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Dr. Rassman,

Right off the bat, I have to give my deepest appreciation and gratitude for everything you do here! I have 3 seperate questions for you. I don’t believe I have seen these specific questions on your blog before, so hopefully you won’t have to be repeating yourself!

1. For anyone willing to send you pictures to publish with your comments (I am), what are factors should we keep in mind? For example, eyebrows raised are good, correct? What about wetting your hair vs. keeping it dry? Are pictures easier to dissect and faux diagnose if it’s longer or shorter? What about including older photos of yourself? Lighting, etc.
2. I realize every case is different, but generally speaking, at what age do you think people should start seriously considering transplants for receding hairlines? I’m 27, and I realize my mature hairline may continue to recede until at least age 30. If that’s a good rule of thumb, is it logical to wait until approximately age 30 to consider restoring your hairline? (I’m sure the last thing anyone would want is to transplant your hairline too early, only for your natural hair to recede more, leaving you with a bald gap!)
3. While I don’t quite understand why this occurs, I often see the immediate results of transplantation, which is often scarred and scabbed looking. How long does this look last? The reason I ask is regarding those who perhaps want to try and not let EVERYONE in their office (& life) know they had a procedure. If one were to take a week off work to let their scalp heal, would it look back-to-normal after 7 days? Then can you just wait for the hair to start growing in? I haven’t seen many week-by-week photo diaries online. Most tend to be more month-by-month, IF that.

I appreciate any detailed insight you might be able to give. Thank you, sir!

If you want a formal consultation from me, you can call (800) NEW-HAIR or send photos to this address and make time for a phone consultation. Sending pictures to BaldingBlog and having me comment on it will be just generalizations. I recommend taking the photos outside in daylight with some close-ups that wrinkle the brow so I can estimate where the hairline belongs. I also recommend taking some photos with the hair pulled back and even some with the hair wet if you think it will help me see what you want me to focus on.

I have performed surgery on men in their early 20’s to late into the early 80’s. There is no one age I would recommend. It all depends on what you are trying to do and your expectations and your maturity and understanding of what is possible (realistic expectations).

The scabbing after a hair transplant can last as long as one or two weeks, but it all depends on how well you clean and wash your hair. It can look “normal” after one day, and patients who have considerable existing native hairs in the recipient area often have their own coverage. In other words, if you already had some hair in the transplant area, you can use that to camouflage it. If you had no hair in the area at all, that wouldn’t work for you… so we often suggest changing your face by growing a beard or mustache to give a different look overall and detract from your scalp until the healing process is done.

Hello Doc,

Thanks a lot for the blog. I’m 22 and I have a full head of hair, but all the hairs are very thin. Moreover, there is distance between my hairs. Also, I have a problem of small acne kind of thing which keeps popping all over my head. However, I have started using betadine scalp and skin cleaner which has resolved the problem but I have tiny round scars all over my scalp. The main problem is my hairs are very thin. When I make them long, it covers my whole head but it gives a see-through look. When I get a buzz cut, no body knows that im balding.

IN YOUR OPINION,

1.Is there a way that each hair of my head can be thickened? Is it possible for thick-hair-promising hair oils and home remedies (egg yolk, etc.) to penetrate the scalp and nourish the hair from the roots? what about lasers, i know they cannot grow new hair, but can they make thin hair thicker (many doctors on tv say they can)?

2. Any update from lexington? They said something like they were going to publish their results in the scientific journal?

You can put styling products (pomade) to make your hair “feel” thicker. Medically, you can take Propecia (finasteride) to thicken the shaft size, but it is not a permanent solution. Herbal products and shampoos that claim hair thickening may accomplish this by adding water to the hair shaft. There is no scientific proof that Low Level Light Therapy (LLLT lasers) work in my experience.

There was a study published in Journal of Cosmetic and Laser Therapy last year that an insightful BaldingBlog reader wrote a response to — Reader Checks in with His Thoughts on the Latest LaserComb Study. I can’t seem to find the actual study online anymore though.

