About     Contact     Archives     Videos     Events     Hair Transplant

dear dr farjo,
i live in the UK and have consulted a few transplant drs up to this point- but neither of them could give me a conclusive answer as to whether the hairloss i have experienced is the development of a mature hairline or early stage MPB. (I have minor recession at the corners of my hairline, and am 24 yr old male)

I would be interested to know how you would assess this and do you perform the miniaturization study like dr rassman? as the drs i have consulted so far did not.

thank you

The following response is by UK-based physician Dr. Bessam Farjo:

Response by: Dr Bessam Farjo United Kingdom

Well, I start by asking you about your own hair loss history and its progression. I then obtain a thorough family history to assess the likelihood of progressive hair loss. Unfortunately the younger you are the harder it is to be accurate. An examination of your entire scalp follows to see if you are losing it in a genetic pattern. I may even suggest a genetic test to help predict your future loss but that is not definitive either.

I can certainly assess your miniaturisation like Dr Rassman. One of the other video microscopes I have is also capable of measuring hair calibre and has the software to compile such data.

A genetic test to assess responsiveness to finasteride is in development and I will be able to provide that when ready.

Hi. I’m a 24-year-old white male who has been having hair loss issues for about a year now. Based on family history, I know it’s probably AGA, but since I don’t seem to be following the classic NW pattern, and because the thinning became apparent suddenly, accompanied by severe shedding and following a stressful period, I’ve often wondered if I could be experiencing telogen effluvium. A hair pull test I performed on myself in May 2008 seemed to support this notion.

The shedding has long since stopped, but my hair has not returned to its normal density. My question is, how often is telogen effluvium concentrated in one area of the scalp? Almost every description I’ve read says it’s diffuse, but I’ve seen pictures of post-op patients suffering from it who have lost an appalling amount of hair on top but relatively little on the back and sides.

Generally speaking, telogen effluvium (TE) is spread throughout the scalp. This is the time to see a doctor and be examined for:

1. A miniaturization mapping of the scalp hairs
2. A genetic test for the balding gene, if appropriate
3. An experienced doctor who knows what to do

This is not the place to write a textbook for a complex problem like you are describing.

I’d like to know if finasteride is safe for an 18 year old boy. Can it interfere with a possible genitalia growth spurt that I’ve been told can occur even after complete bone growth up to age 20 or 21? My son appears to have male pattern baldness, so his Dermatologist has put him on the drug, but his Endocrinologist advises against it. My son doesn’t want to lose his hair so he’s taking Propecia, but doesn’t know about the other possible problem. It’s not something I want him worrying about unless the drug can really interfere with genitalia growth, in which case he should know so he can decide for himself whether or not to take the drug. Please advise.

Propecia (finasteride 1mg) is safe for 18 year olds and this medication is not known to retard genitalia development in young men. The 5-year effectiveness and safety study submitted to the FDA included men aged 18 to 41 years old. He is correct that to hold on to his hair, this is the best approach.

You’ve said that daily shampooing of hair won’t cause hair loss unless we wash too rigorously. Disregard the physical aspects of washing. Can the chemicals in shampoo be affecting our hair follicles? I know that hair is “dead” when it grows out of the skin, but I’m concerned our hair follicles are shallow enough that the shampoo may be affecting them. Although if this were the case, perhaps a lot more women would have the same type of hair loss as men.

Sorry, but you’re completely off base with this. Shampoo itself has nothing to do with hair loss… absolutely nothing if it is a good commercial shampoo.

Why can’t you transplant hair from one person to another? if the hair is exactly the same colour and close enough the same texture is it possible to do this? Also, on the same note can hairs remove during a procedure be preserved or do they have to be put into a head straight away? honestly it would be a great idea, people with generously thick hair “sell” their hair to you and then you could probably charge 3 times that amount to put it into someone elses head, it would make lots of money.

There is a lot of experimentation occurring, but nothing that exists at this time. Hair grafts start dying at about 8 hours out of the body while kept in ideal conditions like iced Ringer’s solution at about 34 degrees Fahrenheit. The death rate for grafts occurs at a rate of about 1% per hour after the 8 hour period. In 24 hours, there will be 24% death rate of grafts, 48% at 48 hours etc.

