Author: Dr. William Rassman

I am about to undergo Chemotherapy for breast cancer and I have been told that I will lose my hair. Is there anything I can do to prevent this?

We have written about a device called the Cold Cap before HERE

Many patients over the years have written to us about the successful use of the Cold Cap at preventing hair loss from Chemotherapy. You can review our previous posts on the subject. For reasons unclear to me, I have been told that many cancer oncologists resist this approach under the analysis that if there is metastasis in the tumor, the reduction of blood flow to the scalp limits the amount of chemo-drugs to the scalp skin. The value of not loosing ones hair seems far more advantageous to a remote risks that were brought up by some opposing doctors.

This is a review of a hair transplant surgery at the New Hair Institute and what is possible for a Norwood 5 patient.
This patient had two procedures totaling 4774 grafts. He still has about 2000 to 3000 graft extra reserve if he has further hair loss on his crown area where there is significant miniaturization. He should stay on Propecia/finasteride to slow down the crown hair loss which is an almost certainty considering the amount of miniaturization that he has in the crown. Needless to say a very happy patient!

After photos – taken September, 2006:

I am a medical student and was wondering how finasteride works to give people a fuller appearance of hair.

In the Journal of the American Academy of Dermatology July 2006, Volume 55, Dr. Vera Price summarized the action of finasteride as follows:

“Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

This is important, because what she implies is that the miniaturized hairs reverse. That is why it is so important to map out the scalp for miniaturization and to perform bulk measurements with the HAIRCHECK instrument. These two approaches used prior to starting finasteride (Propecia) gives us a baseline metric to determine the value of the treatment. I have seen people with miniaturization in the 80% range, reduce substantially to almost normal levels (under 20%). This is why everyone taking finasteride should be evaluated prior to starting the treatment by a doctor who understands this process clearly.

I am a 17 year old male. When i turned 13 I dyed my hair about 5 times, and bleached it once. The following year I began to lose my hair. You can see my scalp on the back of my head, not greatly, but very noticablly. The hair on top of my head is very thin now, and u can almost see through to my scalp. My hair has stopped falling out since then but the damage has been done. I have been to several doctors, and dermatologists, they all say it’s hereditary, since my father is bald. My questions are, if the hair loss is hereditary why did I start losing my hair at such a young age? If my parents and I consider hair transplantation am I guaranteed to have a full head of thick(er) hair? If we decide to have the surgery should I start taking Propecia to prevent any future hair loss? I would love nothing more than to have a full head of thick hair again. This has been a very stressful situation, being in my prime teen years, and entering my junior year of high school in September. I would greatly appreciate it if you respond to my message. Thanks for your time!

You are almost certainly too young to have hair transplants. Wtihout seeing you and examining you, I can not really understand what your hair looks like throughout the scalp. Seeing through the hair to the scalp means that you hair is probably very, very fine. This is a common look, something that my generation called a towhead. I would not be surprised to hear of balding in your family as 50% of men in their lifetime do have some form of balding. Some of your hair loss may be the results of the chemicals you put on your head when you were young. Before you start on a treatment plan, please read Miniaturization: Critical to the Master Plan for Hair Loss and develop a Master Plan for your hair. I can not really advise you without seeing you.

Dr. Rassman

My daughter has many bald spots on her head, we noticed this back in August of last year and it dosen’t seem to be getting better. I am at a loss as to what to do. I have had her saliva tested and put her on a vitamin and mineral regiment. She has also started to eat more vegetables at our urging to help with her problem. She is seven years old and has always been concerned with her appearance, I am very concerned that this will progress and affect her forever. Please send me any information that you think may help us.

Take her to a good dermatologist. Spots of hair loss are signs of something wrong like a fungal disease of the scalp or alopecia areata or a variety of other conditions. This is not the place for the amateurs (or even online opinions) and your daughter deserves a good professional opinion from an expert in person.

