Hair Loss InformationHair Loss and Accutane – Hair Loss Information – Balding Blog

Dr. Rassman,
Thanks for taking the time to review my circumstance. i am 35 yrs old and have been thinning for the last 5-6 years. I currently use minoxidil and the lost has seemed to stop. A dermatologist said it was MPb after a brief exam. There are a couple of reasons why i disagree with this. first there is not one case of any member of my family even thinning much less losing their hair. second my hair doesnt look like a typical MPB patient. i have a real good hairline and decent coverage all over the top its just thin, much thinner than the sides which are quiet full. i also visited a Hair center to discuss some options and the interviewer was agreed that it didnt fit the normal profile. I am wondering if it is a hormonal issue. I took accutane when i was younger if that has any bearing. Also around the time i started losing my hair i started to sweat a bit more than usual Any help would be greatly appreciated

Block Quote

Genetic variations are wide and family patterns do not always show balding. Now with that said, I would want to see you to map out the miniaturization in the head and then determine if this is one of the variations we see in genetic hair loss. Accutane clearly does participate in the process and if you are genetically prone, it may contribute to the genetic hair loss.

Send me pictures as a start (my email address is on the Contact page). You clearly need a diagnosis. Let me know which city you are in and if you are not near one of our offices, I may be able to refer you to someone who can help make a diagnosis.

Hair Loss InformationFemale Hormones and Hair Loss – Hair Loss Information – Balding Blog

I was prescribed topical estradiol shampoo .05% for hair loss (Bout with TE spring 2004, Hair wasn’t growing back in very well in some areas). Within 3mos. of using this hair is now falling out. Do you have any information on this. My Dr. says that it does not cause hair loss suppose to maintain growing phase longer. Came across a study that says that it can induce hair into telogen. Who’s right? Any help would be greatly appreciated!!!!

Block Quote

Yes, hormones can cause hair loss. Female hair loss is a strange ‘beast’ because our understanding of it is very poor. The best indication of the hair loss impact of your estradiol is the observation that it caused hair loss in your situation. I would suggest stopping it and seeing if it returns. You might have to wait 6 months for reversal.

Hair Loss InformationHair Salesman – Hair Loss Information – Balding Blog

I went to a hair transplant facility the other day and had a consultation. Most of the time I was there was spent with a salesman. Is this usual? Do they generally get a commission of I sign up.

Block Quote

Your question is a good one. Unfortunately, many doctors in this field do use salesmen as communicators for their patient interactions. Although I have never done this, I do understand the huge costs involved in patient education and communication. The salesmen do perform that role well, but in the ending part of the question, you raised the most important issue, the one which defines whose interests are being weighed during the consultation process. The laws of all states generally forbid the payment of commissions to ‘communicators’, but I have no doubt that most salesmen have incentives to sell the hair transplant process. The doctor, on the other hand, is sworn by oath to put your needs ahead of his financial interests. There is clearly a conflict between selling you the transplant and watching out for your needs. You might judge the doctor by how much of his time you are worth.

Megasession Healing Time (with Photos) – Hair Loss Information – Balding Blog

The idea of a Megasession frankly scares the hell out of me. I am an executive of a large company and fairly bald. I want to keep my vanity problems to myself. If I have a Megasession, how long will it take me to look normal so that I can go back to work. Will everyone ask me where all of the hair care from?

Block Quote

The healing is best answered by looking at two patients with megasessions. The photos here on the left and middle are of Patient A (3,628 grafts) immediately after the procedure; the photo on the right is Patient B (4,676 grafts) one day after his procedure.





Most patients will have no sign of a transplant within a week or so. Some will have no sign of a transplant in a day or so. There is a difference in the way we heal, but with that said, today’s good clinics use very small needles so that the “tracks” of a transplant heal with amazing speed. I tell the patients that they can resume full activities in 5 days (except for heavy lifting, sit-ups and body presses). I have had one patient enter a 120 mile bike race on the 5th post operative day.

The average patient returns to a normal look in about a week, then the hair stubs that are there fall out and by the 3-4th week, most patients look totally like they did the day before their hair transplant. Then in 2-5 months, the hair starts to grow, very insidiously. It is rarely picked up by anyone, even by those who sees the patient daily, much like watching a child grow (never sees it happen). The two examples shown above are two different examples, one with some hair (Patient A) and one almost completely bald (Patient B) except for hair in the middle of his head. A famous celebrity (who shall remain nameless), told me that after his hair transplant, everyone knew something changed, but no one, not one single person pegged the hair as the cause of his change. He was 48 years old when I did his hair transplant and people thought he had a face lift because he looked so much younger. He told everyone he just lost some weight after working out a bit more and no one questioned that.

Hair Loss InformationFunny Patient (with Photos) – Hair Loss Information – Balding Blog

The photos below are of a patient who came to my office yesterday, now 11 months after his transplant of 2403 grafts. When he saw his before pictures, he asked me to cremate them because that man no longer existed. We had a great laugh together as he shared his own amazement of the transformation which he had not fully appreciated until he viewed those old photographs. The humor took another step as he put on the Groucho Marx mask that we bought to give to his grandson. It was one of those joyous experiences that I see day after day. For me, it’s the impact on peoples’ lives that really makes my day.





This patient is a Norwood Class 6 with salt & pepper, medium fine hair. “Before” on the left; “After” in the middle and on the right.

Hair Loss InformationPropecia and Liver Disease – Hair Loss Information – Balding Blog

I have been taking propecia for about 6 years. I also have Primary Scholerosing Cholangitis (PSC), a liver disease. Do you know of any studies or have any other knowledge about the impact of propecia on the liver? Thank you.

