Author: Dr. William Rassman

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Another Story of Gabapentin and Hair Loss

After 6 months of excruciating pain, I was prescribed gabapentin. I took this drug in January 2018 for nerve pain related to Herniated disc in C6 & C7. I took the drug for a month while waiting to get everything in order for disc replacement surgery. Then, the day of my last appointment before the surgery, I woke up pain free!!! No pain since. I could not believe how fortunate I was. Was it the drug? Did my body heal? I didn’t care as long as I was pain free. We postponed the surgery. If the pain returned, we would move forward. 2 months later, I still had no pain. Then, I noticed a little extra hair when I brush or wash my hair. It turned into hand fulls of hair! I had waist length, full bodied hair. So much that I fought to wrap a pony tail holder around my hair twice. It is June 2nd of 2018. I can now wrap a pony tail holder 6 times. Yes, 6 and it’s loose!!!! I touch my hair. I pull back loose strains. From May to June, I have lost an estimated 75% of my hair. If I had known this was a side-effect, I never would have taken this pill. There are other options. I have started taking folic acid in hopes it will trigger the hair follicles to begin regrowing.

I am assuming that you are a female. You need to meet with a doctor who specializes in hair loss. The figure 75% of your hair lost is more than I have ever heard. Without seeing you, I can’t give you an opinion.


2018-10-10 12:21:38Another Story of Gabapentin and Hair Loss

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Two post op patients (with photos)

This patient had surgery yesterday. Other than the tape that is applied to his forehead to prevent swelling from working its way down, there is no evidence of the surgery from yesterday. He had 1600 grafts from a combined strip and FUE surgery. He came in for his hair wash this morning which guaranteed that there was no crusting present anywhere to see. On the third day, he can remove the tape and go to work Monday morning.

 

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This second patient is 10 days after his surgery and there is a small beard present in the hairline that goes in front of his previous natural hairline which you can see; however, when looking at him from any reasonable distance, there as no evident hair transplant unless you had to look at it up close as this photo does. These hairs should fall out in the next week or so.

PAK70176 PAK70180

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Another patient with finasteride, minoxidil and microneedling 9 months (photo)

This man used finasteride, minoxidil and microneedling for 9 months and clearly increased the density of his forelock. His hairline did not return to normal so I wonder if he used the microneedling on the original hairline as well but that failed to regrow?


2020-08-13 10:01:15Another patient with finasteride, minoxidil and microneedling 9 months (photo)

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Antiandrogens may protect against covid

https://pubmed.ncbi.nlm.nih.gov/32977363/

“Anti-androgens commonly used in the treatment of AGA such as finasteride, dutasteride, spironolactone, and bicalutamide could improve outcomes among men infected by SARS?CoV?2.”

We have known that men do worse than women when contracting Covid, with higher death rates. So this may help us understand the role of androgens in Covid

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An Answer to a Patient’s Questions

Dear Dr. Rassman,
Thanks for taking the time the other day to visit with me and also for the very informative follow-up letter and your recommended plan for my hair transplantation. Over the last two months I have been seriously looking into the hair restoration field and have read three credible books and studied every web site of every accredited hair doctor. I also consulted with doctors that I felt were very respected in hair restoration. My conclusion is that I need to stay on Propecia consistently to preserve the hair I have right now and use the follicular unit transplantation (FUT) technique exclusively, to replace the lost hair.

But I am confused by the number of grafts recommended. So far, I have heard various numbers ranging from 1,000 to 3,000. After visiting with you and hearing your recommendation of 2500 grafts, I wrote back to a very reputable doctor who had recommended a session of 1,500 grafts and told him that another clinic had recommended 2,500 grafts. He then told me that 1) each person has very limited donor supply and one must plan a session based on future hair loss, and 2) the survival rate of transplanted grafts deteriorates as the number of them placed close to each other is increased, as is done in megasessions. He told me that other clinics have no guarantee or refund policy if the hair follicles don’t grow back, so they just transplant as many as possible, even if not safe for the patient.

So my questions are:

  1. What does ‘limited donor supply’ mean in my case? You saw my hair, how many good donor grafts in total do you think I have for now and the future? What would it be if Propecia did not work and I continued to lose hair?
  2. Have you seen any side effects with larger sessions such as more noticeable scar in the donor area, loss of transplanted grafts, excessive swelling of the forehead or longer recovery periods?
  3. Do you or can you guarantee a certain survival rate for the transplanted grafts?

I appreciate the time you have taken to help me with my hair loss problem. I guess I can’t help it, I am a natural engineer, and this being the most important decision I probably ever make I have just been researching the hell out of it! I am confident, however, that I am talking to the best source there is out there.

