Day: January 1, 2023

I know dr.rassman has mentioned a few times that if a person is genetically balding their hair has a certain lifetime (example 5 or 10 years) , with or without the use of finasteride, before it completely dies. If that is the case, what is the point of taking finasteride if the hair is going die anyways within 5 or 10 years? Could finasteride prolong the hair from falling out early?

The point is you have the extra 5 to 10 years or possibly more of good hair. Imagine being 20 years old in your prime and you notice thinning. Imagine taking a drug that can postpone this until you’re 30 or 40. To some this may be worth while.

Apologies in advance for yet another question on this drug, but I cannot seem to find a good answer to it!

I am just wondering how the dosage of minoxidil has an impact on the hair. The Rogaine 5% minoxidil foam I use recommends 1g twice a day. This seems to be based loosely on expected application to the vertex/scalp.

Now, like so many people out there, I predominately use it on the hairline (though I know results can be hard to come by here). I have some moderate, uneven recession which may just be maturing, but I know maturing can quickly shade into MPB, and I have balding in the family.

Since the corners of the hairline make up a smaller area than the vertex/crown, is it still appropriate to use the full 1g? Does it matter if the full 1g is used in a more concentrated, smaller area? Does using more than the recommended 1g per application dosage ONLY increase the risk of side effects, or can it also have adverse effects on the hair?

In other words, is 1g simply the limit they set to to achieve maximum effectiveness whilst limiting side effects (similar to how 1mg is used daily for finasteride), or does going beyond that have adverse effects?

I only ask because I tend to use the full 1g (half a capful) to cover both corners (0.5g each corner), sometimes more, and I worry this may do more harm than good if I am using too much!

On the flip side, I wonder how people with more advanced/diffuse thinning manage to use half a capful to cover all the effected areas, and achieve good scalp penetration? It doesn’t seem enough!

I think it should be quite simple by using the medication as directed. Rogaine 5% is a topical medication and it is to be used twice a day on the area of balding on the scalp. Applying it, unfortunately, is not a science especially when you have to put it one in areas you can not see easily. It is used for balding on the top and crown areas where it is most difficult to apply and it probably does not really work well on the frontal corners. I realize some people use it for growth on the frontal corner areas in hopes it may work. There is nothing wrong with this. If your head is big or the balding area is big, I would use more to cover the areas needed. I do not think there is an absolute limit that you can realistically apply and what you apply needs to get on your scalp, not your hair. I also realize if you use too much you may have some side effects such as a drop in your blood pressure so use your good judgement.

Thank you for the great blog. Can you kindly comment on the study of the hairmax laser comb? There was a study published on the American Journal of Clinical Dermatology in 2014: Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study

It seems like a good study but the results and conclusions from the study is plainly states: “A higher percentage of lasercomb-treated subjects reported overall improvement of hair loss condition and thickness and fullness of hair in self-assessment, though the results did not always reach statistical significance.”

It means the subjects felt improvement but the results did not always show statistical measurable significance. In fact, it states Rogaine and Propecia worked better overall in the end.

The report ends by stating: “Further clinical trials are needed to define the optimal duration of treatment, the duration of response, and the use of the lasercomb in other alopecia conditions.”

This reflects what I’ve been saying and seeing in my office. I personally do not think that the laser therapy for hair growth works. I have seen many patients over the years and some say it helped a bit but they cannot see the gross cosmetic difference (a real change someone can see). I have not been able document the results in numeric terms or objective terms even with our recent laser trials here either. It doesn’t mean patients were not dissatisfied but I did not find a documented benefit. I still remain unconvinced that it works. As for my opinion, it’s a free world and a free market. Any one is welcome to spend the money to try it for themselves. It’s apparently declared safe by the FDA.

We’ve written about it here, here, and here.

Maybe I”m off but if technicians are doing most of the procedure I would think the rate of transection would be high. I don’t know what kind of training they’ve had. I assume just in house training. Obviously they’re needed considering the number of grafts but it’s a concern of mine.

In the United States and most of the world, only licensed physicians can perform hair transplant surgery. Doctors make incisions, harvest the grafts, harvest any FUE grafts, and they also make the hundreds or thousands of individual incision of where the hair follicles need to go. The technicians sort the grafts and individually insert the grafts into the pre-made incision sites that the doctors created. For strip surgery, the technicians also dissect the harvested grafts under the microscope into individual follicles. The technicians are trained to perform this highly specific task and the doctors oversee the process. For FUE, a doctor must be the person performing this step, but many doctors just can’s do this very well, so they use someone on their staff (not a doctor) to do the FUE extractions. This is frankly illegal, but as the State Medical Boards are not in the operating rooms, the doctors get away with it. On the other hand, some doctors who purchase an Artas® Robot, can use technicians to operate this machine. That seems to be accepted as legal, although the medical boards in most states have not ruled on this.

