October 2011 – Page 6

October 10, 2011

Transplanting an Eroding Hairline – Balding Blog

Hello Dr. Rassman

In one of your latest replies you suggested that transplanting grafts just to thicken the regions close to hair line is not advisable as it can damage existing original hairs. Also you said you have applied this to some actors. Didn’t their existing hairs get damaged as you said? Could you supply us some further information?

There are judgments that are made based upon experience. If a hairline is eroded or eroding and the person is on finasteride (Propecia), I would treat the hairline that has hair present in it, provided that the patient understands the nature of progressive hair loss. In the young man, the erosion of the hairline is just the beginning of the balding process, so keeping a fuller hairline with transplants and following the loss as it goes back is not unreasonable.

What I avoid is someone who has miniaturization in and behind the hairline, but the hairline is still normal. Getting to know the patient has a lot to do with what I do and I tend to be more conservative than most doctors are protecting the patient from unnecessary surgery.

From time to time, I see a person with a Norwood Class 2 pattern that received 3000+ grafts in the frontal hairline. As a Class 2 patient, unless the hairline is eroded I do not usually transplant these patients… but if I do, just a few hundred grafts usually work. To give these patient 3000+ grafts means that the doctor is money hungry, pushing aside ethics to get as much of the patient’s cash as possible.

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October 10, 2011

In the News – UK Sexual Advice Group Studies Erectile Concerns – Balding Blog

Snippet from the non-hair-loss article:

More than two-thirds of men who contacted an email advice service run by a leading sexual advice charity had erection problems, which were frequently linked to loss of sex drive, according to research in the October issue of IJCP, the International Journal of Clinical Practice.

The study by UK researchers also found that a large number of men from the Middle East and Indian subcontinent sought email advice on problems with premature ejaculation and masturbation. Previous research has suggested that these issues are often related to arranged marriages.

Read the rest — Email Sexual Advice Study Highlights Problems Raised by Different Ages and Cultures

This isn’t about hair loss, but it’s interesting nonetheless. The frequency of libido or erectile dysfunction (ED) problems reported are far more common than previously thought. Granted the results are just from email surveys, but the report just scratches the surface of a common problem.

The real question is — how much of this reflects the physiology of these men? I suspect that the ED problems reflect not just the physiologic changes of aging, but of the social fabric that men fall into. Such things like alcohol consumption, depression, marriages that lost their vitality, etc… are amongst the problems that cause the libido and ED problems.

One particularly interesting bullet point from the article says that most of the masturbation related worries come from India, and I’d estimate 95%+ of the “masturbation causes hair loss” emails I get come from the same area (even though I’ve written over a dozen times that it is just a myth).

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October 10, 2011

Finasteride Caused My Slight Weight Gain and Watery Semen – Balding Blog

Hello Doc, following is a brief summary of finasteride experiment on myself, maybe you share it.

Age: 25
Gender: Male
Ethnicity: Caucasian
Hair: Light Brown / Fine hair
Hair Loss: Norwood 2

Treatment: Propecia (3 months just finished), Minoxidil (Over a year), Nizoral Shampoo

Sides: Watery Semen and decreased volume of ejaculate, slightly weight gain. No loss of libido. I think watery semen is much more common than %2, at least %40 in my opinion.

Recovery During Medication: After 3 months semen is looking dense as before, volume increased. Body weight is back to normal. These are my observations however, i dont exactly know drug effect and my body reaction to it detailed.

Hair loss: I believe this drug works. I dont see hairs in my hand as before. I dont think i even shed 100 hairs a day which is even normal. However my expectation is high and i expect new hair growth. With the help of minoxidil there is slight but visible hair growth on my corners(hairline)

Thank you for sharing your experience.

You are correct in stating the “watery semen” phenomenon probably occurs more than 2% of the time. I suspect it is in the 20% range. I’m sure you’re still losing the normal amount of hair daily as your hair cycles (perhaps in the shower or even when you walk down the street), though.

