Combining finasteride and minoxidil is a good idea. You should get a HAIRCHECK instrument test to find out exactly what hair you are losing and how these drugs reverse the process. IF you are in Southern California, my first visit for this test is free
Many times the transplant does not provide enough hair to cover an extensive balding pattern because the donor supply density is too low for the high demand of the balding pattern. When that happens, the surgeon who is skillful with both hair transplants and SMP will know how to use the transplants to form a good foundation so that the SMP will make the hair look much fuller.
Here is an example: The picture on the right has the exact same amount of hair as the picture on the left except that SMP was added to fill in the thinning hair.
Thank you for posting my comment on your blog this week. I re-read my comment and thought it may have been unclear so I wanted to clarify a point.
Haber’s original data set showed some peculiar results for the finasteride (F) group versus the control (C). It is very widely accepted that finasteride impairs sexual functioning compared to the control but that was not what Haber found in his study due to the research design. I don’t really know how to put it any more nicely unfortunately. According to the ASEX score, (F) had only 24.3% with some sexual dysfunction versus 38.4% for (C). Libido was similar between groups with (F) showing 22.8% with libido loss and (C) at 22.2%. Reduced sexual functioning was much lower for (F) at 17.8% versus 24.2% for (C).
Keep in mind there is a small amount of missing data in the fin group but it shouldn’t matter that much. Because of the way they excluded patients who stopped taking the drug, likely due to side effects, the data appears to show that on average finasteride improves sexual functioning but that isn’t true because the data isn’t properly randomized. Everybody basically knows that finasteride causes sexual side effects and the data is growing ever stronger that a small group gets persistent side effects. When their data showed the opposite effect and they didn’t stop to question why, they decided to completely ignore the data and conclude “there was no difference in loss of libido, reduced sexual performance, or the number of men with an ASEX score indicating sexual dysfunction.” I’m really not sure how this article got published but the authors appeared to have willfully distorted the data and study design to meet their presumed conclusion.
https://baldingblog.com/reddit-reader-comments-on-a-baldingblog-post/
My experience parallels Dr. Haber’s experience as well as another few dozen doctors with lots of experience. From a first hand perspective, I take it and don’t have ED or libido issue and my son took it and got an increased sexual drive. My patient’s parallel the official reports with about 2-4% ED and libido issues, possibly slightly higher. I have written thousands of prescriptions for finasteride and that makes me more of an authority than those who look in from the sidelines.
2021-07-02 02:03:042021-07-02 09:00:05Comment on Dr. Haber’s Article on finasteride
I live in New York City and am looking into scheduling my second session of FUT this fall. I’m transsexual and need to finish rounding out my m-shaped hairline after having done my first session last year out of the country because it was done within a week of another surgery.
This time I’m looking to stay close to home and have been speaking to a surgeon recommended by a friend, Michael Beehner, located far upstate in Saratoga. I like him because he’s communicated in depth with me over email and has a decent amount of before and after photos of trans women. I don’t think all surgeons/technicians are good at creating natural looking hairlines and I also don’t think my hairline was drawn properly the first time so I want it reevaluated.
What makes me hesitant in scheduling is the four hour bus ride for someone who charges $5/graft. I’m wondering if anyone in the NYC area can give me a comparison to other doctors here. Bernstein’s office told me $7. Maxim seems the cheapest, although I’m not sure by how much: their website says $2.95, but I saw a blog post from last year where a woman was quoted $4. Basically, if I feel like I’m getting a deal for a top notch surgeon and team then I’d feel a lot better about making the trip.
Never buy based upon price! Always check out the quality of the doctor. If you get a doctor who discounts his prices because he isn’t good enough to compete on quality, then you could buy less quality with a lesser price. I know both Bernstein and Beehner and they are both first class doctors.
