Hair Restoration Blog

Q:

Hello, I have a question, can you please help verify the answer to this. I am really stressed out regarding the situation. I can’t ask my doctor because he is on vacation for the next month.

I was prescribed propecia for hairloss, but I am reluctant to take it because of hyperandrogenicity from finasteride. Is there any truth to that? is there a chance that a person can develope hyperandrogenicity from taking propecia and making a persons hair loss even worse. By the way I also have acne, and I am scared that the hyperandrogenicity can make my acne worse and skin more oily.

Please help me. Can propecia(finasteride) cause hyperandrogenicity, or is it not true. Can the increase in testosterone from propecia cause more hairloss and make the situation even worse.

thanks in advance

A:

Finasteride (Propecia) is a 5 alpha reductase inhibitor. That means that it blocks the enzyme that converts testosterone (male hormone) to Dihydrotestosterone (DHT) in the body. The main cause of baldness is DHT and not testosterone in addition to having the gene of hair loss. When first getting started on Finasteride, some men may even have an increase in their testosterone levels because it is no longer being converted to DHT and therefore its levels goes up. However, please be aware that these changes are temporary. Some men may feel an increase in sexual urge due to the increased testosterone for a few days but it is temporary. Since testosterone does not directly cause hair loss and its effect is due to the production of DHT, elevation of DHT should not worsen your hair loss in any way.

The increase in testosterone levels can affect your acne. I am not sure how significant the slight elevation of the testosterone could be on your acne and for that you need be seen by a dermatologist.

Q:

Hi doc?  could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.

A:

Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.

Q:

Good Afternoon Dr. Mohebi,

My body trainer recently recommended that I go on a medication for body building purposes.  The medication that I am planning on taking is ANAVAR (an anabolic steroid), so I just wanted run it by you to make sure it would be OK to take it along with the Propecia I am currently taking.

I appreciate all you help, Thanks!

A:

Anavar (oxandrolone) is a weak androgen and is considered an anabolic steroid.  It is indicated as adjunctive therapy to enhance weight gain after weight loss due to an extensive surgery, infectious disease, trauma and so on.  Anavar has also been prescribed to some patients who for no reason fail to gain weight despite of proper nutrition and work out schedules.   It may also be used to maintain normal weight or to prevent the catabolism due to prolonged administration of corticosteroids.

There have been some online reports of hair loss with Anavar’s use and some exagerated hair loss reports in patients who take both Propecia (finasteride) and Anavar (oxandrolone) in conjunction. Although my personal searches in medical publications have never revealed any studies supporting this information, reports can be found online by its claimed users.

My general recommendation is, unless there is a strong medical indication for its use, those people with any evidence of male patterned baldness should stay away from anabolic steroids.  Although you may find some anabolic steroids over the counter, your family doctor should always be involved and aware of any anabolic steroids that you take as part of your body enhancing plan.

Shock loss after a second hair transplant

Q:

I am considering a second procedure in a few months for additional coverage in my mid-to-crown area, will the frontal area (my first procedure) be affected with ‘shock loss’ during the healing process of the second procedure?

Thanks again for your replies.

A:

Transplanted hair from a previous surgery won’t be affected as native hair to a second hair transplant procedure, however, the surgeon should be extremely careful with transplanting into the area that has already been transplanted. We at US Hair Restoration use special devices and needles to minimize the transaction rate of preexisting hair follicles.  Some loss of the transplanted hair may be seen when we transplant to thicken up the already transplanted area, but it will be reversible as opposed to the permanence of shock loss.

Q:

It is now 4 days following our procedure and everything seems to be going quite smoothly.

I have been taking care to wear a hat during the day outside and shampoo as I was instructed twice a day.  I have experienced no bleeding thusfar and the swelling has dissipated and gone.  The redness is diminishing and I now have sensations back in the back of the head.  Actually, the sensitivity there was back within 12 hours or so.  The pain is minimal and I have only taken generic Tylenol twice for it.

