Author: Dr. William Rassman

Hello i have been following in the background for a while about methods of treatment of hair loss. A few years ago we had quite a few biotech companies looking at researching hair loss. There was intercytex, aderans, histogen, follica and replicel. Many of these companies no longer exist or else news of hair loss treatments and their pipeline after phase 1 have faded and other products have replaced them. I was basically wondering since i have been away for a year or two from heavy research into this. Has all this research faded now? are there any companies coming in to replace these ones or are we seeing that this sort of application is perhaps more difficult than we expected and as such people have given up on it? Sorry to be fatalistic.

Bosley’s parent company Adarans, stopped funding one of the very promising solutions for hair loss a couple of years ago. A few other companies have dropped their hair research efforts. Intercytex seems to have nothing on their website that indicates activity in the hair arena. It does seem that the failures to achieve good hair loss solutions have thwarted some of the research. I really cannot comment on the biotech companies aside from what you may find on the Internet and speculations. It does seem that the ‘cure’ for hair loss is not as easy as one may have imagined.

In getting a haircut, I’m always adamant that the barber not “texturize”/thin the front of my hair, which is already thinning considerably. Sadly, my new barber did just that unpromted. My question is: is the damage permanent or will the shaft return to its normal (albeit miniaturized) thickness?

A bad hair cut is a bad hair cut. It is not permanent. In time your hair will grow for the next round of hair cut.

Hair loss from genetic causes is different. It gets worse with time and you may find that a bad hair cut just makes things look a lot worse. As your hair grows back out (from a bad hair cut) you may perceive your hair status to be worse than it was before the hair cut. But that may just be a recollection bias coupled with the steadily worsening hair status. It is human nature to blame something tangible like a hair cut – something you can control. It is often hard to accept the progressively worsening hair loss that you have not much control over.

Hey doc! I’m a longtime reader and follower of your blog and I highly trust your advice and recommendations. I want to thank you in advance for taking your time to provide your insight to my question. I’d first like to provide a short description of my hairloss observations and results from treatment:

I’m nearly 23 yrs of age and have been on Proscar daily (cut into quarters) since January 2006. The efficacy of the pill peaked by the time I turned 21 and so far, all its been doing is maintaining my existing hair. I’m more of a gradual diffuse thinner than a genetic balder. Ever since last year, my head has become rather itchy and I’ve always felt a sore burning spot right in the centre of my vertex. It became quite unbearable to the point where I shaved my entire head last November just to make it stop.

By December I started using Nizoral 2% and Head & Shoulders everyday (I currently use them every other day). Although some soreness is still present, it has subsided quite a bit and the itching and flaking isn’t as bad anymore. What’s interesting is that my hair has gone from relatively sparse last year to a lot more fuller and abundant this year. I believe that, from my observations, I’ve regrown perhaps 80% of previously lost hairs due to genetic balding. I’ve also noticed that, from continued use of Nizoral, Head & Shoulders and T-Gel plus Proscar for maintenance, I’ve seen individual hairs reverse in miniaturization (hairs with thicker roots and thinner ends)

Am I seeing things or could I be responding well to inflammatory shampoos? My hair is about 6 inches long and tends to get very oily overnight.

My other question is,
In my crown area, especially near the spot where I feel a sore/burning sensation more often than naught, my scalp produces thin hairs and although cosmetically it looks as if there’s no sign of genetic baldness present in that area, I would like to tackle this problem before it does become apparent. I was wondering if you would recommend using a lotion which contains copper peptides to compliment my regimen? I would rather not use minoxidil due to cost issues as I’m still a student.

Thanks again!

It takes at least 2 years to maximize the value of finasteride. That may explain part of your experience with hair regrowth. Also, there are some reports that ketoconazole (Nizoral) may help with treating hair loss, but the studies are limited and I personally have not seen patient results to be convinced. If you’re seeing these treatments work, that’s great!

There is been no proven benefits of copper peptides in the prevention of balding or regrowth of hair. That does not mean that it does not work, but it means to me that the value has not been proven scientifically. If you have used minoxidil and then you stop, it will cause a reversal of the benefits (if the drug produced value) and as hair that was lost is known to be minoxidil dependent, stopping the drug can cause hair loss. The thin hairs that you see in the crown are the result of genetic balding and they can get thicker from finasteride. The younger you are, the better will be the result of finasteride. Men in their 20s like you, get much better results overall from finasteride than men in their 30s and 40s. Men in their 50s and 60s often have no response from the drug. My patent attorney, went on Proscar for prostate problems (it is finasteride) and he grew back quite a bit of frontal and top hair. He showed me the hair with a Cheshire smile. I told him that he had unusual response but congratulated him nevertheless.

