Author: Dr. William Rassman

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Telogen Effluvium & Propecia – Hair Loss Information – Balding Blog

Hello, Dr.Rassman.
I have been on finasteride and minoxidil for eight months. In the first five months, they worked fine for me with shedding about ten hairs in my hand while shampooing. But after five months, shedding increased apparently and the situation seemed to suit for the Telogen Effluvium. Someone told me it was induced by finasteride and rode it out. Is it a good sign to indicate the possibility to reverse MPB? And if I experienced a Telogen Effluvium and rode it out, does it have the possibility to reoccur again?
Thanks.

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What you are describing is the acceleration of the hair loss process that normally comes in spurts. Propecia does not cause this; it generally slows it down or stops the loss. Unfortunately, the genetics in some men has a stronger influence than the DHT blocking ability of Propecia. On the other extreme end, we have had some patients completely reverse the male pattern baldness, even in the frontal area where it rarely works to reverse it.

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Calculating Future Hair Loss – Hair Loss Information – Balding Blog

Hi Dr. Rassman,

I have two questions. Is there any standard rate at which MPB occurs or is it completely unpredictable? I am 27 and would like to be able to look out 5-10 years and calculate where my hairline will be. I have been on Propecia for 3 months and am waiting to start a Rogaine program, but I am shedding so much that I would like my scalp to stabilize before I start.

I am also considering a FUE HT through my hairline. I have thinning in the front of the hairline but it hasn’t recessed yet. I’ve read that a FUE HT causes the hairs around the implants to thin out. Is this true? Is there any way to impant FUs in this thinning patch to make it appear thicker?

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You have raised many issues here so I will try to separate them and address each of them.

Predicting hair loss is difficult. It is best done by looking to your family, finding the various forms of balding there and trying to identify one person that matches the timing of your hair los. Generally, those people who will become very bald, show their balding pattern well before the age of 30. You appear to be in the group where anything is possible, so look to your family patterns.

With regard to Propecia and Minoxidil, I like to start off with one drug (usually Propecia) and then after 8 months, add the second. In this way I get an idea of the value and effectiveness of both drugs and can separate them out. Propecia shows much of its impact in 8 months. Minoxidil, when it works, kicks in within 4 months.

With regard to Follicular Unit Extraction, when it is well done by those who really have a great deal of experience and expertise, it should not damage the surrounding hair. What often happens, is that when the experience is not there, the surrounding hair may be directly damaged in the transplantation process.

Putting in transplants to make hair appear more dense is done when there is reduced risk of damaging the thinning area. Good judgments are required here to be sure that the degree of miniaturization that is present does not reflect ‘active’ hair loss in one of its accelerated modes.

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Alopecia Areata in Women – Hair Loss Information – Balding Blog

I had alopecia areata 7 yrs back. i am female -30. i had alopecia again after 2 and a half years. both the times it got cured by the use of minoxidil 2%. This time i have developed a bald patch at the hairline in the front and am having excessive hairfall all over my scalp. I count the strands. They vary fom 60 strands to 130 strands a day.There is excessive hairfall on the days i wash my hair. Also my eyebrow hair falls. What i have realized is that over these 7 years my hair has been becoming less dense and is not as thick as it used to be. My doctor has advised me to use minoxidil 2% all over the scalp [1 ml in the morning and 1 ml at night]. Also am applying Mintop on the bald patch at the hairline.

Will my hair ever be the way it was and will i ever get thickness in my hair? What do i do to arrest my current hairfall? Can my alopecia be cured permanently? India is not really that advanced. If i need to come to you i have no problem. Please help.

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Alopecia Areata in some people comes and goes. After the first attack, if you are lucky enough to get the hair back, you get excited and think that it is over. In some people, one episode is all they get. In others, like you, repeated episodes are the pattern and then when the hair does come back, it is often a finer hair and often not all of it returns. The use of Minoxidil may have value and has little down side, as long as you do not develop any intolerable side effects.

Unfortunately, we do not really understand this disease, but there is a great deal of research going on that may point to better solutions in the future. I wish I could help you more.

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Hair Loss InformationRacial Differences in Hair Loss – Hair Loss Information – Balding Blog

Are there racial variations in hair loss. Which races have the most hair loss and which have the least?

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Male and female hair loss is common to all races. If you separate the races, the American Indian whose ancestors came from the Alaskan bridge have no balding. The more advanced hair loss patterns appear to impact Caucasian males most frequently. There are different distributions of balding that may favor one race or another. Asians often do not have the very advanced hair loss patterns, but then again, I have seen such patterns in some from these ethnic backgrounds.

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Hair Loss InformationPrednisone and Hair Loss in Women – Hair Loss Information – Balding Blog

I have crohns disease and I went to the hospital and stayed for about 3 wks. I was given mega doses of prednisone intravenously. Shortly after I got out of the hospital, my hair started gradually falling out. (I am a 53 yr.old african american female) I eventually cut it all off. Will it ever grow back or is it doubtful?

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Hair loss is not a published side effect of prednisone except in men with male pattern balding. You need to have a full evaluation for the presence of other diseases. Assuming you are healthy and do not have the female version of genetic hair loss, you styand a good chance to grow back your hair in one to two years. If there is a disease process that is causing the hair loss (e.g. thyroid problems), then the cause must be addressed first. For example, women may get hair loss with pregnancy and these women almost always grow the hair back, usually in less than one year (can take up to two years) after the baby is born.

