Hair Restoration Blog

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, formed primarily in the prostate gland and hair follicle cells. Hair follicles contain DHT receptors. Over time as males produce more and more DHT, the DHT molecules cause hair follicles to miniaturize and eventually fall out permanently in people who are genetically prone to baldness. In other words, some males have more hair follicles with these receptors than others.

DHT is the primary contributing factor in male pattern baldness. Unlike men with male-pattern baldness, women with female-pattern baldness are usually not characterized by increased production rates of DHT. Women with increased levels of DHT may develop certain male secondary sex characteristics, including a deepened voice and facial hair. Hair in the Crown and top of the head are usually loaded with these receptors in men with male pattern baldness. But the hair on the sides and the back, termed the permanent zone or donor area, are not affected by DHT. This allows us to transplant hair from the donor area into the frontal area without fear of it falling.

The transplanted hairs keep their resistance to DHT after hair transplant. Propecia is a drug that decrease the production of DHT by blocking the enzyme 5-alpha reductase that converts testosterone to DHT. This is how Propecia is effective in treating hair loss. Hair loss patients will decrease levels of DHT when they are on Propecia and this will help maintain and un-miniaturize hair follicles or even increase the size of hair shaft within the first year of using them.

I visited a woman today who was suffering from female patterned baldness. She said she heard about the great work we do and she was interested in having a hair transplant procedure done at US Hair Restoration. Since her hair thinning pattern was typical of hair loss in women with female patterned baldness (also called female patterned alopecia) I decided to post this article on women’s hair loss and hair transplant to answer some of the questions many women have pertaining to female hair loss.Our hair loss patient was around 50 years old with a history of hair loss for over 6 years with more accelerated hair loss in the last 2 years. This woman has dark hair and white skin. As you can see in the picture, the thinning in the front and top was giving her the appearance of balding in front that she could not hide this with regular styling techniques.

Patients with female pattern baldness usually have significant miniaturization of hair follicles and significant widening of the spacing between hair shafts. Miniaturization occurs when hair follicles start to get smaller and smaller and they look like baby hairs that do not grow past a certain length. This miniaturization and space widening occurs in a large area of skin including their donor area. The donor area is the hair on the sides and back of the head, which remains intact in men with male patterned baldness due to male genetics.

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We discussed different medical problems that could cause hair loss in women and the importance of discussing those with her family doctor, internist or endocrinologist. The most common causes of accelerating genetic hair loss in women are:

• Iron deficiency

• Thyroid disorders
• Female hormonal imbalance or the use of OCP ‚Äúthe contraceptive pill‚Äù
• Excess levels of male hormones
• Auto-immune disorder
• Some medications

My recommendations to this patient and other patients with this similar condition are:

1. No hair transplant as of yet
2. Visit her family doctor with our letter in hand to look for any treatable causes of hair loss
3. Rogaine 2% lotion, twice a day
4. Visit us in a year to be evaluated with another miniaturization study for the progress of her hair loss or gain
5. Coloring hair lighter to decrease the sharp contrast between hair color and skin tone to create the appearance of fullness
6. Toppik, which is a topical hair product that can give more body to hair shafts

For more information on women’s hair loss you can also visit US Hair Restoration.

I met an internist friend today and he asked me whether or not I do hair cloning for my patients. Obviously my answer was no. He mentioned that Dr. X does offer cloning to his patients and in fact plans on doing it for one of his current patients. My comment is this: The field of hair transplant surgery is a buyer beware market; just like any other fields in cosmetic surgery.

I have heard many doctors calling themselves a pioneer on this and that technique. If your doctor told you that he or she is the inventor of some popular method, make sure to ask for a published article from him or her on the topic in a peer reviewed medical journal. In medicine, we don’t keep secrets. When any inventions are formulated they are presented in scientific meetings or published in peer reviewed journals.

Hair cloning (as it is being called by people) or hair multiplication has been studied extensively in America and Europe over the past few years. There are some reports on the success of culturing hair and making new hairs from one in animals and human. There are also claims that phase 3 of clinical trials has started, but we do not know much about the success of this procedure since we don’t have any published articles as of yet. We don’t know anything about the possibility of mass production of hair through hair multiplication nor its feasibility and safety on human.

It is very likely that hair multiplication will be available in the future, but as of now we can not make any comments on the timing and quality of it.

Question:

Hi, My boyfriend here wants to know what he should do to prevent more hair loss. He has hair now but it’s receding a bit on his front at right and left sides.  He’d be most grateful for some advice. (Or I could just listen on Saturday!!)

