https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/
Conclusion: Preliminary results on the use of topical FNS are limited but safe and promising. Continued research into drug-delivery, ideal topical concentration and application frequency, side effects and use for other alopecias will help to elucidate the full extent of topical FNS’ use.
2021-07-13 01:55:572021-07-11 16:03:32Recent article on finasteride (topical and oral)
Key PointsQuestion For male androgenetic alopecia, what is the relative efficacy of monotherapy with orally and topically administered minoxidil, dutasteride, and finasteride?
Findings In this network meta-analysis of 23 trials, the rank of efficacy across treatments and the relative efficacy for every possible pairwise comparison of treatments were determined for 4 end points (ie, change in total and terminal hair count after 24 and 48 weeks). The results of this meta-analysis indicate that 0.5 mg/d of oral dutasteride has the highest probability of being the most efficacious treatment, followed by these agents in decreasing order of efficacy: 5 mg/d of oral finasteride, 5 mg/d of oral minoxidil, 1 mg/d of oral finasteride, 5% topical minoxidil, 2% topical minoxidil, and 0.25 mg/d of oral minoxidil.
Meaning The findings of this meta-analysis contribute to the comparative effectiveness literature for AGA therapies with regard to the compared interventions.
Dr. Rassman’s Concern: Dutasteride has a half life of 5-6 weeks so daily dosing at 0.5mgs make little sense to me. Blood levels and other organ impact at this dose building up over time, have not been analyzed or published.
Dermatology News Wrote: Here are comments and an analysis of this article which our readers may find significant: https://www.mdedge.com/dermatology/article/251693/hair-nails/male-alopecia-agents-ranked-efficacy-meta-analysis
My hair is thin everywhere, front, top, crown, and the sides of the hair. Each doctor I met with gave me a different number for transplants, but isn’t it of a concern with such much thinning all over my head.
Yes, what you are descriging is diffuse hair loss. This is common as a genetic trait in some women and they may see it in their mothers, sistgers, aunts. When this is the case, this is not a transplant situation, Diffuse unpatterned hair loss, typical for many women with genetic hair loss, should never be transplanted. I suspect that the doctors are looking at you as a source of paying off their mortgage. We would perform Scalp Micropigmentation on your scalp, which is a cosmetic unique stippled tattoo and will change the color of the scalp and make the thinning almost disappear. This is not hair, but a highly specialized tattoo, see here for many good examples: https://scalpmicropigmentation.com/smp-for-women/
2017-12-04 06:45:202017-11-19 15:45:50I have received many quotes for hair transplant number from different doctors.
You used the term 7,200 hairs, not 7,200 grafts. The average Caucasian has about 8,500 hairs in about 4,500 grafts. I don’t know why the doctor used the term hairs instead of grafts, other than to make you think you got more value. There is a standard nomenclature that is used in this industry, and doctors who go outside of this standard nomenclature often do so to mislead the patient.
Yeah I’m not dealing with this. Life already sucks to go through right now. I’m not sure which treatment I want to do. Surgery is too expensive. The libido sides from finasteride and minoxidil aren’t really an issue for me but it’s still a bit iffy. What do you suggest is the best course of action? I’m already not a looker
I doubt that your hairline is receding. Sometimes the mature hairline appears at your age and that maybe all it is. Send me photos and I will give you an opinion but be sure that your photo has your full face with your eyebrows lifted so that the forehead creases. A mature hairline is one finger breadth above the highest crease of the furrowed brow., see here: https://baldingblog.com/mature-hairline-photo/
2020-07-03 11:16:372020-07-03 11:16:37Receding at 15?
From my brief research, FUE results seem to vary, but I wonder how common dissatisfaction with the results is. Has anybody had the procedure and downright regrets it? I remember reading something once where the guy was sorry to have had it as it left him with bad scars (and yes, it was FUE) and he was continuing to lose his hair anyway. I was under the impression that FUE leaves barely noticeable scars, as seen here: https://www.youtube.com/watch?v=JfONQWMTkcAMoreover, I thought the transplanted hair is supposed to last and not be subject to ongoing MPB, even without finasteride.
Bakcground: I’m rapidly heading for NW 6. I tried cropping it short, but I look horrible and the contrast between my pale skin and dense dark hair is making my horse shoe stick out bad no matter what I do. So I’m considering FUE at this point, though with the extent of my hair loss it’s questionable what can be done. I wouldn’t mind keeping my hair buzzed as long as FUE added some density without obvious scarring. What I hate is that sharp line dividing the remaining hairline from bald areas.
