Author: Dr. William Rassman

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2011 ISHRS Meeting Review, Part 5 – Finasteride

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 5. More to come…

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Does finasteride (Propecia) impact the body’s inflammation response in hair loss?

    Dr. Marty Sawaya produced evidence that there is a connection between genetic hair loss and inflammation of the hair follicle. She believes that DHT may have a direct impact on the inflammatory process. With this insight, other potential treatments for genetic hair loss and other hair and skin disease may evolve.

 
Are finasteride’s sexual side effects overstated?

    Despite internet complaints to the contrary, there are no case reports of sexual dysfunction that remained after finasteride was stopped in those patients who reported sexual side effects. The medical literature shows that sexual dysfunction is present in 40+ percent of men over age 50, so it was difficult to assess the 2% occurrence of sexual side effects in a comparable population. Despite this, changes in warning labels have been mandated in the United Kingdom, Sweden and most recently the US.

    One joke on the floor I overheard was that based upon the internet reports, the average 50 year old had a better than 40% risk of sexual side effects, but that reduced to only 2% for those reporting side effects from Propecia, making Propecia less risky for those side effects.

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2011 ISHRS Meeting Review, Part 6 – Finasteride

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 6. More to come…

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Does finasteride induce mood and other psychiatric changes?

    A case report and literature review showed a connection between finasteride and mood changes. In one case presented, a patient suffered from severe disabling mood changes on finasteride, which ceased within a week after stopping the medication. After a short time period he restarted finasteride, and the mood changes returned within a few days. Other cases were reviewed with similar problems. There is little doubt that in some patients, mood changes and other psychiatric problems appeared with the use of finasteride.

    I believe that these case reports are the exception to what we commonly see and that finasteride is generally safe, but if a patient feels that they have changes in their personality or mood since the drug was started or if a family member sees changes in their mental state, they should meet with their doctor to discuss the appropriateness of their continued use of the drug.

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21 Female with A Hair Loss Story

I (21F) have always had dense, silky straight hair. Around 2 years ago I noticed some sparser sections along my hairline, but I had pretty bad anxiety so I chalked up to that. About a year ago I went on BC (LoLo Fe) and noticed about 2 months after starting that my hair was starting to thin a lot. I could see parts of my scalp when I pulled my hair back that I couldn’t before, and my ponytail was close to half the size of what it had been (I previously could not see any scalp when my hair was wet, and now can see it along the sides and some on the top). I’ve recently gone off the pill, and noticed some sections of my hairline are growing back, but I still feel like I am losing a lot of hair. I read that going off BC can cause some short-term hair loss, so I am hoping this loss is just from the adjustment period. My question is, what can I do to best take care of my hair while it hopefully grows back? I’ve switched to a natural, sulfate free shampoo, and I do not use heat styling. I’ve also started eating healthier and oil massage my scalp occasionally. Are there any other steps I should be taking, like maybe switching to Nioxin or a different type of shampoo/conditioner? I was also wondering if I should continue to use a wide-tooth comb in the shower when I condition, as I was told it helps to spread the conditioner but it is also when I lose the most hair in the shower (wasn’t sure if this is too harsh on wet hair or not)

Birth Control pills can and often cause hair loss. The question to ask is it possible that you have genetic hair loss. Are any females in your family (mothers, grandmothers, aunts, sisters, have hair loss in any degree. If so, then you need to see an expert to see what you should do. (here are some of my posts on female hair loss which you might want to read: https://baldingblog.com/?s=female+hair+loss+blood+tests)


2020-09-15 16:16:3621 Female with A Hair Loss Story

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21 years old and just starting my hair loss treatment

So I went to a GP as I wanted to get a prescription for Finasteride. Of course the doctor had never heard of the drug and apparently he had never had anyone come to him about hair loss. He started reading about the drug online and asked if I had tried minoxidil. I told him that I have been on minoxidil for two weeks but I wanted to use both treatments together. He responded to this by telling me that I should only use one treatment at a time and that I would have to choose which one I wanted to use. I told him I’d choose Finasteride and he wrote me script for it. I’m still considering using the two treatments together as I can’t find anywhere that says there’s something wrong with using these two treatments together. Has anyone else heard of this before and do you think that I should still use Minoxidil and Finasteride together anyways?

Brief History: I’m a 21 year old male, started noticing my hairline receding 2 years ago, it has been receding very slowly ever since but my hair loss has progressed to the point where I need to stop it before it becomes too noticeable. No hair loss on the crown and all my hair is still very thick.

If you have a balding or thinning area already, using minoxidil on it in addition to finastetide is something I often recommend. I like to get a HAIRCHECK test on all of my patients to be able to measure the progression or the reversal of hair loss while you are under treatment.


2020-02-04 12:45:3921 years old and just starting my hair loss treatment

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2011 ISHRS Meeting Review, Part 7 – FUE Robot

ISHRS 2011

Note: The annual meeting of hair surgeons was in held in Alaska this past week. The following review is very selective and is biased by the things that were interesting to me and what I (Dr. Rassman) thought could be interesting to the readers.

This is part 7. More to come…

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Robot assisted hair transplantation was introduced for sale at the meeting.

