Author: Dr. William Rassman

Hello Dr. Rassman,

I was wondering whether you thought that there was any merit in the following theory which explores the relationship between hair loss and progesterone/cortisol levels.

Thanks and keep up the good work!

Theories that reflect excess free radical damage are abundant. We really do not know enough about the free radical impact on hair. I would ask why some hair is impacted and not other hair. If the genetic issues that relate to defects in the formation of the hairs is explained by the missing progenitor cell theory, maybe there is more logic in the application of the theory. It makes for interesting reading and I would let the readership make up their own minds (read here: http://journal.frontiersin.org/Journal/10.3389/fcell.2014.00010/full).

I have a lot of thick dark hair on the nape area of my neck. If I were to have a large strip procedure, could I then have the nape hair planted via fue into the strip scar so I could wear my hair short?

You can do this, but you will have to wait until the scar forms and heals (6+ months). If you are worried about wearing your hair short and scarring, why not just do the FUE procedure instead of the strip as that will obviate a linear scar? Keep in mind that neck hair does not behave like scalp hair as it is not permanent in many men as they get older. Anatomically, the neck starts below the skull, so if your feel the scalp and the skull beneath, and then move down, the nape of the neck is encountered without the skull underneath it, just muscle. As I said above, ask your doctor about doing an FUE for the entire hair transplant.

I’ve tried taking Fin twice now and both times have developed chest pain, I wonder if this is coincidence or an actual side effect. Unfortunately I live abroad in a rural village, and don’t have access to medical care.

The first time I took 1.25mg each day for about 2 weeks, and then stopped because of the chest pain. The second time, about 3 months later, I took .625mg every other day, and developed pain after a week (4 doses).

The pain can appear at any point on my ribcage, most usually along the outside of my sternum where the pectoral connects. Commonly under my pec, just inside of my nipple as well.

I’m wondering if this could be the onset of gyno, although I haven’t experienced any nipple sensitivity or pain.

Finally, it’s worth mentioning that I go to the gym 4x/week and am taking a generic version of Fin produced from a pharmacy in Costa Rica.

What you are describing is very unusual and I don’t have the luxury of examining you in person or taking a detailed medical history. You need to talk with a doctor as the cause of your chest pain may be something more serious than a simple side effect of a drug. Finasteride can cause gynecomastia in rare cases but that should not cause chest pain.

This blog is great for answering questions always and thank you for that. Im a 30 year old male with thick hair wavy hair. I slicked back my hair the other day and saw that theres a part were it looks thinning. I went to the dermatologist and he told me that its a part that I’ve always have had and sometimes the parts look like there thinning because the hair going in different directions. Is this true what my dermatologist told me? He is one of the top in the state to let you know how good he is. I also took pictures with my iphone and parted my hair to look if the diameters are different in the hair from others I saw some that were diameter of hair thinner looking and most were not.. I told him and showed him and he said this was completely normal on non-balding man and that I was stressing out about nothing. Does taking pictures with iphone close up prove that if you see some hairs different form others you have miniaturization or could it be normal? Is it more accurate to do it with a digital microscope ? He told me I had no signs of male pattern baldness or thinning and I have a full head a hair. I was happy with the visit. I also told him about the Haircheck device and he said that he heard that device can be accurate but it could be normal even if you had a small amount different from the back donor hair like 6% could be normal for a non-balding man too. What percentage would be normal for a non-balding man with the hair check device from the donor hair to the hair in the front region? Thank you so much for always reading as many emails as you can and I hope to hear back from you soon! You can post this on your blog too.

You can always take photos with any good camera to see if there is a change in hair but that would be very subjective on how you take the photo and over a relatively short period of time, it may not have much value. Things like combing style, hair length, the lighting, the style or part of hair, the angle, etc. are significant variables that ten to confuse an objective viewer. We try to objectively quantify potential true thinning with the Hair Check device which will give a clear measurement when compared with the donor area, Microscopic devices to determine the degree of minaturization for comparison purposes, with analysis also helps region by region. These measurement are also variable and about 10% difference is within the margin of error but as the areas are very small, finding the same spot over and over again over months is not reasonable to document change. I don’t think most people would care about 1 to 2 % change in hair density or hair bulk. What meaning would it really have when no one can see it?

