Category: Uncategorized

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I Lose Hair In The Shower, But My Friends Say They Don’t

Dear Dr. Rassman,
Im 17 an i have been noticing when i shampoo im losing quite a bit of strands, i know its common to loss up to 100 strands but i ask my friends if they lose any strands of hair in the shower an they all say no. Also none of my family members have ever gone bald, so does this mean that i can or cant go bald?

You are correct in that 100 (and even as many as 200) hairs a day and is normal to lose. Hair grows in cycles, so sometimes you may notice more hair loss. If your hair loss is within that range, I wouldn’t be worried. Your hair may be in a cycle where it is in its shedding phase, but when we go into a hair loss cycle associated with genetic hair loss, the loss in the shower may be higher. The best way to judge is to:

  1. compare what you are seeing to what you had been seeing in the past
  2. see a good doctor who will map our your scalp for miniaturization looking for the findings that are always present in genetic hair loss

Hair loss in your genetics can skip generations, so even if you do not see it in your immediate family, it does not necessarily mean that nobody in your family has experienced balding to some degree. And chances are that your friends do lose hair in the shower and it goes down the drain. I couldn’t tell you for sure though — I do not shower with your friends.


2006-05-08 08:50:01I Lose Hair In The Shower, But My Friends Say They Don’t

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I Only Get Peach Fuzz in the Crown from Minoxidil

Hi, am hoping you can provide a clinical opinion on my experience and usage with 5% minoxidil.

I am a 52 years old male. My main area of thinning/hair loss has always been my crown area (about a 2-3 inch diameter). My crown started thinning noticeably in my mid 40’s. I have been using 5% minoxidil for almost 4 years now. At first it seemed to definitely halt further hair loss in the crown, but it has never filled in that area. I only get peach fuzz type hairs that never fully develop into mature hairs. Am I wasting my time continuing to use minoxidil on my crown? I appreciate any response on this, thanking you in advance.

Even though some people get good hair growth from minoxidil (Rogaine), the majority of people are like you, getting peach fuzz rather than really good, strong hair. Whether the limited results you’re seeing is wasting your time is up to you to decide.

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I Saw Hair Loss After Dieting, Then the Hair Regrew a Different Color and Character!

Hi,

About a year and a half ago I went on a diet and lost over 100 lbs during the course of a year. After about 6 months my hair started to thin out all over my head. I got nervous and started taking a multi-vitamin and a vitamin for healthy hair. Most of the hair I lost gradually returned but it was much darker and thicker. My natural color is light brown/blonde. The hair that grew back had a straw like texture. It was black and wiry.

I visited my family doc and a derm and both said the color change and thickening was odd. They did a full battery of blood work but it showed nothing. Now after about six to eight months of having alien hair the dark, thick, black hairs are shedding like crazy. 90% are gone at this point. What is left is the hair that is my natural color and texture. It is much thinner than usual because of the shed the past few months. I can see some light colored peach fuzz sprouting up where the dark hair fell out but that just started in the last two weeks. Luckily, I had super healthy, thick hair before this so if I style it correctly I still have coverage.

When it turned black friends asked if I colored my hair. Now that it is going back, I’m getting the same question. Docs suggested hormones. I did have a stressful year and a half. They said I could use rogaine or propecia. I didnt want to start either of those because from what I read they need to be continued for life. Very nervous about propecia especially if my hormones were out of whack naturally and have recently returned to normal on their own. I doubt that would help make things better. No doctor would say for sure it is MBP, not even a local hair transplant doc I went to a consult with. He said give it 6 months and come back. He never saw hair get thicker and black before and couldnt explain it.

Everything I’ve read about MBP talks about receding and gradual thinning. My hair went from perfect with no signs of loss or family history on either side to thin to thicker and black back and now to normal color but thin in just over a year and a half. I do not have any bald spots just my normal hairline of the past but a general lack of density because of what I lost. I’m frustrated and out of options as far as I know. I’m hoping you could offer some insight. I just want to know what I’m dealing with so I can decide on a course of action. Thanks in advance for your help.

Hair color change and texture change are not likely related to dieting, but perhaps your hair loss was “triggered” by the extreme dieting (a common condition). I can’t explain the reason for the wiry, black hairs that you’re describing. It is a little odd, and I’m sorry to say that I don’t have any further insight.

