What Can I Ask My Doctor? Nobody Has Any Clue How to Help Me! – Hair Loss Information by Dr. William Rassman

(female) I think the biggest frustration is the fact that we search sites and find answers like: You should ask a local doctor… but the problem is that doctors either don’t know or don’t take the time to find out. I have been “undiagnosed” for almost 2 years. Severe hair loss (50%) burning scalp after hair fall, outer eyebrow loss, fatigue, hair growth on arms, visual changes, etc. but no abnormal hormone tests, no thyroid issues. It makes no sense and I can’t just keep asking doctors because they truly don’t know. I need to find out if I had TE and I was genetically predispositioned to FPB and it is DHT I need to be targeting or whatever. It gets very old when you watch your hair fall with no hope of stopping it. Please let me know if there is anything else (disease) I can research. Thank you.

I am sorry to read of your frustration and its unfortunate that this isn’t the first time I’ve read or heard similar stories. Its quite often, in fact. Even as a hair specialist, I sometimes do not have all the answers as to what is causing the hair loss. Many times doctors are just acting like mechanics. They fix a problem without fully understanding the cause.

In your case, the symptoms of visual changes, hair growth on your arms, fatigue, and burning sensation are very troubling to me. You need to find a doctor (I realize that is the hard part) that can sit down with you and find what is going on with you and explore all possibilities from Lupis to Multiple Sclerosis to Sarcoidosis to other female diseases like Chronic Telogen Effluvium. Many of these conditions require a biopsy and the diagnosis can be made under a microscope. There’s little I can do via the internet without examining you, and I don’t have any local recommendations in your area. I wish there was more I could say to help, but at this point my hands are tied.

Scarring in Donor & Recipient Area, Body Hair, FUE – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m considering going in for a FUE hair transplant and I understand that there is minimal scarring involved. I was reading up on the New Hair Institute web site and noticed there are many “mini” scars. Will these scars be only in the donor area or where there is transplanted hair?

I’m also considering using body hair as a viable source for donor hair. I’ve seen a few surgeons doing this. Have you personally performed such an operation? I would love to hear your thoughts on this procedure.

Best regards.

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Follicular Unit Extraction (FUE) produces very small scars in the donor area, usually less than 1mm (there are 25mm to an inch). The only way most people could see these scars is a complete shave of the head (not a short hair cut, which probably would not show any of these scars). In the recipient site, the grafts are always trimmed (in our office, anyway) to cut away the unnecessary skin so that these grafts should not produce any visible scar in the recipient area. My understanding from the recent ISHRS meeting in San Diego, is that most surgeons doing FUE do not trim the grafts and therefore may get very small recipient area scars.

I have commented on body hair transplants before, but I’ll recap the biggest problem with them. Due to the short growth cycle, body hair will not show up very well (quantity) because for every body hair that is transplanted, less than half of them will be in growth phase at any one time. That means that less than 50% of the hairs will grow according to what you can see. At the meeting in San Diego, one doctor who does a lot of body hair transplants showed two patients who had them done. The growth in numbers was far less than 50% of what the two patients and the doctor reported was put in at the time of the surgery. The only good news about what I learned at the meeting with regard to body hair is that the length of the hair does double to what the person had in the chest or back (natural position). I would want to have a face to face meeting to understand your focus on the body hair, why you wanted it, and to see what else was available to meet your needs.

Bald Spot Just Appeared on Back of My Head – Hair Loss Information – Balding Blog

I am a 21 year old Male who up until a few months ago had no problem with balding. I was getting my hair cut relativly short and my hair dresser noticied I had a bald spot on the back of me head about the size of a quarter. I kinda ignored it figuring it would grow back but it has been about 5 months now and my hair is longer but the bald spot is balder then bald and seems to be getting bigger according to other people (as I cannot see the back of my head). I was just wondering what the cause for this is and if it can be anything serious or just stress related possibly? Thank You very much.

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Send me a photo of the spot you’re talking about so I can see what you’re referring to. At 21, you are relatively young for crown balding. I have some important questions for you:

  1. Is the spot in the center of the head where the swirl is located or is it off to the side?
  2. Is there still some hair present in this bald spot?
  3. Is there any balding or thinning any place else on your head?
  4. Do you have a family history of balding in the crown (back) of your head and if so, at what age did it happen?

