Month: January 2023

1. Is initial shedding experienced with minoxidil the same as loss due to trauma? That is, does the initial shedding often experienced from a topical solution represent permanent loss (like loss from surgery or medications), or is it simply the start of a new hair cycle, with potentially thicker hairs growing back. Or is this the same as traumatized hair that, once it falls out, regrows weaker and smaller? I ask because I began adding liquid Rogaine on weekends in addition to the foam during the week (it is just too greasy otherwise), and I am hoping that maybe some of the most recent loss might have been caused by the liquid formulation.

Minoxidil is known to cause shedding in the initial use. It is not comparable to trauma. The hair should come back and start reversing from the short term loss within 2 or so months.

2. We discussed formula 82M. So, in addition to 5% minoxidil, it contains retinoic acid, tretinoin, 0.01% topical steroid fluocinolone, and oleanolic acid. I am just curious if you would expect to see any real difference in response to treatment between 82M as opposed to Rogaine. I have not felt any irritation from the 82M upon application, but my scalp has become extremely dry with a tremendous amount of skin flaking (when I wake up in the morning, my pillow looks like it has been sprinkled with confectioner’s sugar). I never had a problem with scalp irritation from either liquid or foam Rogaine. If there is no reason to expect different results from 82M versus regular minoxidil, I do not know that it will be worth using in the long run.

The various acids in the 82M or other similar medications generally cause the scalp irritation, dryness and flaking. The basic theory behind the extra ingredients is to irritate the skin to absorb the minoxidil better.

3. Many doctors promote PRP treatment, and I know you remain fairly skeptical without good clinical evidence, but have you actually seen positive results in any patients anywhere? Is it a hit-or-miss type of treatment, where some people respond and some do not, or is it purely nonsense?

PRP has not shown any value. This came up at the recent international meeting for hair restoration surgeons and after review, it was my conclusion from that meeting (as well as many of the respected doctors who where there) that PRP has little value, if any in the various balding or hair transplant scenarios.

I have not seen positive results or met anyone who claimed positive results.

4. There are no solid studies regarding the effectiveness of LLLT on hair growth. Despite the question of efficacy of LLLT, I wonder if it is still possible to determine which device may be the best choice for the end user. I was considering trying a new laser, if only for better coverage and convenience of use, but is there any reason to think that the hair cap, for example, is any better than other laser products?

I have tried LLLT on patients over the years and I never saw any value and that is my belief. One doctor I respect, told the meeting that of the various devices, the Laser Hair Comb might be the best. I ask the best of what?

Dr. Rassman,

I have been a patient of yours for over three years now and I recently visited your office back in August. After seeing you again it was established that my hair loss had not progressed from last year and had possibly even improved. Unfortunately, over the past month, I have been experiencing non characteristic loss. When I am in the shower, I have never ending clumps of hair coming of my head and clogging the drain. Also, when brushing my hair there is even more loss. Dr. Rassman, this has never happened before and I have no idea what to do. Is it possible that the Propecia that I have been taking since November of 2005 has stopped working for me and my genes are taking over?

All of the loss has been occurring since I have been out of town on a job. I seem to even have some kind of infection on the corners of my lips. I am sure the two things are not related, but I figured I would tell you.

Anyway, is this a normal experience for someone on the drug as long as I have been? Should I take more of it? Is it possible for a person to lose all of his hair immediately? Could this be a possible hair cycle or allergy? Again, I have no idea what to do and what to expect. I appreciate you taking the time to read this and your advice/help would be greatly appreciated.

Thank you and looking forward to hearing from you soon!

Hair loss can increase from stress amongst many other things, such as the normal progression of hair loss that occurs in some men (even those on Propecia). As one of my patients, please come see me and let me see if your miniaturization has increased. We can get a baseline on the HAIRCHECK instrument by measuring your hair bulk now and then repeat it in a year to see, for future purposes, if you are continuing to lose your hair.

I am 18 years old and I am seeing my hairline rising. Can we stop this change with Propecia?

The mature hairline is present in about 90%+ of men as they mature. I don’t have any experience with stopping the hair loss in the very front of the hairline that is typical of children. At 18, without seeing you, I don’t know where you are in the process; however, I don’t believe that the zone between the leading edge of your juvenile hairline and the place where a mature hairline will end up (see reference above) is mediated by the balding gene as this is not balding in the typical sense of the word. These hairs undergo Apoptosis (cell death) and that is programmed into your genetics. I have had young men on Propecia in the past, and I do not remember any of them where the transition from juvenile hairline to mature hairline was stopped by this drug.

