Author: Dr. William Rassman

Posted on

I’ve Experienced Shedding After 4 Months on Propecia and Now I’m Freaking Out! – Balding Blog

Whats up Doc?
I am 25 and in the early stages of balding, almost 4 months on propecia (112 days to be exact) and the front of my hair line, not at the temples, but the the middle, is noticeably worse/thinner than it was when I started. Now here are my questions: Is it just that it hasnt started to work yet (I know its still early). Or am I experiencing a shed? Or at the worst case scenario is it making my hair worse! I dont really see any hairs on my pillow or shower drain or anything, but im def losing them. In all of your years of experience, is this normal at around the 4th month mark? I know I have to wait a year, to start seeing results but, the hair loss seems to be quickening! I go to a dermatologist who is convinced it will work for me, but at the same time doesn’t really seem to know what they are talking about when it comes to hair loss. I am aware that you can’t make a diagnosis over the internet but how about an educated guess? Ive read on some sites that this is normal and that new thick hairs will grow in, but im still starting to get a little freaked out here. THANKS!

It could just be a shed situation. Many men will lose hair after a hair cycle is complete (ending in catogen) and not restart another cycle right away due to the genetic situation. This could be what you’re experiencing. I wish that I could be of more help, but you will probably know for yourself in another 4-6 months.

For me, the measurements that I take when I start a patient on Propecia (miniaturization mapping) are good for comparison purposes down stream, when there is a change going on. Change tells a great deal with regard to miniaturization and I would hope that the miniaturization that you had present when you started the drug has reduced, rather than increased. I like all of the insights I can get to render a prediction as to where a patient’s hair loss pattern is going.




Related Posts Plugin for WordPress, Blogger...

Balding Forum - Hair Loss Discussion

Posted on

Hair Loss InformationNHI Surgical Team – Hair Loss Information – Balding Blog

Dr Rassman,
You may or may not have seen this post on the online forums that you visit. Dr Shapiro was the only Dr to answer these questions and as a reader of the forums i wanted to see if you would answer them about NHI?

Do all NHI’s surgical technicians have valid, unrevoked, or unsuspended certificates/licences? Do they place the grafts in the receptor sites during HT surgery? And if they do, Is The surgeon in the room all the time with his HT patient,supervising that process of grafts transplant?

Block Quote

NHI TechsAt the New Hair Institute, our technicians were all internally trained by me. They are not certified by any state agency. If you check with Dr. Shapiro, you will find that I was the doctor who trained him in FUT. Our technicians do both cutting and placing of the grafts and the surgeon is either in the room or close by checking on the progress of the technicians frequently. As these technicians have been trained by me, I know what is happening at all times. I am supervising everything that goes on before and during the surgery. Either Dr. Pak or I usually see the patient the next day when we wash the hair and make sure that the scalp is clean of all crusts (mostly done on the day of surgery).

The quality of the technicians determine the results you will get after 8+ months have passed. I recently met with a patient who had over 4000 grafts from an experienced doctor (at another clinic) with what I suspect was a very weak and inexperienced team. When I viewed his results 1 year after his procedure, it was evident that there was easily a 90% failure of the grafts to grow. If the surgeon does not have absolute control over the technical process minute by minute and the technicians and nurses are not very experienced, these large sessions often fail. Here I am just questioning the quality of the technician work in this particular patient. Many doctors have difficulty in hiring experienced people, particularly if they attempt these large sessions and hire inexperienced people. The sloppy work by many itinerant technicians reflects poor training and the patient becomes a victim, never aware of what is happening to him. Even the technicians are victimized by the heavy workload of a very large surgical case and few can manage the tedious work for hour upon hour (e.g. often 7-9 hours for a 4000 graft case with a highly experienced and competent team).

The tragedy here is not just the wasted money (for many people their life savings) but the depletion of the donor hair supply (an invaluable and non-replaceable resource). I warn patients all of the time that as they do their diligence, they should command the ‘team’ nature of this surgery and not go for the least expensive bargain available. This patient paid $2/graft and lost a considerable amount of his donor supply. To say he got what he paid for would be insensitive on my part.

Posted on

Female Hair Loss in the Back of Neck – Hair Loss Information – Balding Blog

(female)
Dear Dr. Rassman,

The hair on the back of my neck is disappearing and I have no idea why. It started in the end of January 2009. It’s getting thinner from the middle and outwards and creates a parting in the shape of a crooked L (down and off to the side. The hair at the very base is short and thinner and doesn’t seem to grow (at least not very long terminal) I’m not sure if this description is enough for you, but I am at a loss of what to do! Do you think this will subside with time and then the hair will grow back again? I know neck hair tends to grow slower.

Block Quote

Neck hair genetics are different than scalp hair genetics and unfortunately there is little that can be done other than the possible use of minoxidil. I do not believe that I have seen anything written in the medical literature on the loss of female neck hair, but there are many men who show it so why not women? Send me a series of photos and maybe I will understand more of your problem.

  • What is your age and state of health?
  • Are you taking birth control pills or other medications that can cause hair loss?
  • Could it be that you had a tight hair style that pulled on the hairs at the base of the skull, causing traction alopecia?

You get the idea here — a single description of a problem without my ability to ask questions with a good medical history leaves me in a difficult position to help. Consider a visit to my office and then at the least, I can perform my usual extensive examination of your scalp and neck.

