Author: Dr. William Rassman

Posted on

Hair Loss InformationThe Hair Loss Consultation – Hair Loss Information – Balding Blog

Hi, I believe I asked a question some months back but you only responded by asking me to come in for a consultation. So, let me try to get into specifics before considering coming in. I have been undergoing some stress lately and noticed thinning of my vertex. My hairline is completely unchanged… same as it has been since high school. I am also underweight for my height. Male, 28 years old 6’2″ 160-165 lbs. I have been underweight for the last 4-5 years. My average weight was 180 lbs in the past but have been eating less due to shortage of time and decreased appetite from work, plus I exercise 5-6 days a week. Also, my protein intake has fallen drastically.

I am contemplating whether I am experiencing MPB or Telogen Effluvium. Few months back I noticed a lot more shedding from the vertex area, mostly in the shower. I would pull at my hair and more than 4-5 strands would come out at a time and would not stop until I have pulled out an average of 10-15 strands. This happened every morning in the shower. It has somewhat slowed down, but now I am seeing some hairs come out that underwent miniaturization. Maybe I am experiencing a combo of both Telogen Effluvium and MPB. But has there been cases where men only experience balding in the vertex only?

My father is balding at the age of 59 (typical horseshoe). My mother’s side shows no signs of hairloss from anyone. He informed me that he experienced loss in the front first. If I inherited his baldness, would I follow his pattern?

Detailed feedback would be appreciated. Is consultation by appt only?

Block Quote

Yes, consultations are by appointment only. Your case, like many, are not as cut-and-dry as you’d like it to be, so it would be difficult to just make random assumptions about your hair loss without an exam. I’m not trying to “rope” you into coming in, but I’m also not trying to steer you in the wrong direction. This does require an exam, which can and should be done locally. When I see a patient for the first time (let’s say you, for example), I would plan on spending an hour with you, which gives me time to:

  • Get to know you
  • Listen to the problem you will be defining
  • Examine your scalp and hair in detail
  • Discuss a ‘plan of attack’ based upon a Master Plan we would setup to manage your hair loss problem

MPB can be limited to only the vertex (crown), or it may start in the front and progress backward. Genetic hair loss generally occurs in patterns (see Norwood Chart). Telogen effluvium, on the other hand, would be diffuse and not only limited to a patterned area.

If you’d like to setup a free consultation, you can either call my office at 800-NEW-HAIR or fill out the form on my site to Request Additional Info and someone from my staff will get in contact with you.

Posted on

Testosterone Booster vs Propecia – Hair Loss Information – Balding Blog

I have been taking Propecia for 22 months. It worked wonders for me. After 2 months my hair loss stopped. After 10 months I would estimate 40% of my hair grew back. After 20 months my estimate would be that close to 60% grew back. I had a small bald spot on my crown less a 1/2 inch in diameter that completely grew back. The front of my head was receding rapidly and looking thin. The receding stopped and I actually got regrowth mostly only on one side and overall my hair looked drastically thicker. I swore by the stuff based on the results that I saw.

About two weeks ago I got a very short hair cut, not a buzz cut but real short and about three weeks ago I started taking a training supplement that is a testosterone booster. (I purchased at GNC) In the last 4 or 5 days I have suddenly noticed shedding in the bath tub and my hair is looking much thinner in the front than it has in a long time. I am 35 and never miss taking a 1mg pill first thing in the morning.

My guess is that taking the testosterone booster has messed with my system and is dulling the effectiveness of the propecia. Can you comment?

Block Quote

My guess is that you are right. I do not know of a testosterone booster natural supplement, but if it indeed increases testosterone, then you will likely have more DHT production as a result and this may tip the balancing scale over to more hair loss. It seems that your Propecia (DHT blocker) regimen was working well. I would stop taking the testosterone supplement if you are noticing a direct correlation to hair loss.

