Category: Hair Loss Causes

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Hair Loss InformationDutasteride vs Propecia, Round 2 – Hair Loss Information – Balding Blog

Another Propecia question, this time from Thomas…

I have been on propecia now 9 months and have receded more and gotten thinner on top. Propecia either accelerated my mpb or did nothing for it. I am worse off now then when i started. I never used to have hair in the shower, on my hands, or in the sink..Ever since the 3rd month on propecia, it has not stopped. My head even itches now sometimes when it NEVER used to before. My question is can Dutasteride help me or because i had no response to Propecia, is it a waste of time?

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I do not know your age or family history, when you started balding, or what pattern you are heading to. This information is critical. Already you know that Propecia has not helped you (slowed or stopped the hair loss) so this is already atypical. It is possible that you have other than a genetic cause for hair loss. Thyroid disease and some other medical conditions can produce hair loss that will not respond to Propecia.

With regard to Dutasteride, there is no doubt in my mind that it is a better DHT blocker than Propecia, but it has not been proven to be by appropriately controlled studies. A few doctors who I respect have used it for genetic hair loss and they tell me there is significant benefit in some patients that do not respond to Propecia.

First and foremost, you need to have a competent doctor make the assessment. If it proves to be genetic hair loss, then using a non-FDA approved medication (called off label use) has implications for both you and your doctor. If you are in the California area, I would be happy to see you personally and make that assessment.

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Advanced Balding in Young Man – Hair Loss Information – Balding Blog

I am a 23 year old male with an extensive family history of balding. I am well on the way to follow my father and grandfather’s pattern. What can I do?

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I just had a patient of the same age and with the same problem in my office, so I thought it might be worthwhile to read what I wrote to him. I send comprehensive letters like this to all of my prospective patients out of respect. It is always an honor to be able to play such an important role in the life of a patient.

Here’s the letter:

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You have an unusual problem found in less than 1% of balding men. Your donor hair density in the rim of ‘permanent’ hair around the side and back of your head is higher than average (300 hairs/cm2 while the average is 200 hairs/cm2) but 1/3rd of these hair show miniaturization. This is the same process that goes on in the balding area on the top of your head and it should not occur on the side and back. When it does, it reflects a condition we have defined in the medical literature which we call Diffuse Unpatterned Alopecia. In essence, you have a process going on throughout the hair on your head, even the ‘permanent’ zone. Now with that said, your effective donor density of 200 hairs/cm2 (which reflect the sum of your hair count less the miniaturized hairs) is from a practical point of view, normal. But the fact that you have this process going on in the permanent zone means that the future of your permanent hair is uncertain. In my fairly wide experience, people who have had Diffuse Unpatterned Alopecia, have not experienced progressive extensive balding in the ‘permanent’ zone, but there is not certainty in your future. In determining your predicament, I would like to call your attention to some of the other elements of the examination I performed on you. Your hair is more coarse than most people, which means that the value of each hair is much higher than a normal person. There is a slight wave to your hair which means that it grooms and covers well with its strong character. Your hair is black and your olive colored skin provides moderate contrast between your hair and skin color, and although your olive skin offsets the dark hair a bit, it still calls attention to a lighter background which might require more coverage to get a full look.

Your biggest problem is the extent of your balding, which appears well on the way to becoming a Class 7 balding pattern (the most advanced pattern) and one that runs in your family. At the age of 23, you have a typical early appearance of this advanced balding process, but that balding process although mild in the top and crown of your head at this time, may respond well to the drug Propecia. You indicated your objection to using this medication to slow down or arrest the hair loss in the top and crown area. Your objections are over the side effects of the drug (rare and unusual). Considering your age, you have a good chance to get some reversal of the balding process in the top and crown area. With the diagnosis of Diffuse Unpatterned Alopecia that we found our your examination, I see even more reason to use the drug. I have seen fully half of the men who take Propecia see some reversal of the diffuse hair loss process in the ‘permanent’ zone, giving you two reasons to reconsider your position against taking this drug.

When dealing with a young man, I tend to be conservative, leaning on the drug treatment to slow down the balding process and for the maturity of the patient to line up with the extent of the problem. By saying this, I do not mean to be offensive, but young men are driven for now answers and often do not see themselves through the entire balding process which may take years. Transplantation, although a wonderful solution when appropriate, is the wrong answer for those who have not worked out a Master Plan with a good doctor that accounts for the worst case scenario of the balding process as modified by a transplant program. That is the dilemma before you and I at this time. You have to convince me that you understand what I know about your hair loss and what can be and can not be done about it. I must understand your maturity in dealing with a transplant program that will be with you the rest of your life. A good doctor/patient relationship is what I am talking about, something that is not easy to obtain in an hour visit to my office.