Posted on

Hair Loss InformationTake One More Objective Look at LLLT – Hair Loss Information – Balding Blog

Well, I have been reading some of the information on your site and even checked the details of the LLLT device you had in your office: Revage 670. I think taking one more objective look at LLLT would be a good idea rather than discarding it. I can tell you have a big readership on your site and I will recommend you check out what is being done by ordinary people these days without even going to a clinic to use an over-expensive and under-powered, under-performing laser. Please check out: regrowth.com. Then, see the tons of information about LLLT at OverMachoGrande.com.

Lots of pics of ordinary people using home-built LLLT can be seen by following the links on: regrowth.com.

Thanks.

Block Quote

In my clinical experience, laser light therapy for hair growth did not work on the many patients who used it in my office. I even offered its use at no charge. I do not run a research institution so I can not afford to create a formal study on this subject. I returned the laser to the company. Of course, one can argue that its just my personal experience and opinion, but I do not have any financial motivation for such claim. Plus, I find it somewhat troubling when the author of such study sells and promotes the very item he’s studying.

Posted on

Scalp Peeling Left Me with Hair Loss – Hair Loss Information – Balding Blog

Im a 20 year old male. At the beginning of the year, I had some pretty major peeling of my scalp along the left side of my hairline. The peeling caused the hair in that area to come out as well. I finally went to the doctor and he prescribed me some special shampoo and the peeling has been gone for approximately 4 or 5 months. However, there has been nearly no hair re-growth in the area the peeling occurred, just some small hairs that recently began growing. How long will it take this hair to re-grow or could this loss be permanent?

Block Quote

This sounds like a form of seborrheic dermatitis or possibly psoriasis, though I’m not entirely sure what you mean by “peeling”. Go back to your doctor and ask him/her about these conditions. Generally speaking (without reference to your “peeling”) either of these conditions should not cause hair loss unless you picked the skin and pulled out your hair. I would keep waiting to see if the hair will regrow.

Posted on

Predisone Caused Giant Clumps of Hair Loss in Woman – Hair Loss Information – Balding Blog

(female)
I had an allergic reaction about a year ago and they put me on prednisone 50mg. I had to take 8 of those for 3 days and then every 3 days I go down 1 pill. It took about 3 weeks to get off of them and then as soon as I started taking them my hair started to thin. Then eventually it was coming out in giant clumps. It took about 2 months for me to lose all of my hair. Is that normal for that amount of meds I was given? To lose that much hair in that little of time?

Block Quote

Steroids (like prednisone) are a cause for hair loss. You need a good doctor to analyze you, your general health, and your overall hormone balance. This can not be done over the internet.

Posted on

Hair Loss Information » Is Acne Caused by DHT? – Balding Blog

You said before that Propecia/finasteride has no effect on sebum. And some people have complained that Propecia has increased their acne. I was on Propecia for 58 days and I didn’t notice my acne getting any better or worse. This being said, is it safe to say that acne is not caused by DHT? Sure, DHT might be present but maybe it’s caused by something on the surface of the skin, such as skin cells not being sloughed off fast enough.

According to Wikipedia, “[acne] is a common skin condition, caused by changes in the pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland via androgen stimulation.”

The pilosebaceous unit (hair, gland, and follicle) become infected as they are colonized by bacteria that destroy some of the microscopic anatomy. The output of sebum just feeds the areas which become infected and the circulating androgens. The list of causes are listed here, as well as descriptions of the social impact of the process in its teenage victims. DHT is just one of the androgens that contribute to acne so the use of drugs like Propecia usually fail to solve the acne problems.

Posted on

I Don’t Know if My Finpecia is Working – Hair Loss Information – Balding Blog

I am 24 year old Indian. I started losing my hair when I was 19. Ten months before I went to see dermatologist, and he prescribed me 1 mg generic Finpecia(cipla). I am taking since then, but I havent seen any difference. Moreover for past 2 months, I think my hair are falling at slightly more rate.

I have less density at crown area, my hairline is not so affected. Do you think finpecia is working or not? I know that you cant tell properly without examining me, but still I would like to know about your opinion. Moreover,I know finpecia is not FDA approved, but in India, we dont any any FDA approved finastride tablet. What are your opinion regarding Cipla’s finpecia?

Thanks & Regards

Block Quote

CiplaI can’t tell if the Finpecia (generic Propecia from India) is working or not without an examination, but it sounds like you’re seeing most of the loss in the crown, which is where finasteride tends to work best. I would stay with the medication, but discuss this with your prescribing doctor to find out his thoughts.

Cipla is a very large drug company and I haven’t heard or read any complaints about their 1mg finasteride being anything less than the regular Propecia. It isn’t sold in the US due to patent laws, but I’m not sure how those laws would apply to the Indian market. I believe Indian law requires drug makers to provide compulsory licenses to other companies to allow generics to be made, regardless of patent. There seems to be a lot of sales over the internet from sources outside the United States, though I don’t have any recommendations (nor would I provide them for legal reasons).

Posted on

Does Diet Stop Thinning Hair? – Hair Loss Information – Balding Blog

I read an article suggesting that the thinning hair can be reversed (care2.com). Could you comment on it please.

Block Quote

A good diet is always important for good health, but thinning hair in a person with any reasonable diet will not improve or reverse without a more direct ‘attack’ on the problem. First, find out what is happening (diagnosis), then probe treatment options with a good doctor.

The photo used in the referenced article shows a thinning Norwood Class 6 patient who will probably lose much of his hair from genetic causes over the next 10-20 years unless he does something about it. Home remedies are fine if you want to get your bathroom tile clean or get the stain out of your shirt, but I’ve yet to see any diet that works to regrow or halt hair loss.