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just saw this article online about Wayne Rooney’s hair. Seems like it is thinning on top, what are your views?

Link: Time to ask for a refund? Wayne Rooney’s hair appears to be thinning… just months after £30,000 transplant

The UK press is sure being hard on this guy. It takes around 8 months to see even 80% of the results of a hair transplant. I don’t think enough time has passed to see the final result here.

Loss of the original frontal hair is not uncommon with a transplant if a person is not on finasteride. I suspect that he does not take finasteride, because it is a drug that is detected when screening professional athletes. Many organizations ban finasteride since it can be used to mask steroid use. Because of this, he may not get his ideal result until perhaps after a second hair transplant, which would address the loss of native hair caused by the first hair transplant.

Dr. Rassman,

I started Propecia eight years for preventative purposes. My dermatologist said he may have seen some slight thinning on the crown area. However I still had a full head of hair.

Throughout the years I have not shown any indications of balding possibly or likely because of the medication, but who knows. My hairline has not receded and looks the same. But I do not want to be on a prescription med if it is unnecessary. However back then I thought hair loss would run on your mothers side and now my understanding is it can be either or.

My question is, is if I were to stop and see if the medication is even doing anything for me, what would be the best way to tell. Obviously hair loss is the only way, but at what months should I get checked out. Would the HairDX test in you opinion help me in making my decision? And do you think it would be worth a trial without it?

Thank you

My suggestion would be to gather as much information about the status of hair loss that you may have. A hair bulk analysis is the best and most sensitive way to evaluate genetic balding. Considering that you have been worrying about this for at least 8 years, if you would have any balding or thinning of the hair anywhere on the scalp, it would show up in the bulk analysis. With that information, you can be pretty sure that if there are no changes in your hair bulk anywhere on the scalp (including the crown), that you would be reasonably safe to stop the medication. To be extra sure, repeat the test 3 months after stopping the medication.

Hi. I wonder if diffuse thinning stops or if you’re losing it diffusely, are you’re sure to end up a NW 5/6? I mean some people’s hair loss stabilize at one certain point like NW3 (like my dad who’s been a NW3 for about 20 years). But if you’re a diffuser, does the same thing happen?

Thanks.

You need to be examined by someone with competence in genetic hair loss and who can predict the hair loss based upon miniaturization and bulk analysis. Without an examination, I couldn’t say one way or the other if your diffuse loss would cause you to finalize to a Norwood 5 or 6 pattern.

I can’t take Propecia because of the sexual side effects and after I visited your office, the news as to where my balding might be going (as you said the worst case) could be a Class 6 pattern. I already had two hair transplants and I have a scar on the back of my head so I can not even shave my head. I am 21 years old now, so I get depressed when I think that I am going down the toilet with my hair problems. I don’t want to give up my girlfriend as sex is important to us and the Propecia stopped that cold. What can I do?

There are no easy answers. Your examination in the office showed that you have already lost 61% of the hair in the crown, 26% of the hair on the top, and 32% of the hair in the front. With my naked eye and your blond hair color, one can’t really make out the balding at this time. The crown is fast approaching the point where the balding can be detected in bright light. You are lucky, because if you had dark brown or black hair, the hair loss in the crown would be very evident, but in blond men, the loss may approach 90% with average weight hair before it would show.

If you can not take finasteride because of the sexual side effects, these numbers suggest that you may eventually end up with a Class 6 pattern (worst case). At 21 years old, you have a lot of balding that may show up as you go through your 20s. If you want to shave your head, you might want to consider Scalp MicroPigmentation (SMP), and provided that the area pigmented was in the distribution of your existing hair, you would have the option to keep it long and/or shave it. We can discuss this option at your convenience.

There is no substitute for Propecia (finasteride) on the market. You might get some benefit by taking 25% of the therapeutic dose (0.25 mg) and this might allow you to get some of the benefits of this drug without the sexual side-effects. Young men (20 years old) who start the transplant process without a good Master Plan and have side effects from finasteride, probably should not have started the transplant process at all, as there may not be enough donor hair to complete the process. Your first transplant doctor should have discussed these issues with you before you started this process. Fortunately, there is the SMP option if you get caught between a rock and a hard place.

Snippet from the article:

Mean hair counts rose and mean hair loss slowed after injections of botulinum toxin A.

Botulinum toxin A (BTX A) has been used for the treatment of wrinkles, hyperhidrosis, and headaches. Now, here comes an open-label pilot study from Canada of BTX A to treat androgenic alopecia. The study was supported by an educational grant from the manufacturer, and the authors hold intellectual property rights to the treatment process.

Fifty males with Norwood/Hamilton alopecia classes II to IV had injections to the scalp muscles (divided equally to the frontalis, temporalis, periauricular, and occipitalis) of a total of 150 units of BTX A, followed by a second session 24 weeks later. Assessment included change in hair counts in a 2-cm scalp area, changes in hair loss counts collected by lint roller from the subject’s pillow, and patient responses to a questionnaire. The 60-week study period consisted of a 12-week baseline lead-in period and two 24-week treatment periods following each BTX A treatment session.

Read the rest — Growing Hair with Botox

As I wrote a couple weeks ago, I am concerned that there may be a rush to use Botox in balding men and women since this could become a lucrative money machine for the doctor. I’ve been asked if I’d consider offering this as a service, and to be honest, I probably would on the proviso that the patient will allow me to make bulk measurements of the scalp and hair before and after a period of 6 and 12 months. My goal here would be to determine if this approach works or not. With bulk measurements done before the treatment is started, the patient acts like his own control. In this way, this becomes an experiment of sorts and the results would then be made available to the medical and lay community.

