Month: January 2023

I am 21 years old and my hair is everything to me. I don’t want to lose it, even when I grow older. Is there a mature female hairline like the mature male hairlines you write about that I should worry about?

Unlike the male’s mature hairline which is V shaped, the female hairlines are usually rounded. The rounded hairline may move upward and in most women who are under 40, the upward movement does not change the rounded shape. If by chance you do not follow this rule of thumb, you can always have hair transplants to restore your rounded hairline. Check it out with a doctor who understands the female patterns of hair loss.

Doctor,

I had a hair transplant in July 2009. The physician completely re-constructed my anterior hairline. There was no hair growing there before he transplanted some. In September of 2009 I began monthly injections of 1ml of testosterone. I noticed my hair really filling in from the transplant until about 6 months ago. Since then I have noticed a definite thinning of my hair including the reconstructed frontal hairline which was exclusively transplanted hair. Is it possible that the testosterone treatments have caused the transplanted hair to fall out? I have been taking 1mg of Propecia religiously since the transplant, but it doesn’t seem to be making a difference. Thank you.

It is possible that the testosterone impacted the transplanted hair and almost certainly may have impacted the native hair that is present. If the hair transplants are falling out due to the testosterone injections, it might even suggest that the hairs used in the transplant didn’t come from the donor area (permanent zone in the back of the scalp). You need to discuss this with your surgeon, as he has the insights into your case and I only know what you told me above.

I realize you indicated that you’re not in the Los Angeles area, but if you make it out this way I would be happy to examine you.

The use of testosterone supplements is on the rise. The medical profession does not understand what this hormone does for men if they have a normal testosterone level but somehow, the male audience seems to think it has value (I do realize the body building community seems to see the value – at least in their marketing.). Certainly for the half of the population that has genetic balding, added testosterone will probably accelerate the hair loss picture for that individual. For this reason, I revisited this older post from a few years ago.

I started to lose your hair this July. About that time I also went on hormones, DHEA, and antibiotics. Could these medications have caused my hair loss. I recently stopped taking these medications and think that the loss may have slowed and some reversal may be going on. Is this possible

I believe that considering the short period of use and the known relationships between DHEA and hair loss, it is reasonable to expect that the hair loss you had might be related to the medication. You think that the hair loss is reversing upon stopping the medication so it is reasonable to expect that your progress will continue. You need to determine the status of your hair in and around your head, get the hair and scalp mapped out for miniaturization and if this is normal, that would make the process most probably reversible.

Dear Dr Rassman

I have been using Minoxidil once per day since November 2013 on the temples and hairline (as well as finasteride)

I haven’t ever experienced a noticeable shed, or any regrowth. My hair has continued to get slowly worse. I have continued using Minoxidil as I thought that maybe it could at least be contributing to help slow down the MPB process – but I am unsure if this is the case

The Rogaine website states that treatment should be stopped if no results (i.e. regrowth) are seen within one year. My questions are therefore

1) Is it best that I quit using minoxidil?
2) Is there a risk that healthy hair would have become dependent on minoxidil, and fall out if minoxidil is stopped?

I look forward to hearing from you.

Thanks

If you hair loss is just the frontal hairline and the temple peaks, I would not expect to see hair regrowth in thise locations. The maturing hairline does not respond to minoxidil or finasteride. If you are sure that there was no benefit from the use of minoxidil, then stopping it should not make a difference; however, if there was some benefit, stopping it might cause loss in those hairs that benefited (something I doubt). So it really is important to be sure.

QUESTION FROM THE PAST
I have been taking Propecia for just under a year with really no ill effects, and some good results. But in early November 2006 about 5 weeks ago I noticed discomfort and some swelling in my right nipple. I had a sonogram and was put on two different antibiotics for one week, each to no avail. The doctor thought it was mastitis or a staph infection. I had blood work done and all appears normal. I spoke with a surgeon today and he said I had Gynomastia and needed surgery next week. I want another opinion.

Can I simply stop using propecia and substitute with another treatment? Must I have the surgery? Please help thanks

It is very difficult for me to judge your nipple problem over the internet. My answer therefore will be in the general view, not specifically targeted to give you a medical opinion. If I were to examine you directly, my opinion would be based upon having all of the facts, which is simply not the case right now.