A patient who had a surgery yesterday, told me about his experience as he was walking the two blocks to his hotel. His surgery was finished at about 4:00 pm and he was wearing a surgical cap (to cover his FUE and hair transplant surgery) and a doctor’s scrub top (given to all of our patients for surgery). He was approached by two beautiful women who seem to be tourist with Russian accents. They flirted with him and struck up a conversation eventually asking him what type of doctor he was. While he loved the attention and as a single eligible man on the dating scene, he just had a hair transplant procedure and it was not the time to flirt back. He thought “what would be the chance of meeting women like that after his hair grew out wearing a surgical garb?”. We both had a real good laugh.

Hello, I was hoping you could clear up something regarding the percentage of men who go bald or experience thinning.

I’ve read that only 50% of men are bald by 50, but I’ve also heard that the American Hairloss Association did a study that found 2/3 of men are bald by 35, and 85% of men are thinning by 50. These statistics seem in conflict with each other.

Does the American Hairloss Associations study reflect the percentage in ALL men, or just American men? Websites I’ve been on are inconsistent on which one it is. If you could clarify, I’d appreciate it.

To my knowledge there isn’t a landmark study of epidemiology or the prevalence of male pattern balding in men. Male pattern balding is genetic and it follows a “pattern” as the name implies. Thus by the definition, a slight front corner recession of a Norwood 2 could be termed a mature hairline which is not “balding”. However, when most people hear the term balding they assume a full Norwood 6 or 7 type of balding. The Class 3 pattern reflect the early corner recession in a maturing hairine (see: HERE)

I often write that about 50% of men have the genetic make up to have some type of balding (Norwood 3 to 7). I often write about 7 to 8% of men are Norwood 7 (completely bald with only a 2 1/2 inch rim of hair around the back and sides of the head). It is also understood most male pattern hair loss may begin after puberty, but most men start their balding process in their teenage years to their late 20s, and by the time you are in your middle age 40-50 you would have an established pattern of balding (or no balding). You will find these numbers may be variable depending on the source as you suggested.

The American Hairloss Associations on the website claim that by the “age of thirty-five two-thirds of American men will experience some degree of appreciable hair loss (I doubt this statistic), and I believe that by the age of fifty approximately 50% of men have significantly thinning hair” not the 85% suggested by the American Hairloss Association. I do not know where these statistics come from. Furthermore the term “thinning” can also mean gradual change of the character of the hair as one ages that is not genetic balding (just more fine hair evolves). Men who never go bald will have some thinning as they age but they will not go bald or show a “patterns” of balding as depicted in the Norwood scale.

I am a 33 year old woman who has been completely bald (by choice) about eight times. I have been shaving my head since 2008, and my hair is usually about a number 1. I did not do this to raise money for cancer research, or anything similar. I shave my head because I love having short hair. I think it is very sad that so many people consider hair loss to be a bad thing, and spend ludicrous amounts of money just to have more hair.

I shave my head myself every week and spend about 30 cents a week on shampoo. I own a few beanies for Winter, and in Summer I never have that disgusting feeling of sweat-soaked hair.

Why have hair, when you can just shave it all off? I used to have beautiful long hair, but it is more fun to NOT have hair.

If you are worried about hair loss, you must have a very boring life!

Thank you for sharing your experience. I think bald can be beautiful too! But hair loss does bother many men and women and at least they have a choice to do something or nothing about it!

I hear every conceivable answer to the question of washing ones hair. Should it be done daily, twice a day or weekly?

A famous hair researcher recently suggested that a wool sweater of the highest grade, if washed everyday for a year, would eventually show significant wear and tear after a year. That is because the soaps and detergents used would break apart the wool fibers with time. Better wools stand up to the detergent attacks better. So it is with hair, more washing eventually damage the hair over time as the wax that protects the hair shafts (sebum) is washed out. The shorter the hair, the less the problem as the older hair (ends of the hair) show the damage of washing over time much more than short hair. Women with long hair complain of ‘split ends’ often and this is the result of accumulated washing and drying of the hair. Blow dryers produces more damage to the hair.

For most men who do not let their hair grow to shoulder length, wash as often as you wish. Use good quality shampoos and if you add a conditioner, it will re-hydrate the hair shafts after the detergents take out the wax that normally protects the hair.

Dr Rassman,

My question is: does finasteride play any role in maintaining minoxidil dose-dependent hair?

