Author: Dr. William Rassman

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0.6mm Tool for FUE – Hair Loss Information by Dr. William Rassman

Hello or “Hej” – as we say in Sweden.

I did read a post from you talking about FUE instruments, you use 0.9mm and smaller tools will cause greater follicular holocaust, you said.

Recently I did read a blog entry from you where you talked about FUE and the development of smaller tools.

I’m confused. Here in Sweden we have an intresting option, 0.6mm. Is this pure nonsense or could this surgeon be that good? Method is called “FUE plus” and is said to transplant 120-180 hairs / cm2.

I did notice that you said that 200 hairs / cm2 is the original density provided by the “man above”.

Why increased follicular holocaust when using smaller instruments?

I am hopeful that some breakthrough will come about that will allow smaller instruments to be used, but alas I have not seen them yet. Without knowing the doctor who proclaims such miraculous instruments, as a betting man, I would wager that some lack of proper representation is the case here. Add to such a wonderful instrument, the ability to achieve within 90% of God density and you have FUE God Plus. That means that some doctors can improve on what God might do if he (or she, depending on your beliefs) was a transplant surgeon here on earth.

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Are the Propecia Site Photos Altered? – Hair Loss Information by Dr. William Rassman

dr. Rassman,

I read one of your articles about laser light therapy and the results of the pictures from the LLT could be altered or they could have been touched up to make it look as if more hair growth occurred. Saying that, how do we know that the people on the propecia.com website didn’t alter their images or the images you see from propecia or avodart results are altered?

Yeah, propecia could work, but to what degree and I personally thing propecia just maintains what you have unless you use minoxidil. What do you think?

The studies that show the benefits of Propecia used in Merck’s material are the results of well controlled and audited scientific studies, some of them done under FDA guidance. I would trust official Propecia photographs from Merck, but I would not trust many of the commercial photographs that are produced just to ‘prove’ that the changes are real. If you look carefully on many photographs used for the various potions, lotions, and herbal solutions for hair loss, the lighting, the hair length, the view — they are all different. On some photographs I have even seen scalp coloring agents used in advertisements, particularly for the crown shots on many commercial products.

So, always check the authority of photograph sourcing. For hair transplantation, I offer open house events at both of my offices just because even from the photographs on our website, the average person may have difficulty in determining just what the change really is. When you meet a patient face to face, what you see is reality and not the best view or an illusion created by the person taking the pictures. Of interest, at each of our open house events, we often have a person present who had created all of the benefits on Propecia alone (no transplants) and they have their before shots to prove where they came from. I still believe and preach: Let the Buyer Beware.

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Bioidenticals and Female Hair Loss – Hair Loss Information by Dr. William Rassman

Two years ago I had my ovaries removed due to solid cysts. I have had problems with HRTs. Some of the physical problems I had with synthetic hormones went away when I started bioidentical hormones. As soon as I started bioidenticals, I could literally watch the hair fall out of my head. The loss has alternately slowed or stopped,however, on a lower dose of estrogen my scalp is very sore to the touch & itchy. (The soreness is not because I have been scratching my head. I haven’t). What causes this?

Also, I had hormone levels tested before going on bioidenticals(18months after surgery & 16 months after HRT) and it showed I had very high androgen levels, but doctors & pharmacists can’t seem to tell me why, or what I can do about it. Any suggestions?

See Bioidentical Hormone Replacement – HRT Without the Side Effects.

Taking out the ovaries will produce an imbalance in your female to male hormone ratios. Many doctors treat women with HRT (Hormone Replacement Therapy) to adjust to the changes associated with surgically induced menopause, which follows the loss of your ovaries. I have no doubt that naturally occurring herbs will supply hormones that have the capacities that you outlined, but the amounts of hormones that you are mimicking with these herbs are clearly producing hair loss. This suggests that the testosterone and androgenic effects are inducing the genetic hair loss that you have programmed in your genes. I would generally tell you to stop taking the bioidentical hormone replacement and see the effects on your hair loss. Seek out the advice of a competent doctor to try to manage what you are treating.

