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Hair Loss InformationTidbits: Balding in Indians and Asians – Hair Loss Information – Balding Blog

A few times each month, I will post some random hair-related information, which I’m calling “tidbits”. I spend hours each day writing responses to questions I receive on this blog, so it is a nice change of pace. For example…

American Indian

The American Indian (or Native American, if you prefer) has no genetic balding if their ancestry is from the Alaskan Bridge. American Indians that came to North America from Central America can have genetic balding. There has been no explanation why the American Indian does not have genetic balding, making him unique amongst all men (except those born with genetic defects in the DHT making enzyme or those who eat large amounts of DHT blockers in their diets, a group of primative people from the Central American rain forest).

The observation that men from Asia, India, or China have less balding is certainly not a reality today where the wig business is thriving. A theory put forward by Dr. Masumi Inaba in his 1996 book “Androgenetic Alopecia” claimed that there was more baldness in the post WWII Japanese men than in the earlier generation to which he belonged. I think that he attributed this to dietary change and in particular, to more saturated fat in the Japanese diet. The same theory, if true, could apply to Indians, who have only a small meat intake back in India (strict Hindus eat no meat at all). Dr. Inaba’s theory never gained any credence then or since, but history shows that if his theories are proven correct, he would not be the first scientist to be proven right a decade or more after his death.

History points to insights as we get further away from the facts as we see them. Dr John Snow back in the mid 19th century proclaimed that Cholera came from contaminated water while most other “experts ” believe it was transmitted by bad smell (the “miasma”). The entire London sewerage system was designed to get rid of the stench that permeated the city every summer (and coincided with cholera outbreaks) . The sewerage system was an engineering marvel with the worlds largest pumps and miles of brick lined tunnels. It got rid of the smell and coincidentally got rid of the source of water contamination and cholera became very rare. The cholera organism and its lethal effects were not discoved until many years after Snow was dead and buried. (This last paragraph was written by Dr. Richard Shiell of Sydney Australia)

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Hair Loss from Tuberculosis? – Hair Loss Information – Balding Blog

My 17 years old daughter was diagnosed with inactive tuberculosis about 8 months ago and has been taking INH. However, about 18 months ago she started losing her hair. Could this be caused by the tuberculosis alone?

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I have written on this medication with tuberculosis before (see Tuberculosis Drug and Hair Loss). The disease itself is a wasting disorder which is known to produce hair loss, as with other wasting disorders. The same recommendations I made before apply: good diet and appropriate vitamin therapy. A full work-up for female hair loss is in order here as there are many diseases that cause hair loss in women (see Female Hair Loss category). Read these pages carefully and seek out a good doctor to follow through with a thorough examination of your daughter. Also, you might want her to see a hair specialist who will study her for female genetic hair loss and assess the miniaturization of her hair to see if the pattern is typical of female genetic hair loss.

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Coverage with FUE – Hair Loss Information – Balding Blog

I’ve heard that 20 to 40 fue per centimeter is recommended.Is this true? Does this give someone enough coverage? What do you recommend? I hope I asked the question correctly.

Thank You

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This is a good, but difficult question to answer. What you are really asking is: “What density of follicular units is enough to give you good coverage?” Whatever the harvesting mechanism used, (FUE or standard strip harvesting) the amount of density achieved reflects fullness as modified by hair and skin color, hair thickness of each hair shaft, and the character of the hair (curly or straight). The health of the scalp determines just how close you can place the grafts (for scalp that is atrophic and lost its infrastructure of blood vessels, glandular structures and fat less densities are often better).

The normal density of a person is 100 follicular units per square centimeter (200 hairs), so clearly the amount that is placed will depend upon what you buy, the size of the balding area, etc. For blonde people, low density is often able to look full, while in a black hair person with white skin, higher densities are often needed.

