Author: Dr. William Rassman

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Hair Assessment in Early Balding

Hi Doctor,

I am a 26 yr old male started thinning about 11 months ago sometime in december last year. My hair was really thick before so obviously I didnt realise I was thinning when it kicked in during the early stages.

Observations :
1. I notice about 18 -25 hair every morning on my pillow. Most of these hair are very fine and shorter than usual. Some of them have a white bulb at the end.
2. Even at work I notice about 4-5 hair falling on my desk/ keyboard everyday even when I gently rub my fingers on my scalp.
3. During a shower when I apply shampoo on my hair I get about 10 – 12 hair sticking on my hands/fingers even though I shampoo very gently. I wash my hair with shampoo and conditioner ( Clairol Herbal Essences/ Nizoral; was using Garnier Fructis earlier) about 5 times a week usually after a workout.
4. My Hair is thinning all over my scalp. Even on the back although since there is a higher density of hair so No scalp is visible.
5. Some of the common symptoms I have experienced in the past 8-9 months are itching, flaking/daindruff, A kind of burning sensation as if there is some heat generated from my body which is burning the hair roots on my scalp, and obvoiusly my hair is a lot thinner than a year back.
6. I do not see any receding of my hairline( thank god for that)but the area right behind my hairline/top has some noticeable bald spots where it seems like the hair thinned a lot and i have lost some hair.
7. Been on propecia for almost a month and do experience some pain in my balls of late (after ejaculation) however I dont think its reduced my sex drive or erections but I am determined to ride it out.
8. Overall When I examine my scalp minutely,I notice my hair still grows fast however the quality of hair is much more thinner than a year ago annd as a result a lot of scalp is noticeable. I probably have some hairloss too.
8. The worst part is I am not able to comb my hair like before and if I make it puff from the top/front My scalp is very visible from the front. I really woe the fact that I should have taken corrective measures early (when visible hair loss/thinning started about 10 months back but like most people I was in a denial mode and just would not digest the fact that I was loosing/thinning for good.

I have spent many sleepless nights on this issue in the past month and literally think bout it every 30 minutes.
I am a vegetarian and take about 100 grams of whey protein (courtesy GNC) per day for supplementation. I would say My professional life isnt that stressfull at all. The pics in the album were taken with a Kodak 4.0 MP digital camera under bright light.

1. I am applying Minoxidil twice a day but I am thinking bout changing it to once a day at night. I apply it mostly at the top and some on the vertex. Also its too flakey and makes it look like I have daindruff on my hair. Do you think this is a good move and is once a day 5% effective ?
2. From my pictures can you tell me whats my norwood scale ? I am thinning considerably from the top. The hair on the top of my scalp are very thin compared to last year. As a result They tend to clump together when I make them wet or when I apply hair gel. Sometimes in the morning when I gently rub a wet hand on to my scalp I get about 6-8 hair sticking into my hand. Will Propecia or Minoxidil make them thicker again ?
4. From the pictures how bad is my vertex ?
5. Realistically what are the chances I will retain my “Hair Glory” I had in Sept 2004 ? Or is it all downhill from now ?
6. Is there any way i can get the thickness measures with a densitometer in the North California area ?

Photo Album at [link removed for privacy]

Most of the pics in the first album were taken immediately out of the shower. these days I just stand under the shower and let the water wash the shampoo itself with out rinsing it off after applying. No towel dryng too. Notice how the thin hair clumps together from the force of the shower and my scalp is exposed. Or Am I balding on those areas ? looking at my current situation do you think I should continue using minoxidil 5% I started it 2 weeks back in panic I use it twice a day for now. Should I cut it back to once a day or totally eliminate it ?

I would appreciate your assessment of my situatiocn.
Best regards

Your photographs are consistent with genetic hair loss, but there is no substitute for a good examination as I have said many times in this blog. You should not be your own doctor. The miniaturization mapped on your head will allow the doctor to determine the pattern of the hair loss. The Propecia you are taking will probably stop much of what you are seeing, but you do need to have the examination for miniaturization, or you will not ever truly know if you are actually benefiting from the drug, or if the problem was just temporary and drugs were not necessary. You discussed your hair glory, wanting to go back. I can not (nor can anyone else) predict your response to Propecia, although I have seen some men return to their ‘hair glory’. Responses depend upon the time you have been losing hair, the genetics of each patient and the timing with regard to starting the Propecia with regard to when you actually started losing your hair. The quicker a young man starts Propecia, the greater the overall effect I generally see. As to your question about using Minoxidil while also using Propecia, I’ve talked about this a few times before: here, here, and here. I am in Southern and Northern California, and would be happy to perform such an examination on your free of charge. I can not make a doctor recommendation in the North Carolina area, but you could take a look at the physician search on ISHRS.org. Be sure to do your research before chosing a doctor.

