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Dr.Rassman, you have written that it is common to lose between 100-150 hairs per day. You have also stated that it is common to see a lot of these hairs when showering as you loosen dead hair follicles and hairs trapped with styling products. In a recent post (Oct.27th) an individual wrote in regarding his shed high shed count. You asked if he had noticed area specific shedding - ie. top of the head as opposed to the sides or back as this could be an indication of genetic balding. I wonder if you could elaborate on this for me.

I too have high shed counts and have for years now, I would say on average I lose between 60-80 hairs per shampoo session - over 100 if I go days without washing my hair. I also use a heavy, sticky texturing salon product and frequently wear a hat all day long if I haven’t kept up on the shower regimen. So whenever the alarm bells sound as I get the old hairy palms in the shower I chalk it up to those factors and try to accept my precious follicles washing down the drain. This is difficult because you’re never quite sure if this is “normal” or early signs of hair loss.

When you spoke of area specific loss this got me interested. I have noticed when shampooing that the vast majority of the hair that comes off on my hands originates from the front/top of my scalp. Assuming that shedding is within the normal range does this area specific loss still suggest pattern balding? Could there be other factors at play that would make hair loss appear greater in that area? Is it normal to shed more on top than the back/sides? Your insight on this issue would be greatly appreciated.

I concur, it can be difficult to determine whether you’re seeing just normal cycling or early signs of hair loss, but I really do not know the answer to your question. Your hair should shed evenly throughout your scalp, but it could be that you apply more of the sticky hair product to the top of your head for styling purposes and it traps the normal cycled hairs from falling. Couple that with not washing your hair for days,and you’ll notice the shed hairs will accumulate on your head. Then, of course, washing the hair will show the accumulation since the last wash. Wearing a hat will also increase the accumulation of shed hairs, which normally would blow away on their own.

Hello Dr Rassman,

While scouring some medical journals, I came across this 2007 clinical study that involved a comparison between Finasteride, Dutasteride and a Placebo. The subjects were 18-55. And the study seemed to confirm your suspicions concerning sperm count; however, not to the extent that may have been feared. Please find link below:

Journal of Clinical Endocrinology & Metabolism

Thanks for bringing this study to my attention. What is needed is a double blind approach where sperm count is high on the list of targeted outputs. Without such a study, the safety of dutasteride (with regard to fertility) may be a problem for young men wanting children.

I am considering my second hair transplant as I have developed some baldness since the first procedure. My question is, can the old donor scar be made into a tricophytic scar during the second procedure?

Yes, the trichophytic closure can be done on the second or even third procedure to try to make the scar smaller. I haven’t written much about the trichophytic closure in recent months, but essentially it is a technique to minimize donor area scarring for those that have a hair transplant using the strip method. You can find photos here and here.

Snippet from the article:

One of the UK’s leading cosmetic surgeons is calling for age restrictions on hair transplant surgery, after seeing an alarming rise in the number of teenage boys wanting to go under the knife.

Dr Bessam Farjo, co-founder of The Farjo Medical Centre and past President of the International Society of Hair Restoration Surgery, has seen a 23 per cent increase in enquiries coming from men aged 20 years or under over the past 12 months. Some of the enquiries the centre has received have come from the parents of boys as young as 16-years-old.

Read the full article Plea For Age Limits On Hair Transplant Surgery

I’m glad Dr. Farjo is speaking out about this. I get quite a few emails from teens asking for surgical advice, but you must understand that hair transplantation should not be an option until you’re an adult. It’s not like getting a nose job, where once it’s done, it’s done. Hair loss is progressive.

I’ll give you an example: You know how you can see those old, ugly hair plugs on some men that had surgery many years ago? They likely didn’t see those plugs of doll’s hair at the time, but as the hair loss progressed around the plugs, those very plugs that were adding fullness to their hair eventually became the focal point of their scalp. Granted, today’s techniques are different in terms of appearance, but my point is that your hair loss will likely progress to some extent and you don’t want that touch-up work that you had at an early age be the only thing you have on your head as an adult. This is exactly why I mention the need for a Master Plan. Think long term!

Hi Dr

I just want to check with you on treatments other than Propecia and Minoxidil. I am 28 this years and have tried Laser, herbal treatment, proscar, minoxidil and even acupuncture on the scalp. Currently i am on proscar, minoxidil and Nizoral cream and still i am losing hair, is there any other way i can try to get some of my hair back. I am desperate now and hair transplant is my last resort. What do you think of Avodart , i am worried of the side effect like sterility that might happen. Please advise.Thanks

Even drugs such as Propecia (finasteride) and minoxidil have limitations, as they will only slow the process down or grow some hair. Nizoral (ketoconazole) is an antifungal treatment and hasn’t been proven to my satisfaction to treat hair loss. I do not recommend Avodart (dutasteride) until more studies on safety are completed and can be reviewed.