I cannot comment on whether your hair will grow back; it may or it may not. If I was a betting man, I’d say that your chances of growing more hair back is slim, but stopping the offending formulaes you are taking would be wise. This is just my opinion though and I am not your doctor.

Posted on

Each Transplanted Graft Is Slightly Raised – What Can I Do? – Hair Loss Information – Balding Blog

I had a hair transplant about a 2 years ago, mostly around my temperal area and a minimal amount in the very front of my hairline.

I have a question about scarring. My donor scar is fine and doesn’t bother me, but where each hair was transplanted the skin is raised just slightly so it’s like i have very tiny little bumps all over my temples and the front of my hairline. They are tiny enough that i assume most people never notice, but if I look in bright lighting I feel that it’s very obvious, at least to me.

I figured they would become less raised over time, but they are still there. I have become self conscious about being under bright overhead lights and even about being outside when the sun is bright without a hat. It’s really messing with my head, no pun intended. But seriously, it’s taking quite a toll on my self esteem.

Is there anything I can do that would just smooth the little tiny bumps, like laser therapy? or would that just make things worse and remove hair?

Any advice would be very greatly appreciated.

Block Quote

This problem was common in the old days, when doctors placed larger grafts in the transplant area. Your doctor may have left too much skin on the graft surface and had them elevated at the time of the transplant surgery.

Lasers to the skin might kill off the hair. Dermabrasion will probably discolor the skin in the area that it is abraded. I have seen many examples of people who had scalp skin abrasion. I would think that careful ‘shaving’ of the bump would reduce or eliminate the bumps, but this would have to be done by an expert in the field and it would be a tedious procedure under local anesthesia. You would likely have to have your head hair brought down to skin level (shaved close) to get the bumps addressed.

Posted on

Atopic Dermatitis in Baby – Hair Loss Information – Balding Blog

My 9mos.baby has Atopic Dermatitis, Doctor prescribed use of Cetaphil Lotion as shampoo. Now her hair is falling and she has itchy scalp.If it is allergy to the lotion how can i treat it to return to normal condition?

Block Quote

It seems that you are asking for a second medical opinion. This is not a place for such advice. If it is an allergy, it is very important for you need to go back to the doctor who prescribed the medication and ask him/her about your concerns. Your baby’s relationship with the doctor did not end with a prescription and the doctor needs to be kept in the loop if something is not going well.

I am not evading your question, but you should know that my practice is basically hair loss in adults with a leaning to surgery as a solution (when necessary). Clearly, the area of a 9 month old with atopic dermatitis is outside my relm of expertise.

Posted on

Will Propecia Offset Steroid’s Negative Effects on Hair? – Hair Loss Information – Balding Blog

What if you are taking propecia. Can that offset the negative effects of the steriods and let you keep your hair if you have mpb genes???? Please let me know you answer…

Block Quote

Norwood Class 5ASteroids may accelerate the time it takes for your body to move to its final hair loss pattern. For example, if you are destined to become a Norwood Class 5A by the age of 40, the steroids may induce this pattern to develop earlier (age 25+). You will not become balder than your destined pattern. Propecia may slow down the impact of the steroids, but it will not completely stop it from occurring.

Posted on

In the News – Obesity and Cancer Linked? – Hair Loss Information – Balding Blog

From time to time, I like to pass on some important health information (not hair-related) and insights that I come across. In the November 3rd issue of New Scientist magazine, the editorial “What’s for dinner?” was about the issue of linking cancer to obesity. The article suggests that there is a clear connection between obesity and cancer and gives ways to reduce this risk with good exercises, reduced weight, proper diet (not junk food), reduced meat intake and staying away from salt above 5gms per day.

I realize this article is over a month old now, but I was trying to get clearance to publish or link to the full article here. Unfortunately, I can’t link to the full article for legal reasons, but New Scientist does allow you to read it if you pay for a membership to their site. The link to the article preview is here.