Diffuse hair loss and patterned hair loss are generally two different things. For example, if your hair loss is deemed to be telogen effluvium, then your hair will likely grow back in a year. If you have another exam (find another doctor that can give you answers after an in-person examination) and can get the MPB diagnosis, then medication like Rogaine or Propecia would be helpful. If you don’t have genetic male pattern baldness, Propecia isn’t going to help you.

You need to figure out what is going on before you can figure out how to treat it.

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I Stopped Propecia for a Week and After Restarting I Have Side Effects

Hi I have been on Propecia for over 5 years with little side effects except a little decreased semen. I missed dosing for over a week because I lost some of the meds. I started shedding alot but restarted my regime. Now I have premature ejaculation and a depressed mood. Is this temporary could stopping for 10 days and restarting have negative effects? Is it normal to shedding that fast from stopping the meds for 10 days? I was getting hand fulls

Your experience of these new side effects and hair loss is very strange only after 10 days of missing the Propecia dose. This drug, although out of the blood stream in 24 hours, remains ‘fixed’ to the tissues inside the cells for as long as a week. I have no answer to your question based upon how I know this drug works.

I would recommend that you follow up with your doctor.


2011-09-11 10:03:33I Stopped Propecia for a Week and After Restarting I Have Side Effects

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I Take Propecia and My Girlfriend Is Now Pregnant

I have been taking Propecia for 2 years. Recently my girlfriend got pregnant.. Should I be worried? Will everything be O.K.? Thanks!

Congratulations! I don’t think you have anything to worry about with respect to Propecia use and conceiving. There is no evidence that I’m aware of to suggest that it would affect your fertility or have an impact in conceiving a child.

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I Thought Miniaturization Analysis Was the Best Test for Balding!

After my visit to your office today, I was more confused because your miniaturization analysis showed no miniaturization and your bulk analysis seemed to contradict the finding by identifying early balding. I thought that miniaturization was the most important test a doctor could do to determine balding. Please help me understand what appears to be a discrepancy.

I am sorry that I confused you. Before the Haircheck bulk measuring device was invented by a Florida hair transplant surgeon, the only way one could tell if hair loss was occurring was:

  1. Seeing excess hair falling out (very early and not conclusive)
  2. Seeing a balding pattern developing (maybe too late)
  3. Looking for miniaturization (does not always appear, especially when hair loss is slow)
  4. Taking photographs and comparing them (often too late)

By doing bulk measurements, it is a very sensitive way of understanding hair loss with a metric that is replicable once the measurements are repeated and compared over time. In your case, the metrics showed early hair loss, but there was no miniaturization present in the area of concern. Based upon this, the drug finasteride was recommended. By repeating this test in a year, you will know if the hair loss is stable or reversing, and if you are progressing in both anatomic areas as well as local measurements to see the state compared to what was done today.

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I Want a Hair Transplant, But I’m Prone to Forming Keloids

i’m an 19 year old girl suffering from androgenetic alopecia. i’ve been losing much hair and tried everything(rogain 2%, hormone therapy) but didn’t see any major results. i’m considering of having FUE on my frontal hairline, the problem is, my skin is prone to forming keloids. I know that keloid will probably form on the donor area but is there any possibility at all that keloids will grow on my hairline??

Yes, you are at risk of forming keloids on your recipient area (frontal hairline), but the risk is low. In all of my years, I have never seen a keloid in the recipient area. At a medical meeting some years ago, we polled the audience of about 300 hair transplant doctors to ask them to raise their hands and tell us if anyone ever saw a keloid in the recipient area. No one raised their hands.

You must also consider that androgenic alopecia in a 19 year old female is very rare and make sure that you have the correct diagnosis along with realistic expectation of what you are trying to accomplish and the fullness that you are going to have from a transplant. In other words, you must weigh the risks versus the benefits and you absolutely need a diagnosis by a competent doctor.


2007-09-14 14:03:41I Want a Hair Transplant, But I’m Prone to Forming Keloids

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I Want to Get Rid of My Hair Plugs!