Finally when you part your hair, you will naturally see scalp when the contrast between your hair color and your skin color is high (e.g black on white). This present in normal, non-balding adults when you comb your hair. Many people comb their hair to take advantage of the natural part and if they are balding, exploit comb-overs to hide thinning. Yes, your dermatologist is correct, that a subtle change in hair growth direction usually shows the scalp.

Thanks for donating your time to this great site! I have been taking proscar for ages side affect free but lately I’ve noticed a few. I’m also in my 40’s now too mind you. Question is, how long would I have to stop to see them possibly go away? Also if you say a month or something, would that be enough time for me to start a catch up hair loss phase? Please let me know your opinion. I really appreciate it

This is something you need to bring up to your primary doctor or the doctor who prescribed you the medication. Side effects you are attributing to the medication may be something totally different and you may have other health related issue. If it is a sexual side effect, many men in their 40’s have sexually related issues just due to age itself – as high as 40% of men who are not on Propecia (finasteride).

Hi Doctor thanks for the great website. I’m currently still trying to pinpoint where the mature hairline exists.

Would you say the ex president George W. Bush, actor Matthew Mcconaughey (post wig/ transplant) and actor Jim Carrey have mature hairlines, this is of course without a personal examination by you. I’m sorry to ask you about celebrities but they are the only people I can really compare my hairline to without being creepy and staring at strangers hair.

I have seen in photos of Matthew Mcconaughey which showed a frontal balding pattern. Whatever he did, it reflects something that is difficult to analyze. Hollywood can create wonderful hairlines in movies and on TV that can completely obscure the absence of a hairline. Another possibility is a really bad photo that is not the most flattering. I actually met Matthew Mcconaughey in person and I can tell you he has not had a hair transplant. While I’ve never met the former president or Jim Cary, I would guess that neither of them had a hair transplant. Jim Cary has a Class 3 pattern on the Norwood scale.

Ronald Regan and Bill Clinton both had juvenile hair lines.

You can search my BaldingBlog (see upper right) for “juvenile hair line” to read about the numerous posts I’ve written. You can also look at this POST. Generally, it is easiest to see the highest crease on the forehead to determine if the hairline is mature or receding. That requires the cooperation of the person being photographed or can be seen if the person being photographed was excited enough to lift his eyebrows up.

Hello, I have a curious question regarding the medication finasteride for male pattern baldness. I visit your balding blog website, and noticed how amazing and smart you are when it comes to propecia. I have a question

Im curious when the testosterone increases from finasteride if it can speed up hairloss in the frontal area? So propecia could in theory speed up frontal hairloss while slowing down vertex/crown hairloss? Propecia also permanently increases receptor areas for dht? So in reality propecia could make hairloss worse it is possible?

I do not believe you analysis is correct. DHT blocks the 5 alpha reductase enzyme production which causes the hair loss in genetically prone men.

I am finding that there is a trickle of these types of questions. Propecia (finasteride) is prescribed for slowing down genetic androgenic hair loss. It does not cause more hair loss. I do not know why there is a belief that testosterone causes frontal hair loss. On men who take finasteride, they still produce healthy amounts of testosterone. Sometime, the testosterone levels increase when a person is on the drug finasteride.

I am 55 years old and started working out for the first time in my life a couple of years ago. I want to be healthier and found that my testosterone levels were in the low normal range. I had a full head of hair before I started to think healthy. I take supplements for working out to stay healthy, but I have been losing my hair for the past couple of years. If I am healthier, why would I be losing my hair?

We lose hair for a series of reasons. If you were mal-nourished or rapidly losing weight, you might precipitate your genetic balding pattern which could have been silent before you started working out. Good nutrition is important, but if your supplements contain any synthetic steroids (I do not know if they do), that would induce acceleration of your genetic hair loss pattern. Hair loss in men is fundamentally genetic and although some men do not ‘express’ their balding pattern (express is a genetic term), taking any form of steroids could be enough to bring on your genetic balding pattern.

I would like to clearly state that exercising does not cause hair loss. Natural over the counter supplements should not cause hair loss. The steroid factor from taking natural supplement is hypothetical. You could be just expressing your genetic pattern for your age (a bit late for a 55 year old).

