Dr. William Rassman – Page 1786

June 23, 2006

Tangled Hair From Styling Products Used to Cover Bald Spot – Hair Loss Information – Balding Blog

Dear Dr. Rassman,
First of all thank you for caring enough about all our concerns to have this blog. I’m writing to ask you about tangled hair. I have kept the top of my hair long for many years now to comb back and cover the balding crown but my hair is coarse and somewhat curly. For some reason when I shampooed I began being unable to wash out all the build up of gel and hairspray and it was difficult to comb through. At the beginning I used to force the issue and would pull out lots of hair. Now I’m much more gentle but its still frustrating to not be able to comb through. I’m afraid I’m damaging my hair more and more. What would you recommend? Any shampoos that could clean this build up? What about detanglers?I haven’t fared better with them either. On another note, several years ago I had a transplant which I believ was good. But I now am planning to have another and am certain you or your staff at NHI will do it. I received your materials in the mail (Thank you), I’ve heard about your excellent reputation from other sources also.I like that you’re not ONLY interested in the $$$ but you have a passion in an artistic sense as well as a humanitarian love. God bless you and I look forward to hearing from you. Let me see you! A round trip from Las Vegas is very inexpensive now as the summer season comes into swing.

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I’d see a good hair stylist with experience in African hair (they understand tangling and how to untangle the hair without pulling it out). It sounds like you need to get styling control on what you use and how you use it. Traction alopecia can occur with pulling on normal hair, but imagine if you can lose normal hair by pulling on it — what would happen to weak hair that is miniaturized from the genetic balding process? Bad news.

Visit me in Los Angeles if you want a hands-on examination. I will map your scalp for genetic hair loss and give you a glimpse into what will happen to you in the future (by developing a Master Plan for you).

June 22, 2006

I Lose Hair Transplant Grafts in My Sleep – Hair Loss Information – Balding Blog

I had a hair transplant last night and this morning I found grafts on my finger nails along with blood clots. My transplant surgeon told me not to worry about them after I said that there were about a dozen grafts that I could count. He said that he did not have to see me. What would you do for me in this situation?

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Recliner I had a patient who picked his head in his sleep, just like you seemed to do. Knowing this, I had his wife make him wear ski gloves in his sleep the rest of that week. I did view the patient, but as the grafts had been already out of his body for hours, there was no point to put them back as they would not have grown. The grafts on this patient came from the crown, where he had 1500 grafts placed by me. He had about 10 grafts lost and they did not appear to be significant, considering the large number that we placed there.

I had another patient leave the office after the surgery and from the edge of the limo, he scraped the scalp removing about 150 grafts in the car’s gutter. We quickly retrieved them and washed the grafts with saline and put them right back into his head. Fortunately, the time out of the body and into the saline was only a minute or two. The grafts grew, but I think that we all had anxiety over this one.

I do not use bandages to cover the recipient site and I tell my patients the importance of keeping their hands off of the head and recipient area. I generally like a person to use a recliner chair for the first and second night, to keep the head elevated and make it more difficult to scratch the recipient area when they sleep. I have not had a problem like the ones I spoke about for over 10 years.

June 22, 2006

I Want Body Hair Transplants – Hair Loss Information – Balding Blog

Dr. Rassman,

I have been reading quite a bit about BHT recently, you have done a remarkable job on my hair but I have very little donor area left. Have you considered adding this procedure as it would help many who need additional donor hair, I myself could still use more hair to help fill in old plug donor areas that still bother me. It would be nice to cut my hair to a short length and not worry about the old harvested areas. I ask this because of my respect for your abilities and I frankly would prefer to only have you perform any future procedures.

Thanks

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I know how you feel. You just want to be normal again. The problem is that when you have had these old type of hair transplants, you may have given up the ability to be completely normal. Keeping your hair longer and use styling to augment any problems in your look may be critical to being as normal looking as possible. Body hair transplants are a general waste of money with poor results that can be anticipated.

The doctor’s site that you included in your email shows that he has very little experience in this field. Perhaps he just does not know the information that I have covered in this blog many times. I have discussed this in my piece, The Truth About Cheap Hair Transplants, and I would recommend that you read this carefully. As you are a former patient of mine, just come in and let’s take another look to see what can be done, if anything. You know that I won’t do anything just to get into your wallet.

