Author: Dr. William Rassman

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Hair Loss InformationI Have a Full Head of Hair and I’m Constantly in Fear of Losing It – Hair Loss Information – Balding Blog

I have started worrying about losing my hair. Until recently I hadn’t worried about losing my hair since my temples receded slightly as a young man. I had no reason to believe I was losing my hair. Since I have started worrying (triggered off by the fact that I am about to turn 33 and feel that as a hairy bodied man, I must start losing my hair soon) I have started to spot signs of losing hair.

I have looked at the hairs from the top of my head and they seem to be finer than the hairs at the back of my head. However, I have no way of knowing whether this was always the case. The hair seems a little thinner in the temples and doesn’t seem as thick overall as it used to but I am aware that hair naturally thins over your life and this isn’t necessarily MPB.

Basically this has become a problem for me because I can’t stop worrying about it and constantly check my hair, look for information on the internet, and stress out. If you saw me you would think that I was worrying about nothing – I have a full head of hair at 33 and as such am unlikely to go completely bald, if at all. Also, balding in older men is often part of the aging process so I am effectively worrying about getting old. Am I just being neurotic?

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If you’re not actually seeing any hair loss, but THINK your hair MIGHT be getting thinner up top, the only thing I’d recommend doing is getting your hair bulk analyzed with the HairCheck instrument. Beyond that, stressing out and worrying about maybe losing your hair might actually cause hair loss due to the stress. I hope I didn’t stress you out more by saying that!

There’s no point in being anxious about possibly losing your hair, especially since you’re in your 30s and aren’t seeing loss by now. Most men that are destined to lose hair due to their genetics will start to see the process starting in their 20s.

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Hair Loss InformationI’m Losing Hair at the Temples, Sides of the Head, and Nape of the Neck – Hair Loss Information – Balding Blog

I have dramatic hair loss these last three months. Also on sides and behind the head on the neck (not in donor area). Also having too much dandruff and also losing hair on the temple.

Can dupa cause so much dandruff? Can hair loss on sides be caused by aggressive MPB? Can any chemical or toxin cause DUPA by consuming it once? Thanks for answers!

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Diffuse unpatterned alopecia (DUPA) is unrelated to dandruff. Male pattern baldness (MPB) does not include hair loss on the sides of the head. I don’t know that you even have DUPA. There is nothing I can tell you other than what you told me. You need to see a good doctor to give us an opportunity to make a diagnosis.

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Could I Be Allergic to my Chemical Hair Relaxer? – Hair Loss Information – Balding Blog

Hello,
I am experiencing hair loss in the crown of my head the size of a quarter. I am an african american woman. When I keep my hair braided with no chemicals, the hair grows back, so I know that it has the ability to grow. When I put a relaxer on my hair, I experience itching from within in only one area, then a month or so later the hair will fall out, but it only comes out in the same area. Could I be just allergic and sensitive in only one section of my hair. What do you recommend?

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Yes, an allergy would be highly probable. It might also be a chemical burn. I have no suggestions other than speak with your stylist or your dermatologist.

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Hair Loss InformationWhy Does Propecia Eventually Lose the Battle to Genetics? – Hair Loss Information – Balding Blog

Dr. Rassman, hi again.

I’m a long-time follower and fan of your blog. Besides enjoying the quality of the information you share, I really admire your realistic and down-to-earth approach when making comments about new treatments and current research. Some people consider your view to be pessimistic but I find it downright sincere. Thanks for the great job.

My question today refers to something I find in your comments quite often: the idea that even if someone has been on Propecia for quite a while, he will eventually lose the battle against hair loss. Now, assuming my understanding is correct, Propecia will keep DHT levels low for as long as the patient takes it, correct? If that’s a fact, why do we eventually “lose the battle”? Is it because the % of DHT that is not blocked by Propecia is enough to eventually affect the hair we retain or is it because besides DHT, there are other root causes still unknown to us?

Thanks a lot, Dr. Rassman!

