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Removing a Widow’s Peak – Hair Loss Information – Balding Blog

Hello Dr. Rassman,

I am a 22 year old male with a widows’ peak that I would like removed. I also have bad acne if you take care of that at all. Please let me know costs, etc…

Thanks

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Removing a widow’s peak is not easy and has side effects which include scarring, depigmentation, pitting, etc. That of course, depends upon the mechanism that you chose to remove the widow’s peak. FUE works, but may leave small depigmented areas, just like electrolysis might do. Laser hair removal may work but also runs the risk of depigmentation and the failure rates with laser hair removal and electrolysis is higher than 50% per hair treated.

With regard to acne, you need to see a good dermatologist. Costs are not appropriate to discuss at this time, because there is much to do to determine if you are a candidate for any of the treatments I discussed above. At 22, I am concerned about a focus to remove a widow’s peak.

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Transplanting the Crown – Hair Loss Information by Dr. William Rassman

Greetings,
After seeing Steve Hartman of CBS/AM570 in person I am amazed at the process of his hair restoration. My situation is the typical male pattern baldness on the top and back of my head, not the front. How do you handle that?

Steve Hartman’s hair transplant procedure is what I like to refer to as the fast-track approach. With his situation, one surgery did the job he needed and if he stays on Propecia, hopefully he has seen the end of any more than this one surgery. For transplanting the crown, I have general reservations in the very young men (under 30) unless there is very good donor hair density and good laxity (looseness) of the scalp in the back of the head. Other elements of the supply/demand formulae must also be accounted for and those men with good quality hair and skin color tend to do better than those without either when the hair must be distribued to cover a wide balding crown. I am always worried that the crown will take all of the donor hair and when the front balds, then the patient may run out of donor hair. There are many times, however, that crown transplants are appropriate. In those men over 35 (for example) with a 3 Vertex balding pattern (frontal corners and crown only balding) or those with pure crown (vertex) balding in people like me. I had 1600 grafts into the crown and my frontal hairline is normal without any balding. I use Propecia to maintain any further hair loss and I have been stable for years since my transplants were done in the late 1990s.

Propecia is the mainstay for hair restoration in the top and crown (particularly for the younger men whose final pattern is not predictable), so you should first get assessed for miniaturization and then go on that drug if appropriate. Transplants rarely will be needed if you catch the top and crown loss early enough.

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Prescribing Avodart for Hair Loss – Balding Blog

Dear Sir:
Thank for writing your informative blog. I find it very useful. I am a 34 year old physician; I have been on Propecia for 3 years and am pleased with the results. In preparation for the future, for when Propecia might stop working, are there any doctors you might recommend who feel comfortable prescribing Avodart for off label use in treating male pattern baldness. From reading your posts, I am assuming it is unlikely that Glaxo Smith Kline will see enough of a profit margin in Avodart in investing in a controlled trial to get FDA approval for avodart to be used for male pattern baldness.

Thank You in Advance for your response

Prescribing this drug for off-label use is not an issue if the patient is well informed about the risks and has read much of what I have written on these pages. I believe, like you, that it is unlikely that Glaxo Smith Kline will see enough of a profit margin in Avodart by investing in a controlled trial to get FDA approval for treating male pattern baldness. You sound well informed.


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Higher Strength Minoxidil? – Hair Loss Information by Dr. William Rassman

Dr. Rassman,

My hairline continues to retreat. I have been using Propecia and Minoxidil 5% for more than 6 years with some success. What do think about using additional topicals such as Spironolactone 5% and higher strength Minoxidil? Have these topicals proven to be worthwhile? Should I just accept the continued loss of my hairline?

Thanks

There are mixed feelings about higher doses of minoxidil, mostly positive providing that the skin irritation and other side effects do not increase significantly. As you may know, minoxidil can drop your blood pressure and make you light headed and it is a skin irritant. Be sure that the side effects do not become a problem.

With regard to Spironolactones, see my previous blog answers here: Spironolactones

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Aminexil, Propecia and Erectile Dysfunction (ED) – Hair Loss Information by Dr. William Rassman

Hi doctor, A doctor in france suggested to me to use Aminexil SP94(by Kerastase) capsules (commercial name:”Vichy Dercos”) applied on the crown area and the shaded are of the head directly. I noticed from many people’s feedback in France that dermatologists there recommands to apply Aminexil as a safe alternative to propercia since it doesnot have any sexual side effects,and that Aminexil actually stops the thining of the hair caused by dihydrotestesterone ( it does not stops DHT like propecia), rather it thickens the hair follicle which becomes resistive to DHT. What do you recommand doctor i need please your advice please(ie: I used propecia from several weeks and i have serious sexual problems). Thanks A lot

I looked up Aminexil and found that it is basically a minoxidil compound with the type of results that minoxidil gives. The question of course becomes, “Is it better than minoxidil by itself?” I would think that no one really knows the answer to that question, because they may not want to know. The general thought about minoxidil is that it may impact the length of the hair cycle by increasing it, amongst other benefits. That would add more hair, as less hair would be in the catogen phase and more hair in the anogen phase at any one time.

With regard to sexual side effects from Propecia, they are very rare (less than 1%) and much of it may be the power of suggestion as we men are very sensitive to anything that MAY impact the performance of our penis. It is great to blame Propecia for erectile dysfunction (ED), when in actuality it may not be the Propecia, but rather psychological or relationship issues associated with social issues that occur. That is clearly not always the case, but I suspect that it is mostly what is being reported on the sexual erectile dysfunction (ED) issue.

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Hair Loss InformationCompassion for Balding Men – Hair Loss Information – Balding Blog

I am down right angry about everyone targeting balding men as the butt of jokes. People do not understand that behind every bald man, is a feeling sensitive man and I wish that people will stop jabbing at us.

