Category: Hair Loss Causes

I read your post on Aug 13, 2014 on how Asian men have low density of hair. How successful is hair transplant in Asian men who have low density of hair?

Asian men usually have dark black hair on fair skin giving them a high contrast that makes thinning stand out. Their hair is also straight and not wavy which does not cover the thinning as well. These factors are not as favorable when compared to blond, wavy hair on fair skin or dark curly hair on dark skin. Med with fine hair require more hair than men with medium of coarse hair. Asian men don’t have the high hair density of Caucasian males.

However, we work with what we have and we have great results. It is more about managing expectations and individual goals. The following photos are of a Norwood 3a/ 4a patient who was in his early 20’s who looked like he was in his late 30’s with his hair loss pattern. While he may not have the full density, his styling and 1700 grafts provided a permanent front hair line and a new frame to his face. He looks his age.

I have been taking Propecia since my early 20’s and I am now 39. My crown was thinning back in the day and that’s what inspired me to start the drug. My brother is totally bald but my frontal hairline seems to be in near perfect shape all these years later. I am considering stopping taking it because I’m worried about the long term effects and I think as I age my hormones may change and I’ll develop issues from it. In your humble opinion at this point do you believe propecia is keeping my hairline intact? I’ve read that propecia rarely works on hairlines and I’ve heard you say it’s a tug of war between genetics and propecia. I just think I wouldn’t experienced some form of loss by now. The crown is ok but not what it was 6-7 years ago. You thoughts?

Please speak with your doctor for these issues. In general if you stop Propecia you can ‘have catch up hair loss’ where the hairs you kept or regrew over the time you took Propecia, may fall out on stopping the medication. Long term use of Propecia from studies show no adverse effects. There was a study that show high dose (finasteride 5mg) can even lower the risk of prostate cancer and many doctors believe that this benefit extends to the 1mg dose, but this particular point was not studied and is just conjecture.

Hi, I’m wondering if the change in skin colour after hair/eyebrow transplant is ever permanent, I had eyebrow restoration 7 weeks ago and the area is still very pink/red. Does it completely return to skin colour eventually? Whats the longest it can stay discoloured for?

Skin or scalp can have some color changes after a hair transplant or eyebrow transplant surgery. The skin can look a little red but this usually goes away after several days, weeks or to the extreme to several months. Every person is different and every surgeon’s techniques may be different. Please follow up with your doctor.

Hey doc. Love your work!!

1) Why so sceptical over PRP when there are so many pics, videos and documents online supporting it as part of the overall treatment for baldness. Heck there’s even an article on the ishrs.org website so I’m guessing there must be something in it.

2) Assuming all the research into PRP was true then would it make a good proscar replacement for people with ‘side effects’.

3) Depending on the baldness scale / category one fits under is it possible that you might never have to take drugs again? I guess what I mean is that if your body is always producing dht does that mean after a while all your hair will eventually get effected or is some hair safe?

4) I once spoke to a guy at a Clive Clinics who said if you don’t take proscar each day it’s a waste of time. The doc who prescribed it countered his opinion by saying although it might not be perfect less dht is being produced by your body so it must slow down your hair loss. I take it twice a week What do you think?

Thanks heaps!!!

PRP (Platelet Rich Plasma) is hype without good science behind its value on hair growth. Doctors make money offering it. Photos or videos on line do not prove anything. There’s documents, photos, and videos of aliens here on Earth but that does not mean it’s true. I need to see good science before I recommend it and try to cash in on it. It’s not that I’m a skeptic, but maybe it an ethical decision. I am just maintaining a scientific approach in expressing my opinions on BaldingBlog. I have been known to use Google and read Wikipedia for information but I also know that what I read may not be accurate. I encourage our readership to do their own research. But if you’re asking for my opinion on hair loss topics, I attempt to give you a sound clinical, scientific based answers.

Stopping Propecia for something that does not work does not seem like a reasonable choice to me, but you are in the driver seat with the decisions you make. I do not believe that what you said as ‘gospel’.