Posted on

Sweaty Scalp and Hair Loss – Hair Loss Information – Balding Blog

my scalp has been ictching and feels burning for about 1 1/2 years.i also get spots on my scalp which are really sore.my hair is thining quite bad.i have the same symtoms all over my body. i sweat a lot on my scalp,underarms and groin.when i sqeeze a spot on my face i get a white sticky discarge which smells like vomit please help as i am a single dad of 2 and also have a bad deformed head an do,nt what to lost my hair.

Block Quote

“White sticky discharge which smells like vomit”…? I think losing hair should be the last of your worries. Please see a doctor for an examination of your problems.

Posted on

Hair Loss InformationUpdate on Dutasteride – Hair Loss Information – Balding Blog

This blog entry was written by Bernard P. Nusbaum, MD, and posted with his permission.

—-

FDAFinasteride, which is the generic name for Propecia, has been approved for the treatment of Male Pattern Hair Loss since 1998. Finasteride works by inhibiting the enzyme ,5 alpha reductase type II, that forms DHT. There has been a lot of interest by both patients and physicians in dutasteride, which is a drug that inhibits both type I and type II 5 alpha reductase enzyme.Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. Dutasteride is not approved by the FDA for the treatment of Male Pattern Hair Loss and is approved at a dose of 0.5 mg a day for the treatment of prostate enlargement. While both the type I and type II enzymes are found in the hair follicle, there is a recent study which shows that type I is present in the human brain.The function of this enzyme in the brain is still unclear.

The most extensive study of dutasteride in the treatment of male pattern hair loss was published by Olsen and others in the Journal of the American Academy of Dermatology in December of 2006. This was a randomized, placebo-controlled study of 416 men for a 24 week treatment period. The study evaluated various doses of dutasteride versus 5 mg of finasteride versus placebo. At the time of the study the 1 mg finasteride dose (Propecia) was not commercially available, but the comparison is valid since the effects on hair growth of 5 mg. 1 mg. of finasteride are equal.

The results of the study were as follows: Hair counts in the vertex showed that only dutasteride at a dose of 2.5 mg a day (which is five times the dose approved for prostate enlargement) was better than finasteride at 12 and 24 weeks. When an expert panel evaluated photographs before and after treatment, the 2.5 mg dose was better than finasteride at 12 weeks and both the 0.5 and 2.5 mg doses were better than finasteride at 24 weeks — in other words, dutasteride at a 2.5 mg daily dose worked faster than 0.5 mg .

Scalp DHT suppression, which is felt to be correlated to a drug’s effectiveness, was measured and showed that finasteride decreased scalp DHT by 32%, dutasteride 0.5 mg by 51% and dutasteride 2.5 mg showed 79% suppression. DHT concentration in the blood was decreased 73% by finasteride, 92% by dutasteride 0.5mg. and 96% by dutasteride 2.5 mg . The speed by which drugs are eliminated from the body are measured by a value which is called “half-life”. The half-life of finasteride is six to eight hours whereas for dutasteride it is four to five weeks, which means that when one stops taking dutasteride, it will take several months before the drug is out of the system. When blood DHT was measured in these patients 12 weeks after stopping the medication, the finasteride treated patients had a normal DHT level while the dutasteride 0.5 still showed a 10% decrease and the dutasteride 2.5 mg treated patients still had significantly lowered DHT levels.

Sexual side effects were determined and, although there were no statistically significant differences between placebo, finasteride and dutasteride, it is noteworthy that in the patients treated with 2.5 mg dutasteride daily, 13% complained of decreased libido. As has been the experience with finasteride, half of these patients experienced resolution of their side effects despite continuing to take the medication. The other 50% had to stop the treatment in order for side effects to subside.

