Category: Uncategorized

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Can Miniaturization Be Reversed?

Dear Doctor,
If you have miniaturization developed in the past 6 months at a rapid pace is it possible to fully reverse it or maybe most part of it ? I Got onto propecia last month once my derm confirmed I have MPB. I am thinking of adding Minoxidil too to the regimen the logic being since the miniaturization/ slight halr loss too has been in the past 6 months Minox might help steer those hair follicles slipping away into complete dormancy. Is my thinking right ? or will propecia and something like a 2% nizoral shampoo be enough to do the job/revive thoseminiaturized follicles ?. My miniaturization is mostly on the top and my hairline is intact. My hairloss history is about 7 months. I am late 20s. Also What is the ideal times a week you should wash hair for a male who has a desk job from 9-5 and works out 4 days a week. ?
I will appreciate your feedback.

In my opinion, I would hold off on the minoxidil and stick to the Propecia for the first 8 months. If the hair loss is as you have defined, then there is a high possibility that it will reverse because it seems to work best for short term genetic hair loss. If you take other drugs like minoxidil and make too many changes at once, then you will never know which one worked best and you’ll be ‘hooked’ on both of them for years. Play your bet out and try the 8 months of Propecia first.

As for washing your hair, I’ll just quote what I said in an earlier blog entry: “Frequent shampooing does not hurt, but aggressive massaging during shampooing and rough brushing will cause fragile hair to break easily.”

To conclude, yes miniaturization can be reversed. The more advanced the balding you have and the longer time you have had it, the less likely will be reversal of the balding process. But the resuls with Propecia (in particular) have at times been very powerful and I have seen a few men who I would have never guessed would reverse, reverse it nevertheless.

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What You Need to Know About Forehead Reduction and Hairline Lowering Surgeries

There are two types of procedures for lowering a hairline. One is a surgical excision of the upper forehead, followed by the downward advancement of the hairline up to an inch from where it was prior to the surgery. To accomplish this, the entire scalp from the frontal hairline to the very back of the crown is lifted up and pulled forward. When this is done by an experienced surgeon, the hairline can often be advanced about 2/3rds – 1 inch, if there is enough looseness when this lifting process is done. This procedure is often completed in one surgical session; however, it may not address receded corners of the hairline if the corner recession is significant. A great advantage of this surgical approach is the immediate impact of the procedure on hairline location, with healing usually complete in a week or so. Sometimes, this procedure produces a scar in front of the hairline, and if this is the case, a hair transplant in front of the hairline can address the scar. If there is corner hair loss, or if you are a male, a hair transplant lowering surgery is better, because the risk of recession in men with genetic balding is very high. A recession will always reveal the scar from a hairline advancement surgery. The only disadvantage to the transplant is that it takes 6-8 months to fully grow out. For men, a hair transplant is a better procedure because the risk of hair loss is high, and hairline recession will show the scar from a hairline advancement surgery.

The second type of hairline lowering procedure is done through hair transplantation. The number of sessions varies by the thickness of the hair. For women with other than fine hair, they might do this in a single session. With fine hair, it often takes two sessions. The time to see the impact of a hairline lowering hair transplant procedure is 5-7 months after the surgery date, and if a second session is required, it will take another 5-7 month wait for full growth. See web references below for photos of this process on women we treated. When done properly, a transition zone is created that makes the frontal leading edge of the hairline soft – what I call a no-hairline hairline. See here: https://newhair.com/female-hairline-lowering/


2018-05-22 10:05:17What You Need to Know About Forehead Reduction and Hairline Lowering Surgeries

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Can a Person Run out of Hair for Hair Transplants?

I don’t get it!!! Doesn’t every strand of hair for men have a genetic life cycle that eventually runs out in some areas?? (Hairline, crown). How can a male have unlimited replenishment of hair?