The word alopecia means hair loss. When the donor area is Over-harvested such that too much hair is taken from it, then it becomes thinner the more hair that is taken. In some people, the thinning is severe enough to produce a bald donor area. As the inventor of the FUE (see here: https://newhair.com/wp-content/uploads/2018/11/mp-2002-fue.pdf), I have always cautioned that the FUE has a limit for each person and that limit is determined by the density of the donor area (I have defined this limit here: https://newhair.com/resources/#tab-id-4
When it is done within these limits, the results are as you have shown in the link you provided above and undetectable; however, when it is Over-harvested the results may look like this collection of patients I have accumulated who unfortunately fell in the hands of unscrupulous doctors or clinics, many from Turkey (https://baldingblog.com/?s=over-harvested&x=0&y=0).
We love performing FUE but we also know its limits. As a buyer, you must know these limits and find a doctor who is highly ethical and knows the FUE limits as well.
Three links, two in the Express (a popular UK based newspaper) and a review of many medical articles from Pubmed (third link):
https://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&from_uid=26010505
2018-09-14 05:30:442018-09-14 11:24:00More and More We Are Realizing Hair Loss in Men Increases Anxiety and Health Risks
I recently met a prospective patient (Asian male) with a very low hair density who kept his hair very short. He wanted a follicular unit extraction (FUE) procedure and I strongly advised against it as in his particular case, the tiny white punctuate scars he would get from FUE might become detectable. His skin was a dark olive color. He did consult with another doctor by phone who told him after seeing his photos that he could easily get 4000 FUE grafts in the first session followed by 3000 in a second session and that he would have a reasonably full head of hair.
We then discussed a strip procedure and I told him that in a single session he might get approximately 1500 grafts, yet still another doctor told him that he easily could get 3500 grafts from a strip session. The prospective patient asked me why these other doctors were so enthusiastic about the surgery they recommended and why I was so low with my estimates on the strip procedure. I told him that I was an ordinary, mortal doctor with human limitations and he needs to understand that this is more than a number difference because the doctors may be talking about different things. I always talk about follicular units which is the graft count that I obtain at surgery. In other words, I’m not going to recommend something to this patient that will ultimately not be in his best interest and I am not one who victimizes patients for what they have in their wallet by charging for something that is not a follicular unit.
There is math and economics in these various estimates. For example, this patient’s graft count could be pushed higher if the grafts were divided so that each graft would have less hair. What one doctor calls a graft (1-3 hairs each) another doctor can cut down into grafts that contain less hair each (shifting to mainly 1 hair grafts) and get the illusion that there is more ‘value’ because the number of grafts is higher. If the amount of hair is say 5000 hairs, one can produce grafts ranging from 1500 to 5000 grafts from this hair count. So first, one has to define what the doctor means by a graft, does he cut them down into small units to get higher number of grafts? Economically for the doctor, it is better to cut these follicular units down (in the number of hairs each) because the fee is based upon the number of grafts. So more grafts means more money for the doctor (and higher fees for the patient). What matters is not just the graft count, but the total amount of hair that is removed in the procedure. Then add to that the way it is divided into small hair units (ideally it should be true anatomical follicular units). In the case of a strip procedure, the value would reflect the ‘area’ of excised scalp. Grafts should reflect the normal anatomy of the follicular unit that G-d created, not one that the surgeon invented (a subset of the follicular unit devised to push up his income).
We are not all equal with regard to the amount of hair that can be moved in a single session because the hair density between people can vary significantly (some people have more than twice the hair density of others). Also the looseness of the scalp may mean than in one patient twice as much scalp can be moved than in another patient. Merging these two measurements, when comparing two people, the maximum safe capacity for moving hair can reflect differences of 4-5 fold. I believe what is ethical from a fee point of view, should reflect the amount of work that the surgeon and his team invest in performing in the surgery. That is why, if true follicular units are what is counted, then the ‘apple for apple’ comparison is appropriate in the calculations for value. A patient should demand knowing that he is receiving follicular units, and not a number reflecting a subset of the follicular units for the purpose of pushing up fees.
We spent some time talking about what he could and could not expect. Expectations really reflect the amount and distribution of hair used in the transplant. The issue of value discussed above, should reflect the number of actual ‘true’ follicular units removed. It is wrong for not educating the patient. A doctor who did not take the time to review what he was going to do, how he was basing his graft count, what constitutes a graft and how he determined the charges for each graft is not doing his job. If you know this information, then you have done the proper research and you have a better chance of getting what you are paying for.