I understand you are desperate, but you need to educate yourself and make intelligent choices. Remember, there is no cure for hair loss. You now belong to millions of men and women out there that have paid lots of money and time and effort to find such a cure with no luck, only to contribute to the economy of capitalism. I don’t know enough about your history (how long you’ve been taking the medications, your degree of hair loss, etc.) to provide much help here.

Snippet from the article:

A Chicago-based company that claims its combination of laser therapy and scalp treatments can regrow hair is being sued for allegedly making false statements based on unsubstantiated scientific claims.

Atty. Gen.Lisa Madigan filed a lawsuit Tuesday in Cook County Circuit Court against Natural Hair Growth Institute, claiming the company has failed to provide consumers with full refunds for services that average between $8,000 and $12,000.

Read the full article — Lawsuit alleges hair growth firm’s claims are bald

From what I gather, a hair laser and snake oil sales clinic promised results in 6 months and offered a full money-back guarantee, of which they decided to conveniently disregard. They also falsely claimed that their laser was FDA Approved (in fact, none of the hair lasers are “Approved”). Now they’re being sued for the cost of the services plus $50,000 for each violation of the Illinois Consumer Fraud Act.

My scalp is very wrinkly, almost like a shar pei dog. What is this and how can I fix it?

This is called cutis verticis gyrata (CVG). The cause is unknown and there’s no known cure (though cosmetic surgery might be an option).

Basically, the condition is when a great deal of skin, far more than is needed to cover the skull, is generated by the body. I have seen a few mild cases of this condition and have written briefly about it a couple years ago. Look at Google for more examples.

Some of the hairs on one side of my head, located at the hairline by a part, are shorter than other hairs on my head and do not seem to grow out to the same length. Are these hairs miniaturized, and I will lose them, or is this just the way those hairs are. They seem to be similar to the naked eye in every way except the length.

We all have different hair lengths because of hair cycling. It can, I suppose, be regional.

You know how the literature says that Propecia takes a few weeks at most to leave the body because of tissue fixation? How come when people start a new diet, such as cutting out milk, gluten, or soy, they say to wait 90 days in order to see results? An herbalist told me the threshold is 90 days because that’s the time it takes for the blood to recycle/cleanse completely or something.

Of note, red blood cells have a life span of 120 days, but this really has nothing to do with tissue fixation. Red blood cells are not tissue nor do they carry Propecia.

You are asking me about starting a new diet and things that herbalists practice. They generally do not have any good science behind them. Let me reiterate with an example: A few of my acquaintances heard about colon cleansing (colonics) and how it rids the body of toxins, so they went as a group to try it since they thought it was a great idea. Now personally, I find it a bit disturbing to go with a group of friends to have a stranger in a white coat put a hose up my bottom, followed by flushing gallons of fluid up there for a good sum of money just so I can watch the fecal waste come out. Granted, I’d find it equally disturbing if it wasn’t a stranger… but the point is, there is no good science behind colon cleansing. All of this is a bunch of B.S. (pardon the pun).

I realize I’m going off on a tangent, but people will believe what they want to believe. I also realize there is a community of alternative medicine supporters out there, but I’m a Medical Doctor. There are some alternatives that have been shown to work just as well as claimed, but there are also many of them that are just don’t work at all.

I come across this web site. Please mention your remarks about the various products related to hair. Especially an oil called anti-graying. Can gray hairs be prevented through topical oil applications and reversed? Your general opinion about all the hair loss products in that website is needed for me. Because without your advise Iam not going to follow any treatment relating to hair. Unlike all the other herbal remedies they didn’t use Saw palmetto, which you normally wont recommend, that’s why this site will be of some interest to you.

Oh boy. Herbal balding remedies simply do not work as claimed. That should be the end of it, right? You are asking me as a resource to recommend a herbal product that works for graying or hair loss. Just like there is no herbal remedy to change the color of your eyes or to make you taller or to make your penis longer/larger, there is no herbal remedy to reverse graying of hairs or balding. By the way, if anyone out there thinks there is an herbal remedy to make your penis longer, that is another issue for another forum.

Gray hairs come about due to genetic predisposition. There is no topical oil that reverse your color permanently. If this oil does anything, it probably colors your hair.