I got started on 5% minoxidil topical in early Feb, 2009. My derm prescribed Finasteride oral 1mg/day too, but I did not pursue that medication due to the usual side-effects related concerns. There was an initial minox-induced shed: not a massive one, but scalp showed. Things started looking up 4 months later but then again in July/August a bout of minor shedding ensued. Survived that too. In November yet another shed started and this one was bad; short fine hairs all over the pillow in the morning. Scalp showed yet again, as bad as after the first shed in March. In December, I panicked, decided that Minox wasn’t working for me, and got started on Finstaride 1mg.

By mid-Feb this year, there was a sort of minor miracle on the top of my head. My hair is looking its best in maybe two years. I hope you agree with me that it’s unlikely that Finasteride started growing hair within 10 weeks of beginning its use. My (semi-literate) guess is that Minox first grew “peach fuzz”, which gave way to intermediate hair, which then was replaced by terminal hair. I suffered synchronized sheds, the last one being the shedding of intermediate hair. Maybe more sheddings are in store for me, maybe not.

To get to the point, I am so pleased with the result that I’ve gotten greedy: I want Finasteride growth too. No sexual side-effects so far. I’d like to press on with Fin, and reserve the option of discontinuing it in future if side-effects show up. I understand that that would result in catch-up loss, but then probably I’d be content with the hair that Minox grew for me.

Hence the question: do minox and Fin have a cumulative beneficial effect on the same hair follicle? Will minox-dependent hair too be lost in catch-up loss if Fin is stopped? If the answer is in the affirmative, I’d probably be better off stopping Fin right away, since I’ve been using it only for 3 months.

Thank you for a patient reading, and thank you for your time.

You would have to poll each hair follicle and ask them what they liked better. If you can not communicate with them, then you are like me who frankly does not know the answer to your question. My best guess though (keep in mind I could be mistaken) is that because the medications work in different ways and finasteride will not keep hair grown from minoxidil and vice versa, that the benefits are independent of each other. Many men do use both medications concurrently, and as long as you can afford both (and maintain the regimen) I say go for it! It’s ok to be greedy and want your hair to look as great as possible. If the meds work well for you, that’s great news!

While it is unlikely that any major hair growth you’ve seen in just 10 weeks occurred from finasteride, you could’ve seen benefits from the medication that have helped your hair look better overall. The two drugs work differently. Minoxidil will grow new hair but the quality of the new hair varies in individuals from thin and poor, to strong and good (less than 15% of people). Finasteride probably does not grow new hair, but most likely works on the miniaturized hairs that we see in male pattern balding as it progresses. This is why finasteride (Propecia) will have no effect on the new minoxidil produced hairs. Minoxidil has not been shown to work on miniaturized hairs, at least that is what is presently understood.

Dr. Rassman

My daughter has many bald spots on her head, we noticed this back in August of last year and it dosen’t seem to be getting better. I am at a loss as to what to do. I have had her saliva tested and put her on a vitamin and mineral regiment. She has also started to eat more vegetables at our urging to help with her problem. She is seven years old and has always been concerned with her appearance, I am very concerned that this will progress and affect her forever. Please send me any information that you think may help us.

Take her to a good dermatologist. Spots of hair loss are signs of something wrong like a fungal disease of the scalp or alopecia areata or a variety of other conditions. This is not the place for the amateurs (or even online opinions) and your daughter deserves a good professional opinion from an expert in person.

Dear Dr Rassman,

Your blog entry of 17 July 2007 includes before and after pictures of a man with a receding hairline who has been transplanted. I am curious how you would mange his follow-up care if he was 30, 40, 50, 60 or 70?. Is balding in this particular pattern common in younger or older men? Am I right in assuming that most men with this kind of hair loss will need more transplants later on as the balding progresses?

His before photo is on the left; after photo on the right. Click the photos below to enlarge. For more photos, see Results After a Single Session.

 

This patient has a Norwood Class 3 balding pattern, and yes, it is quite common. He is over 50 years old but we commonly see this pattern in men in their 20s and 30s,. The older they are, the more stable is their hair loss. As he is 50, I would not expect his pattern to advance much at all. If he was 25 years old he could lose hair behind the transplants particularly if the balding pattern was really much worse. Many men like this develop crown balding (a Norwood Class 3V pattern) which may require another procedure. For men with only frontal hair loss like this patient (age 50+), I would probably not use Propecia (finasteride) but in men 20-40, that would probably not be my position. By taking Propecia (finasteride 1mg) the hair loss pattern may not progress very fast and is more likely in younger men. I don’t like surprises and nor do my patients, which is why miniaturization mapping and a good Master Plan in the hands of a caring, experienced and focused doctor go together hand in hand.