Scalp pigmentation is a tattoo for the scalp. It appears that body tattooing has been around for at least 10,000 years. Carbon black from various sources is the basic ingredient but henna appeared early on the list. I am sure they used whatever colored minerals they had in their region. Australian aborigines painted their bodies with various local pigments for ceremonial occasions and used the coagulation properties of blood to attach feather down to their bodies. I have seen no reference to tattooing but scarification of their bodies in ornamental designs (making use of their propensity to hypertropic scarring), was very popular in some areas of the Continent. It was the Pacific Islanders, particularly Maoris, who went into tattooing in a big way. It was claimed that these designs “lasted for life” but of course we don’t know how long they lived in that war-like country or if the pigment was “topped-up” from time to time. I am not sure if they used any colors. More research needed.

Dr. Rassman: Tattoo inks have been described as “remarkably nonreactive histologically”. However, cases of allergic reactions to tattoo inks, particularly certain colors, have been medically documented. This is sometimes due to the presence of nickel in an ink pigment, which triggers a common metal allergy which is fairly rare. Women may be more sensitive to the inks so we test concerned patients (who have known allergies) with tattoo inks prior to performing scalp micropigmentation with a patch containing ink on the skin of the forearm and then wipe it off 5 minutes later and look for a reaction.

Our office is closed today and tomorrow to celebrate Thanksgiving with our families. We’ll be back on Monday!

My father (age 60) is pretty bald (Class 6 balding pattern) but he still had hair on the top of his head. I am also a Class 6 (age 40) person but more balding than my father as my scalp is clean of any hair on the top. I went to a hair transplant doctor and he recommended that I get 1500 grafts on the front and top of my head. I was curious as to how much hair that would be, so I asked my dad if I could count the hairs on the top of his head. He had lost his hairline over 20 years ago as I have. I counted about 3000 hairs on his head, so assuming that I get 1500 grafts averaging two hairs each per graft, I realized just how much hair I wold get from such a transplant. He looks sickly with his 3000 hair if it were not for his top shape and his workout routine. Did I do this right to see what I think that I would like with 3000 hairs in the 1500 grafts recommended for me?

Answer: The recommendation of 1500 grafts in a completely bald class 6 pattern, would not give a big impact for you. To cover the class 6 pattern, you would need closer to 5,000-7,000 grafts depending upon the thickness of your hair shafts (fine, medium or coarse). Spreading 1500 grafts around a Class 6 pattern will not give you much coverage unless your hair shafts were thicker than his and the grafts were focused on the front and forward top areas of your head. I found a 44 year old male with a Class 6 pattern on my website (http://newhair.com/photos/patient-xk/). He had 4178 grafts in two sessions. The redness in the front reflected a hair system (wig) he wore which was glued to his scalp. His hair was of medium weight. If you hair is of medium weight, then you could expect to look like this with about 4000 grafts. Look at his before picture and tell me if this is the type of hair that your father has? If so, it might be miniaturized (very fine) so it will not give much coverage, so 1500 grafts of non-miniaturized hair placed in the frontal area might look ok, but significant coverage will not be obtained and these grafts should not be placed in the top and crown area.

To take a look at two other patients, I offer: http://newhair.com/photos/patient-ba/ (patient BA) and http://newhair.com/photos/patient-cd/ (patient CD). Patient BA’s area of coverage with 2184 grafts of medium weight hair that is straight (no wave in it) combs over nicely to cover the bald area. Patient CD had 1349 grafts with good frontal coverage because his hair was coarse and very curly (kinky). Patient CDs hair attributes give more coverage than people with medium weight, straight hair as seen in patient BA. If the hair was fine in either of these men, the coverage would be thinner.

I hope that these comparisons will give you an ability to estimate what 1500 grafts might do. Compare your hair attributes to those of these men and then you might be able to see the value of the recommended 1500 grafts.

hello Doctors, about 2 years ago i was shaving my hair with a trimmer and it pulled a chunk of hair out at the widows peak, the hair has never grown back properly and when light hits that area it appears shiny and bald. But on closer inspection there are loads of tiny thin hairs… these hairs have remained for over a year and never grow any longer than half a millimeter. I would imagine this is miniaturization ? but from reading up usually miniaturized hairs fall out…. these hairs have been there for over a year and never shrunk or grown more ? any ideas what might be going on and if i could use something to make
them grow normal ?

