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Hi. I am from Europe in Slovenia. In 5 months i’m gonna move to Canada for studying. So I wanna know, is “different” water gonna hurt my hair and started to make me bald? I am 18 years-old. And if water is bad there (in Canada) or if there’s “hard water” there or filled with chlorine… so if I don’t wash my hair with that water and I wash it with bottled water from stores, will that be OK, will the water be good for my hair, prevent baldness because of the “bad water”?

Thank you in advance for your answer.

When you go to Canada, look around to see if the people there are all bald. If the people’s hair in Canada look like they do in Slovenia, I wouldn’t worry too much.

Hard water (with a high mineral content) won’t make you go bald, though you might notice your hair lacking body or shine. If you are still worried and don’t want to even chance it, I suppose you will be spending lots of money on bottle water… or you could invest in a water filter.

Dr, I wanted to share a success story with you that I recently had with telogen effluvium of the eyebrows.

After some stress, I got seborrheic dermatitis which triggered telogen effluvium. After about 5 months with no end in sight to the shedding, a skin care specialist told me about her success she had taking 6000mg fish oils (I cant remember what her skin condition exactly was). But long story short, I began taking them & I actually take about 7000mg. My seb derm. & tel. eff. both stopped. I’m very happy about that, & I read your blog & your new posts weekly so I thought I would share this & maybe it will benefit some of your readers.

BTW, fish oils are like $10 for 400 capsules of 1000mg capsules.

Thank you for your story and experience. I’m not suggesting fish oil supplements will work for everyone that is seeing eyebrow hair loss, but your advice may help others and the risks are very low in trying it.

I had strep throat and the doctor gave me a steroid shot to bring down the inflammation. Now, I am assuming one little shot should not have any effect on my hair, correct?

I would agree with your assumption if you are looking for some assurance, but hypothetically, if you knew the single steroid shot caused even minor hair loss, would you have refused treatment for your strep throat?

Dear Dr Rassman,

Great blog with an incredible depth of information. I had a hair transplant 12 month ago with a reputable European surgeon. I am very pleased with the result; I had 1500 grafts placed at the front, restoring my hairline as i have quite thick hair. However, I was considering having further surgery to further thicken the frontal areas and also increase the density around the temples.

My question is two fold:

1. Would you recommend such as course of action? My surgeon is reluctant to do so in case there is future recession behind the grafted hairline, thus causing a splitting effect. I am currently on propecia and have not noticed any further recession but am aware this may happen.
2. How many hair transplants can you reasonably have and what is the optimum amount of hair you can transplant? I ask this because I am slightly conscious that if i do have further surgery to thicken up the front then i might not have enough supply if i do further recede.

1. I have no recommendation. How can I? I have never seen you, examined you, or even have any idea of what your balding pattern and level of thinning or your donor hair density, etc. Before any surgery, you must have specific goals and a Master Plan, which is a plan for your future balanced with your donor hair reserve (this is very important).
2. The number of surgeries or the optimum number of hairs you can transplant is highly variable on each individual. It depends on your hair density, scalp laxity, the number of grafts you attempt for each surgery etc etc. These are very basic questions that your surgeon can easily answer. I want to help you but you need to first start by talking to your doctor and asking these same questions to him. Maybe you can write your questions down on a piece of paper and ask those questions one by one to your surgeon. I am not trying to be facetious but I do realize that maybe when confronted face to face with a doctor your mind may go blank.

For your general knowledge, the donor area is between 25-35% of your total scalp area. That means that the average person with 100,000 hairs on their head have around 30,000 donor hairs. Keeping half and transplanting half means that this person with average sustained laxity can move up to 15,000 hairs or 7,500 grafts in his lifetime. Those with higher densities can move more, those with lower densities can move less.

The Asian man with 80,000 hairs or the African man with 60,000 scalp hairs still must maintain 15,000 hairs (approximately) in the donor area. That means that the number of transplantable hairs in the lifetime of a person with low density will be less (you can do the math). With these numbers, your having 1500 grafts means that you probably had 3000 hairs transplanted (assuming that you have an average hair density) leaving you with lots of reserve hair for future hair loss. This is a general rule, and your doctor will modify it based upon his examination and your vital statistics. If your scalp became tight after one strip harvest procedure, then you may not be a good candidate for another surgery, but possibly follicular unit extraction (FUE) would be a good alternative.

Further reading on this topic:

• How Many Donor Grafts Does an Average Person Have?
• How Much Transplantable Hair Does A Person Have?
• Follow-Up: Are Doctors Promising More Grafts Than Can Possibly Be Delivered?

I just started using kirkland minox two days ago and after my second application last night I woke up with dried blood on my nose and I had blood in my phlegm. Should I be worried about this?