There is usually no rush to tackling even a small nipple mass in a young male when there is pain present. Stopping Propecia is a reasonable thing to do first and if the nipple pain is induced by the drug, then the pain might go away in a week or so. Ask your doctor why he feels that there is some urgency to the problem. Some men with breast pain from finasteride (Propecia) may not see it go away by just stopping the medication, but stopping it is a reasonable first step.

Dr. Rassman:

Prior to reading this, thank you for your time. Your insight and knowledge is of great appreciation.

My situation is as follows:

I started propecia, was on it for a month, then underwent a HT of 1,900 grafts mainly in the front hairline. I continued to use propecia for 2 more months and began to experience some serious sexual side effects. I stuck it out for another 3 weeks however the side effects continued so I stopped the propecia. The sad part is that the propecia began to halt my hairloss however I could not deal with the sexual side effects.

Sadly my hair is shedding. After another apt with my hair restoration doctor, he suggested I take Avodart 0.5mg twice/week. He had mentioned that some of his patients who were having side effects from Propecia took the Avodart bi-weekly, (due to the drugs long half life) and were able to halt hairloss but did not experience the side effects which I was experiencing from my daily 1mg Propecia regiment. I have read all of your posts in regards to Avodart and I understand that it is not FDA approved nor do you prescribe it to your patients.

My main question to you and issue at hand:

I know that when people start taking Avodart they experience a shedding phase which generally kicks in after the first month or two of starting the drug and can last a few months there after. My first question – If I am only taking the drug twice a week and have only been off of propecia for 4 weeks will I also experience a shedding phase? I am confident that the shedding phase is the transition to a greater good…as the weaker hairs fall out months later they are replaced by stronger, new hairs. My problem is that I am in the entertainment industry and will be starting a one month taping of a TV series from June 30th-July 30th of next year. I would like to have as much hair as possible by that time so would I be better off waiting to take the Avodart after the taping is complete, or should I start now and hope that the avodart will not cause a drastic shedding phase and help me stabilize the hair that I currently have? I guess this really comes down to a game of timing.

It will be 14 months since my HT when the taping starts in June so I am hoping that the transplanted hair will already be full by then. Also, most of the hair that I am losing is from the front hairline and temples. The crown seems to be doing ok.

Thanks again for your time and I would also be interested in undergoing a transplant with your team following the taping.

I really do not have a clear answer to your situation. In general, Propecia or Avodart will not be as effective on your front and temple areas. They each work best on the top/crown areas of your scalp. I do not know if you will have more or less shedding as everyone has different results, different side effects, etc. Shedding isn’t seen by all men that start the medication. Really, only time will tell and there is no clear way to predict this.

It would be interesting to know if Avodart did indeed change your sexual side effect issues, as I would expect that it would not make it better. There’s not enough reported about Avodart dosing in the treatment of hair loss for me to suggest that bi-weekly pills are the way to go.

So, Dr. Rassman, it’s the day after my surgery and I don’t think I’ll be able to sleep for a few days. No, it’s not because of any pain or discomfort; rather, what you and your team did today will forever change my life.

As you know, my journey began in late 1993 in Beverly Hills. One scalp reduction and two 100-graft sessions later, even I could tell my ‘Master Plan’ at the time was bunk, BS, a no-go situation. And I’m no doctor, mind you.

Because I was still losing hair and now my large grafts began to show, I entered the world of hair systems ala Hair Club for Men two years later in the fall of 1995. The cover charge for entry into Sy Sperling’s party was a steep $2625.00, however, and that took me by surprise. Funny thing is, I now look back at those photos from that period of my life, and the hair looks shiny and oh-so-fake. Kind of like a horse’s tail. Maybe it was? No, that’s too harsh. I’m sure it was farmed from ladies in the far east, stripped of its cuticle and dyed to my hair color. It just had this otherworldly sheen to it and in no way did it appear real. Man, I wonder how many people knew?

