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Hi doc,
How do you tell the difference between Telogen Effluvium and Diffuse Alopecia Areata?

Diffuse alopecia areata can look very similar to telogen effluvium. The only way to tell these two diagnosis apart is by performing a series of biopsies of the scalp. Alopecia areata can be diagnosed histologically.

I am afraid that I might loose all of my donor hair & I might require an eyebrow transplant in the future. I am wondering if it is possible to use facial or chest hair for an eyebrow transplant if necessary?

Yes, chest or body hair can be used for eyebrow transplants, but that would not be my first choice (see past entries I’ve written about body hair transplants). Eyebrow transplants do not usually take much hair.

Doctor
I like your methodical approach as far as coming up with a master plan, mapping hair out for miniaturization, but after many many hours of researching all the info on the web, I’m not sure what the point is. From what I’ve learned Propecia has been shown to work for the vast majority of people. Minoxidil works for most people also, just not as well. By working I mean even in the cases where neither has shown to grow hair there has been the benefit of retaining hair or at least slowing the process down.

Everything I’ve read seems abundantly in favor of these drugs working for most. So why not just use them quit counting hairs, especially hairs in the sink (I’ve found shedding is not always balding)knowing you’re doing everything you can. I know you don’t like to start both drugs at once, but if the point is to grow, halt, or slow the process quickly with maximum benefits, odds are they’re both going to work to some extent and work better together. (No real studies I’m aware of prove that)

Why add Minoxidil 2 years later and be 2 years off baseline than if you started 2 years earlier? So again my question is why count hair or measure density? Everything I’ve read even on your blogs suggest a benefit from these drugs. Again just go off one of these that isn’t working and you’ll find out the hard way.

Sorry for the length of this question(probably too long for here) but I wanted to be clear. This is my conclusion. But I obviously defer to your experience and knowledge. Where am I off here doc? Thanks

It is clear that you read my posts here and understand it well. There are those people that want to know what is happening to them and those that don’t. If you’re curious about microscopically seeing your hair loss progress over time, miniaturization mapping is important. For those individuals who have a hair transplant, the Master Plan is very critical, because it allows you to address what you have growing on your head and adding hair where it will make a difference. I always build a Master Plan for all of my patients who have transplants so that they know when to stop or go forward with more transplants.

Drugs don’t work for everyone, and the financial costs involved with using multiple medications daily are a good reason to try one alone before adding another. One of two medications is available by prescription, the other is over the counter. Yes, the smart thing is to see a doctor for a finasteride prescription and then try minoxidil if you want to throw everything at your hair loss.

I read your blog daily and I know you are very skeptical about laser treatment of hair loss in men/women. However, it benefits us all to know about new stories and developments so I figured I would send this to you and ask your thoughts about it. I saw a laser procedure on the T.V. show “The Doctors” of a woman receiving a procedure and as I could not find it discussed on your
site, here is the link: thedoctorstv.com

Is this basically the same thinking behind the Lasercomb and other laser treatments or is this something new? Is this something only to be beneficial to women and not men is this is something worthwhile? I am skeptical about it myself. Thank you for your time!

The machine they showed looks to be the same one I had in my office for some time (and got rid of). Each hair laser maker will tell you their product is best because of various reasons, but you’re good to be skeptical. As soon as the FDA clearance (showing that it is safe, not that is effective) happened for the lasers, the flood gates opened. There are very few options for women with genetic hair loss, so it’s not hard to see why someone might try to market a new hair device towards the female group. Plus, it makes for good television.

I’ve written about the various handheld and full sit-down lasers before. Bottom line — there is no solid scientific evidence that the low level light therapy (laser) will positively impact hair growth.

Hi doc, I would like to know your opinion about aderans. They are conducing trials in NY, and they say that the results of the experiments will be available in the next 4 mounths. The trials will be concluded at the end of 2010. Do you think they possibly provide us their treatement by the end of the decade, as they promised?

Thank you, best wishes

It is difficult for me to answer your question, as I am not an insider with Aderans. Should we just take them at their word and look for more announcements in the months ahead? Like you, I’m waiting for the results of these trials to be announced. The following is from their website — “We anticipate that patients will have access to hair multiplication technology by the end of the decade, and will enjoy the convenience of same-day office visits, much like the most common cosmetic procedures.”

Aderans clearly has high hopes.

I look at pictures of other patients that have a strip scar and my seems to stand out a lot more than the ones I see. Even if I shave my head on the longest of length it shows up. Is there anything I can do to make it smaller, like having it redone for a tri-stitch?