Traumatic pull of hair and hair loss resulting from such trauma can take about a year to grow back. If it has not grown back in one year, then we generally assume the hair is lost. In most cases it does grow back if the pulling is not chronic over time.

However after 2 years, I suspect what you see is what you get. The small fine hairs you may be seeing is just vellus hairs that is present on our bodies that is not necessarily scalp hair. I cannot tell you exactly what you are seeing without an examination.

I really enjoy visiting the website and reading the wealth of information that is posted on here.

I know dr.rassman has mentioned a few times that if a person is genetically balding their hair has a certain lifetime (example 5 or 10 years) , with or without the use of finasteride, before it completely dies. If that is the case, what is the point of taking finasteride if the hair is going die anyways within 5 or 10 years? Could finasteride prolong the hair from falling out early?

Male pattern balding (MPB) also known as androgenic alopecia (AGA) is genetic. There is no cure. But there are two drugs: Propecia (finasteride) and Rogaine (topical minoxidil) that can SLOW the process down. In some men it can sometimes REVERSE and grow NEW HAIR! But eventually over time, you will continue to lose hair in the genetic pattern.

If you are rapidly losing hair in your 20’s and 30’s and you can take a medication to slow or sometimes reverse the balding process down for about 10 years, that may be worth it to some people. It is an optional medication with a low side effect profile. The most significant side effect for finasteride (Propecia) is sexually related (erection issues) or reduced sexual drive and it occurs in 1 to 2% of men who take the medication. The side effects are reversible once you stop taking the medication. But there are a subset of men out there who claim that the side effects are permanent. It is very difficult to prove or disprove the permanence of the validity of long term sexual dysfunction, but this is a consideration you must weigh if you take this drug. The risks and benefits should be individually discussed with your doctor.

The following is a LINK of before and after photos of men who took Propecia with great results.

I just recently quit taking finasteride due to experiencing some sexual side effects that did not decrease when trying a smaller dose. My doctor advised me to stop finasteride for six months to see if my sexual symptoms improved. I took my last pill a month ago.

I was on finasteride from age 24 to 27, and, while not improving my hair loss, it at least kept further loss from occurring. I’m starting to feel anxious about the catch-up hair loss that could come within the next few months. Would minoxidil help prevent this catch-up loss from occurring, or is it more or less inevitable?

If you had unwanted side effects with a medication, you did the right thing by discussing your options (weighing out risks and benefits) and stopping the medication. The catch up hair loss can happen over the next 6 months after stopping Propecia and that is something that cannot be completely stopped.

Starting another type of medication such as topical minoxidile (Rogain) may help but since it works in different ways than Propecia you still may experience hair loss from the “catch up” phenomenon. Everyone is different and you won’t know until you try.

Do you ever increase density to an area in anticipation that there will be some shock loss?

Maybe I”m off but if technicians are doing most of the procedure I would think the rate of transection would be high. I don’t know what kind of training they’ve had. I assume just in house training. Obviously they’re needed considering the number of grafts but it’s a concern of mine.

No one can predict shock hair loss from surgery precisely. As a general rule the younger you are (early 20’s) with active (noticeable) hair loss in the preceding months would be very concerning for shock hair loss. If one is in their 30’s and 40’s with no significant change in their hair status in the last several years the chances of shock hair loss will be less. This is further improved by being on Propecia / finasteride.

If one were to go ahead with a hair transplant surgery, we take all the above in to account and balance out the risks (shock hair loss) versus the benefit of (new hair growth).

We do overlap the “risky” areas where there may be future hair loss with additional hair. This is not necessarily anticipating shock hair loss but rather anticipating further natural genetic hair loss. So that as you age the transplants would naturally blend in with natural thinning. This is basically part of the global MASTER PLAN that we always talk about at New Hair Institute.

With respect to the technicians who assist with surgery, they are the ones responsible for dissecting the grafts and inserting the grafts. This is their MAIN job. They do their work better than any surgeon – which is painstakingly dissecting and separating each individual hair follicles under a microscope. It is a very detail oriented work that require years of practice. The transection rate under a good technicians’ hands are very low. Most of the technicians at New Hair Institute have more than 10 to 15 years of experience trained personally by Dr. Rassman.