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I just read a very interesting article in the current NewScientist magazine (issue 2576) that I wanted to comment on –

• Tressed to impress: Our love affair with hair

“…with the exception of the musk ox, humans are the only mammals with almost continuously growing hair… Different parts of the body is what determine different lengths of hair… Leg hair, for example, last around 2 months, armpit hair .. make it to six months but head hairs grow nonstop for 6 years or more. … and there are hundreds of genes involved….. there are 10 main genes for the keratin from which our hair is constructed.”

Furlessness may be a better way to manage hair loss in the savannas for human hunters which allows for better thermoregulation. The authors of the article believe that there are several good reasons to become less hairy, evolutionarily speaking. Fighting disease is one such good reason, since “hair is a prime habitat for parasites.” The authors believe that the driving force for change in our evolution is mostly cultural.

“Darwin believed that less hairy was a sexual selection process and those with less hair were the most attractive…. Those people who did not groom, became ‘the mark of the outcast, the lunatic and the social pariah’.”

For proof of the value of culture working with evolution, the authors suggest that we look at well groomed animals such as the African baboon (magnificent manes), Amazonian cottontop tamarin (punk head tufts), emperor tamarin (imperial mustaches), and India’s lion-tailed macaque (chic eloquence).

Baboon	Cottontop Tamarin
Emperor Tamarin	Lion-tailed Macaque

These animals have fur that grow to a fixed length and each of the primates are groomed constantly by peers in their social organization. The world’s oldest profession possibly may be the hair dresser, certainly competing with prostitutes and soldiers for that distinction.

Hi,

i knocked my head and there was a bump where its knocked, after few days the bump is gone, however that area where I knocked has no more hair. Few months has passed but its still the same I was wondering if there is any way to have the hair grow back? Or do I have to wait longer?

After a local trauma on the scalp, hair that falls out usually grows back. I would wait a good year before considering that it may never grow back (you should probably see growth return in 3-6 months). If it does not grow back, and if it still bothers you, you may be a good candidate for a hair transplant procedure to cover that area (I doubt that it will not grow back). Send me a picture after 6 months and I would be happy to review it. Please reference this blog posting when sending the photo.

Hello-
I had a hair transplant done over a year ago. It was great, I love it- however, they are having me take Propecia every day. Is that necessary? Do I NEED to take it? It’s SO expensive that I’m seriously wondering why I need to take it and if it’s totally necessary - I had the transplant already, shouldn’t it “stay”? The way my hair was thinning, by the way, was down the middle…I read that Propecia helps with thinning hair on the crown.

Just wondering if I can save myself $200 every couple of months!

Thanks!

Propecia (finasteride 1mg) will give you the benefit of slowing down futher hair loss or even reversing some of the loss. It compliments your hair transplant surgery, especially the hair on your crown area. The transplanted hair will stay, but the hair around it may still be genetically determined to fall out. This is why continuing the drug is a good idea. If money is the issue, I give a choice to my patients to take generic Proscar (finasteride 5mg) and cut it in fourths to make it semi-equivalent to the Propecia dose. This will save you hundreds of dollars per year.

Hi Doc. I had taken 1mg of propecia for 4 months with great results for hairloss. I started to notice some sexual side effects and went off the med. I’d like to take it in smaller doses or take 1mg once or twice a week. Any info. available regarding much smaller dosage to avoid side effects?

That is a very good question. In my practice I generally tell my patients (if they are experiencing any negative sexual side effects which occur in about 1% of patients) to cut the pill in half and and then take a half pill daily. It is better to do this than take one pill every other day because the half life (the time it takes for half of the drug to be out of your blood stream) is 5 hours. So if you skip a day you will not benefit from the drug since it will be completely out of your blood stream the next day. Even a quarter of a pill a day may have value. See what you need to keep the side effect away and then watch the hair carefully to see if the dose is holding on to the hair. The reason that Propecia is a prescription drug is for advice like this and you should be getting it from the doctor who prescribed it.

