Author: Dr. William Rassman

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Hair Loss InformationHas Low Testosterone Kept My Hair? – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I’m a 28 year old male, and I’ve had low testosterone for years, and the associated symptoms (low sex drive, depression, anxiety, erectile problems). My latest levels are 294ng/dL Testosterone, and 6.7pg/mL Free Testosterone.

About two weeks ago I went on 5mg Androgel, and have started to feel a little better (still have a long way to go). However, I’m really worried about triggering hair loss. I’ve heard that transdermal testosterone can cause high DHT levels.

My hairline has moved up gradually in recent years, and I have thinning at the upper temples, which is visible under bathroom lighting. I’m probably a NW2, most people would say I have a full head of hair still. Could this testosterone replacement therapy cause me to lose hair faster? I’m thinking of possibly going on Propecia as a pre-emptive measure. Have I kept my hair just because of the low T level? What are your thoughts?

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Before you jump into a lifetime course of Propecia, have your hair mapped out for miniaturization to find out if you have genetic hair loss in process now. If you do not, the addition of testosterone should not impact normal non-balding hair. But if you do have genetic balding characterized and diagnosed with this mapping process for miniaturization, then Propecia would be a good idea for you. I always like to know what I am treating before I recommend a lifetime worth of drugs. If you are asking me if your low testosterone has helped you keep your hair, well if you have genetic balding it might have helped a little.

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Hair Loss InformationFinasteride Questions – Hair Loss Information – Balding Blog

I am a 25-year-old male that started on Proscar three weeks ago (I split the pills into fifths). My hairline has is receding, and over the past couple of years, the hair on the top of my head has gradually become noticeably thinner than the hair on the sides and back, although people that look at my hair think it is thick. It obvious the top is thinning when you run your hands through it though.

I have three questions:

1.) In just these three weeks on Proscar, I think I have noticed my hairline retreating a little more. Is this most likely the normal accelerated shedding process that takes place at first, to be replaced by newer, thicker hair?

2.) Given my age, what are the prospects that the hair on top will thicken up like the sides?

3.) I am a little concerned about the hormonal implications of the drug. In a previous post you mentioned that there is a spike in testosterone and estrogen when starting the drug, but the body adapts. My question is first, how soon for the body to adapt, and secondly, with respect to the adaptation, do the horomone levels return to normal or does the body merely adjust. I am worried about the sexual side effects, and also about having unnatural hormone levels in my body for who knows how many years.

Thank you.

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Finasteride should not produce accelerated loss, though it has been reported by some of the readers of this site. When it works, it works better at restoring hair in the back of the head than on the front, but I believe that it sill slow down hair loss everywhere it is occuring in most men. Hormone changes (based upon patient reports only) usually return to normal levels in just a couple of months. If you do not develop sexual side effects in the first few weeks, I would expect none over time.

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Hair Loss InformationHair Transplant Failure? – Hair Loss Information – Balding Blog

Dear Doctor Rassman,

I live in Turkey.I had a hair transplant about six months a go. 2900-3000 grafts were planted on my head (mostly on middle and vertex area, some in the front). The planted hair on the front and middle area of my head has grown not so badly,and now (after six months) the front and middle areas appearance is not bad. But, my vertex area is still empty. The interesting fact is that the planted hair in the vertex area had been seen to grow satisfactorily until the fifth month after transplantation. But, between the fifth and sixth months most of the planted hair on the vertex area has fallen out. Is it normal that after six months the planted hair has fallen out? My doctor could not make me a satisfactory explanation and advised to wait more. I am depressed.

Sincerely yours

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Once the hair transplants grow, they should not fall out. Are you sure that they were growing at some point and not just stubble from the original procedure?

The vertex of the head is a big area and many times the amount of hair put into the vertex is dwarfed by the size of the area. Transplants placed into the front and top will layer, such that coverage is easier to achieve. The vertex (crown) has a change in hair direction so layering is not easily accomplished. Be sure that what you are looking at is now just the effects of the swirl and the large area, but try to have the actual hairs counted.

As you are only 6 months out of the surgery, I would wait another 3 months before reacting too much to it.

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Woman With Thinning Hair After Family Tragedy – Hair Loss Information – Balding Blog

I am a 38 year old African American female. My hair started to thin after a tradgedy in the family. Now I am balding quickly. My hair has taken on a totally different texture. I’ve had the blood work down for my thyroids, which was normal. I have now noticed that I have dark spots on my scalp. What else can I do?

Thank you

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Stress can accelerate what your genes are destined to do. If thinning is in your future (genetically) then losing hair mass with stress can be expected. Reversing such changes is difficult, but Minoxidil has been shown to help in these situations. Learning to manage stress is more important that anyone wants to admit. The impact of hormones and general stress can be seen in the way the body handles wound healing, for example. See these articles for more about stress:

No surprise that the toll we pay for stress in other situations such as heart disease, diabetic management, and certainly hair loss is important to understand. The key here is to learn stress management. For those who master stress management, life is better and the individual looks and feels healthier.

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Small-Toothed Comb and Hair Loss – Hair Loss Information – Balding Blog

I use a very small toothed comb to comb my hair because it creates a better look then the large toothed combs. Can the pull that the small toothed comb creates damage my hair?