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Minoxidil Side Effects? – Hair Loss Information – Balding Blog

Hello Dr., I have been using minoxidil lotion for two months now. I do not suffer from any systemic side effect as yet. BUT, every time I apply it I have noticed that I ,almost immediately, with in minutes experience a little bit of strain on the skin under my eyes. When I look in the mirror it appears that I have developed dark circles. With continuous use I notice fine lines and dryness on my face. Now to avoid this I have started applying the lotion in supine position while rubbing the tip of the dropper on my scalp. I stay in that position at least for next 20-30 minutes. This is to make sure not even a trace of medicine flows down on my face. But still I have the same sensation on my face. All these effect however disappear even if I discontinue the medicine even for two days. This has been a repeated experience. Any comments?!! Do other patients also complain about the same problem?

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This is the first time I have heard anyone report this. I can not understand it unless the medication is actually landing on the skin of your face or around the eyes. There are reports of local skin reactions to minoxidil that ‘irritate’ the skin. Some of the medication can be absorbed through the skin and drop the blood pressure a little and this is a transient effect that does not last long. Maybe this medication is not worth the trouble it is causing you. Clearly if you stop it, it goes away. Is there are real benefit worth the problems you are experiencing?

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Hair Loss InformationHair Loss from Steroid Use – Hair Loss Information – Balding Blog

Your office is not that far from the famous Muscle Beach. Do you get many of the hardcore bodybuilders in for hair transplants? And taking all of those steroids…wouldn’t it be courter productive or should I say maybe a waste of time to get the hair transplant for those prone to baldness anyway or do they just take of more and different drugs of the estrogen blocking nature?
The reason I ask is that when I was in my younger days when I first really started loosing my hair( after two knee surgeries by the way???)I started weight lifting/bodybuilding to conpensate for my emotions concerning my hair loss, I had a rough time dealing with it. So I was tempted to take them (back when they were legal)but after reading about the hair loss side effects I changed my mind. Does the transplanted hair suffer from heavy steroid use or does it stay protected? Thank you

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I believe that the permanent zone hair (the hair we transplant) is protected from steroids. The other hair that is not the rim hair around the sides and back of the head can be ‘killed off’ with steroids in those genetically prone to balding.

Yes, we see many, many weight lifters who have accelerated their hair loss and like you, panic when they see it falling out. The high they get from the steroids and the benefits in the sport, seem to offset the liability for most of them.

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Hair Loss InformationHair Transplant Growth Success Rate – Hair Loss Information – Balding Blog

What is the growth success in 100 grafts that are transplanted?

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This is a good question. We really do not know exactly. I suspect that the growth rate success in our hands is over 90%, but it is almost impossible to count the transplanted hairs and compare their numbers to what was moved.

I have had opportunities to transplant a limited number of hairs in a scar, or an area of the head that was easy to separate from the rest of the areas and when I counted them, they all grew. I do test grafting in people with Alopecia Areata when I believe that the disease is inactive. In those patients who have inactive disease, I put in about 20 grafts into various areas of a bald patch of scalp. If the disease is really inactive, all 20 grafts are counted after some 6 months. I do the same for some burn patients where the scars may not support the grafts. When the scars can support the grafts, all grafts are then counted and if one grows, they all grow. This experience does show what is probably the case in our typical hair transplant sessions.

What we stress is a quality control process to minimize those factors that can cause hair loss in the transplant process. For the natural hair that is still present, we use drugs like Propecia before surgery. Various technical systems are enforced which guarantee that the grafts do not dry out (the leading cause of graft death), gentle handling (the second most common cause of graft death) and very experienced technicians (we have no turnover of clinical staff). A good transplant with a high success rate depends upon good team work with employees that know how to work together. Just like a good football team, every player in every position must work at peak efficiency to win the game. Winning the game in hair transplantation is a combination of 100% growth and good esthetics. This is why we show off our patients after their procedures at our open house events and also have a live surgery so that you can see, first hand, what will happen to you both in surgery and then 8 months later.

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Hair Loss InformationPropecia for Women – Hair Loss Information – Balding Blog

a short while ago, you answered a question on the use of Propecia in women. It was your feeling that this drug is not indicated in women, yet some doctors are using it in women. Are there any indications for female Propecia use?

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There is no long term studies on safety in women for Propecia, but there are certain conditions that cause a woman to make a great deal of male hormones and as such, may actually develop a male patterned hair loss. In these diseases and only in a woman past child bearing years, a trial of Propecia may be indicated, but the patient must be made aware of the possible appearance of conditions that ‘theoretically’ may develop which could impact the breast, uterine and ovarian organs. For example, cancer risks have never been studied when a women is placed on Propecia and those women who are genetically prone to breast, uterine or ovarian cancer may find themselves at greater risk.

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Hair Loss InformationDo Hair Doctors Still Use Plugs? – Hair Loss Information – Balding Blog

Are doctors still using the plugs that I see on the street, in the malls and at airports all of the time?

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Not as a rule. The old plugs that gave this industry a bad name in the 1970-80s have largely been replaced with small grafts that are called follicular units. But there are some doctors that use ‘combination grafting’ which is a mixture of larger small grafts and naturally occurring follicular units. Only the follicular units are undetectable in bright light or close inspection.