I went to the dermatologist to talk about my hairloss. Due to the how fast I lost my hair (almost 70% density in a year), the doctor did a hair biopsy and apparently the results show Alopecia Areata. I have been going back to the dermatologist once a month for the past 2 months for cortisone shots and have not seen any results. I am a bit skeptical about the Alopecia Areata diagnosis, mainly because their is typically a circular bald pattern associated with it and my hairloss isn’t like that.

The picture you show of the back of your scalp is typical of alopecia areata; however, the quality is poor and out of focus. With good photos, one should see on close examination Exclamation Mark hairs in and around the hair loss areas. This is sometimes a difficult problem to reverse. Because the quality of the photos are so poor, Don’t hang your hat on the diagnosis I gave you above until you either send me better photos or see a dermatologist

I have been transplanted twice. Both times, this bald spot, which was transplanted, didn’t seem to take the grafts and grow out like the rest of the hair.

You most likely have Alopecia Areata. This condition will cause the hair to fail to grow in an active area of the disease. I recommend that you see a dermatologist. He will look at it via microscopic examination and possibly find ‘exclamation hairs’. He will also perform a biopsy to confirm the diagnosis. This is a critical step for you because this disease can get worse.

An Article published in the British Medical Journal in September 2016, based upon “two populations of men free of risk factors for erectile dysfunction and other sexual dysfunction or its treatment: men aged 40 or more with benign prostatic hyperplasia who received a prescription for a 5-alpha reductase inhibitor (finasteride or dutasteride) or alpha blocker, or both, and men aged 18-59 with alopecia”, suggests : “The incidence rate of erectile dysfunction was lowest among users of 5-alpha reductase inhibitors only (15.3 per 1000 person years, 95% confidence interval 14.3 to 16.5), and similar among users of 5-alpha reductase inhibitors+alpha blockers (19.2 per 1000 person years, 17.4 to 21.1) and alpha blockers only (20.1 per 1000 person years, 19.6 to 20.7). Compared with users of alpha blockers only, the adjusted incidence rate ratios for users of 5-? reductase inhibitors only and 5-alpha reductase inhibitors+alpha blockers were 0.92 (95% confidence interval 0.85 to 0.99) and 1.09 (0.99 to 1.21), respectively.” Of further note: “cases of erectile dysfunction were more likely than matched controls to be overweight or obese (as measured by body mass index) or to have a diagnosis of non-erectile dysfunction sexual dysfunction, hypertension, diabetes, hyperlipidemia, depression, orchitis, or alcohol misuse before the index date.” Of course, this study was done in an older population that is prone to Erectile Dysfunction

https://www.bmj.com/content/354/bmj.i4823#:~:text=The%20risk%20of%20erectile%20dysfunction%20increased%20with%20increasing%20number%20of,odds%20ratios%20were%20statistically%20significant

Comment: The risks of ED rises with age, so the groups tested were clearly at a higher risk of ED than younger men. The statistics reported by this article suggest that in this higher-risk population, the risk of ED was 1.3%, less than was reported in the original Merck study or in the Propecia ED risk factors brochures. I am wondering why so many younger men are reporting ED, considering the above statistics?

The best and only way to repair this donor area is with Scalp Micropigmentation, which makes it look like you have hair where there is none. This technique does not add hair, but will accomplish the goal of scar coverage and camouflage. These photos suggest that you had too many grafts removed by the FUE based upon your donor density. The hair that was harvested exceeded the areas of “safe” donor hair that is considered permanent. Considering that you received 5,000 grafts, very few people can support this magnitude of harvesting without donor depletion. This problem was 100% predictable. Your surgeon should have known better and told you to expect this type of balding in the donor area, unless your surgeon was greedy about making money from you or just plain ignorant.

My idea is to use topical once every other day and and oral every other day as well, like

Monday : topical

Tuesday : 2.5mg oral

Wednesday : topical

and so on…

I’m using topical min since 1.5 years now and would like to add oral min to increase effectiveness. It’s also getting really tiring to apply the topical everyday. Topical min was really good for me but I feel like it lost its efficiency. I’m also on 1mg finasteride for 2 months.

This makes no sense to me. If you are on the oral minoxidil, stay on it and forget the topical. You don’t want to overdose this medication because of heart side effects.

These photos were sent to me by Dr. Richard Burgmeier in Arizona who had a patient with Alopecia Totalis that failed to respond to treatment for many years. Dr. Burgmeier said:

“The patient is sixteen years of age and had the problem since the age of twelve. She has seen different doctors and has tried multiple treatments with no improvement. She started the Laser (LLLT) in November 2005 and at the same time started Joe Soaza’s protocol which included L-Tyrosine 3 pills in morning 2 at night and minoxidil 5% twice a day after showering. Since November 2005 she has been getting treatments with the Laser for 20 minutes twice a week. The patient is very excited with this treatment. This is the best treatment she has tried. It is the only treatment that has stimulated hair growth over her entire scalp. The patient stated “This is the most hair I have had in 2 years.” She has had problems with eczema over her scalp that has completely resolved since her treatments started.

We currently have 10 other patients that have been using the Laser Hair Care System 20 minutes twice a week for the past 6-8 weeks. So far every one of these patients have been very happy with results. These other patients have only been treated with the laser.”

It is clear to me that the results in a very short time frame were beyond what Dr. Burgmeier had expected. Like our last blog entry for the laser therapy, Laser Treatment (LLLT) for Hair Loss (with Photos), there were multiple therapies used, but clearly the results were spectacular for the early treatment of this combined therapy. Dr. Burgmeier feels that the laser treatment has great value based upon his experience with it. If this patient continues with this type of gain, we all hope that much more of her hair will return. A bald female at 16 needs all the help and luck she can get. The relationship with the laser and the cause of its benefit is not clear from a scientific basis. I would have liked to see the treatments added with one therapy and then a second therapy separated over time so that their incremental value would be more directly evident. Then we might know which treatment actually produced the benefit you see here. Is there hope for this young girl? Frankly, I am a perpetual optimist, so I hope for her sake that she will continue with the growth, covering a wider and wider area. I will get follow-up pictures on her in the next few months and post them here. What I would hopefully see is that these small islands of hair will grow larger and then merge together to appear like a full head of hair (ideal result, of course). Click the photos below to enlarge.

Do hairs like this stand a change with medication? Is a HT even a viable option to increase density?