Dr. William Rassman – Page 1771

July 24, 2006

Hair Loss InformationWhat Causes Missing Facial Hair? – Hair Loss Information – Balding Blog

i just wanted to know what causes the bald spot in my beard and will it ever grow back? please help me

Block Quote

A very short question without any detail is hard to answer…

If the bald spot is from a scar, it will likely not grow.
If the bald spot is genetic, it will never grow. American Indians and some Asian people do not have full facial hair and this is genetic, easily treated with transplants.
If the bald spot is from you pulling or plucking your hair, it will not grow unless you stop. If you pulled it too long, it may not grow.
If the bald spot is from a cancer, you should see a doctor.
If the bald spot is from shaving, it will grow back.

I hope this helps.

July 24, 2006

ScalpMed and Propecia – Hair Loss Information – Balding Blog

I started Scalpmed and stopped taking Propecia. About that time I experienced hair loss. That was about 4 months ago. I thought that Scalpmed would do a better job. Do you think that it was not the right thing to do?

Block Quote

I would suggest that you get back on Propecia, for its possible benefits. The result of stopping Propecia means that you played “catch-up hair loss” which means that you lost all of the benefits of the drug, something that happens over a period of about 4 months. I have seen some wonderful results and am generally enthusiastic about this drug as part of a master plan for stabilizing hair loss (at a minimum), but without the drug, you are exposed to the impact of DHT on the genetically impacted hair follicles.

ScalpMed appears to use minoxidil as an active ingredient but it does not stop the DHT from doing its job. Restart Propecia and pray. For more on ScalpMed (or Scalp Med), please see here.

July 21, 2006

Desperate at 23 – Is a Hair Transplant Worthwhile to Me? – Hair Loss Information – Balding Blog

Letter from a person in Europe:

I am 23 years old and i am suffering from hairloss male pattern with a receeding hairline. I am contemplating a procredure and I want you to tell if it it is worthwhile. They assert to be the best in the industry. Can i trust them?. Have you heard of them?

Going through such a horrible condition at such a young age, as you can imagine is truly stressful. My personal doctor says nothing can be done and i have seen dertmotologists who say nothing can be done either. So i am taking things to the extreme.

Thanks

Block Quote

I have reviewed your pictures today. You appear to be a Norwood Class 3V pattern. At the age of 23, I would rather that you start taking Propecia (finasteride) before you do anything. If you have a transplant without that drug, you will accelerate your hair loss and if you think you are miserable now, it will be worse if you became much balder immediately after a hair transplant. The issue always is: Where is your balding going and what is the Master Plan for what you will have to manage over the years in front of you? With the genetic balding that you are showing in the photos you sent to me, anybody that would recommend transplants without giving you at least 8 months of finasteride, would be in my opinion incompetent and immoral. There is no doubt that a transplant on you now will leave you more bald, not less so; PLEASE do not start transplants without 8 months of oral finasteride. Get your hair mapped out for miniaturization to anticipate your pattern of eventual hair loss and then get a competent doctor who will put a plan for your long term (you have years to live and I do not believe you want to live it as a bald man). I have seen too many unhappy men your age who go for a transplant out of desperation and then use up the valuable donor hair without any plan and no way to ever look normal again. Do you get what I am saying?

July 21, 2006

My Doctor Told Me To Use These – I Need an Opinion – Hair Loss Information – Balding Blog

I was on Depo Provera for 9 months (3 shots) for ovarian cyst control and as of my last shot, my hair started falling out in large quantities all over my head. Some days it sheds a lot ( more than 150 hairs), other days it’s normal hair shedding, but I now have 1/2 the hair I had 3 months ago and my scalp tingles. My regular doctor said that shedding is possible with Depo and it should stop soon when the Depo wears off. I am now on Microgestin for the ovarian cyst control and just found out that it is high in androgens, so I’m not sure if that means my hair will take longer to grow back in. I feel fine on it, other than the continued hair loss. While on Depo, I was prescribed Nizoral shampoo 2% for the control of excessive dandruff and scalp flaking, but I am wondering if I should keep using it given my hair loss? Any helpful info would be appreciated.

