Author: Dr. William Rassman

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Cymbalta, Atenolol, and Female Hair Loss – Hair Loss Information by Dr. William Rassman

Hi I’m a 24 yr old female, with some questions I would like to ask you about my hair that is thinning. About 10 months ago I was getting a haircut and the stylist had mentioned to me that my hair was thinning a lil at the crown of my head…It wasn’t very noticable, so I didnt think anything of it, and just went on with my life…I had started taking an Anti-depresent called Cymbalta, and a high blood pressure medicine called Atenolol, at around that time as well. Well in january of 2006 I noticed that my front part of my scalp, maybe from my hairline & back 2 inches was very thin. I couldn’t understand why, because it was an over nite thing, I would have noticed if my hair was thin, and i even look back at christmas pics from the month before and my hair was like usual, so I know it was a very immidiate thing. I had disconntinued my anti-depressent and blood pressure meds, like 1-2 months earlier, because I could no longer afford health insurance, so I had been med free for about a month when I noticed the thinning frontline. its now almost 3 months later and im starting to think the thinning is getting worse in this reigion only…i started to take folic acid and a prenatal pill, because I read folic acid helps with re-growth, but I dont know what to do..I cant see a Dr, for another month untill govt health insurance kicks in, but in the meantime what should I do??..i know I had blood test run before about 8 months ago checking for throid disease, but it came back normal, so could something medical cause this..because no one in my family has a balding problem, my mom is 47 and just started to thin, and thats only because she used many products in her hair for so many years. do you think my hair will grow back or get worse?…I heard it takes about 3 months for the hair growing process to start showing, but its been about that much time and i dont see any improvments…Ive looked through the internet and read some scary stuff that can cause hairloss…but im so down about this, becuase i am soooo young, and I dont know why my hair is falling out…please help me if you could, thanks alot and have a wonderful day.

You are in need of a good doctor and there is no substitute for what the doctor does. Problems like yours can not be managed well by a doctor through the internet, nor can you manage depression and high blood pressure combined with hair loss by yourself. Look through the many posts in this blog on female hair loss to educate yourself and then get a good doctor.

Balding Forum - Hair Loss Discussion

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Hair Coloring and Scar Visibility After Transplantation? – Hair Loss Information by Dr. William Rassman

Hi-
Over the past 3+ years, I’ve had 3 transplant surgeries and I’m tremendously happy with the results. Some years ago, I used to occasionally double process my hair blond (it’s dark brown naturally) and I liked the results. Is this still a possibiliy or is it to risky for my hair. Will it make the scars more visible? Needless to say, I wouldn’t want to damage my transplants in any way. Many thanks

Colored HairYour hair is your hair and a hair transplant, once done correctly, means you can dye it, cut it, perm it, spike it, etc. The beauty of a good hair transplant is that it is just like you never had lost your hair. As for the scars, I couldn’t tell you for sure, as there are a number of factors such as width/length of your scars (I am assuming you had strip procedures) and the length of your hair. However, I do not think the scar visibility will be an issue with processing your hair blonde, but the only way to know for sure is to try it once. Generally, the only time the scar has a chance of being seen is when the hair is cut way too short (like crew-cut length).

Balding Forum - Hair Loss Discussion

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I Don’t Like Having a Mature Hairline – Hair Loss Information by Dr. William Rassman

I am 23 and notice I have a mature hairline. its a 2 on the scale. I dont like my hairline though and would like to get the hair around my temples back. Is there any procedure that can fix this? If so please tell me

I have transplanted the juvenile hairline back in some men, but I do so only under certain conditions:

  1. There is no evidence of advanced balding either on examination or in the family line.
  2. I want to get to know the patient and he must be mature and able to understand the ‘worst case’ scenario that could happen (in your age the worst case thing is advanced balding).
  3. I look at the value of the various elements of hair quality, skin color, hair density, and overall donor supply characteristics and connect it with potential demand considerations.

I have clearly done this more than once, but in my present memory the only ones I have done under 25 years old were professional actors, television soap opera sexy men, or models whose livelihood depends upon that ‘youthful’ look.

