Month: January 2023

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My Wife Won’t Let Me Start Finasteride

So I went to the dermatologist after my barber noticed a bald spot on my crown. He didn’t seem to really care (as he was bald) but he wrote me a prescription for finasteride and minoxidil. However, my wife and I are about to have our first child and we want to have another one. She’s taking a strong stance on me not starting finasteride until we have our second kid. She’s worried about fertility. Is it worth starting on minoxidil then getting on finasteride in a couple years? I’m worried I won’t stick to minoxidil twice a day since I work shifts so it makes it really tough to apply.

You can use minoxidil once a day at night after a hot shower and leave it on until morning. That works and it is less of a headache.


2019-02-14 06:39:14My Wife Won’t Let Me Start Finasteride

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Wierd SMP

When I see an SMP like this, I must assume that this man wanted this look and found someone to do it for him because I can’t imagine any professional would do this voluntarily. I wouldn’t do it if I were asked, not for any money!


2021-10-05 09:55:14Wierd SMP

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Widow’s peak

Had a question about my hairline and widows peak. My mom has three brothers. Two have normal straight hairlines and one has a widows peak. My mom also has a widows peak. Her other sister does not. My moms mom does not have a widows peak but my moms dad does.

On the opposite side my dad or grandfather does not have a widows peak. My moms brother who has a widows peak has a good hairline for 60. Much like my moms father up until he passed away at 40. Is it safe to say im following there pattern for hair given my widows peak?

The widow’s peak is a remnant of the juvenile’s hairline which means that the hair around it (when you were a child) disappeared leaving the point called the Widow’s peak. I would suspect that you might follow this pattern as well

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Why wouldn’t everyone just choose FUT instead of FUE?

FUT is cheaper and has better yield. Why does everyone care about the scar when you have hair? If you want the option to shave your head why get a transplant? Ok surgery recovery time is a small factor…
FUE and FUT are equal quality today. That may not have been true years ago, but today the tools are so good that FUE in the right hands produces quality grafts. The advantage of FUE over FUT is (1) less pain, (2) no linear scar, (3) full activity after within 5 days with no limitations. FUT advantages (1) no shave of the back of the head, (2) long hair covers the donor area so you can go to work the next day as long as the doctor doesn’t shave the recipient area, (3) better for advanced balding patterns as large graft removal never produces a see-through donor area if it is done understanding the limitation of the donor supply.


2019-12-02 15:56:26Why wouldn’t everyone just choose FUT instead of FUE?

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Why Would Shock Loss Cause Permanent Hair Loss?

Why does the hair that you lose from shock loss not regrow? I asked my dermatologist about my shock loss and he said he expects that the hair will grow back and that it would be unlikely that the scalp would just stop working and stop growing hair because of the surgery.

Nobody really knows for sure. Shock loss in a man with genetic hair loss often just accelerates the hair loss process. In women, a telogen (sleep) phase occurs and the hair almost always grows back. In men, it is thought that hair lost from “shock” after a hair transplant surgery is mainly the weaker miniaturized hairs that were already predestined to fall out as part of the male pattern balding. The “shock” from the surgery would cause these hairs to fall out earlier than normal just as any stressful event (even an appendectomy). Thus Propecia (finasteride 1mg) has a protective effect on preventing some hair loss from “shock” loss in miniaturized hairs. This is the reason why younger men who are actively losing lots of hair are at an increased risk for shock loss and must use finasteride to protect themselves from the awful complication.


2007-09-24 14:36:03Why Would Shock Loss Cause Permanent Hair Loss?

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Why Was I Born with a Bald Spot?

Hi,
I am a 28 year old woman that was born with a bald spot in the middle of the back of my head. Do you know what may have caused this? And do you know how I may be able to fix this? I never wear my hair down because of it and it’d be nice to. Thanks!

I really couldn’t tell you why you have a bald spot on the back of your head. The bald spot may just be a birthmark or it could have been a result of trauma when you were a baby. I do not know. If you want to address or fix the bald spot, you can consider a hair transplant.


2008-01-23 12:15:49Why Was I Born with a Bald Spot?

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Why Was I Born With a Bald Spot That Won’t Regrow Hair?

Ive had a bald patch on the left side of my head since birth. It has decreased in size over the years but my doctor has said it will never fully grow hair. I was wondering what caused this and what other alternatives there are.

I cannot tell you why you have a bald patch that you were born with, but think of it like a birth mark. It is what it is.

In most cases, the easy solution to this is with a small hair transplant to the area.

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Why So Pessimistic About Ketoconazole?

Dr. Rassman,

I enjoy reading your blog, and nearly always agree with you, but I do feel you are a bit to pessimistic about ketoconazole. In another response to another member you dismissed of a Japanese, justifiably I suppose, because of the small sample size. (Have you seen the pictures of the impressive regrowth seen in three of the six patients? They shows an obvious reversal of AGA.)

What about this controlled study: “Comparative efficacy of various treatment regimens for androgenetic alopecia in men”

In this study men were divided into four groups: “Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.”

I don’t believe this has been mentioned on your blog before, and the results are exactly as most men would expect them to be:

Finasteride + Minoxidil > Finasteride + Ketoconazole > Finasteride Alone > Minoxidil Alone after one year.

I’m sure, like every study, this one also has it’s flaws, but together with all the other research — from Piérard-Franchimont C (1998) to Rajput RJ. (2010) — I’d say that the evidence for the efficacy of ketoconazole in AGA is highly suggestive. It’s certainly much stronger than for the majority of the things men try outside of finasteride/dutasteride and minoxidil.

And we know that all anazoles are somewhat antiandrogenic, but only ketoconazole will compete for the AR, and is used in androgen modulated prostate cancer.

How can you be so pessimistic about it in light of the totality of the evidence? Do you believe it to be dangerous?

I am not pessimistic about ketoconazole. Our job on this site is to educate you, the reader, on the realities of such claims and treatments and warn you if there is danger in using such “stuff”. While I don’t see ketoconazole (better known as Nizoral) as dangerous, it has yet to be proven to my satisfaction that it’s a treatment for hair loss. I’ve always maintained that Nizoral is a good shampoo for treating dandruff and fungal infections.

What I have always maintained is that nothing stops a genetic trait. There are drugs that slow it down and there may be other remedies that also work, but my mantra has always been “buyer beware”. The small study you referenced is indeed suggestive of positive benefits, and if the readers out there want to try it, I think that is their choice to make. But keep in mind that while the 1% ketoconazole is available as an over-the-counter shampoo, 2% ketoconazole (as used in that small study) is a prescription medication and as such, you need a physician to oversee the treatment. Side effects include burning and itching sensations.

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You asked me to raise my eyebrows for a photo, why?

Raising the eyebrows gets the forehead to wrinkle and this shows the anatomy of the muscles under the skin. The distances between the Glabella (the bridge of the nose) and the highest wrinkle on the forehead tells me a great deal when measuring the leading edge of the hairline. A normal mature hairline is usually one finger breadth distance between the highest wrinkle and the midline hairline. A picture of your entire face allows me to judge general proportions, chin to nose, nose to Glabella and Glabella to hairline. Michaelangelo in his status of David, put the proportions of these distances 1/3rd, 1/3rd, and 1/3rd however most normal people find that the distance between the chin and the tip of the nose is equal to the distance between the Glabella and the leading edge of the midline hairline.