I am not firm against a transplant solution for your balding but because of the Diffuse Unpatterned element of your Alopecia, I need some comfort that whatever we plan is going to be the right plan for you. I want to speak with you again about the Propecia option and dive more into depth on the various subjects we discussed. We spent a great deal of time discussing the safety issues with Propecia, hopefully giving you more comfort in considering this drug as part of the long term treatment of your progressive hair loss problem.

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Hair Loss InformationIs Shock Loss Permanent? – Hair Loss Information – Balding Blog

In the interest of keeping things as private as possible, I have removed the Doctor’s name from this email I received…

Hi Dr. Rassman,
I read your recent comment about young guys under 30 years old who get an HT and are not on Propecia. I fit into that profile. I recently had a HT with [another doctor] and its 4 months post -op now. had a lot of shockloss of original hair post op and am really concerned now that I read your comment online [see: Hair Loss After Transplants]. Since I had sexual side effects when on Propecia, I had to quit it and cannot tolerate being on it.

I received a total of 3366 grafts in total. Am attaching Before Hair transplant pictures with this email and 6 weeks post op pictures. According to [my hair transplant doctor], he feels that the shockloss will mostly come back and eventually I will have good results. He recently asked me to take Saw Palmetto and see if I can tolerate being on it. Started taking 320 mg of Saw Palmetto twice a day recently.

Please advice what I can expect from the procedure. Do you think that I will permenantly lose a lot of original hair that has fallen due to shockloss for good? Or will it mostly come back?

I’m seeing growth in the 4th month but not sure if the shockloss hair is coming back or it is the new grafts that are growing in. To highlight my case, I mostly had diffuse thinning in frontal 1/4 of my scalp. The hair that was there was strong and had a thick shaft, there might be other miniaturized hairs, but looking at my pre-op pictures you will get an idea of the state of the existing hair follicle.

Thanks a lot for your time and effort.

My current regimen includes : minoxidil 5%, topical Spironolactone 5% cream from Lee’s, 3000 Mg of MSM, 2% Nizoral trice a week, Recently added : betnovate topical lotion, 320 mg Saw palmetto twice a day, Folligen lotion.

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I have had an opportunity to review your questions and photographs. For our general audience who are reading this, I will summarize the salient points.

You appeared to have a large surgical session with dense packing based upon the number of grafts reported by you. The frontal area appears to have been shaved for the procedure and the growth of the hair does not reflect the normal growth that one would expect in 3 months. This is a case of hair loss transplant shock in a young man, just as my previous responsive email reported to another young man. There is a possibility that the hair that you lost may come back. Most likely though, it will not return. Other medications have not been shown to be effective (like Propecia). In people like you, I generally try to cover the short term transplant period with half of the Propecia dose, even if it causes some drop in sexual performance just to protect the hair.

The good news however is that the new grafts that you had done should (hopefully) more than offset any loss you may have. You will know reasonably well at about the 7-8th month by comparing the two sides. The left side that seemed to suffer more of the reactive hair loss needs to be compared to the right side. If the hair loss was reversed, the densities of the two sides will be the same. Please drop me a line or send me photographs at the 7-8th month and I would be happy to give you further insights. Good luck.

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Hair Loss InformationFUE in Stress-Related Hair Loss – Hair Loss Information – Balding Blog

Rick asked…

Unlike the 62 year old man, I’ll soon be 48 & my loss started about the age of 25, gradually. Now, I am about a VI hair loss on this website’s Norwood Scale & will this new minimal hair transplant I saw on Ch. 4, Bruce Hensel, work for me ? I think the root cause(no pun intended !) is primarily stress. Many thanks in advance.

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Stress is one of the four causes of hair loss in the genetically prone individual. Yes, the minimally invasive surgery, the FOX™ Procedure (Follicular Unit Extraction) can work, but before embarking upon that route, plan on a visit to a competent doctor’s office. If you are in California or the New York area, we have easy access. I assume that since you referenced NBC Channel 4 News, you are local to the Los Angeles area. If you would like more information from me directed at you and your condition, please call for a free consultation or at the very least, send me a photo of your hair loss from a series of views. A good digital camera will work, or call my office at 800-NEW-HAIR or fill out the form on my website and we will send you a disposable camera.

