Author: Dr. William Rassman

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Hair Loss from Blunt Trauma to Scalp? – Hair Loss Information by Dr. William Rassman

My husband was smacked by a 2×4 on top of his head and left him with a bald spot, about 2 years ago now. Wondering if there is anything he can try to regrow hair in that spot. (Hes in his 20s)

Thank you.

2x4Did your husband have sutures or staples placed to fix a laceration/cut over the area in question? Often times, areas of sutured/repaired hair can cause strangulation of the surrounding hairs, leading to a bald spot. Although there is no specific hair regrowth treatment for this type of loss, hair follicles can be transplanted into the area in question with good results.

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Is Propecia Making Me Constipated? – Balding Blog

I been on Propecia for 11 days now and since like day 5 I had constipation and lack of bowel movement. I couldn’t find any info that Propecia causes this. I also take Zegerid 40mg 2x daily and Carafate Liquid 2x daiy but I been takin those for like almost 2 years for my severe throat acid reflux. But I never had a prob with those. Also within this time I had no food or lifestyle changes the constipation was just sudden.

Could it be that Propecia is kinda interacting with those meds? But my doc said Propecia doesn’t interact with anything especially my meds.

Bread - fiberPropecia (finasteride) is not known to cause constipation. It is unlikely that Propecia when taken with your other medications is causing you to be constipated, however, all medications have the possibility of interacting with one another. You need to discuss with your doctor other varied yet potentially treatable causes of constipation such as hypothyroidism, dehydration, depression, etc. Perhaps you need more fiber in your diet?


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Telogen Effluvium and Male Pattern Baldness, Together? – Hair Loss Information by Dr. William Rassman

I am a 21 year old suffering with MPB. Even though I have not been mapped out for miniaturization,I know I am a NW2 and what made me realize I MPB was the back of my crown felt thinner. My question is this.

Can Telogen Effluvium occur along with Male Pattern Baldness? The reason I ask is the fall of 2007 I lead an extremely stressful nine months of school combining with that I did crash diet where I ate healthy but I did not eat enough, I was technically starving myself. From 2004 to 2008 I wore my hair to my shoulders and when I cut it off this past April I noticed how thin my hair specifically my front and back had become.

Did TE set in along with MPB or did my stressful life speed up my MPB?

Thank you also for this website, it is very informative.

Yes, telogen effluvium (TE) and genetic hair loss can co-exist. Your history of weight loss and stress can cause TE, but with this in your past and the stress and starvation corrected, the hair should come back to normal within a year or so. The risks here are that your stress and poor diet could also have kicked in the genetic hair loss, but a good miniaturization study should show that if this is the case. Also, if you do a hair pull test this will show TE if you have it.

I’m borrowing the following paragraph of text about the hair pull test from DermNet NZ:

“Hair loss associated with excessive shedding results in a positive ‘gentle hair pull’ test. Grasp a lock of hairs to determine if any can be extracted with firm pull. Normally 0-2 telogen hairs can be extracted: these are hairs in the resting phase, identified using magnification by a rounded bulb at the proximal end. An elongated or tapered end indicates anagen hair (growing phase); anagen hairs extracted by the gentle hair pull test are pathologic.”

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Inherited Baldness Gene – Will the Pattern Be the Same? – Hair Loss Information – Balding Blog

Hi, I have some questions about Propecia. First, after about nine months and a very disappointing 1 month bout with Hair Club (which I think did more harm than good), my hair loss seems to have stabilized. Currently, I’m somwewhere between a Norwood 2 and 3 and there is actually a little bit of regrowth around the temples of all places.

Here are my main questions:

  1. I seem to have inherited my baldness gene from my maternal grandfather, who went totally bald. I’m 26, so, if Propecia has currently stopped the process and there are reports of patients keeping what they have up to 10 years, is it possible that my ultimate hair loss destiny may be signifcantly postponed?
  2. I read on one message here that “even though you inherit the baldness gene it can be expressed differently.” Does this mean it is possible for you to get a slightly diffeent pattern than the person you inherited it from. My hair loss seems more like that of my maternal grandfather but not exactly.

I know without a personal meeting you can’t answer 100%, but I just wondered if these things are a possibility.

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You’re right — a personal one-on-one examination of your scalp is best, but I’ll try to answer your questions as best as I can:

  1. I do not believe genetic hair loss (androgenic alopecia) can be completely stopped with drugs. Propecia (finasteride 1mg) is a great medication, but it may not stop the process completely… and it almost certainly will slow it down. Results are variable for each patient as everybody has a different “destiny”.
  2. Just because your maternal grandfather was completely bald does not mean you will be completely bald, even if you inherit his genes, because the expression differs. Also, there is more than one gene for balding and if you inherit one, it does not mean that the rest follow. Again, everybody is different.

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Hair Loss InformationUltra-Refined Hair Transplant – or URFUHT, If You Prefer – Hair Loss Information – Balding Blog

Hi Doctor,
I had a look at thread Ultra-Refined Follicular Unit Transplantation (FUT)?

