Author: Dr. William Rassman

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Hair Loss Information2011 ISHRS Meeting Review, Part 6 – Finasteride – Hair Loss Information – Balding Blog

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 6. More to come…

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Does finasteride induce mood and other psychiatric changes?

    A case report and literature review showed a connection between finasteride and mood changes. In one case presented, a patient suffered from severe disabling mood changes on finasteride, which ceased within a week after stopping the medication. After a short time period he restarted finasteride, and the mood changes returned within a few days. Other cases were reviewed with similar problems. There is little doubt that in some patients, mood changes and other psychiatric problems appeared with the use of finasteride.

    I believe that these case reports are the exception to what we commonly see and that finasteride is generally safe, but if a patient feels that they have changes in their personality or mood since the drug was started or if a family member sees changes in their mental state, they should meet with their doctor to discuss the appropriateness of their continued use of the drug.

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Hair Loss Information2011 ISHRS Meeting Review, Part 5 – Finasteride – Hair Loss Information – Balding Blog

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 5. More to come…

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Does finasteride (Propecia) impact the body’s inflammation response in hair loss?

    Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.

 
Are finasteride’s sexual side effects overstated?

    Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.

    One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.

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2011 ISHRS Meeting Review, Part 3 – ACell – Hair Loss Information – Balding Blog

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 3. More to come…

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Dr. Hitzig and ACell

    I had breakfast with Dr. Hitzig, known for popularizing the use of ACell for plucking hairs. For those unfamiliar, the idea was that by plucking a hair and keeping some of the genetic material in the original donor area, that plucked hair would grow into a full hair (with the use of ACell), along with the regrowth of the hair in the donor area. Essentially getting two hairs out of one.

    I shared my experience with him (100% failure to have plucked hair regrow into new hairs in a balding area of the scalp). After considerable discussion, Dr. Hitzig seemed to retract his stance that ACell works with plucked hairs in a bald scalp. His present view is that these plucked hairs have to be put into an area where there is already hair present. This appears to be a 180 degree turnaround position from his previous reports that it can grow hair.

    Of course, if it can not grow a hair, then obtaining two hairs from one is not possible, and the hair multiplication process is improperly named for this technique. I was a bit angry, considering that I offered this procedure to multiple patients (at no charge of course).

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2011 ISHRS Meeting Review, Part 2 – Female Hair Loss – Hair Loss Information – Balding Blog

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 2. More to come…

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What is the role of immunity in the development of androgenic alopecia in women?

    In men and women, it was suggested that there is an immune response in genetic hair loss that could either trigger the process or be an early sign that hair loss is about to start. Dr. Neil Sadick of New York has been following female hair loss for years. He showed his results from scalp biopsies of the scalp in women with hair loss. What he saw were findings that were similar to the conditions found in diseases like lupus (an autoimmune disease). He believes that female pattern hair loss is attributable to immune driven inflammation and he believes that this interferes with hair stem cell activity as they enter into the growth phase of the hair cycle.

    The earliest symptoms of many women and some men start with pain and itching of the scalp, a set of symptoms that reflect the inflammatory response that he believes is always present, but often ignored. He raises the issue that if the connection is correct, the scalp may respond to the use of steroids in the earliest phases of the hair loss process.


 
Double trichophytic closures

    Double trichophytic closures were demonstrated in a poster presentation, suggesting that this procedure can “wipe out” scars from FUE in 99% of patients. I personally doubt this claim. This reflects first time surgery patients only, as these patients are at a lower risk for significant scarring.

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Hair Loss Information2011 ISHRS Meeting Review, Part 1 – Hair Tools – Hair Loss Information – Balding Blog

ISHRS 2011

The annual meeting of hair surgeons was in held in Alaska this past week. The meeting was very well organized, but because of the location, many physicians chose not to travel the long distance. The weather was ideal, as good as California in its best season. About 15% of the 260 doctors who registered were new to the field and used this meeting as an educational opportunity to enter the world of hair restoration.

The following review is very selective and is biased by the things that were interesting to me (Dr. Rassman) and what I thought could be interesting to some of the readers. Since there’s so much to cover, I’ll break this up into multiple posts to make things easier. Stay tuned for more.

There were many innovations in surgical tools that may be too technical for most, so I won’t discuss them too much here. That said, I did write a little about some tools that might have some interest, so let’s begin with those…

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Tool for measuring scalp laxity

    A new instrument for assessing the safety of strip excision as it correlates to the size of a donor strip was introduced by Dr. Parsa Mohebi. He presented the second version of his Laxometer, which should be used to measure the limits of the width of a donor strip.

 
Using HairCheck for bulk measurement

    The HairCheck hair bulk analysis system, which we have been using for a year or so, was reported by many doctors as a positive tool for measuring the hair mass of scalp hair. Readers of this site probably know how much we’ve mentioned hair bulk analysis, and it’s good to see it finally gaining some traction in the physician community.

    The reason we like it is because it enables doctors to compare results over time with real numerical values, which shows the value of drugs like finasteride, and allows physicians to make the diagnosis of genetic hair loss in young men now more certain. Many young men with hair loss in the family who are concerned that they will also inherit the hair loss gene can now be evaluated for the presence of hair loss in its earliest stage. Proper diagnosis should cut down on unnecessary use of hair loss drugs.