I took Proscar (1/4 of pill per day) for 2.5 years for my hair loss problem .I haven’t seen a clearly any side effects in the past 2 years but lately I read that Proscar causes erection dysfunction so I stopped using it three days ago and I tried to masturbate but I ejaculate quickly and before that my penis get rigid enough(I ejaculate before get hard) but just last week my sexual life was normal but now I have difficulty to achieve a correct erection . I still have nocturne erection while sleeping and in the morning so do you think this problem is caused by Proscar or just due to stressful situation after knowing that Proscar could causing irreversible sexual disabilities .

are the sides effects of Proscar irreversible? do I have to consult a Doctor? how much time I need to take a ride of the side effects(testicles pain,libido,ED.. ? can I take other medicines to heal theses sides effect are they effective ?

This seems more like a psychological problem rather than an effect of the finasteride. You took the medication for quite a while without issues, then after reading about possible side effects you suddenly developed them. Ever hear of the power of suggestion? That’s what is sounds like to me.

At any rate, this is a prescription drug… so definitely see your prescribing doctor if you feel you’re having issues with libido or any pain and let him know of your recent issues.

Hello, I have a question about the shower and hair loss.

My question is, is it harmful to your hair if you do not shower daily, or sometimes go a few days without showering? Does not showering daily or showering every other day cause hair loss/is it bad for the hair to not shower often? Thanks so much!

You do not need to shower or wash your hair daily. There are many people all over the world who do not have access to water and they have the same frequency of balding that we see in countries that have the luxury of lots of water for frequent hair washes. I think a nice shower just feels good.

i don’t think that every body looks bad bald. i think that everyone looks better with a full head of hair, but men who are taller than 5′10, have masculine facial features, are muscular e.g bushy eyebrows, chiseled jaw, large cheek bones, big intimidating eyes can actually pull off looking okay bald.

The funny thing is I think that when Kelly Slater and Kurt Angle both had full heads of hair, Kelly looked way better, now that they are both bald, Kurt looks better. Both men looked better with full heads of hair and I’m not trying to tell you that being bald doesn’t reduce your looks, it does, but some people have the facial features and head shape to carry the bald look well. let me emphasize this, Kurt Angle DID NOT HAVE MODEL LOOKS WITH HAIR AND HE DOESN’T NOW EITHER

Here is an example of Kurt Angle. The photo is good, but not superb and he is BALD AS A CUE BALL, NO HAIRLINE.

I guess your point is that some men can pull off the bald look just fine, and I agree with that. You just need to have the right head for it (I’m sure we’ve all seen someone with a weird head shape that could probably be improved with hair).

Many readers might not know who pro surfer Kelly Slater or pro wrestler Kurt Angle are, but the bald look can work for a variety of men. For action stars like Vin Diesel or athletes like Michael Jordan and Kurt Angle, it can even provide a more intimidating “tough guy” look. Kurt Angle was losing his frontal hairline in a classic example of male pattern baldness, so just shaving the head provided a quick fix of sorts to that aging look with the deeply receding hairline.

Hair restoration surgery isn’t for everyone, and the reason some celebs (actors, athletes, politicians, etc) decide to just shave their head could come down to personal preference. There’s nothing wrong with that, of course. For others though, hair transplant surgery can restore the hair and confidence that many men want… and again, there’s nothing wrong with that either.

Hi

I’ve just started on finasteride, and I’m wondering if it is possible to see side effects (impotence) after only a couple of days on the drug. I’m not sure if it’s just my anxiety and over-analysis causing the problem, or if it’s actually the drug itself. I’d really really appreciate a private answer.

Thanks!

(24 year old male)

What you’re experiencing may be due to anxiety and what I generally tell my patients is to continue the medication for a month and try to ignore the erection problem if it is there. I do not know anything about you. I would need to get to know you to assess the anxiety element. The power of suggestion could certainly be in play here.