I could not understand completely if Ultra Refined Follicular Unit Hair Transplantation (URFUHT) and Follicular Unit Hair Transplantation (FUHT) were same if additional care was taken while performing FUHT. My doctor mentioned that both are same and he suggests a 2 sitting complete transplant using FUHT. He also said that people would be happy with a single sitting. Is this multiple sitting (2 sittings) required for URFUHT also?

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These are just different names for the same thing. The people who defined the term “URFUHT” have a marketing agenda which is supposed to say that this is the best form of follicular unit transplant (FUT). If you do FUT correctly (as defined in our published articles from over a dozen years ago), then a classy job is a classy job by any name you give it. Any good doctor should try to get your surgery completed in one session if it is possible.

Here’s a short list of some of the earlier FUT articles:

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Hair Loss InformationZinc and Hair Loss? – Hair Loss Information – Balding Blog

Hello. I have heard conflicting things about zinc supplements in regard to hairloss. Can an increased amount of zinc actually cause more hair loss? If so, what amount would be beneficial?

Currently I am taking about 41mg/day of zinc in supplement form (11 from a multi-v and 30 from optizinc [monomethionine] which also has 300mcg copper to offset). Is this too much or is it low enough not to be a detriment to my hair?

Thanks!

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I do not keep up to date on supplements and dosing because the studies have little scientific base. Take everything in moderation and always clear this with your primary care doctor, because I don’t know the reason why you are taking these supplements or that if you even need to be taking supplements. There are some reports that zinc in high doses can cause hair loss, but it is not clear that the websites that report this have valid studies behind the reports.

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Hair Loss InformationOver a Week After Surgery, My Donor Area Is Still Sore – Hair Loss Information – Balding Blog

Hi Dr Rassman
I had a procedure done, it’s now day 8 post surgery, and I get my staples out in 2 days. The donor area is still a little sore but not to bad. It’s mainly when I put pressure or sleep on back of my head, and some of the scabs are coming off now. I would like to get some exercise and go surfing.

Should I wait a little longer? Is it normal to feel a little sore in the donor area 8-10 days later? Is surfing 11 days post-op too strenuous, or could the ocean water cause infection? Of course I would take it easy and certainly wash my hair right after.

Thank you Dr. Rassman for your blog and reply

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Since you have staples, I’ll make a wild assumption that you had the strip method surgery, in which case the wound should not be soaked for easily 3-4 weeks after a surgery. If you had a surgery using the follicular unit extraction (FUE) technique, then you could probably go surfing. The wounds are not strong at 10 days, but at about 3-4 weeks, around 70% of the final healing strength will be present. I’d keep waiting.

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Hair Loss InformationVery High Estrogen Levels After 4 Months on Propecia – Hair Loss Information – Balding Blog

Hi there!
I’ve been suffering from side effects from propecia. However, after 4 1/2 months it worked very well for me. I had some bloodwork done and my estrogene lvl was HIGH above range (2x the maximum). Is it possible that not the reduction of dht, but the raise of estrogens (which we all know that can be caused by propecia and which may lead to effects like gynecomastia) and not the reduction of dht is beneficial for the hair? And do you think i could have success with a lower dose finasteride together with a hormonal balance supplement like “DIM” to reduce side effects? Or is it to dangerous for a guy like me (i’m 19, you saw that i reacted quite sensitively to hormonal drugs). thanks

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You need to discuss this with your prescribing doctor, of course. Possibly a lower dosage (1/2 dose of Propecia) will have less impact on your estrogen levels. The impact of Propecia on estrogen appears to be as an antagonist and the body has feedback mechanisms that may very well be what you are observing.

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Clarify About Folliculitis Decalvans and Hair Transplantation – Hair Loss Information by Dr. William Rassman

In your post here you say: “This is your worst case scenario. I have had 3 such cases over my years in practice.”

Can you clarify what you mean here? Are you recommending not getting cosmetic surgery if the disease is under control? Or, are you just saying that as a general warning of what could happen if one did get cosmetic surgery? Have you only had 3 cases of this disease to treat with a hair transplant?

My areas are I guess you could say small, but they feel like they are the size of a baseball on my head. Right now, only one area is really noticeable. How long should one wait, to consider the disease under control to have any type of cosmetic surgery? I have not had any activity in a few months now. Three doctors have recommended that because my areas are “small” a doctor may be able to just remove the scared area and fuse my scalp together. Is this a viable option?

If the areas are smaller, what are the typical prices for hair transplant?

The medical field is not clear about the cause of folliculitis decalvans. It is thought to be an autoimmune disease that presents like an infection of the hair follicles, but it does not respond to traditional treatment. The disease can be aggressive and destroy many hair follicles and badly scar the scalp. Hair transplants into this area may likely fail and may reactivate the disease (bad news when this happens). I always want to know if the benefits will significantly outweigh the risks.

The decision to have another surgery within less than a year from a previous episode may not be a good decision, but you and your doctor are in the best place to make that determination. I haven’t treated you, and I couldn’t make any recommendation without examining you at the very least. Our fees are listed here.

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