I am VERY happy with your work thus far and please feel free to quote any of my questions on the blog, anonymously.  I have attached two pics for you to see my status: 1 from last night and 1 from today with my hair styled.  No swelling!

Now, for my questions:

1) I go back to work tomorrow, the 5th day post op.  You instructed that I can begin to shampoo and normally style my hair then, correct?  Does this apply to any leave-in conditioners or should I wait on those?

2) A few pesky blood-caked scabs aren’t washed off and dry, flaky skin is forming around the middle of the sagittal.  I believe this is all normal and part of the mitosis process.  Right?

3) Can I start applying over-the-counter ointments like neosporin to my hairline to aid with the elimination of the tiny red dots of incision?

4) The back of my head feels quite tight.  Will the procedure on Saturday help with this or is this just a process of healing?

5) And finally, I know this is a really really silly question, but it seems fairly obvious that the grafts are growing.  I know more than likely this is actually just them getting ready to shed and go into dormancy.  But, I wonder, if you think, given that I have been on finasteride since the beginning of December and the hairline and temples were the first areas worked on, if there’s a good chance I get to keep most of them?  I also hope that I will experience little to no “shock loss” with the ‘native hairs’ so they should not theoretically go into a ‘dormant’ phase, correct?  The problem is that it would be very hard to conceal the growth I have with my longer hair if it wasn’t for something to work with, as it were.  The tiny hairs provide an anchor to rest longer hairs on.

I apologize for the length and perhaps detail of my questions but as I’m sure you know, this is a VERY personal procedure.

THANK YOU SO MUCH.

A:

I am glad you had a smooth post-operation period after your hair transplant surgery.

Here are the answers to your questions in the order you asked them:

How to use shampoo and conditioner use after hair transplant?

Yes,  anytime after day 4 you can go back to your normal routine in terms of using shampoo and conditioner and combing your hair normally.

How to deal with scabbing, dried blood removal after hair transplant?

Flaky skin could be seen any time in the first few days to weeks following a hair transplant surgery.  Dried blood due to some oozing in the first few hours after hair transplant should be dealt with carefully for the first 4 days and if still present after your instructed hair wash in the immediate post op period, it needs to be washed off more efficiently.  After day 4, you can shampoo your scalp and keep the foam for about 10 minutes each time.  This will allow the dried blood to become loose and come off easily with the soft brush that was provided to you after your hair transplant.

Do I need antibiotic ointment after hair restoration surgery?

Neosporin and any other antibiotic ointments are not necessary after hair transplant.  You have medications that were provided to you after your hair restoration which are used to help minimize the redness following surgery.  The small red spots that have been seen from the incisions or local anesthesia injections will be gone in 4 to 7 days following the day of surgery.

How about tightness of scalp after hair transplant?

The donor area is closed with staples that might be felt a little bit before we remove them at day 10 after hair transplant.  We also removed a strip from your scalp with significant number of grafts.  That stretches the skin, but the tightness that you feel know will be gone in a week or two after hair transplant.

Am I going to keep the hair or lose it?

I hope you are among the small group of people who does keep their transplanted hair and begins growing from the day of surgery.  However, the general rule is “Don’t count on them”.  We put most of our patients on finasteride after their hair transplant, but still about 80-90% shed all transplanted hair.

What is the chance of shock loss after hair transplant?

Shock loss is a different story and considering that you have been on finasteride before and will continue it after hair transplant, you have a good chance to prevent and significantly reduce the chance of shock loss.

I look forward to seeing you soon for your post operation visit at day 10 after hair transplant.

International Society of Hair Restoration Surgery (ISHRS) has done a nice work on its website.  The organization that is the most prestigious organization for hair restoration surgery has challenges people for the differentiating a transplanted hair to a natural head of hair without any hair restoration surgery done.

The site requires you to take a survey to see if you can detect which of the people in the photos in the site have had a hair transplant and to determine how important hair is to you. The survey will only take about 5 minutes to complete. Here is the questionnaire.  By responding to the hair transplant challenge survey you can help to add to the knowledge about hair loss and hair restoration surgery.

