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Dr. Rassman,

I have used the search function and read all about telogen effluvium and shock loss post-transplant. I just had a very minor FUE procedure of 400 grafts performed a few days ago.

I have been on Propecia (1 mg) for over a year and have diffuse alopecia. However, I am now experiencing hair loss all over my head (including what I believe to be the donor area). Is this telogen effluvium from the shock of surgery or just ordinary shock loss? The doctor said it was probably just some shock loss. What the are long-term effects of something like this?

I notice the hair loss by doing a gentle (very gentle) pull test in all areas. Thanks for your help.

I honestly do not know. I am not trying to brush you off, but every case and every patient is different. What is your age? What did your hair look like under miniaturization mapping prior to your follicular unit extraction (FUE) procedure? Did you have diffuse unpatterned alopecia (DUPA)? If you had done a proper pull test, you might have developed a telogen effluvium (TE). Differentiating TE and shock loss may be difficult at this time. If you had DUPA, you could be at the forefront of disaster. If it is TE, then the hair may return, but if you are under 30 years old, I would want to know, because shock loss is often permanent in the very young men. For shock loss, it does not matter if you had a small surgery or a big surgery, as just the anesthesia can precipitate the process (even without the surgery).

This question points out a series of problems for me when trying to answer some questions here. I sometimes get minimal information and am asked about diagnosis and prognosis. What I do when I see a patient is get a complete medical history, including significant discussions on the hair loss history. Then I perform a very thorough examination, which includes mapping the scalp for miniaturization. I put it all together at that point. As you can see from the above email I received, when little information is available to me it is difficult to really help.

Consider a visit to my office for an appointment and then maybe I can help you more extensively. The cost of a trip to Los Angeles has to be minimal when compared to a large amount of hair loss, which is priceless. Or please speak with your doctor regarding this matter. In your case only time will tell and following it with your doctor may give you some comfort in what is happening to you.

Dr Rassman,

I thought you would be interested in this study, if you have not already seen it: ScienceDaily

This study reports that small doses (0.5mg/day) of dutasteride have indeed been proven to be effective for hairloss. It would seem the study only followed a single pair of twins, but from what I’ve seen you report about dutasteride, you don’t seem to be aware of any such study.

Does this change your attitude about dutasteride even slightly?

Before I would prescribe Avodart (dutasteride) I would want to see an FDA clearance on safety. In previous posts I believe I’ve referenced that at the 0.5mg dose, Avodart is no better than Propecia. This was based on early information received, but I’d need to see a more extensive study than the one referenced in the article you sent. The article isn’t clear about a lot of things… like even mentioning how wide the study was. There have been studies done on effectiveness, but I’m also looking for safety.

As of today, Avodart is not FDA cleared for treating hair loss and my insurance company would not cover me if a complication should occur like sterility. I’m not anti-dutasteride — I just want to see the facts spelled out before I treat my patients with it.

While there’s really no such thing as a do it yourself hair transplant, this man in the video above makes a fine attempt. There’s a funny and a serious side to it. Funny because it is an awkward approach that is somewhat uncomfortable to watch without knowing the end, and in thinking about how if his girlfriend ran her fingers through the lush patch of hair that came off in her fingers. On a serious side, this man showed just what a hair transplant could do for him and how it would change his appearance. He did his own sales job. I congratulate this man for proving the old adage that necessity is the mother of invention… plus, for having a great sense of humor.

Locally, there is a product on the market called, “Minoval” which is a 2% formula of Minoxidil. There is nothing said about having to have a family history of balding to use it. It is highly recommended by many which report remarkable results without a family history of balding. Do I really need to have a family history of balding to use the Rogaine for men or women? And what will happen, other than facial hair (5%) if I use it and I don’t have a family history of balding?

Minoval is another product out there that contains minoxidil as the active ingredient to regrow hair, and the biggest difference with this one is that it is produced in Haiti. Along with the hair growth, minoxidil can also cause small drops in blood pressure (producing fainting).

Minoxidil should have no effect on normal hair. I am not sure why a person would use it if they are not balding, though.

Hello Dr.
I was recommended by a hair specialist to use 2% rogaine to stop my hair loss. However, I have gotten hair growth all over my face and my body, but I am afraid of stopping the rogaine because I really dont want my hair to start falling out again. I am a 26 year old female. Is there anything that I can do, or anything else that I can use? I know that there aren’t many options out there for women. Please help! Thank you.