    It had been approved by the FDA earlier this year. There was considerable excitement generated by doctors, however, the high price tag ($200,000 plus $1/graft) certainly dampened the enthusiasm. This meeting was a come out party for Restoration Robotics’ hair restoration robot, a very impressive modern technology. The company believes that hair transplants will follow other minimally invasive and more precise surgeries such at the robot assisted surgery for the prostate, the heart, the uterus, the lung, and on and on. The hair transplant robot is called Artas® system, and will clearly standardize the quality of FUE grafts and minimize the damage when used by surgeons who are not as skilled in the manual techniques as some of the more experienced surgeons; however, all three of the first surgeons to buy the robot are experienced in the field of FUE. Restoration Robotics wants only the best surgeons to purchase and use the system.

    One experienced hair surgeon, Dr. James Harris, has been testing the robot for some time for the company. Dr. Harris invented and marketed the most popular FUE harvesting tool (The SAFE System), which has been installed in over 200 hair transplant practices around the world. Although the two technique are comparable, Dr. Harris felt that the robot will minimize the tedium of doing the procedure for the doctor. I totally agree with him and I firmly believe that the new technologies like the robot will become the way of the future as FUE gains market share. The only question yet to be answered is “Who will pay for the higher costs of this procedure?“. As many of today’s hair transplant surgeons do not offer FUE, this opens the appeal for doctors to buy into the FUE technology to expand their service offerings. The unit is expensive, but should pay for itself easily in 4-7 years.

    The Artas® system will generate more interest in FUE and many newcomers in the field will start to offer manual FUE at discounted prices to kick-start their business. All FUE techniques and surgeons are not equal and new doctors without extensive experience are bound to create significant transection of FUE harvested grafts causing more than their fair share of hair transplant failures. Unfortunately, the average prospective patient who does not do their research may fall trap into the pricing competition. The results will be (1) high transection rates with graft kill, (2) failure or the hair transplant to grow in significant quantities, and (3) large scale destruction of the donor area hair (something that is never reversible). This, as I have said before, is a buyer beware business for the potential FUE candidates looking for a bargain.

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Balding Blog – 2014 – Hair Loss Information

We’re taking a few days off for the New Year holiday.

2015 marks the 10th year of Baldingblog with over 12,363 posts to date!
A special thanks goes out to all readers of this site with never ending hair loss questions.

We’ll be back in 2015!!!

Happy New Year

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21 and thinking about a hair transplant

i’m only 21 so i can’t really get a hair transplant until down the line. i got put on 2.5 mg minoxidil earlier this year and i passed on using fin. i’m fine with using this pill for the future because it hasn’t really affected my day to day life in any way and my health is fine, but i was just wondering if it’d even be worth getting a hair transplant down the line if my balding is genetic and it will keep slowly spreading, wouldn’t i have to get like several transplants over time?

I make my living doing hair transplants, but I almost never have done it on someone of your age. I wait until 25-6 before even considering it. Maybe the oral minoxidil will work and you will not bald. Give the drug a chance and stay on it.

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I am a 21 year old Asian, can I transplant my hair now? (photo)

What you need is to find a doctor who understands the progressive nature of genetic balding in men. With this much balding at 21, you may be heading for a Class 7 pattern but typically Asians do not have the donor supply to treat such a large area of balding if you should evolve into a Class 7 pattern. What you need is a Master Plan for your hair loss, not a hair transplant at this time. I have just received two emails from different doctors who reported that they had patients your age who reversed their hair loss completely with Minoxidil and Finasteride alone and no hair transplant. One of these two enails reported that his patinet had this reversal last since he was 21 years old, which is 15 years ago. Too many doctor will rush to transplant you because they make a lot of money doing it but they would be leaving you with an incomplete end result, so be careful. Try a combination of medications with the help of a good doctor.


2017-12-14 22:22:10I am a 21 year old Asian, can I transplant my hair now? (photo)

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Balding Blog – 2011 – Hair Loss Information

I’m very seriously considering starting a course of propecia/proscar. But before I began I wanted to ask two questions.

1. It has been said that if you start propecia early the better chance you have of slowing down/halting hair loss, but that doesn’t tally with the propecia chart from studies which show that it generally peters out after 3 years. so surely you’d only save your hair for 3 years and then it would quickly regress, not making much difference how early you start because you only have 3 years of good hair.

2. I was wondering if you could recommend a good dermatologist/hair doctor in London, who I could have a consulation with before I begin taking proscar, do you know any who do miniturisation tests or some kind of form of monitoring on hair loss? There are a lot of snake oil merchants in London that are willfully telling you that you must get on medication and I just want to talk to who is honest and experienced.

Block Quote

I have many patients that have reversed their crown loss and held the reversal over 10 years. Everyone is different, but the official studies show that the expected maintenance should be about 5 years on average. That means that some men get better than 5 years and some worse results while on the drug. It depends upon how aggressive your genes are.

As to your second question about London-based doctors, Dr. Bessam Farjo is a contributor to this site. He and his wife are terrific doctors and worthy of a trip to their offices (in London and Manchester). They may be able to give you a referral if you call their office.