I am 26 years old and had a hair transplant last week and my surgeon recommended that I take Propecia to prevent shock loss. I am afraid to do this because I heard that I won’t get erections on this drug. Is this true?
The risks of ED with finasteride is 3-4% while the risks for young men in their 20s for shock loss after a hair transplant is probably 90%. You should have been on the drug before your surgery. Now it is completely your call.
From Reddit: So, I recently did a AMA on hair transplant, answered many questions and reacted to several people’s stories. I want to make something clear to everybody interested in or planning a HT. Fin is mandatory. Unless you just want to correct a shitty natural hairline and have solid reasons to believe you have no MPB in your genes, finasteride is a must do. I mean, use common sense here: if you have receded from NW1 to NWX over the years, what do you think is going to happen over the next decade? Hairloss doesn’t just stop at 30, 40 or whatever. At best it slows down.
So, if you do a transplant, especially at young age as I did, and don’t prevent further loss you are at risk of being in a situation aesthetically far worse than just balding. You are literally at risk of getting thinning or bald spots behind your transplanted area. And you cannot work you way around it:
You cannot do surgery after surgery over the years to maintain a decent set of hair. I mean, you can… but this is totally sub-optimal. First, because you only have a certain amount of donor hair. At top density with no diffuse you have in between 9 000 and 10 000 donor grafts. That’s a a lot. But if your crown balds and get diffuse thinning all over (which is usually the case of people considering HT) this easily drops down by 50 or 60%. You cannot fully compensate it with body hair. Unless you are a gorilla you don’t have tons of body hairs and their regrowth rate is way poorer than actual hair (around 60% for chest hair). Second: because you would have to wait to get significant balding/thinning to perform another operation (see point below) so you would look stupid in the meantime. And third: it would cost you a fortune, especially if you are planning several op because you would want a top doc that would take extra care of your donor zone.
You cannot merge grafted hair into the native hair to give you some leeway in case hairline recedes further back. This is not how it works. Unless you have a severe lack a density you cannot plug follicles between the original ones. There is too much risk of damaging the latter, so no decent surgeon will agree to do that.
That being said, I think HT are great. I also think it is okay to have it young and potentially have several transplants if required, but imo that can only be done once you max-out the preventive treatments for hairloss.
I suggest the use of finasteride in most men who do hair transplants with us under the age of 35. That is when the hair loss is most at risk, more the younger you are. A condition called Shock Loss occurs after a hair transplant in younger men who find that they often lose a great deal of their miniaturized hairs after the transplant, thereby accelerating the loss factor. Finasteride usually prevent this from happening. Many men who refuse to take finasteride, have never tried it and assume that they will get sexual side effects, which of course if they believe that, they will. I also noted more recently that sexual side effects are more commonly reported, but I am not sure if that is because of the power or the market focus on sexual side effects and Post Finasteride syndrome which frightens many potential users away, or it is real. We may never know but in the first 10+ years of prescribing thousands of young men this drug in my practice when the drug was introduced (prior to the introduction of PFS as a potential syndrome in 2011), the incidence of sexual side effects were consistent with the Merck study of between 2-4% in my practice from 1997-2010. That experience has been echoed by many of my colleagues.
2020-01-03 02:24:502020-01-02 10:26:36Must I take finasteride if I have a hair transplant?
Hi Doc, I have a buring question, I am a 29 year old Asian made with very thick black and have very good hair coverage, my question is when i comb my hair I see thick black hair that come out approx 10-15 not what you would describe as minutrized hair. Must hairs be minutrized when they fall out as mine seem very strange becase they appear to be very health ‘normal’ hair?
Thanks doc
I do not believe that hair must be miniaturized to be lost hairs in the balding patterns. Miniaturization does point to a problem, though, for as the DHT attacks the hair, the impact suppresses the hair growth to normal circumference (hence “miniaturized”). As the balding process probably reflects the number of cycles of a hair in any given location, a hair will only live out the number of cycles it is destined to live (for example, hair in the front might have 10 cycles in your lifetime of 3 years each). The hairs around the head usually will outlive you, while the hairs in the front for a Norwood Class 4A (see image at right) balder may last only 7-12 cycles, on average.
2009-09-18 12:36:332009-09-17 08:56:12Must Hair Be Miniaturized Before Falling Out?
Does 1mg of Finasteride per day have any adverse effects on muscle growth in a natural bodybuilder mid 40s :~)
Nope, there aren’t adverse effects on muscle growth with finasteride (Propecia). Some people assume blocking DHT (which is what finasteride does) will cause you to develop feminine qualities, and others believe that finasteride will increase muscle mass; both of these are also false.
I have had multiple surgeries and my hair has thinned considerably. I am 24 years old and am taking birth control pills. My doctor told me to take Rogaine, but I continue to have a very see through hair.
Female genetic loss can be accelerated and presented as thinning hair with any stress and surgery is such a stress. We have cosmetically treated such women with Scalp Micropigmentation, two of the women in my family have had it done. See here: https://scalpmicropigmentation.com/smp-for-women/
Also, I have attached a photo of a woman with black hair who has scalp micropigmentation done to address her thinning hair
2017-02-10 07:27:192017-02-10 07:27:19I have had multiple surgeries and my hair has thinned considerably
(female)
I have noticed that my hair is breaking off. There are several pieces of hair that are only two inches long on the top of my head. I color my hair to cover the gray, but I am also on several medications. I was diagnosed with MS in 2003. Do you have any thoughts on what could be causing this?
Thank you.
Look at the medications that you are using for the cause of your hair loss. Some medications used in treatment of multiple sclerosis (like mitoxantrone) can cause mild hair loss. Speak with your doctor about them.
I just visited a doctor who took me into a surgery and showed me nails in the head of a patient. He said that these kept the wounds open and makes the graft placement easier and produced less damage to the skin and hair. He also told me that he used a multibladed knife to harvest the grafts. I thought I read somewhere that these instruments cause damage. Can you explain what I am being told?
These nails that you are describing are something that was invented by Dr. Manny Marritt in the mid-eighties to make the placement of smaller grafts easier. Within a year, he abandoned the use of these dilators as his staff built the skills to not need them anymore. He concluded that these dilators did not have great value to anyone other than the novice. I did try them early on in my practice, but I quickly abandoned their use within a month. For more information on dilators, including a photo of what they look like, please see this dilators page.
After I designed the 2 bladed knife with the offset of 30 degrees, I built a multi-bladed knife with variable settings to it. I eventually found that when I used the final design on the first 9 patients, the results were decent (I estimated the loss at about 15%). Then on the 10th patient, I had a follicular holocaust with a loss factor of 70%. Fortunately, on these first 10 patients, I only used it on a limited area, but the high transection rate on this 10th patient said to me that inconsistency was going to be the problem. If I could do it 9 times right and then 1 time wrong, the technique was flawed.
This clinical research was done by me in 1992-1993 when cutting was a manpower problem that I eventually solved with a larger and better trained staff. The multi-bladed knife was the wrong answer to this problem and that is my final opinion on the subject. With multi-bladed knives, the labor that the doctor saves does not offset the hair that is killed off. I believe anyone who uses such instruments today are subject to the same type of variables.
In a single hair pull like you are discussing, the hair usually returns within 6 months. However, a few reports indicated that it did not return, so then a hair transplant is the solution.
I have reported this here before on BaldingBlog: https://baldingblog.com/?s=hair+pulled+out&x=0&y=0
Red meat does not contribute to hair loss
2019-03-02 05:55:142019-01-02 12:55:31How much does red meat contribute to hair loss?