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When to Start Using Propecia? – Hair Loss Information by Dr. William Rassman

Hello Dr. I am a Marine stationed in Twentynine palms CA. I am currently deployed to Iraq and out here my hairloss isn’t exactly priority so there is no Dr. I can see about this right now. I did some reading and wanted to try propecia Is there any way it can be perscribed to me without being seen at an office? I would greatly appriciate your help with this. I am also considering starting transplantation before the loss becomes noticable to others. Would you recomend starting that early? Thank you VERY VERY much for your time!!!

If you are in your early 20’s, then I would recommend that you give Propecia a try first. Starting Propecia early is a great idea to help regrow your hair, stop hair loss, or reduce hair loss. You should notice its full effect after 1 year. I recommend against hair transplantation for you right now at this age, as you should first be sure that the Propecia is working or not. On some websites, you may order Propecia online through an interactive doctor. The medication should be over the counter, but alas, the FDA does not listen to me.

As a former Vietnam veteran, I appreciate in many ways what you are doing for our country’s efforts. Thanks.

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Spironolactones and Minoxidil – Hair Loss Information by Dr. William Rassman

Dr. Rassman,
I read your comment on Spironolactones.

However, some doctors argue that combined application of Spironolactones with minoxidil significantly enhances the regenerative effect of minoxidil. Would you please make a comment on this? Thank you

I am always concerned that some doctors speak because they have to differentiate themselves from the crowd of doctors trying to sell you something. If I believed that these two medications added value, I would be at the head of the crowd recommending and using them.

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Female Hair Loss — What to Do? – Hair Loss Information by Dr. William Rassman

I have been losing my hair for years. I’ve been a sucker for many high priced hoaxes and am now to the point where the comb over is barely hiding it anymore. I’ve lost so much of my hair on the front/top and am ashamed to even look in the mirror, I feel like crying each morning when I style my hair. When people look at me I can’t help but feel like they are laughing, I’m only 30. I had asked my doctor awhile back (when I was about 22-23), but his advice to me was to learn to live with it, there’s nothing that can be done for hair loss. Please, is there any product out there that you would recommend for me to research, (I know in the medical world you can’t recommend a product for me to try), so all I’m asking for is a point in the right direction. Every time I try I just feel more defeated, there are so many products out there, I know most of them are little more than snake oil. Please please help-I don’t know where else to turn for an unbiased recommendation.

I hesitated to write an answer to you because I did not want to contribute to the many failures of treatments you have experienced. It sounds like you are accepting your balding without having a medical work-up. Please review the many pages of answers in the Female Hair Loss category, and then get a good doctor who will work as a professional in helping you to surround the diagnosis and treatment for your hair loss. Good luck.

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Considering Future Hair Loss – Hair Loss Information by Dr. William Rassman

i am 56/m, bald at the crown. with general thinning on the top and front. because my hair is still falling out i would expect to be compleatly bald in the norwood 6 area in 1 to 2 years. my hair is very fine. can i get a transplant that will also take into consideration my future hair loss, or will i have to repeat the process as my natural hair reduces to zero. if this is a stupid question please forgive my ignorance.

p.s. can you recommend a surgeon in the u.k. who is of your standard both ethically and medically. also i am a blue coller worker, so i would need a to get a loan, can you give me a estimate of a average price for a norward 6 transplant.

p.p.s. GREAT SITE.

At 56, it would be unlikely that you will complete your expected Class 6 pattern, because at your age, the hair loss is often very slow (almost to a stop) in most men. If you want to fill in the frontal and top areas, that would be the best place to start. The crown often takes a great deal of hair to fill in. With regard to a hair transplant surgeon in the UK, consider the physician search at ISHRS.org for a place to look and be sure to read The Truth About Cheap Hair Transplants as a buyer’s guide to selecting a doctor. Both the NHI site and my book also cover different aspects of the buyer’s challenge. Loans vary with the doctor, where some have arranged credit sources. Many of our patients put the hair transplant on a credit card.

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Burns to the Scalp – Hair Loss Information by Dr. William Rassman

I have researched your website and I am curious as to whether or not any of these procedures would work for me. I suffered from 3rd degree burns resulting from being trapped in a burning car after a MVA. My scalp was burned past the follicle in a large area ( mainly the top). I have been undergoing burn treatment for the past few years. My surgeon and have been using tissue expanders to restore my hair. I am concerned that this is a long process and involoves a few surgeries every 6-9 months. So I am looking for options and short-cuts. Any suggestions?