Block Quote

You should ALWAYS consult with your doctor for any medication changes. You may also benefit from seeing a good dermatologist for these problems and also explore any medical conditions (other than medication related) that may be responsible for your hair loss. Female hair loss is frustrating for doctors because there are few treatment options if the diagnosis is purely genetic.

July 21, 2006

Treating Female Androgenetic Alopecia with Proscar and Avodart? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

Thank you for your ongoing commitment to hair loss! You are a Godsend, my friend.

I have female androgenetic alopecia (first uncoverd after using Accutane) diagnosed at age 27 by scalp biopsy. I began using regular Rogaine, only available at that time. I am now 41 and use an advance regimen of Xandrox 5% BID topically, Proscar 5 mg QD, Spironolactone 100 mg BID, Avodart 2.5 mg (just started two weeks ago) as well as Saw Palmetto, Stinging Nettle, Pygeum, Soy Isoflavones, as well as a few other things like Viviscal and use the Laser Comb every other day. I try to keep up with the latest advanced and spend a lot of time and resources keeping my hair on my head.

My question is there is conflicting information in the literature about the best birth control pill to take to help with adrogenetic alopecia. I currently take Desogen but have tried Ortho Cyclen, Ortho Tri-Cyclen and Yasmin. I use the American Hair Loss Associations guidelines now. Can you weigh in?

Also, any idea when there will be a topical growth modultor that keeps the follicles in anagen? I’ve seen Dr. Kevin J. McElwee of the University of Vancouver’s work with mice and it is facinating.

Your thoughts on these issues as well as any other advice is much appreciated. Take care and thanks in advance for your kind reply.

Block Quote

You are scaring me!

Finasteride currently does not have a FDA approval for use in women. Even if it did, Proscar (5mg finasteride) is a very high dose for androgenic alopecia and in the studies on men, it was shown that the 1mg dose was just as effective as the 5mg dose. That is why the recommended dose is 1mg for androgenic alopecia.

Avodart (dutasteride) is not FDA approved for the treatment of androgenic alopecia. There are many patients who still use Avodart for hair loss, but they typically do not use it in combination with Propecia or Proscar and I do not understand the logic for this therapy. Avodart has a very long half life (the time it take half of the drug to be cleared from the blood stream) measured in weeks or months (compared to a few hours for Propecia) and this makes its dosing a controversial issue because nobody really knows what the best dosage to use is. The most important factor for women taking these medication is its potential implication of cervical, uterine, ovarian, and breast cancer because of its hormonal interactions and its potential for birth defects (well proven in pregnancy).

General disclaimer that needs repeating — BaldingBlog is not meant to diagnose medical condition or give medical treatment plans or advise. It is meant to educate the general public on hair loss issues. Before taking or stopping any medication, please see your doctor and discuss any issues, but I can state categorically that you are on a plan that has little benefit in sight and great harm as a possible clinical outcome.

July 21, 2006

Birth Control Pills and Hair Loss – Hair Loss Information by Dr. William Rassman

Hello Dr. Rassman,

I am a 29 year old female and have been slowly losing my hair for several years. It’s gotten to the point where it is noticible and I am very concerned. I have been to my pcp and determitologist. I have had the standard thyroid tests, etc. and everything is normal. I also have mild vitiligo which I have heard can cause hair thinning as well. I am currently taking spironolactone and am using minoxil. They don’t seem to be helping but I know those can take time.

I have also been taking Levora for about 8 years. I hadn’t thought about that as being a possible cause, but then I noticed that it is listed as a possible side effect. And one of your posts mentions that hair loss is a side effect of birth control pills in 1-5% of women.

Any suggestions? Are there better pills to be on or should I try to go off the pill?

Thanks for your time

It is true that birth control pills can cause hair loss. I realize hair loss is a very sensitive topic, especially for women, but so is an unplanned pregnancy. You should definitely discuss any medication changes with your regular doctor. Some birth control pills may have more hair loss than others, so ask your doctor to experiment with a few of them to determine which one has the least impact on your hair problems.

Paid advertisements (not an endorsement):

July 21, 2006

DHT and Transplanted Hair – Hair Loss Information by Dr. William Rassman

I would like to know how a hair follicle falls off. I was told that as DHT accmulates at the bottom of hair follicles hair falls off. This DHT is produmed by male harmones. Is this true? If this is the case even after hair transplantation DHT will be accumulating and it will cause the transplanted follicle to fall off. Then how is hair transplantation a permanent solution?