I had an old fashion hair transplant using the large plug method. Now, I would like to cut my hair short (or shave my head). The plugs on the top of my head are virtually undetectable. I can probably have a laser treatment to completely hide them. No hair really grew anyway. But here is the real question, how do I get rid of the .75 inch high by 4 inch long rows of plugs where the donor area exists? I have spoken to several surgeons and have been told things from FUE to simply cutting around the entire area and sewing it back together. I am no surgeon, but cutting the area out and sewing it back together just seems like a waste of good tissue and hair follicles. Why can’t a surgeon simply re-cut the existing holes and sew them back together leaving the surrounding skin and hair intact. This is similar to the way he/she would do it if removing plugs on the top area of someone’s head? Any thoughts or comments would be greatly appreciated.

There is an art to managing this problem and we published the various methods of repair in distinguished medical journals in the 1990s. One way, when the hairline is too low, is to remove the frontal hairline surgically — and then re-transplant it with modern techniques. This approach leaves minimal scarring and what scar may be developed is completely covered by the hair transplant. Another approach is to remove the big plugs one at a time. Using FUE, we can often just thin the plugs.

As you indicated you’re in the Los Angeles area, you should come in for a free consultation and then allow us to make a recommendation. Also, see past posts about Repair, many of which are about fixing old plugs.

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I Want to Take Propecia Temporarily Before Surgery

Dear Dr. Rassman

you mentioned before “Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men” …

Well i used propecia before for 9 months and had great results. but by the 8th and 9th months it killed my libido and impotence although i was 26 years old only.. but as you said shock hair loss is really scary. so if i wanted to use finasteride just to avoid the hair shock loss post surgery, how many months you advice me to take it temporary, definitely im not willing to go on with it…

thanks doc…

Stopping the finasteride after a hair transplant has been done with a few of my patients with success. The risk of shock loss is mostly in the first 4-6 months, and those that stopped it after the transplanted hair grew out did not have a problem with shock loss. Of course, they had the benefit of hair transplants to cover any new loss of the original hair, so they may have lost some hair without knowing. This may be a better route than not taking the drug at all, but you will still face the natural evolution of your hair loss over time without the drug on board.

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I Was Diagnosed with PCOS Six Years Ago and I’m Losing My Hair!

I am 23 years old. I was diagnosed with PCOS when I was 17 and was placed on birth control pills. I started to take them regularly, but they started making me sick, so I quit taking them and didnt take them for several years. Just recently I went back the the practitioner who diagnosed me with this and she placed me on a slow-release iron tablet daily along with a new birth control that has iron in it.

I have started losing hair around the middle-back of my head mainly around the crown area. It looks like my part is getting a lot wider, and the part is spreading down to the back of my head. I used to have really thick curly hair but now it is getting thin around the top, and in some patchy areas.

At first, since I am a Registered Nurse, I thought stress was causing it. The last time I went to the doc, she said I was anemic with low iron levels, hence putting me in daily iron, so I thought my anemia was causing it. I’ve been on and off birth control, so I thought that could be another cause.

Am I too young to use a topical treatment such as Rogaine? or Sephren? Sephren is an oral and topical treatment for hair loss in women. What do you recommend? I feel like I am losing more and more hair by the day and it really stabs a knife into my self image and self confidence. I’m desperate for some answers. I wish someone would lead me in the right direction so I can start growing hair in those thinning spots. I don’t want to be bald by the time I’m 30. PLEASE HELP!!

Polycystic ovary syndrome (PCOS) causes hair loss in women who can also inherit the genes for balding/thinning. It is a very difficult condition to treat, as the treatment is often unsuccessful. Since you’re already under the care of a doctor, I’m not sure what I can offer. You need a good doctor/patient relationship.

Hormone therapy might help with the PCOS-related hair loss, though since you mentioned stress and anemia, those are other potential reasons for your thinning hair. I just have no way to know what is causing your loss, or whether it is a combination of things. You aren’t too young for minoxidil (also known as Rogaine, which is FDA approved to treat female hair loss), but the oral Sephren is just a vitamin supplement with no peer-reviewed published clinical evidence that it works.

There is a new cosmetic treatment that we’ve mentioned here called Scalp MicroPigmentation (SMP) which we offer to address the thinning problem in many women. One such patient can be found here.