Category: Physician training

Dr Rassman

Can you please tell me the role of scalp testosterone (not serum) in hair loss/growth?
Thank you

The scalp does not make testosterone, but it does metabolize it with the enzyme 5alpha-reductase, the same enzyme that Propecia (finasteride) blocks. During the metabolism of testosterone in the scalp, 5alpha-androstane-3beta-17beta-diol appears to be formed and the formation of androstanediol (a steroid byproduct created by the hair apparatus in the metabolic process) has some effect on the functioning of the sebaceous glands, as well as (possibly) accelerating the hair loss. It probably impacts the sweating and the sebum production. We really do not know this for sure so I would consider what I said here as an intellectual logical exercise (taken from what I read which incidates that much of this information is based upon experimental work from in-vitro research studies).

On a practical level, I think that you may be thinking about the length of time it takes to block DHT production. The answer here may be in the duration of action of the particular DHT blocker you are using. Propecia has a 5 hour half life, Avodart has a half life in months and other claimed DHT blockers do not have a clearly defined life of action. It is better off sticking with known drugs that are fully researched by standards established by such bodies as the FDA.

Why does hair vary so much with people? Does coarse hair or kinky hair have an advantage over fine hair?

I remember a television piece done by CBS News’ 60 Minutes where they tracked what was claimed to be one of the original 12 tribes of Israel deep into the African continent through genetic testing on the Y Chromosome. In the few thousand years since the migration, the physical characteristics of the African became evident in these people with bigger lips, a wider nose, and kinky hair. I think that thermal regulation has a lot to do with the kinky hair, which allowed better cooling as a person chased an animal in the savannas of Africa during the hunt. Wide nasal passages allowed better air movement for breathing as well. The scalp is a major releaser of heat by preventing overheating in the summer, especially when heat generation adds to climatic conditions. On the other side, we know that when the French invaded Russia in Napoleon times, the winter killed more Frenchman than the battles. We also know that the bald men died during the retreat at a much higher rate than those with a full head of hair. Conservation of our body heat in the cold is another function of hair. In your question, you suggest that there is a better hair type; but better for what? Those with thin hair that sticks to a sweaty scalp may insulate better than a person with kinky hair, but not with coarse hair that lies flat. Also, there are no kinky-haired people outside of the original African population, indicating that kinky hair had an evolutionary advantage, so it evolved as the people adapted better to their geography and climate. If everyone originated out of the middle east, then we should look to our cousins there to see where we may have started from. This could be interesting topics of conversation for those of us who believe that one type of hair/person is better than another. When we put esthetics into the formulae for your question, then culture and vanity act as modifiers that go well beyond the influences of climate. Thanks for the insightful question. I always enjoy the wide variety of questions posed in this blog.

i am a 26 year old female from scotland, and i would like to know if you could recommend a clinic in the UK who do the hairline lowering procedure. Please say there is one!

I don’t have any personal Scotland-based recommendations, but I would check the International Society for Hair Restoration Surgeons (ISHRS) site at ISHRS.org. Use the physician search section to look up doctors in the UK. You can then call and get a direct referral from someone within the United Kingdom.

I read your blog from beginning to end and found it very resourceful- thank you. There are a few questions on which I would like clarification.

1. I have read briefly about itchy scalp which requires use of Nizoral. Is this a very common side effect which I should expect if I decide to take Propecia, or does this only happen to a small number of patients you have seen? I had to stop using generic Minoxidil after three days because it gave my hair a greasey feel. Will Nizoral cause a similar problem or other side effects?
2. I have read somewhere that you might expect to see accelerated loss for the first four months as the follicle’s “cycle” adjusts. What percentage, if any, of your patients would you estimate see this accelerated loss?
3. I take various supplements for body building purposes, such as creatine, glucosamine, and whey protein. Since hair loss is related to testosterone/DHT, are there certain substances which I should be avoiding in order to prevent extra testosterone generation in the body?
4. What is your real world experience with the Laser Comb? With all the various internet sites which sell this type of gadgetry, is there a reputable company or site which you would trust?

1. Itchy scalp does not require any particular treatment, but some people feel strongly about their medications and post their opinions on the internet. This is particularly true for those who sell the medications. In my experience, not one patient complained about itchy scalp after being placed on Propecia, but they do complain of this from the use of minoxidil. Many people find that styling hair is made difficult with minoxidil. If you want the non-greasy minoxidil, try the minoxidil for women, as it is alcohol based and is not greasy.
2. I have personally not seen any patients complain about a period of hair loss when they start Propecia, but I have heard reports by some of my colleagues. I must therefore assume that it is a rare occurance.
3. Anything that builds up testosterone production will raise DHT levels and accelerate the course of male pattern balding. Check with the claims on the bottles and check out each component of the nutritional substance you are taking.
4. I have no personal experience with the Laser Comb. The story is still out on all laser hair treatments, but I remain very hopeful. See Low Laser Light Therapy for Hair Loss for more details.

How long does it take for the transplants to grow?

I generally tell my patients to wait a full 8 months to have 80-90% of the impact of growth on stylable hair. Hair grows about 1/2 inch per month and as transplants often do not start until 3-5 months after the surgery, growth can be calculated from that point. For those hairs that start to grow at 5 months, they will be 1 1/2 inches at 8 months, while those that started at 3 months will be 2 1/2 inches long. Usually a person has a combination of the two. On less frequent occasions, about one in twenty people have instant growth of all of their transplants.

In good hands, however, growth will always occur. I hope that answers your questions.