the patent rights of Merck… which is why this medication isn’t available here in the US yet.

I’ve never seen a case of breast cancer from finasteride and some recent studies of a few thousand men failed to show the connection that the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) warns of. For women who have a history of breast cancer, there may be an increased risk when taking finasteride… and this is just one of the reasons the medication isn’t approved for women. The MHRA warning itself states, “Fifty cases of male breast cancer have been reported worldwide with the use of 5 mg finasteride (Proscar) and three cases have been reported with the use of 1 mg finasteride (Propecia).” So there have been 3 cases of male breast cancer out of the million+ Propecia users?

The warning also mentions, “the overall incidence of male breast cancer in clinical trials in patients who received 5 mg finasteride was not significantly different compared to patients who did not receive finasteride” — so why was there a warning at all? I don’t know how a connection could even be made. If you’re really worried about this, don’t take the medication. It’s not worth the anxiety. Personally though, I don’t see how this is significant enough to warrant a warning at all.

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