Author: Dr. William Rassman

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Hair Loss InformationTraction Alopecia from Tight Eyeglasses? – Hair Loss Information – Balding Blog

Hello,

from 2010 until September 2011 I was wearing eyeglasses that were too tight, and I suppose the tightly fitted frames lead to a pressure-induced alopecia at both lateral scalp sides, decreasing the blood flow passing through the external carotid artery. I have attached a photo which shows the right side of my scalp, and which shows the reduced hair density.

Is this due to an ischemic process? How do I know if the alopecia is scarring and if this process is reversible? Up until now the hair hasn’t regrown. Thanks a lot

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I would think that it is almost impossible to reduce the blood supply enough in that area to produce ischemic changes. The fact that your hair is thin there could be the result of constant rubbing of your eyeglasses if they are as tight as you seem to think. Get glasses that don’t rub and see what happens. Give it 6 months to see if it improves.

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My Scalp Itches Like Something is Crawling On My Skin – Hair Loss Information – Balding Blog

I suffer from a very itchy scalp and hair loss. It feels like i have something crawling on my skin but i don’t. i do get spots as well which itch and scab over. i also have an underactive thyroid. Please help

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This could be a variety of things, from allergy to fungus to lice to other diseases. You should meet with a dermatologist who can give you an answer to why your scalp is itchy and why you’re getting scabs on your scalp.

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Hair Loss InformationMy Doctor Prescribed Nandrolone Decanoate to Treat My Hair Loss – Hair Loss Information – Balding Blog

Hi Doc,

I am 27 years old and I am suffering from MPB.My doctor prescribed me nandrolone decanoate and minoxidil 5% 2x application which worked well for 2-3 years but seems like its not working anymore for me. I am planning for making a switch on dutasteride 0.5 MG/day.

I would like to know if nandrolone decanoate really helps in treating hair loss. Nandrolone decanoate and dutasteride can be used at a same time?

Please provide some information on this.

Thank you.

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Nandrolone decanoate is an anabolic steroid and is not used or approved by the FDA for treating male pattern baldness (MPB). Anabolic steroids would likely accelerate your hair loss.

Dutasteride is not FDA approved for treating MPB, and I’ve written about the medication before many times. Some people are prescribed dutasteride (Avodart) off-label, but the proper dosage for treating hair loss isn’t clear. The only FDA approved oral medication for treating this is Propecia (1mg finasteride).

What you are doing and your treatment seem unorthodox. Please follow up with your doctor, address these issues, and get a clear explanation.

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I’m Having a Face Lift Done Soon – Can I Save the Sideburns to Transplant to My Eyebrows? – Hair Loss Information – Balding Blog

I am going to have a face/neck lift in the next few months. The skin on which my sideburns are will be cut out as part of the procedure. I wonder whether I could use those hairs to fill up my eyebrows? Could they be ‘saved’ by the surgeon temporarily for the hair surgeon?

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Face lift and hair transplant can be done with the extra hairs harvested from the face lift surgery. But it needs to be coordinated by a hair transplant doctor and be done on the same day.

So technically yes, the hairs could be transplanted to your eyebrows… but both procedures need to be organized so that the grafts are not kept out of the body for too long.

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Hair Loss InformationFUE Transection – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

One of your patients just checking in to say hi and ask a simple question:

Its been 10 years since your famous article on FUE (you link it frequently on this site)

How have your transection rates improved since then?

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Back when we originally defined this procedure and published it in a peer reviewed journal (see here), we classified patients in 5 different categories defining the difficulty in doing FUE and the transection rate. These groups still apply and there are occasional patients (under 10%) who are still not good candidates for FUE. In other words, the human physiology has not changed over time.

Some patients may NEVER be good FUE candidates. We still strive for improvements, and with Dr. Pak’s engineering and clinical background we have changed our technique with a much better instrument that we pioneered to minimize transection. We recently received a patent on this instrument. When we made the breakthrough years ago, we called it the FUE2. This technology combines injecting fluid into the wound around the punch simultaneous with the extraction. The actual instrument has an injection needle welded to it. This has allowed us to decrease our transection rate in most of the patients years ago that we called “FOX negative”. The instrument design also allows us speed in the extraction process. Thanks to these innovations, the procedure is more practical, more efficient, and just plain better than most other instruments available (at least in our hands). Note the quality of the grafts in this link. The grafts are beautiful shaped and clearly show no transection.

Transection rates of under 10% should be the norm and when the transection rates go up above this number, we address with each patient who is impacted by a less efficient process. We still occasionally perform our infamous FOX test, which is essentially a test of up to 10 grafts extracted and the transection rate examined in this test group so we can anticipate the transection rates in advance. Unfortunately, not many doctors offer this test and the world continues to believe FUE is the best way to go about surgery (without taking transection into the equation).

