If I Don’t Take Propecia, Will My Transplanted Hair Fall Out?

Hello Dr. Rassman,
I have done a hair transplant surgery about 6 months ago and I am using Rogaine twice a day along with Hairman comb for maintaining my hair. I am not using Propecia as it is having sexual side effects. My question is that since I am not using propecia which stops DHT which causes hairloss, are my new hair follicles in danger of falling out? I am 26 years old.

Another question that I have came across a clinic in London and they are offering Minoxidil 12.5% which stronger then the normal 5% Minoxidil. Minoxidil 12.5% have to be used only once a day. Switching to Minoxidil is a safe idea, please advise.

Your prompt response will be appreciated. Regards

Transplanted hair is from the donor area (back of the head), so it should not fall out from genetic causes. If you didn’t experience shock loss after your surgery, particularly since you’re a young man, you are quite lucky. There is a chance your loss could still progress, but there is no laser or topical treatment that will prevent that. Actually, there’s nothing that will 100% prevent all future hair loss (that would be called a “cure”, which doesn’t exist).

Propecia helps slow the progression of genetic male pattern baldness (MPB), but if that isn’t an option for you, I’m not sure what to tell you. Did you experience side effects yourself or are just frightened by what you’ve read on the internet?

Minoxidil has been proven safe and effective at 5%. If clinics are offering stronger medication, that doesn’t necessarily mean it will work better. You do run a higher risk of irritation and other side effects from minoxidil as the concentration is increased. Have you tried the 5% without success? I’m confused as to why you’d want to try a very high strength right off the bat.


2011-06-07 11:17:22If I Don’t Take Propecia, Will My Transplanted Hair Fall Out?

If I Don’t Like SMP to My Donor Scar, Can I Have FUE Into It Later?

Hi, if you do scalp micropigmentation to correct a donor scar with non-permanent ink. Can you later do FUE into that scar afterwards if you don’t like the results of the micro pigmentation. How long do you have to wait before doing it ? Must all pigments be faded ? Are there any risks ?

Thanks

Since we have been performing Scalp Micropigmentation (SMP), there have been various clinics that started offering something like SMP, but with non-permanent ink. Non-permanent ink is just like makeup or just drawing something on your head with a pen, in my opinion, so you don’t have to worry about other procedures (it will erase off like a pen eventually).

On the other hand, SMP is permanent… but like all tattoos or cosmetic/medical pigments, it fades to a lighter color over the years. You may need a touch up, but it will NOT just erase. SMP is great to disguise an old hair transplant scar if you are going to shave your head or buzz it short with a zero guard.

There is no issue if you choose to have another hair transplant (strip or FUE) after the SMP, or even transplant into the scar if that is what you want. It just means that there will be more scars (linear scar from strip or hundreds of FUE scars) and you will need to pay and go through the entire SMP process over again if you want to hide the new scars. Very few patients have actually had another transplant into the scar, because our satisfaction rate is extremely high.

If I Damaged My Follicles, Why Aren’t They Repairing After a Few Years?

So a few years back i had a scalp problem that involved flaking and i got into the habit of picking the flakes which also led to hair loss because of it. The hair never grew back but when i decided to shave my hair due to having patchy looking hairloss i noticed that in fact the hairs had grown back (well kind of). It was the exact same colour as the other hairs and not the blonde vellus looking hair i would have expected when damaged hair was growing back. But they were much thinner looking than the surrounding normal hairs and they also never grew past 1/2 a millimetre in length.

From what i have read once a hair follicle has been damaged it takes a long time for it too repair and that is why the hair is thinner and not growing like normal hairs ….. But these hairs have been like this for well over a year and have shown no signs of growing back any thicker and longer? but at the same time haven’t disappeared and left the areas bald.

So what is going on? are they gonna grew back or is the damage done and if so why are they still growing to half a millimetre

thanks

The normal hair cycle is somewhere between 2-4 years, so if your hair can recover, it might take that long to see it in its next hair cycle. Also, it is possible that the damage produced by picking has irreparably damaged these hair follicles (traction alopecia), so what you are seeing are miniaturized hair as a step towards total loss of these follicles.

Hair transplants can work very nicely in these areas if you do not have a massive hair loss, as the grafts would be transplanted from the back of the scalp and not subject to the old damage you caused from the picking. Have you seen a doctor for an examination?

If I Can Only Afford 1 Transplant Procedure, But I Might Need More?

Hello Doctor,

I am a hair loss sufferer, but my hair loss is more of a diffused type, with thinning across the scalp. I am considering hair transplant but would like to get your opinion before I make the decision since I am living in India and will be traveling to US for the transplant and want to make sure the trip is worthwhile.

I have been saving for a hair transplant for the last few years and at this point I can afford a little more than 2000 grafts. Do you think hair transplant is the right option for someone if they cannot afford any follow up procedures after the first transplant? Do you think I should keep saving for some more time so that I can get maximum amount of grafts in one go that can last me for a much longer period without having to go for a second surgery for a very long time?

All my calculations are based on $5 per hair graft that I got from your site for prior fixed appointments. Also is the $5 per graft inclusive of all charges or are there some overheads as well.

Thanks

MoneyAt NHI, our fees are fully inclusive without any additional charges. The $5/graft fee you mentioned is for Dr. Pak’s standby rate, so you’d need to be a little flexible with the scheduling. We do offer a travel discount, too.

Indians generally have lower hair densities than Caucasians by about 20%. Assuming that you take the pill finasteride and you are under 30 years old, the following may apply:

  1. Class 3 pattern — may work well with between 1300-1800 grafts, depending upon hair shaft bulk. Coarse hair is better than fine hair.
  2. Class 4A pattern — can be filled nicely with about 2000 grafts.
  3. Class 5, 6, and 7 patterns — you may not have enough hair to cover the crown.