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I Want My Donor Area Repaired So I Can Shave My Head – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

I am looking to have the donor area from an earlier procedure eliminated so that I could wear my hair extremely short or shaved.

Please let me know what you recommend.

Thanks in advance.

All cuts on the skin will produce a scar and most cannot be completely eliminated. Scars can certainly be minimized depending on the individual healing characteristics so that short hair is a reasonable option. At New Hair Institute (NHI), we continually strive to incorporate scar minimizing techniques in all our procedures and will tackle repairs of scars if they are there. Please refer to Techniques to Minimize Donor Scarring. Your original hair transplant surgeon should be able to address your scar. If not, I would be happy to meet with you in person or by phone to discuss your options.

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Is DHT Produced in All Men? – Hair Loss Information by Dr. William Rassman

So DHT is the hormone that causes male pattern baldness? And that hormone is produced in all men who will experience from male pattern baldness after puberty? So is DHT only produced in men who will experience male pattern baldness or is it produced in all men? And if DHT is produced in all men after puberty do they only start experiencing baldness when another gene triggers it? How do you tell if you are genetically going to have male pattern baldness? My dad does and so did his dad and so did my mums dad but my uncles (on my dads side and my mums side) dont and both have full sets of hair at 55 and 58? So how do i know if i too will experience it ?

All men produce DHT, unless they are born with a genetic defect and missing a particular enzyme that makes DHT. There is no way (at the moment) to tell who has the gene for hair loss and if they did know, they wouldn’t know if or when it will be expressed in the lifetime of any particular man.

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Why Would a Doctor Limit to 1000 Grafts Per Session? – Hair Loss Information by Dr. William Rassman

hi Dr,
i am considering getiing FUT done in the near future. i am from Ireland and there are limited surgeons here. one surgeon, has an excellent reputation, and an impressive bio, but limits his sessions to 1000. I would need about 2500 to 3000. what would be the reason for the limitation, and do you know of Doctors that also limit their sessions?

The limitation on the number of follicular units transplanted may be due to the limitations of the doctor’s staff and time. For example at New Hair Institute, we are capable of transplanting 3000-5000+ grafts in a day. This is possible because of our experienced staff, mastery of the tools we use, and techniques we have refined over many, many years. We were the first medical group in the world performing sessions of 1000, 2000, 3000 and even 4000 grafts (in 1994). The key to doing these larger sessions must address reasonable limits based upon each patient’s dynamics, skin laxity and supply/demand considerations. Then, the doctor’s team should become a focus and one should never push a doctor or his team to do more than they can competently handle. The level of competence with these large sessions varies between doctors.

If you are referring to Follicular Unit Extraction (some doctors may use different terms) where individual hair follicles are harvested one at a time, 1000 may be a reasonable number because it is a very laborious process, but here too, as the originator of the FUE process, we have performed as many as 2200 grafts in a single session in appropriate candidates. It is all a matter of experienced teams of doctors and staff working together after years of training. If your doctor is unwilling to perform a larger session, either stick with him/her and do more surgeries with smaller numbers of grafts or find another surgical team able to perform larger sessions with lots of experience doing them.

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Propecia and Follicular Neogenesis – Hair Loss Information – Balding Blog

Hello Doctor and thank you for this your answers on this forum. I was curious about two things. First, is it true that taking Propecia will SOMETIMES help maintain the other areas of hair you are not taking the medication for? In this, I mean if I were to take Propecia for very minimal vertex thinning, but my hairline and frontal hair are perfectly fine the way they are right now, will propecia help keep those hairs in perpetuity? (in general of course, I know there are no guarentees in all of this). Second, do you keep up on the latest information regarding the process currently being worked on called follicular neogenesis (the elusive “cure all” for baldness? I’ve heard from many sources (including Bosley reps) that within 8-10 years, all the kinks MIGHT finally be worked out of this, thus hopefully ending and curing baldness. I know the key word is “might,” but I was just curious how much you’ve heard about it and your thoughts. Thank you so much.