People have been using over the counter hydorcortisone cream (anywhere from 1% to 2.5%) on their scalps and reporting hair growth. What is your feelings on hydrocortisone use on the scalp?

People report many things but verifying that what they report is true is another story. I have heard of hydrocortisone cream on the scalp, but there are no good medical studies to prove this grows hair and I suspect it might even hurt. Hydrocortisone cream can cause your skin to weaken and even potentially cause hair loss and make no mistake that medications put on the skin do get absorbed into the body. Long term use of topical cortisone can produce a variety of problems.

Hi Dr Rassman, I thought I recently heard you say on this site that minoxodil stays effective for 22 hours, did I hear you right? Because my thoughts are that I would like to cut down my use of minoxodil to once a day if it would have the same effect and save $ or did I misunderstand what you may have been saying? Thank you. Great blog.

Minoxidil is a twice daily treatment for best results. You might get benefit once a day, but why take it once if twice a day is better (and the recommended dosage). It is not a very expensive medication, so go for it the right way.

I had a transplant in late-May. I still show no results and it is almost November. I also still have redness on my scalp. Shouldn’t I now show some hair growth? Should this redness have subsided by now? Finally, is Tricomin shampoo supposed to speed up growth?

If the redness and the lack of growth concerns you I would follow-up with the doctor who performed your surgery. Not everybody reacts exactly the same to the surgery, but it is relatively rare to see redness continue after the first month. With respect to growth, it may take up to a year to see the complete results. I would not put much faith in Tricomin shampoo to speed up the newly transplanted hairs. After 8 months, if you do not have styling length hair, then you might have a failure of the transplant, but wait it out before drawing conclusions.

My daughter is 11 years old. We recently noticed a gray patch of hair along with a pink spot on her scalp. What caused this? She had braids this summer and it was not there. Please help because shse is being teased at school now.

Sometimes it is normal to have patches of hair that is different in color. I doubt it had anything with having braids. You may want to have your daughter seen by a dermatologist if you are noticing something different on her scalp. There may be a medical condition that may be causing the change in her scalp and hair pigmentation (such as ringworm, which is common in children).

I thought it would be nice to share a 2 month post surgical donor wound (still a bit light pink) with hair growing out of the wound from a trichophytic closure. By the 4th months, this wound will become virtually invisible.

For more information about the trichophytic closure technique, see Techniques to Minimize Donor Area Scarring.

Click the photos to enlarge.

(female) I think the biggest frustration is the fact that we search sites and find answers like: You should ask a local doctor… but the problem is that doctors either don’t know or don’t take the time to find out. I have been “undiagnosed” for almost 2 years. Severe hair loss (50%) burning scalp after hair fall, outer eyebrow loss, fatigue, hair growth on arms, visual changes, etc. but no abnormal hormone tests, no thyroid issues. It makes no sense and I can’t just keep asking doctors because they truly don’t know. I need to find out if I had TE and I was genetically predispositioned to FPB and it is DHT I need to be targeting or whatever. It gets very old when you watch your hair fall with no hope of stopping it. Please let me know if there is anything else (disease) I can research. Thank you.

I am sorry to read of your frustration and its unfortunate that this isn’t the first time I’ve read or heard similar stories. Its quite often, in fact. Even as a hair specialist, I sometimes do not have all the answers as to what is causing the hair loss. Many times doctors are just acting like mechanics. They fix a problem without fully understanding the cause.

In your case, the symptoms of visual changes, hair growth on your arms, fatigue, and burning sensation are very troubling to me. You need to find a doctor (I realize that is the hard part) that can sit down with you and find what is going on with you and explore all possibilities from Lupis to Multiple Sclerosis to Sarcoidosis to other female diseases like Chronic Telogen Effluvium. Many of these conditions require a biopsy and the diagnosis can be made under a microscope. There’s little I can do via the internet without examining you, and I don’t have any local recommendations in your area. I wish there was more I could say to help, but at this point my hands are tied.