Author: Dr. William Rassman

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Hair Loss InformationIn the News – Miss Delaware 2010 is Bald – Hair Loss Information – Balding Blog

Snippet from the article:

Kayla MartellLike many beauty queens, Kayla Martell is beautiful, blue-eyed and out to support a good cause.

Martell, the newly crowned Miss Delaware 2010, also is completely bald. The 21-year-old pageant winner suffers from alopecia areata, a condition that causes hair loss and afflicts 4.7 million Americans, according to the National Alopecia Areata Foundation.

Sporting a blond wig, Martell beat out 15 other women — all with full heads of hair — to take home the Miss Delaware crown this month.

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Read the full story at AOL News — New Miss Delaware Says Bald Is Beautiful

This is quite the inspirational story and should help bring awareness to alopecia areata patients. She competed four previous times in the pageant before taking home the crown on June 12. Congratulations to Ms. Martell!

There’s also a video available within the article from the CBS Early Show that is worth a view, and you can learn more about the new Miss Delaware at her blog.

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Hair Loss InformationI Had Trichotillomania as a Teen, Now My Hair Is Thinning More – Hair Loss Information – Balding Blog

Hello Doc,

I am 24 years old and rapidly thinning out. I noticed this a little over two years ago as I was graduating college and it really hit me hard. I have had a tough time accepting it and it has crippled my confidence and social life.

In addition I had a severe case of Trichotillomania when I was in my teens years (13-15 or so). I would repeatedly rip my hair out with a brush in front of my bathroom mirror. I outgrew my bad habit eventually, but there is no doubt that this disease is the main reason for my permanent hair loss.

Is someone with my case treatable? And what steps should I take to start. I sincerely appreciate any feedback or comments.

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Wow, this is a difficult if not impossible request without a good examination of your hair and scalp. Many people with trichotillomania just continue the pulling and compounding the problem, so you need to be completely sure you’re not still doing this (perhaps without realizing it). With an examination, I’d be able to tell if you stopped pulling out your hair, a critical first step to solving your problem.

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Hair Loss InformationCosts to Remove Hairline Cowlick? – Hair Loss Information – Balding Blog

Hello. I have read in many places about how expensive it it to fix a cowlick (in the front hairline, in my case) by surgery. However, I have not yet found an estimated price range. Could you ball park what it would be to align the folicles into a more regular hairline pattern? I am a 25 year old male, and the pivot is quite pronounced about half way between the middle and the side.

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I am not sure where you have tried to find the information, but here at New Hair Institute (NHI) the minimum cost of a hair transplant surgery is $3000. Otherwise, the cost of each graft ranges anywhere from $5 to $6 a graft (see fees). I don’t know that any clinic would have a flat “cowlick removal” fee.

You are more than welcome to send in some photos to me of your problem area and schedule a phone / photo consult. From those photos, I may or may not be able to quote you without seeing you.

Or…. electrolysis might be a reasonable way to accomplish what you want without surgery.

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Hair Loss InformationWould Getting a Hair Transplant Give Me Cloning Priority at NHI? – Hair Loss Information – Balding Blog

Dr. Rassman I have an odd question for you. I plan to have a hair transplant with you in the near future. Playing devils advocate here, let’s say that hair cloning is a viable option in five years and the demand would be great.

Would having a prior surgery with you give me an advantage of getting this procedure done sooner? (i.e. cutting in line)

Thank you for your time.

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First and foremost, having posted over 8000 questions on this site and answering some real doozies, I don’t think yours is all that odd.

Hair cloning just means there will be more hairs available for transplantation and you will not be limited to the donor hair. With respect to priority, our surgeries are scheduled on a first-come, first-served basis… but when it comes to procedures done with hair cloning, it’s all hypothetical at this point. I’d like to hope that in 5 years from now we’ll be transplanting with cloned hair, but that remains to be seen.

We look forward to seeing you!

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Hair Loss InformationWhy Doesn’t MPB Occur on the Sides? – Hair Loss Information – Balding Blog

Greetings Dr. Rassman. I just would like to know why most MPB only occurs on the top of the head(meaning frontal, top and crown area) and not on the sides?? What is the difference of the scalp on top of a male’s head and the scalp in the sides?

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Norwood 7There is no clear answer as to why the hair only falls out at the front, top, and crown. The reality is that the fringe seen in the Norwood Class 7 pattern is permanent hair that is never lost in 99+% of men with male pattern baldness.

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Hair Loss InformationFamily History Shows Men Losing Hair Later, So Why Am I Losing Hair at 19? – Hair Loss Information – Balding Blog

My father start to lose his hair at 45 and my uncle at 35-40, and no grandfather have hairloss problem. I have 21 now and for 2 years i’m fighting to keep my hair with avodart, kirkland and some vitamins named forcapil, but this seems that not work very well for me. Why i begin to lose my hair at 19 if my father start to lose at 45. I can make something else for my hair?

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ForcapilFamily patterns do not necessarily follow either by the degree of balding or the onset of balding. Sometimes they can be used as a guideline, but it’s not a guarantee. So why did you start losing hair at 19 years old? I guess you can attribute it to bad luck.

You’re young with early hair loss and you’re using multiple treatments. Let’s break down your regimen:

Avodart (dutasteride) — I assume you don’t have a prescription, as I’d expect most doctors would not prescribe this strong prostate medication to a 19 year old with early hair loss. Avodart is not approved to treat hair loss at this time. Although there is evidence it works to treat genetic hair loss, most doctors would not be comfortable prescribing this until at least dosing and safety data is available. If you do have a prescription, you should be talking to your doctor about this.

