Hormonal Differences Between Men With and Without MPB?

Are there any hormonal differences in general between men with male pattern baldness and men without MPB?

We know that in men, testosterone gets converted into dihydrotestosterone (DHT) and it is the 5a-reductase enzyme that converts testosterone to DHT. Some men do not have the genetics markers that cause the DHT to induce the (hair) loss, though. In other words one can have a very high DHT level and never have hair loss (because they do not have the genes for genetic hair loss).

DHT can be inhibited/ reduced with drugs like Propecia (finasteride 1mg). Although women also make testosterone (lesser amounts) the impact of Propecia does not stop or reverse genetic female hair loss as it does in most men. This suggest that women’s hair loss is not related to DHT.

With all that said… I don’t know of any specific hormonal differences between balding and hairy men.

Homogeneous Genes and Hair Loss

Dr. Rassman,

I understand that hair loss is understood to be a dominant trait. I also understand that men can be homogeneous dominant or heterogeneous. Would it be fair to say that main with homogenous genes are the ones to lose their hair early? say in their 20s and 30s, while men who are only heterogeneous dominant lose their hair later in age? say their 40s and 50s, I was just curious because I figured that maybe men who have a double gene are the ones more likely to have severe hair loss. Or does it not matter either way?

Regards

Hair loss is not a dominant trait. If so, a bald man’s sons will all be bald — which is not the case. What you are describing is a classic Mendelian type of genetic inheritance. The expression of the genetic factors also often skip generations. The hair loss gene(s) is not so simple to categorize and no one really knows how many genes are involved with hair loss.

Homeopathic Hair Cures?

Any comments on Dr.Batra, he claims to have cured 70,000 hairloss patients. It supposedly worlds biggest homeopathic chain of clinics. Does homeopathy have any drugs that are proven?

I’m not familiar with Dr. Batra, but homeopathic treatments have been used for years and are claimed to be effective in a variety of ways. Unfortunately, most of these claims are not supported with scientific research and third party studies that do not have a financial interest in the success of the products, are rare. This clearly applies to claims of cures for the treatment of baldness. We can recommend a procedure or treatment only if it is proven to be safe and effective.


2007-05-11 11:38:38Homeopathic Hair Cures?

I Have Lived With My Nightmare Freaky Hair Transplant Look Too Long

I have lived With my nightmare Freaky hair transplant look too long, what can I do about it? Can you help me?

This patient would not allow me to show his pictures, but I will tell you in general what his “freaky” hair looked like. He had four scalp reductions (removal of bald scalp from the crown of the head) which left a scar down the middle of his head, and he had 4 partly failed transplants creating the old doll’s head look. Between all of these procedure, his entire donor area (except for one area high in the donor area that might still provide for hair for another hair transplant – perhaps not the best option). You can see through the hair on the back of his head and he looks like a cancer survivor despite his good health. This surgery was done over 20 years ago by a Los Angeles surgeon known to the professional community for this type of terrible work, but not known by his victims. The patient was in his early 20s back then and wanted to believe in the doctor and after many surgeries there was a progressive loss of trust. His hairline was placed an inch too far above its normal position, so he even looked worse.

My job was to assess his situation, communicate realistic (not idealistic) possibilities clearly to him and then recommend a possible treatment for him – if one was possible or agreeable to the patient. Many patients like this have few options and the 8 previous surgeries and all of the deformities that were created, left him mistrusting all doctors with few options. None of the options would bring him back to being completely normal without sacrificing certain styling options. Some of these options were:

1- Shaving his head and having Scalp Micropigmentation done, This is a reasonable option if he can put up with a shaved head and many people in his situation select this option. For an example of a result he might expect, go to scalpmicropigmentation.com and see patient 161 who has deformities in the back of his head similar to this patient. His after pictures show camouflage of these deformities but the deformities and scarring will still be there on close inspection.

2- Fortunately, I believe that he has enough hair that I can still harvest to recreate his frontal hairline with hair transplants. Then he can then have SMP done to cover the massive scars on the back of his head and cover the scars in the front, top and crown of the head. A good frontal hairline will allow him to let all of his hair grow out and style it once the new frontal hairline is created. SMP will help to minimize the look of thinning and scarring.