I’m a medical student from New York that has been taking propecia from 18-26 years old. Stopped for about 6 months and noticed growth of body hair, especially facial, in addition to additional muscle mass growth, increased libido, and decreased brain “fog”. The lack of facial hair wasn’t apparent to me as I attributed the smooth face to my own luck (even though my entire family has relatively pronounced facial hair) rather than the propecia. Learning more about hormones I got off the drug, lost some hair but lost body fat around my buttocks, face and thighs and gained muscle mass without change to any daily routines (not active in the gym or any exercise besides walking). I’m sure loss of body hair isn’t a side effect most men would consider negative, you shave far less and the embarrassing strands of chest hair are repelled, a major convenience that I can’t see many men reporting or taking issue with. Thank you for your time.

In my 23 years in the hair restoration field having seen many men who were on finasteride Propecia, I have come across a handful of men (less than 10) who complained of less body hair growth, and brain fog. One to two percent of the patients speak of sexual side effect, consistent with reports by the drug company Merck. I have also seen many body builders who started, stopped, or restarted Propecia without any reported changes in muscle mass. So what you describe is not very common.

I do believe what you’re saying and I have treated thousands of men on this drug, Perhaps you can send us your pictures (on and off Propecia) and with your cooperation it may be publishable in a medical journal as a case study.

We now know that there is a gene that contributed to Alzheimer Disease. It is called ApoE4 and is found roughly in 15% of the population. Although males carrying the gene are only slightly more likely to get the disease, women had a 180% increase in the incidence of those carrying the gene. The gender specific nature has not been explained. Why am I writing this for a Hair Loss Blog is because we all have parents and you might find that this information becomes valuable if your parents are over 60 year old.

Dr. Rassman,
I was looking at Dr. James Harris’s website and noticed some research he has done with new instrumentation for his SAFE System. I e-mailed him and asked if he planned to try to get this published and I have not heard back from him. Is there any data on the industry average of transection rates? Here is some of what his research stated according to his website:

“In the study by Rassman, Bernstein, et al, 20% of patients were “not” good candidates for FUE due to the high rates of follicle damage. Dr. Harris’ Safe System is being used by many doctors as a tool for FUE. It uses blunt dissection. It was this technology, that was adopted by the Artas® system and incorporated into their FUE protocol.

“Discussion/Results: Over 40 patients have been subjects of this new methodology and instrumentation. The range of grafts extracted in this series has been between 50 and 1400 grafts. Transection rates of hair follicles have ranged from 0% to 8% thus far. All patients so far would be considered candidates for FUE using the SAFE System, as the follicle damage rate is less than 20%. The rate of follicle extraction has been as high as 300 grafts per hour. A test case on the extraction of 20 grafts each on an African American patient and a gray haired patient revealed a 0% transection rate.”

Conclusion: The SAFE System has the capability to expand patient candidacy for FUE to virtually 100% of patients, including African Americans and those with gray hair.

Source: http://www.hsccolorado.com/Research.aspx

Cheers

Dr Harris is my friend and he is a great surgeon. He has devised a powered blunt punch technique which seems to solve the transection problems in the hands of many doctors. There is no data on the industry average of FUE transection rate. My publication with Dr. Bernstein is the only publication I know of and in my opinion the true industry average for transection is probably more than 10%. It’s just that nobody will ever admit to it since it will kill their business. In my practice with Dr. Pak (in which he performs most of the FUE procedures), our transection rates range from 3 to 10% (depending on the individual patient’s hair/scalp characteristics). In the past, we have disqualified patients who were poor candidates (produced transections above 10%) as we test them prior to the scheduled FUE surgery.

In my humble opinion, there is no such thing as 100% success or 0% transection rate. Only thing 100% in this world is death and taxes. Transection rate is not necessarily the golden standard, as damage to the hair grafts occur when they are removed and probably cause more damage than a transection rate of 10%.

I have a question about DHT that just occurred to me.

DHT is, at this time, considered to be the main cause of male-pattern baldness. If this is really the case, could you please explain the following …

DHT levels are highest in early adulthood and gradually decline with age, yet most men do not suffer from hair loss until later in life (when their DHT levels are much lower).

If DHT is really the culprit of hair loss, why does most hair loss in men seem to occur about the same time that DHT levels are declining and stabilizing? It really makes no sense to me.

Your statement is false in that GENETICS is the main cause of male-pattern baldness (MPB) otherwise referred to as genetic balding or androgenic alopecia (AGA) and when you have the balding gene, it is the hormone dihydrotestosterone (DHT) that causes the hair loss process when the gene for hair loss is present. There may be other undiscovered hormones and mechanisms but DHT is the one hormone that we know about at this time.

