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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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 20 years old, can I have a hair transplant or should I wait?

You are correct to wait until you are older to be sure where your balding pattern will show up so you will know what you are in store for. Your family history might indicate where your balding may be going. Look at your brothers, uncles, father and grandparents on both sides of the family to see what they hair loss pattern is/was, Usually by the age of 25, you will know and you can then build a Master Plan with your doctor.

20 year old

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20 year old wants a ‘small’ transplant (bad thing to do)

I am on Fin and Min and my hairloss doesn’t seem to progress. Because I have high temples naturally and no regrowth, I wanted to ask if there are clinics that transplant hair from the top of the head, rather than the back. As I believe I will lose all hair eventually, I would like to have a small transplant of hair that will fall out with the other hair if I stop Fin. I am 20 right now by the way.

You are absolutely wrong about your hair loss. The back and sides always stick around regardless of how much hair you lose. A small transplant is like being a little bit pregnant, there is no such thing. If a 20 year old gets a little transplant, then the balding will accelerate (worst and most probable case), and you lose out big time. See a good doctor, make a Master Plan with that doctor and follow that plan with that good doctor for the next 20+ years. Look at this previous post I wrote which defined the issues very well: https://baldingblog.com/22-year-old-received-a-hair-transplant-of-2800-grafts-from-reddit/

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I am 21 and just got an FUE to the frontal 2cm of my hairline and my crown. Should I transplant everything else now?

This is a terrible question as it reflects a doctor who is not ethical and a patient who is naive. A 21 year old might have early crown hair loss and frontal hairline loss along the hairline (Called a Norwood Class 3 Vertex pattern) which is not uncommon in a young man under 23 years old. Most of these men can stop their hair loss on the drug finasteride, but of course the doctor can’t make money that way, so this poor fellow had a hair transplant and will be destined to continue having hair transplants until is final balding pattern is evident (about 26 years old). If he does not have the donor density for this, he will look freaky as he runs out of hair chasing possibly the impossible. Ethical doctors are in the business so if you are under 25 and have hair loss, see on of the ethical doctor who does not rush you into surgery to pay for his new car.

Norwood Class 3

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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.

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21 Year Old Male with Hair Medication Questions

Dear Doctor,
I just recently stumbled across your site while doing research. I’m glad that I can actually speak with a doctor, as opposed to self-proclaimed hair loss zealots on forums and other sites. Here is my current situation.

I’m 21 and about four months, and I do believe that my hairloss started when I was just turning 19, maybe even as early as 18. All my hairloss practically is from the crown area. It started with a quarter sized essential bald spot, and its spreading to either side of my crown. My hair was always thick, and it has thinned somewhat, but still remains pretty thick. I have little to no signs of a receeding hairline. I tried finasteride (finpecia, www.unitedpharmacies.com) for six months, and tried generic mixodil 5% for a little over a month. Currently I am taking nothing, and it seems to be getting somewhat worse. I am a college student, so once I get enough money I intend to take finasteride again.

I have the following questions…

  1. Is the generic finasteride I found on unitedpharmacies.com legitimate?
  2. Should I definitely use Minoxidil in conjuction with finasteride?
  3. Are there any shampoos/conditioners, that will help my situation?
  4. I’ve heard that in Canada hair transplants are much cheaper than in America
  5. Is Hair cloning going to be legal in any time in the near future?
  6. Maintaining hair is one thing, but I would really like to regrow. Is there anything besides the above mentioned treatments that may help my cause?
  1. Please be aware that finasteride is covered by a series of U.S. Patents held by Merck (drug company), one of which I believe is about to expire shortly. I am not in the drug manufacturing business so I can not state with any certainty that someone will be able to manufacture and sell a ‘generic’ Propecia in the United States anytime soon. Any generic finasteride you purchase, may or may not actually be finasteride — there is no way for you to easily be sure.
  2. You do not need to use Minoxidil while being on Finasteride, especially considering that you are college student without much money, but crown hair loss (your pattern) is most impacted to finasteride, so that would be my drug of choice here. If you want to be sure and knock down the price, then some people will purchase Merck’s Proscar (5 mgs of finasteride) and cut it into quarters — though it is available by doctor’s prescription only. I can not advise that you do this, but I know that it is done. I believe in Propecia/Proscar/finasteride use in all genetically balding young men.
  3. I don’t believe one brand of shampoo/conditioner is better than the other in saving your hair.
  4. See my blog entry titled The Truth About Cheap Hair Transplants and draw your own conclusions. Buyer beware.
  5. See the Hair Cloning category, but don’t hold your breath.
  6. Not that I can endorse.
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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.