Good question. In every one of us who is balding, the pattern of balding we inherit determines the extent of the permanent hair on the side and back of the head. Because we can’t predict the pattern we inherited with absolute certainty, I assume that only the fringe area in a Class 7 patient is the permanent area. This area has a finite amount of hair (about 20% of the total birth hair population on the scalp). You can have this 20% area (called the donor area) harvested over and over again until the area has lost 50-70% of its hair density. Then, the donor area is depleted and no more hair can be harvested without producing balding in this area around the back and side of your head. Each hair has both a hair cycle (Anagen and Telogen) and a limited number of hair cycles that it can have in your lifetime. For the balding Class 7 patterned patient (with only 20% of his hair remaining in a rim around the back and sides of the head), the hair that was lost underwent apoptosis (an effective cell death). These men often have fewer than 10 hair cycles (as few as 6-7) of their anagen/telogen cycle. We know that these hairs, which are absolutely gone to the naked eye, are actually in some stem cells located where each hair used to be. One day, some doctor/researcher will find the switch to turn on these hair stem cells to create new hair. I believe we may actually see this breakthrough in the next few years.


2018-08-15 09:33:32Can a Person Run out of Hair for Hair Transplants?

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Can Propecia Stunt Growth?

Can Propecia taken by mid-teen guys stunt height growth?

There are some teenagers who take Propecia (finasteride) under the care of their doctors, but it is generally not prescribed to teenagers. The effects of finasteride on developing teens is not clear and should probably not be used in those who are still in growth mode (usually under 17-18 years old). It is theoretically possible that it may stunt growth during the puberty years, as it interferes with testosterone conversion into dihydrotestosterone (DHT). DHT is one of the many hormones that is involved with secondary sex characteristics such as beard, chest, and pubic hair.


2008-09-24 08:45:29Can Propecia Stunt Growth?

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Newb Here. Thinking of Getting a Hair Transplant and Needed Advice (From Reddit)

ANSWER TO THE QUESTIONS BELOW:
  1. At the age of 38, you are certainly old enough to get a hair transplant. If you are really a Class 2, then it might mean that you are not balding but have been developing mature hairline. A good picture will go a long way for me to see what is really going on. If you want to send me photos, show me a front and side view with your eyebrows lifted high, so I can see where the hairline belong anatomically. (Send photos to wrassman@newhair.com)
  2. I think that trying a few hair transplant is nuts. That is like being a little bit pregnant. Once you have an anesthetic for a hair transplant, regardless of size, the transplant will accelerate the hair loss you may be having now. You will not have to shave your head for the hair transplant procedure.
  3. At 38, the use of medications like finasteride (Propecia) is something you would want to speak with your doctor about. People undergoing hair loss at the time of the transplant would be better on finasteride to prevent shock loss from occurring.
  4. Once the transplant is done, it is done. Follow-ups are more for you and your doctor to compare each of your expectations. A well done hair transplant does not require followup unless there are complications.
  5. A hair transplant requires the doctor to start up an operating room, break open supplies and instruments, and mobilize staff. This is the expense, even if I did 10 grafts. That expense is fixed and ties to the length of the surgery after the start-up costs.

Newb here. Thinking of getting a hair transplant and needed advice from tressless

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Can Scalp Exercises Grow Hair?

I see you posted about this website before – https://www.hairloss-reversible.com/my_approach.htm. It recommends treating hair loss by using the muscles at the front and back of the head to move the scalp back and forth.

I know this is unscientific and likely ineffectual. But I actually discovered how to do these exercises as a way to self-treat tension headaches and scalp tension, before I read the website or had any hair loss.

So my question is, might such exercises have any impact at all on miniaturizing follicles, particularly those being treated with minoxidil? I still like to moderately exercise my scalp in this way during the day (when no-one is looking, of course) but wonder if there might be some negative cross-over effects to moving about the scalp and follicles?

On the flip side, scalp exercises seem to be recommended to help loosen it prior to hair surgery?

exercise

Someone put the time and energy to put together that information.

