Author: Dr. William Rassman

Posted on

How do you select a doctor

I wrote about this here: https://baldingblog.com/selecting-hair-transplant-doctor/

This is a global approach to selecting any doctor for cosmetic work anywhere. We have monthly open house events for prospective patients to (1) meet many patients one-on-one and judge the quality of the work for themselves, (2) see a surgery live actually on the day of the Open House and (3) get a free consultation to get a Master Plan built for your hair covering short and long term hair loss possibilities. Few doctors will do this because dissatisfied patients come and can ruin such an event as happened a number of years ago where former patients actually picketed the doctor’s office. Your doctor should be proud of his/her patients and willing to bring patients for meetings to educate you. I also started doing this in 1993 at medical meeting where I brought my patients to teach doctors what a good hair transplant should look like. After many years, the ISHRS (International society) had established patient ‘live viewing’ sessions at every annual meeting. What is good for the doctor, should be good for you, the patient.


2019-12-31 09:36:36How do you select a doctor

Posted on

How Do You Know If You Lose 100 Hairs A Day?

Hi Doctor, you say that one lose on average 100 hairs each day. On what basis you say that? is it based on a scientific research and finding or just your own guess based on average number of hairs on someone’s head and the percentage of hair in telogen phase and length of the latter. If any of these parameters is in fact different, which is likely to be, then your assumption will not be accurate or correct. Thank you for all

The 100 hair loss a day has been widely published and accepted as the normal shedding of hair. Also note that it is not actually 100 hairs a day everyday, but “UP TO” 100 hairs a day.

If you take in to account that our hairs are also growing in cycles or telogen (resting), anagen (growth), catagen (transition) phases 100 hair loss a day out of 100,000 hairs is 0.1% of your total hair count. Also take into account while you are losing 100 hairs there are likely another 100 hairs that are starting their anagen (growth).

Anagen phase in measured in years, telogen phase in measured in months so more hair is actually in the growth phase in a normal cycle.

There are always exceptions to the rule, and not everyone is the same.

Posted on

How do you make the diagnosis of DUPA (Diffuse Unpatterned Alopecia)?

The only way to determine DUPA is with a video microscope showing the details of the donor area. I always insist that the area I look at is cut short (a couple of mm long) so that I can count the miniaturized hairs. A count in excess of 20% of miniaturized hairs reflects DUPA as I defined it in my published article. Yes, finasteride sometimes works to reverse it (less that 50% of the time).


2019-11-08 08:34:07How do you make the diagnosis of DUPA (Diffuse Unpatterned Alopecia)?

Posted on

How does Finasteride cause ED when it does?

The NHS wrote: This US study looked at a medical records database to see how common erectile dysfunction (impotence) was among men prescribed two drugs, dutasteride and finasteride, both used to treat non-cancerous prostate enlargement. The drugs work by blocking the male hormone testosterone. A low dose of finasteride is also used to treat male pattern baldness.

Overall they found that around 1 in 17 of all men prescribed either drug for prostate enlargement had erectile dysfunction. This figure fell to 1 in 31 of those prescribed finasteride for baldness. Using the drug for longer was generally linked with a higher risk. However, in 99% of men, stopping the drugs solved the problem so it wasn’t as catastrophic as the media implies.


2020-08-02 15:46:11How does Finasteride cause ED when it does?

Posted on

How do you tell if finasteride is impacting your brain?

I am about to get on fin but the one thing holding me back is I’m scared of suffering mental sides. How do you even know if you are suffering from them and not just… well… dumber?!? Makes me nervous cause of other things in my life. Curious if any fin users can add to this from their experience. Thanks!

People who have mental side effects generally don’t feel right. This is rare.


2019-05-19 10:22:52How do you tell if finasteride is impacting your brain?

Posted on

How Does a Surgeon Fill In a Hairline Without Causing Shock Loss?

How does a HT doctor, not recreate, but fill in an existing hairline without causing trauma to nearby follicles. Is shock loss inevitable because of close proximity to existing follicles?

Thanks

We do not recommend surgery if we believe there is a greater risk of shock loss over the benefits of a hair transplant procedure. In other words, we do not blindly advise surgery to everyone.