Many men elect to have one surgery and be done with it, or have multiple surgeries over time. It’s up to you. I haven’t seen you, so keep that in mind. I’m not sure how many grafts you’d actually need or what your hair loss pattern even is. You should send me photos if you’re considering surgery and I’ll be able to hopefully tell you a little more.

Photo credit: Origami artist Won Park

If I Already Lost Half My Hairs, Should I Still Be Losing 100 Hairs a Day?

I have already lost more than half the hairs on the top of my head. I have been reading on your blog, that it is normal to lose up to 100 hairs a day. However, given my current state of hair loss, does the number of “normal” hairs to lose decrease? In other words, since I have lost half the hairs on my head already, should I only be concerned now if I lose more than 50 hairs a day?? I ask this question largely because I am about to start taking Propecia and I want to guage an idea of what kind of benefits I can hope for. Thank you!

While it is normal to lose 100 hairs a day, there should be 100 other hairs growing at other parts of your head to replace the lost hairs. It is just difficult to find the growing hairs and easy to see the falling hairs. If you are bald and have lost 50% of the hair population, then you will cycle about 50 hairs per day, not 100, and that is what you will see on your pillow (if all of the hair loss was at night when you slept).

If you have considerably thinned and are still losing hair (100 or 50 or 20 hairs a day), you may have hair loss that is genetic in nature (male pattern hair loss). If this is the case and you are worried about this, you may consider having your scalp hair mapped for miniaturization to see the pattern and state of your hair health.


2007-02-27 14:52:52If I Already Lost Half My Hairs, Should I Still Be Losing 100 Hairs a Day?

If Hair Cloning Ever Goes Mainstream, Would FUE Become the Gold Standard for Surgery?

Hi Dr. Rassman,

My understanding from reading your blog is that FUE is over-hyped because it does not produce a linear scar, but is still inferior to the strip method in producing the most number of grafts with the least amount of transection. If hair cloning technology was to ever become a mainstream option that hair transplant surgeons offered, would that then make FUE the gold standard/go-to choice since the number of grafts needed could be created from a smaller amount of donor follicles?

Thanks

The point of the post you’re referencing from a couple weeks ago (FUE Back into the Linear Scar vs Scar Revision) was that once a strip surgery has been done and a linear scar is already present, a FUE procedure should not be the harvesting method of choice.

To answer your question on cloning, if the clone somehow came from the scalp, then FUE would be used, but if the cloned hair came from a petri dish, then no harvesting mechanism will be needed and the cloned hair would be put directly into the recipient site.

If Facial Hair Loss is Not MPB, What Is It?

You said in en earlier archive, “You can have very high levels of DHT, but as long as your hair is not sensitive to DHT, Propecia will have little effect on the normal hairs.” My question is what causes hairs to thin where its not male pattern like a mustache, sideburns or a beard. Both my doctor and dermatologist, prescribed for me to take propecia or Rogaine but I haven’t any signs of male pattern baldness. The hairs on my mustache have become very thin, brown and a little white. 4 years ago the hairs were denser and black. I am a 26 year old male with African/Caucasian decent.

You are correct that MPB and DHT do not impact the facial hair. We see changes with age in many people, although you are young for thinning of facial hair. At this point, I do not have the answer to your problem. I would love to examine your beard and measure the thickness of different hairs from different parts of the face. That would give me more insights into your problem.

If Exercise Increases Testosterone, Wouldn’t it Also Increase DHT and Hair Loss?

I noticed your recent post about protein powders and how they have no effect on DHT and hair loss. I’ve seen some posts on your site, but I feel that exercise and supplements (other than steroids which obviously impact hair loss) have not been adequately addressed.

For example, many studies indicate that creatine increases testosterone and DHT. Also, generally speaking, exercising increases testosterone levels. Therefore, wouldn’t exercise and working out increase DHT and therefore hair loss? Also, maybe we can get a more straight forward answer on certain common supplements such as Creatine and Glucosamine. Thanks

I do not believe that working out will increase hair loss, but the straight forward answer is that we don’t know for sure. If you search the web, many talk about creatine and how it may relate to increased DHT, and ultimately hair loss. I do not know of any well constructed, reliable, or definitive studies about it, though.

In the world of genetic male pattern hair loss, the keyword is genetic. I suppose there are extraneous things you can do or take (anabolic steroids – a drug/hormone – not a supplement) to make the genetic trait worse or accelerate it. But in the end, even if you don’t do anything, but you have the genes for it, you will lose hair.

If taking creatine or glucosamine or other supplements worries you, then consider not taking them. Prioritize your goals. If you are taking these supplements to enhance your workout and gain muscle etc, nothing beats actually working out (an extra day per week or an extra 10 minutes in the gym is better than any supplements in my personal opinion).

If Every Male in My Family Lost Hair in Their 50s, Will I Follow Their Rate of Loss?

first i would like to say that i greatly appreciate your website and the time you put into it.

does the rate and age at which a male starts to bald corespond to the rate and age at which other men in their family start to bald? in other words, my dad and every guy on his side of the family and on my moms side of the family started going bald in their early 50s. does this mean that i will also start balding in my early 50s. also is it possible for me to start balding at the crown eventhough everyone in my family has never shown signs of baldness in that area?

i have been reading that scientists in britain have said that weightlifting can increase the rate of the male pattern baldness? is there any truth to this? do aerobic exercise reduce testosterone levels in your body?

thanks for your time

There is no way to be definitive in answering the question. Many people do follow their family patterns of hair loss. You may or may not. I do not believe that exercise increases hair loss unless you are taking exogenous steroids.


2008-11-17 13:48:56If Every Male in My Family Lost Hair in Their 50s, Will I Follow Their Rate of Loss?