Hair Restoration Blog

Q:

Hey Doctor Mohebi,

I was wondering, I’m thinking about getting a hair transplant, but I’m afraid of telling my future wife and female friends that I’ve had a hair restoration. I know men may not care that much, but if I’m dating someone and eventually I tell them I’ve gotten a hair transplant, I fear that they may get turned off.

I kind of look at it like plastic surgery. I know when I meet women who has undergone a nose job, I kind of feel strange about it and think maybe that person was not happy with their looks.
To be honest, it  turns me off.

So, my question is: from your experience with patients, do they keep it a secret from others or do they not mind telling people?

A:

Today, we have capabilities we did not have 50 years ago. As a young soccer lover, I used to have the disadvantage of wearing glasses.  It was very difficult for me to stay competitive in succer team without wearing my glasses.  Every now and then, I use contact lenses to be able to put aside my glasses. I am planning to get a LASIK procedure for that as well.

If I undergo a LASIK procedure, does it make me an insecure person. Not at all. I call it using all your resources to look your best.

We do have technology that we did not have 10 years ago. I say: why not use it? A lot of people are doing it, and nobody cares if these peoples’ hair is native hair or transplanted. The point: they are not bald any more and they can be as competitive as their non bald rivals in life.

One time, I met a very beautiful woman at a party and I ended up having a conversation with her.  When I told her I do hair transplants, she told me a story about someone who proposed to her and she rejected him. She said the man was bald. But I’m not saying because he was bald that he got rejected, but because he did not do anything about it. I know the argument can be made that what the woman did is sad and superficial but, hey, looks do play a part in initial courtship, whether we would like to admit it or not. And it was her prerogative to make that decision.

My point is: Be yourself and do whatever makes your heart happy. No matter what you do with your life, there are going to be people who may not like it. It should not influence your decisions.

We just had a hair transplant surgery for a child with Congenital Temporal Triangular Alopecia (CTTA) yesterday. He had a patch of baldness since birth and it started to bother him at school recently to the degree that he could not even wait until winter break – the time his parents originally planned to get it restored. The procedure went well and we densely packed 470 follicular unit grafts onto the bald patch of his temple area. He is happy and looking forward to the final growth of the grafts in a few months.

Congenital Temporal Alopecia is a patchy hair loss condition which is generally present at birth in form of a patch of hair loss on the child’s temple. The balding patch may consist of very fine hair. This non-scarring alopecia has been reported to respond well to hair transplant surgery.

Q:

I am a 26 year old female and felt like the world was mine, and then this happened and now I would rather hide, so I understand about feeling like a freak. But I think we all have to remember that we have nothing to be ashamed of This disease is more widespread than we think and people are more understanding than we give them credit for. We can all still live long and happy, if a little self consciously. Since getting AU, I have heard of so many people who have friends or family with this disease - there are a lot of us, and we are still lovable, attractive, successful and admired. We may look different but if we can overcome the self-imposed stigma of it, I think it will just serve to make us stronger.

Speaking as a woman, let’s give our daughters, sisters and mothers a good example for self-respect, and show them how to be fearless, how to overcome obstacles and show them that women are more than long shiny hair and a media approved image.

I know I am young and have not yet suffered with this disease as long as any of you, so it is likely easier for me to say these things. I just hope to remain this optimistic and not let it get the better of me. We are all more than our hair. And if being bald and shapely or hairy and fat is the choice, I choose to keep my body healthy on the inside instead of just looking it on the outside.

Thanks to all of you, I wish you all the best and just remember, you are more than your hair and do not accept feeling like a freak! Remember the people that love you when you are at home and hairless for all to see, what they see in you is what you truly are, not the you that has to wear a wig so people don’t stare or the one who has come to hate the wind.

A:

I like your attitude.  Treatment of Alopecia Universalis (AU) could be difficult or impossible in some cases.  You have to come to my office and talk to some of my patients who think the world has come to an end because they are losing their hair.

This is what I always say to my patients: It is important to try to look your best. If you have the option to change your appearance for the better, do it as much as possible, but for the part that you cannot change, accept it.  Learn to use it to your advantage and learn to love it.

