Author: Dr. William Rassman

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My Friend Found Anti-Propecia Articles Online, But I’ve Had No Side Effects – Hair Loss Information – Balding Blog

Dr. Rassman,

I have been taking Propecia for 2 years with some positive results. One of my friends, who is also losing his hair, commented on my progress and asked what my secret was. I told him about Propecia, a drug which he has surprisingly never heard about, and he did some research online. A few days later when I spoke with him again, he came across countless articles and webpages stating how dangerous the drug is, cursing my name for even suggesting he take it. He showed me one article in particular that indicated that Finasteride inhibits crucial neurosteroids such as allopregnanolone, and many people online concluded that finasteride can likely cause serious neurological problems down the road. Have you seen this article, and are you able to comment on the validity of these types of conclusions?

I have not experienced any side effects thus far, but I want to ensure I am not setting myself up for disaster down the road. After all, I trust the word of a doctor over a thousand know-it-all’s who post in message boards!

Thank you kindly for your time

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Your personal story is like the thousands of men I treat with Propecia (finasteride), including my own son. The internet does tend to blow information out of proportion at times, and Propecia seems to have polarized many balding young men.

I’ve written much about this medication on this blog, so the search box at the top might have what you’re looking for. As for your friend, if you’re not experiencing any negative effects and have seen positive results, I don’t know what more he might be looking for. It’s a prescription drug and completely elective. If he has hair loss and wants to take it (or just wants more info), he should talk to his doctor.

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How Could Transplanting New Grafts Cause Existing Hairs to Fall Out? – Hair Loss Information – Balding Blog

Hi Doc..

When restoring the frontal hairline that’s thinning, by implanting hair in with existing hairs to create fullness I can’t see how the trauma to the area could not create loss to existing hairs. How off am I? Because that would be extremely frustrating.

Thanks

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Existing miniaturized hairs are more fragile and we do see shock loss in young men following a hair transplant. Finasteride seems to protect the patient from this. If your question reflects the mechanical damage that can be produced by making recipient sites in the frontal hairline, this can be avoided by a surgeon who is careful as he/she does the transplant.

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Hair Loss InformationPatient Result – 1 Year After Rogaine Foam and 0.25mg Finasteride (with Photos) – Hair Loss Information – Balding Blog

This post comes from Dr. William Parsley in Louisville, KY:

Just saw this fellow (around 50 yrs old) today for follow up. I placed him on 1/4 tab of Propecia QD (0.25mg) along with Rogaine Foam BID a year ago. Attached are his results. Don’t know if he would have had a much better result with a higher dose. The appeal of a very low dose got him to give it a try, as he wasn’t excited about using it for worries about side effects. He had no side effects fortunately.

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Click the photos below to enlarge:

After (1 year of 0.25mg finasteride and Rogaine Foam):

 

Before:

 

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Hair Loss InformationI Had My Old Punch Grafts Removed and Re-implanted, But Now I’m Low on Donor Hair – Hair Loss Information – Balding Blog

I had my first hair transplant in the mid 1980’s with punch grafts and over the years i have had micro grafts and more recently single grafts taken from strips. the old punch grafts were removed and then re-implanted via single grafts. My hairline looks pretty good but i am now losing a lot of hair on my crown but have very little donor hair left do i have any options?

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Donor hair is finite and many people in your situation have depleted donor supplies with significant donor area scarring. More surgeries will often make the scarring worse. I see people like you all of the time and lately I have been seeing more of them. Everyone is different and an individual assessment based upon remaining donor supply, donor area scarring, the existence of old “plug grafts”, hair color (graying is good), and hair characteristics all must be considered in the equation on what to do.

I could write a book on this, but this is not the place. I would suggest that you find a hair transplant surgeon with a lot of experience in repairs.

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I’m Worried I Ruined My Transplanted Hairline Right After My Surgery! – Hair Loss Information – Balding Blog

I just had a hair transplant procedure performed on 12-06-11. I was given one of those surgical caps to wear on my head to help shield my scalp, but my scalp was still bleeding a little. I went to sleep with the cap on and woke up the next day trying to remove the cap. I could not remove the front part of the cap because the blood had dried up and become stuck to some of the areas where the grafts had been put in. I tried pulling gently on the cap that was stuck to the area where some of my grafts where placed and managed to pull it off but it came off with a good amount of scab and what I believe to be a single hair follicle.

Now I am worried that I ruined my hair line and the surgeon may not be able to do anything about it. Is it possible to have another hair follicle out in to replace the one that i accidently removed?

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A surgical cap should never be worn to cover the grafts, for as you said, this could be a problem.

You should ask your doctor about the loss of grafts. If you only lost one graft, then consider yourself lucky.

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Hair Loss InformationImportance of Scalp Laxity, FUT Scar Concern, FUE Drawbacks – Hair Loss Information – Balding Blog

Hi Doctor Rassman,

I have a few questions concerning transplants.

— How big of an issue is scalp laxity? I.e., do you often have patients who still possess donor hair, but who are unable to have FUT a 2nd/3rd/4th time because their scalp has become too tight? Should this be a concern in planning for the future?