Block Quote

There are warnings on the use of Propecia for those people with liver disease, however, it is not clear if the drug can negatively impact the liver directly in those with active liver disease. What I suspect is that the metabolism of the drug may be affected by active liver dysfunction. I will ask Merck, the makers of Propecia, about it and get clarification from them, getting back to you in the very near future. They are usually responsive to my questions.

UPDATE (May 3, 2005): Please see the response from Merck here.

Hair Loss InformationUse Minoxidil After Transplant? – Hair Loss Information – Balding Blog

Hi,
I am 6 weeks post op. I received 1500 fu’s and earlier punch graft work repaired. Other than some minor shock loss in the donor area, I seem to be healing fine for 6 weeks. My question is this; I have never used Propecia or Minoxidil before. I am curious if 5% Minoxidil would speed up and/or enhance grafts. It states that Minoxidil only works in the vertex area. Would that not apply to recipient area on the top of my head? After all, the grafts were taken from below the vertex. Also, I’m using Mederma for scarring from old plug extraction on crown. Is it wise or safe to use Mederma and Minoxidil at the same time? I have purchased the Minoxidil, but have not used it yet. Any information would be appreciated. Thank you.

Block Quote

The donor hair will not be affected by Minoxidil so I do not recommend its use after a hair transplant. I generally put people on Propecia if they are young and in the balding process at almost any stage, as hair transplants can accelerate any hair loss process that is active. Mederma is an over-the-counter herbal medication that is recommended for (1) old scars, and (2) new scars. Its claims include that it softens the scars. It has no defined scientific benefit that I know of. I suspect that it is safe, but I do not have first hand knowledge about it.

Hair Loss InformationHair Transplant Advice – Hair Loss Information – Balding Blog

Dr. Rassman:
I am a 25 year old male who over the past 2 years has begun to see hairloss (receding hairline starting at the front middle forehead and working its way back). I am using rogaine 5% and Propecia daily. Its been 12 months and I swear it doesnt seem to be working. Now I never noticed hair on the pillow, etc, but the loss was becoming apparant, and I am still not seeing it on my pillow. I can not go bald (many many nasty scars on the old dome). At 25 is it reasonable to get a transplant if I want to keep from getting to stage 3, 4, etc. My mother’s father was almost entirely bald, but no one else seems to have problems. What else should I try or do? Suppliments? I live in Florida and noticed you are only in California. How can I get an idea of cost, etc without flying to California? Please help!

Block Quote

At 25, with your history, it is most likely that your genetics are dictating the hair loss process. With both Rogaine (weak medication) and Propecia (strong medication) your ability to stop frontal hair loss appears improbable. You must assume that you will be like your family hair loss pattern (worst case scenario) and if you elect to go the transplant route, then starting in the front and working backward is the best way to go about it. It is possible that the medications you are taking may stop the hair loss short of your full family pattern, but I suspect the frontal hair will be lost. These medications work better on the back of your head than on the front. This makes you a wonderful hair transplant candidate, something we do on young men of your age all of the time.

First, take some good digital pictures of your balding head from front, top and sides, wet and dry then email them to me (my address is on the Contact page. If you are not technical, call my office 800-NEW-HAIR and we will send you a disposable camera. Then the next step will be a telephone consultation with us. From that point on, at the least, we can talk from ‘the same page’ knowing what is really happening. If you elect to come to California, then there is air fare subsidization of your trip and a night in a hotel (on us) once you arrive for your surgery. More info on the NHI Travel Program available at this page. When we speak, I can give you a cost estimate, best and worst case.

Hair Loss InformationProcerin Info – Hair Loss Information – Balding Blog

Dan wrote…

a website called consumer-review.net/hair-loss.html rates a product called procerin higher than propecia, procerin’s website, procerin.com elaborates on their product. I was getting ready to order some procerin, when my wife heard your ad on the radio and I checked out your website, and read about dutasteride. Are you familiar with procerin ? Also could a dermatoligist prescribe dutasteride to patients before it has fda approval ? please advise

Block Quote

The product you described, like many other similar products, adhere to a very loose standard for the health food additives which are naturally found in the environment. There are many natural herbs that are poisonous as well. There is no requirement for any of these products to prove effectiveness or safety, unlike those that go through the rigorous FDA process. This is the reason that I maintain what I believe is a healthy skepticism for these ‘natural’ products. The same is true for my attitude for prescribing dutasteride for hair loss, which has not been shown to be both safe and effective for hair loss. I am familiar with hearsay reports that the libido impact is greater for dutasteride than with Propecia and the drug has a very long half life, which means that it takes months to get out of your system. If you should take dutasteride and develop a libido problem (for example), it may take 6-12 months for it to rectify, while with Propecia is would disappear in days. I personally would not be against prescribing dutasteride, but I have not done so yet. My motto, like any good doctor’s philosophy must be “Above all, do no harm”.

Also, it should be noted that the link on that consumer-review.net site you mentioned is an affiliate link to the Procerin site, meaning that Procerin pays that site if people use their link to buy the product. In that regard, it would seem that it’s in that site’s best interest to highly recommend Procerin.

Hair Loss InformationFirst Course of Action – Hair Loss Information – Balding Blog

I am 34 years old and I have a receding hairline. Now, I am getting a bald spot on the top of my head. What should be my first course of action to save my hair?

Block Quote

The first course of action should be to see a competent doctor who understands the male pattern balding (MPB) process. He will examine the hair on different parts of your scalp and look for the amount of miniaturization that you are showing in various locations. The things he will identify will not be the level that you can see with the naked eye as balding occurs slowly and insidiously and can not be picked up without high powered examination of the hair. Based upon a proper examination, he should develop a master plan for you that will cover your worst case scenario and probably include the use of medications for MPB if that is your diagnosis.