Author: Dr. William Rassman

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Hair Loss InformationWould 0.25mg Finasteride Be More Effective than Saw Palmetto? – Hair Loss Information – Balding Blog

Hi Doc,

I’m a 26 year old male with a fairly aggresive NW4 developing, and need to do something to stabilize this before going for a HT next year.

I’ve grown pretty scared of finasteride side effects through the experience of a good friend who unfortunately suffered some of the psychological sides we’ve all been reading about online.

Question is, would a 1/4 dose (0.25mg) finasteride still be more effective for someone in my position than the full (320mg) recommended dose of saw palmetto? I’ve tried the latter before with no side effects, but didn’t stay on it long enough to evaluate the results.

Thanks doc and keep up the excellent work!

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Propecia is finasteride in 1mg strength that you take daily for genetic male pattern (androgenic) hair loss. It’s been indicated that 0.5 mg finasteride daily is about 70 to 80% as effective as the full 1mg dose. I suppose you can infer how a 0.25mg dose may help. But in general if you are going to take a drug, you should take it as directed and speak with your doctor about all these issues. With saw palmetto, you really do not know the dose of the effective ingredients as they vary per manufacturer. Add to that the knowledge that saw palmetto has never been proven to work on hair reliably with a good scientific study.

My final point is that if you are going to read the issues of Propecia on the Internet and scare yourself with unsubstantiated reports without even seeing a doctor, the chances are you will likely have a side effect from the sheer psychological impact.

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Hair Loss InformationI Don’t Know If My Hair Loss is Genetics or Chemical Burn from Relaxers – Hair Loss Information – Balding Blog

Dear Dr. Rassman,
I am 28 yrs old have been suffering from hair loss since I was about 22 years of age. I am about a norwood 3 right now. I had chemically relaxed my hair once when I was 18 and a second time when I was about 21, while suffering a minor burn from my second treatment. I have taken the hair DX test and I have been told that I have a moderate predisposition to male pattern baldness. Can my hair loss be due to a combination of both factors?

If it were solely due to the chemical relaxers, would I have lost my hair when the injury occurred and wouldn’t my hair loss be more diffuse? If it is due to the insult by chemical straightening, would the hair/hair follicles show the same progression of hair loss as if it were male pattern baldness? I can’t change the past, but I would just like to know if my chemical relaxer treatments have led to this.

Thank You

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You have a complex story and it would likely require a complex examination. Without seeing you and examining you, I can not tell you the cause of your hair loss or what you can do about it. The HairDX test can tell you if you’ve got the genetic markers, but it won’t tell you if or when you’ll see those genes expressed.

See a good hair transplant doctor who cares about your welfare and then you will know more than you know now.

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Hair Loss InformationBilateral Varicocele and Propecia – Hair Loss Information – Balding Blog

Yes, another Propecia question for you. Sorry :) I am 37 and have a bi-lateral varocele, grade 2 on the left and grade 1 on the right. If I started on propecia, could its side effects be more potent or affect my condition? From what I remember, the Merck studies did not get into the issue of results or drawbacks of people with Varocle.

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This is a question you must ask the doctor who is following your problem. There is no obvious answer, other than you cannot just correlate any medical issue with a side effect. I am not a urologist nor do I treat varicoceles, so I am probably not the one to answer the question.

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Hair Loss InformationCaution for Balding Sufferers – Be Careful What You Wish For – Hair Loss Information – Balding Blog

The following post is by UK-based physician Dr. Bessam Farjo:


Written by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

While I have discussed my reservations in previous blogs with regards to younger men undergoing hair transplant surgery, I felt that the most effective way to raise my concerns is by offering examples of cases I’ve dealt with in the past.

I’ve been liaising with a patient for several years who first came to me at the age of 19. After a couple of consultations at our practice, we advised him that he should try a course of Finasteride or Propecia before surgery. The patient went away and, after a couple of years, returned to the practice having undergone extensive scalp reduction surgery in Europe.

Scalp reduction surgery is a surgical hair restoration procedure that surgically removes bald scalp and stretches hair-bearing scalp upward and across to replace bald scalp that has been removed. While this is considered an effective treatment for sufferers of hair loss especially in the past, it was not the appropriate surgery option for this patient at the time.

He was 21 when he came back to our practice and had since suffered further hair loss. Once again, we advised he was still too young to undergo more surgery as the full extent of his hair loss was still unknown at such a young age. Against our advice, the patient had a further two hair transplant procedures at another clinic which he was unhappy about. He is now 24 and we’re still in regular contact as his hair loss has severely affected his confidence and self-esteem.

While we’re working with him to try and rectify his situation, it’s imperative that potential patients are educated correctly on the future consequences that may result from premature surgery as well as the, potentially irreversible, damage that can be done.


The second case is a patient who came to the Farjo Medical Centre less than a year ago. At age 25, he was again advised that perhaps he should first consider medication before undergoing surgery. It turns out that he wasn’t happy with our advice and we have since received angry correspondence from the gentleman who informed us that he went ahead with surgery in another country. Interestingly, he says he is very pleased with the result after only 3 months.

While I’m sure his surgery went well, my concerns lie with what the future holds for him and his hairline. At 25 it’s still too early to say how far his hair loss will go, he may need subsequent operations and treatment which, if achievable, will come at a significant cost. There may also be issues with his donor area and whether or not he has enough hair to undergo further procedures in the future.