Without seeing you it is difficult for me to tell you what to do. There are scar revisions that can be performed with trichophytic closures that might help you. For more on that, see:

• Techniques to Minimize Donor Area Scarring
• Where’s the Scar? Hair Transplant of 1807 Grafts (with Photos)
• Result from Trichophytic Incision (with Photo)

The problem is that in some people who stretch scars, the scar tends to return… so that is a risk in undergoing a scar revision surgery.

Dear Doctor

First of I would like to congratulate you on this wicked resourse, I have a buring question wondering you can shed some light on. One of the common side effect of taking Finastride is that it directly effects the sperm making it watery etc. We planning for a baby and I am wondering taking Finasteride will directly effect the child, growth etc? I have not yet seen my GP but everytime I put my hand through my hair I get 2-3 hair that come out, front and crown. but still got a thick head of hair.

Thank doc hope to hear from you soon.

If you are worried about the quality of your semen, then get it check out by your doctor. Finasteride does change the quality of the semen in some men (about 20%), but it has not been reported that it will reduce your chance of getting your lady pregnant or effect the child’s growth. It is normal to lose 100 hairs/day.

Hi there doctor, I have a question about hairloss products like finastride and saw palmetto! I have been taking saw palmetto and finastride for the last two years due to hairloss! Before I started taking these products I suffered from depression! One of the things I was depressed about was the fact that my libido was really low in other words my sexual hunger had gone! Since taking saw palmetto I have found that my sexual hunger is up and my hair is slowly growing. the only thing I am concerned about is the safety of these tablets? I really don’t want to stop taking them cause I feel like I have gained hair and gained my life back, I have so much energy and feel great. Please help me? Also do these tablets cause you to gain weight?

I report these comments, but I don’t know what to make out of them. Both of these medications could increase testosterone, but most of the time they have no long term effects. I’m not sure what you’d like my help with if your libido is up. They do not make you gain weight.

Hi Doctor,

With all the talk recently about steroids in the news, I’ve made the decision to start taking them. At 30 years old, being 6′5 165lbs is no longer an option, and I’ve tried everything to gain mass. I was wondering what steroids can be taken without having a significant impact on hair growth. I’m pretty sure I have MPB. Some companies offer steroids that “have no DHT conversion”, also this website claims certain steroids are safe for hair: http://www.hairloss-research.org/steroids.html. Any help would be greatly appreciated. Thanks.

I use steroids for therapeutic reasons and I have no experience with them to build body mass. Check with your family doctor for his/her recommendations.

Doctor I found a bunch of so called “cures” for hair loss online can you tell me if any of these are true.

(taken from Amazines.com)

“Excess stress, lack of hair care, a dirty scalp, and the lack of nutritious foods can precipitate hair loss. As well, consuming excess amounts of caffeine, sugar, fats and carbonated drinks can cause hair loss.

On the contrary, various forms of exercises that require the body to be bent forwards or backwards will also result in increased blood flow to the scalp, which will promote healthy hair and a healthy scalp. Consuming foods rich with essential nutrients will also promote healthy hair growth.

Home remedies for hair loss are the best options, and they are safe and dirt cheap. They do not have any side effects and don’t cause any damage. And the good news is that there are so many remedies available to stop hair loss, that if one doesn’t work another one might.

One of the methods is to take some fenugreek seeds and soak them in water overnight in a big bowl. Next morning, apply the water to your scalp and wrap the head in a towel.

Let it remain like that for three hours and then shampoo to get rid of the fenugreek smell. Following this routine daily for a month may solve your problem; however, those who catch colds easily shouldn’t try this or stop as soon as they feel that they are about to catch cold.

Another method for hair loss prevention is to apply castor oil to hair roots and scalp before bedtime, yet try to avoid getting castor oil on the rest of your hair. In the morning, shampoo to remove the oil. Continue this process once every week for 7 to 10 weeks. This is one of the many hair loss treatments that may stop hair loss, although it may not work for some people. There is no harm in trying this treatment.”

If none of these are true why are so many people so ignorant on hair loss?

We all look for that miracle cure for hair loss, but it is elusive. I couldn’t begin to guess why people are ignorant about these “treatments”. Perhaps the power of suggestion is at play. Perhaps they are easy to dupe. Perhaps, perhaps, perhaps…

Quite a funny list there, though. Why not apply manure to your head? I mean, fertilizer helps crops grow in the field, so why wouldn’t it work to regrow hair on your scalp? I’m sure if I put a “Rassman’s Own” label on a bag of cow droppings, someone would buy it with the express purpose of applying it to their head. Any takers?