Author: Dr. William Rassman

Posted on

I’ve Got Thick Hair from Acromegaly

i recently was diagnosed with something called acromegaly which partly means the pituitary gland produces too much hgh. one of the symptoms of this disease is course or thick hair, which i have. i’m wondering once i correct this issue & my hgh levels return to normal. will this cause hair loss of any kind whether its the legs, eyelashes, etc…

Many of the body’s changes from acromegaly do not reverse after the pituitary problem is fixed. Unfortunately, I have no real experience dealing with this disease or the hair changes that go along with it. Perhaps you can find more info here or here.

Posted on

I’ve Got Stress, My Wife Finds Balding Men Sexually Repulsive, and Now I’m Worried I’m Losing Hair

Hi,

I am 36yr old male and have just had a baby as well as a herniated disc which incapacitated me for 3 months (this was on top of an interstate move and loss of my job). I received an epidural steroid injection to minimize the pain. I am now on the road to recovery, however my hair is falling out at an alarming rate, I would estimate a 30%-35% loss but have not noticed my hairline receding. I am noticing many hairs on my computer keyboard, pillow in the sink etc etc. I also have pretty bad dandruff at present.

I have always had VERY thick hair as does my father (he’s 74 now and still with a full head) but my uncle and grandfather on my mothers side are bald. I think i am noticing small re-growth hairs on my hairline but read that this is actually the hairline receding. I am very worried as my wife has always told me she finds balding or bald men kind of repulsive (sexually). I of course went to my docs who took bloods and found everything was normal so i asked for a referral to a dermatologist but the only clinic in Portland OR cant see me for 4 months. I find myself in a catch 22 cycle of worry, please help.

My questions are as follows….,

May i be experiencing stress related hair loss and if so will the hair that has fallen out grow back?

If i shave my head now will that affect regrowth if it indeed occurs or will it just speed up the process of my ‘losing everything’?

I have read that Rogaine does not work on the front of the scalp, is Propecia my ‘best bet’?

Best Regards

You might be experiencing stress related hair loss. If you have the genetics for losing hair, stress induced loss might become permanent. Otherwise, it should hopefully be a temporary hair loss. Try to get your stress under control and have some patience that your hair may regrow within a year.

If you shave your head, you will have a shaved head with the same amount of hair follicles which will grow out to the same status as you are now, unless you are losing hair. Shaving the head doesn’t speed up hair loss or induce hair growth.

Before you make a decision on going on any hair medication, do two things:

  1. Send me photos of your head from various angles and with your hair pulled back and your eyebrows lifted high. Reference this post when sending.
  2. Find a doctor in your area that can provide a hair bulk analysis with the HairCheck instrument which will absolutely let you know where you hair is being lost, if at all.

I wait anxiously to hear from you, as it sounds like you are coming into a personal crisis.

Posted on

I’ve Had 3 Transplants to My Eyebrow Hair

Hello, I was missing the middle of my eyebrows ever since I was a child. My oldest child pictures have virtually no eyebrow hair in the middle but it wasn’t noticeable until I became a teenager and they darkened. I have no idea how I lost them or perhaps I was born that way. When I was a teenager the remaining hair started seemingly shedding. So I got 2 hair transplants with a doctor.

What I am concerned about is the remaining original eyebrow hair seems to be shedding too much and it seems from the before and after shot I have less of the original hair than I had before. Today when I put tea tree oil on the original hair to get rid of the dry skin 15 hairs from my original brows came out. I just had a third hair transplant into my eyebrows so the trauma from the surgery might be why but still it’s just an example. The transplanted hair does not seem to be effected like the original hairs but if possible I still want to protect what I have left of the original hairs in case I am loosing them. I did pluck a lot of the dry skin plaques out so I might have lost some of the hairs to traction but that doesn’t explain why the hairs shed so easily and I’m wondering if this shedding suggests that the follicles are in danger.

My dermatologist doesn’t know whats wrong. Is their any tests I could take to determine what is causing the excess shedding and possible hair loss such as a hair biopsy or skin biopsy? Could the inflammation from the dermatitis be causing telogen effluvium or something? Is there anything I could do to stop it? I feel very discouraged about finding out what the problem is.

If you have seen a good dermatologist and had a good hair transplant doctor, I can not add much here as I would have less information than they have. You could be experiencing some shock loss in your eyebrows, but I’m just not sure, as I’ve not examined you and am not familiar with your history. If your dermatologist doesn’t know what the problem could be, I’d try another dermatologist.

Posted on

I’ve Had Sexual Side Effects Since Switching to Generic Finasteride 2 Years Ago

Hey Dr. Rassman,

Have been taking propecia for approximately 4 years and for the past two switched to finasteride due to it being cheaper. Have had fantastic results with my hair (have more hair now at 30 than I did at 24!)

However, I have slowly been developing sexual side effects over the past 2 years which has come to a breaking point recently. It is now difficult for me to get and maintain an erection and my semen is watery/decreased volume. I am currently taking 1.25 mg of fin a day. I am seeing a doctor today to get my hormone levels checked. I have two questions for you:

1. Do you think these side effects may go away if I lower my dosage to 0.5 mg/day and do you even think that is worth doing? I would love to keep my hair but I am worried I am poisoning my body.

2. If I want a hair transplant in the future, will me being off finasteride significantly limit my options?

Thanks

Lowering the dose of finasteride may lower the side effects, as I have seen this in my practice. Always discuss your medication changes with your prescribing doctor.