Side effects of dutasteride which have been reported in the treatment of prostatic enlargement are 1) breast tenderness and enlargement, and 2) reduced sperm counts. In a separate study of 28 patients treated with dutasteride 0.5 mg daily there was a significant decrease in sperm count at 26 weeks of treatment. That study states that it is difficult to determine the significance of these sperm count abnormalities and that the reports vary as to what sperm counts are required for fertility. It is quite concerning that two of the 28 patients in the study had a greater than 90% decrease in sperm count while taking the medication and 24 weeks after stopping the drug, they still had a 70% reduction in sperm count. Although the study did not give figures on the percentage of patients that developed sperm count abnormalities, this side effect, in my opinion, is worrisome especially since we commonly treat young men for male pattern hair loss. It should be noted that finasteride 1 mg (Propecia) was shown in a separate study to have no effect on sperm count.

In conclusion, dutasteride improved hair growth in male pattern hair loss more rapidly and to a greater degree than finasteride at a dose of 2.5 mg per day which is five times the dose approved for prostate enlargement. Dutasteride is approved by the FDA for the treatment of prostatic enlargement at a dose of 0.5 mg per day and there is insufficient safety data on higher doses. Dutasteride is NOT approved by the FDA for the treatment of Male Pattern Hair Loss and patients should be informed about the benefits versus the possible adverse effects. Finasteride 1 mg (Propecia) has been shown to stop the progression of male pattern baldness in 90% of the patients treated with the drug. It has an excellent safety profile with only 2% of patients experiencing decreased sex drive and no reports of sperm count abnormalities.

We are currently awaiting the results of a phase III study being conducted in Korea to evaluate dutasteride 0.5 mg daily in the treatment of male pattern hair loss.

Posted on

Castration Proves that Masturbation and Hair Loss Are Linked. Wait… WHAT?! – Hair Loss Information – Balding Blog

You have stated that masturbation has no effect on hair loss, However i cant see this being true. Castration prevents male patern baldness for people who are genetically predestined to go bald. This shows us that if our testes which produce sex cells enabling us to masturbate are castrated this cancels out testosterone inturn DHT and other androgens which may play a role in MPB. So if u no longer masturbate your ruducing testosterone and DHT dramatically. Which in a sense by not masturbating which castration prevents you from doing you are trying to create a castrated form. What i mean by this is that if i dont masturbate for a number of years i am helping stop part of the role that castration does. There is an undeniable link between masturbation and MPB, castration proves this by the fact that it stops us being able to masturbate proving that if we dont masturbate we will reduce balding dramatically (Or as far as not being castrated will take us).

Block Quote

Apparently I’ve struck a nerve with the former chronic masturbators out there. When you search for “masturbation” and “hair loss” in most search engines, this site comes up pretty high on the list. While that is good, it leads to waaaaaaay too many emails from people wanting to tell me how masturbation and hair loss are linked, then trying to piece it together with some flimsy logic. Please, please, please think!

It is normal for men to have sex often — daily, twice a day, twice a week. We are all different with our sexual habits and routines. Having sex with a partner or masturbating is the same thing with regard to the way your body reacts. If you are having sex often (with yourself or another person), then that is normal. Hair loss and sexual activity should not be related, but clearly you believe otherwise. This is not the forum to discuss this and if you believe it to be true, then show me the connection in a well controlled study.

Posted on

Does Laser Hair Removal Harm the Skin? – Hair Loss Information – Balding Blog

Hi Doc
I was thinking of laser hair removal of my chest, neck and parts of my back. I was just wondering, do these repeated laser procedures cause any harm to the skin, short and long term. Also, I understand waxing is painful and may take time, but could it really be permanent.

Thanks.

Block Quote

I am not completely familiar with laser hair removal or even hair removal in general, as my practice involves adding hair, not removing them. From what I know, laser hair removal can irritate the skin and it is a relatively painful procedure usually requiring more than one treatment to get complete hair removal, because hair that is in telogen will not be killed from a laser treatment. When this hair finally gets out of telogen, it then has to be lasered. About 40-70% of body hair (depending upon where in your body we are talking about) is in telogen at any single time, so multiple treatments to kill off this hair is totally logical. You should ask these questions to the doctor who will be performing your laser hair removal, as I am not an expert in this process by any means.