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In this week’s issue of The New Yorker magazine (January 9, 2006; pages 43-48), there is an excellent article about hair loss titled “The Power of Hair”, by Burkhard Bilger. There is a great quote in the article from an anonymous source that says, “The man who isn’t bald never thinks about baldness. The man who is losing hair never thinks about anything else.” It is full of wonderful stories about balding looking backward in time, and looking forward to genetic cures, cloning, and some of the recent work done on an experimental basis. The article is worth reading, concluding from a patient who had a hair transplant, “Having hair on your head, you feel like you’re still young. You feel like you’re alive. Nobody wants to look old, man. Nobody want to look old.”

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Hair Loss InformationFemale Hair Loss from Iron Deficiency? – Hair Loss Information – Balding Blog

I am 29 years old and am losing hair. After the shower I can see lot of hair fallen around. In my diet, I dont include iron-rich food. Would it be a possible reason for hair loss? Can you suggest a good diet for preventing hair loss?

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Speak to your doctor and have your iron levels measured. This is an important step if you think that you have an iron deficiency, a common occurrence in women. Historically, women needed to eat meat to replace the iron they lose from menstruation which is why iron deficiency is not uncommon in women. A good general diet with red meat may be all that you need if your iron levels are bordering on the low level, otherwise, see you doctor and get his/her recommendation. If you have hair loss, then as I’ve suggested many times in this blog, you need a good examination for miniaturization to get the best diagnosis for cause.

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Hair Loss InformationShould I Start Using Rogaine for Women? – Hair Loss Information – Balding Blog

I am a 27 year old, female of indian ethnicity. I always had extremely thick hair, but have noticed over the last 5-7 years, a dramatic reduction in my thickness (probably half the thickness it used to be). Admittedly my hair is probably still considered thick, but I am concerned that at the rate of my hair loss it could become dramatically worse, and want to prevent this from happening. My mother’s hair has dramatically thinned (you can see her scalp visibly) and I am hoping that is not what I am getting. I do notice slight regrowth but this does not seem sufficient to be replacing all my lost hair.

I notice that I lose a lot of hair in the shower, when I style my hair, and anytime I just pull my hair together, and also see that I lose strands of hair throughout the day (my floor perpetually has a lot of hair on it and my clothes usually grab a fair number of hairs as well). I have been perpetually on different antibiotics for acne for about the last 10 years (not sure if this is an influence).

I want to start using Rogaine for Women but am not sure if I am too young for this, and also dont want to use this unnecessarily. Can you please tell me if I can/should be using a product like this? Also, should I see a doctor regarding this (what type of doctor is best), and what tests should I be asking for? Any feedback you have would be appreciated.

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Self-diagnosis is difficult for me to recommend, because if you have a medical condition causing the hair loss, then you will not get a proper diagnosis. As I’ve said before, there many reasons for hair loss in women, including hypothyroidism, ezcema, alopecia areata, telogen effluvium, lupus, drugs, stress, crash diet, and infections. As you will see when reviewing the list of problems, hair loss in women is not as straight forward as in most men. Before starting more medications, you should get a metric (measurement) to get your scalp mapped out for miniaturization to determine if you have premature genetic balding for women.

A good dermatologist or family doctor can perform the basic blood tests and a dermatologist will be able to do biopsies when appropriate. Rogaine for Women may work if you do not have one of the medical conditions listed above.

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How Long Does The Balding Process Take? – Hair Loss Information – Balding Blog

I am a 27 year-old male from Toronto, Canada. I have a family history (faternal family and partenal family) of MPB. In the summer of 2005, my stylist informed that I was thinning at the top/front. I was in denial as I have used lots of gel or similar styling products and have been able to see my scalp. I later noticed the front thinning a little, but did not really care as it did not seem to be serious. In late December 2005, my uncle asked me if my hair was thinning (which he has always done b/c of the gel) and my aunt said that my hair was thinning from the crown….my sister said she noticed it as well. The next day I asked my barber not to use styling product and he said that would be good b/c of the thinning on the top (the first time he has mentioned it since the summer!!!). Needless to say I am no longer in denial BUT I WANT TO TAKE ACTION AS QUICK AS POSSIBLE.

I am going to speak with my family doctor about propecia/proscar. I have bought rogaine (2%) but will wait to use it, as I would like to see the doctors say and b/c of your advice to start out with one remedy so that I can know what is effective. I have also bought nizoral (2%). The rogaine seems like a pain to use. I am a very very busy young professional.

I have a few questions:

  1. do you have suggestions for a good doctor in Toronto, Ontario, Canada (preferably downtown core) where I can get miniaturization done?
  2. how long does the balding process take? I am concerned that I will lose a lot more hair before any medication kicks in. I would BE QUITE HAPPY IF I COULD MAINTAIN MY CURRENT HAIR for the next 8 – 10 years as I love my locks.
  3. Is avodart available in Canada?
  4. do you recommend any particular thickening shampoo and styling product? I want to avoid the revivogen and stuff like that.

Thank you for your help.

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  1. Check with the ISHRS for a doctor near you by using their physician search.
  2. The balding process varies with each person. The reality is that very bald men are usually on their way to that diagnosis well before their 29th birthday.
  3. If you do have genetic hair loss, Propecia or Proscar (broken down to 4 parts of a tablet) is more appropriate than Avodart at this time. That being said, I do not know of the availability of Avodart in Canada.
  4. I don’t believe that styling shampoos or any topical agents will help.

It sounds like genetic balding is the diagnosis, but I couldn’t properly determine that without an examination. As you know, we tend to follow our family patterns, which also includes the rate of balding. Find out who you take after, and you will have a better idea of what may happen if you do not go on such medications as Propecia.