June 22, 2006

Born Without Pubic Hair! – Hair Loss Information by Dr. William Rassman

I was born without pubic or underarm hair, I have eyebrows but they never grow long. The hair on my head is thick and lustrous – other body hair sparse. What causes this?

There are genetic patterns that each of us inherit associated with both our heritage and our ancestry. American Indians, like their Asian ancestors, have very little body or facial hair. Many Asians do not have pubic or under arm hair. We have transplanted many Asian women who want pubic hair, but it will grow like your head hair, a bit more curly, so you will have to cut it to keep it short.

For your eyebrows, it sounds like you have very short hair cycles there, which means that the eyebrow hair may only be there for a very short time when it falls out and eventually gets replaced by other hairs. When this happens, the length is usually very short and the growth rate is always slow in the eyebrow, possibly slower on you then in many other people of similar ethnic background.

June 22, 2006

I Want to Sue My Dermatologist, Part 2 – Balding Blog

Dr. Rassman, I’m the poster of “I Want to Sue My Dermatologist” and I think you misinterpreted a few things in the post. First off, I’m already 18 and have already been taking propecia for 2 and a half months, and yet the problem seems to be getting worse. I would also like to mentione that when I saw my first dermatologist, I was 15 years old and walked in to the office looking for a treatment, not a diagnosis. I was very aware that I was losing my hair and wanted to stop it from progressing, however this first dermatologist denied that I was actually balding, thus my reason for wanting to sue would be an incorrect diagnosis. You yourself said that you would prescribe propecia to someone who was balding under age 18, which my (initial) dermatologist did not do.

Now I am 18, and the (new) doctor I saw 2 and a half months ago indeed confirmed that I was balding, thus prescribing propecia. I know it can take months to have an effect, but it has already gotten much worse than it was even as little as 2 weeks ago. I want to sue my initial dermatologist under the grounds of mis-diagnosis (thus causing severe psychological damage) in order to pay for a hair transplant, so I won’t need to walk around walk around like this any longer.
As far as needing a final hair loss pattern, I already have that- my brother… my 22 year old brother. His situation is nearly identical to mine and his hairline along with thinning on the top are the same that I am experiencing.

Now for the anxiety/depression. I have had a history of therapists that have done nothing, prescriptions that were effective as sugar pills, and all that jazz. Problem is, I’m a science-type person. My brain can’t go a second without making a qualitative analysis of my condition. What do I mean by this? I mean to say that any attempt to “make my problem better” doesn’t work at “making my problem better” because I’m still losing my hair. There is no such thing as coping, but rather deceit, tomfoolery, a jedi mind-trick. The only way I will get out of this is to get what I want. End of story.

What I ask of you is to inform me whether or not I honesty could win a lawsuit on this to afford my transplant, because I don’t really know the law when it comes to medical issues.

Law The basic grounds for a successful lawsuit against a doctor must show:

Damage as a result of the doctors action (inaction is much more difficult and in your case in particular it would be an uphill battle)
Not meeting the standard of care (it might be successfully argued that the experience in genetic hair loss for the 15 year old is NOT prescribing Propecia and this may be a reasonable standard for most doctors).

Doctors generally prevail most of the time in any malpractice action unless there would be deforming or life threatening situations caused by the doctor’s action.

To take a trial before a jury, you would have to get the jury’s sympathy and understanding. They would have to look at you (at the 15 year old young man you were) and ask if you were their child, what would they have done. It would take a masterful lawyer’s argument to prevail in such a situation, so to answer your question in a nicely bullet-pointed way –

I do not think that you would find any lawyer willing to take this case on with a contingency fee
You would probably not win
And if you did win, the damages would be very small

As far is your continued hair loss, wait this out for a few months and hopefully you will see some benefits of taking Propecia at this time.

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June 22, 2006

Taking Propecia For Over 6 Years – Hair Loss Information by Dr. William Rassman

I recently made a trip to my doc and he told me that he has known people that have been on propecia since it came out back in 97, and they are still on it and they still have their hair today. Can this be true, people taking it for over 6 years and it still being beneficial? I don’t think my doctor would lie, at least I hope not. What do you think. How come it only works for some patients and not for others? From your experience, those patients that have been on propecia for more than 6 years, have they retained all their hair?