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Hair Change After Chemotherapy

why does your hair change after chemotherapy. hair is a genetic code in your DNA so does that mean that it changes your DNA?

Hair has a very high metabolic rate just like the cancers you are treating with chemotherapy. These chemotherapeutic agents get to cells that have a high metabolic rate, which include: hair, elements of bone marrow, intestinal cells. So when you get chemotherapy, it gets to all of the fast growing cells. That is why people become anemic on chemotherapy, or get diarrhea from damage to the intestinal lining of the stomach and intestines, so I would expect that if the hair is not forced into its telogen cycle, the hair growing out would not be normal.


2008-09-15 15:11:29Hair Change After Chemotherapy

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Hair Breaks 3 Inches From Root

I have a question for my friend.. She has had hair breakage about 3 inches from the root. She has had over 15 surgeries in the past 7 years due to a motorcycle accident.. Her hair breaking has been an issue for over a year or 2.. She has had blood work done and nothing was found wrong. She has made an appointment with a hair specialist to do a test on a piece of her scalp. Is there any other simple reason that the doctors would be looking over like her nutrition? I am concerned for her and I wanna help her as much as I can.. If you have any answers for me I would appreciate it.

Stress from surgery can cause hair to fall out. I have often stressed (no pun intended) the importance of miniaturization mapping of the scalp to see the pattern of hair loss. This may be of benefit to your friend.

With regard to hair breakage (if it were you), I would want to know more about how you manage your hair, how you brush/comb it, what shampoos and conditioners you use, what changes you have implemented prior to noticing the breakage problem, and what the nutritional status of your body is (the hair may reflect vitamin and other nutritional deficiencies).


2006-08-10 07:03:10Hair Breaks 3 Inches From Root

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I Had a Hair Ball with a Hair That Was About 5 Inches Long from a Hair Transplant I Had One Year Ago

If the graft was placed upside down and it grew for months, it might have grown to full length inside your scalp at a rate of about 1/2 inch per month. I am sure that your doctor remove the hair that came from the cyst (and it most likely was created from an ingrown hair).


2018-06-22 12:31:08I Had a Hair Ball with a Hair That Was About 5 Inches Long from a Hair Transplant I Had One Year Ago

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The hair in the back of the head is not growing well after my FUE (photo)

You have possibly been over-harvested and have developed donor site depletion. If it does not get better, the only treatment that can make the back of the head look better is Scalp Micropigmentation (https://scalpmicropigmentation.com/scar-covering/#!)


2017-09-19 05:30:45The hair in the back of the head is not growing well after my FUE (photo)

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My Hair Was Burned With a Relaxer and It Falls Out and Grows Back Every 3 Years

I had my hair relaxed 9yrs ago and got a burn in the balding area. the burn healed but hair from that area started thinning. 3 yrs later it fell off then grew back again, thinner and on a larger area. 3yrs later same thing happened again. Last yr was another 3yrs later when it fell off again. i haven’t used hair relaxer on my head since 9yrs ago.my scalp hurts a lot on that area.what can i use to restore my scalp and get my hair back. Please please help

You seem to describe a cycle of 3 years where your hair thins and grows back. I have never heard about such cycle and I am not sure how it relates to the chemical relaxer from 9 years ago. Our hair does grow and fall out in cycles but it is not very predictable nor synchronous. Human scalp hair is constantly growing and falling asynchronously. We can lose 100-200 hairs a day but there are 100-200 new hairs growing elsewhere on the scalp at the same time. So this cycle should not be readily perceptible. On occasion some experience telogen effluvium where there is significant hair loss without any inciting cause. There is no treatment for telogen effluvium other than time, as hairs do grow back within a year.

Pain on your scalp is not normal and you should have it checked by your dermatologist.

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Hair Cloning

Benjamin asked…

Are there any doctors who can clone donor hairs so that the amount of available donor hairs is no longer an issue with transplants?