Snippet from the article:

We are a culture obsessed with hair: From the big and small screens to the pages of fashion magazines, it seems no woman’s look is complete without a perfectly-coifed ‘do – and that poses a serious hurdle for aspiring actress Georgia Van Cuylenburg. Van Cuylenburg is bald.

Like 5 million others in the U.S., Van Cuylenburg suffers from alopecia areata. The disease results in sudden and often unpredictable hair loss on the scalp and often across the rest of the body. It is cyclical in nature and has no known cause or cure.

For the effervescent Van Cuylenburg, it is particularly ironic because she used to be hair model.

Read the rest — Hair Model’s Worst Nightmare: Going Bald

This is the story of a young woman’s journey after she suddenly found herself losing most of her hair from alopecia areata.

I have a question about dense packing.

I always thought dense packing referred to a higher than “normal” number of grafts placed into a given area of the scalp.

However, I just read this on the glossary section of another surgeon’s site: “Dense packing is a hair transplant procedure in which several hairs (follicular units) are ‘packed’ into a single slit in the scalp.”

Can you please touch on this. His definition seems completely at odds with my current understanding of the term.

Your original understanding is correct. Some surgeons increase the number of hairs per graft by adding single hairs to a two hair graft to make a 3 hair graft. This is not dense packing, but it achieves the same result.

This is the final part of our post on epigenetics. Part 1 of this series can be found here, and part 2 can be found here.

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I continue to hear from patients who say they look like their dad or their grandfather, but “he has more hair and lost hair much later in life” and this suggests environmental issues that are impacting and accelerating the epigenetic changes influencing the timing and degree of male generic hair loss. It will be helpful to our patients if we can learn more about them.

Stress is also an important factor in hair loss. I saw a 45 year old man go from almost full head of hair to a Norwood class 6 pattern balding in just half a year, as his 6 year old daughter died after a difficult bout of leukemia. The stress must have been enormous.

Dr. Richard Shiell wrote that smoking is an interesting factor and he tried to do some trials about 30 years ago. The strange thing is that his hair transplant patients were all such “health freaks” that after 6 months he had not gathered more than one or two smokers, so the trial was given up. I know many surgeons attribute poor-growth of transplants to post-operative smoking, but this was never able to be confirmed and occasional “poor” results may have been due to other factors.

The real issue is to see if there may be dietary manipulations that can benefit our patients. If we think there may be a way to do that, we should not leave it in the hands of someone who has questionable ethics, but we should not ignore any useful message we get from dietary supplements in the epigenetic story as it unfolds.

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This post was in part taken from an email sent by the brilliant Dr. Sharon Keene in Tucson, Arizona.

Press release from ISHRS:

International Society Of Hair Restoration Surgery Maintains Safety And Efficacy Of Propecia (Finasteride 1mg) For Male Hair Loss Is Backed By Proven Scientific Data

According to the International Society of Hair Restoration Surgery (ISHRS) – the world’s leading medical authority on hair loss and hair restoration – recent anecdotal reports of persistent sexual dysfunction by some men who have used finasteride 1mg (Propecia) to treat hair loss should not define the safety and effectiveness of this drug. Propecia is the only oral medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of hair loss in men.

From a scientific standpoint, there are no evidence-based data substantiating the link between finasteride and persistent sexual side effects after discontinued use of the drug in numerous, double blinded, placebo controlled studies conducted evaluating the use of Propecia 1mg for hair loss.

“As one of the 900 physician members of the ISHRS, the health and well being of our patients is our utmost concern – whether prescribing medications like Propecia or performing hair restoration surgery,we have treated hundreds of men suffering from hair loss with finasteride 1mg with virtually no side effects.”

Since receiving FDA approval in December of 1997, 20.5 million and 6.7 million patient-years of exposure using Proscar and Propecia respectively are recorded with a low adverse event profile. The ISHRS believes that these are the most current and reliable data available until further studies are conducted.

Sexual dysfunction is a very complex disorder, and its incidence in the general population is known to be quite high – as high as 49% in middle-aged and older men according to one study published in 2006 in the Archives of Internal Medicine. That being said, we owe it to our patients to address valid concerns in a scientific manner and to clarify any misleading reports so that men can make informed choices regarding the use of this medication.

The ISHRS has called on the medical communities of dermatologists, hair loss physicians, urologists, endocrinologists and sexual medicine specialists to join in a colloquium to share all data and experiences with finasteride in a fact-based manner.

The above text is a press release sent to ISHRS member physicians to send out with individual doctors names attached. We’re posting it without the personalization, but we agree with what they’re saying about the lack of evidence-based data when it comes to persistent sexual side effects from Propecia.

Hey I had a quick question,

I am sure this has been answered before but can you explain how someone with no history of balding on either sides of their family can go bald? And vice versa how someone whose entire family is bald can keep their hair their entire lives?

Thanks

Genetics should be studied back a few generations to outline the real incidence of balding in the family line. Balding can skip a generation or two. In some families, a child may be adopted and not be told, so the genetic line may not be pure. In any case, I hope you are not going to blame your grandparents for the balding you may be experiencing.

As for how someone can keep their hair with a great incidence of balding in their family — well, it’s just how their genetics played out.