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My bother-in-law is one of the most brilliant men I have ever known. I do not mean the Einstein type, but rather, he’s incredibly practical, creative, and clever. He ran a dairy farm passed down from his father in Ireland’s lush countryside, and gave me the opportunity to experience farming firsthand. Enthralled with his inventiveness with solutions to his daily problems on the farm, I realized the creative opportunities in farming. So in 1976, while running one of the busiest surgical practices in Vermont, I decided to enter the farming business. I really knew nothing about farming, but felt deep in my heart that this was a venture I would prosper in and enjoy the rewards of manual labor, something that the surgical practice did not offer. So… I bought a farm. With the agreement of my surgical partner, I took off enough time to set up the farm I purchased, which already had almost 100 dairy stock cows. My wife grew up in Ireland and as a child had to milk 7 cows each day by hand before going to school, so I figured that the difference between milking 7 cows by hand and 100 cows by a set of milking machines could be made up by just hiring a few farmhands. I purchased the farm in May and almost immediately had to plant my corn to feed the herd, so I was off and running right from the start.

It was a marvelous experience and I really fell in love with being a farmer. I felt invigorated after a day’s work and I put on muscles I did not know I had. I even bought a horse and broke it, and she only threw me once before we became bonded and I felt like a true horseman. I was really living the life, but things weren’t always so rosy. There were lots of problem with the farm, economics being the first one I never sensed I would have. Like any company, one needs a business plan that would anticipate the potential problems, but in the autumn of that first year, 40 cows developed pneumonia. I went to the hospital, got lots of IV solutions, and created an intensive care unit in the barn. I asked the drug reps for antibiotics, which they freely gave me, and used the hospital lab to help me treat the cow’s infections. So I now had two medical activities: my busy surgical practice and a fill-in veterinary practice. All of the sick cows never recovered their milk production and this failure almost lead me into bankruptcy. I learned that the pneumonia was caused by not allowing free circulation of air in the barn, so when I tried to regulate barn temperature I then created a situation where the cows easily became overheated. That was a costly lesson. I had to repurchase an entire herd.

Greetings,
Solid good data base you have built on this blog Dr. rassman. Thank you

My question is: Can you transplant hair from the upper sides of the head “left and right” about 3 inches above the ears, or is it only possible as a donor area to be from the lower back above the nick ? Reason I’m asking this question is because I have what i want to define as “Global hair loss/damage”. Meaning even in the donor area it’s clearly visible that i do not have a normal hair distribution/density “there is holes among the donor area” but, in my sides “just below the flat crown of my head” the hair is extremely healthy/dense/thick and can grow for long time with out being damaged.

Your time and answers are greatly appreciated

First I though you were describing diffuse unpatterned alopecia (DUPA), but if there are clearly areas of your scalp that are full and lush, and they are about 3 inches above the ear, I would rule out DUPA on first glance. I would have to examine you to understand what you are telling me.

As a rule, however, the donor fringe is only 2 1/2 inches high on the back of your head and about 3 inches high on the side above the ear. Donor hair implies that the hair is permanent when full balding (up to a Class 7) occurs. Note the diagram at right of a Class 7 figure and you will see the 3 inches high fringe above the ear. Donor hair taken above the 3 inch level will not be permanent hair for the advanced balding patient.

I’ve recently read on a couple of websites that the silicone compound Dimethicone, an ingredient in most shampoos and conditioners, could impede the absorption of topical minoxidil products (eg. Rogaine). The theory is that this ’slilcone oil’ leaves a thin film on the scalp (even after rinsing) that prevents the topical solution from penetrating. Could this be the reason that many men see little or no result from Rogaine, while a minority of patients see significant regrowth of hair? Should all Rogaine users ensure that their shampoos and conditioners are dimethicone-free?

It is, of course, just a theory that dimethicone impacts Rogaine (minoxidil)’s absorption…. but if you’re concerned about it you can buy dimethicone free shampoo. I do not believe that any single process or product will be responsible for drug absorption or modifying the results of specific drugs. Men have seen variable results from this medication since it was first released as a topical for hair growth. I don’t have an exact explanation why, though.