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Hair Loss InformationTransplant in Diseased Scalp – Hair Loss Information – Balding Blog

Essie writes…

I have discord lupus and the scarring on my face I know can not be repaired. I also have hair loss in the very front top of my head and where there was hair, there is now scarred scalp. I just want to know if it is possible for even a little encouragement for this head of mine.

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If your disease is not active, then it is possible to use hair transplants to address the balding area. If the disease is active, it will attack the transplanted hair as it had the original hair. Sooner or later, the disease will burn out and then a transplant might become a good option for you.

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Hair Loss InformationTransplant in Younger Person – Hair Loss Information – Balding Blog

Dr. Rassman,
I am considering hair transplant but have a question that I cannot find the answer to on any website. What are the long term cosmetic issues associated with a younger person (I am 26) who has hair transplant surgery?

In other words, my hair has begun to recede to an NW 3 (approx.). If I was to have transplants, and several years later my hair line continued to recede, wouldn’t that make an unnatural and strange looking hairline? I.e. there would be transplanted hair at the very front, then further up the scalp there would be a zone with thin or non-existent hair, then there would by my natural hairline.

I hope I have adequately explained myself. Any info you could provide would be great.

Thanks,
JX

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This is a great subject, one that is important to everyone who undergoes a hair transplant. In essence, JX is asking, “How does the hair transplant fit into the changes that keep producing more hair loss?” Much of this material is covered in a book I wrote, The Patient’s Guide to Hair Restoration. You can get a free copy of it by calling my office at 800-NEW-HAIR, or visting our website.

Everyone will lose hair to whatever their genetic pattern will eventually be. Those with advanced balding, usually develop indications of their pattern by the mid-twenties. Most will have their pattern evident by the time they reach 30. It is rare that people will start with hair loss beyond their 30th birthday so a good examination by a competent doctor will show the signs of ‘miniaturization’ on microscopic examination of the hair throughout the head. JX reports a Class 3 pattern hair loss at 26 years of age. Assuming that the pattern will not progress much further (that there is no ‘miniaturization’ of the hair in the mid head or crown), it would be safe to assume that he will not develop an advanced hair loss pattern and that a hair transplant program will never make him abnormal as he progresses slightly from this pattern. If he wishes to get the hair transplanted in the front to return his hair to its normal mature position, he can do this easily. If he uses the drug Propecia, his ability to slow down or stop the hair loss is good. There is now 8 years of good data on Propecia’s ability to slow the hair loss down, but only time will tell us if the medication can continue to be effective in the long term.

I generally tell my patients to create a Worst Case Master Plan which assumes that progressive hair loss will occur. With that Master Plan, you can estimate what might happen and plan for it both economically and socially. The one evident thing to point out is that once a hair transplant process is started, it should be followed with more transplants until the loss stabilizes or it takes you to another hair loss pattern that is found normally in nature. Frontal hair loss only commits the patient to frontal work, not to crown work. Worst, worst case is that with transplants in the front, the balding in the back will reflect what many men have naturally: a full-haired frontal look and a balding or thinning crown. This last scenario is JX’s worst case. If he wishes to see his worst case, he can visit me and look at my before pictures. I had a normal full front of thick hair (naturally) and a bald crown (which I elected to transplant but could have left it alone as an alternative option).

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Hair Loss InformationHair Loss After Transplants – Hair Loss Information – Balding Blog

I have heard that people who have transplants get more loss because transplants produces hair loss of normal hair. Is this true?

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First let’s answer this question in the typical young man, for the answer differs slightly than the older men. If a man (under the age of 30) has a transplant and does not take the drug Propecia, the normal course of hair loss that he could expect without the transplant could occur in a shorter period of time (e.g. two years of hair loss in as short as 6 months of time). To understand this lets focus on the causes of hair loss for a brief moment. The four causes are (1) hormones, (2) genes, (3) time and (4) stress. The stress of a surgery in a genetically impaired patient who is undergoing active hair loss (most young men under 30) are being attacked by hormones actively. In guys over the age of 30 when time has already taken its toll and the hair that was going to die, did die, the sensitivity to hair loss is less. In the days before the drug Propecia was released, these men under 30 lost enough hair from a transplant that they had to play ‘catch up’ (which meant that some hair was lost earlier than they expected and this required more transplants to treat). The drug Propecia has almost completely stopped this from happening and we use it on most men to prevent it from happening today.

In men who are older, the risks of reactive hair loss go down, as the hormone attack on the susceptible hair follicles have already done their damage. I have seen far less reactive hair loss on men over 30 and the older the man gets, the less risk there is to reactive hair loss.

