Month: January 2023

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Frontal Fibrosing Alopecia

What is frontal fibrosing alopecia? I haven’t heard of this before and I just read an advertorial that mentions that it is a cause of hair loss in women.

Link here

Frontal fibrosing alopecia (FFA) requires a microscopic diagnosis made in the hands of a good dermatopathologist. To quote the link you sent, FFA “can cause women to lose up to five inches from their hairline. If FFA goes undiagnosed, women can even lose hair at the sides and back of their head.” For more info and some photos, see DermNet NZ.

In general, there are two types of hair loss — scarring alopecia and non-scarring alopecia. Genetic (male pattern) hair loss is the non-scarring type. We usually do not perform surgery for those with the scarring alopecia, because as the name implies there is scarring and inflammation underneath that is causing the hair loss. So a hair transplant would not likely work because your own immune system can still attack the transplanted hair.

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Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

This woman had hair loss and went to a surgeon a few years earlier who recommended surgery. Her condition is a clear diagnosis to a doctor with experience, a disease called Fibrosing Frontal Alopecia, which will cause any hair transplant to fail. Although this occurs more in women then men, it does occur in men and an astute doctor who is knowledgeable is critical before you get a hair transplant that will fail if you have this condition.


2020-01-11 07:37:05Frontal Fibrosing Alopecia – FFA (Commonly Found in Women) – (Photos)

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Frontal and crown reconstruction in 50 year old male

 

Over 20 years, this patient lost a lot of hair and as it was filled in, he ended up with a total of 7635 grafts, 2000 to achieve the goals shown below. His last procedures is show here, which reflect before and after pictures on moving his hairline down and filling in the crown. Clearly, he did not dye his hair in these after pictures.

tj crown before tj front before

tj fromt and crown

 

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From an Irrational, Mad as Hell Doctor

As a doctor in the hair transplant field, I take affront to this blog, the general tone of it and your almighty view of ethics that you published last week. You are forgetting your roots. Your ego-centric sanctimonious approach gets me sick. I hope your readers can see your self-serving motives here and I sincerely hope that you become a victim of your words.

I normally would not publish this type of statement, but it looks like it illustrates the points I made in my blog entry from just last week, The Truth About Cheap Hair Transplants. I think that this doctor is forgetting his roots, which lie in the Hippocratic Oath taken when he became a doctor. Maybe his Mercedes and mansion mortgage burdens are clouding his priorities.

I’ve been reminded that my blog posting from way back in June entitled Doctor Availability, may have also contributed to this doctor’s rage.


2005-12-05 19:39:01From an Irrational, Mad as Hell Doctor

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From a Reader — A Note to Teenagers About Hair Loss

Well doc, I’ve got to hand it to you. You’ve solved all my problems. I’m 20 years old, and had been losing hair for over 2 years now. I was worried,stressed,depressed.. dreaEverything you can imagine.

I also tried all the products on the market that claimed to stop hair loss- creams,oils,herbal ‘remedies’. I didn’t use propecia though,it required a prescription which would mean I’d have to tell someone I was losing hair. No product seemed to work. Suddenly,long after I stopped using these products, my hair loss stopped.

Finally, I realize that my hairline was just maturing. All thanks to your site. I never knew such a thing existed!

Anyways, the point I would like to put across is to teenagers, who seem to be flooding your site with questions. The point is, your hair will be there till you are in high school, and till you graduate from college(assuming you arent unusually old for school). These are the two places where girls would superficially judge you (and where you’re just looking for thrills). After high school and college, its a different world. Girls turn to women, and they’re looking for more than just arm candy then. Your hair would NOT matter as much as you’d think.

So don’t worry about your hair too much; even if it’s rapidly falling,it would take a while for you to bald completely. And by then,you’d be through the superficial stages of life. And remember, nothing really causes hair loss apart from your genetics, which you cant change. So don’t worry about things that are not in your control.

Otherwise,there’s always Dr.Rassman ;).

Thanks for the comments! For those that still don’t know what a maturing hairline is, you should certainly read Maturation of a Hairline — Moving From Juvenile to Mature.

