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I am a 54 year old female who had a complete hysterectomy four years ago. eight months ago I started noticing itching on the top of my head then all over my head. I also noticed my hair falling out after washing. it is now much thinner than it was (I had thick hair it is now quite thin). The doctors have said male baldness except it is a loss all over. They say it is hormones (the lack of) but it has been four years and the itching is not a hormone symptom. they say to try dandruff shampoo but it didn’t stop the itch. they checked thyroid and ruled it out even though my numbers were on the low end and my T-3 was a little elevated. they say it is normal. they have now said to try Free and Clear shampoo (perfume free etc.). I just want the itch to stop and my hair to stop falling out. What can this be?

Women who have hormone shifts like you did with your complete hysterectomy (I assume your ovaries were removed also) will precipitate a diffuse balding process in almost half of the female population that have some genetic propensity for it.

A good examination with bulk analysis and miniaturization studies will confirm this… and it’s something that you should consider if you can find a doctor who does these studies in his/her office.

Dr. Rassman,

I am really interested in the new SMP procedure that NHI is offering.

My question is as follows: What effect, if any, will use of Rogaine Foam on the SMP treated areas have on the long-term viability of the ink (i.e., would it cause the ink to fade quicker or run together)?

Thanks in advance for your time spent answering this question.

I do not believe that minoxidil will have any effect on the pigment that is placed into the scalp, but no study has ever been done to confirm my suspicions.

Dr Rassman

Let’s assume someone’s donor area may yield, say, 5000 grafts using the strip technique. Is it better to have 1 mega session or 3 smaller ones? Is the yield better when cutting the skin only once (or twice) with megasessions compared to 3 or 4 times with in smaller operations?

I have always believed that less surgery is better than more surgery in people with more extensive balding patterns. If you can get 6,000 grafts in two sessions, why go for 6 sessions of 1000 grafts each? If the density and laxity allow for it, most of my patients prefer to have one larger session and hopefully just be done with the surgical process quicker. This means in a practical sense that 6-7 months after the first session of 3000 grafts, you can see results which will impact your ability to style your hair.

Alternatively, I can make an argument against the large session. Multiple FUE procedures or smaller strip sessions have a relatively short recovery time, but for FUE, the shaving of the donor area can be a problem unless you elect to keep your hair short, so regrowth of the donor area usually occurs in about 10 days. Smaller strip cases will have their donor scar covered by the existing donor hair.

Incremental surgeries have really no downside other than the length of time from the point you start to the time you finish. It is possible that more surgeries could give you wider scars, but this has never been studied with any direct comparison. Few patients approach me with a desire for multiple smaller surgeries and prolonged benefits, as they want the benefits quickly and would like to say goodbye to me and the hair transplant process altogether. I am, however, open to performing multiple smaller surgeries.

i have been talking propecia for over 5 months and it does not even look like the hair loss is slowing down. In the past two weeks it seem like it is getting worse. More hair is falling out then ever before. I thought after 5 months hair loss was supposed to slow. I am using rogaine to and nothing appears to be working.

You need a measurement with comparisons of the hair bulk over time to answer the question you posed. This is the very reason we recommend miniaturization studies and bulk analysis of the hair with the Hair Check device. I would get your hair bulk analyzed and then wait another 7 months to see what the metrics tell you. That way you can put an actual number to it, rather than just going on visual guesswork.

I don’t know anything about you or your hair loss history, your dosing, where you obtained the medication, how long ago you added Rogaine, etc, etc. Propecia is a prescription medication, so I assume you were prescribed that drug. You should talk to your doctor about it further.

I moved into a house two years ago and noticed some mold in the basement. Over the past two years, I have been losing hair and I have seen hair loss in my children. Could the mold be responsible for the hair loss we are observing?

Yes, molds have been responsible for hair loss. Some molds are less toxic than others, but still could be causing your thinning hair. I would suspect that this is the cause, because if hair loss is impacting you and your children, that suggests an environmental cause. It’s really not that uncommon.

See a good dermatologist and ask about it.

I know the subject of celebrity hairlines is somewhat like beating a dead horse, but I have a new one.

Would you say that actor Christopher Pine has a normal mature hairline? (The actor who played Captain Kirk in the new Star Trek Movie). My hairline looks a lot like his and so I am curious.

Based on the photos I’ve seen (the image to the right and a couple from Google Image Search — here and here), I’d say that Chris Pine is not balding, nor does he have a mature hairline. I suspect this is probably the same hairline he had when he was 12 years old.

