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Clearly, there are two factors that are critical to determining the value of an FUE graft. (1) the thickness of the hair shaft itself is important as that reflects to weight of each hair shaft as it is viewed. A fine hair is less weight and less value than a coarse hair as shown in the patient’s magnified view of his donor area as he has coarse hair. I tell my patients that two fine hairs is equal to one medium weight hair and two medium weight hairs is equal to one coarse hair. (2) the numbers of hairs per graft is also critical. This is a racial thing, Caucasians average 2.2 hairs in each follicular unit, while all Asians average 1.6 hairs per follicular unit as do many people from the middle east. The patient’s donor area here measures about 1.6 hairs/follicular unit. He is of Arab decent so that makes him average. In this magnified photo, I tried to circle the number of hairs per follicular unit and put a number on many of them. This is what the surgeon sees when he is doing an FUE under magnification. An FUE removes the follicular unit and each FUE itself is created with a punch and has a wound associated with it.

If you ever read about the number of FUE grafts done in Turkey in the 5000 graft/session range, think about it and then look at the patient below. This patient has less hair density than a Caucasian and the number of grafts per FUE will have less hairs. That means that there will be more wounds created for the FUE with a less hair yield. In this man, if he had 5000 FUE grafts in the back of the head and did not develop necrosis of the wound, he would almost certainly develop a see through donor area (balding in the donor area) something that we are now fixing with Scalp Micropigmentation.

I am 21 years old and have been on minoxidil for 7 months and my hair is falling out more than before I started it.

7 months of shed is probably not a shed from the minoxidil but rather an acceleration of your natural genetic hair loss. Are you unusually stressed or undergoing rapid weight loss? I am looking for accelerants.

A good hair transplant surgeon will transplant all ethnic hair types. Only the African hair type requires special skills because it is not straight below the skin as the hair on top of the head is curly. For African men, we use special tools for FUE or STRIP surgeries; whichever they decide is appropriate for them.

Thank you, Dr. Rassman. I know I am definitely thinning. Especially after shaving my hair. In certain lighting it looked like I had no hair in my corners and I could see straight through to the scalp. I have been using minoxidil with a bunch of hair sprouting along the hairline. And a great change in density. I did have a question for you though, how long would minoxidil keep my hairline? And if I start on finasteride, how long would that keep my hairline. I am being optimistic but I am hoping it extends my current density for the next decade if I use both together. I am also very hopeful that there will be better alternatives in the next decade, or quite possibly a cure.

I also would rather not consult my doctor as I know it is very obvious I am experiencing hair loss. I mean, I will have to when I go for finasteride. But I am someone who participates in homeopathy up to a point. So I would rather not alter my hormones unless it is my last resort.

Combining both minoxidil and finasteride will give you the best opportunity to hold on to your hair. I always tell my patients to look at hair loss as a ‘tug of war’, with treatment on one side and the hair loss process on the other side. As long as the pull from the medications is stronger than the genetic pull, you win. When the pull reverses, hair loss is the consequence.

Objective: The effects on scalp and serum dihydrotestosterone (DHT) of different doses of a novel topical solution of 0.25% finasteride (P-3074), a type 2 5?-reductase, were investigated in men with androgenetic alopecia. Methods: Two randomized, parallel-group studies were conducted. Study I: 18 men received 1 mL (2.275 mg) P-3074, applied to the scalp once a day (o.d.) or twice a day (b.i.d), or 1 mg oral tablet o.d. for 1 week. Study II: 32 men received P-3074 at the dose of 100 (0.2275 mg), 200 (0.455 mg), 300 (0.6285 mg), or 400 (0.91 mg) ?L or the vehicle o.d. for 1 week. Scalp and serum DHT and serum testosterone were evaluated at baseline and treatment end. Results: Change from baseline in scalp DHT was -70% for P-3074 o.d. and approx. -50% for P-3074 b.i.d. and the tablet. Serum DHT decreased by 60 – 70%. The doses of 100 and 200 ?L P-3074 resulted in a -47/-52% scalp DHT reduction, similar to the 300 and 400 ?L doses (i.e., -37/-54%). A -5.6% inhibition was observed for the vehicle. Serum DHT was reduced by only -24/-26% with 100 and 200 ?L P-3074 and by -44/-48% with 300 and 400 ?L P-3074. No relevant changes occurred for serum testosterone. Conclusions: The novel finasteride 0.25% solution applied o.d. at the doses of 100 and 200 ?L results in an appropriate inhibition of scalp DHT potentially minimizing the untoward sexual side-effects linked to a systemic DHT reduction.

Have you ever seen an elderly man who was bald, had a terrible comb-over, and wondered how a person got there? Well, this young man shows how it all begins. It starts off with a very subtle restyling of the hair to cover the areas of thinning and/or balding. Then, as age takes its toll and more balding develops, the altered styling changes to adjust to the new status of the balding. Over years, this change is subtle every day as the hair loss slowly advances. Sooner or later, however, the bald area becomes so large that the man starts running out of hair styles, so he moves down to the side of the hair just above the ears. The hair 2 1/2 inches above the ears never disappears, so by parting this hair and letting the hair grow long, the hair can be made to cover the entire head. The man in the mirror never sees this subtle change. Many celebrities use some version of this comb-over, or comb-back as shown here:

Thought I’d share the funny way I style my hair. All of the pics are recent. What hairstyles do y’all use ? from tressless

Peyronies disease from tressless

There are many people with such deformities. The association with finasteride has not been shown as one on one. Despite this, there are many claims that the two are related and the courts are full of men with such complaints. The prevalence of Peyronies disease is 1.5-6.5% (1.5% in young men and more common in older men as high as 6.5%) and this has nothing to do with the drug finasteride. Pictures of this condition can be found here: https://peyronies-disease-help.com/pictures-peyronies-disease-penile-curvature/