Author: Dr. William Rassman

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More Effective — Avodart or Proscar? – Hair Loss Information by Dr. William Rassman

Do you think Avodart 0.5mg or Propecia 5mg is more effective for hair loss?

First, Avodart (dutasteride) is not FDA approved for the treatment of male pattern baldness (MPB), although because of its mechanism it should work in the same manner. Perhaps one day it will be approved, but it currently is not. Tests are presently underway in an approved FDA contractor to determine the safety and effectiveness of dutasteride. Early studies show it is more effective at much higher dosages which may cause sterility in young men.

There is no Propecia 5mg — you’re confusing it with Proscar, which is 5mg finasteride (for prostate treatment). Propecia is 1mg of finasteride and is FDA approved for the treatment of MPB. Propecia and Proscar are the same drug in different dosages.

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Beard Hair in Older Women – Hair Loss Information by Dr. William Rassman

Why is it that as a woman gets older, her vellus hairs begin to show more. Do they get longer, denser, or what? I notice they are still fine and white(not talking about beards or increased coarseness), but they just seem to show more on older women.

Since they are white, I know they can’t be lasered, but what about electrolysis? Could the shafts get coarser if they are electrolysized and they grow back? Are there any potential drawbacks to electrolysizing the vellus hairs on a woman’s face?

Any beard hair or increase in vellus hair thickness is the result of hormonal changes. As women get past menopause, there are greater effects of normal androgens in a woman’s body than would be the case in much younger women. We also see this in medical conditions like Polycystic ovary syndrome (PCOS), where androgenic effects are evident.

With regard to your questions on electrolysis, when it is successful it works well. Unfortunately, a small whitish area around the skin adjacent to the hair shaft occurs with electrolysis and this could be a problem if your skin is dark. Failure rates are high with electrolysis and it takes a real expert to do this, a skill not commonly found. If there is a failure (about half fail in competent hands), the hair does not grow more coarse.

Balding Forum - Hair Loss Discussion

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Does This Sound Like Natural Balding? – Hair Loss Information by Dr. William Rassman

Hi,

Im 34 and I have been experiencing hair loss (gradual) for more than 10 yrs now.

Things observed during these yrs.

  1. Hair loss, thinning of hair etc.
  2. Hair falling out from the root/base.
  3. Lack of natural oil secretion from scalp
  4. Itchy scalp (flacking)
  5. Oil massage has not helped me.
  6. Very thin new hair – at the areas of hair loss

Just wondering if its fungal etc or just natural balding. Pls let me know what you think about my case.

Thanks much in advance.

Without examining you it is impossible to say much from your listings above. Is the hair thin all over the head, including the back and sides? As you are not clear about this, I can not tell if you are changing hair character or are experiencing genetic thinning/balding. Some of the items on the list, like reduced oil secretions and itchy scalp, go together and may reflect changes in genetic balding.

Balding Forum - Hair Loss Discussion

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Finasteride and Semen Quantity Reduction – Hair Loss Information by Dr. William Rassman

Hello Doc..
What is the exact mechanism of finasteride to reduce the semen quantity? Does everyone who is taking finasteride face the problem of reduction in semen quantity to some extent or are there people who do not have any reduction in semen quantity??

People react differently to certain medications. There is a small percentage (1-2%) that sees a decrease in libido, however, there are others that see an increase. Along the same lines, some may have a decrease in semen volume (not uncommon), however, according to an article from October 1999 in the Journal of Urology titled “Chronic treatment with finasteride daily does not affect spermatogenesis or semen production in young men“, the authors concluded that, “Treatment with 1 mg. finasteride daily for 48 weeks did not affect spermatogenesis (sperm production) or semen production in young men.”

A more recent study does report two patients with decreased sperm counts.

Balding Forum - Hair Loss Discussion

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I Get White Hairs When Stressed – Hair Loss Information by Dr. William Rassman

Im 27 yrs old female and when I get stressed I get White hairs not gray. But sometimes I get striped black and white hairs I dont think I have a brain tumor like one blog said and I dont have any med. problems so whats up with the striped hair?

Very interesting. Unfortunately, I have no experience with a person whose hair turns white or gray and is stripped. I have seen stripes of white hair mixed with dark hair. Maybe what you are reporting is something that I should have observed in some of my patients. I don’t have all of the answers and am often humbled by my ignorance.

Balding Forum - Hair Loss Discussion

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My Dermatologist and My Hair Doctor Disagreed About Propecia – Hair Loss Information by Dr. William Rassman

I’m 33. About 6 months ago I went to see a ht doc, and my doctor and dermatologist. The ht transplant doc prescribed propecia and told me to come back in a year, but my doc and the derm would not. My doc said you could see a little of my scalp on top but nothing out of the ordinary. The derm said, along with my family history, that “there are no signs of mpb and your hairline is strong.” But I had bad imflammation, he prescribed Luxiq, a topical steroid, but I have been feeling like I was losing more than normal/thinner than normal. About a month ago, I started the propecia, just to see how it went, because I was nervous about losing anymore.

The inflammation has only gotten worse, and now in the last few days, I am shedding like crazy! My head does not itch, it is just a dull pain/feeling on the vertex. The last few days I lose up at least 50 hairs so easily when styling my hair for just a minute – much, much more than ever before. I’m afraid to even touch it.

So – can you shed on propecia if you arent actually actively losing hair? Does the shedding hint that I actually am losing hair? Also, if I decide now to stop the treatments and follow up again with my derm, will the hair that I’ve shed come back, even after stopping the treatments?

Thanks

I would assume that the hair transplant physician did a miniaturization study to come to the conclusion that you have male pattern balding and that you need Propecia. Eyeballing someone’s scalp is not the equivalent of this. I would make make an appointment with your dermatologist and have him/her recheck you since you are having more problems. I can not tell you what is going on without knowing what your dermatologist is treating with the steroids. Having said that, I would doubt that Propecia is causing your hair loss.