Hair follicles are organs, and like with a kidney, liver, or heart transplant, these organs also have limited times to get them into their new and final resting place. You would have to take anti-rejection medication for the rest of your life if you used anybody’s hair organ other than your own and the risks of these drugs are high for death — a risk perhaps worth taking for a heart or liver, but for hair? No way. These medications can lead to other health complications, and since a hair transplant isn’t exactly a lifesaving procedure (like a heart transplant would be), the end doesn’t justify the means.

This is a continuation to last week’s post, Intercytex Announces ICX-TRC Phase 2 Results by Dr. Bessam Farjo. He had included these images with the text of his original article, but I didn’t have captions for them so I held them back until they could be presented in the proper context. The captions and images were provided by Dr. Farjo. Click to enlarge:

–

Baseline MacroPhoto of tattooed study area 1 week after injections

 

MacroPhoto of tattooed study area prior to cell injections

 

Preparing multiplied cells in solution in GMP facility

Dear Dr. Rassman,

I know there is no standardized evidence to say one way or another, but in your opinion is 2 mg of Propecia (1 mg taken in the morning, 1 mg taken at night) more effective at preventing hairloss than 1 mg Propecia?

The reason I ask is I have been taking 2 mg Propecia daily for almost 3 years now, and have started to experience “clumpy” semen and painful ejaculation. I am thinking this is due to a side effect of Propecia. I am kind of in a dilemma now because I don’t know if my fight against hairloss will be affected by cutting down the Propecia to 1 mg or altogether. I am 26 yrs old and single so hair is very important to me.

Thanks Dr. Rassman!

I would reduce the dose of Propecia to 1mg taken in the mornings. The higher the dose, the more side effects you are likely to see. The 1mg dose has been shown to be just as effective as higher doses in the formal studies of drug dosing done by the manufacturer. I recently saw a patient with a similar complaint, and he halved the dose and the side effects went away. He was taking 1mg and reduced it to half a pill of Propecia, which has been reported to be about 80% as effective (0.5mg vs 1mg). In your case, you’re taking too much of the medication to begin with. 1mg a day is fine.

Dear Doctor:

This is in response to a post that I saw regarding grapefuit juice and Propecia/Avodart absorption. Grapefruit juice inhibits the Cytochrome P-450 intestinal enzyme CYP3A4. It does not affect the hepatic enzyme apparently. Dutasteride is metabolized extensively by this enzyme. The serum level of any CYP3A4 substrate, such as Dutasteride, will be elevated in the presence of GF juice. Additionally, grapefruit juice takes quite some time to leave the body, so it’s effect is cumulative. If someone drinks 1 glass a day for 5 days, CYP3A4 will be significantly reduced. Additionally, one 8-oz glass of grapefruit juice inhibits CYP3A4 as much as 2-3 double strength glasses, so you don’t need much. Ketoconazole is also a very potent CYP3A4 inhibitor. Now, I am sure most readers would not be against elevated serum levels of Dutasteride/Finasteride as the effects of dutasteride (at least) is dose-dependent. However, many other drugs such as antivirals, statin drugs, antihypertensives, antiseizure medications, and many allergy medications are also CYp3A4 substrates. Elevated serum levels of these drugs can prove deadly, so as a general rule, patients should check with their doctors regarding any drug/food interaction.

Just my 2 1/4 cents. Thanks!

Thanks for the information. There are some medications that do not do well with grapefruit juices, but here some other links to explore about this –

• Grapefruit Juice And Medication Can Be A Dangerous Mix
• Grapefruit juice squeezes more out of some medications
• Drug - Grapefruit Interactions (Review)

And there’s more links in a previous blog post here.

I was in a fight in high school, and my hair was pulled out in the back of my head. As a result my hair has never grown back correctly. My hair isn’t bald but short in this one spot. My mother told me about hair growth treatments in the salon what do you suggest.

I would need to see it. Hair transplantation works well for missing or short hairs and could be a solution for you. Generally, hair that is pulled out once will return almost 100% of the time, but if you were treated with strong chemicals to try to bring it back, the chemicals may have burned/damaged the hair follicles enough to make them weak.

Hey

I have a question and would be glad to get a response.

Can the kind of water I use cause baldness? I hear that Chlorine water and the , metals inside the water we shower in can cause baldness.

If so, can applying small amounts of water everyday increase baldness?

The answer is simply: NO. Water is good for you, but you can be poisoned with salt water or chlorine water, not the metals in the shower water in the United States.