The hair cloning issue keeps coming up because it seems to be promoted by some unscrupulous people who use the cloning ‘card’ as a way to elevate their own position of authority in this business. There is no cloning on the short-term horizon for hair, despite claims to the contrary. If and when the cloning problem for hair is solved from a research perspective that can be replicated , it will take legislation to make that reality into a clinical tool. Hair was first cloned by Jahoda in Scotland in the late 1980s. Since then, there is been a relatively long silence in the industry on repeating his work. His report stands alone as a successful cloning experiment. Attempts to do this in mice and other animals have produced many dead animals in at least one study I have been told about. Attempts to do this in humans have met with failure after failure. Fortunately, no deaths have occurred. I would urge all of my readers to be cautious about the cloning option and look skeptically at anyone who promotes it at this time.

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Hair Breaking After Chemical Straightening

I recently had chemical straightening and have now noticed that my hair is breaking of a lot. i am scared i am getting bald. i have had straightening done in the past but havent ever had this much hair fall. is there anything special i need to do. how do i stop hair from breaking off. Please let me know i am getting very stressed out

Thanks

If you’re seeing a lot of hear breakage from chemical damage, there is not much you can do since damage is already done. The good news is that your hair will grow out if it is not damaged at the root. The only thing you need to do now is be patient. Stress could lead to other problems, including additional hair loss. If you are worried, see a dermatologist or your primary care doctor.


2010-09-16 11:25:09Hair Breaking After Chemical Straightening

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Hair Coloring After Transplant

Hi Dr. Rassman.
First I would like to thank you and Dr. McClellan, for doing such a great job. It has only been a week since my surgery 1,700 grafts. 5 Years ago I had 1,100 grafts. Healing is occurring quite rapidly, and I feel the positive results around the corner.

I have somewhat fine, and curly hair age 38. Auburn brownish is my natural color. Redhead when I was younger. My father grayed heavily in his thirties, as did my brothers & I. I use either “Grecian Formula”, or “Just for Men” 5 minute hair coloring. (Light Brown to get as close to my natural color as possible). About a month prior to surgery, I had my hair highlighted bleach blonde, and the results were fantastic. I looked a lot less bald, with wonderful full blonde curls, and my brown underneath. It looks so natural and subtle that everyone thinks I have just been in the sun for a week. I am very pleased with this coloring. Because I only highlighted, the brown color treated area remains, its brown status.

The main question becomes at this point, is when can I use the “Grecian Formula”, or the “Just for Men 5 Minute Hair Coloring again as my base?

And, when can I “bleach” highlight again?
A) My regular area.
B) Donor, and Transplanted area.

Thanks again to Dr. McClellan for doing such a great job last week.

Thank you for your kind words! I am hesitant to post this for fear that readers may think this is a ‘planted’ question, but you do raise some issues that have not been addressed in this blog. You can begin to color or bleach your hair once there is no more scabbing present and the skin is smooth. This usually happens within the first after surgery (in some people in days). I generally advise people to dye their hair immediately prior to the surgery so that there is no significant disruption to their schedules.

You also bring up an important point on the value of hair coloring. Lightening the hair always adds the look of fullness. In a question posed to me on April 21st (see: Platinum Blonde Patients), the question of blonde hair came up in a different context. That question has bothered me since it came in and as I looked through hundreds and hundreds of patient photos, fewer blondes were in my hair transplant group than non-blondes. Then I realized that the lack of blondes in my database of photos came about for two reasons:

  1. There are fewer blondes in the population (estimated at less than 10%). We are led to believe that the actual number is higher because there are many, many blonde women. Could it be that because ‘Blondes have more fun” women are becoming blonde far more frequently than men are?
  2. A platinum blonde man can lose 85% of the hair on the front, top and crown without knowing that he is going bald. This is because of the low color contrast between hair and skin color and that the shiny hair platinum blondes have makes balding less prominent.

In conclusion, men who are balding should think more like you and consider taking charge of coloring like some of the women out there are doing regularly. Maybe, just maybe, coloring can solve the hair thinning problem without a hair transplant for those who are not quite bald yet.

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Is Hair Cloning Right Around the Corner?

I saw this article yesterday about hair cloning on the UK’s Times Online: Baldness cure firm heads for AIM

Here is an example of a business deal coming down the pike shortly which mixes the anticipation of raising a large amount of money with the excitement of hair cloning. Growing hair in a test-tube from parts of the hair follicle that might eventually produce a head of hair in a balding man is the dream. How far from reality is this? I suspect that the clinical trials will tell us that, but as you may know, clinical trials take time to get from testing to fruition and an FDA approved process that is both safe and effective. Many of these processes fail to make the final mark, so this is a high risk deal for those of you wanting to put your money behind the cloning endeavor. It is even a higher risk deal for those of you waiting and waiting and waiting for the cloning answer to your balding prayer.