Thanks as always for your time.

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Small toothed combs tend to pull more on the knotted hair than large tooth combs. Pulling on miniaturized hair can cause it to either break or just pull out, possibly damaging the hair if the pull is repetitive.

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Mole on Scalp – Hair Loss Information – Balding Blog

I have a mole on my scalp. This mole has been frozen several times only to grow back in length and size. I had the mole surgically removed and it grew back again. I went through another episode of freezing that still proved to be of non-effect. In the mean time my scalp is itchy and feels like something is crawling under neath the surface of my scalp. I have loss halp of my hair already. I had to have my hair cut to cover up the long strains from the holes from hair falling out. What is this? P.S. When I had the surgical removal of the mole, it was tested. The results were that it was just a mole. (Female)

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Sometimes the doctor does not cut out the entire mole (assuming it is benign) so what is left behind just grows again. Some of these moles are caused by a virus, so cutting them out may not cure it, because the virus could be in the normal skin adjoining the mole (or growth). You need to go back to your doctor and get the answers to your questions. Clearly this is not something I can do on the internet.

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Is My Thinning Normal? – Hair Loss Information – Balding Blog

Dear Dr Rassman,
Firstly congratulations, seen your CV and it’s full of degrees. I am currently in the phases of completing my first BSc in Computing. I am noticing hair changes in the following way:

1. Temples & frontal hairline receding. Temples receding more than the frontal hairline.
2. Hair in the parietal part is getting thinner than the temporal and occiptial parts. Also, the frontal part (like a penninsula) is still thick.

Is this male pattern baldness? Or is it normal? I am 23, male, my father started balding at age 50. Mum’s head is full of hair. Her 3 brothers bald; and her father started balding in late 40s.

Thanks

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You can not predict the genes that you will express, so that is why you need to have good measurements made to establish the diagnosis and prognosis. I’d have no way to make an educated guess without examining your scalp for miniaturization. Please see previous blog posts regarding mature hairline for more.

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Asian Hair Transplant Patient (with Photos) – Hair Loss Information – Balding Blog

I’ve been asked via email to post photos of an Asian patient, so by request, here’s a recent patient who had two surgeries with NHI. The photos below show the “before” view and two “after” views — one with his preferred spiked hair style and the other with his hair pulled back. Please note that we only put the hair in, the patient decides the way he wants to style the hair. Personally, I like his hair combed back, but then again it is his hair, not mine.

The photo on the left is before, the middle and right photos are after two procedures totalling 3,388 grafts. Click the photos to enlarge.




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Can I Sweat After A Hair Transplant? – Hair Loss Information – Balding Blog

Hello Doc,
This is a wonderful service that you provide here. I applaud your commitment and dedication. I am scheduled for my first HT and am nervous after reading some web postings on a site that indicates HT’s are not the answer. Pretty scary stuff…See: home1.gte.net/dschrode/newtransplant-tales.htm

Anyway, I live in the Dominican Republic and have decided to work with Dr. Alba Reyes. Currently I am in the states and wanted to ask you a couple of questions.

Does the recipient area always have to be shaved?
Will Avodart provide the same protection as proscar for shock prevention?
How long until I can sweat as I live in a warm enviroment and go to the beach often (I wear a hat)?

Thank you again and I look forward to your reply.

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Reading the horror stories are part of good research. They are the exception to the general work being done now, though. A good doctor is your assurance that these terrible things will not happen to you, but unfortunately there are still some of those doctors out there today. As I like to tell my patients, do your research! Much of this research is covered in this site in many ways (see The Truth About Cheap Hair Transplants).

To answer your questions —

  1. The recipient area where the strip is harvested does need to be shaved. Once the strip is harvested, the longer hair area above and below are brought together so that no shaved area should be seen.
  2. Avodart (dutasteride) will provide the same protection from shock loss as Propecia/Proscar (finasteride).
  3. You can sweat after the first few days and even run a marathon after 5 days if you have good post operative care and washing.

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Hair Loss InformationMuscleMilk and Hair Loss? – Hair Loss Information – Balding Blog

Hello Dr. Rassman,
I saw in your response to a question about a GNC Mega Man product that it contained DHEA which can cause or accelerate hairloss. Could you please tell me if the supplement MuscleMilk made by CytoSport contains this chemical or any other chemicals which are known to cause or increase hairloss? Thank you very much!

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MuscleMilkMuscle Milk appears to be a whey based product. Whatever the cow ate, the hormones that the cow produces and the hormones that the diary farmer gave the cow will appear in the milk of the cow and in the whey based products that make up many of the nutritional supplements that ‘fitness’ focused individuals take. The use of growth hormones in some dairy cows will be in the milk and the whey (whey is a byproduct of cheese manufacturing — a concentrated milk byproduct). Even without added steroids, these products may have some steroid-like impact (see: LE Magazine). You may have risk here, but as I am not an expert in the use of these supplements, I am hesitant to make a statement about the things that are either naturally in the supplements from the whey itself, or added by those that manufacture such products as GNC Mega Men or Muscle Milk.