DHT is created when your body metabolizes testosterone. It is mostly made by your liver. For people who have the gene for genetic balding, when the hair is at the point in time when it is susceptible to the effects of DHT, it usually starts to get thin (we call that miniaturized) and as it thins out more and more, eventually the hair will permanently fall out. Sometimes the hair just falls out rather than going the route of miniaturization.

Transplanted hair does not have the faulty genetic code, because hair from the sides and back of the head (for reasons not clearly understood) have normal genetic code. These hairs are not vulnerable to the effects of DHT. Look at the people who are genetically bald. They always have hair around the side and back of the head, always. I can not tell you why that is the case, but I know for certain that these hairs around the side and back of the head are programmed to grow for life, so when they are moved in a hair transplant (to a new home in the front), they keep growing as they did at their old ‘home’ in the side and back of the head.

Paid advertisements (not an endorsement):

July 21, 2006

Doctor Won’t Transplant Me Until I’ve Taken Propecia for a Year – Hair Loss Information by Dr. William Rassman

I met with a doctor in Madison Wisconsin, Dr. Gencheff.

I am 21 years old, soon to be 22. He advised me to start taking Propecia first to “stabilize” because he said young men can have an “shock loss” if transplantation is performed without it. This was in December 2005. It’s been 6 months roughtly since I started the drug. I actually take “Finpecia” which is a generic finasteride. I think it is working to slow down the process, but I can’t tell the full results yet. I will continue to take it as long as i need. He mentioned that transplanting in the crown area is not a good idea. I am not exactly sure why, i think he said its because you don’t know how far its going to progress. All in all, he said I had good hair to transplant with, but he said he wouldnt operate on me until I had taken Finasteride for at least a year. Is it possible to transplant in the crown area? By the way, i think he diagnosed me as a future 5a. The mid scalp is thicker as well as the front hairline. Thank you for your help, I may be seeing you soon.

From your brief description, I agree with your doctor that you should be on Propecia for a reasonable amount of time before resorting to a hair transplant surgery — especially at the age of 21. Your doctor seems to be looking out more for your interest than his own bank account, which is definitely a good thing. I often write on BaldingBlog about the “Master Plan” of a life long goal of maintaining a desirable head of hair, rather than just achieving a quick fix. If you are indeed a future Norwood 5A (assuming you are a Norwood 3A now) then it would be wise to see how much Propecia can slow, stop, or even reverse the hair loss process. Maybe you will be lucky and reverse some of the process you are now experiencing. I look forward to seeing you in San Jose and would be happy to map out your scalp for miniaturization, trying to outline where you may be going with the balding process.

July 21, 2006

Shaving Head After FUE Procedure – Hair Loss Information by Dr. William Rassman

How long after FUE is it safe to shave the head short? Is there danger of pulling out grafts.
Many thanks for your time.

I clip the patient’s hair short on the day an FUE is performed and you can keep it that way. Shaving the head can be safe at about 1 week. Be careful not to cut the new skin in the donor area, though.

These photos are from 11 days after one FUE procedure of 1,901 grafts. Click the photos to enlarge.

Paid advertisements (not an endorsement):

July 21, 2006

Should I Be Using 2% or 5% Minoxidil with Propecia? – Balding Blog

Hi Doc, what a wealth of information this blog is so many thanks. I have recently started propecia for vertex thinning and am thinking that i should also probably use minox in conjunction with it. Do you have any thoughts on wether it should be the 2% or 5% dosage or if i should use it at all. Im 7 months into my propecia regime. thanks

In my practice, I generally recommend one change at a time. Wait out the full 8-12 months on Propecia before you add minoxidil. You should be using a good metric on this treatment (mapping out your hair for miniaturization) so that you know what is really happening and what you really need.

Higher concentrations of minoxidil have a greater risk of potential side effects such as dizziness and fainting from low blood pressure. Minoxidil and Propecia have different mechanisms of action and do not have any significant interactions.

Paid advertisements (not an endorsement):