Author: Dr. William Rassman

I’m a male patient. i’ve been recommended to go to your practice for grafts by another CA doctor. he says i’d need maybe 1000 at most…can that be done in one session? I have a severe case of stress/surgery-induced telogen effluvium and a maturing hairline not MPB according to my doctor, who is a member of ISHRS. he says he does not see miniaturization beyond the mature hairline position, only thinning (effluvium). my concerns are…will the FUE grafts (when placed) be put over live hair follicles and damage them? Or is the magnification procedures used during surgery good enough to make sure the grafts are placed over dead follicles? Thanks,

Telogen effluvium could be a contraindication for hair transplants if the process is still going on. A visit to my office is critical before any conclusions be drawn. I would want to do a pull test and measure your hair for miniaturization and bulk. That will help me confirm your active diagnosis.

Hi DR Rassman. Thank you for providing this very informative blog.

I’ve wondering about this and trying to find the answer on the internet for ages – sometimes when I rub my head in the morning I see some slightly thinner hair than my normal healthy looking ones. I went to the derm and did a miniaturisation test and had less than 10% miniaturisation. The derm said I am not balding, however when I see these slightly thinner hairs I get worried…

So I guess my question is do these slightly thinner hairs (intermediate?) grow on a non balding scalp? They grow just as long as my normal hair and are same thickness throughout the strand.

Thank you

If you have less than 10% miniaturization and your dermatologist told you that you are not balding, I would stop worrying. Non-balding people shed about 100 to even 200 hairs a day. Perhaps you’re seeing hairs going through various growth cycles?

If there is any doubt, then have a bulk measurement of your hair done, which will show beyond any doubt if you are thinning or balding. If you have miniaturized hairs, those hairs will not grow at the rate or to the length of normal, non-miniaturized hairs.

I started Minox around 2 weeks ago, putting up to 1ml of 5% generic liquid once per day on my scalp. Today, I experienced heart sides (chest pain, tightness in the chest, rapid heartbeat) for the first time after a few days of increased libido and headache.

An incident this afternoon, which I believe might have been a panic attack coupled with dizzyness, led me to look up ‘minoxidil panic attack’ on the internet.

The lower 2% minoxidil has less side effects when used topically, and works well with once a day applications. Yes, there are side effects for everything. You could get in a car accident, but will you stop driving if you have to drive?

These crusts should be allowed to shed with shampoo regularly, leaving the shampoo on the scalp for 10 minutes and then gently rubbing them until they come off. It may take a few days? but don’t push it. After 2 weeks, the risk of graft loss is minimal. Compare this man on the left 1 weeks from his surgery with the man on the right, just 3 days after surgery. The difference is good post-operative washing. The man on the right was our patient and nobody could tell he had a hair transplant done at any time so far, at least.

Hello, I am very curious about the hair loss I have been experiencing. I’m 22 years old with no family history of male pattern baldness. Over the last 4 months my hair has been falling out at an alarming rate. You can now see my scalp through my hair. It is not at the rear of my head like most men, but all over the top of my head. I also have swollen glands on the inside of my jaws, however, I have no idea if that means anything. Do you think it could be male pattern baldness, or am I dealing with something else. Thanks for your time.

This appears to be two separate problems. The swollen jaw and swollen glands need medical attention. If you are balding, then it is best to see an expert on that as well. Male pattern baldness might be something you’re experiencing, but the swollen glands are unrelated.

I have male pattern baldness, yet I have thousands of tiny translucent hairs on my scalp. They are short, and do not seem to grow much, if any. When light is shinning from behind me the hairs are very noticable and people look shocked, as I look bald when no back light is present. What are these hairs and why don’t they grow to full length? Have not been able to find anything written about these type of scalp hairs on the internet.

Congratulations! You are a polar bear. A polar bear’s fur is translucent despite its apparent white hue.

Kidding aside, what you are describing seems to be vellus hairs that commonly grow all over our body (look closely at your face… its all over — except for our palms and soles). These hairs are not like normal hair on the scalp and will not grow to normal scalp hair length, and in each follicular unit (which normally has 2-4 hairs normally) there is usually one vellus hair (which is not seen with the naked eye). When there are translucent hairs on the scalp that do not grow (instead of full pigmented hairs) then that is often seen in advanced balding/thinning. These hairs are usually miniaturized and do not grow normally as the genetic factors come into play. You should have your hair mapped out for miniaturization to find out what is going on.

He sent me an email complaining that he couldn’t get a hair cut and had to live with this hair uncontrolled. I think he was bragging. I had performed 3200 grafts one year before.

I have two crowns on the top of my head. If I can expect to start thinning at the crown later in life, will it be from one crown over the other, or both? One of my crowns in more centralized in respect to the other. If only one were to experience thinning, would that be the most likely culprit?

Also, any news on the alleged hair loss creme that reduces PGD2 levels in men? It was announced in 2012 that because there are already cremes that reduce PGD2 levels for other ailments, that we could expect it on shelves as early as 2014.

Two crowns…. do you have two heads? The crown is the top of your head. Are you referring to two cowlicks or swirls on your head? If you were born with the genes for male pattern baldness, then you will lose your hair in a certain pattern as described in the Norwood classification chart (see here).

I am not privy to any new hair loss treatment creams that work. Prostaglandin D2 (PGD2) was being touted as a potential baldness “cure”, but the last I remember reading about it was that it was going to start clinical trials in a couple years, not necessarily be on shelves by then. There’s a long way to go still before PGD2 is proven to work for humans beyond hypotheses and lab mice research.