Taking these two cases into consideration, I do hope those younger people reading this blog see the downfalls in rushing into undergoing surgery at such an early stage. If, like the first patient, you feel that your hair loss is severely affecting your self-esteem, there is comfort in controlling further hair loss first and there are people out there who can help. Visit your local ethical hair loss centre, your GP or family doctor or go online for support forums such as the Hair Transplant Network, Bald Truth, Hairloss Experiences and others.

I really can’t stress enough how important it is for the younger generation who are losing their hair to think about the future and how surgery may affect them in the years to come.

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Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

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Hair Loss InformationBest Topical Cover for Female Hair Loss? – Hair Loss Information – Balding Blog

I am 30 yr old female and have been experiencing frontal hair loss. What is the best way to hide the scalp? – toppik, easibang, anything else? Does toppik have any side effects or does it damage hair/scalp?

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Many people use Toppik, as it has no side effects. There are a variety of topical camouflaging agents that work well, but some people will try out a few and stick with their personal preference.

You should get a diagnosis and be examined by a competent doctor who does this type of work. You may be a good candidate for a hair transplant if the hair loss is only frontal. Women are usually not the best hair transplant candidates, but seeing a good hair transplant surgeon for a consultation would be the best way to figure it out.

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Hair Loss InformationCan My Hair Just Thin and Never Go Completely Bald? – Hair Loss Information – Balding Blog

Is it possible to thin out over the top of the head without ever going completely bald in that same area? Will a NW6 difuse thinning pattern always lead to a fully bald NW6?

I suppose what I’m asking is can hairs stop miniaturising once they’ve started without medication OR can a good proportion of hairs remain healthy even in an area where there are also miniaturised hairs?

Thanks.

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Norwood 6With medication, residual hair may remain in an obvious pattern like a Norwood class 6 pattern. For those not on medications, sooner or later the pattern will advance, but the fringe area may remain.

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Hair Loss InformationI’m In My 40s – Am I Too Old for Finasteride to Help My Recent Hair Loss? – Hair Loss Information – Balding Blog

Hi Doctor, I am 47 yrs old and my hair started thinning a bit at the crown 2 or 3 years back. I started using minoxidil a couple of years back and it seems to have slowed things down a bit.

I was thinking of using finasteride as well but am wondering am i too old for fin? Also i am not that hairy, with very little chest, arms, legs and general body hair so would that mean that my dht levels are low anyway? My father’s hair started to thin in his 40s and he is now in his 70s and still has most of his hair, just thin around the crown with no bald spot. Thanks

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Finasteride works best on people with recent hair loss, especially in the top and crown. You are not too old and I would consider this as an addition to the minoxidil you are presently using. Talk to your doctor.

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Hair Loss InformationPatient Results – Say Goodbye to the Old Plugs (with Photos) – Hair Loss Information – Balding Blog

This patient has dark hair and white skin, and visited our office to repair his hairline. He had the old pluggy hair transplants that were common in the 1980s and 90s. He’s a Norwood class 6 pattern with slightly wavy, fine hair.

The repair took 2 procedures totaling 3401 grafts. These pictures show the entire story of building a frontal transition zone in front of the old plugs to camouflage and hide the deformities. He is very grateful that he now has a natural looking hairline, recently stopping by to say hello and show me the results of his repair. Click the photos to enlarge.

Before on left / After hairline repair on right:

 

More photos:

Left– Another angle before repair / Center– 8 months after 1st session / Right– Less than 4 months after 2nd session:

 

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Hair Loss InformationI Want a Scar Revision After 5 Hair Transplants – Hair Loss Information – Balding Blog

I have had 5 hair transplants. All were done by way of the strip method and I am very pleased with the ultimate outcome. However, the linear scar from my 4th surgery is horrible. It is very wide and red. The scars from my prior surgeries and the one subsequent surgery look fine. Because of concerns about elasticity issues, between the 4th and 5th HT I did scalp exercises to improve the donor elasticity which I found on Youtube. My Doctor said that the elasticity between my 4th and 5th surgeries was greatly improved and attributed it to these exercises. With this improvement, I am considering a scar revision with the hopes that the scar from my 4th surgery can turn out like the one from my 5th surgery. Is this realistic?

Lastly, in general would you recommend a plastic surgeon for the scar revision or a hair transplant Doctor? I traveled some distance to have my last hair transplant and don’t plan on making this trip again for a scar revision so I would look for local Doctor to do this procedure.
Thank you for your time

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Scar revisions in the hands of an experienced surgeon that deals with hair transplant scar issues on a regular basis is generally better than a plastic surgeon for this type of work. Experience is everything in this process. I don’t know what is realistic to expect, as each case is unique and I haven’t seen you.

If you want to find a doctor in your area, I’d suggest using the physician search at ISHRS.org.

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Can Stopping Proscar Bring on Side Effects? – Hair Loss Information – Balding Blog

I have been taking proscar for hair loss for about 12 years and recently read a disturbing article in Mens Health regarding side effects. Has new long term evidence emerged that shows greater risks? Can stopping the use of Proscar actually bring on side effects?

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We are being overwhelmed with negative information that is out of proportion to the reality of the actual numbers of side effect and the statistics that go with that information. Are you willing to take the chance on reversing the hair benefits that stopping the medication will bring about? Any benefits, even reduced prostate problems, will reverse if you stop the medication.