I have literally seen thousands of patients like this over the past 24 years, and helped many of them. By helping I do not mean making the deformities go away, but with good styling and some surgeries, at times, a much improved look is very feasible. Since Scalp Micropigmentation has been available in our practice, we have been able to create amazing improvements in patients like this. I think that we have done more of these types of repairs than any medical group in the world today.

Hives, Papules, Pimples — What Could They Be?

I just came across the diagnosis of trichostasis spinulosa, which I have seen in my practice on occasion and have failed to come up with a diagnosis.

eMedicine states, “In trichostasis spinulosa (TS), clusters of vellus hairs become embedded within hair follicles, with resultant elevated, dark, spiny papules on the face or trunk. Trichostasis spinulosa frequently is discovered as an incidental finding, and often it is confused with keratosis pilaris or acne comedones.

This condition is more common in men, but does not cause risk for the people having it, just some cosmetic deformities of varying degrees. To see the various forms that it takes, see Google Image Search. Maybe you have seen these on your own body and wondered about it.


2009-11-17 11:32:59Hives, Papules, Pimples — What Could They Be?

HIV Positive and Hair Transplants

I have been diagnosed with HIV which is now under reasonable control. For a period of time I was very sick, but now with the proper balance of medications, I am healthy and active. The problem is that I lost a great deal of hair from the time I got sick 2 years ago to the present. I am 54 years young and I do not like looking 80 whic is what I feel I look like when I saw a recent picture of myself. Can I have hair transplants or does the my HIV status impact either my candidacy for surgery or the results of hair transplants? Will the doctors turn me down for surgery because I am HIV positive?

A healthy person who is HIV positive may be a good a candidate as an HIV negative person. Your sickness probably caused the ‘expression’ of your genetic balding process on an accelerated timeline. At your age, I would be surprised if it continued to progress, but after mapping out your hair for miniaturization, I would go on Propecia to protect you hair from further loss and then be evaluated for a hair transplant if you want to change your look.

Under most state laws, doctors can not discriminate against someone who is HIV positive. Some doctors fudge on this and do what I call ‘closet’ discrimination where there are convenient reasons to turn down patients, but not only is this against the law, it is against the oath we as doctors are supposed to adhere to. If you are healthy, you can expect that you should be a reasonable candidate, certainly one worth evaluating. I perform hair transplants on many such patients each year.


2006-05-30 07:59:28HIV Positive and Hair Transplants

HIV and Hair Transplants

I just had a patient who, in our routine testing, had a lab test that was HIV positive (he was very surprised). He is over 50, recently married and his wife of three years was tested for HIV prior to her marriage, but he was not. He and she came into the office quite calm. They had just returned from getting the news from their family doctor who wanted to repeat the test considering the patient’s history would not support a high risk status. When he came in, we spoke calmly about it and we ran tests from our lab on both the patient and his wife. Within 2 days, the tests from my office came back negative, as did his family doctor’s repeat test. What a hell he must have gone through!

I have dealt with many men who were HIV positive and who wanted a hair transplant. They knew that they were positive to the test, were already under treatments, and had good control of the disease. I took them on as patients just as I would anybody else. I routinely screen for HIV, although I am not hard on this rule. I have had 5 patients with positive tests when these men did not suspect that they were positive to the virus. The shock of my interviews with these patients is memorable and I spent a great deal of time working with them, arranging a repeat test, being sure that the tests are not false positives and advising them as any good, concerned human being would do. This was the first time (1 out of 6) that the test came back negative on re-running the tests. Four of the six patients eventually had hair transplants with me including the patient who tested a false positive this week.