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October 7, 2011

I’ve Had 8 Transplants Over 20 Years and Can Still See My Scalp Under Harsh Light – Hair Loss Information – Balding Blog

Hello there,
I hope you can help me please? I am 51 yrs old and over the last 20 years have had about 8 hair transplants, the last one being a FUE procedure in London approx one year ago. I have an average height hairline which had around 1400 grafts to thicken the frontal area.

Under normal light my hair (which is quite short and brushed back) does not appear thin, but under sunlight and house lights I can see through virtually the whole top. I have a good crown and temple peaks which have not receded at all.

My Q’s are – could the hair be taken from my temple peaks and from the front hairline to move it approx one half inch back on my head then place all these hairs on the top to thicken that area further?

Also, could a small area, say half a centimetre be taken from around the bottom rear of my hairline extending over my ears, with a view to putting these hairs on the top of my head too ?

Thankyou for any reply you send me. Regards

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That seems like awfully too many hair transplant surgeries. Added to that, if you are still considering having more surgeries it sends a huge red flag. I read your requests and it seems a bit too drastic, but also note that I do not know your history or even know your ultimate expectations (as 8 surgeries in the past did not fulfill them), so I am just speaking in generalities based on your one email.

Perhaps you are trying to set a goal you will never achieve or had surgeons that never developed a Master Plan for you? Again, this is a generalization and I really cannot answer your question in detail without a private consultation. You may have many options once you are evaluated, such as Scalp MicroPigmentation to increase the appearance of fullness (see example) if you are running out of donor hair to harvest.

We do not harvest hair from 1/2 centimeter around the bottom of the ear and hairlines.

October 7, 2011

In the News – Alopecia Areata Treatment in Testing – Hair Loss Information – Balding Blog

Snippet from the article:

New findings that show T-cell activation plays a critical role in the development of alopecia areata has opened new doors to treatment.

A report last year from a genome-wide association study involving 1,054 patients with alopecia areata (AA) and more than 3,000 controls, identified eight genes strongly linked to the disease (Nature 2010;466:113-7). One of the gene’s codes for a ligand, ULBP3, appears in the dermal sheath of hair follicles in patients with AA. The ULBP3 ligand appears responsible for attracting the cluster of T cells that produce the characteristic histopathology of affected hair follicles, Angela M. Christiano, Ph.D., said at the meeting.

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Read the rest — Genetic Basis of Alopecia Areata Leads to Abatacept Trial

Abatacept is a rheumatoid arthritis medication marketed as Orencia. The study will include 56 patients receiving either an abatacept or placebo injection over the course of 6 months.

Dr. Christiano is a top physician that has made treating alopecia areata her mission, and I hope this study shows some promise for those suffering with this disease.

October 7, 2011

Woman Lost All Her Arm Hair – Balding Blog

Recently I have lost all the hair on my arms, also a scar disappeared on my arm. I’ve never had hair on my legs, but being a female… Also, I lost weight,and I’ve gained a lot of veins on my hands,and arms. I don’t know what to do.

If you have any idea as to what is going on, I would sincerely appreciate your time and effort.

Thank you.

I don’t know anything about your history, age, etc, so there’s not much I can offer. You would need to be examined by a physician. Hormone changes and weight loss do strange things to a woman’s hair distribution.

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October 7, 2011

The Only Side Effect I Found from Finasteride is… – Balding Blog

Hello, Dr. Rassman. I’ve read your blog for a while and am always impressed with your frankness and professionalism. I don’t see a lot of people that have had good results using finasteride posting, probably because once the problem is corrected you stop endlessly searching for answers on the internet. I started noticing hair loss about four years ago, and decided to control it a couple of years back.

From my experience, when I started finasteride I was looking for any of the side effects that might come with it under a microscope, but there were none. The only noticeable difference I saw (besides the shedding almost disappearing) was that I started getting morning erections again (I’m 31 and hadn’t really noticed I had stopped getting them for a few years). I would probably have been scared away from it if I hadn’t read your blog and your professional opinions. Good work, Doctor.