Thank-you for answering my questions

Propecia will continue to work for as long as you take it. There is no guarantee that it will override the progressive nature of hair loss completely, but it will continue to help as long as you take it. If works better on some people than others, that is just the way it is. We are all different and we respond to our balding genetics differently.

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June 22, 2006

Thinning Very Slowly for Over 13 Years – Hair Loss Information by Dr. William Rassman

I’m 34 with hair only thinning in the front. I first started noticing the thinning at around 21 years. My thinning has been really slow, but lately, in the front, I noticed more than usual. Is this slow, then fast pattern typical for hair loss? I read on some of your posts that loss typically plateaus around my age. Just wondering what I should expect in the future. Thanks for your help.

Many times a person may lose much of their hair without knowing that they have a problem. Blondes or curly hair people with light hair color or darker skin can lose 70-80% of their hair before they note the problem. What you have been calling thinning over the past 13 years, may be worse than you know. A Master Plan can be put together with a good doctor. Your call, of course, because you have control over it.

June 21, 2006

Proscar Warning Label and Possible Birth Defects – Hair Loss Information – Balding Blog

Dr. Rassman,

Thank you for continually answering questions on this forum. I am amazed how I routinely learn about hairloss by just reading the answers you post in response to other readers.

My question is about proscar. I’ve decided to switch to proscar over propecia because quite frankly, it is much more affordable to buy and split proscar into fours. I read in the past on this forum how you stated that Merck removed the warning about possibly passing Finasteride to a female through semen. My information leavelet that came with the Proscar had the following on it (women should not) “be exposed to the drug through sexual contact with a man taking Proscar”. It suggests that you should use a latex condom during sex. Does this mean that you should not try to have children while taking Proscar/Propecia? Does the fact that the dosage in split Proscar/Propecia is significantly lower than that of regular Proscar eliminate or reduce the risk for “birth defects” in a baby’s sex organs?

Also what you heard or know about a product advertised on TV by the name of Procede? They claim it is once every three months treatment.

Thank You

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Middlesex What is known about finasteride is that if a baby in the womb is exposed to this drug (dosage is not understood) that the development of their sex organs and possibly the way their brain is wired (female vs male) may be influenced. Genital abnormalities can be created by the influence of this drug in the first trimester of pregnancy. These abnormalities, when associated with finasteride, had been observed when the natural form of finasteride was ingested in very, very large doses (based on the research of a mountain village in the Dominican Republic).

The warning by the drug company reflects that knowledge and that a risk may be present. These are clearly warnings that are meant to protect the drug company, but to my knowledge, even with the widespread use of Propecia in young men (over a million men) there are no reports that I know of that show that there is a link between women who got pregnant with their men on Propecia and the creation of genital abnormalities in any of their children. I have one of my sons on Propecia and when he is ready for a family, I will not recommend that he change his usage of this medication. He likes the hair that is now strong in the frontal area and was thinning before he started to use it.

A little bit of history (though having little to do with your exact question) — One of the untold stories in medicine are about the hermaphrodite whose sex is misdiagnosed at birth. The absence of a penis may cause a baby to be classified as female or the presence of a large clitoris, may cause the baby to be classified as male. These children are then raised according to the original sex designations from the birthing room. These situations lead to great tragedy. For those of you wanting to learn more about hermaphrodites, I suggest that you Google the term hermaphrodite. Also, I have recently read a best selling novel titled Middlesex by Jeffrey Eugenides (a Pulitizer Prize winning epic that follows many generations in a family that had a hermaphrodite inheritance pattern in the family line). It puts a face on this tragedy and is a recommended read.

With regard to Procede, please see past responses here.

June 21, 2006

Hair Loss InformationIs Hair Always Uniform Over the Head of a Non-Balding Person? – Hair Loss Information – Balding Blog

I’m a 24 year old male, and I have a family history of balding. I have close-cropped hair, and I noticed that I can see a bit more scalp in the “runways” along the sides of my head and around the crown than I can see on the top of my head. The individual hairs in the thinner areas do not actually seem to be miniaturized compared to the hairs in the thicker areas, which is what confuses me. It looks like there are just fewer overall hair follicles in the thinner areas. It may have always looked like this and I never noticed, since I never thought to check until my brother started balding. My front hairline is not receding at all. Could this be a normal (non-balding) hair pattern, or is hair always completely uniform over the entire head on a non-balding person?

