Author: Dr. William Rassman

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Hair Loss InformationMy Doctor Suggested I Use Minoxidil for 1 Year, Then Gradually Stop Using It – Hair Loss Information – Balding Blog

Dear Dr. Rassman.

I wrote you before about my hair condition. I am male, 22, caucasian. I went to the trichologist last week and was prescribed to apply topical Minoxidil 5% +mpg 0.0125% together with some vitamin-enriched solution called “Biostim” (ingredients include: Aqua, Sabal Serrulata extract (biogen), mono propylene glycol, ceramide, panthenol, calcium pantothenate (vitamin b3), vitamin E, vitamin A, Vitamin H (biotin), vitamin H (P.A.B.A.), Inositol (vitamin B8).

The doctor I went to also told me the weirdest thing about the long-term treatment plan. he suggested that I follow the usual minoxidil regime for 12 to 14 months, then switch to less concentrated solution with less frequency of application until I’m in my late 30s. What he added to that,that it is possible to take me out the medication at that age, because (quote) my “hormone levels will settle up”… I don’t know what to think of it? It sounds like some sci-fi scenario for me…

another thing I want to ask you is that I’m currently quite happy with my hair – I have slight recessions at the temple area and that is my only problem. I always had quite high hairline, so recessions are quite visible (if I for some reason will go for shorter haircut). I have no history of baldness in my family (my father is 60 and he is on NW3, so are/were most of my family). So as far as I understand the idea of the treatment is not to let my hair loss progress…

I’m very confused abouth this whole situation. Should I trust my trichologist, or does he sound ridiculous? Should I consider undergoing Minoxidil treatment at this stage or not?

I look forward to your reply.

kindest regards

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Hair loss is a progressive process and if you think about it, you can logically figure out if the Master Plan made by your trichologist makes common sense. Certainly, I approach the problem with a solution (Propecia and/or minoxidil) and continue treatments that are successful. The idea of starting minoxidil and withdrawing it if it is working, guarantees hair loss from that withdrawal. Propecia always works at least by slowing down the hair loss (to what degree though, is different per person), possibly stopping it altogether, or maybe reversing it.

As for the Biostim product, the only place I can find that references this is one trichologist in London, leading me to believe he is the exclusive marketer of this product. Perhaps it is a private label item and he is just looking to make some money? I don’t know. The ingredients you listed do not look like they’ll do much for your hair. It is your call, of course.

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Hair Loss InformationAny Idea Why I’m Still Experiencing Pain in My Scalp 5 Years After a Hair Transplant? – Hair Loss Information – Balding Blog

im am experiencing increasing amount of pain and discomfort causing lack of sleep and loss of concentration and its been 5 years since i had a hair transplant and 4 years since scar revision which has caused this pain (pulling, burning). I ve seen many doctors, neurologists and have been to pain clinics with no success. any thoughts as to why this is happening? thanks

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Did you follow up with the doctor who performed your surgery? I do not even know if your pain is related to the surgery. It is possible (speculative) that you have a nerve entrapment which can sometimes be determined in your examination. I have seen patients present to me with a long-term nerve problem from this cause. I am sorry, but there really is no way for me to tell especially after what you tell me of seeing all the specialists. If those doctors (who actually examined you) cannot help you, I highly doubt I can tell you what is going on, certainly not without a direct examination.

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Hair Loss InformationLorazepam and Hair Loss – Hair Loss Information – Balding Blog

Howdy Dr. R!

As a faithful reader of your excellent blog, I wanted to pass along some (hopefully) useful information to your readers. I have been taking Propecia for 6 months now and have been VERY pleased with the results. It has strengthened and increased the hairs on my crown and even some in the front hairline! About a month ago I noticed that my hair was becoming thinner, and I was seeing more hair come out in the shower, and seeing more scalp than normal. After looking into what might be causing this change, I realized that I had been taking Lorazepam on an almost nightly basis during this period. After realizing this, I stopped taking Lorazepam completely and saw an almost immediate return to healthier, thicker hair. I understand that many factors vary from one individual to the next, but I think people should be aware of the negative effects that I experienced with Lorazepam.

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Thanks for your comments. Perhaps other people will have had similar results to report. Lorazepam (also known as Ativan) does list hair loss as a possible side effect. I’m not suggesting that readers discontinue any medication without consulting their prescribing doctor first.