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Propecia generally impacts only 70% of the DHT by a process called competitive inhibition. This means that the drug competes with DHT at its receptor site. We really do not know much more about this competitive process, but we know that some people get great responses from the drug at the 1mg dose, while others do not. I think that the sensitivity of the receptors varies as the genetic process advances.

I have discussed apoptosis in the past, which is cell death, and this hits the hair follicles at the end of their lives. The drugs can not give back the life that the process takes away. Take a look at the various posts in the past that discuss apoptosis here.

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Hair Loss InformationCan a Man Have Hairline Lowering at 20 Years Old? – Hair Loss Information – Balding Blog

Hello Doctor,

I’m a 20 year-old male with what I consider to be a high hairline (7cms from brow ridge to hairline). I know it falls between the male average of 6-8cms, but I have rather effeminate features that cause it to look disproportionate.

I recently talked to a highly regarded hair transplant specialist in my area to inquire about lowering my hairline with a hair transplant. He told me that my hairline was fine, and if I did go through with a transplant it would look fake and I would be very unhappy with it. Is this true? Or is it just because of the risk of further balding later in life?

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Decisions like this are made between the doctor and the patient. As for whether any surgery would look fake, I suppose that depends on the skill of the surgeon. But if your doctor is recommending you not have a procedure, I’d defer to him. If you want a second opinion, I am unable to give you one over the internet.

I am generally averse to doing any hair transplant or hairline lowering process on someone who might be balding in their future. At 20 years old, it probably wouldn’t be in your best interest.

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Hair Loss InformationA Few Weeks After Switching from Finasteride to Avodart, I Saw Major Shedding – Hair Loss Information – Balding Blog

Hello Doctor,

My question is: Ive been taking proscar 2.5 mg for a while with good results, after some time i felt that it wasnt working that good anymore. Regardless, one day i visited a local hair surgeon and after a brief talk about surgery the discussion moved on to hair medications, which he told me that i should switch to avodart (which he’s taking as well) so i did.

The first few weeks was awesome, after that i am experiencing major shedding which continued for the past 2 months (i’ve been on it for 2 1/2 months) so i dont know whether to switch back to finasteride or wait to see what happens with the avodart?

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Honestly, you need to ask your doctor. This is a prescription medication that I did not prescribe to you. I can’t tell you whether you should switch between medications. Sorry.

avodart, dutasteride, finasteride, propecia, hairloss, hair loss

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Hair Loss InformationBoard Certification in Hair Transplantation – Hair Loss Information – Balding Blog

Hi Doctor Rassman,

I’ve been trying to make sense of all the internet literature that states that “Board Certified” by ABHRS is not technically certification by medical standards. What would be the difference if ABMS were to include ABHRS? Would that keep incompetency to a minimum or make me safer?

Other statements made by AHLA such as, “the AHLC uses remarkably outdated information that is dangerous so avoid them etc.” It’s hard for me, to get a real confident feeling, not knowing how to determine whether I’m safe in my decision.

Thank you very much for your time and professional opinion

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Hair transplant surgery is NOT technically certified by medical standards. In the United States there are 24 approved medical specialty boards that are overseen by the American Board of Medical Specialties (ABMS), a not-for-profit organization. Certification by an ABMS Member Board has long been considered the gold standard in physician credentialing. To be ABMS board certified means that the physician has undergone formal educational and clinical training at a medical institution after earning their medical degree, and has successfully passed a level of competence via written or practical or oral examinations. I (Dr. Rassman) am ABMS Board Certified in General Surgery and my colleague Dr. Jae Pak is ABMS Board Certified in Emergency Medicine.

Hair transplant surgery is not a part of the ABMS so there can not be any physicians that are board certified as a hair transplant surgeon. This is mainly because there is no formal training or credentialing in hair transplant surgery. There is no standard curriculum. There is no oversight or direct review of the quality of the work being done. Unfortunately, there is no ABMS sanctioned facility to enroll and learn hair transplant surgery. To date, the only way to learn how to perform hair transplant surgery is to read a book, attend a seminar, or become an apprentice to a private practice hair transplant surgeon. Even ABMS board certified plastic surgeons do not receive training in hair transplant surgery as part of their formal training.