For further reading, plenty of similar links to past blog posts can be found here.
The photo below shows a man with an advanced balding pattern (Norwood Class 7 pattern). This is the pattern that is a risk for every man having a hair transplant. Everyone runs this risk. They could lose all of their hair except for this 2½ inch rim of hair around the back and sides of the head. The white line shows where the neck hair begins and the arrow is 2½ inches long. The neck hair below the white line is not permanent hair. So if your surgeon takes hair above this rim area (where it is bald) or below the white line (neck hair) in any FUE surgery, you run the risk of eventually showing scars all over your head where the hair used to be before the balding happened. Not good!
This is why strip surgery is a better surgery for people with advanced balding patterns. If the density of this rim hair is good, then the area immediately above the white line can be harvested over and over again, decreasing the density of this rim with each successive harvest. I have harvested as many as 10,000 grafts from this rim in Class 7 patients and still left enough hair to keep the rim area covered when the density was very good. I have also been able to harvest routinely 6000-7000 grafts in people with average donor hair densities. If this area is harvested with FUE, the surgeon must stay away from the upper border or the FUE scars would show as balding progressed (https://newhair.com/donor-area/). The depletion of the donor area with FUE is not uniform so the number of grafts taken from this area is more limited than with the strip which is always harvested and re-harvested just above the white line if the surgeon does it correctly. The density of the residual hair after a strip surgery is always uniform. Of course, the scarring risk from repeated strip surgeries is real, but because there is always hair above the scar and Scalp Micropigmentation can address the scar so this is a manageable problem if it should happen (https://scalpmicropigmentation.com/scar-covering/).
The other important issue is the size of the bald area, which in this man is 80% of the original hairy scalp. So, this rim must supply hair to cover the entire bald area. The math is a real challenge and that is why your surgeon must be both an artist and a mathematician. Your surgeon must calculate what you need now and what you might need later as your balding progresses. This donor area is limited to about 50% of the original donor density. EVERY balding man will develop more hair loss over time, so a great surgeon understands this and should always be able to give you a status report of your reserves for future hair loss. Maybe you will not progress to a Class 7 pattern but rather a Class 6 pattern as only 7% of the population ever progresses to a Class 7 balding pattern. Poor planning by the doctor or patients who are in a rush to satisfy their immediate goals (particularly when they are early in the hair loss process) at the expense of your future needs, is not good. You and your surgeon must always develop a Master Plan for your future hair loss. Always think long term so that your decisions will be calculated to address the problem you have now and the problem that you will almost certainly have in the future.
2018-06-06 06:30:492018-06-07 08:57:48What Is the Real Extent of the Donor Area Hair (Permanent Hair That Lasts Your Lifetime)?
We received a lot of emails about last week’s post — I’m Suicidal Over Losing My Hair at 18 Years Old! — and I wanted to share this one with the rest of the community.
Dr. Rassman,
I read this blog regularly and when I read your post yesterday about a young man dealing with suicidal thoughts, I had to write in.
Young people out there need to understand that they have options but doing something drastic (like a transplant at 18) years old or worse (harming yourself) only eliminates options. I came to your office last year young, scared and anxious about hair loss myself. I was convinced that things were only going to get worse, but a year ago there wasn’t a hair bulk analyzer or A Cell. Imagine, just a year later and suddenly I am hearing about all these innovations. Maybe I overreacted?
It is amazing what happens when you take a deep breathe, research your options and gain a little perspective. I was given great advice by the doctors at NHI and they were words I needed to hear. Hair loss still bugs me but I now have every option open to me because I did not jump into a rash decision and young guys (I am 25 and empathize with you) need to understand that, just because you are not happy with what the mirror is showing, it doesn’t mean you can’t be happy ever again.
This is not the end of the world. Balding doesn’t rob you of your vision, your hearing or your overall health. This young man still has eyes to see the world, ears to listen to wonderful music and a capable body that can laugh, love and live. Getting a quality doctor to help you deal with your problem will keep you from being a slave to your hair and will help you get on with living.
While most of the emails (and comments) had positive messages of support, I felt the above email perfectly expresses what many compassionate people relate to. Thank you for writing.
2010-12-13 10:49:242010-12-12 12:54:57Readers Respond to Suicidal 18 Year Old