Flash forward to the year 2000. I joined the Directors Guild of America (DGA) that year, was making union wages as an Assistant Director, and then stepped up a notch to a Richard Farrell hair system. Farrell reminds me a lot of you. He blows the lid off the hair replacement industry, and has a completely transparent salon. His systems are indeed the best, but no matter how much they appear to be growing out of your scalp, they are not. Further, they never will. My first two systems in August 2000 were just over $3000.00, reasonable for the quality I was getting. Since the lace bases were very sheer, they eventually ran their course and were replaced. In 2005 I did just that, except the cost of two systems at that time was $5000.00 (inflation of course). So, that’s $8000.00, excluding the monthly servicing, coloring, hair additions and haircuts I received. When you include those items, I spent $16,2000 from August 2000 through January 2006. OUCH!

Of course, the sad truth is I work in the film industry on set as an Assistant Director. I had the good fortune of working with Scorsese, Coen Brothers, Clint Eastwood, and directors of that caliber who attract similarly-accomplished crew members. I was unfortunately busted wearing a hair system by the hairstylist of a prominent Hollywood actor by none other than George Clooney’s personal hair stylist, a guy named Waldo Sancez. He is a cool cat, and he personally didn’t make fun of me or even let one that he knew (a class guy). He simply relayed to me that the entire hair and make-up trailer was abuzz because they were convinced I wore a hairpiece. When I was in the dressing from, he looked at my hairline the entire time, and never asked me if it was true. Conclusion: They all knew. OUCH!

Don’t get me wrong, if I were an accountant, mortgage broker, etc, I could have gotten away with a system of Farrell’s quality. It’s a completely different story, though, when you are standing eye-to-eye with an Oscar-winning hair and make-up artist giving warnings to the actors sitting in the chair getting ready for set.

After Waldo’s revelation, I was never the same AD. My self-confidence deflated like the proverbial balloon. I wore a ballcap every single day on set since 2000. All the while paying thousands of dollars to upkeep the systems that were supposed to allow me to NOT wear a ballcap. Irony anyone?

Flash forward to today, Feb 23, 2006. NHI is the real deal! You are every bit as caring and accomplished as any doctor I’ve met. I’d even hire you as my primary care physician if you moonlighted on the side. Bottom line: Your patients come first; your company’s earnings are secondary to the end result (and safety!) of those who enter 9911 Pico Blvd. looking for help.

I CAN NEVER THANK YOU FULLY for what you did for me-hell, and my career, for that matter-today. I am in the queue for a HUGE movie later this fall, and I know my confidence will be at an all time high. You can’t put a price tag on that. It’s about value, and what you’ve done for me far exceeds the “price” of what I paid NHI yesterday.

This fall, I can’t wait to knock on the trailer door, look the hair department head in the eye and proclaim, “Camera will be ready in 10 minutes. What’s your best guess on having actor _______ ready?”

I edited this letter before publishing it here, because it contained things that should not be the focus of such a letter (even for humor). I always believe that if you have nothing good to say about someone/something, best not say it. This man was a delight to work with and we bonded in a very special way (I always seem to develop a special bond in this strange world of the hair transplant repair process). Many repair patients have a unique type of pain that they live with, a type of pain that fortunately does not happen much with the modern techniques used today. The bonding requires building trust where none existed because of the history of the bad experience, well defined by this patient. I was humbled by reading his letter as I am every day working in this field.

William Rassman, M.D.

This is a review of a hair transplant surgery at the New Hair Institute and what is possible for a Norwood 5 patient.
This patient had two procedures totaling 4774 grafts. He still has about 2000 to 3000 graft extra reserve if he has further hair loss on his crown area where there is significant miniaturization. He should stay on Propecia/finasteride to slow down the crown hair loss which is an almost certainty considering the amount of miniaturization that he has in the crown. Needless to say a very happy patient!

After photos – taken September, 2006:

This is an excellent discussion of how to apply a traditional body tattoo. Posted by Destin at SmarterEveryDay

This is an excellent discussion of how to remove a traditional body tattoo Worth a viewing. Posted by Destin at SmarterEveryDay

Scalp Micropigmentation (SMP) is essentially a specially applied tattoo where a pigment is deposited under your skin. I think that everyone who is going to undergo any tattoo, like Scalp Micropigmentation (SMP) view these videos. The traditional tattoo moves the ink deeper than SMP does so colors can be blended with each other as an illustration is made. With SMP, every “dot” is controlled with regard to depth, time in the wound that is made and the angle of placement. The goal with SMP is to make every dot look like a follicular unit. With the limited volumes used in SMP, the migration of the pigments should be significantly less than with traditional tattoos.