In women, the problem differs. Some women, whose hair is easily stressed, could experience a temporary hair loss from a transplant (a minority) but in my many years in the field, I do not recall any female that had permanent hair loss from a transplant.

Previous hair transplanted grafts almost never suffer from reactive hair loss (far less than 1% of transplanted patients).

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Hair Loss InformationHair Loss and Chemotherapy – Hair Loss Information – Balding Blog

I am African American, and was diagnosed with cancer a year ago (Hodgkin’s). I was told that Chemo would definitely leave me bald. I was one of the lucky ones that did not go completly bald, but my hair sheded a lot leaving it fragile and very very thin. Now that I am cancer free (praise God), I would like to know if there is anything I can do to grow my hair back. I also have anemia, something I’ve had all my life (not cancer related). I have not had Any chemicals on my hair in about seventeen months. Can I use perms again?

Thank you for your response in advance, for this is a very touchy and hard to speak on subject with the oncologist, I think they feel my concerns are vain.

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Unfortunately, some doctors are still in the middle ages when it comes to hair loss, but your oncologist should not be in that situation. Curing cancer is very important and getting back to normal is just as important. Chemotherapy may cause hair loss and sometimes it takes a couple of years for the hair to return to normal. You should be extra-gentle with the hair while you are waiting it out and not use chemicals that might damage the hair while it is fragile. Hair thickeners do not cause much of a problem. If your African hair allows the use of thickeners, you can increase the fullness of each hair shaft with their use. Your hair situation may be still the result of other elements that followed your treatment. Anemia is known to contribute to hair loss as is thyroid problems so a good evaluation of these other systems are important. Hormone assessment is also important, particularly if you are female. If you are a male, Propecia may have value.

Take the time to get you doctor to sit down with you and review every factor that may contribute to hair loss in your case, based upon his/her experience. I am sure that he/she sees this problem often so do not be shy or embarrassed about talking about it.

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Hair Loss InformationAfrican-American Female Hair Loss – Hair Loss Information – Balding Blog

Here’s an email I just received today…

Dear Dr. Rassman,

I am an African- American female, aged 62, with pattern baldness around my hairline. I would like to know if the “new hair” will grow and how will any chemicals, ie. straightners, dyes, etc. might affect the transplanted hair. I would also like to know where and how I can schedule an appointment for consultation ASAP. I have been using Rogaine but I am still compelled to wear wigs to look my best…HELP! I am VERY interested in getting this procedure and I have the blessing of my husband of 40 years!

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I have done work on many African American females. As you may know, frontal balding is common amongst African American females largely because of the combined effect of pigtails that were used for styling in their youthful days as well as the abuses with chemicals, ie. straightners and dyes. First, a good examination needs to be done to separate the effects of chemicals and pigtail styling (if appropriate) to the female genetic hair loss. Then, a complete examination needs to be done to make sure that other medical conditions are not the cause of the hair loss such as thyroid disease, hormone imbalances, anemia, etc. There are a series of blood tests that can rule this out.

My recommendation is to make an appointment first (if you wish to see me, ask for me by calling 800-NEW-HAIR). The consultation is free.

Thanks for the good question.

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Hair Loss InformationHair Loss in the Mature Man – Hair Loss Information – Balding Blog

Reader Tom asks…

My hairline has been receding for a number of years, I am now 62 and recently had a heart attack. It seems to me that the hair loss has accelerated since that trauma. My hair now has sort of a trough down the middle that was not there before, but it was thinning. My question is, Can a heart attack cause acceleration of hair loss and can hair replacement techniques be employed to reverse it? Thank You

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Hi Tom, thanks for writing.

There are generally four causes of hair loss in men. Genetic inheritance and male hormones are the two most important. Time and stress are the other two. Typically, genetic hair loss occurs well before 35 years of age, and in most people it slows down with time. There are some older men who start showing the hair loss over the age of 45, although this is more the exception to the rule. Don Ameche, a popular film actor in the 1930s and 40s, was a hairy sex idol even at the age of 50, but was bald at the age of 75 when he had a prominent role in the movie Cocoon. So, he had an ‘expression’ of his genetic balding late in life. Your heart attack certainly brought on ‘STRESS’ and with a delayed genetic expression, probably precipitated your hair loss. I have seen this in illness or even divorce, both of which are heavy stress induced initiators for hair loss in the genetically prone man.

As your hair loss is recent, I would probably recommend that you go on the drug Propecia, because continued hair loss is possible. This drug may slow or stop the progression of the hair loss and it might even reverse it. If it does not do the trick, then a hair transplant works wonderfully.

Hope this answers your question.