Balding Blog

I had a hair transplant 3 weeks ago and the scabs are still present. I can not take off my hat. As an executive of a large company, I took off the first 2 weeks, and had to go to work with a baseball hat on. Having a hair transplant was a terrible decision. Whey don’t you guys tell people like me what to expect? I think you can tell that I am angry as hell.

I am certain that we did not do your hair transplant as our patients are devoid of any major scabs after about a week if washed twice a day. More importantly we make every effort to educate our patients of what to expect.

In fact, my wife (Mrs. Rassman) had a hair transplant in the frontal hairline just a few weeks ago, and the transplant was barely detectable by the first day after surgery. The key to keeping a hair transplant less noticeable is to have a washing program that keeps the scabs off. Most of our patients leave the operating room without much evidence of the surgery because we wash the scalp very thoroughly before leaving the operating room. We have the patient usually come back the next day and we wash their hair ourselves and instruct the patient in the washing process. The old adage that cleanliness is close to godliness, applies here in the post operative care of a hair transplant. Your doctor should have explained this to you.

I’m 28 years old. I got a hair transplant done in November 2013. After the transplant, I lost some hair and seemed to be more hair loss in the first three months. Now that i’m approaching my one year period soon, why is it that the amount of hair that was planted has not grown? I was expected a least twice of what i see. When i comb myself i still look like someone who is losing is hair, and i hate it, especially when i go under a light or out in the sun. What is your suggestion to my situation.

Setting expectations is as much the ‘art’ of what I do as doing the surgery. That is why I have open house events every month, so that people who are going to have surgery can see and meet someone with a similar balding pattern and hair color and ask them about their experience. It is possible that you lost a considerable amount of hair from the hair transplant surgery and the transplants actually grew but because of your shock hair loss, the net gains was zero (worst case). If you were on the drug Propecia (finasteride) it may have helped but that is hard to tell.

If the hair did not grow, then the question should be ‘what went wrong?’. Maybe it did grow but your expectation was unrealistic and the communication between you and your doctor may have been an issue. You can always get a second opinion, but first, ask the doctor who did it and find out if your doctor’s expectations were met and ask him/her to examine you for the results of the hair transplant.

A recent article in the International Journal of Cardiology showed that baldness is tied to Heart Disease (coronary artery disease, the metabolic syndrome,hyperinsulinemia,insulin resistance. higher cholesterol, higher triglycerides, and higher systolic and diastolic blood pressures (high blood pressure). The article summarized 31 studies involving 29,254 subjects with alopecia and found these relationships. They pointed out that such measures such as weight loss, smoking cessation, and other modified risk factors should be the way patients fight for their health.

Hi doctor Rassman. you have an amazing blog and are so informative when it comes to hairloss.

I have been taking propecia (the brand version from merck frost) for 6 months and 3 days to be exact. (I started taking it on June 1 2011, and today is december 3 2011). I have seen no change in my hairloss at all. My hairloss has not gotten better, or it hasn’t gotten worse. It is at the same rate prior to taking propecia. So basically its like I have taken the propecia for nothing. They say you are suppose to see less hairloss by month 3. this is now month six and still nothing.

I went to see my dermatologist and he told me that since I haven’t seen any results within these 6 months that I should stop taking it if I want and further treatment with it will make no sense since it has done nothing in the first six months.. he basically left the decision up to me. These were his exact words, “If I were you, I would stop taking it because since it has done nothing, i don’t think it will be of any benefit, but its up to you. you can keep taking it for another 6 months and see where that goes”.

Now this is my question to you doctor rassman. I know you can’t give medical advice and such, and I completely understand. I just want your opinion on the matter. Since you are a hair restoration specialist, I feel that your opinion is far greater than any dermatologist.

do you think 6 months is to soon to give up? should I continue in your opinion? Have you had any patients who started seeing the benefits after 6 months and such. what do you think? I just want your opinion. I really appreciate it. thank you

Without an examination or documentation of how your hair loss has progressed in the last 6 months, I really would not know what to advise. I can’t tell you whether you should or shouldn’t take a medication I didn’t prescribe to you, but it could be worth sticking with it for a little while longer before making a decision either way. Your doctor gave you the same advice.

We advocate miniaturization studies, bulk measurement studies, and even take photographs under consistent lighting. These tests, while not perfect, are an attempt to quantify and scientifically track hair loss. Hopefully one day we can accurately measure and document hair loss more accurately. As a matter of fact, we have just been granted a U.S. Patent on such method a method (see here).

If you want an evaluation of hair loss and options, I would seek a hair transplant surgeon in your area. Your situation may not be hopeless as finasteride almost always works to some degree, even if it is just slowing the process down. I generally tell my patients that they need to take Propecia for 6 to 12 months before the effectiveness can be assessed but that same advice should extend to a few years with Bulk measurements taken yearly. I also make it a point to tell those patients that while they may not notice any difference (or even notice more hair loss), that could mean the genetic predisposition to hair loss is winning out over what the drug can offer. It’s possible that the medication has slowed the rate of your loss, and had you not taken it for these past 6 months you’d have even more hair loss than you have now. Really though, I don’t have any way to know unless you get two measurements for hair bulk over a 12 month period.

Swedish researchers published an article in the British Journal of Medicine (October 2014) which showed that a “high intake of milk may be associated with higher mortality and fracture risks in women and higher mortality risk in men”.

61,433 women and 45,339 men (women 39-74, men ages 45-79) were followed during a medium of 22 years. They were asked about diet early in the study with questionnaires. 15,541 women died and 17,252 had fractures. during a 13 year follow-up, 10112

They analyzed outcomes from enrollment (from 1987 to 1990 for the women and January 1998 for the men) through December 2010. During a median of 22 years of follow-up, 15,541 women died and 17,252 women had a fracture. During a median of 13 years of follow-up, 10,112 of the men died and 5379 men had a fracture.