At our office, we do the FUE manually with instruments of out own design. Although we ‘invented’ the optical technology for the Artas® Robot, at $260,000 plus $1/graft, that would drive the prices too high for our patients, so we have continued to advance our manual technology which is faster and more efficient (in our hands) than any Artas® robotic surgery. We feel that the Artas® Robot and our manual technique are comparable in quality, but our manual technique is much faster and more efficient in our hands than what we have heard about the Artas® Robot.

Aside from the individual task of each team member, hair transplant surgery is a team effort. It takes a highly coordinated team to execute a successful surgery. That is why the reputation of the medical group or clinic is just as important than just the name of the doctor.

I am a 33 year old male. I had been using Propecia for 3 years and switched to Dutasteride approximately 6 months ago. Since switching to Dutasteride, I am experiencing less sexual side effects than Propecia, even at 1.0mg daily dose (twice the dose which is recommended in treating BPH) – I am also experiencing more hair regrowth than Propecia. I am wondering how and where you draw the inference that Dutasteride has the potential to cause sterility. Any firm evidence, clinically?

Just like your positive hair growth experience with dutasteride there are others who have negative experience with sterility and sexual side effects.

I cannot find a study or firm evidence, but I always try to balance risks and benefits. If you are never planning to have children, then it may not matter but if you are, why would you want to risk it? In addition dutasteride is not approved for the treatment of genetic balding and there is also no clear evidence it is much better than Propecia (despite your personal experience). If you want to know if you now have a problem, your doctor can order a sperm count which will show a problem if there is one.

About a year ago, I noticed a receding hairline. Hair would fall out during a shower, or even I would see some strands on my pillow. My dad and his dad started balding at my age, so it is most likely genetics. It is really embarrassing. I told my parents about it and they won’t take me anywhere. They feel like I am exaggerating. Plus, i do not think we have insurance, so that is also a reason why I haven’t seen any doctors. That is also the reason why I haven’t been to any doctor/dentist in well over 5 years. People are starting to notice a receding hairline and it is really stressing me out, thus more hair falls out, thus more stressing. Please help

The best help I can offer you is to go see your doctor. If not for the hair, but for a general check up. You are under 18 years old and a minor. You should have insurance through your parents or the state that provide free health insurance. The most common cause of hair loss in men after puberty is genetic male pattern balding (MPB) or androgenic alopecia. At your age there is a good option in medications. You can also see a hair transplant doctor but you will need a parent to accompany you to be able to address the situation if the examination confirms your suspicion.

Dear NHI Team – your blog is one of the most informative and professional online resources.

In the past you have written that of a belief that Propecia works for all men. Dr Bernstein in NYC, Dr. McAndrews in LA have made similar statements. The Merck claim is that it stops hair loss in 9/10 men. Perhaps you are saying that the one man left will go on to lose hair but a slower rate?

Could please elaborate on your opinion?

Propecia is for the treatment of androgenic alopecia in men. I’m not sure if Merck claims it “stops” hair loss, but I think Merck is claiming it works in 90% or 9 out of 10 men. The degree of how well it works on the individual is variable. Over the long term, even if you do take Propecia, you will continue to lose hair, albeit at a slower rate. For example, instead of losing most of your hair in your 20’s you may be able to prolong that fate to your 40’s. To some that may be worth it.

Finally, unless you’re doing this for research or intellectual purposes, the statistics don’t matter when it comes to personal experience. No matter what the percentage of successfully growing or slowing down hair loss, men may try the medication in hopes it will work. Likewise, no matter what the percentage of negative sexual side effects, men may not try the medication due to fear of it happening to them.

(Since these topic tend to be hot debates, the following was taken from a comment section from a recent post) The statistics posted in this blog entry are not correct. The frequency of ED in men in the 20s is much lower than 20% and it does not increase linearly by 10% every decade. It would be nice because the numbers are convenient, but it just simply isn’t empirically observed.

If you look at the Propecia clinical trials which included men under the age of 40, only about 1% in the placebo had sexual problems of any kind. A lot of hair transplants make the argument that sexual dysfunction is common to minimize the likelihood that sexual problems are caused by Propecia, but this is never backed up by fact mainly because it isn’t true.