You are absorbing the minoxidil into your body and in your case, it is a potent hair stimulator. Facial and body hair are known side effects of minoxidil (Rogaine) and if you are so sensitive, this is not the medication for you. With regard to other options, there are not many options for women wanting to treat their hair loss, but it is best to talk this through with your doctor.

Hi. Has anyone managed to stop their genetic hair loss without drugs? The idea of taking meds scares me -all those side effects. There seem to be some options out there: ShenMin, BioFen, Essential Oils for example. I would be curious as to what people’s experiences are.

Thanks

Good luck with this probe. We get many thousands of visitors a day to this blog, so maybe someone has seen value in these natural “home remedies”. I certainly have not seen positive results from those treatments, but I hope some of the visitors will be able to contribute here.

hi doctor,
every hair transplant surgon (including yourself) always says a person has to be a good candidate for hair transplant to be feasible and succesfull. what exactly do you mean and how do you define a good candidate?

A good candidate understands the process of balding and the limitations of a hair transplant surgery (where the transplant process works and does not work). The presence of realistic expectations reflects the supply/demand issues of the donor supply and this requires some prediction of your long term balding patterns. The concept of a Master Plan is critical in knowing that you can meet your goals. The rest is determined by the relationship between and good doctor and a patient willing to accept what transplants can and can not do.

All too often, patients who are 21 years old (too young) do not want to bald and they are not willing to really understand what they have to do (from taking medications to following the miniaturization mapping). It’s also worth noting that there are some things that might immediately disqualify you from a surgery: some forms of OCD like trichotillomania (until you have it under control), some forms of alopecia (we don’t want to transplant diseased hair that will just fall out again), etc.

Dr. Rassman,
I wanted to know what you thought of the NeoGraft system. The “FDA-approved NeoGraft automates the surgical removal of individual hair follicles, one at a time”. Do you think this will be just another flash in the pan invention or could it help assist hair transplant surgeons in the future?

Here is the link to the story: New NeoGraft Device Improves Hair Transplants

Regards

The story is actually a press release, which explains why it enthusiastically approves of the tool. One thing I’m disappointed with right off the bat is that it claims “no visible scars” occur if this tool is used, and that is simply untrue. Any puncture made to the scalp will result in a scar to some degree. I know what they were going for, but saying “barely visible scars” or “no linear scar” would’ve been more truthful.

I watched the video and it appears that the doctor is using a drill to remove the grafts from the donor area. It still seems tedious and I could not inspect the follicular units for transection rate analysis (damage done to grafts), which I would need to do to make a judgment on this FUE instrument/technique.

Hallo,

I had an hair transplant on my temples about 7 months ago. After my transplant I had minimal and certainly not complete at all loss of transplanted small hair. After about 5 months I could see results which were incredibly positive and the hair in the transplanted areas was long and rather thick.

What I have experienced in the last 2 months has been a visible decrease in density of the transplanted hair. Is this possible? Also my hair loss in non transplanted areas has increased (I have been on propecia for 8 years)

Thanks a lot for your help

It is difficult for me to guess at what you are talking about. Existing original hair may continue to be lost to the balding process and even at 6 months shock loss can occur by accelerating the hair loss in the areas you are discussing. You doctor should have good photographs from just before your surgery to help you analyze what is actually happening. That is where you should get the answer to your question. Even if I saw you personally, I may not appreciate the changes you discussed above and the time line of those changes.

Hello Dr. Rassman,

Great blog and thanks for taking the time to help out so many people at not only no cost to us, but at the expense of extra time and effort on your part. It’s very appreciated.

Anyways, I am a 25 year old male with an equally diffused pattern of MPB that has been increasingly noticeable for less than a year. I have a couple detailed questions about Propecia. I understand that 10-17% of males on propecia still experience hair loss, but are those who experience a slower rate (but still losing) in hair loss included in this 10-17% or in the other 83-90%? Also, if I experience a Propecia side effect like chest soreness/pain/tenderness and I am I willing to live with the discomfort, is this actually going to hurt my body?

Keep up the great work!

I’m not sure where you got the 10-17% statistics, and I wouldn’t know how the figure was even calculated. There are percentages at the Propecia.com site and they explain how those numbers came to be — see here.

I do not expect that Propecia will produce chest pain of any type. I would hope that with these pain symptoms, you would seek out medical care from your primary doctor looking for real diseases that cause chest pain.