The harm came from drinking 3 or more glasses of milk per day. “The researchers found that women who drank three or more glasses (680 g) of milk a day had almost twice the risk for death compared with women who drank less than one glass a day (hazard ratio [HR], 1.93, 95% confidence interval [CI], 1.80 – 2.06). Women who drank more milk also had a higher risk for any type of fracture (HR, 1.16; 95% CI, 1.08 – 1.25) and for hip fracture specifically (HR, 1.60; 95% CI, 1.39 – 1.84).”

Although the researchers found that men who drank three or more glasses of milk had a slightly higher risk for death compared with those who drank less than one glass (HR, 1.10, 95% CI, 1.03 – 1.17), men did not have the excess risk for fracture seen in women.

Men did not see the high fracture rate thwt women experienced. Yogurt and cheese did not show higher risks for either death or fractures.

Further analysis of the men and women who had increased risk was not done.

The body of a supercentenarian expands science’s appreciation for the physiological limits of aging.

This article was Published in The Scientist:

Two interviewers chatted with the now 113-year-old van Andel-Schipper back in 2003. The interview was also repeated at age 111 (neuroscientist Gert Holstege) and again at 113. She was amazing with memories going back to the details of a soccer game in 1898 when she predicted that her favorite soccer team was not going to be successful and she was right.

“She knew exactly what was going on in politics, in sports,” recalls Holstege”… “She could explain … exactly what happened in 1898 when Wilhelmina became queen [of the Netherlands].” She remembered the details of the parties she’d gone to with Dutch soldiers as WW1 began in 1914. “She was completely alert.” She died at age 115.

I (Rassman) had a great grandmother who lived to 114 years of age and I remember her well. Like Andel-Schipper, her brain functioned reasonably well, but unlike her, she was not in a nursing home. She lived with her daughter (my grandmother). Every Sunday, the family would get together with her. She was born before Lincoln became president and was alive when I went to medical school. She gave me the following advice. “Marry a rich woman until you get established and she puts you on your feet. Then get a divorce and marry for love the second time.” It could be modern day advice for many of our peers.

Dr. Stuart Gitlow of the American Society of Addiction Medicine says “we’ve known that people who use marijuana when they are younger tend to have cognitive abnormalities”. He studied were people in their 40s who smoked about 6 joints a week when they were 18-20. Brain scans were done which showed volume, shape and density changes in two key regions of the brain. These areas deal with emotion, motivation and decision-making…. “This is the part of the brain you don’t want to mess with”. says Northeastern University psychiatrist Hans Breiter……” The more marijuana that users smoked, the more their brains differed from normal brains…..

As we move to more and more legalization of this drug, we should ask ourselves what is the price we will pay? This will obviously impact schooling, and everyday life. Can you afford to take this risk?

Long-term use of both mobile and cordless phones is associated with an increased risk for the brain tumor called glioma which is the most common type of brain tumor. The study was published online October 28 in Pathophysiology.

The Glioma risk tripled for people who used any wireless phone for more than 25 years. The risk was increased in those individuals who started using the phones before the age of 20 reported Lennart Hardell, MD, PhD, professor, Department of Oncology, University Hospital, Örebro, Sweden. He suggested that doctors speak with their patients about this risk. In this phone based society, we can protect ourselves by using hands-free phones with load speakers, text messaging and blue tooth technology in our cars.

Rassman Comment: We have seen this concern raised many years ago but there was no proof that the risks of brain cancer with phone use was so high. This article may be a game changer requiring all of us to keep the hand units away from our brain. When I walk in public places or pass by schools, young people can be seen with phones looking like they are ‘glued to their ears’. As parents and grandparents, we should be cognoscente of this risk and get our young people to use text or hands-free instead of long term phoning.

“About 40% of US adults will develop diabetes, primarily type 2, in their lifetime, and over 50% of some ethnic minorities will be affected” according to the Centers for Disease Control and Prevention (CDC) and Emory University, Atlanta, Georgia, published online in Lancet Diabetes & Endocrinology.”

Obesity is the major cause of adult onset diabetes as people have great difficulty in managing sugar. If you are worried about this, get your doctor to perform a basic blood test called ‘Hemoglobin A1C’ which will tell you if you run a high blood sugar at times. I am a big fan of finding out risks and addressing them in time before problems set in. The good news is that once you know your Hemoglobin A1C level, you can take appropriate actions with the help of your doctor if needed. We know that diabetes accelerates heart disease and many other conditions including stroke, so the theme of this post is ‘find out and then take action’.

In 2006 I had a hysterectomy (uterus only). This past July my doctor put me on 1 mg. of Divigel. I’ve noticed the past couple of months that my hair is falling out. I don’t know if it is the hormone replacement therapy or not. I should note that when I’ve had surgery or a stressful time in my life, I tend to shed, but the hair comes back. I’m wondering if my “empty nest” this fall or the Divigel is causing the hair loss. Any ideas?

Stresses (emotional, surgical, medical, etc) can all cause some degree of hair loss. It usually takes about one year or so before you notice the hairs regrow once the stress is under control. Or, it could be the medication you’re on. Divigel (estradiol gel) does list mild hair loss as a common side effect.

It is best to discuss your concerns with your doctor that is treating you. On top of the stress and medication, there may be other medical issues that you are not aware of as well. In the end, hair loss for women is very frustrating for doctors and patients alike. There is no one magic bullet or a defining cause. And worse yet, there is no definitive treatment (let alone, a cure). Good luck.