A good doctor may be able to diagnose a possible cause, such as ringworm, alopecia areata, etc. There is not substitute to a good doctor’s examination for you. If this is genetic balding, you would want to get your hair mapped out for miniaturization, as genetic hair loss has patterns of thinning which appear before developing a bald spot.

My Dermatologist Stopped Prescribing Proscar for Hair Loss – Hair Loss Information – Balding Blog

I’m a male, age 27. When I began seeing a dermatologist 4-5 yrs ago, he prescribed finasteride 5 mg and had me cut it into quarters.

That went on for about a year or so, but then he said that there was some sort of regulation restricting physicians from doing this. Since then, I’ve been paying the higher cost of the daily 1 mg tablets. Was the doc telling the truth? I understand that the clinical indication calls for a 1 mg tablet, but are doctors really not allowed to prescribe the higher dosage with the understanding that the patient will do his part and cut the pill into the appropriate size?

thanks

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Many doctors prescribe medicines for off label use. Proscar (finasteride 5mg) is a medication marketed for benign prostatic hypertrophy. Propecia (finasteride 1mg) is a medication marketed for androgenic hair loss (male pattern hair loss). They are the exact same drug with different strength dosing. That being said, if someone (or a computer, such as your insurance company) sees that you have been prescribed Proscar, they may think you have a prostate problem even if you were prescribed it for the intention of using it for hair loss. This is a story that is told by my Propecia drug representative – so there is obviously a bias there and I am not sure how true this story is — but it is plausible.

I give a choice to all my patients and do not favor one or the other, because they are the same medication in different dosages.

Rogaine Not Proven to Work Past 48 Weeks? – Hair Loss Information – Balding Blog

I noticed on the pamphlet with my rogaine bottle that it says the medication has not been proven to work past 48 weeks. Does this mean that Rogaine doesnt work pass that many weeks or that the study was only conducted for 48 weeks? I have been using rogaine for 4 months and have seen fantastic results. Before then I was only using propecia without any results, now I use both.

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I found the following statement, “hair regrowth has not been shown to last longer than 48 weeks in large clinical trials with continuous treatment with 5% minoxidil topical solution for men”. This implies that the study only went out 48 weeks. I have seen people on this medication for years and years and when and if they stop it, they lose hair. This phenomenon suggests that the Rogaine held the effect and benefit for the years it was used.

Anticoagulants and Hair Transplants – Hair Loss Information by Dr. William Rassman

What if your on coumadin, do you have to wait until your off the medication? I am told yes.

Just to clear it up for the readers out there, I believe you’re referring to waiting until you’re off coumadin before having a hair transplant.

It is wise to reduce or stop coumadin (an anticoagulant) prior to having a hair transplant. I have had the misfortune to do a hair transplant on a number of patients on coumadin (it can be reversed with Vitamin K) and on Plavix (can not be reversed). There was very mild bleeding from the recipient site the night of the surgery. The surgeon must understand why a person is on these medications and weigh out the safety of stopping them or staying on a lower dose of these medications. Each case is medically evaluated independently.

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Mood Stabilizers and Hair Loss – Hair Loss Information by Dr. William Rassman

My husband is 40 and until recently had a head full of thick black hair, I noticed when he turns his head that you can clearly see his scalp and it has thinned out tremendously. He is on mood stabilizers for bipolar disorder and I know these will affect hair and cause hair loss. Will anything help his hair come back if this is related to his medication.

Medications to treat bipolar disorder (such as lithium) can cause hair loss. Just because you stop the offending medication, it does not guarantee that the hair will come back. More importantly, you should discuss any change in medication with your prescribing doctor. Sometimes, these drugs precipitate the genetic hair loss process. A good dermatologist (or a good doctor that specializes in hair, like myself) can make a diagnosis that will define any genetic component of what is happening to him. The drug Propecia (finasteride 1mg) might then help, at least by slowing or stopping the process. Try to surround the diagnosis. Some people who actually have hair loss from genetic causes, do not notice it until it gets more advanced. Could that also be the case?

Not Seeing Results from Finasteride After 9 Months – Hair Loss Information by Dr. William Rassman

Dear sir, I am 29 years old. My hair loss(from crown moving to the left frontal area) started 4 years back. I have been taking Finax(Finasteride)for last 9 months. I have not seen much or benefit from it, instead there is increase in my see-through hairs on the right side when i see it from the top in the mirror. I do not think it is working, still I am not going to stop it. My question is if my hair loss is still progressing and I am not a candidate for transplant, what are my options in the long run. Please reply.