Dr. Rassman,

Thanks you for the informative site; I have been following for years.

I am 27 years old and thinning on the crown and top of my scalp. I have been on finasteride for 4 years and, while I have had success slowing the process, it definitely did not stop it. I have been in to see Dr Hasson in Vancouver several times, since I live in Vancouver. I did not make the decision to do a HT, and he recommended that I didnt, but that I increase my finasteride does to 2.5mg/day. But like I said, it has not reversed any loss. And while I hold my breath for a permanent cure, I realize that may not be any time soon as well - 5 years ago it was allegedly supposed to be available in 5 years!

Anyways, the reason for my email was to ask a few questions regarding FUE. If I am going to get a HT, I want to ensure that I get the best possible treatment/option for myself.

1. Do you have to shave the donor/recipient areas for surgery? It is important to me to keep any surgery I have quiet…to the best of my ability.

2. What cost would I be looking at? From past consultations it was estimated I would need 2500-3000 grafts

3. What timeline would I be looking at? Like I said, I live in Vancouver, so there would be travel involved.

4. What impact would the transplant have on my native hairs in the area?

I realize it is next to impossible for you to answer most of these questions without seeing me, but Im just wondering in general, from your past experience. Thank you again for all your hard work and dedication. It is much appreciated.

Considering that you had an opinion from a good doctor who recommended not having surgery, you should take such advice into your thinking. I don’t quite follow how you can be told you need 3000 grafts but that you shouldn’t have surgery. So unless I read your email wrong, then pursuing a hair transplant is probably not a good idea at this time. I will nevertheless answer your questions:

1. You need only to shave the donor area. For small procedures, shaving can be striped as shown here.

2. Costs of FUE at NHI is $8/graft.

3. You need to set up an appointment to be examined. Send us good photographs with frontal views and top down views. Be sure to wrinkle your brow (lift your eyebrows) on the frontal view. The waiting list extends some weeks. There is travel reimbursement available.

4. If you are using finasteride, a hair transplant most likely will not have an impact on your existing hair, unless there is extensive miniaturization present. This is clearly a real risk.

Hello Doctor,
you have told many times in your lovely blog that we have to go for a miniaturization mapping to see whether we are progressively losing hair or not, but the problem is that I currently live in a country that Hair transplant Doctors do not do that, and I am considering a hair transplantation. I’ve been taking propecia 4 months ago.

my question: is there any home based way for us to be able to measure it ourselves, for example should we look for something special, or any device being used for other purposes that can be used for this purpose too.
thanks alot.

We actually wrote a 3 part series about this a little while ago. The microscope reference has since been discontinued (they have a newer model), but any video microscope should do the trick. You can do it yourself. Here’s part 1 (links to the other parts are on that page).

Alternatively, you can send photographs to the address on the Contact page and we can speak over the phone. For the frontal view, always lift your eyebrows so the forehead wrinkles. That will tell me much about what you lost and what you will need.

This is a follow-up to our post from earlier this month: Scalp Lacerations Required Staples — Will Hair Regrow There?

Thank you for responding so concisely to my query regarding hair regrowth surrounding a scalp laceration closed with staples.

The orientation of the wounds seems to be almost perfectly aligned with the Langer lines (the wounds are located upon the occipital protuberance and are titled stightly from being perfectly horizontal). From your commentary, I find this encouraging.

Also, to remove the guess work of assumption, the wounds were stapled about 1 hour after initial injury, the wounds were created by the fist of a criminal assailant, and no infection has henceforth appeared. I even went so far as to have the staples removed by a plastic surgeon so as to avoid further damage caused by clumsiness.

I gather, from your comment, excision is contra-recommended. How many follicular hair units am I looking at to fill the described area via hair transplant if there is not satisfactory hair regrowth?

The size of the wound and the character of your hair will dictate the number of grafts. If the infrastructure of the skin is intact, one session should be adequate, but if there is no infrastructure (can feel the skull) then sometimes two smaller sessions are needed.

There is no substitute for a direct examination, which then relies on the judgment of the surgeon and his/her experience.

is Liquid Rogaine compatible with Foam Rogaine? is alternating daily OK?

Yes, I don’t see why you’d want to do this… but you can do this. Both the Rogaine liquid and Rogaine Foam are 5% minoxidil, just in different application methods.