Regards

Please make an educated guess. What do you think? If something is causing you to wake up with blood in your phlegm, I’d say that is cause for some concern. Minoxidil isn’t known to make people cough up blood, but if it continues it is something you need to take seriously.

Who knows… maybe you had a bloody nose, the blood dripped down your throat, and you coughed up the blood in the morning. Dry air can cause a bloody nose. Or you could have had bronchitis and broken a small blood vessel in the lung. Or you might have cancer of the lung. These are obviously just complete guesses, so please go see your doctor.

Hi,

About 6 months ago i noticed i was shedding hair. i had low B12 a few months ago, but have been taking vitamins since (my B12 is now normal). now, as far as i can tell my hair is thinning, but not receding. since at every hair loss site i look there’s the NW scale for hair loss, which shows the hairline receding gradually, i’m wondering - is overall thinning a form of MPB? could this be something else?

You are asking two different things here. MPB stands for “male pattern baldness” and just as the name implies, the hair loss would be seen in a “pattern”. Diffuse hair loss would have no pattern. Either form can be genetic, but the diffuse loss may be caused by diet, vitamin deficiencies, or many other conditions.

I assume you saw a physician for your B12 deficiency diagnosis, and I would suggest you should see a doctor that can make a diagnosis for you about your hair.

Hey Doctor
Thanks for the website. In a person with average hair denisity, what is the maximum number of grafts on average that you would believe could be extracted over time using FUE (i.e more than one procedure)?

I really do not know the maximum and I would be just giving you a theoretical number. In practice, I believe we may have done about 4000 grafts over several procedures using only FUE.

Hi Dr. Rassman,

I’m writing you to ask whether significant hair loss over the course of a couple months can be due to just MPB? Last august, I had a nearly full head of hair, but I admit it was a little thin on top. THEN, I started medical school and my hair is now thin both in front (along the hairline) and even more so at the crown. Did the stress, lack of sleep and not-so-great diet I’ve been eating simply exacerbate the balding process, or could there be another problem?

I’ve actually already seen a dermatologist regarding my hair-loss, but he didn’t ask me about the time frame whatsoever, so I figure there’d be no harm in asking you for a second opinion. He recommended I start taking finasteride and using minidoxil daily, which I’ve been doing for about a month now. Excuse my complete lack of medical knowledge on this, but I’m just a first-year, so we haven’t touched upon it yet.

All the best

There was a story I remember learning when I was in medical school, that a few years before I attended one medical student practically lived off of Twinkies and junk food. He developed scurvy from malnutrition. That is an extreme form of poor diet and I will assume your diet is a bit healthier.

With respect to my recommendation, I really do not have one to give you other than to follow your doctor’s advice. You need a medical diagnosis and a treatment plan and someone to follow up with you to see if that treatment plan is working.

In general, stress may accelerate the genetic process, but it is not a direct cause and effect type of relationship. I don’t know how old you are, but it could be quite possible that the timing of your MPB starting is coincidental to the start of your schooling.

Hello, I am a 21 year old male, and I don’t have any dramatic balding, but I am noticing my hair is thinner than it used to be when I was younger, but perhaps I am just being paranoid. I am a Sikh, and part of the religion is to keep uncut hair tied neatly in a topknot. I do not tie this topknot very tightly, and I leave a lot of slack between the knot and the root to make sure I am not putting any unnecessary tension on my roots. I wash my hair every 2-3 days depending on how greasy it gets.

My question is: does combing your hair in the opposite direction (as I must to bring my hair in the upward direction to tie the topknot) lead to any sort of increased hair loss? I comb, not vigorously, all the hair at the back and sides of my head “up” in order to tie the knot, meaning I run my comb from the top of my neck to the top of the crown, and I am scared that this is the cause of thinning hair.

Combing your hair “against the grain”, so to speak, wouldn’t cause hair loss.

Tightness can cause tension hair loss which sounds like something you are now experiencing. This hair loss in the front and sides is very common amongst Sikhs from what we call traction alopecia. It is caused by a tight turban which pulls against the healthy hair.

Image source: Wikipedia

Snippet from the article:

Follica has raised more money for its quest against hair follicle disorders like male pattern baldness. The biotech startup, which is developing drugs that could spur the formation of new hair follicles, has raised $7.5 million in equity financing, according to an SEC filing.

Read the rest at Xconomy.com — Follica, the Biotech With Potential Drug Against Baldness, Nabs $7.5M Venture Financing

Follica is still in the development phase, so there’s no telling if this will end up working as well as many folks on the internet hope. The company’s policy is to not comment on their research and development, but the article at Xconomy.com does provide more insight into the venture capitalists that are funding it.