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Will a Trichophytic Closure Still Leave a Noticeable Scar if My Hair Is Cut Short? – Hair Loss Information by Dr. William Rassman

Would you generally advise transplanting hair to the temple area where no hair is currently there? I’m thinking this can maximize the chances of a fake look? Am I right?

I read about the trichophytic closure technique — if it only covers 1mm of scar area, then would that leave a NOTICEABLE average of 1-2 mm of scar area still visible if hair is cut short (2 with guard, that is)?

Yes, it may. Scarring is highly variable with different individuals. You can have a doctor with poor surgical skills perform a procedure without a trichophytic closure and still have a great 1mm scar. Or you can have the best surgeon using a trichophytic closure and have a wide noticeable scar. 1-2mm is considered a great scar and it may still be noticeable with a very short hair cut. A #2 guard may hide the 1 to 2mm scar, but this also depends on your hair color, scar color, scalp color, hair coarseness, hair waviness, etc. As you can see, there are many variables.

Balding Forum - Hair Loss Discussion

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Actor Joe Penny Shows Off His Repaired Hairline (with Photos) – Hair Loss Information – Balding Blog

Joe Penny, perhaps best known for his starring roles in hit 1980s television series Riptide and Jake and the Fatman or more recently his guest spot on the popular TV show CSI: Crime Scene Investigations and the Hallmark Channel’s Jane Doe TV movies, has agreed to let me show his results from a repair job started years back. Due to a variety of professional obligations, we were unable to schedule more work until about a year ago. When his old, ugly plugs from another doctor showed, I was reluctant for him to tell people that I was his doctor (even if only for repairs, because I did not finish the repair job)… but now things are very different as these two month old pictures show.

He tells me that on many occasions he’s overheard fellow actors talking about hair transplants, expressing fear of taking charge and doing something about their thinning hair. As Joe puts it, “It takes a great deal of courage to make the decision to get a hair transplant, especially when you see so many bad jobs out there in Hollywood. You get gun shy after making a bad decision and it took me some time to make the decision to fix my bad hair job. But now, when people talk about a hair transplant for their balding and struggle with the hair loss problem, they don’t look at me as an expert any more”.

Update 2/1/08 6:00 pm:

Joe just wrote to me. He did not know that I put him on the blog today, even though he gave me permission to do this over a month ago. This is what he said: “I want to thank you again for your kindness and your generosity in my case. The last procedure I had..even after seeing you a couple of months ago..has still continued to grow and thicken. Also the donor area…because of the expert surgical job you did… is so loose I cannot believe it! It is truly astounding to me. I mean…I new you were good but WOW! The results speaks louder than words. I have recommended several people to come and see you. I know that some of them have already come. They called me and were very angry at me, meaning…well the dialogue went something like this…”Why the hell didn’t you tell me about the NEW HAIR INSTITUTE BEFORE” My response was “I DID…YOU WERE NOT LISTENING”. They are extremely satisfied, as I have been for years. So I will keep spreading the word about the fantastic work you and you Doctors are doing at NHI.

After I received this email, I wrote to him asking for permission to use the above email. His response came in at 9:00pm and this is what he said: “Yes, you have my absolute permission to post my email. Please consider this communication as my acknowledgment that it is absolutely OK with me to post it. Not a problem Dr. Rassman. If there is a group oif men or if there is an open house going on at the office with people who are considering it and might feel a little shy or afraid of a surgery, just let me know and IF I, AM…AND IN TOWN….I WILL DO MY BEST TO ATTEND AT AN OPEN HOUSE!

Thanks You Doc,

Sincerely,

Your fan forever, Joe Penny
God Bless You And Keep You

Joe is not atypical for someone who has gone through a type of hell with the old type of hair transplant plugs done years ago. I am absolutely humbled by his comments. For as long as I have been in this industry, I have been pleased to be able to help men like Joe and there have been hundreds of them, but it is even better to put hair back on a new patient who would never have to experience Joe’s type of pain.

Click photos to enlarge.

After repair:

 

Before repair (scanned photos):

 

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10 Days After Surgery, My Doctor Pulled Off My Dry Scabs – Hair Loss Information – Balding Blog

Hi! Thank you for taking the time for answering my question. I had a Hair transplant 10 days ago. My doctor did not really brief me about the swelling and shampooing my hair post op. I was scared to shampoo my hair. I shampooed it on the 3rd day, on sixth day the scabs became really hard i couldnt resist to to rub hard but i didnt pull, some came out though no blood just scab attached with hair. I went to see him on my 8th day he said everything looks fine and that the grafts are secure. He started breaking up the scabs on my head i was not comfortable at all i told him that i read on the internet that pulling dry scabs moves the graft. He’s like this is not the first time i do it i’ve been through thousands of heads. I’m on my 10th day now the scabs are all gone. My new hair is there i still have the strong urge to rub my skull.

Did he ruin my grafts by pulling the crushing and pulling dry scabs? does rubbing the new hair effect the growth?

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Let me get this straight — you trusted your doctor for his expertise and judgments to have him perform a hair transplant surgery, but now you don’t trust these very same things because you read things on the Internet about post-operative care and scabs?

I highly doubt your doctor ruined your grafts. We did do a hair pull study and published the results of it with The American Society for Dermatologic Surgery in 2006 (see Graft Anchoring in Hair Transplantation PDF) and we found that the grafts were not totally secure if there was scabbing present. Each graft was pulled out day by day to get the results that we published. With that said, I would assume that your doctor knew this and was very careful in cleaning you up. What we generally recommend is washing your hair daily to keep the scabs down. Most of our patients are scab free within a day or two.