Dr. Rassman,

I have been a patient of yours for over three years now and I recently visited your office back in August. After seeing you again it was established that my hair loss had not progressed from last year and had possibly even improved. Unfortunately, over the past month, I have been experiencing non characteristic loss. When I am in the shower, I have never ending clumps of hair coming of my head and clogging the drain. Also, when brushing my hair there is even more loss. Dr. Rassman, this has never happened before and I have no idea what to do. Is it possible that the Propecia that I have been taking since November of 2005 has stopped working for me and my genes are taking over?

All of the loss has been occurring since I have been out of town on a job. I seem to even have some kind of infection on the corners of my lips. I am sure the two things are not related, but I figured I would tell you.

Anyway, is this a normal experience for someone on the drug as long as I have been? Should I take more of it? Is it possible for a person to lose all of his hair immediately? Could this be a possible hair cycle or allergy? Again, I have no idea what to do and what to expect. I appreciate you taking the time to read this and your advice/help would be greatly appreciated.

Thank you and looking forward to hearing from you soon!

Hair loss can increase from stress amongst many other things, such as the normal progression of hair loss that occurs in some men (even those on Propecia). As one of my patients, please come see me and let me see if your miniaturization has increased. We can get a baseline on the HAIRCHECK instrument by measuring your hair bulk now and then repeat it in a year to see, for future purposes, if you are continuing to lose your hair.

This is a review of female patient who wanted a more rounded (feminine) hair line. Sometimes it takes more than one surgery to give the perfect rounded shape. Dr. Jino Kim of New Hair Institute in Seoul Korea was able to accomplish the goal with one surgery!

QUESTION FROM THE PAST
I have been taking Propecia for just under a year with really no ill effects, and some good results. But in early November 2006 about 5 weeks ago I noticed discomfort and some swelling in my right nipple. I had a sonogram and was put on two different antibiotics for one week, each to no avail. The doctor thought it was mastitis or a staph infection. I had blood work done and all appears normal. I spoke with a surgeon today and he said I had Gynomastia and needed surgery next week. I want another opinion.

Can I simply stop using propecia and substitute with another treatment? Must I have the surgery? Please help thanks

It is very difficult for me to judge your nipple problem over the internet. My answer therefore will be in the general view, not specifically targeted to give you a medical opinion. If I were to examine you directly, my opinion would be based upon having all of the facts, which is simply not the case right now.

There is usually no rush to tackling even a small nipple mass in a young male when there is pain present. Stopping Propecia is a reasonable thing to do first and if the nipple pain is induced by the drug, then the pain might go away in a week or so. Ask your doctor why he feels that there is some urgency to the problem. Some men with breast pain from finasteride (Propecia) may not see it go away by just stopping the medication, but stopping it is a reasonable first step.

QUESTION FROM THE PAST Please help me – I’ve been suffering from hair shedding since Aug 2007. I was on the pill for 12 years and came off in august just after my wedding to conceive. I concieved straight away and am now 7 months pregnant. In Dec 2006, I was in hospital for a day with an infection which caused a hemorrhage. The shedding does seem to have slowed down now so losing about 25 after washes and I feel spiky bits all over my head. This has lasted about 7 months now and just wanted to know how long it usually last for and if it will stop? Will I ever get the thickness back in my hair?

I’m so depressed about this and would be grateful if you could help me. Thanks

You have many potential causes for hair loss, including:

• Pregnancy, which can cause hair loss that should reverse after about a year
• Changes in your hormones from the withdrawal of birth control pills
• Illness from the infection that put you into the hospital

It is likely that this process will reverse. You are not alone and the experience of others with this problem have been far from hopeless.

I started to lose your hair this July. About that time I also went on hormones, DHEA, and antibiotics. Could these medications have caused my hair loss. I recently stopped taking these medications and think that the loss may have slowed and some reversal may be going on. Is this possible

I believe that considering the short period of use and the known relationships between DHEA and hair loss, it is reasonable to expect that the hair loss you had might be related to the medication. You think that the hair loss is reversing upon stopping the medication so it is reasonable to expect that your progress will continue. You need to determine the status of your hair in and around your head, get the hair and scalp mapped out for miniaturization and if this is normal, that would make the process most probably reversible.