From a medical point of view, scalp exercises will not grow hair or help miniaturized hair.


2015-09-05 22:34:22Can Scalp Exercises Grow Hair?

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Nizoral, Milk, Cows and Hair Loss

Hi Dr. Rassman,

I have a couple questions to ask you regarding my hairloss situation. First of all, im 21 yr old male. I recently began losing a lot of hair suddenly throughout my whole head at about 8 months ago. I have been on propecia for 7 months now. However, the majority of hairs that fall out(about 75%) has a white hard mucus substance that can be scraped off from the end of the hair. I lose about 150ish hairs and they are basically always all the same size hair. I also seem to have a lot of dandruff (im assuming, white mucus-like flakes) that fall off also with the hair.
I just went to a dermatologist the other day and had him look at everything. He looked and sifted through my temple region hairs with just his eyes but didnt really look closely at anything else (no magnifying or anything). When i asked him about the white mucus stuff, he said it was normal to have that. (For the record, i know that hair has little white bulbs on the end of a hair, but this isnt the case here. it is real scrapable stuff, NOT the bulb)I then asked him about taking a scalp biopsy and he told me that that wouldnt really show anything. I then asked him about measuring my level of DHT in my body to see if its really high and he said that also wouldnt show anything because it doesnt matter how much DHT we have in our system, it only matters how much the hair follicles react to that DHT. He then gave me a form to get my thyroid, iron, and blood glucose? tested, which i will do now.
He then concluded that the acne on my face that is deep down inside my skin (never been able to get rid of it) could have something to do with my scalp and the flakey-ness as well as the mucus on the hair pieces so he prescribed me Nizoral 2% shampoo as well as Nizoral pills to get deep down and clear out my face and anything in my scalp. He also believed that milk could be playing a part in my hair loss because of the hormones milk has and how it bypasses the DHT blockers in propecia. (I do consume a lot of dairy products) He was very adamant about it and said how americans are much more balder than other countries and how the US drinks much more milk than others, etc. and how he is planning on doing a research project on it with candidates, etc. So he told me to stop all intake of milk, cheese, ice cream, etc. and see if it improves in the 2 months when i see him for a followup appointment. I asked about the loss of calcium etc. and he said that i would be fine without it and the loss of dairy products wouldnt have that big of an effect. (i could get it from other food products, etc.)
What im wondering is if what you think of my situation and about the dermatologist. I was just a little taken back about how he didnt give me a scalp biopsy, or look in a magnified glass to see deep down in my scalp. I dont doubt his intelligence because he told me that he was one of the doctors that got the creation of Nizoral, etc. and he is very well known and popular. (takes 3 months to get an appt.) I was just wondering if you agree and what your thoughts are on what he said about the different tests and if the examination of me seemed correct because i really wanted a biopsy and DHT test since i heard it worked well. Also, what are your thoughts of the acne issue and besides the thyroid, iron, and blood glucose tests, are there any other tests or procedures done to see if my hair loss is normal. And lastly, what is your opinion on my hair loss situation and is this normal? If that white mucus stuff isnt normal, does that mean that as each one of those hairs falls out, does that mean that particualr hair will never grow back? (is that the hair follicle or something meaning permanent loss?) I will send you a picture of my hairs and of my scalp.
Thank you so much for your time in reading and replying to this, it means so much to me. Im really having a hard time trying to deal with this.

The tests that your dermatologist told you about are always a good idea, so he can be sure that you do not have other causes of hair loss (other than genetic male patterned balding, which is the most common). We generally lose 100-150 hairs per day, so seeing the hair come out does not bother me. If you are picking because of the scaling, then more hair loss with bulbs may be detectable. What I always do and think is important to do, is a thorough analysis of your scalp by region, looking for miniaturization, which is the hallmark for genetic balding and some other forms of balding as well. Any good long-term plan, which is critical for someone of your age, must have periodic follow-ups of the scalp, quantifying the degree of miniaturization and any changes over time. Without that step, there is no possibility that a diagnosis of genetic male pattern balding can be made. Hair falling out is normal, provided that your body replaces the same amount (usually between 100-150 hairs per day).