While it is advantageous to be on finasteride when considering a hair transplant surgery, it is not an absolute factor. Many patients undergo hair transplantation without taking finasteride.

Posted on

I’ve Had Significant Diffuse Hair Loss On My Entire Scalp and Face

I’ve experienced significant diffuse hair thinning/hair loss over my entire scalp and facial hair about 8 months ago.

Could this be anything else besides Androgenic Alopecia? I’m 41 and was slowly losing hair only on top since I was 20. Been on finasteride for 7 years. Should I see a dermatologist first?

You should just see your primary doctor to make sure you do not have any other medical causes of hair loss.

Androgenic alopecia is also known as male pattern baldness (MPB). As the name implies, there is usually a “pattern” to the balding. Diffuse hair thinning all over your scalp, including in the donor area, would not be MPB… but could point to something like alopecia areata.

Posted on

I’ve Got Thinning in 2 Spots and Small Bumps Near the Crown

Im a 21 year old male and my family doesn’t have much history of early balding. However im experiencing thinning on the back of my head in two spots on each side of the spiral. Also sometimes ill have some sensitivity and have small sore bumps in these areas. My hair line is not receding.

If you can help I would be very grateful. Thank you.

I think you should see a doctor, as I’m not sure how I can help you via the Internet with a simple description.

What you’re describing could be an infection or some type of balding, but I have no way to know. Sensitivity and sore bumps lead me to believe it’s something that a dermatologist should have a look at. You can find a dermatologist in your area here.

Posted on

I’ve Had Diffuse Shedding Since Starting SSRI?

Had a slight thinning of hairline and a diffuse shed since starting an ssri. i have heard this is due to high prolactin caused by the ssri medication. could the thinning/receding hairline be the result of the medication?

While some medications can cause hair loss, medication is generally the last consideration among the list of other causes of hair loss. You may just have genetic hair loss that can cause thinning in the hairline. There is a reason why we call it male pattern baldness. Genetic balding has a pattern to it — like a receding hairline.

It’s even possible that you have a combination of things going on, with your genetics causing your hairline recession and the SSRI causing a diffuse shed elsewhere on your scalp. Many SSRIs are known to have hair loss as a rare side effect, but you really need to speak to your prescribing doctor about the medication and any issues you may be having because of it. I’ve written about this before here.

I simply don’t know enough about your case history, including your age, how long you’ve been taking the SSRI, family history of hair loss, etc.

Posted on

I’ve Got Thinning On the Sides and Back of My Head

Hello Doctor,
I would really appreciate it if you could answer my question. In the past 5 years I have started thinning slowly. My question is are there “unconventional” balding patterns for men. I have a receding hairline and a thinning crown which points to mpb, but recently the sides of my head as well as the back have started to shed and thin a bit. If my destiny is severe mpb (as it might be since I’m only 23) can this happen, or could it be some other health problem? Thank you very much for your time!

You need to be examined by a good doctor and get a miniaturization mapping to find out if what you think is happening is actually happening. If the sides and back are indeed thinning, that is not typical genetic loss and could point to disease or maybe an allergy. I could guess all day, but you should get to a doctor to find out what’s going on.


2009-07-21 11:22:40I’ve Got Thinning On the Sides and Back of My Head

Posted on

I’ve Had a Bald Spot My Entire Life

Hi I’m a 25 year old male and i have a patch of hair on the side of my head that has never grown in… It is approx 2 inches above my right ear, and it is about 3/4″ to 1″ in diamater. I am not asking about hair loss because my whole life, the spot has been there. I can’t get my hair cut certain ways as this spot makes me very self-conscious. My question is: Would i be able to benefit from a hair transplant even if there was no hair in that spot to begin with? As far as I know, there has never been hair there

This sounds like an ideal case for hair transplantation. So the answer is simply, yes. Follow the rules set up here on how to select a hair transplant doctor. With today’s techniques, you won’t even know that you even had a bald spot with the right surgeon and team.


2006-09-19 09:26:37I’ve Had a Bald Spot My Entire Life

Posted on

I’ve Had No Hair Loss Over the Past Year and a Half — Is Now the Time for a Transplant?

Doctors,

I have been taking proscar, religiously, cutting it up into quarters for the past 5 years. I have had moderate success in keeping what I have, but not any new hair growth. My temples have still receded and a little bit of the front part of my hairline has receded. However, in the past year and a half there hasn’t been any hair loss whatsoever. I am 29 years old, if I haven’t seen any hair loss in the amount of time I mentioned does that mean I have reached my final hair loss pattern and I will no longer experience hair loss, and I can go for a transplant procedure?

The last thing I want to do, go for a procedure and then all my native hair falls out and I am left with only transplanted hair. That is why I am sometimes confused as to how long one should wait to get a transplant and how would one know what the “final” pattern is at such a young age like mine.

The real question is: Is this your final hair loss pattern? You can guess at this, but at 29 years old, that might be difficult. Well-delineated patterns often show the final pattern. That means if you are (for example) a Norwood class 3 pattern, the area where the hair is should not have any miniaturization when looked at under a video microscope, and the hair behind it should not have bulk reductions as measured by a HairCheck instrument.

If you had clean borders and no loss of hair bulk behind your existing pattern then you could assume (not 100%) that for the moment, the hair loss should have stopped. The problem is that many people who see it stop may find that it picks up again years later. With the combination of what I discussed here with the continuation of the finasteride treatment, you may be one of the lucky few. If you are in Southern California, I would be happy to do these tests for you in my Los Angeles office.