I remember one patient who had advanced HIV, not controlled by medications very well. He was healthy enough to have a hair transplant and did after I worked through this decision with his doctor. I remember him well for two reasons: (1) He felt that he was going to die and wanted to meet his maker looking good with a full head of hair, (2) I accidentally cut my hand with the scalpel that I used on him. Yes, accidents can happen, and this was certainly one that I’ll never forget. Over the next six months, I tested myself for HIV monthly and have done so yearly, every time being negative (that was 10 years ago). I learned that the risk to a person who cuts his hand with a surgical knife that was previously exposed to HIV blood is less than 1% in contracting the disease, but had it been a needle with a drop of blood in it, the story would have been different. In fact, most healthcare workers who got HIV from a hospital accident got it through a needle that originally contained blood. About a year after the incident, this patient’s mother came by my office to inform me that her son had passed away. She smiled as she told me, ” He was happy in the last days of his life, and when he looked in the mirror, he liked the new look he got from the transplant.” She went on to tell me that her son wanted to lie in an open casket at his funeral and he wanted to have his own natural hair at that time. He wanted his friends to remember him that way. I realize that this story may seem a little morbid to some readers, but I wanted to share this very humbling experience where I helped someone achieve one of their final goals in life, even it the goals were outside the goals I normally see.

Hit head, lost grafts 3 days after surgery, what to do?

You have a surgeon, so your surgeon should address your problem. That has happened in my 16,000 surgeries over the past 29 years twice. Once I was able to retrieve the grafts from the car door, wash them and replace them and they grew just fine as it happened in front of my office. The second time, I replaced them at no charge to the patient. I always do the right thing for my patients, so should your surgeon.


2020-08-08 09:48:14Hit head, lost grafts 3 days after surgery, what to do?

History of Hair Transplant Pricing

I am someone who currently is probably not the best candidate for a hair transplant but may be interested in the future if my pattern of loss continues. While the FUE procedure looks like a desirable option it is expensive for someone on my salary/budget. I’m curious about how much the cost of hair transplantation has gone down or up in the past and what that could mean for the affordability of hair transplants in the future. Also, I understand that the costs of hair transplants vary based upon the quality as well as other factors but Im wondering more from the perspective of the hair transplant industry as a whole. Any thoughts would be appreciated. Thanks!

MoneyHair transplant pricing follow the rules of supply and demand. There are discounters who sell it for less and many of these discounters will not provide the same quality. Quality is defined by the percentage of grafts that really grow and the art of the distribution of the hair. Price ranges from follicular unit transplants range between $15 and $2/graft depending on where you live. FUE (follicular unit extraction), on the other hand, seem to have a slightly higher rate ranging from $20/graft to $7/graft. Because of the recession, prices have dropped. We have dropped our FUT (strip method) pricing by 20% to reflect the hard financial times in the economy. See our fees here.

Histopathology of Non-Scarring Alopecia

Hi Dr. Rassman, I was wondering if you knew the histopathology of non-scarring alopecia in a 21 year old male? My dermatoligist said I had diffuse hair loss and non-scarring alopecia and prescribed me Propecia; I am also taking Rogaine. Additionally, what do you think of spirinolacatane as a topical treatment as an anti-androgen for this type of hair loss?

Thanks

The histopathology of non-scarring alopecia is just as it states — When you look under a microscope of your scalp biopsy there is often cells seen that reflect some autoimmune disorder, but no scarring where there is hair loss. Examples include anagen effluvium, androgenetic alopecia, chemical alopecia, folliculitis (mild), inherited disorders of the hair shaft, telogen effluvium, alopecia areata, and traumatic alopecia.

Of the list above, the most common non-scarring alopecia is genetic balding (otherwise known as androgenic alopecia — AGA; otherwise known as male pattern baldness — MPB). And since your dermatologist prescribed Propecia for your non-scarring alopecia I would guess that your dermatologist thought you had MPB. It probably would’ve been much easier if you were just told that you have male pattern baldness. If you have diffuse unpatterned alopecia (DUPA) then the donor area behind your head would have substantial miniaturization. Speak with your doctor about how he/she arrived at the conclusions.

Finally, spironolactone has anti-androgenic properties, but clinically there is little good evidence that it helps with MPB.


2008-02-20 17:14:36Histopathology of Non-Scarring Alopecia