Balding Forum - Hair Loss Discussion

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I Need My Hair To Be Colored… – Hair Loss Information by Dr. William Rassman

I dyed my hair blackey blue about a month ago and it is in quite a dry condition. However the colour is fading there are now brown patches(my natural colour) becuase each time I straigthen my hair (which has been reduced to about twice a week)strips the colour slightly. This upsets me as my hair looks a mess and I do not know what to do. I have a school prom in three weeks time and would love my hair to look nice for it. However I do not really want to dye my hair again as the damage done to it will be awful and I do not know whether it is worth taking the risk again as the starightners will probably just strip the colour. Please help! Also my hair is starting to snap and becoming thin! Please, please get back to me!I will be grateful forever! xx

Sounds like you need the help of a good hair stylist, not a doctor. Have fun at prom.

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Skip Taking Propecia a Couple Days a Week To Make Supply Last Longer? – Hair Loss Information by Dr. William Rassman

Hi Doctor. So if I skip taking my morning Propecia a couple times a week, I shouldn’t be at risk of making the Propecia ineffective right? I just want to see if I can make this 30 day supply last maybe 38-40 days. I know the Propecia is working for me since I stopped seeing hair falling out and landing on my shoulders, but I want to make this stuff last as long as possible. Thanks!!!

Propecia has a half life of 4-6 hours, which means that it will be effectively out of your body in a day. Prolonging the time between doses will just guarantee that the drug will be less effective for you.

Balding Forum - Hair Loss Discussion

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Hairline Regrew with Meds – Hair Loss Information by Dr. William Rassman

I’m a 27 year old with recession to a NW2 pattern, but thinning over a NW5 area. I’ve been using Propecia, Minoxidil and Spiro for roughly 1 year, and I’m noticing pigmented hair starting to sprout around my original NW1 hairline. However, the density on the top of my head appears to have gotten slightly worse. Maybe it’s a shed, I don’t know.

With success continuing on the hairline regrowth standpoint, do you think the thinning on top is just taking longer to grow in — or could it be possible I’ll end up with a NW1 hairline, but with a thin NW5 pattern? I understand that hairlines usually come back in (if at all) AFTER the crown and vertex have filled in…? It just seems odd to me to be having regrowth success in the one area people have a lot of trouble with, but be lagging behind in the areas that are meant to respond best to treatments.

My father has a NW4 recession/NW6 thinning pattern at 55, and my hair loss seems to be following the same pace and pattern as his did at my age. In the scenario that I don’t achieve desirable density on treatments in the next 12 months, is FUE an option to fill in the density of the thinning pattern? On that same note, if I were to have FUE done in the next 1-2 years, would it still be possible to pursuse Hair Multiplication when it became available? I can’t remember where I read it, but someone mentioned that previous HT patients would not be suitable candidates for HM for some reason. Or maybe I misunderstood/misread…?

Call it vanity or risk, but I’d rather have decent hair in my 20s and 30s, and the confidence that goes with it, and worry about my 40s onward if/when I get to them. What can I do NOW to achieve my goals, even if they’re temporary fixes until the next great drugs/procedures come along?

Thanks

Norwood Class 2

Norwood Class 1

I am very impressed with your questions, particularly the way you distinguish the difference between the way to classify recession and thinning patterns of hair loss. You are correct to assume that the impact of medication is different between the front and the top/back of your head. I do not understand why the treatments you are having are impacting the juvenile hairline (Norwood Class 2 pattern moving to a Norwood Class 1 pattern).

With regard to filling in a thinning pattern — that would depend upon many things. There are many doctors who would gladly sell you hair to fill in a thinning pattern, but there is always the really important question to ask: Will the gain off-set any loss from the transplant? Many unscrupulous doctors would like to tell you that this is preventive hair transplantation to stop the balding. When I hear that statemen (preventive hair transplants) I know that the doctor has ethical problems and $$$ are getting in the way of his/her judgment for good patient care. To get a proper answer to that question, you MUST find an ethical doctor who will answer it from your perspective. Judging that you are focusing upon a Norwood Class 1 pattern, I might think that you are overly worried. If you choose to have an FUE or a conventional strip procedure, that is an independent decision to having a transplant in the first place.

Any transplant you *or any person having them) might have will not interfere with the advances in hair cloning or hair multiplication that may come up in the future. You are worried about what you will look like in 13 years, but I would ask you to have you scalp mapped for miniaturization and if you really are thinning in the patterns you discussed above, then the drug of choice is Propecia/finasteride and that could do more to fix the thinning problem than any hair transplant you can do.