On August 12th, you wrote a post about megasessions suggesting that the Asian patient would probably not be able to to get 6,000 grafts in one session. Please explain your logic.

A Caucasian with an average hair density would have 1250 hairs per square inch found in 625 follicular units which average 2 hairs per follicular unit. A typical Asian patient would have 1000 hairs per square inch found in the same number of follicular units (625) averaging 1.6 hairs per follicular unit.

This particular patient was measured by me to have 500 follicular units in a square inch, thus averaging 1.4 hairs for each follicular unit. In a FUT strip surgery, one would have to remove 12 square inches of scalp (from the strip) to get 6,000 grafts. In other words, to get 6,000 grafts from a strip surgery, the doctor would have to remover 12 square inches of scalp with a width of 1 inch and a length of 12 inches (imagine a school ruler sized area of scalp removed)! This is a very wide strip for very low hair yield of 9600 hairs from the targeted 5,000 follicular units (a typical Caucasian would yield 15,000 hairs) from that same strip size.

The issue of safety is the real issue here. What are the risks of removing a 12 inch by 1 inch strip from the scalp? In the hands of any surgeon, the main risk will relate to (a) wound closure, (b) wound healing, and (c) scalp necrosis. In some hands, this type of surgery might work when good judgments are used. All of these are huge risk categories for the patient and most of these complications come with significant infection that sets in after the surgery. I remember one patient who had a strip taken that was too wide. He suffered from Scalp Necrosis

The first time I saw him was about a month following the strip transplant. He presented with active necrosis and an infection of the wound. As he healed and the infection was controlled, he developed a very wide scar. With the help of Dr. Kabaker (Oakland Surgeon) and we put in a balloon tissue expander into his head and after 10 weeks of constantly inflating the balloon, we removed the scar successfully. He was lucky as his infected scalp could have killed him. The scar he ended up with was minimal. He was very grateful. I remember another patient who came to see me 6 months following his second session of FUE, bringing his total FUE count to 6700. He had poor growth and loss of much of his donor area hair. The grafts probably were taken too close to each other impacting (I believe) the blood supply to the donor area.

For this Asian patient, his scalp was tight and his donor density was poor. His balding pattern was a Norwood Class 5, which meant that we felt he could not achieve his goals of a full head of hair in one large transplant session.

What is the take-away here? Be careful and do your homework when checking out your doctor for any cosmetic surgical procedure. If something sounds too good to be true, get a second opinion. We are talking about not only your looks for the rest of your life, but possibly your life. This is true about any elective surgical procedure and hair transplantation is just one of the examples which I defined here.

Bloomberg News (8/13, French, Basak) reports that according to the National Institute of Mental Health, symptoms of depression “vary and can include feelings of hopelessness, extreme anxiety, appetite changes, insomnia or excessive sleeping, and suicide risk.” Sadly, “just half of Americans diagnosed with major depression are treated and only 20 percent are cared for according to practice guidelines, according to the National Institutes of Health.” ….. It “affects rich people, it affects poor people, it affects people across the spectrum.”

We see a very high suicide rate in the military and in teenagers, young people who have stress that they can’t handle. Most people know of someone or some family member where suicide occurred, a sad statement on how we recognize and manage this problem. In my 20+ years as a hair restoration surgeon, I’ve seen patients with depression who look to cosmetic surgery for the wrong reasons (to cure their depression). I can remember one patient who was scheduled for a hair transplant and I cancelled his surgery (on the morning he was to have surgery) and referred him to see a psychiatrist that same day! It was the right choice for him and he was treated. (He never ended up with a hair transplant surgery as it would have been the wrong choice.)

I also remember two patients who committed suicide because of depression where balding was the tip of the iceberg. I recognized one of these two individuals as severely depressed, and tried to get involved in his life by recommending appropriate treatment, constant follow-up and I had discussions with his family about the problem. This second patient was from the mid-west so meeting with him regularly was out of the questions and my many phone conversations just showed caring. After he committed suicide, his mother called me to thank me for my support, but clearly not enough was done for him. It was a very sad experience for me, a frustrating one, as I felt helpless.