What you said sounds like your doctors know what they are doing and have developed a good, sound strategy. If you would like a second opinion, it would be very difficult to do it over a long distance. Sending photographs of good quality would help and I would be willing to take a look and verify the plan, but it sounds like you are in good hands. Why are you writing to me now? How far have you gone with your present medical team? Are they responsive to your questions and do you have confidence in them? These are basic questions that may speak to your overall comfort and the communications you have with your medical team. When you have the confidence in the team, then you should stay with the winning team. There are no shortcuts to problems of your type. Be sure that when transplants are the refining step, that your transplant surgeon knows how to manage a case like yours, as the transplant surgeon will frequently have different skills than the team of plastic surgeons who are managing your ’tissue expanders’.

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Hair Loss InformationGenetic Code Catching Up – Hair Loss Information – Balding Blog

In a previous post you said “Remember, hair loss is progressive and either with Propecia or Avodart, sooner or later your genetic code will catch up with you.”

What do you mean about genetic code catching up with you even if you take Propecia or Avodart?

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Thank you for drawing attention to my cryptic medical speak. This is best explained by using an example.

First, it is important to show the Norwood Classification chart, so that the readers here can see what I am referring to.

Norwood Classification

Now, let us assume that your genetics will eventually take you to become a Class 6 patterned hair loss, but now you show only a Class 4 pattern because you are still losing hair and have not arrived at the final hair loss pattern you may have inherited from your family. In some people, their hair loss is so slow that they progress from the Class 3, to a Class 4, to a Class 5 and so on. The change can take years and be very slow to occur. In other unfortunate people, the loss may first show as thinning in the Class 6 pattern and then advance to a complete Class 6 pattern within a couple of years. If you are that Class 4 pattern person and take Propecia, the size of the bald spot in the back of your head may become smaller and the hair in the top may fill in a bit. You may go backward on this chart from a Class 4 to a Class 3 Vertex pattern, or you may regrow your thinning Class 6 pattern to a full head of hair with Propecia alone. If you stay on Propecia for life, maybe you will stay at a Class 3 Vertex, or you may slowly progress to a Class 4 or 5 or possibly 6 pattern over your lifetime (it could take 20-30 years or so to get there). If you got back the thinning hair in the 8 months that it takes for Propecia to act, you could lose it again, finding yourself back to ‘square one’ as the progressive nature of the hair loss continues to take its toll on you. We do not know if drugs like Propecia will stop the Class 6 pattern that you were destined ‘genetically’ to become, but it is not unreasonable, with what we know of today’s medications and what we know about Propecia, to actually see the value of this medication decrease with time. That means that the drug may eventually become less effective in preventing the progressive nature of the hair loss.

Avodart is a stronger medication for blocking DHT, and maybe by the time Propecia stops working for you, the FDA will clear Avodart for use in preventing hair loss. More likely, however, some new medication that is more effective than either of these drugs may come to market. It is my hope that medical research will continue to improve the effectiveness of medications for hair loss prevention or regrowth. What we must do now is to be patient, use what is there and what is safe, keep our fingers crossed and use the transplant ‘card’ when you are not satisfied with what you can achieve with drugs.

For people who have a Class 6 pattern and do not like it (or a lesser pattern hair loss which can be seen in over two hundred patient pictures at newhair.com), for example, they can become more hairy and reduce their balding appearance to a Class 3 or possibly even a Class 2 pattern if they have the donor hair to do it. That is what I mean by the hair transplant ‘card.’ We live at a wonderful time, where a simple outpatient surgery can transform a patient from a Class 6 to a Class 3 pattern in just a single surgery (under the right conditions). That means, between modern medications or hair transplantation, you can take charge of your life and your ‘hairy’ appearance. Remember, you are in the driver’s seat, so drive carefully.