I have recently seen a familial case of hair loss that was caused by exposure to fungus toxin.  Three members of a family were referred to me by their doctor for hair loss problems secondary to the diagnosed chronic mold exposure.  The family used to live in a house with a sewage problem causing some molding in the old walls approximately three years ago.  The walls with mold were painted over but never changed.  The family members presented a variety of symptoms such as nausea, sleep disorder, and speech problems.  The female member showed some cognitive disorders with episodes of sever confusion and was initially diagnosed with premature Alzheimer’s disease at the age of 53.  A 34 year old male member of the family had seizure attacks and episodes of nose bleeding.  What was reported by all these patients was hair loss.

The female member of the family had diffuse loss of hair as universal thinning and loss of hair volume.  During the examination, hair thinning was obvious on a large area of the scalp.  Microscopic examination did not show significant miniaturization, however, hair density was significantly lower than density of a normal Caucasian woman with no hair loss.  We scheduled her for a follow up visit in 6 months.

A 34 year old male member of the family showed evidence of typical male patterned hair loss that was not evident in the pictures from 3 years ago (before the mold exposure).  The miniaturization study was similar to atypical male patterned hair loss with preserved hair on the donor area with minimum miniaturization despite having significant miniaturization on a large area at front, top and crown areas.  I prescribed finasteride and scheduled him for a follow up visit in 6 months.  We will address the need for a hair transplant at that point.

A 40 year old male member of the family showed diffuse miniaturization throughout scalp.  The patient did not have any hair loss problem before the exposure to the toxin.  This patient has also been started on finasteride with a follow up visit in six months.

Below we describe two known fungal toxins that may cause hair loss in addition to other symptoms.

Stachybotrys

Some strains of this fungus (S. atra, S. chartarum and S. alternans are synonymous) may produce a toxin, which is poisonous by inhalation. The toxins are present on the fungal spores. This is a slow growing fungus. The dark colored fungi grow on building material with high cellulose content (wooden material). Areas with relative high humidity that are subject to temperature fluctuations are ideal for toxin production.

Individuals with chronic exposure to the toxin produced by this fungus reported cold and flu symptoms, sore throats, diarrhea, headaches, fatigue, dermatitis, intermittent local loss of hair and balding and generalized malaise. Animals injected with the toxin from this fungus exhibited the following symptoms, necrosis and hemorrhage within the brain, thymus, spleen, intestine, lung, heart, lymph node, liver, and kidney.

This organism is rarely found in outdoor samples.  Appropriate media for the growth of this organism will have high cellulose content and low nitrogen content. The spores will die rapidly after release. The dead spores are still allergenic and toxigenic.  Percutaneous absorption has caused mild symptoms.

Aspergillus

Aspergillus is the most common genus of fungi in our environment with more than 160 different species of mold. Sixteen of these species have been documented as causing human disease. Aspergillosis is now the 2nd most common fungal infection requiring hospitalization in the United States. Exposure to aspergillus can often cause skin rashes and hair loss.
Symptoms of Fungal Exposure (Mycotoxicosis)
Mold toxicity is often the end result with constant exposure to mold of a toxic substance. A common misconception among allergists who are untrained in this type of toxicity levels in humans, which is technically not their area of expertise unless they have trained specifically in environmental medicine with their background in immunology, is to do general allergen testing. Most tests usually result in an unequivocal result, a 2+ or less.

This induces some physicians to order allergy shots, regardless. These shots are absolutely worthless (and could possibly be harmful) to a person who has been heavily exposed to these mycotoxins as they are already in a state of toxicity. If anything, this could exacerbate the problem. Because many doctors are not trained in this field, they may try to “guess” at a diagnosis.

In laymen’s terms, molds produce mycotoxins. These substances, although unseen by the naked eye, are ingested and then enter the body through the skin, mucous and airways. Once ingested, mold has the requirements to colonize and spread. In doing this, it can compromise the immune system and damage the everyday processes of the body. Mold and yeast are interchangeable only in their dimorphic state, which is often a big misconception, although both are fungi. There has been a theory of a connection between Autism Spectrum Disorder onset and Candida Albicans in the body.  Studies have started since the first quarter of 2006.

Fungi, which include yeasts, moulds, smuts and mushrooms, are responsible for causing four types of mycotic (fungal) disease:

• Hypersensitivity - an allergic reaction to moulds and spores
• Mycotoxicosis - poisoning by food products contaminated by fungi
• Mycetismus - the ingestion of preformed toxin (toadstool poisoning)
• Infection (systemic) - (Mycotoxicosis; the subject below)

The following are a list of the most common symptoms of fungal exposure. Most people with some forms of Mycotoxicosis meet at least 8 symptoms of the following criteria:

1. Fibromyalgia/mps (and several correlated symptoms)
2. Respiratory distress, coughing, sneezing, sinusitis
3. Difficulty swallowing, choking, spitting up (vomiting) mucous
4. Hypersensitivity pneumonitis
5. Burning in the throat and lungs (similar to acid reflux and often misdiagnosed as such)
6. Asthmatic signs; wheezing, shortness in breath, coughing, burning in lungs, etc.
7. Irritable bowel syndrome, nausea, diarrhea, sharp abdominal pains, stomach lesions
8. Bladder, liver,. spleen, or kidney pain
9. Dark or painful urine
10. Dirt-like taste in mouth, coated tongue
11. Food allergies/leaky gut syndrome/altered immunity
12. Memory loss; brain fog, slurred speech, occasionally leading to dementia
13. Vision problems
14. Swollen lymph nodes
15. Large boils on neck (often a sign of anaphylaxis)
16. Yellowing of nails, ridges, or white marks under nail
17. Thyroid irregularities, sometimes leading to complete dysfunction; adrenal problems
18. Headaches
19. Anxiety/depression, heart palpitations - confusion, PTSD
20. Extreme blood pressure, cholesterol, or triglycerides irregularities
21. Ringing in ears, balance problems (very common), dizziness, loss of hearing (aspergillus niger)
22. Chronic fatigue (also included under this classification directional confusion)
23. Intermittent face flushing; almost always systemic, Called the Mylar Flush (neurological»
24. Night head sweats, and drooling while sleeping, profuse sweating
25. Multiple chemical sensitivity; only upon exposure to Stachybotrys and Chaetomium
26. Nose bleeds (stachybotrys)
27. Bruising/scarring easily; rash or hives, bloody lesions all over the skin (Often systemic)
28. Reproductive system complications; infertility, changes in menstrual cycles, miscarriage
29. Sudden weight changes (Detoxifier genotypes tend to gain weight, non detoxifier genotypes tend to lose weight)
30. Cancer
31. Hair loss, very brittle nails, temporary loss of fingerprints (in rare cases)
32. Joint/muscle stiffness and pain
33. Irregular heart beat/heart attack
34. Seizures, inadvertent body jerking, twitching, inadvertent facial movements or numbness in face
35. Hypersensitivity when re-exposed to molds, which can lead to anaphylaxis
36. Anaphylaxis upon re-exposure to mycotoxin producing molds
37. Death, in extreme cases

Q:

I just had a few questions following the consultation,

As you said I have slightly more miniaturization in the crown than the donor area, but still in normal range, what would cause me to have more in one area than another other than MBP, is that normal for non MPB scalps?

• Could finasteride worsen the hairline due to the rise of testosterone, or is that irrelevant?
• Are there any safe and minor treatments to slow the progress of maturation or reverse it that you would recommend at this stage?

A:
I will be sending you a letter with all information that we discussed during our consultation at US Hair Restoration Beverly Hills Office.  You may have very initial signs of MPB, but the numbers for miniaturized hairs are not far from high normal.  Let us wait and see your progress before putting you on hair loss medication finasteride.  Early stages of male patterned hair loss may not always be obvious enough in our scalp microscopic evaluation to be differentiated from having upper normal levels of miniaturization.  Propecia (finasteride) is a great hair loss medication to prevent balding, but I know many people who went on it without the proper documentation of their miniaturization.  These hair loss patients may have to take it for the rest of their lives without knowing that they have really needed it to start with.

The main cause of hair loss is DHT (Dihydrotestosterone) and not testosterone, so finasteride can not deteriorate your hair loss or hairline maturation changes. Maturation of hairline is a natural phenomenon and should not be mistaken with balding.  We do not want to stop it.  I do not recommend any medications to stop the maturation of hairline either.

1.    When can my son start handling his hair after his hair transplant without any caution whatsoever regarding physically touching or handling his hair, for example, with a full shower head, and rubbing his hair dry with a towel.
2.    He uses his comb just a little right now.  For example, he will comb his hair forward in anticipation for going to school.  Once in a while the comb hits his scalp, albeit pretty gently.  Is that O.K., or is it bad?
Thank you greatly.  All my best,

A:
Any time after the first four days from the day of a hair transplant surgery, patient can go back to his or her regular routine for washing and handling of their hair.

At this point (5 days after hair transplant), there is no limitation in daily hair care except in regards to sun exposure.  I don’t recommend excess sun exposure for 6 months after hair transplant to the newly transplanted area.  It should not be a problem for your son since he is combing his hair forward and covering the transplanted area.

Q:

I am a 21 year old boy and I started losing my hairs an year ago .I was preparing for my exams and i had some sort of food poisoning thing which affected my health adversely and I couldn’t had a proper diet for two months which resulted in a dull patch of baldness over my scalp.. I consulted with my local doctor and he suggested me minoxidil with some diet supplements(BIOVET-biotin and EMVIT-amino acids ,follic acid and some other vitamins).Now the hair fall is minimal but then too I suffer intense hair fall sometimes . I also took propecia after consulting with a doctor but it aggravated my situation and it catalyzed the hair fall instead. I was suggested that the hair fall will be temporary. I was scared so i discontinued the medicine.I took the medicine for 10 days specifically. Baldness is inherent in my family. What should Ii do?  Please guide me regarding the various hair treatments.  I dont wish to use propecia as I am scared about after mariage issues involved the medicine Hoping for your response as soon as possible.

Thanking You

A:

If you have a strong family history of hair loss, you may be heading in that direction already.  Vitamins for hair loss could be needed in case you are diagnosed with having vitamin deficiency.  However, a person with a balanced diet should not lose hair because of lack of vitamins.

Propecia, or finasteride, is by far the most effective medication for treatment of baldness or prevention of further hair loss.  You may experience some increase in hair shedding in the first few weeks to months, but that should not discourage you.  Hair growth with Propecia won’t be seen before six months from the time you start the medications.

You need to establish a good relationship with a good hair transplant doctor to properly diagnose your hair loss condition.  If you are diagnosed to have male pattern baldness or typical men hair loss you need to start taking hair loss medications and eventually get a hair transplant if need be.

As for “after marriage issues,” I believe you might be referring to the report of side effects associated to the use of finasteride. It has been reported that only 1 out of 100 patients (or less than 2%) have experienced some form of sexual side effect (erectile dysfunction, less desire to have sex, problems with ejaculation such as a decrease in the amount of semen released). The side effects have usually been temporary with continued treatment or disappeared when treatment is stopped.  It is a safe and proven product and should not be disregarded as a way to treat hair loss.

Q:

I am a male to female transgender.  I have some hair thinning on top with receded corners as a male hairline.  I am already taking Propecia and Spironolactone to block my testosterone effect. I would like to change my hairline from a male hairline with corner recessions to a female one. I have some thinning on the top too.  I have fine and curly hair to start with.  How can a male hairline be converted to a female pattern?  Do you recommend hair transplant for transsexuals or is there any other options to restore receded corners to a perfect feminine hair line?  I’m interested to know my options and what you recommend.

A:

Male to female transgender patients may experience two personal problems.  The first is having receded frontal corners in mature male patterned hairline which is what makes the frame of the face “masculine”. Receded corners can be easily restored with hair restoration through follicular unit transplantation.  The second issue is when there is also miniaturization or balding of the rest of their hair in a male patterned baldness that may require further hair restoration.  Taking anti-testosterone medications can help to slow down your hair loss, but it does not stop the balding process completely.  Removing the testicles surgically as part of a transgender procedure can eliminate testosterone and, in turn, stop the process of male pattern hair loss in people who are genetically susceptible to it.
If you are only changing your male mature hairline to a feminine one or if you have male patterned balding, a hair transplant can help you.  Obviously, you need to continue with your anti-testosterone medications and get a hair transplant to reshape the frame of your face.  You may need more than one hair transplant procedure for maximum fullness of the hairline in a perfect female pattern.

Transsexual hair transplantation is a meticulous procedure and the hair transplant surgeon needs to understand your facial proportions.  Your Hair transplant doctor needs to be experienced with shaping the hairline in women.  Women hairline is different from male in many aspects such as: the location of the hairline from eyebrow level at mid frontal and laterals; temples need to be restored in a complete female shape; direction and orientation of hair shafts are also different between men and women.  All these features and details need to be dealt with meticulously.  We at US Hair Restoraiton offer quality hiar restoration to change a male to female hairline for transgenders.

Q:

Dear Mr. Mohebi,

I would like to ask you a question concerning possible side effects that finasteride (Propecia) may cause. I read on the manufacturers instructions that broken tablets must not be handled by women who are or may become pregnant. Can finasteride cause damage to pregnant women health or to the health of the developing fetus? Here I’d like to know also if finasteride can be found in body liquids such as men’s saliva, sweat or sperm? In such case is there any risk that a pregnant woman is exposed to finasteride? Are there any recommendations concerning taking or not propecia before planned or during wife’s pregnancy?

Could you please comment on this?
Thanks in advance.

Best regards,

A:

This is a common question that many of my young patients ask me.  Finasteride (Propecia) blocks the conversion of testosterone to dihydroxytestostrone (DHT).  DHT does not have any known role in adult men development, but it is crucial in development of a male fetus and child external genitalia (their penis).  We at our Los Angeles, California hair transplant clinics don’t recommend taking finasteride for hair loss prevention and treatment before adulthood while maturation of external genitalia is not completed.  Pregnant women should not take finasteride because of its effect on the external genitalia of their male unborn baby.

The pharmaceutical company (Merck) recommends that pregnant women or any women who might have a chance of being pregnant should not be exposed to finasteride.  They should not even be cutting pills that might increase the chance of inhaling small particles of finasteride.  You are right about finasteride being present in body secretion such as semen and saliva.  However, the amount of the medication is so small that it is considered negligible or safe for pregnant women.  So the research shows that it is safe for pregnant women to be exposed to the secretions of a man whom takes finasteride.  That is why we do not recommend men to stop taking finasteride if their wife becomes pregnant.  There has been no evidence of any risk to a male baby from secretion of finasteride through the father’s saliva, sweat or sperm.

Q:
Well I am only 18 yrs old from India and I have got a hair problem. usually when I was young I didn’t care much about my hair, but now I have  found that I have  lost my hair and they r falling very rapidly.

Well my diet is also not too good as I am very lean…..now I am getting very worried about my .They have not completely gone…. but volume or (say) quantity of hair has reduced very much from all over the head and the effect can be seen more on the crown area I don’t use much shampoo and usually I didn’t use to use oil but have started now.

My father is too bald so please help me that what should I do …so that I can restore my hair back……

A:
Your hair loss is most likely genetic and you might be experiencing the early stages of male pattern baldness.  Although malnutrition may cause some types of hair loss, it won’t happen until your are severely deficient of some particular elements.

Having said that, it is a good idea to see your doctor to confirm the diagnosis of the hair loss, especially if your hair loss does not follow a typical male pattern like what you can probably see in other male members of your family.  Men hair loss in its male pattern type is seen in men between their early 20s and will deteriorate for many years.  There are many hair loss products out in the market, but none of those are really proven to work except a few medications that are FDA approved such as minoxidil and finasteride.

My recommendation is not to start using hair loss medications before your diagnosis of male patterned baldness is confirmed by a doctor.  Hair transplant might be an option for you in the future so it is good to start your relationship with a hair transplant surgeon now.