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Hair Loss InformationAll of My Body and Scalp Hair Just Stopped Growing! – Hair Loss Information – Balding Blog

Five days ago the hair on my legs, underarms, etc. just stopped growing. I am 45 yrs. of age. No other symptoms except that for the past two years I have had very irregular periods approximately every two weeks. It has been 4 weeks since the last one this time and still no period. I have been to my gyno a year ago and everything seemed ok. I am scared that I will now loose the hair on my head but so far so good even though it is not growing any longer.

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I am not your doctor and I can not offer an opinion based upon what you gave me above. However, at 45 years old with a change in your menstrual cycle, the first thing I would think about is menopause, so your gynecologist may be the first place to look for answers.

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Hair Loss InformationAlopecia Contentionalis – Hair Loss Information – Balding Blog

Dear Dr. Rassman

What do you think of the new (hypothetical) concept about hair loss called “Alopecia contentionalis”, i.e. high scalp tension causing less blood circulation?

Wouldn’t the risk of getting this condition increase by the number of FUT’s (strip extraction)?

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If you are suggesting that a tight scalp that undergoes strip excision will get tighter, I believe you are correct. I do not believe, however, that a tight scalp causes hair loss.

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Assisted Reproductive Technologies (ART) and Female Hair Loss – Hair Loss Information by Dr. William Rassman

I am a 37 year old breastfeeding mom. My hair started thinning in my early thirties a little, but not noticeably. I had to have two rounds of in-vitro fertilization to have my baby (17 mos old now). After the first round of IVF (not pregnant) my hair started really falling out, thinning all over but more at the crown and top. My doc said he didn’t think there was a connection. The second IVF was successful and my hair got thicker throughout my pregnancy until my baby was three months old. Predictably, my hair started falling out again, but just to the thickness it was before. However, after my baby turned one, I started losing more hair and now my scalp is visible in the crown/back . I’ve been to an endocrinologist (i have atypical PCOS symptoms. he recommended propecia when i am finished procreating) and a dermatologist who specializes in hair loss. The derm said she would put me on Rogaine and Yaz birth control pills once I stop breastfeeding. I do not want to wean my baby for this. However, I am panicking a little because my hairloss is so rapid! I am otherwise healthy, and am normal weight, no thyroid issues. My questions: is there any research into ART and hair loss; and is there anything I can do to treat my hair loss while I am breastfeeding? Thank you so much for your time.

Generally, when you breastfeed, you do not want to take any medication because it will enter your baby through the breast milk. I rarely deal with women who have polycystic ovary syndrome (PCOS) or endocrine issues that could relate to hair loss. Propecia (finasteride) may help, but absolutely not when you are ever going to have a child. You need to discuss the risks with your doctor. While I’m not sure of any research relating hair loss and in-vitro fertilization, I am aware that fertility drugs like Clomid (clomiphene) can cause hair loss in rare cases (see RxList.com).

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Hair Loss InformationIf I Start and Stop Propecia, Will My Hair Be Worse Than Before? – Hair Loss Information – Balding Blog

I am 28 years old and have noticed that my hairline has changed over the last year (at the temples). This has caused a great deal of alarm that I might go bald. I went to Dr. Bernstein for a free evaluation & he said that he saw some minaturization in the front but as to future predictions, it’s hard to say as i’m adopted.

I have wrestled with whether or not I should take propecia as I don’t like medications/side effects. It is possible that my hairline might “mature” & then stop… but i don’t want to wait until it’s too late.

IF i start propecia & then decide to stop – will my hair be worse than if I had never started in the first place? If in-fact fate/genetics have it that I am not meant to go bald – will taking propecia interfer with the “nature of things?” and leave me dependent upon a medication whereas I wouldn’t have needed it before?

Thank you.

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Think of a timeline that you are progressing on (your timeline), then look a couple years down that line — assuming you took Propecia (finasteride 1mg) for the first year and then stopped it, you will be in exactly in the same place as if you never took it. I always tell patients that when you stop taking Propecia, you undergo what appears to be rapid hair loss, but it is just ‘catch-up’ hair loss to bring you back to the degree of hair loss you would’ve had anyway. Propecia will not reverse the mature hairline back to your juvenile hairline.

My process for following patients is simple: the full value of Propecia takes a full year or so. We use general rules about balding and although most men slow down their balding process in their 30s (28 is almost 30), some don’t follow the doctor’s rules. Hair loss is a progressive process in most men, but fortunately it slows down to a “crawl” by the time most men reach their 40s. You should be followed by a good doctor with yearly miniaturization studies and Dr. Bernstein in NY is a good doctor to do this for you. At the least, it will give you a good metric as to how you are doing. Good photography will also help define what is happening to you. You need to have a good dialog with a doctor who can work you through the process.