There are some who are vocal about Propecia’s negative side effects and you will find their thoughts readily on various forums and even the comments section on BaldingBlog. I wouldn’t be surprised if the same few men that write comments on nearly every Propecia related posting leave a comment on this one.

As you state, the many who are pleased with the results will almost never write about their experience… as they will stop reading this blog or spend countless hours on the Internet on the topic. The happy ones just move on and find other topics of interest. Those that feel slighted will spend an awful lot of time trying to drown out the rest.

Good luck, good morning to you, and thanks for your kind words of support.

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October 6, 2011

Bumps in Donor Area After FUE – Hair Loss Information – Balding Blog

I had a FUE operation of 3650 grafts exactly six weeks ago to my frontal hairline NW2. I recently, last 5 days, have about ten bumps like pimples in the DONOR area? what is going on?

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Norwood 2 If you were really only with a Norwood Class 2 pattern balding, why would you have 3650 grafts transplanted? This just does not make any sense to me.

Two things come to mind that could explain the bumps you’re seeing — 1) When transected hairs in a graft are placed, they can act as a foreign body. 2) There may also be folliculitis at the recipient sites.

If there is a folliculitis, the treatment should be incision and drainage of the bumps, a culture of what comes out of the wound and the use of antibiotics. Once the culture has grown out, the organisms will be identified and tested against the medication that the doctor will give you. That will tell him if his guess is the correct diagnosis.

For transected hairs, there may be a different course. As much as I would like to help you, I think that you will be best served to go back to your doctor.

October 6, 2011

Balding in Mixed Race Men – Hair Loss Information – Balding Blog

Hi, i’m a 21 years old male, and i’m mixed caucasian/african.

Here’s my question. My dad’s (caucasian) been balding since age 30, and is now completely bald at age 60. He is the worst case of MPB in my entire family. On my mom’s side, there is no history of hairloss whatsoever. Myself, i’ve got a lot of hair, semi-african and semi-european, but very dense, with a kind of “coarse” afro look (very far from my dad’s hair). I have my mom’s hairline (mature, typical from her race, where there are no hairloss), and thick hair (i think).

I’m afraid i might end up as my father, but is there really a risk? If i ever go bald, at what age it might happen? Don’t the african genes dominates caucasians’ (i’m dark skinned)? What about mixed people in MPB?

Thanks a lot for your help!

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There’s no way to tell if you will be bald simply based on your race… mixed or otherwise. Even with a family history, it is never truly clear. It’s possible that the balding gene exists somewhere in your mother’s family tree, too (and it can skip generations).

The best thing to do is to go see a doctor for an examination. Tests such as miniaturization studies and bulk measurements can establish a baseline so that you can track what is going on with age. You can also get a genetic test called HairDX, which is about 70% accurate, to find out if you have the gene. It won’t tell you if/when it’ll express itself, but it’s a start.

October 6, 2011

My Doctor Said to Use Propecia Daily for a Month, Then Every Other Day Afterwards – Balding Blog

I’m a 22 year old suffering from hair loss. I was using 5% Minoxidil at the advice of my local physician for the past 2 years with limited sucess as it managed to slow my hair loss but not reverse it. After seeing a dermatologist recently, he advised me to use propecia once a day for a month and then take it every other day afterwards.

He said that after a month Propecia will lower DHT levels in my system and will be effective for 72 hrs which is why he said I only need it every other day as this will save me money. Do you believe that by taking propecia this way it will have the same effect as using it once a day?

The recommended dose of Propecia is one pill a day for treating hair loss. I do not understand you doctor’s logic, but I will defer the treatment to your doctor as you are under his care… not mine.

I do know that Propecia’s half life in your blood stream is 4 to 6 hours, which means most of the drug will be gone from your blood stream in one day.

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