Author: Dr. William Rassman

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Hair Loss InformationWould My Slow Hair Loss Rate Prevent Me from Having a Transplant? – Hair Loss Information – Balding Blog

This may sound like a weird question and it might not really happen. If an individual is 29 years old and is on propecia losing hair at a slow rate initially, and then all of a sudden starts to lose it a rapid rate, and then goes back to losing it a slow rate what is the cut off age for you to perform surgery? I ask this questions because I am in a similar situation and I feel that my hair loss at a slower rate is preventing me from getting a surgery right now. I have minor thinning in the front which is noticeable in certain lighting, but still enough to cover it up for the time being.

I am afraid if I get surgery done right now, the shock loss will for sure kill those hairs I have in the front. And if I am losing hair at a slower rate it will be hard to determine when I will reach my final hair loss pattern, so by me getting a surgery will be pointless because I will always be losing hair, albeit it a slower rate. Please help!

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If you want to have a hair transplant, taking Propecia (finasteride) in advance and through the process beyond 8 months, should reasonably be expected to prevent shock loss from the transplant. This has been my experience. Hair loss is progressive, and taking this medication should halt or slow your continued loss so that you’re not just chasing your loss with transplants.

As for your surgical candidacy, that is up to your doctor to determine. You’re not disqualified from surgery at 29 years old, though.

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Hair Loss InformationIs Polysorbate a Hair Loss Treatment? – Hair Loss Information – Balding Blog

Doctor,
Is polysorbate an ingredient (in a cosmetic creme or lotion) which could temporarily increase the diameter of thin & regular size hairs? If so, how long would the effect persist after a single application? And assuming no commercial product is available could it be compounded by any pharmacist?

I am asking these questions because years back a commercial lotion, supposedly from Norway which (falsely) claimed to be the solution to baldness incorporated polysorbate (I can’t remember if it was polysorbate 20). An employee of a pharmacy who told me he was using the product stated that he had noticed an apparent increase in hair density over a short period of time which could not be from new hair growth. I did not try this product after reading critical comments. But I wonder if one could safely use polysorbate or for that matter other products to improve the apparent hair density.

Thanks in advance

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I have no experience with this approach for using polysorbate (80 or 20 or any number) as a hair regeneration treatment. If it really worked, I would suspect I would know about it. I will, nevertheless, keep an open mind and probe it with some of my colleagues.

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My Doctors Are Experts and Have Differing Opinions – Balding Blog

Hi,

I am a 41 year old female and have been thinning for several years. My hair loss was triggered by the removal of an ovary and a tubal ligation of the other. I have visited many doctors over the years with no success. Two have indicated that I have androgenic alopecia, the rest indicate I have telogen effluvium because my hair loss has a diffuse pattern and I show no miniaturization. I had the HairDx test done and the results were high androgen sensitivity and low risk of AGA. Both my physicians (an endocrinologist and dermatologist) are considered experts in their field and have a different set of opinions based on the results. One indicating no treatment needed and the other indicating I should go on finasteride. What is your take on this result?

I can not possibly form an opinion one way or the other based on what you wrote. I would need to examine you and make a determination based upon my observations and measurements.

Female hair loss is not as clear cut as male hair loss, so differing opinions are not unusual. Finasteride is not FDA approved for treating female hair loss, but your high androgen sensitivity (as revealed by the HairDX test) means there could be some benefit from the medication. It would have to be prescribed off-label, and is something you and your doctor should discuss in depth.

Ultimately, you may have to go with your gut feeling on this one.




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Balding Forum - Hair Loss Discussion

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Suicide in Young Man with Gynecomastia – Hair Loss Information – Balding Blog

This isn’t hair loss related, but it’s something I wanted to write about…

Bullying is one of the evils found in schools, and the spotlight has been placed on this topic as of late. When a young man develops adolescent gynecomastia, he often become the target for bullying and peer ridicule. This is common and often not a subject of focus between parent and child. I have just become aware of a suicide in a 16 year old boy who was the target of bullying when his peers found out that he had breast swelling. His parents did not recognize the social impact on his psyche.

Here’s a post on a gynecomastia forum that serves as a heart-wrenching example of the feelings of a man with breast enlargement, which may be a silent epidemic.

The good news for parents and men with gynecomastia who might read this post is that there is a simple surgical cure for this cosmetic defect. If you are so impacted, look to your communities for doctors who offer treatments.

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Hair Loss InformationI Stopped Finasteride Because of Decreased Libido (Which I Had Before I Started the Drug) – Hair Loss Information – Balding Blog

I took finasteride for two months and then stopped because of decreased libido. However, I am not sure they were because of the drug. I had low libido even before I started to take it. It just got worse, but it might have been just in my head anyway.

Now, my libido is back to normal so I am considering starting propecia again. My question is, if I already have taken propecia without permanent side effects (because everything is fine now, those side effects were clearly temporary) does that mean that I will surely not have adverse side effects if I get back on it again? That even if I do have the side effects they will be temporary?

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I think the key is that you had low libido even before starting Propecia (finasteride 1mg). You should speak about this with your doctor and consider further testing of your hormone levels. If you took Propecia and you believe it caused side effects, you can try a lower dose (such as 0.5mg). A lower dose may give you no or lower side effect profile, and is about 70 to 80 percent as effective for treating your hiar loss. In all my years in practice I have never seen irreversible side effects or even heard of them from short term use (2 months or so).