2020-01-23 04:00:402019-11-22 15:39:19Comparing Prices for Hair Transplants
Hi Dr. Rassman,
Searching the internet and various websites I always seem to hear/read about women who have severe diffuse hair loss and have developed female pattern baldness when they are around 20-years-old. Is this very common? Some information I’ve come across says it’s very very common while other says it rarely happens. Do you have any statistics on it?
I am not aware of statistics, but from my experience, women often follow the females in the family that have genetic balding in the time of onset and the pattern. There is a strong one-to-one link between mother and daughter in this condition and it is not infrequent to see it in your mother’s mother or aunts. Female genetic hair loss is not common in very young women, but in each decade, the frequency rises until menopause when almost 50% of women experience the problem. We see hair loss after pregnancy in many of these women as well.
I was advised by a dermatologist NOT to have a hair transplant because of the reasons mentioned above: shock loss and possible acceleration of hair loss.
If the reader is over 26 and is willing to take the drug finasteride, the risk of acceleration of the hair loss and shock loss are mitigated.
2019-03-14 05:08:542019-03-19 07:44:57Comment by Reader on Risks of a Hair Transplant from Dermatologist
I generally agree with this analysis; however, I believe that for men with an advanced balding pattern and a finer hair and particularly those with a lower than average donor density (which includes a lot of Asian men), the FUT is a superior procedure because it avoids the moth eaten appearance which is inevitable with FUE.
2020-10-07 04:51:512020-10-07 04:51:51Comparing FUE and FUT from Reddit
I figured I would offer my opinion here since the reader asked for a reply from somebody who had a similar experience and the response doesn’t really answer the question. I used Propecia about a decade ago and developed general sexual dysfunction (not just ED) that continues to this day.
Unfortunately nobody can provide you with the reassurance that you say you desperately need. You won’t know for sure if the side effects will be permanent unless you stop taking the drug. The doctor highlights that you risk “catch up hair loss” which provides an incomplete picture to the decision you need to make. On the other hand, if you continue taking the drug you risk “catch up side effects” because the side effects can get worse than they are today. You need to think about what is most important to you and how much you value your general health versus your hair in order to make a smart decision. There is uncertainty in making a decision like this which is stressful but the right decision is different for everybody.
In my practice, when a new patient goes on finasteride and has sexual side effects, I tell him to stop the medication. I have them report back to me about their sexual side effect which usually goes away within a month or so. I have not seen any patient tell me that after stopping the drug, the side effects continued.
After the recent FDA approval of the HairMax LaserComb, there have been many brief articles written based upon the press release that the product’s manufacturer had sent out. Most articles I’ve seen have been essentially disbelief that a product like this could’ve been approved, while other articles were simply rehashing what the press release stated.
The following comments regarding the HairMax LaserComb were written by a well known dermatologist. He asked that his name not be used, but agreed to let me post this:
“I think it is the physician’s responsibility to inform the patient about the proven value of any treatment, regardless of any stamp of approval, be it perceived or real, from any organization. This product has had some “approval” in Canada for some time, yet it does not receive any acknowledgment or significant medical approval by practicing physicians, and certainly not by dermatologists whose credibility would be potentially significantly damaged by such commercial endorsement. I think we all recognize that there is still no good study to substantiate or prove the validity of this treatment modality. Promoting this product without the strength of good science puts any physician in a category where public perception might be that ethics and science are colliding with monetary gain and marketing advantage. The decision to advocate this therapy at this point in time where the support for its validity is at best weak, can have consequences. I don’t believe it is sufficient for physicians to hide behind the notion of FDA approval in order to legitimize this modality.”
I realize that everyone is looking for the magic treatment that is not expensive, but the point of my post was that there are risks that most of the users do not appreciate. I have no first-hand experience with such risks. Infection risks are theoretical, and they could occur with disastrous consequences in the ‘worst case’ I can think of.
2018-05-02 06:58:252018-06-19 10:27:06Are Your Comments About Dermarollers Real? Those of Us Who Use Them Are Somewhat Desperate.
