Author: Dr. William Rassman

I have been on Finasteride for 4 years and my hair didn’t really change much. I did, however stop the drug for the past two months, but am back on now. 1) could my hair have changed in those two months? 2) what pattern do I appear to be? 3) a reputable IAHRS surgeon consulted me and recommended 1200 graft FUE , what are your opinions on that?

If you trust your doctor then go with it!
The Internet is not a place to receive a second opinion.
If you would like a second opinion it is best to consult with another doctor in person.

Photo(s) are not a good way to determine if you are balding or if you “need” surgery for the following reasons:

1) There is no way to know your history in detail. This involves a dialogue between a doctor and patient. A consultation usually involves 30 minutes or more.
2) There is no way to examine your hair under a microscope to understand how much miniaturization you may have (to plan for a possible surgery). What will you do if you have further recession or balding after the surgery? Are you prepared to have another surgery to fill in the gaps? You need a Master Plan.
3) Photos do not convey your understanding or expectation of a hair transplant surgery. Someone with your hair loss may be happy with 1200 grafts. Another person with the exact same hair loss may not be happy with 1200 grafts.
4) Photos do not convey your goals. Someone with your hair loss may want a drastically low hair line where 1200 may not be enough. Another person with the exact same hair loss may want a very conservative hair line where 1200 may be too much.
5) FUE or Follicular Unit Extraction is just a harvesting technique. It has nothing to do with the end result. In fact FUE may give you a suboptimal result over a FUT (Strip) surgery. Did your doctor tell you this?
6) etc

I visited your office last year in august and I was told that I most likely did not have “balding” just that my I had low hair density. This is contrary to a what another office told me. Quite frankly I trusted your doctor more, and he advised that since I was already been taking propecia to continue it if I wanted to be safe. Well I did continue it but have only been taking .25mg 3 times a week for over a year now and my hair has remained the same. In your opinion do you believe that .25mg 3 times a week would actually do enough to maintain my hair as it has if I was truly suffering from balding? I want to come off completely because I do suffer from some side effects but am afraid that if I do I will lose hair density.

If one doctor says you are not likely balding and another doctor says you are (and may need surgery) it is definitely a confusing situation. You may consider visiting a third doctor for another opinion. You may also consider the motivation behind any recommendation. If we told you that you were not balding, we must have used the HAIRCECK instrument to measure your hair bulk which is a very accurate way to determine if you are balding. If we did not use it, come back and let us do so.

With respect to Propecia, the recommended dose is one pill (finasteride 1mg) a day. Taking 0.25mg three times a week is not a typical way to take Propecia. Some people do take 0.5mg or 0.2mg daily. The key is taking the medication on a daily basis. It is important to note that you should contact your doctor if you want specific guidance.

Prenatal exposure to pot is associated with differences in the thickness of the brain, particularly in the frontal brain, in preadolescent children. This was a study done with MRIS. This was written by Hanan El Marroun, Department of Child and Adolescent Psychiatry, Erasmus University, Rotterdam, the Netherlands and published online June 15 in Biological Psychiatry.

Children aged 6 to 8 years were invited into the MRI component of the program and the mothers use of cannabis exposure during pregnancy was measured with maternal self-report asking questions for each each trimester of the pregnancy. 113 nonexposed children; 96 children whose mothers smoked only tobacco during pregnancy; and 54 children whose mothers were studied during the pregnancy.

When comparing exposed to non-exposed children, those exposed to cannabis had “thicker frontal cortices, specifically, a thicker superior frontal area of the left hemisphere… and a thicker frontal pole of the right hemisphere” This part of the brain, the prefrontal cortex, supports functions such as the ability to suppress responses and thoughts, attention, higher-order motor control, and working memory.

The New York Times “reported a study published in BJU International found that the sperm of male smokers was “damaged in ways that could reduce the chance of fertilization and might also lead to health problems in the baby.” The researchers found that the “DNA in smokers’ sperm was fragmented, probably because of oxidative stress from the cadmium and nicotine in cigarette smoke,” which has been associated with increased risk of genetic problems and childhood cancer. They also found nonintact acrosomes and changes in seminal plasma, both of which “might impair fertilization.”

It is clear that if you want to avoid a stroke or heart attack in your life time, there are some simple steps you can take which have proven statistically significant. These are simply: (1) treat high blood pressure if you have it, (2) stop smoking if you smoke, (3) treat your cholesterol if it is high with statins and diet also keep your red meat down in your diet, (4) regular exercises on a daily basis to keep fit, (5) keep your weight in normal ranges for your age, (6) take one baby aspirin each day which has value not only for prevention of cardiac and stroke events, but also prevention of many forms of cancer.

The formula is easy and you don’t have to be a rocket scientist to understand these 6 simple things to keep you healthy.

This is an excerpt from the FDA website from 2010 on finasteride (https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788s018lbl.pdf). Dr. Ed Epstein, from the Bosley Medical Group is a urologist by training and has kept up on the latest information on the impact or lack of impact of the drug finasteride on risks for an unborn fetus. “I am not aware of new studies on amounts of finasteride in semen or vaginal absorption data” that reflect increased risks for fetal abnormalities induced by finasteride other than what is written in the FDA white paper referenced above.

Some doctors are concerned that patients who go on finasteride should get semen analysis to keep track of semen levels in case these level dropped while a patient was on the drug finasteride. Dr. Epstein said: “Concerning getting semen analysis on child bearing age men starting finasteride, I totally disagree. Typically a male infertility workup is suggested after one year of unprotected intercourse. The subgroup of men who have low sperm counts on finasteride are those with preexisting conditions and appear to respond to discontinuation of finasteride.”

In other words, he feels that a young man should not worry about either low semen counts caused by finasteride, but that they could always stop the drug and if there was a causal relationship, it would reverse. He also suggested than men with low sperm counts while on finasteride, probably had it before they started the drug and should get any low sperm count evaluated by an expert.
The FDA while paper referenced above showed that studies on semen in sperm were either not present or when present were so low as it not cause a risk to a pregnant woman or a woman who is expecting to become pregnant. “Semen levels have been measured in 35 men taking finasteride 1 mg/day for 6 weeks. In 60% (21 of 35) of the samples, finasteride levels were undetectable (<0.2 ng/mL). The mean finasteride level was 0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using the highest semen level measured and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal absorption would be up to 7.6 ng per day, which is 750 times lower than the exposure from the no-effect dose for developmental abnormalities in Rhesus monkeys and 650-fold less than the dose of finasteride (5 ?g) that had no effect on circulating DHT levels in men”

I could’t help but think about what we do in our practice vs what Stossel talked about in this article. “the hospital’s customer service stinks. Doctors keep me waiting for hours, and no one bothers to call or email to say, “I’m running late.” Few doctors give out their email address. Patients can’t communicate using modern technology”.

http://www.foxnews.com/opinion/2016/04/20/stossel-have-lung-cancer-medical-care-ive-received-is-excellent-but-customer-service-stinks.html

At the New Hair Institute, every patient:

1. Has the doctor’s cell phone number.
2. Does not wait more than a few minutes before being seen.
3. Service reviews are fantastic nearly 100% of the time.
4. The service is personalized because we do not run a hair transplant ‘mill’ and care about our patients as human beings with a problem.
5. Sterile condition and safety are top priority (not an infection in over a decade).