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There are two independent measurements that will point to what is going on. There is the actual hair counts by area and miniaturization by area. Both of these metrics can be obtained when you map out your hair for miniaturization. I do not always do hair counts in all of the areas I map, but in your case, this might be worthwhile.

Genetic hair loss causes both miniaturization (thought to be a precursor of balding, but not always) and direct reduction of hair counts without going through the miniaturization process. What you are viewing should have numbers put to it so that the diagnosis is in hand answering the basic question: Do you have genetic balding going on?

Most people will have some variations of densities by the part of the scalp, and these differences do have some consistency in the population. Hair along the sides is often less dense than hair in the very back of the head, for example. Yesterday however, I met a man who had just the reverse — a higher density on the sides, less in the very back. Good baselines are critical to understanding your hair loss, and good measurements in the hands of a good doctor will reveal that information for you.

June 21, 2006

Propecia’s Impact on the Liver – Hair Loss Information – Balding Blog

Dr. Rassman,

I am an old patient of NHI (got HT in July, 2003). I have been on Propecia (or the generic equivalent of it made by Cipla, India) since June, 2003.
However, something had me worried recently. Please take a look at the following data –

Date Propecia Started – 6/2003

Date of Test – 1/8/2004 ALT – 53 (Propecia Daily)
Date of Test – 1/6/2006 ALT – 56 AST – 33 (4 times a week)
Date of Test – 3/8/2006 ALT – 47 AST – 29 (4 times a week, none before 2 days of test)
Date of Test – 5/21/2006 – CT-Scan – Fatty infiltration of Liver

What I gather from my Doctor is elevated ALT / AST and fatty liver is somewhat common. Though it makes me think Propecia has something to do with it.

At the same time, after making significant investment after two HT surgeries — and obtaining wonderful results – I’ll be sad to see my hair go! But if it comes between liver (or any other organ) and hair — I know what I will choose! I do not smoke, drink very occassionally and always moderate about it (was a heavy drinker in my 20s but!), has a healthy lifestyle (workout 3-4 times a week, no significant stress etc).

Can you shed some light on (long-term) impact of Propecia on Liver? I read about the “3-page report” Merck sent to you on Propecia’s effect on Liver. Can you share it with me so I can take it to my Doctor? All my research indicates that there’s nothing to be seriously worried about either fatty liver or elevated ALT — but I’m worried how this will impact my health in the long term (say, 10 years from now). I’m giving it a serious thought to either reduce the dosage (2-3 times a week) or totally stop it.

Let me tell you why I got CT-Scan done. I recently experienced some (right-sided) abdominal pain (possibly from Epididymitis / spasm caused by heavy lifting) that also radiated to my testicles and lower back. I got tested for blood, testicles, urine etc. several times – but there was nothing else wrong. So the Doctor ordered CT-SCAN and all they found was fatty liver. As you can see, I have a high level of ALT from Jan 2004 — and never experienced something similar; so the pain might be from weight lifting as the doctor(s) have suggested.

I will be interested to hear your opinion. Please let me know if you want me to schedule a visit – I will be more than happy to see you.

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To my knowledge, finasteride (Propecia) does not have any adverse effects on the liver. Your liver enzyme values seem within normal limits and it can vary day to day and month to month and also by different lab techniques. It can also be affected by strenuous exercise like weight lifting and drinking alcohol. Fatty liver can also be a variation of the normal state (depending upon the amount of fatty infiltration), but it can also be seen in alcoholics, various forms of hepatitis, and other medical conditions. It seems you are concerned about your lab results and your medical diagnostic tests. You should definitely seek the advice of the doctor who ordered these tests. Even as a former patient, I do not hold myself out to be an expert in every facit of medicine today and use experts to help me manage difficult medical problems or even problems like yours which may not be clinically significant.

BaldingBlog is here as a general education forum and not meant to diagnose individual problems. I can only offer you my opinion that Propecia does not have adverse effects on the liver, but the reverse is important to those people with significant liver dysfunction (does not appear to be you) who may have to reduce the dose of Propecia, because the liver will not break it down fast enough. If you elect to reduce the dose, take a half pill a day rather than alternate days, because the half life of the drug is 4 hours and by the end of the first day, the drug is essentially gone from the blood stream.

As a patient of mine, come pay me a visit and I can expand upon these issues if you like.