Part of what is important about being a doctor is the concept of mutual respect. The person who wrote the email to me on this blog, is analytical and clearly fully aware of the subject material. Good communication produces respect so a doctor should spend an appropriate amount of time and focused attention to address your concerns at the interview and in followup to that interview. I would welcome a call from you to elaborate on this blog answer.

  1. Some people do not have the donor supply and when that will be an issue, I tell them. The amount of donor hair is a calculation of density in the donor area plus laxity of the skin. Finally, the size of the bald area and the final worst case pattern must be taken into account. As measurement is critical to this process, one must make direct measurements of the density in the donor area. I was the first to publish on the measurement of the donor supply and the instrument I invented to do this is now used by every competent doctor in this industry. There are no other instruments that are used for hair measurements that do not fall under my U.S. Patent. The average patient has about 6,000-12,000 grafts to move but the wide spread reflects the many variables discussed above.
  2. If you come to our free open house events, you will meet people who had thousands of grafts and see for yourself what happens. The key to understand the safety of large sessions is to meet directly with many people who had them. I would not be doing large sessions if they were not as good or better than multiple smaller sessions. With good decision making by the doctor, large sessions should not scar more than multiple smaller sessions but there may be a cost for aggressive decisions in large session transplantation if the doctor is not experienced in such procedures.
  3. This type of complaint usually reflects the act of denial which most people exercise when they forget what they looked like ‘before’ the started the hair restoration process. Sometimes, people continue to loose hair and think that the new hair loss reflects a transplant failure when it really reflects the unpleasant idea that balding continues. To address the growth of the transplanted hair, wWe guarantee our work. Anything that does not grow, we will replace at no charge. This almost never happens, so I rarely discuss it unless asked.
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Anti-Nuclear Antibodies (ANA) and DUPA

Doctor, when a patient have DUPA, his/her ANF (Anti-Nuclear Factor) is positive? I have no balding parents nor relatives (until the 4th generation above myself), but I think I’m suffering DUPA and it began just after a heavy stressing period

The diagnosis of DUPA (diffuse unpatterned alopecia) is made by mapping out your hair and scalp for miniaturization. A good examination is critical. Hair loss in men comes about for four reasons:

  1. Genes
  2. Male hormones
  3. Stress (you seem stressed)
  4. Time (the longer #1-3, the worse the problem will become)

To avoid confusion, ANF and ANA are the same thing (see Wikipedia for more info). I am not familiar with a positive ANA factor as a participating cause of DUPA. Conditions like DUPA can occur with a variety of autoimmune diseases of which some of them may have positive ANAs.


2008-05-29 15:29:48Anti-Nuclear Antibodies (ANA) and DUPA

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Anti-Graying Pill — Go Away Gray

Hi,

I have recently come across with this product: Go Away Gray

Your remarks will be appreciated.

I have no experience with Go Away Gray (and this is the first I’ve read of it), but I invite my readers to comment if they do have experience with this pill that promises to make gray hair disappear. What I could find on it (aside from a ton of sites trying to sell it) was that the pill contains catalase, and a study from last year did find that gray hair was caused by the body’s lack of catalase production as we age. That isn’t enough to convince me just yet, but I am open to learning more about this and reading some actual reviews. You can read more about last year’s gray/catalase stories here and here.

CBS stations around the US picked up the story and ran it in their local markets, causing at least one TV critic to dig a little deeper into why the product is getting all this publicity (see here).


2010-05-14 06:40:20Anti-Graying Pill — Go Away Gray

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Balding Blog – Hair Loss Information – Your hair loss questions, answered daily.

CDC recommends young women avoid alcohol unless they are using contraception

USA Today (2/2, Szabo) reports, “Women of childbearing age should avoid alcohol unless they’re using contraception, federal health officials said” yesterday. “‘Alcohol can permanently harm a developing baby before a woman knows she is pregnant,’ said Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention.” Schuchat pointed out, “About half of all pregnancies in the United States are unplanned, and even if planned, most women won’t know they are pregnant for the first month or so, when they might still be drinking.”

The Washington Post (2/2, Izadi) reports in “Health & Science” that “an estimated 3.3 million women who drink are sexually active but not on birth control,” according to a CDC report released yesterday. In addition, “three out of four women who want to get pregnant don’t stop drinking alcohol when they stop using” contraception. The agency “warns that consuming alcohol during pregnancy can lead to fetal alcohol spectrum disorders,” and “there is no known amount of alcohol that’s safe to consume while pregnant.”

Hair transplant surgery, or in fact any surgical procedure has the potential to harm a fetus in the first trimester of pregnancy. For women who have such surgery and are not on birth control pills, they should get a pregnancy test BEFORE undergoing any such type of surgery to avoid miscarriages or other fetal problems.