In addition, if you have the genes for balding, most men lose most of their hair in your 20s and early 30s. Of course there are exceptions to the rule, but chances are if you ask a bald man (e.g. Class 7 pattern of balding) when he started to lose his hair, he would likely say in his late teenage years or his early 20s.

DHT is a byproduct of testosterone metabolism and it is true that young men have more testosterone and DHT than older men but testosterone or DHT levels don’t cause the balding process… GENETIC predisposition does. Perhaps many people are confused on this fact because it’s sort of like a chicken or the egg dilemma. Does DHT trigger the balding, or does genes trigger the balding? (Answer=genes) Men start balding process in their 20’s and 30’s mainly because that is when their genetic destiny is triggered by DHT. If a man did not have testicles, he would not make DHT and therefore, he would not bald even with the gene for balding.

It is thought that about 50% of men have the genes for some degree of male pattern balding. About 7% of the men have total Norwood 7 balding. The life of a hair is dependent on the genetic timing of each hair’s life and in the pattern of genetic balding. In some patterns, the frontal hairs my die first (in men), in other like me (Dr. Rassman) the hairs in my crown died and my frontal hairline was never impacted (because that was the results of the genes I inherited). The life of a hair follicle relates to how many cycles it has (probably programmed genetically) and the death of that hair follicle occurs when the number of hair cycles is reached. So, for example, if a hair located in the front of the hairline has a 3 year hair cycle and the genetics have programmed 10 hair cycles, then that frontal hair will die when that person reaches 30 years of age. This is impacted by the presence of DHT in genetic “death” of a hair follicle (apoptosis). Without DHT (which can be partially blocked by finasteride), the number of hair cycles may actually increase beyond its programmed death. This is probably a simplistic way of explaining the number of hair cycle that exist for all hairs on your head, but the main point is that GENETICS determines hair loss and DHT is the precipitating cause when the number of genetically programmed hair cycles are reached. Because it is the genes that cause hair loss, the presence of DHT impacts only those genes when the per-programmed hair cycle is reached for each hair.

For men without a genetic inheritance of male pattern baldness, it does not matter how much DHT you have (or don’t have), balding will not occur. The classic case that exemplifies this is a case of twins, where one of the male twins was castrated in his youth for mental illness (a situation that shamefully occurred in the early part of the 20th century). The story goes that the non-castrated twin (who was bald) came to see his brother in the mental institution and saw his ‘hairy’ counterpart. The doctor was amazed and performed an experiment on the hairy, castrated twin. He was given testosterone (which was turned into DHT by the hairy twin’s body). Guess what? He lost his hair just like his bald brother. This final story may spawn new questions on why we don’t take medication that block DHT 100% or take stronger DHT blocking medications such as avodart (Proscar) to treat male pattern balding. It is mainly because once the genetic switch is turned on, you cannot stop it and blocking DHT 100% might slow the process down and may give you unwanted adverse side effects. I doubt anyone would volunteer to be castrated. The only exceptions are transgender males going through hormone therapy and sex change operation/ castration.

Another patient with SMP to the old hair transplant scar. While the scar itself is not the worst we’ve seen, it defiantly shows when the hair is cropped very short. You can see the SMP results after the 2nd SMP procedure. Note the slight redness since the photo was taken immediately after the SMP.

This is a comment from our regular reader/ occasional contributor -BiotechMD- (who is actually a medical doctor involved in many clinical trials and research) I thought I’d post a third party opinion since so many readers and patients are concerned about Propecia and sexual side effects and are quick to blame a side effect over a common issue (that they may not want to admit).

While conducted a number of years ago, one of the largest studies of the incidence of erectile dysfunction (reference below) puts the rate at 40% for men in their 40?s. Given the multiple causes of erectile dysfunction (atherosclerotic disease, diabetes, medications, psychogenic) and the increasing risk of these factors with age, this is not too surprising. There is no scientific evidence in the published medical literature that the erectile dysfunction associated with finasteride is of a different “quality” than other types of erectile dysfunction or that the “whole sexual response is diminished”. Decreased sex drive can be a side effect of finasteride in a minority of patients and even fewer still (<2%) will have both erectile dysfunction and decreased libido.

Feldman HA, Goldstein I, Hatzichristou DG, et al: Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. J Urol, 1994;151:54–61.