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Hair Loss InformationTransplanting Men In Their Early 20s – Hair Loss Information – Balding Blog

Dr. Rassman,
I am about to turn 23 and recently (though I believe it started a year or two ago) I have noticed more and more that my hairline is thinning and receding. The recession isn’t in the dramatic “m” pattern, more of a general recession all the way across, though when pulled back can definitely see the edges going back further (the furthest on the left, the hairline all the way across has become a bit uneven and can see lone hairs as well as other thinned hairs).

My main question is what your feeling on a hairline transplant would be for someone my age. I think I would be more than happy with a transplanted area about a half inch wide or so across the forehead(i’m not sure how many graphs this would approximate to…essentially lowering my hairline a half inch or so). The rest of my head, both behind the hairline and on the crown seem to all be fine. I know I saw a video on newhair.com which showed the results of someone 24 who had a transplant which prompted me to inquire for myself.

I greatly appreciate your time and information

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I have transplanted hair in men of your age. There is no 100% applicable age rule, but there are some requirements that must be met, including:

  • Maturity
  • Realistic expectation
  • Being on Propecia
  • Enough balding to make a difference
  • Enough donor hair to do the short term and long term job
  • A pattern of hair loss that I can anticipate

It would be best to come to an open house event where you can meet with myself or Dr Pak, meet directly with a dozen patients who had the surgery, and view an ongoing surgery that day. There is no better way to do your research in my opinion.

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Hair Loss InformationHigh Altitude and Hair Loss? – Hair Loss Information – Balding Blog

Hi,

I have been using rogaine for many years. I have never been close to bald, but I started using rogaine as soon as I noticed small amount of hair loss. However, I am now shedding hair fast. In fact, at the current rate I will be bald within a couple of months. Is this normal? I am thinking that I have developed a tolerance to rogaine, maybe?

I moved from sea level to high altitude to live about one year ago. The excessive hair loss started about a month after moving to high altitude. Could living in high altitude (5000 feet) cause the hair loss? When I moved here my hair was very thick but one year later I am close to being bald.

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PlaneI highly doubt high altitude has to do with your hair loss. Otherwise, being a pilot may be a risk for balding. I’ve read nothing about this phenomena (you’re the first person to ask this question) and I’ve yet to experience this in my one-on-one with patients over the years.

The most common cause of hair loss in men is genetic male pattern baldness. It is in your genes and it can happen relatively quickly. While it may be possible that you may have built some tolerance to Rogaine (minoxidil), the hair loss should not be as drastic as you describe it, especially if you are still using the medication.

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Hair Loss InformationAntihistamine and Hair Loss – Hair Loss Information – Balding Blog

Im a 30 yr old male who just recently discovered a small round bald patch on my beard about 3-4 months ago.

I am an asthmatic and suffer from Seasonal Rhinitis (Hayfever). for the allergies, i take various antihistamines daily, namely Loratadine (Claratin) or Pseudoephedrine based ones…

My hayfever has been pretty bad over the last few months and i am taking a pill at least once a day round about the time this patch formed…

What started out as a little round patch grew over the last few months into a golf ball sized patch with no hair at all and im starting to notice very small dots forming on other parts of my beard as well as a small one on the front of my hairline.. Im really starting to get worried. I went to see a dermatologist who gave me topical steroid cream and minoxidil 5% as well as a zinc and vitamin C supplment which ive been using religiously over the last 3 weeks, but it has not slowed down the growth of the alopecia.

Last night i read on the leaflet for the antihistamines i take (Loratadine) that some of the adverse reactions to it is Alopecia. Ive also read on tihs site that a few people complained about the same thing, losing hair because of Claratin. I have not found much conclusive evidence online which link antihistamines with alopecia, but as of yesterday ive stopped taking the antihistamines and continuing treating the patch with the oiintments etc.

Is there any proof that there is indeed a link between antihistamines and alopecia..?

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There is no proof there is a link between antihistamines and alopecia. Many drugs can cause hair loss as a rare side effect, but by far, the most common cause of hair loss in men is genetic balding. What you’ve described is patchy hair loss (even around your beard). This may be alopecia areata, but I would follow up with your dermatologist for a diagnosis. I did write about Claritin and pseudoephedrines before here.