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Hair Loss InformationIntense Stabbing Pain and Heat From My Scalp – Is This Aggressive MPB? – Hair Loss Information – Balding Blog

Dr. Rassman,

I’ve had intense burning scalp pain for the past 10 months. It all started during a particularly stressful point in my life so I initially attributed it to that. Unfortunately it persisted so after a month I went to see my general doctor then 3 dermatologists, all whom said my scalp and hair looks fine (albeit slightly pink at times). One of the dermatologists did a biopsy in the spot that hurt the most and came up with nothing indicating why I would be in such excruciating pain. I was prescribed topical steroids which I used and did nothing.

Over the course of the 10 months the areas that are burning have begun to shed hair and not regrow them, where once I had an incredibly thick head of hair it’s started to noticeably thin (top, back). There is a point towards the back of my head to the left of my whorl that I have been told is hot to the touch, and that is the spot that hurts me the most. The best way to describe the pain there is as if someone is jabbing a hot poker into my skull. The rest of the pain in the top and back is like someone poured gasoline on my scalp and lit a match. The pain is so bad that sometimes it wakes me up and I end up throwing up due to the agony. It’s at its worst when I wash my hair, regardless of the shampoo.

Is this some sort of insanely aggressive MPB? Neither my father nor my mother’s father has any history of MPB. I am a 37 year old male and up till 10 months ago had no hair issues. Thanks for any advice/guidance you can give.

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I’ve never heard this complaint before, about the scalp being hot to the touch (hypersensitive skin) as some sign of MPB. I always call on my experience with taking detailed histories from my patients. Sorry!

It could be something like trichodynia that you’re experiencing, which hasn’t really been studied all that much.

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Hair Loss InformationI’m Shedding Different Length Hairs Daily – Hair Loss Information – Balding Blog

I’m currently 19 and my hairline has matured within the normal boundaries of the measurements that you have given and as far as I can tell my hair is not thinning as I am not losing an excessive amount of hair a day. However, I have noticed some shedding of shorter hairs from all over my scalp and I was wondering whether it is normal to shed some shorter hairs along with hairs of my normal length (about 2 inches long). Any advice as to what this maybe or what is causing it would be much appreciated.

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I suspect that we all lose different lengths of hair in our daily hair loss experience. You should be examined by a good doctor if you are losing hair so you can determine what is happening to you and hopefully stop counting your daily hairs in the drain.

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Hair Loss InformationSMP for Younger Patients? – Hair Loss Information – Balding Blog

I understand that younger patients may be denied hair transplants due to the fact they may lose more hair. If this patient gets scalp micro pigmentation as well and is happy with a shaved head if he loses too much hair, is there really a problem with running out of donor hair? I’ve actually seen results of men who get the procedure who still have somewhat of a hairline, and it looks much more realistic overall.

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The desire to have Scalp MicroPigmentation (SMP) seems to be more common in younger men. The choice to do SMP reflects what may be a lifetime decision.

Let’s say, for example, that you have SMP done with your existing juvenile hairline at the age of 20 and then you progress to some hair loss pattern. You would then be stuck with your juvenile hairline even if you were to evolve into a Norwood class 6 or 7 pattern. You would not look normal, as you would have what appears to be a shaved frontal scalp and hair behind it… unless you shaved your entire head. Rarely can a class 7 patient be transplanted to cover the entire balding area (not enough donor hair), and in this scenario, if a 20 year old should let his hair grow out, the frontal leading edge (the SMP treated hairline) would not match the rest of the scalp unless he continued with a shaved look for his entire life.

So let’s say a young man decides to have SMP to address his frontal hair loss and is now stuck to shaving his entire head for the rest of his life. He then decides to do a hair transplant in the same area where the SMP was done, allowing him to then his hair grow out or shave it, and either way, he is covered (unless of course he loses more hair — let’s say in the class 4A pattern). Now the frontal area is covered with hair and pigment, and the back area may or may not be covered with pigment, but the problem now is that between the transplanted frontal area with SMP and the top/back of the head (in front of the leading edge of his natural hair in class 4A pattern), he would have developed a space which now almost certainly will be addressed with more hair transplants, or just SMP. With more hair transplants, he can let his hair grow out, but if he elects to fill the space with SMP alone, he is stuck once more needing to shave his entire scalp to remain looking normal.

There are clearly circumstances where one can receive SMP when hair is being lost in the front, but that does not reflect a stable situation because if this is a 20 year old, his balding will progress. It takes some degree of maturity and an objective mind to filter what I have just described here.

To be more specific, just as doctors would not recommend surgery to a 20 year old, the same reasoning would generally apply for SMP for a 20 year old withclass 3 pattern balding. But the rules here are not hard rules, as we try to educate our patients and understand where their thinking is going.

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Hair Loss InformationMy Hair Has Miniaturized All Over My Scalp, Face, and Body – Hair Loss Information – Balding Blog

Hi great blog, my hair is neither falling out or receding but it has thinned/miniaturised completely as well as my facial and body hair !

Is this MPB or another health issue ? Any information or recommendations would be greatly appreciated thank you.

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The best information I can give you is that you need to have a full history and physical examination by a good doctor and tell him of your concerns. Searching for your medical issues and trying to self diagnose your symptoms on the Internet is not a good way to start.

This is not meant to brush you off or not answer your question, but I would not know where to begin without taking a full history and examining you in person. I can tell you that when we refer to male pattern baldness (MPB), it is the patterned hair loss on the scalp. Body or facial hair loss is something else.