With regard to the milk focus that your dermatologist is referring to, I am not familiar with it, nor have I found that others in the hair restoration community have developed such focus. I was a dairy farmer many years ago, and I do not believe that we are allowed to use the type of hormones in these cows that would produce more hair loss, but it’s been many years since I’ve last milked cows. As for Nizoral, I’ve discussed this previously here: Nizoral Shampoo.

It sounds to me like you need some real assessment of the balding process by a hair specialist, like me. On the east coast, Dr. Robert Bernstein in New York (phone – 201-585-1115) would also be able to do such an examination for you as well.


2005-11-14 16:01:22Nizoral, Milk, Cows and Hair Loss

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Can I talk about sexual side effects if my doctor is a woman?

My doctor is a woman and I’m 18 years old. If i ever experience sides from finasteride, i’ll feel weird to ask my doctor about it. Does it matter about what gender doctor is? I just feel more comfortable in talking to a guy about sides if they ever show up.

Women doctors are just doctors and they often speak about sexual problems with male patients without embarrassment. Focus on your needs, not the sex of your doctor.


2019-01-21 14:43:44Can I talk about sexual side effects if my doctor is a woman?

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Non-FDA Approved Products

Dr. Rassman,

I realize as a doctor you must take the given data to insure your patients are given the “right” treatment for their condition. I do however, wonder how you can comment on products you yourself admit to know very little about. I do not know much about the product either, but a friend has used it and has had very real results with it within 12 months. I am not here to blast your opinion, but as a doctor you are compelled to research things/products that may very well put some doctors out of business. Heart disease for expample, may be a thing of the past in a decade. There are great prescriptions for heart-related conditions, but there are also great things such as diet and herbs that greatly reduce the risk of heart disease. My father was a surgeon who always put the patient first even if it was not the most lucrative choice for him. I am a bioligist with a very firm understanding of biochemistry as well. I agree that nothing is side-effect free, especially if it has any real efficacy, but check closer on some things to make sure you are not missing something out there. Something that may have potential. I am sure I don’t have to remind you that your patients are always first. You know your science works, but remember the light bulb was ignored at first also. oh yes, as far as the FDA works, I have no real comment on that. They have their own job and I am not certain how they work. They do real good things, and it has also been proven that they do real crooked things also.

This sounds more like a statement than a question. Your points are well taken. In my formal capacity, I do not recommend medications/herbs/potions/lotions that I do not know to work. You are correct in that not every medication is good and safe (just look at Vioxx), but the tradeoff between benefits and risks just need proper informed consent for each person using it. I know that Vioxx helped many people handle the pain of crippling arthritis, but some of them paid for that benefit. The issue really is, did they know what the risks were? We all know that the drug Thalamide caused babies with no arms or legs when their mothers took the medications while pregnant, but did you know that this drug was a miracle drug for many problems today in the non-pregnant female? The drug was taken off the market, so some people with particular types of bone cancer go through hoops and loops to get some to help them. It is now being considered for people with advanced HIV infection and body wasting, yet to pass FDA safety and effectiveness clearance. The drug has many uses in the third world.

I believe that we all have the right to know and balance (1) the benefits and (2) the rewards of taking a medication or herbal remedy that is heavily promoting its products. There are two sides of that equation. I do not know if some of these products are safe or effective, so I read the material supplied by many of these companies. When I see poor photographic representations, or scalp coloring agents used to promote benefits which are only created by a ‘can of spray paint’ on the scalp below the miracle new hair (or something similar), then I can not endorse these products. They may be great products, but they burned their bridges with me as a product endorser.