Worse still, many doctors may misrepresent their transection rates and claim numbers that are unrealistic in their hands, but for marketing reasons they make claims suggesting they are as good as the best doctors out there. I know of a few doctors that live in an illusion which reflects technical skills that are way beyond their reach… and we see their patients frequently in the office for a second opinion.

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My Doctor Prescribed Me Avodart When I Expected Propecia – Hair Loss Information – Balding Blog

Hi Doctor William Rassman. I was on a forum called hairloss talk, asking a question regarding my situation, and most of the users there told me to email and ask Doctor Rassman, as you are very prominent and reputable in hair restoration.

I recently visited my dermatologist regarding my hairloss, and after checking my hair he said I am showing signs of AGA, and said if I don’t treat it it will progress. From my research on the net, I figured he will put me on propecia. In fact he put me on avodart. When I told him its not fda approved for hairloss, and propecia is he said avodart is better and brings DHT down more, and propecia is nothing next to avodart. He told me to take it everyday for 2 weeks, then every other day from then on as it has a long half life. From researching on the net, many hair restoration doctors, rarely prescribe avodart for hairloss due to some dangers. whats your opinion on this?

I would love to come see you, but I live in Canada. do you think I should go see another doctor and get propecia? do you prescribe avodart to your patients? or propecia? in fact is avodart that much better than propecia?

Thanks doc, I would really appreciate a reply on your opinion. I know medical advice is not given over the net, but I just want your master opinion.

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Propecia (finasteride) is still the right drug of choice in this situation mainly due to the FDA approval, and the lower side effect frequency than Avodart (dutasteride). I have prescribed Avodart in select cases before, but usually only to poor responders to Propecia.

I don’t know where the dosage info your doctor came up with comes from (14 days of daily use, then every other day), as the dosage for hair loss treatment hasn’t been clearly defined. Avodart does have a long half life, so if you do experience side effects they will take much longer than Propecia would to leave your system. If you’re concerned about the prescription your doctor gave you, you can talk to another doctor for a second opinion.

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Are There Periods in a Man’s Life Where He is More Likely to Be Affected By Hair Loss? – Hair Loss Information – Balding Blog

I am very impressed by your site, a unique thesaurus of scientific knowledge and experience about hair loss and related subjects.

I want to ask Dr Rassman the following question: By your experience, have you noticed (statistically) that there are periods in a man’s life that he is more likely to be affected by hair loss if he carries the the gene(s)? Or “age factor” is a completely random thing?

it is said that men who grow older than 30, have indeed some hormonal changes. Macroscopically, body hair and facial hair can be more thick, regarding, of course the genetic factor

Is this a myth or something more? Thanx in advance

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Genetic balding takes most of it toll on men under 30. The advanced balding patterns often start in the late teens or early 20s and often these patterns are obtained prior to the age of 30. We occasionally see late onset of balding in men past 50, or we see balding appear when severe illness occurs. We know that drugs like Propecia can change the course of balding (slowing it down or stopping it completely), but it is still uncertain if the advanced patterns in the Norwood class 7 patients can stop the process if it is picked up early (age 19-22).

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Hair Loss InformationIn the News – Patients with Rapidly Progressive Alopecia Areata Have Good Prognosis – Hair Loss Information – Balding Blog

Snippet from the article:

Patients with rapidly progressive alopecia areata (RPAA) tend to show favorable prognosis regardless of treatment selected, according to research published online Sept. 24 in the Journal of the American Academy of Dermatology. Over a three-year period, Masaki Uchiyama, M.D., from the Tokyo Medical University, and colleagues retrospectively analyzed 1,030 patients diagnosed with AA.

The researchers found that patients with regenerated vellus hairs showed a significantly higher improvement or cure rate regardless of AA severity. Lower rates of cure and higher rates of relapse were significantly associated with early onset and lengthy duration. Regardless of treatment utilized, RPAA patients tended to show a good prognosis.

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Read the rest — Rapidly progressive alopecia shows favorable prognosis

You can read the study abstract at the Journal of the American Academy of Dermatology.

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Hair Loss InformationSir John Gurdon’s Remarkable Hair at 79 Years Old – Hair Loss Information – Balding Blog

Sir John Gurdon, the Nobel Prize winning biologist has the most remarkable head of hair I have ever seen on a 79 year old man. His hairline is better than mine despite being 50 years younger. He is known as “the godfather of cloning”. Is his incredible mane a coincidence or does he know something we don’t?

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Sir John GurdonAlbert Einstein and Ronald Reagan had great hairlines present throughout their lives, and Bill Clinton still has a beautiful head of hair in his mid 60s. Reagan’s hair looked great into his late 80s (I can’t find photos of him in his final years, but his hair might’ve even been the same into his 90s). Einstein’s hair is mostly known for being a wild mess, but the photos show he had good hair through most of his life. These smart people had enough blood supply to their brains to overflow into their scalp. That is what happens to very smart people.

Of course, I’m kidding. I doubt Sir John Gurdon has been hiding the fountain of hair youth, but his genetics allow him to maintain his hair well into his life.