I’ve actually posted something about this before — Is Dimethicone in Shampoo Preventing Minoxidil Scalp Penetration? — and the commenters at the bottom have some added information that you might be interested in.

Hi Dr. Rassman,

I thought this might be of interest to your other readers. It looks like Intercytex’s old technology has found a new home.

ARI Purchases Intercytex Assets (PDF file)

When word came out earlier this year that Intercytex was closing shop, I received a few emails inquiring about where their assets might wind up. Months later, the announcement has been made. And the winner is…

Atlanta, GA - March 25, 2010 — Aderans Research Institute Inc. (ARI) announced it acquired key technology assets from Regenerative Medicine Assets Limited (formerly Intercytex Group plc), a leading UK hair regeneration company. By acquiring the scientific assets of one of its chief competitors, ARI has further solidified its position as the leading research company in the hair regeneration industry.

Hello Dr. Rassman,

How are you Doc? Excellent work with the blog!

Here is my question: I’ve noticed recently that some of my hair has a “withered” look to it. The hair seems normal and healthy until about 1 cm from the top, then it becomes very thin and wispy looking. Could this be from MPB, poor nutrition, or lack of a recent hair cut?

I’m a 23 year old male, and though I have some miniaturization, these withered hairs seem to be much different than my miniaturized ones.

Thanks and keep up the great work!

Although your description of “withered” doesn’t really explain what you’re seeing, it doesn’t sound like genetic hair loss if the hair is growing healthy from the scalp. Perhaps it is split ends, which can be solved with a haircut. Talk to your barber or a hair stylist.

Hi am 30 years old with a norwood 6 level of baldness. I currently shave my hair with a razor. As i have an extremely large amount of body hair and i guess limited donour hair on my head, is body to head transplant possible? Would it be possible for the transplant to cover the crown as well as the front of the head? What is meant by resting phase for hair and how does that vary from the head and the body? I dont intend on growing my hair long and i would like to keep it at a buzz cut so it would not matter if the transplanted hair was to go frizzy or curly. But i am concerned if there will be a noticeable difference between my current head hair and the transplanted hair. Would i still be able to razor my head after i had a hair transplant? would the be any scars or signs of a hair transplant?

I don’t know why you’d want to just guess about the availability of your scalp donor hair. Have you been examined by a doctor? Body hair transplants (BHT) are technically possible, but they are not something I’d recommend for multiple reasons that I’ll try to explain simply. Body hair is not the same as scalp hair — it looks different, it feels different, it grows different. Even if the procedure is a technical success, it’s not going to give you natural looking results like you can achieve by using hair from the back of your head. Plus, I don’t know enough about your hair loss (donor, density, etc) to really be able to know if you’re even a candidate for any kind of hair transplant surgery.

As you seem to be aware, body hair does not grow at the same rate as scalp hair and about half of transplanted body hair is in a dormant state (see more on that here). Scarring in the recipient area depends on the skills of the surgeon and staff… but if you’re going to shave your head in the future why would you even want a hair transplant? Wouldn’t that be like getting a nose job right before you decide to take up boxing as a sport?

Dr. Rassman,

Thanks so much for this valuable site.

I am considering Propecia. It is the possible sides, not the $$$, that has me hesitating. I have done the research on Clinical Studies, Dr. Frankel’s article, your posts, etc. The data seems to indicate, and you’ve agreed that .5 mg is roughly 80% as effective for hair growth/retainment as a full 1mg. My question is, are the side effects proportionally decreased? Is there any data out there?

B/c of the efficacy of the .5mg dose, and because the decreased DHT/Serum levels appear to stay in the same range for almost 72 hours, my plan is .5mg Merck Propecia every other day, in order to decrease any chance at both short and long term side effects. Does this sound logical to you?

I really do not see your logic. I mostly see your fear… fear that the drug can give you side effects. Is it worth the risk (for you)? Maybe you should question taking it altogether. There is a phenomenon known as the placebo effect… and it goes both ways. If you are preoccupied that a drug will give you a side effect, then you will likely see that side effect because that is what you believe will happen. If you don’t try it you will never know if you will have a side effect.