 
Keep checking back for much more.

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Large Donor Area? – Hair Loss Information – Balding Blog

Recently, when at the barbers, I was told that the hairline at the back of my head was very low. Like most guys, I’d never put ‘hairline’ and ‘back of head’ together. Now that I have, i’m wondering: does having a low hairline at the back of my head mean I have a larger donor area, and the potential for more grafts if needed?

Thanks

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Are you referring to hair at the nape of the neck? I’m a little confused as to what you mean by a low hairline at the back of the head. Neck hair may appear thick in some men, possibly even as thick as the hair in the true “donor area”. For people who have the narrow band of hair seen on Norwood 7 patients, there may be a limitation of your donor hair. However, you may have a very high density of hair, or your scalp may be very elastic, or your neck hair is very thick.

Neck hair is not considered permanent, as a substantial number of men will lose their neck hairs with age… so no matter how good your neck hair is, this should not be considered part of your donor area.

So there is no universal answer to your question without an actual examination by a physician. In matters of surgical recommendations, I would trust a doctor over a barber.

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Hair Loss InformationMinoxidil Made Me Bald in Under 2 Months – Hair Loss Information – Balding Blog

Dr Rassman,
minoxidil is the worst product ever in the world. I started using it 1 and half month ago and then my hair loss reached a shocking amount .I quit minoxidil 15 days ago. My hair loss reduced but still there is some shedding. Now I am look like really bald. I am really worried about it. My social life also is affected. I dont wanna go outside or do something with people. I am really depressed. At the same time I am using propecia but as I said I am bald right now.

My questions are, will my lost hairs be replaced? If it will,how long it will take? I am 20 years old and my hair is really important to me. please help me.

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Hair is really important to a lot of men, so you’re not alone. I am sorry you are experiencing hair loss. Unfortunately, hair loss is mainly due to genetic causes and many men in their late teens or 20s will go through what you are going through.

There have been cases of initial shedding from minoxidil use, but this is usually temporary. I can’t say for sure how long it’ll persist or if those shed hairs will regrow. I do not know anything about you (e.g. age and family history). Please follow up with the doctor who prescribed you Propecia and discuss further options.

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Hair Loss InformationIf Minoxidil Regrew Hair, Could Starting Finasteride Cause it to Shed? – Hair Loss Information – Balding Blog

I have been taking minoxil for roughly 8 months and have had decent results in the hairline area, especially the corners. I’m going to start finasteride soon however I have a question about shedding. As I understand it, the shedding that can happen on finasteride is due to the follicles that are DHT damaged shedding the hair to grow back stronger.

My question is: is hair grown back solely with minoxidil more likely to be shed when starting finasteride?

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The initial shedding is noted with the use of Rogaine (minoxidil) way more often than Propecia (finasteride). I’ve only rarely seen this problem in patients after starting finasteride, but I am seeing growing concerns from readers about it. It’s interesting how various claims can be given so much acceptance when it’s not something widely noted in large scale studies or amongst doctors with patients on the drug.

So unfortunately I don’t have an answer to your question, since I don’t have enough of a patient history that have experienced it.

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Genetics vs Medication Tug of War – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

When a person’s genetics finally wins the tug of war against finasteride or/and minoxidil, will the hairloss then reassume in the form of a slow, steady process, or will the hair maintained by the drugs come off in large amounts within a short period of time?

Thank you for your time.

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The genetic progression of hair loss while on these medications (the “tug of war”) would likely be slow, in the order of months or years. It does not happen over a few days or weeks.

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Off Topic – Heart Disease Contributors – Hair Loss Information – Balding Blog

Dr. Rassman,

Off topic, but as a former doctor working in the heart field and as a doctor who worked in the cardiac field what do you think are the biggest contributors to heart disease? Is there any one variable (e.g., high cholesterol, smoking, diabetes) that is most dangerous?

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CardsThis is not a simple answer for a blog post. I will give a cursory answer to it nonetheless in the hope that what I have to say will help someone and possibly could even save a life. Apologies to those that come here for hair related posts, but this isn’t one of them.

Putting aside congenital heart disease, the things that are most dangerous for developing heart and vascular disease are the lifestyles and diets we have. There’s no one factor that I would be willing to pinpoint. What I tell people who ask heart related questions is that we are dealt a set of genetic cards… and if we win, it reflects the way we play those cards. If we keep ourselves healthy (good diet, exercise, no poisons in our system like cigarette smoking or excessive alcohol) we will live longer.

Some people are genetically programmed for high cholesterol and high body fats, so we must take control of those bad cards by going that extra mile. For example, the vegetarian who eats fruits and vegetables daily will have a lower cholesterol and lower body fat than the meat eater who sucks in daily milkshakes instead of water and consumes excessive calories with Big Macs a few times each week. Even the insulin dependent diabetic can improve his card deck with a good exercise program and controlled diet under good medical supervision. I’m not blowing any minds by saying this, I realize, but perhaps there’s one person out there that it’ll click with.

Just remember, life is fragile and you never realize it until you are given the bad news (like a cancer that you ignored when you notice rectal bleeding over the past few years or develop chest pain with your first heart attack). Those of you who think that your body is impenetrable, waking up with chest pain may indicate that you could be too late.