If is my belief that finasteride (assuming that the medication is really finasteride) always works to slow down the natural course of male pattern hair loss. You are right to stay on the medication, but as the medication is not coming from Merck (drug company in the U.S.), then you should be sure that the company who makes the version you are taking is really that medication. I’m still not familiar with the various brands of finasteride that are available in other countries (or the legitimacy of those brands). I’m a U.S. based doctor, and as such, I am familiar with what is available to my patients here. If you still see progression of the hair loss, then this drug may not be strong enough. Hair transplants may be the only option for you.

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Hair Loss InformationHair and the Effects of Flat Irons – Hair Loss Information – Balding Blog

Hi I am 29 years old, male. Do flat irons cause permanent hair loss? My hair dresser started using a flat iron on my hair 3 years ago, since my hair was wavy, he showed me how I can make it straight. About 2 months after using it (usually once or twice a week) I noticed that my hair was drying out. I stopped, only to use it once in a while. Today I find that my hair is receding on the sides and my crown is thinning. Is this from the use of the flat iron? I’ve stopped using it for about 6 months now but I still find that my hair falls out everytime I wash and style it. I researching on the net about the side effects of flat irons but never found any concrete proof about the consequences of using them. I hope I didn’t ruin my hair for good! What can I do?

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Let’s think logically about this. When hair has grown beyond the scalp, it is no longer a living tissue. Only the hair organ below the skin is living. Hair is made of compressed fibers and a shingle type of structure made up of shed skin cells called cutin. These shed skin cells are in effect the same ‘stuff’ that produces the scales we see in dandruff and may reflect higher turnover of the skin on our scalps. As these shed cells are compressed above the fibers in the hair shaft, they form a layered array just like the shingles on a roof would form to keep out the water. But below the skin, the hair organ puts lipoproetin layers into these scales of cutin that give the hair the character that you have. The presence of fat on the outside of the hair shaft is what brings out ‘luster’ in the hair. Once the hair exits the skin as it grows , it enters the hostile environment of air, wind, weather, heat, etc… and it no longer is subject to what your body can do for it. As the hair exits the surface of the skin, the sebaceous glands secret a waxy sebum that may find its way onto the hair shaft, giving some people an oily hair.

When you iron your hair with heat, you do change the character of the hair and change the configuration of the varying layers of compacted cutin and the fibers that make up the structure of your hair. Heat takes away the luster (shine) from hair, burns away the waxy covering, may denature the lipoproteins on the surface of the hair shaft and it is this that protects the hair from the environment. Heat may damage the core of the fibers inside the hair as well. High heat applications can damage the hair so that it cracks, breaks, and even become fragile, producing broken ends from hair that breaks too easily. Take a look at this illustration of an enlarged hair shaft here (illustrated by Norm Nason). Note the layering of the cutin shingles. Look at the center of the shaft and see the fibers that form the backbone and the strength of the hair shaft. When these fibers are broken, or the shingled cutin is removed, damaged or burned, a pealing process may begin which would reflect the damage to the foundation of the hair shaft, and it can become permanent. When the hair is damaged, then gentle handling is critical to maintain and hold it on your head. You can, of course, cut it off and new hair coming from below the skin which should not grow out damaged, will eventually replace the weak hair. The hair exiting the skin is normal and undamaged so you can and should expect that once you cut off the damaged hair, the new hair will grow to whatever your normal should be. Good cosmetology can hydrate the hair and it might bring back some of its luster and strength. For those of you interested in high powered microscopic views of the hair system below the skin, see here.

So, if you have hair loss or thinning of new hair, it is possibly a new problem, and you need to have your hair analyzed by a doctor like me.

Hair Loss InformationJust Started Losing Hair a Year After Pregnancy – Hair Loss Information – Balding Blog

I am a 31 year old female with a 17 month old son. At about the time he turned one, I started to notice hair loss. It’s all over my head, and has caused my hair to thin a lot. It is still happening. I have been to the doctor and was tested for thyroid. It was negative. What I am wondering is, could this hair loss still be related to my pregnancy? It has also been an extremely stressful time – but could this long period of hairloss be related to stress? Will my hair grow back? And can continued stress mean continued hair loss?

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Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. Your scalp should also be mapped out for miniaturization to define patterns in genetic hair loss that are typical for women. Pregnancy can activate genetic hair loss in some women.