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Q:

Hi Doc! How are you?

I have question regarding my hair loss problem. I’ve noticed it just 3 weeks back. As I’ve been reading your infomercial regarding the causes of hair loss. I think I am categorizing my problem to Alopecia Areata where I have one circled affected areas on the right of my front hairline & 2 at the right side at the back of my head. Before that it was small and now it is becoming bigger day by day.

Hope you could help me to find a solution of my problem. Thanks a lot! Hope to hear from you soon!!!
More power!!!

A:

Alopecia areata (AA) in its typical form is easily distinguished from typical patterned male and female hair loss.  Obviously, you need to be examined by a hair specialist or a dermatologist to confirm the diagnosis.  Alopecia areata generally present itself with a patchy or circular (coin shaped) balding spot and could be seen in almost anywhere in the skin.  The lesions are confined to their primary spots with no sign of hair loss in neighboring areas.  Some authorities have recommended steroid injections to facilitate the improvement of the lesions.  However, spontaneous recovery is seen in most patients with no interventions.

In contrast, hair loss pattern in male or female patterned hair loss is more widespread with the hair miniaturization (thinning) advancing to the neighboring areas.  Hair transplantation is not indicated in alopecia areata while it could be the only permanent solution in most cases of patterned baldness.

I visited a 30 year old patiet for a hair loss consultation a while back who believed he lost his hair due to having too much sex.  The fact is that most patients attempt to find a reason for rapid loss of hair in the early stages.  Thas is often the same age that they are most active sexualy.  The combination of the two may convince them that they may have lost their hair due to having too much sex in those years.

These people are not the only balding peole who try to find an environmental situation and blame it for their genetic balding problem.  Many people blame their partner, bad relations, stressful situations and other significant events in their lives for their hair loss.  The reality is that gene, sex and time are the only major contributors to male or female patterned hair loss and environmental factors only may accelerate the presentation of the hair loss.  Normal people without balding gene may lose hair for different reason, namely stressful conditions, but the hair always grow back when stressor is gone.   This is not the case for people who have the gene of hair loss that may never grow their back what they lost after losing it due to stressors.

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.

Q:

Hiya Doc,

I’ve read in a book on hair loss that mentioned, in certain circumstances, hair loss can be caused by emotional or mental stress. I’ve started to lose a bit of hair, but I’m really hoping it’s only temporary, as I don’t think I have genetic hair loss because my two older brothers seem to be doing OK.

How common is it for hair loss to be caused by emotional distress?

Thanks,

A:

Many hair loss patients who come to me for their initial hair loss evaluation associate the beginning of their hair loss to some stressful event in their lives. Many say they notice hair loss when they moved to another city or different country, got divorced or had significant problems at work or in their personal lives. Usually, they are right as these types of evens can accelerate hair loss.

However, hair loss would not happen to these same people if they were not genetically predisposed to balding. In other words, at age 30 and after, we may have the hair loss gene which is supposed to cause balding. At age 30 or after, if we are involved in a stressful situation, an emotional traumatic event, or major surgical procedure, it can accelerate the hair loss process. So the loss expected to be seen in 10 years could come around sooner.

Stress, trauma, or major surgeries may cause hair loss in people who are not supposed to lose hair, but the condition is temporary and the lost hair will grow back after the passing of the stressful condition, or treatment of the medical condition.

In these cases, patients have a condition called telogen effluvium in which, due to stress, a significant number of hair follicles go to sleep. Remember: patients do not lose those follicles permanently and the follicles can produce new hairs in just a few weeks.

My recommendation for you is to see a hair specialist and get your hair miniaturization mapped by microscope; this way the doctor can tell you whether or not you are experiencing an early stage of patterned baldness or that you have lost your hair due to stress.

If your baldness has just begun, medication may help you. If you are experiencing telogen effluvium without being predisposed to pattern baldness, you only need to wait and your hair will grow back in a couple of weeks.