If you got the drug over the internet, this means that there is likely no professional guiding you on your problem. Consider seeing a good doctor if you do not have one… or if you do, then go back to him/her and ask the questions you posed here.

Greetings,

I am nearly 25 years old and am concerned about going bald. My 60 year old father is bald and my 31 year old brother is visibly balding. My mother’s father also experienced hair loss. At this stage I cannot see any signs of hair loss and still have a full head of hair. So my question is will I go bald/should I be concerned?! If so what preventative measures should I take?

Thank you in advance

Taking hair loss medications now could end up backfiring, so there’s really nothing preventative you should be doing if you don’t see any hair loss. The genes can skip generations, meaning you might not experience any thinning. It’s not uncommon for one child to have visible hair loss while another has a healthy head of hair. You can get a HairDX test to find out if you even inherited the genes for balding or not.

If you’re convinced that you’re destined to follow your family and lose hair, see a doctor and have a miniaturization mapping done of your scalp. Then repeat that again in a year to compare the results.

I had a hair transplant 7 months ago. I have had a re-occurring rash which first appeared about 4-6 weeks after the surgery. Is this a side effect, based on hormones? I have no idea what else it could be related to.

This rash is not something that usually occurs following a hair transplant, so I don’t have a clue what it is without seeing you. You should be asking this question to your surgeon.

My son is 17 and he has been receding and thinning significantly on top for the past 12 months. We took him to our derm and he rxed propecia which he has been on for 7 months today. Not only has he not seen any re-growth but has lost even more hair. We put him on generic finasteride because its cheaper. Should we move him to brand propecia?

Do you have someone in Utah that you would recommend we take him to? And last…how do we know if his hair loss is from MPB or accutane? He was on a low does of accutane for 12 months and that is when his hair loss became noticeable. His derm said MPB but I am skeptical.

In the U.S. generic finasteride is only legally sold in a 5mg dose due to patent laws, so the pill must be cut into pieces to get close to the proper dosing found in the 1mg Propecia. Aside from the difference in size (1mg to 5mg), generic finasteride has the exact same active medication as Propecia. Changing to brand name Propecia will likely not solve your son’s hair loss issue. It just may be that your son has genetic male pattern baldness (MPB) and it is running its course. Remember that there is no cure for MPB, and medication only goes so far. Having a HairDX Test for Finasteride Response may have value in that this genetic test will give insights into his overall sensitivity to the drug.

Sometimes Accutane (isotretinoin) can precipitate hair loss, but Accutane alone is not likely the cause. If there is a “pattern” to his balding, then it is likely to be MPB. The various patterns can be found here.

I don’t have any Utah-based physician recommendations, but you can try the physician search at ISHRS.org to find a doctor in your area. These are going to be transplant docs, but they’ll know hair loss. At 17 years old, no doctor should be even suggesting surgery anyway.

Your son should have his hair mapped for miniaturization, as the microscopic view will point one way or the other to the cause of the hair loss. Mapping the hair will give you the opportunity to follow any progress (or lack thereof) as it extends the science to measurement of the miniaturization process.

I am a black (African American) woman in my mid thirties, and in the top of my head and on the right side, in the front around my ears, my hair is continuously thinning and no new hair is growing so the area is getting bald. I chemically relax my hair, and when the straightened hair grows out and the new curly hair grows from my scalp, I notice that in the area with thin hair there is no new growth.

How possible would it be for me to get a hair transplant to that area of my hairline, that extends to my right ear, and about two inches back from my forehead?

I suppose it might be possible, but this isn’t something I could agree to doing without a consultation. You might not be a candidate for surgery. I don’t know how long you’ve been waiting for the hair to regrow, but it could take a year or two.

There’s just too many variables to be able to give you a yes or no about having a hair transplant without seeing you in person. I’d meet with your doctor to find out if this is chemically related loss or if there is something else at play like a series of autoimmune diseases which can cause localized hair loss. You should try to figure out why you’re losing hair before you try to surgically correct it.