— You’ve said that one of the drawbacks of FUE is that it can waste precious donor hair (i.e. some hair doesn’t survive the transplant procedure?) — just how much hair might be “wasted” by going with FUE rather than FUT?

— Why are some readers so concerned about FUT scars? In most of the photos I’ve seen, the scar is a very thin hairless line — not a repulsive, gnarled mass or anything like that. Even if one cropped one’s hair short so that the scar were visible, what’s the big deal?

Thank you so much for taking the time to do this blog.

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Scalp laxity become tighter after successive procedure, but this is not usual. The use of scalp exercises solves the problem. It sometimes takes 30 minutes/day for 3 months to adequately address the scalp laxity.

In our original article when we introduced the FUE technique a decade ago, we reported a situation where patients differed with transection rates. We believe that if you assume that the surgeon does FUE perfectly, that some percentage of patients will have unacceptably high transection rates. Although this has become less of a problem as we perfected our FUE skills, it is still present in about 10% of patients. It will be interesting to see if the ARTAS robot can impact these problems in those patients. As Dr. Robert Bernstein (co-author on the original FUE article) just got an ARTAS robot, it will be interesting to see if he experiences the 10% patient problems with transection. FUT should produce less than 5% damage in the hands of a good surgeon.

FUT scars are, as you said, not a problem in 95% of patients on the first procedure. Rarely can you see the scar when the hair is kept long. Even after a second procedure the incidence of scarring is not high either, but if it can be seen, it is only seen if the hair is cut very short or if one lifts the hair to examine it. I would ask, even if the scar is visible, how many times would a person with such a scar that is hidden with longer hair (1 inch in length) gets stopped on the street and asked about it.

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Hair Loss InformationSoccer Star Wayne Rooney’s Transplant Looking Thin Already? – Hair Loss Information – Balding Blog

Wayne Rooneyjust saw this article online about Wayne Rooney’s hair. Seems like it is thinning on top, what are your views?

Link: Time to ask for a refund? Wayne Rooney’s hair appears to be thinning… just months after £30,000 transplant

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The UK press is sure being hard on this guy. It takes around 8 months to see even 80% of the results of a hair transplant. I don’t think enough time has passed to see the final result here.

Loss of the original frontal hair is not uncommon with a transplant if a person is not on finasteride. I suspect that he does not take finasteride, because it is a drug that is detected when screening professional athletes. Many organizations ban finasteride since it can be used to mask steroid use. Because of this, he may not get his ideal result until perhaps after a second hair transplant, which would address the loss of native hair caused by the first hair transplant.

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Hair Loss InformationDoes Diffuse Loss Eventually Stop? – Hair Loss Information – Balding Blog

Hi. I wonder if diffuse thinning stops or if you’re losing it diffusely, are you’re sure to end up a NW 5/6? I mean some people’s hair loss stabilize at one certain point like NW3 (like my dad who’s been a NW3 for about 20 years). But if you’re a diffuser, does the same thing happen?

Thanks.

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You need to be examined by someone with competence in genetic hair loss and who can predict the hair loss based upon miniaturization and bulk analysis. Without an examination, I couldn’t say one way or the other if your diffuse loss would cause you to finalize to a Norwood 5 or 6 pattern.

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I Can’t Take Propecia Because of the Sexual Side Effects – Hair Loss Information – Balding Blog

I can’t take Propecia because of the sexual side effects and after I visited your office, the news as to where my balding might be going (as you said the worst case) could be a Class 6 pattern. I already had two hair transplants and I have a scar on the back of my head so I can not even shave my head. I am 21 years old now, so I get depressed when I think that I am going down the toilet with my hair problems. I don’t want to give up my girlfriend as sex is important to us and the Propecia stopped that cold. What can I do?

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Norwood 6There are no easy answers. Your examination in the office showed that you have already lost 61% of the hair in the crown, 26% of the hair on the top, and 32% of the hair in the front. With my naked eye and your blond hair color, one can’t really make out the balding at this time. The crown is fast approaching the point where the balding can be detected in bright light. You are lucky, because if you had dark brown or black hair, the hair loss in the crown would be very evident, but in blond men, the loss may approach 90% with average weight hair before it would show.

If you can not take finasteride because of the sexual side effects, these numbers suggest that you may eventually end up with a Class 6 pattern (worst case). At 21 years old, you have a lot of balding that may show up as you go through your 20s. If you want to shave your head, you might want to consider Scalp MicroPigmentation (SMP), and provided that the area pigmented was in the distribution of your existing hair, you would have the option to keep it long and/or shave it. We can discuss this option at your convenience.

There is no substitute for Propecia (finasteride) on the market. You might get some benefit by taking 25% of the therapeutic dose (0.25 mg) and this might allow you to get some of the benefits of this drug without the sexual side-effects. Young men (20 years old) who start the transplant process without a good Master Plan and have side effects from finasteride, probably should not have started the transplant process at all, as there may not be enough donor hair to complete the process. Your first transplant doctor should have discussed these issues with you before you started this process. Fortunately, there is the SMP option if you get caught between a rock and a hard place.