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My Crown Looks Like It Is Thinning – Hair Loss Information by Dr. William Rassman

Hi, I’m a 23 year old asian male with a norwood 2 hair pattern, I have been since I was 19. I was born with less hair on the crown than most, there’s a small hole there. I was wondering if an HT can cover that up and if it was safe to do so in say 2 years time? Is it also possible that I’m more ‘prone’ to hairloss because of it? I also wondered whether it was alright to have an HT to straighten the hairline? It’s only for cosmetic reasons I guess but I feel quite stupid with my hairline so I’m forced to put my hair out in the front. Thanks

If your hair is very straight and strong, what you are describing is the swirl in the back of your head. In Asians with strong, straight hair, the swirl will show. The swirl is created by the change in direction of the hair in front to the sides and behind it. Like water going down the drain, the swirl emphasized the hair flow and the eye can follow the hair shaft to the scalp. In most Asians, the light skin and dark hair make the swirl area look balding, when it is not actually going bald. Here’s a photo of the crown of our own Dr. Jae Pak, M.D. He is not balding in the crown, but what looks like balding is the result of (1) Asian straight hair that does little to cover the crown, (2) black hair on pale skin, and (3) low density hair, typical of Asians. In some Asians with hair that stands up on its own (like the spiked hair style that is popular today), there is the perception of thinning hair in the front, when that is actually not the case at all. The most difficult areas to get to be full looking therefore are the crown area (particularly in the center) and the frontal hairline where the light penetrates into the hair and the scalp (and when the skin is light and the hair is dark, the background lights up). As you may ascertain from what I have said here, there is a real ‘art’ to doing hair transplants, because the surgeon must understand the blend in color and contrast, hair thickness (like the brush strokes of a painting), the waviness of the hair, and the number of hairs available to fill in the balding area being transplanted. Like a portrait painting, you need to have a good artist doing it for it to look real, that is, unless you like the Picasso look.

If you wish to fill in the crown and make it fuller, you need to find a good hair transplant surgeon, one that is ethical and will be able to meet your goals without risking you to hair loss or deformities created by poor planning.

Anyway, here’s a photo of Dr. Pak’s crown, as mentioned above. Click the photo to enlarge.

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ScalpMed and Hair Growth Rate – Hair Loss Information by Dr. William Rassman

Hello Dr. William Rassman. I have heard that scalpmed supposedly thickens your hair but what I want to know is does it speed up the rate of hair growth as well? For example if my hair normally grows a half an inch in a month, could scalpmed make it grow an inch or more in a month?

Nope. The ScalpMed people are promoting their product very heavily and the claims that seem to be coming through internet chatter is unsubstantiated. There is nothing in that product that can make hair grow faster, because in fact, there is no drug anywhere that will make hair grow faster.

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Shakespeare’s Hair Loss – Hair Loss Information by Dr. William Rassman

How did 16th Century playwright William Shakespeare lose his hair? I’m sure you find yourself pondering that question every waking day of your life. Well, perhaps not. At any rate, I stumbled upon this year and a half old article that has an interesting take on why Shakespeare possibly lost his hair. The title of the article gives away the punchline, but enjoy…

Ouch.

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Shedding Hairs Get Thin At Root – Hair Loss Information by Dr. William Rassman

Hi Doc, I’ve been on propecia for 4+ months. Ive started the infamous sheds about a week ago. I would say 90% of the hairs I shed are extremely thin. The ones that look like they are about dead. What’s weird about it, and what worries me, is that so many of the shed hairs seem like it thins out at the end (closer to the root). What trips me out is that my hair is about 4 inches long, so I get to see the trend of hair thickness from before propecia to now. And the fact that it looks like my shed hairs gets thinner at the roots gets me a little paranoid. Are shed hairs, whether affected by MPB or not, usually meant to thin at the end? Or is this a classic sign of MPB attacking my hair? Thanks Doctor!

What you are seeing is the shedding of the miniaturized hairs. Some physicians believe that the shedding impacts these miniaturized hair as they are forced into the hair cycling. The hair on the scalp follows three life cycles:

  1. Anagen
  2. Telogen
  3. Catagen

Once the hair falls out, I would expect that it would be replaced by a new, stronger hair coming into its Anogen phase.