I don’t know if there is statistical data available that shows decreased side effects with decreased dosing, but I’ve seen that to be the case if a patient has experienced side effects from the full dose. If you have genetic androgenic alopecia and Propecia is recommended by your physician, then I would start with the recommended dose. If you end up with a side effect then you can just as easily not take it and the side effects would be gone.

Hi Dr, I was reading a number of your responses to the queries posted here and was really pleasantly surprised by the straight ahead and honest answers you provide.

I have a query related to what precautions should be taken in one’s sex life when taking propecia, apart from avoiding potential pregnancy. Could the drug be potentially damaging to a man’s partner otherwise? ie during regular sexual intercourse? or, for instance, in oral sex?

I realize these questions may sound ridiculous to someone more informed in the actual working of the drug, but there is a certain amount of vagueness surrounding these issues with propecia that I think a lot of people would like to have clarified.

many thanks. all the best

It’s not ridiculous to ask questions. If a pregnant woman gives oral sex to a man that has been taking Propecia, I would doubt that there was any side effect possible with this related to the drug (the same goes for sexual intercourse). Have fun and you can even return the favor, as there is no risk the other way around either.

For further confirmation, you can refer to a statement from the drug’s manufacturer (Merck) that I published a couple years ago related to this very topic — Propecia’s Effect on Sperm and Pregnancy.

Hi Doc,

I have read places that shaving the recipient area before surgery prevents shock loss and has a higher graft success rate. Do you know if this is true or do doctors who require you to shave your head just want to make the surgery time shorter? Thanks!

It’s probably not true… and you probably learned it from a clinic where the doctor insists on shaving the head. At NHI, we only shave the area that we remove in the donor. The best way to prevent shock loss is to take finasteride before the hair transplant and stay on it for at least one year (better, lifetime). For an experienced doctor and staff, shaving the head is more of the doctor’s preference and doesn’t have much to do with growth / success rate.

Hi Dr. Rassman

I always hear of people searching for unwarranted ways to lower DHT to combat MPB. Whether it be herbs, soy, or saw palmetto, there’s much focus on DHT levels as a marker for MPB. In fact, low DHT diets are all the rage on most balding forums. Perhaps rightly so, however we know the scalp’s sensitivity to DHT is a significantly more accurate marker of MPB and to my knowledge there’s no sure-fire way of calculating this. I say DHT is overrated, and a new focus should be pinpointed on IGF-1 / IGFBP-3 plasma levels.

Some quick definitions…

IGF-1: Insulin-like growth factor 1 (IGF-1), which was once called somatomedin C, is a polypeptide protein hormone similar in molecular structure to insulin. It plays an important role in childhood growth and continues to have anabolic effects in adults.

IGFBP-3: This gene is a member of the insulin-like growth factor binding protein (IGFBP) family and encodes a protein with an IGFBP domain and a thyroglobulin type-I domain. The protein forms a ternary complex insulin-like growth factor (IGF) I or II. In this form, it circulates in the plasma, prolonging the half-life of IGFs and altering their interaction with cell surface receptors.

The study below took 431 men (128 whom had vertex balding) and tested IGF-1 and IGFBP-3 levels in all of them.
-Those with vertex balding had high IGF-1 levels and low circulating levels of IGFBP-3.
-Those without vertex balding had significantly lower IGF-1 levels
(Low IGF-1 levels generally mean a high amount of circulating IGFBP-3 as they show a trend of being inversely significant in a number of other studies)

PubMed - J Am Acad Dermatol. 2000 Jun;42(6):1003-7.

Interestingly enough, in this study Finasteride signficantly increased IGFBP-3: PubMed - Cancer Res. 1998 Jan 15;58(2):215-8.

Perhaps IGF-1 and IGFBP-3 levels can be a highly accurate marker of vertex balding and finding ways to increase IGFBP-3 could serve as a powerful combatant.

I’d like to add that a low-glycemic diet and a diet low in saturated fat have all shown to increase circulating levels of IGFBP-3 as well as increase IGF-1.

Thanks for sending this. It’s beyond me, but I wanted to post it for those that had interest. Let the research begin!