Answer:

The Saturday radio show is going to be a 55 min program on hair loss with a focus on male pattern hair loss. I am sure you will find it useful. Also we have an online consultation page on our website that allows patients from all over the world to ask questions about the characteristics of their own hair and hair loss.

As a general rule, most young men can use Propecia (generic: finasteride 1mg/day), if they do not have any contraindication (allergic reaction or other negative side effects) for its use to prevent further hair loss or slow down the hair loss process. I generally do miniaturization studyies on all my patients to map out their hair loss pattern before starting them on Propecia or any other hair loss prevention medication. This way we can measure their response to the effect of treatment and optimize the medical or surgical treatment if needed.

Dear Dr. Mohebi,

How is everything Dr.? I actually came across something, which might seem a little silly to you. (haha) As the follicle deteriorates, the hair becomes thinner, correct? and this leads to the dying of the hair follicle and hair can’t be grown, right? I have noticed lately that when I shed, the hair is not really thin. Actually the quality of my hair according to my father has improved. Thick hair means that the follicle is still healthy and contains the vital nutrients. Now to sum everything up, even though I still experience hair loss with decent hair quality, does this still mean that my hair follicle is deteriorating or could an internal factor such as stress cause you to lose some hair regardless of its (hair) condition?

The reason I am asking this vaguely put question (sorry) is because earlier when I shed, my hair did get thinner which gave me the signal that it was in poor condition. DHT damages the follicle and causes the hair to become thinner. Sorry to bother you with these questions, it’s just that sometimes I pay attention to little things and I need to find out the answer. Thank you very much.

Answer:
You need to first read one of my articles on hair growth cycle, “The Hair Growth in Good Health and Disease”. The hair that shed is not necessarily miniaturized hair which is in process of balding. Normal hair goes through phases including telogen in which you see normal non-balding hair falls out. If a person is balding he or she may lose a normal looking hair in its telogen phase and grow a finer hair in its place and this process may repeat until your hair miniaturize completely or become non-existant. Loss of miniaturized hair (balding process) is not necessarily sensible, it means that due to the small diameter of hair shafts, you may not even notice your hair falling.

Question:
Dear Dr. Mohebi,

I would like to thank you for your response. I really don’t know what life without you would be like, someone who can answer all my questions. It is funny because when I turn to other people the smartest thing they have to say is I don’t know.  Thank you again for everything. I wish you all the health and success for you and your family for the new year and the ones to come. One very last question, before 2008. (haha) What do you think about the laser hair combs with low level of laser therapy? Many websites claim that it has been used for 30 years and that there is no true side effect. Is that valid even though there have been over 2500 reported studies worldwide? Take care and god bless you.

Best,

Patient’s name

Answer:

The Laser comb is heavily advertised and sold worldwide based on it being FDA approved. You are right, the laser comb has been proved to be safe and that is why FDA approved it like other laser methods being used for hair loss. I would love to see laser comb devices work, so I could have another method to recommend to my patients who are fighting the process of baldness or for people who have significant miniaturization, but the body of medical literature around laser in general and laser comb in particular for treatment of hair loss is seriously lacking.

In the last annual meeting of hair restoration surgery in Vegas we did not see any new scientific presentation concerning the laser comb. So I can not endorse it until we have better documentations on the usefulness of laser as a treatment of baldness.

Have a great new year,

Parsa Mohebi, MD

Question:
I am a 22 year old white male with some recession in the corners that has been bothering me in the last two years. Am I eligible for a hair transplant procedure?

Answer:
I generally don’t recommend hair transplant before the age 24 (with some exceptions). We need to have a better understanding of the pattern of your hair loss before coming up with a surgical plan. If you are destined to become a stage VII (advanced stages of hair loss) the plan should be totally different than if you are going to stop at stage III.

We can usually see the final pattern of baldness by the age of 23 or 24 with a microscopic examination of scalp. We should be able to determine whether or not you are going to stop at stage III or if you are heading to more advanced stages such as VI or VII. We can densely pack the corner areas knowing that the patient had plenty of reserve and is not going to lose much more. But if you are supposed to become severely bald, we should be more conservative in repairing your frontal corners knowing that you are going to need a good portion of your hair for the top and crown areas of your scalp in the future.

If I see the evidences of end stage hair loss at an earlier age, I can more safely plan for hair transplant at that age rather than waiting for a more advanced age since the patient is already showing the signs of sever baldness.