Author: Dr. William Rassman

As a writer focusing on men’s health issues I would be interested in your comments on two areas of my research.

1. I have read a number of reports that suggest that hirsute men (those with a lot of body hair on chest, shoulders etc) are more prone to lose hair from their heads.
2. I have also seen reports that the American Red Indian does not suffer from hair loss.

I do not believe these issues have been dealt with by you before.

I too have seen claims that men with heavy populations of body hair have more balding than their hairless or less hairy counterparts. I can say that in my medical practice, the balding men routinely say: “I wish you can take it from my chest or back”. But then again, I do not have the type of interchange with non-balding men to probe the same issue. There is generally a belief that DHT (the evil hormone that ‘causes’ hair loss), also brings on the body hair, the nose hair and the ear hair along with the balding on those genetically inclined balding men. I believe that in the discovery of Finasteride, the people who ingested large amounts of this drug through their dietary intake of a food stock from the rain forest, did not bald, nor do the men born with a genetic defect where they can not make the enzyme that produces DHT. I recently probed a large number of doctors asking if anyone has found evidence of a reduction of body hair, nose or ear hair with Propecia. Everyone liked the question and told me that although they believed it might just do that, there is no evidence that Propecia or Proscar actually blocks or reverses these less than ideal hair locations.

With regard to the American Red Indian, I am fully aware of this observation. His ancestors came from the Alaskan bridge and they had the balding trait, so it is strange that this particular ‘race’ (the great grandchildren of the migrating Alaskan ancestors) is unique amongst all humans as they do not have balding. Of interest, I am not aware that these people are missing any enzymes for making DHT. Could it be that a primitive people actually wiped out balding genes in their brothers in a relatively short time frame of less than a couple of thousand years?

Hi Dr. Rassman, I was wondering if you knew the histopathology of non-scarring alopecia in a 21 year old male? My dermatoligist said I had diffuse hair loss and non-scarring alopecia and prescribed me Propecia; I am also taking Rogaine. Additionally, what do you think of spirinolacatane as a topical treatment as an anti-androgen for this type of hair loss?

Thanks

The histopathology of non-scarring alopecia is just as it states — When you look under a microscope of your scalp biopsy there is often cells seen that reflect some autoimmune disorder, but no scarring where there is hair loss. Examples include anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia.

Of the list above, the most common non-scarring alopecia is genetic balding (otherwise known as androgenic alopecia — AGA; otherwise known as male pattern baldness — MPB). And since your dermatologist prescribed Propecia for your non-scarring alopecia I would guess that your dermatologist thought you had MPB. It probably would’ve been much easier if you were just told that you have male pattern baldness. If you have diffuse unpatterned alopecia (DUPA) then the donor area behind your head would have substantial miniaturization. Speak with your doctor about how he/she arrived at the conclusions.

Finally, spironolactone has anti-androgenic properties, but clinically there is little good evidence that it helps with MPB.

You have a surgeon, so your surgeon should address your problem. That has happened in my 16,000 surgeries over the past 29 years twice. Once I was able to retrieve the grafts from the car door, wash them and replace them and they grew just fine as it happened in front of my office. The second time, I replaced them at no charge to the patient. I always do the right thing for my patients, so should your surgeon.

I have lived With my nightmare Freaky hair transplant look too long, what can I do about it? Can you help me?

This patient would not allow me to show his pictures, but I will tell you in general what his “freaky” hair looked like. He had four scalp reductions (removal of bald scalp from the crown of the head) which left a scar down the middle of his head, and he had 4 partly failed transplants creating the old doll’s head look. Between all of these procedure, his entire donor area (except for one area high in the donor area that might still provide for hair for another hair transplant – perhaps not the best option). You can see through the hair on the back of his head and he looks like a cancer survivor despite his good health. This surgery was done over 20 years ago by a Los Angeles surgeon known to the professional community for this type of terrible work, but not known by his victims. The patient was in his early 20s back then and wanted to believe in the doctor and after many surgeries there was a progressive loss of trust. His hairline was placed an inch too far above its normal position, so he even looked worse.

My job was to assess his situation, communicate realistic (not idealistic) possibilities clearly to him and then recommend a possible treatment for him – if one was possible or agreeable to the patient. Many patients like this have few options and the 8 previous surgeries and all of the deformities that were created, left him mistrusting all doctors with few options. None of the options would bring him back to being completely normal without sacrificing certain styling options. Some of these options were:

1- Shaving his head and having Scalp Micropigmentation done, This is a reasonable option if he can put up with a shaved head and many people in his situation select this option. For an example of a result he might expect, go to scalpmicropigmentation.com and see patient 161 who has deformities in the back of his head similar to this patient. His after pictures show camouflage of these deformities but the deformities and scarring will still be there on close inspection.

2- Fortunately, I believe that he has enough hair that I can still harvest to recreate his frontal hairline with hair transplants. Then he can then have SMP done to cover the massive scars on the back of his head and cover the scars in the front, top and crown of the head. A good frontal hairline will allow him to let all of his hair grow out and style it once the new frontal hairline is created. SMP will help to minimize the look of thinning and scarring.

I have literally seen thousands of patients like this over the past 24 years, and helped many of them. By helping I do not mean making the deformities go away, but with good styling and some surgeries, at times, a much improved look is very feasible. Since Scalp Micropigmentation has been available in our practice, we have been able to create amazing improvements in patients like this. I think that we have done more of these types of repairs than any medical group in the world today.