Minoxidil (I believe this is what you meant by Kirkland) — This is fine, but I don’t know if you’re following the dosing instructions. Apply it twice a day to the area that you’re losing hair. If you’re losing hair in the frontal hairline, it probably won’t be much help there.

Forcapil (vitamin supplement) — Their site describes it as a “special formula combining vitamin B complex, sulfurated amino acids, zinc and vitamin D3“… which means if you’re taking it with hopes of regrowing your hair this is probably a waste of time and money. I hadn’t heard of Forcapil before, but it appears to be made by a French pharmaceutical company and not sold in the US. I found the dosing instructions are to take 6 pills a day for the first 2 weeks, then 2 pills a day for the next 6 weeks… so I hope you enjoy taking pills.

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Hair Loss InformationAnastrozole and Propecia – Hair Loss Information – Balding Blog

Hi doc! Thank you for your excellent and informative blog! I’ve been hearing things recently about using the very potent aromatase inhibitor anastrozole to prevent the ‘estrogenic’ side effects of finasteride. Anastrozole drastically reduces estrogen levels in men and, unsurprisingly, raises free testosterone as well. Would you be comfortable with one of your patients adding anastrozole (‘Arimidex’) to his propecia regimen, or would you see this is opening up a whole other ‘can of worms’, and potentially serious side effects?

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ArimidexArimidex (anastrozole) is a anti-breast cancer medication for post menopausal women. There are no clinical trials in men. You would basically be experimenting with your body without any knowledge of the consequences. I would recommend against this. Especially since I’ve seen the complaints/worries people have about side effects from Propecia, you would be just adding fuel to the fire.

According to the Arimidex website, some of the most common side effects seen with the drug include, “hot flashes, joint symptoms (including arthritis and arthralgia), weakness, mood changes, pain, back pain, sore throat, nausea and vomiting, rash, depression, high blood pressure, osteoporosis, fractures, swelling of arms/legs, insomnia, and headache”. Also, a less common side effect of Arimidex is hair loss.

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Hair Loss InformationTransplanting from My Hairy Neck – Hair Loss Information – Balding Blog

I have quite a lot of hair in my neckline. The hair is thick and straight, which makes me wonder whether it could be transplanted to my head. I have already had 1000 grafts via FUE, and I see the diffuse pattern from the FUE transplant whenever I trim my hair very close to the scalp. Using neck hair seems like a way to augment the donor pool, but I don’t know how receptive the scalp is to that type of hair and whether FUE performed on the neck would leave visible scarring. What do you think?

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Neck hairNeck hair is not considered “permanent” like the hair on the back of your scalp. There is a chance that as you get older your neck hair will fall out, so if neck hairs were used for a hair transplant it would also fall out. This is what makes neck hair not ideal for transplantation.

In addition, as you clearly have found out, follicular unit extraction (FUE) still produces small round punctate scars. So if you have a FUE procedure to the hairs on your neck you will definitely see the same type of scarring, which would be more difficult to hide.

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Hair Loss InformationIn the News – Anxious People Are Twice as Likely to Have Heart Disease? – Hair Loss Information – Balding Blog

In non-hair-loss news:

Dr Annelieke M Roest (Tilburg University, the Netherlands) and colleagues performed the first-ever meta-analysis on the association of anxiety with the incidence of CHD in initially healthy people, using data from the US, Europe, and Asia. Even after multivariate adjustment, anxious people had around a 25% greater risk of CHD and an almost 50% higher risk of cardiac death over a mean follow-up period of 11.2 years.

In the second study, almost 50 000 Swedish men who were medically examined for military service and followed for an average of 37 years were assessed by Dr Imre Janszky (Karolinska Institute, Stockholm, Sweden) and coworkers. Depression was not a predictor for subsequent coronary disease, but those with anxiety disorders—as diagnosed by a psychiatrist—were twice as likely to suffer CHD or acute MI, even after adjustment for baseline confounders.

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Read the full article — Anxiety predicts heart disease years later

The meta-analysis combined the results of 20 different studies with nearly a quarter of a million people (it mentions that in the article, but I wanted to highlight it here). It remains to be seen if treating anxiety will also treat heart disease, but I’m sure studies about that will be taking place soon enough.

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Hair Loss InformationI’m Worried About Initial Shedding from Finasteride – Hair Loss Information – Balding Blog

Hi there,

Thanks for this blog it really is so helpful to many of us! I am 24 and definitely going bald, all the men in my family on both sides have MPB. Although I am going bald, at the moment I am hiding it pretty well with what I have but it’s getting to the point where I can’t hide it any longer, so I plan on going on Finasteride in the hope I can conserve what I have.

My only concern is that I have heard some awful stories about Finasteride actually causing an initial shed, or at least worsening the hair loss before it makes it better. In your experience have you encountered this with patients? Although I am determined to put a stop to it I would be devastated if taking Finasteride made my problem rapidly worse even if it would help in the long run.

Thanks for your time.

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I have not seen patients in my practice who shed hair after starting Propecia (finasteride), though I have seen patients who shed initially after starting Rogaine (minoxidil). I’ve also seen patients who continue to lose hair while on Propecia, but it may just be regular genetic balding that is outpacing the medication itself. I really haven’t seen a case where someone has accelerated hair loss after starting Propecia. Either way, both medications do help most men in treating their hair loss.

If you are worried about these issues, please discuss them to your prescribing doctor. When you take ANY medication or partake in ANY medical treatment, you need to consider the risks and benefits and understand why and what you are treating. Just being scared will not solve any problem without a good solid assessment of what you are trying to do.

Here are some recent past replies about finasteride shedding, if you’re curious: