Hair Restoration Blog

Q:

I am a 45 year old woman. My dermatologist told me that I have male patterned baldness. I am also diagnosed with Iron deficiency anemia. Can Iron deficiency in women cause hair loss in male patterned baldness and if so, can treatment of iron deficiency help reversing balding process?

A:

Iron deficiency with or without overt anemia can intensify the rate of hair loss in women with either male or female patterned hair loss. If Iron deficiency is the only cause of your hair loss and you are not genetically prone to anemia, hair loss can be reversible. However in many situations, patients are genetically predisposed to patterned hair loss and Iron deficiency has only accelerated the hair loss process. Accelerated hair loss in women who are genetically predisposed to patterned hair loss may not be reversible by just correcting the Iron deficiency. You need to see a good hair specialist to confirm the type of your hair loss and plan the proper treatment method including hair transplant surgery.

Hair transplant cost is one of the questions that we have answered many times in this blog and we still receive it from our patients. The quality of hair transplant surgery have been improving within the last few decades with the use of stereotactic microscopes and advanced methods of handling and maintaining the hair grafts. However, not every hair transplant clinic could have kept up and adopted the new technology.

Cost of hair transplant surgery varies from clinic to clinic and from surgeon to surgeon. You may find a wide variety in hair transplant costs. Many clinics that offer cheap hair transplants are not committed to the quality of service. They hire inexperienced hair transplant staff. Some of the hair restoration surgery clinics do not use microscope and are not scientifically in line with the advanced techniques that are available today. Some clinics are run by technicians and doctor is only involved in a small portion of the procedure.

Hair transplant costs are generally calculated as per hair graft basis. Hair transplantation with exclusive follicular unit transplant could cost $3 to $10 per each graft (average for exclusive follicular unit transplantation). That is the cost of hair transplants with strip techniques of FUT or follicular unit transplant and the price of the FUE (follicular unit extraction) hair transplant is higher. Affordable hair transplant could be found in high-quality hair restoration clinics too. They may not be able to lower the cost of surgeries to $2 per graft (as you may see in some hair transplant offices) because of the fact that having an experienced surgical team and skillful surgeon cost more than that.

As I said, you can find low cost hair transplant centers that still offer quality hair restoration surgeries. Some of them are very skillful and offer individual services unlike the big chain hair transplant centers. The big chain hair transplant centers have a variation in their services due to different surgeons and staff. I have seen a diversity of results from some of those clinics. The variation is generally seen due to difficulty keeping the same standard in different offices. Most patients with a previous surgery in the chain clinics who have a repeat surgery at Los Angeles Hair Transplant center of US Hair Restoration are critical of the lack of personal attention and individual care in those clinics.

In conclusion, although the cost of hair transplant surgery is an important factor, it should not be the sole factor in choosing a hair transplant clinic. I always encourage my patients to educate themselves on the most advanced techniques of hair restoration surgery. Internet is a great source of information. We have a useful collection of hair loss and hair restoration articles in our web site. I also answer the patient’s hair restoration questions in hair restoration blog on a daily basis.

My recommendation is to shop around for the best value hair restoration surgery and not for the cheapest one. Think about it as a lifetime investment. Good or bad you will see your hair every day for the rest of your life.

Central centrifugal cicatricial alopecia or CCCA is one of the less common causes of hair loss. This medical condition, which characterizes with circular balding, mainly on the top (vertex and crown) which can be expanding and only leave a rim or hair around the scalp with total baldness in the more central areas in extreme cases (see picture).

The causes of this type of balding are now quite known. This disease used to be called with different names such as hot comb alopecia, follicular degeneration syndrome, pseudopelade in African Americans and central elliptical pseudopelade in Caucasians. Microscopic evaluation of the hair loss areas shows evidences of inflammation in the area of disease activity, chronic and rapidly progressive skin changes with eventual complete baldness in some part of the scalp with its unique pattern.

This hair loss condition could be started with the evidences of skin inflammation (redness and itching), but this phase might be temporary and patient may not have any signs or symptoms other than hair loss with its specific pattern.

Treatment of this condition could be challenging. Treatment with medications is generally not successful in prevention of the hair loss and to reverse the process. Hair transplant could be an option, but it could not be done in the acute phase of the disease. Hair transplant for Central centrifugal cicatricial alopecia might be considered when the active phase is over and when the inflammation is completely subsided. I would like to do a small test hair transplant before committing to the actual hair transplant surgery to be assured of the survival of the hair grafts.

Q:

Hey doc!

How’s it going? I hope all is well. I have two things on my mind. One is a question: the Murad shampoo directs users to use the shampoo daily.. do you think i is okay to use that shampoo daily? The reason why I am asking is because of the chemical content in shampoo, it is usually recommended to shampoo every other day or so.

A:

I answered another question about Murad shampoo “Murad Shampoo for hair loss” before. I don’t believe that DHT blockers especially in the form of shampoo can be absorbed from the skin to affect the hair growth compared with systemic DHT blockers i.e. finasteride pill. I don’t think that daily use of the shampoo can hurt your hair either, unless it is specifically prohibited by the manufacturer.

Q:

hi, why do men with thinning hair seem to have a reddish color to their scalp and men with thick a thick head of hair seem to have a whiteish color to their scalps……i find it a condition that exists in alot of cases several of the men i observed wear caps when they are outside so i’m quite sure the sun had nothing to do with it. one of my sons has a very thick head of hair……..”whiteish” scalp..my other son has thin hair and a reddish skin colored scalp.

again thanks for your help

A:

Thin (Miniaturized) hair is generally seen lighter and in people with dark but thinning hair, hair could be seen as light brown or reddish color, not because it has less concentration of the pigment (melanin), but due to its smaller size and less number of pigments overall. One of the first signs of hair loss could be lightening hair color in the thinning areas. Scalp tone is also a reflection of hair color especially in people with fair skin that you can see through the skin and hair shaft may alter skin tone.

Q:

Hope you had a great weekend, Just a quick question.

After how long usually I would see the result of those pills (finasteride)? Will it grow like baby thin hair and it thickens over time or should I like shave my head to help it? J just wonderin‚
Regards,

A:

Be patient,

It is unlikely that you grow new hair from the areas that you lost hair follicles. The medication finasteride can help increase the thickness of your miniaturized hairs that normally do not give you any significant cosmetic effects. You should not see the effect of medication before 3-6 months from the time you started it.

Remember, the purpose of medical treatment is not to grow your hair back as it was when you were 17. The goal of medical hair restoration treatment with either minoxidil or finasteride would be to stop or at minimum slow down the progression of hair loss. Shaving your head should not change the progress of hair loss or gain either. When you manipulate your hair whatever you do, you are dealing with external part of the hair, which is not alive. The follicle does not sense what is going on outside at hair shaft level. To restore it more permanently in front and top of your scalp, you would need a hair transplant.

Best,
Dr. Mohebi

Q:

Hi Doctor,

My mother is obsessed with my hair loss and gives me a whole bunch of vitamins and mineral tablets everyday to help regrow my hair.
Do you think they work? Or should I stop them.

A:

Although lack of certain vitamins and minerals could cause hair loss in their sever form, living in north America and having a normal and balanced diet; it is unlikely that you are suffering from vitamin or mineral deficiency. On the contrary, if you look at your family pattern of hair loss, you probably can find other male members of the family who has similar male pattern hair loss. As I always say, you need to have the triangle of baldness, which is “Gene, Male gender, and time” to become bald. Vitamins deficiency is not to blame as part of triangle of male patterned hair loss. You can continue taking vitamins to please your mom, but don’t overdo it since vitamins are not going to bring your hair back. Instead you need to see a good hair specialist or dermatologist and undergo a good hair loss evaluation with miniaturization study and start taking one of the effective medications to prevent further hair loss or to use hair transplant to restore your lost hair.

Q:

I underwent a gastric bypass surgery about 2.5 years ago and since a few months after surgery my hair has been thinning. What do I need to do to prevent further loss?

A:

Losing hair or changing the quality and color of hair after gastric bypass surgery is commonly seen within the first few months after the gastric bypass surgery. This condition can mimic shock loss that could be seen after hair restoration surgery. Right after the gastric bypass surgery your body goes through a period of severe starvation and tries to divert nutrients toward more vital organs instead of skin and hair. Although carbohydrates, proteins, minerals and vitamins especially the family of vitamin B has been blamed for the hair loss in patients who had gastric bypass, it can happen while all of those elements are within normal range and the exact mechanism of hair loss after gastric bypass surgery is not completely known.

The great news is that the hair loss after a gastric bypass surgery is always temporary. Your hair condition should return to normal within a few months of hair loss occurrence. Patients who had gastric bypass should have serial examinations within the first few months of their gastric bypass. Your surgeon should check many elements because gastric bypass surgery could increase the incidence of iron, folic acid, vitamin B12, calcium, and vitamin D deficiency. Most people need to stay on supplementation of these minerals and vitamins. Close monitoring with regular laboratory tests for these deficiencies should be done by your surgeon or primary care physician.

Q:

I have heard high estrogen in males can contribute to hair loss. Is that true? I am a 40 year old man with low sex drive and female patterned hair loss.

A:

High levels of estrogen in men could be seen in many other conditions such as estrogen-producing tumors, congenital adrenal hyperplasia, chronic alcoholism and advanced liver disorders. Elevation of estrogen in men can cause sexual dysfunction, change in body fat distribution in a female pattern and breast enlargement and secretion.

Balding is not a typical sign of excess estrogen. In fact one of the signs of estrogen deficiency could be hair loss in female patients. A common type of this kind of hair loss is seen in telogen effluvium that women lose hair due to sudden drop of estrogen and progesterone levels. Although excess estrogen is generally not the trigger for hair loss, it can affect the balance of other hormones and indirectly cause hair loss. The latter is not a common cause of hair loss in men or women though.

Q:

Hi Doctor,

Some doctors prescribe Dutasteride (Avodart) for hair loss prevention. I know you don’t recommend Dutasteride for hair loss for obvious reasons, but based on available research findings on this medication, what do you think are the most likely possible side effects from using Dutasteride if worse come to worse. Would it be like multitude of finasteride side effects? Again, I know your view of non-FDA approved drugs.

A:

Dutasteride (Avodart) is one of the selective inhibitors of the type I and II of the enzyme 5-alpha-reductase, the enzyme that converts the male hormone testosterone to 5-alpha-dihydroxytestosterone (DHT). In comparison with dutasteride, finasteride (Propecia) acts as an inhibitor of just type II of the enzyme 5-alpha-reductase, which is more specific. Studies around dutasteride mechanism of action shows that, blocking both type I and type II enzyme can be more potent that only one in reducing the levels of DHT in the body.

If you are taking dutasteride for other indications, you may get some hair growth as a good side effect. As you guessed I cannot recommend dutasteride solely for prevention of hair loss not until it is approved for hair loss treatment by FDA. Other than not being FDA approved my other reasons are:

1. The optimum dose of dutasteride for hair loss prevention is not determined.
2. The side effects of dutasteride are much more prominent comparing to finasteride.
3. If you are considering the cost effectiveness of dutasteride, with new price reduction of finasteride that should not be in the picture any more.