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Frightened to take Finasteride

hey dr. wrassman, i know there’s probably no chance you respond, but i wanted to just look for advice.

i’m 19 years old, about to turn 20 in january. my hair has been thinning and i’ve been a diffuse thinner for years, so the thinning is making it slightly worse as time goes on. i want to take finasteride so badly but the side effects scare me. i know they’re present in about 4% of men, but the recent reveal about merck lying about their side effects claim freaked me out as well. would you mind helping me calm down and explaining everything to me?

Most of the guys who take finasteride think that they are just taking their daily vitamins. That is my experience as I take it now and my son’s experience as well. This is completely your decision. If you don’t talk yourself into side effects, then if you get them you can just stop taking it. I don’t believe that PFS ever appeared in a normal person taking finasteride for a short time and then stopping it.


2020-07-16 07:18:29Frightened to take Finasteride

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Frequent emails from many of the same patients asking me about their surgical problems

I get emails every day from patients who had their surgeries from all over the world and couldn’t get their doctors to return their phone calls. One man today told me that his doctor always returned his phone calls when he had questions BEFORE the surgery, but will not now return his calls. Some doctors think that you, the patient, is here for them to make money from. They sell you their services, treat you well until you go forward with the surgery. Then it is the next patient, not you, then gets their attention. Immoral doctors behave like this!!!!!!!


2019-09-05 08:37:12Frequent emails from many of the same patients asking me about their surgical problems

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Freezing donor hair for future balding

For someone paranoid about balding, but currently too poor to do anything about it aside from fin/min (oral+top) and derma-stamping, is there any way to somehow save donor area hair for the future? I worry that if financial security ever comes, it’ll be too late as far as my donor area is concerned. Any cheap solution to this? Do I just scalp myself and toss it in the freezer? (Kidding).

The donor area remains intact in most men throughout their early years until 60. After 60, some men start losing their donor area hair. This is a normal process and nothing to worry about. Freezing hair for future use sounds extreme to me and not practical today.

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Free Testosterone Declines with Propecia Use?

Dear Dr. Rassman,

I am a 31 year old male who has been on Propecia for 5 years. After getting bloodwork done, it was discovered that while my Total Testosterone was high, the percentage of Free Testosterone was proportionately low.

Then, I discovered an article from an Egyptian medical journal entitled “Effect of Oral Finasteride on Serum Androgen Levels and Androgenic Alopecia in Adult men”, which found that all men in the experimental group experienced a decline in free testosterone after taking Propecia relative to no change for those taking a placebo. Were you aware of this? Does this not add to the growing body of literature showing how dangerous Propecia really is?

The main point of why Propecia (finasteride 1mg) works is because it changes DHT hormone levels. DHT is the result of testosterone catabolism (it is a byproduct of testosterone metabolism). So to say Propecia affects testosterone in some way is valid, but I cannot say what this really means. The study you refer to included only 30 men and it does not go on to state what the implication is or what the significance is of the findings.

For those interested, the study can be found here (PDF file).

These are the type of articles that can cause confusion and add fuel to the never-ending debate on Propecia depending on how you parse the information presented. Anyone can quote articles and infer what they want, but the real meaning or significance is unclear. At least this is interesting reading. Let the debates begin… or rather, continue!

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Fraternal twins, one lost crown hair 40% by HAIRCHECK the other did not, can you explain this?

I just turned 20 and recently started taking propecia as my doctor told me I have lost about 40 percent of my crown hair using haircheck (None of this is visible). Even I was surprised to learn that I was actually balding. There is baldness in my genes but it’s not really aggressive or noticeable until older age (40+). Additionally, my fraternal twin hasn’t gotten his hair check but I am assuming he has not lost any hair yet. I am currently on finasteride and planning to take it as long as possible if the side effects aren’t severe. Do you think it’s possible for me to keep a full head of hair (or the appearance of one) through at least my 30s? Thanks

The difference between frarternal twins may be related to stress but the genetics of one does not impact the genetics of the other. Did you have more stress in your life than your twin brother. Did you go on any radical weight loss diet?. These can be causes of bringing out the genetic in you and not your brother but maybe your brother did not inherit the balding. Taking finasteride might work for years, if you are one of the lucky ones.