Block Quote

Divide the term follicular neogenesis into three words and you get:

  • Neo: New
  • Follicular: Refers to hair unit of growth
  • Genesis: A biblical term suggesting source, creation, derivation of something, birth, the beginning or origin

Put them all together and you get a new technology — or at least the name of one. Sounds like a good name to me. There are many people working on technologies that will create new hair follicles from the source (possibly the stem cells that generate hair follicles) once we learn to control the stem cells. The success of forcing stem cells to create hair follicles is about 10% now with a great deal of randomness to the process. I have heard the same estimates of time (10 years) for the resolution of things related to cloning, etc…

Your first question has a problem with it. If the hair is thinning in the back, then there is genetic balding possibly in other areas as well. Thinning either means miniaturization of the hairs or loss of density. Propecia works better in decreasing the miniaturization (increasing the thickness of the hair shafts) than it does with restoring the density (growing new hair). I do not believe that Propecia (finasteride) will prevent the loss of either hair shaft thickness or loss of density, but I do believe that it will prolong the period of loss for years.

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Sexual Side Effects Months After Propecia Use – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

Last year I had a hair transplant done at the New Age Hair Clinic and along with that the recommendation of taking propecia to help prolongue losing more hair, which makes sense obviously. Propecia really worked for me and I was pleased with its results combined with the transplant, however, after six months I noticed those sexual side-effects I had been told about. I never worried about it because it had such a small percentage tagged to it so I figured I wouldn’t have to. But now I have no sex drive and difficulty achieving and maintaining erection…but others as well. There is no orgasm for me anymore and most of the time a loss of ejaculate and when something does come out, it’s almost like a gel… My penis has lost feeling and almost in a way “detached” shall we say from the body because i really can’t feel it that much anymore. This worries me because I have been off the drug for six weeks now. My real question is have you ever seen these adverse effects permanent in a patient? It’s really starting to scare and depress me… I figured it would take a few days to get out of my system and once I saw it was only temporary go back on it because I don’t want to lose what I worked at with the transplant, as is what my doctor recommended, but the effects seem worse now than when I was on it… Can you help me at all? Should I go back to using it or keep waiting till I see improvement and then perhaps use it? I would really appreciate any information you can give me… The dilemma of choosing between hair and sex drive is a hard one being I am only 23… I want both. My doctor can’t help me at all so maybe you can, I’m hoping. Also, have you ever heard of a hair-loss product called scalp-med? I saw it on tv and checked out their website at scalpmed.com and it looked good because they say no sexual side-effects because it’s applied directly to the scalp, but it all seems too good to be true so I was wondering if you knew if it was legitimate or not. Thanks for taking the time to read and respond to this. I appreciate it.

Propecia, hair loss, penis detachment, orgasm, ejaculation… OH MY! From the tone of your writing, I can see that you are very concerned about hair loss and sex. Worry not, for I would say you are like most men. If you obsess over something like your hair loss and image, you can produce impotence. Your sexual problems might be related to the Propecia use, but the problem should go away soon after discontinuing Propecia. Propecia certainly does not stay in your system for 6 weeks after stopping its use. Your sexual problems may be psychological or you may have an underlying medical condition that you have not been diagnosed with. If it continues to be a problem you should see a medical doctor for a formal evaluation. With respect to Scalpmed, there are numerous posts on the product here.

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Thinning Runways an Indicator of Further Baldness? – Hair Loss Information by Dr. William Rassman

RunwayHello,

Thanks very much for answering my previous question. I thought of another question that I can’t find the answer to in previous posts. I know from your posts that recession at the temples and some recession in the frontal hairline is the sign of a “mature” hairline and will not necessarily lead to genetic baldness. Is slight thinning in the “runways” along the sides of the head or on the crown always an indicator of further baldness to come, or can thinning happen in these places as part of a normal mature hair pattern, without leading to further baldness?

Thinning in the runways or anywhere in the crown usually reflects miniaturized hairs. This is often the precursor for balding. Sorry if you don’t like that answer. Few do!