If surgery is recommended, we use the smallest instruments and take great care to avoid trauma to adjacent existing hairs. There will be some trauma to the hairs, but the overall goal is to minimize this and make the hair transplant surgery worthwhile to be of a cosmetic benefit for the patient. This is one of the many reasons you must pick a doctor and the medical clinic with a good reputation and history of doing quality work.

The causes of shock hair loss after a hair transplant relate mainly to the age of the patient and the degree of miniaturization present at the time of the transplant. A patient with active hair loss who is under 28 years old has a higher risk of shock loss than a man over 40 who does not have active hair loss. The use of finasteride tends to protect the patient against shock loss, even in the patient under 28 years old.

Posted on

How Does a Dermatologist Check for Miniaturization?

They use an instrument called a dermoscope (trichoscope)! It looks at the hair with 50 times magnification. This view shows the value of the instrument, especially when combined with the experience of the person using it. Below is a picture of a patient with alopecia areata showing blunted exclamation mark hairs (black arrows) which makes the diagnosis for the expert evident. The red arrows show miniaturized hairs.


2020-03-19 07:52:43How Does a Dermatologist Check for Miniaturization?

Posted on

How Does Propecia Prevent Shock Loss?

My question regards shock loss and the use of Propecia to prevent it. What I don’t understand is, if Propecia’s role is to prevent the conversion of testosterone into DHT, but shock loss is due to trauma rather than DHT, how does the use of Propecia prevent shock loss? It seems like if shock loss is due to the trauma of the surgery, a DHT blocker would not help much. Thank you for your insight.

While we do say that Propecia can prevent shock loss (hair loss following a hair transplant), there is no study I can cite that shows it. The appearance of Propecia on the market in the early days clearly changed the course of hair loss after transplant surgery. We have extensive experience both before and after Propecia became available. In the days before Propecia, I can tell you that the accelerated hair loss after surgery was a real problem which I had to confront, and I frequently chased the hair loss after the first transplant. After the drug was introduced, the accelerated hair loss on patients with Propecia seemed to disappear.

The important idea is that when a patient is on Propecia it is working on the DHT susceptible hairs. Thus when a hair is transplanted in those areas, Propecia will still be ‘helping’ to sustain the native hairs. We do not know the mechanism, but we can postulate that hairs that have been exposed to Propecia seem to be more resilient.

Finally, you do not have to be on Propecia to have hair transplant surgery, particularly if you are above the age of 40-50, have had a stable hair loss pattern that has not advanced in the past 10 years, or have had a recent hair transplant in the previous 2-3 years without experiencing accelerated hair loss.


2012-02-01 11:39:56How Does Propecia Prevent Shock Loss?

Posted on

How does finasteride work?

I know how it works chemically. I mean in practice. I’ve been on finasteride for 4.5 months now and haven’t noticed any regrowth and my hair is starting to shed quite a bit again. I obsess over this every day and it’s destroyed my confidence. My hair is about an inch long right now so i think it would be difficult to notice subtle regrowth anyway. Most of the hair fall I’ve been experiencing lately has been pretty short hairs. Maybe about a centimeter on average. I know finasteride takes time to strengthen miniaturized hair follicles but I guess my question is, is it common for hair to start growing back and then just fall right back out? I’m wondering if maybe it can take a couple of growth cycles for the hair to actually be strengthened enough to grow out and stay without falling. Anyone have any insight?

Hair cycling between growth and rest, is mediated by an enzyme called 5 Alpha-Reductase which is present in small amounts and converts testosterone to dihydrotestosterone (DHT). Testosterone affects lean body tissue, muscle size, muscle strength, and sexual function in men. In men who are genetically predisposed to develop androgenetic alopecia (AGA; male pattern hair loss), endogenous androgens alter scalp hair follicles, resulting in production of vellus-like, miniaturised hair, rather than cosmetically significant terminal (normal, full bodied) hair. This change leads to a progressive decline in visible scalp hair density, readily perceived by the patient as thinning and, eventually, baldness. The benefit to finasteride occur over from 6 months to 2 years.