In the mid-1990s the American Board of Hair Restoration Surgery (ABHRS) was formed by a group of hair transplant surgeons to create an organization that could independently certify hair transplant surgeons. But the ABHRS does not monitor doctor’s training quality and once the testing process is complete, they do not have any authority to enforce any form of discipline. In states like California, doctors are not allowed to call themselves “Board Certified” if the only certification they have is from the ABHRS or other non-ABMS approved boards. They must qualify which board they are claiming.

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Hair Loss InformationDo Hairs Within a Trichophytic Closure Grow At the Same Rate as the Newly Transplanted Hairs? – Hair Loss Information – Balding Blog

Hello Doctor,

I had a hair transplant with the Trichophytic closure method, I was wondering, does the hairs within the scar take the same amount of time to grow through the scar as the newly transplanted ones?

My scar looks good..however, I’ve noticed some small patches where hair hasn’t grown through yet.

Thanks again for this fantastic website

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After a hair transplant surgery you may experience hair loss around the donor area with or without trichophytic closure. There can even be large patches of hair loss. The hair loss is temporary and it usually grows back after several months and it can take as long as a year. Transplanted hair takes several months to grow as well (up to one year). The hairs in the trichophytic area should grow at the same rate as the recipient area hairs.

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Hair Loss InformationHow Long Does Shock Loss Last? – Hair Loss Information – Balding Blog

I had a hair transplant done 4 weeks ago and noticed i had thinned considerably on the front side of my scalp. I hear this “shock loss” process is a temporary stage.

How long would you say that this “shock loss” process will end?

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Shock loss following a hair transplant usually occurs within 1-4 months of the surgery. The process might be temporary, but the results are likely permanent (the hair won’t regrow).

I just wrote a blog post about shock loss last week that explains more about ways to avoid it and why it occurs.

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Where Do the Temple Peaks Come From? – Hair Loss Information – Balding Blog

This is probably a stupid question but your blog popped up in Google when I search the subject and figured you probably would know the answer. Does every guy have those “triangle points” or whatever they are called kinda by the eyes? I have seen some guys with a full head of hair without them and some guys that are slick bald on top but have really full points. Even some guys with just one. I never really noticed this before until someone at work was “lined up” at the barber and had crazy designs put in his. I don’t have them nor do I think I ever did (I kinda have some on one side I guess).

I am not bald by no means even confirmed by my dermatologist. Id ask them this question but I don’t go back in there for months for my check up. Anyway I know its probably stupid but I was just curious as I dont think any of the guys in my family have them, but I see all kinds of combos throughout the day. Maybe its just genetic makeup like hair color or fine vs coarse hair. Thanks for your time.

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Actually, this is a good question. There are two areas where people have peaks in their hairline. Both men and women get them, because these peaks (temple peaks on the sides and widow’s peaks in the center of the hairline) evolve from a concave juvenile hairline that is present in all children of all races. By children, I am talking about those boys and girls ages 5-7. As these children age, there are changes that happen as the hairline recedes either upward (in the center) or back (on the sides). In many men and women, the temple peaks are often left behind as the hair from the juvenile hairlines recede.

Take a look at Ronald Reagan as a young man here. What you will see is an eroded central hairline with the mid-portion slightly lower than the sides of his hairline. Please note the temple peaks. Now if you take a look at a later photo of President Reagan, you will see that these prominent temple peaks are mostly gone. There are some men who retain their temple peaks no matter how bald they become. I have patients with a Norwood class 7 hair loss pattern who retained their temple peaks even after they lost the majority of their scalp hair.

So to answer your question, temple peaks evolve in many men from the young 5 year old hairline and they may keep it their entire lives, or lose part of it or even all of it as you age. I just wrote a paper on this very subject, which will be published this week in the Journal of Facial Plastic Surgery.