It is true that it has not been studied in detail how PDE5 inhibitors will affect men suffering from finasteride related side effects, but many men who develop irreversible side effects also report limited benefit from erectile dysfunction medications. These drugs work for certain types of ED, psychogenic ED included, but it is commonly observed that they are not very helpful for men with post-finasteride-syndrome.

The exact number or statistics on erectile dysfunction (ED) may be of debate since most of these studies are based on self assessment and honestly reporting that they actually have ED. For example, if you wear women’s lingerie, have a small penis, or cheated on your spouse, etc would you honestly answer such personal or embarrassing questions? The answers and its accuracy can vary widely depending on the setting of how the question was asked and even who administered the questions. You can lie just as easily based on the person’s agenda. I use the prevalence of ED numbers more as a generality. You can find evidence on the Internet that may affirm the statistics or disprove it.

As to the persistent side effects of Propecia and post-finasteride syndrome discussed around the web I think it is difficult to confirm. Most of it is “speculation” as noted even by the scientific community that supposedly study the phenomenon. It’s based on self reporting and never clearly back up. You’re basically trusting someone’s word that they cannot have an erection or orgasm.

If you really look into the websites that report these persistent side effects of Propecia/ finasteride, the hidden agenda is a legally motivated.

There are so many other medications (that is used to treat depression and anxiety, such as Zoloft, Lexapro, Xanax, even good old fashion alcohol and marijuana use) that can have a much more profound effect in orgasm, sexual desire, and erections. These are never discussed in the context of Propecia and ED.

I am not dismissing the idea that there may be long term issues with Propecia. It just seem strange that I have not come across someone with these long term side effects in my 23 years of practice.

I was wondering if you could give some more input on the new LLT study from the American Journal of Clinical Dermatology.

What do the results mean? How does it compare to other treatments like Minoxidil or Finasteride?

Would this be useful for someone like myself who is just starting to have miniaturized follicles and are the results of the study impressive at all?

Is it to early to tell or does this study point to LLT being beneficial?

I found a copy of the study online HERE.

If you read the conclusion (at the end) it states there was some statistical improvement after a 6 month study comparable to Rogaine or Propecia use. But in the long term (over a year) Rogaine and Propecia was better.

The conclusion also stated: “A higher percentage of lasercomb-treated subjects reported overall improvement of hair loss condition and thickness and fullness of hair in self-assessment, though the results did not always reach statistical significance.”

In my experience, the results that I have seen from patients who have used lasers were equivocal. I personally did not see gross improvement when I followed up with them. (Results were not dramatic) Maybe this is my bias, but I have on many occasions seen patients who had dramatic results with Rogaine or Propecia. I have not seen a “worth while” results with laser light therapy alone. Seeing a statistical improvement is not like seeing a cosmetic improvement.

I have questions about hair loss. We know that hair loss can be the cause of stress, poor diet, Hair products, and other various known symptoms, especially most heredity (MPB) in men as people say.

Considering male hair loss which actually is hereditary, the scientist have evidence that heredity hair loss in men caused by most Skull expansion (bone growth), anything that it say that the skull develops and shapes, ie, bone grows on our heads, and then slowly approaching scalp tissue, slowing the small capillaries and strangling the blood supply needed to grow hair.

It doesn’t interpreted as someone with a big skull will lose hair and some with a small skull not. Skull expansion simply means that, for those with certain skull shapes, their skull bones will grow and change shape (to be somewhat larger in the process). These include parietal bones and frontal bones aside with DHT.

It is DHT that is responsible and encourage bone formation, not just in our heads but also in our body as we age.

That is how DHT Hormone do, it stimulate hair growth, muscle growth and bone growth, not hair loss.

This is recognized as a true genetic traits.

It is clear why your MPB regions feels tight, hard and bony.

I am amazed at the questions we receive at times.
How does one come up with these things? Late night watching Star Trek?

Hair loss in men that is androgenic alopecia (genetic male pattern balding) is due to the genes. Not the shape of one’s skull or growth of skull shape. You can have a big head or a small head and if you have the genes for hair loss, you will have hair loss. If you don’t have the genes for hair loss then you can have a giant head and still have hair!

The person you referenced that came up with this hypothesis is trying to sell a book for $29.95. Everyone wants to make a buck.

Skull shapes do not have an impact on DHT.