Category: Uncategorized

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Results of Transplanting Firefighter’s Hairline (with Photos)

In my experience, performing hair transplants on firefighters, police officers, and soldiers can be a problem, not because they are different from you and I, but simply because they tend to get more good-natured teasing from their colleagues when issues of vanity come up. Although I haven’t seen any formal studies about it, I’ve found that society looks at the man in uniform as a “macho” guy, and vanity + macho don’t exactly go hand-in-hand. This is why I’ve found that these men can be more sensitive than the average male about having a hair transplant, as they are extremely worried about having a detectable procedure.

This patient had two hair transplant procedures totaling 2431 grafts to the frontal hairline, extending back about 1 1/2 inches. His skin is light and his hair is jet black, but he told me that no one ever teased him about undergoing the surgeries and nobody noticed anything unusual.

The photo on the left is before; the photo on the right is after two procedures. Please forgive me for the quality of the before photo, as it was taken with a different camera under different lighting, but his hair loss is clearly evident. Click the photos to enlarge.

 

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Does shampoo cause hair loss?

“Normally, between 40 and 100 hairs are shed daily on a non- shampoo day; twice as many are shed on days when the hair is shampooed.” Does that mean we shouldn’t shampoo?

Hair that is shed is not coming out because you shampoo your hair, it comes out because it is either going through its normal telogen cycle or you are losing it from miniaturization or genetic factors. Not shampooing your hair will make no difference in your overall hair volume or hair density across the scalp. Brushing it roughly will pull out miniaturized hairs so I generally tell men with hair loss to use a wide toothed comb

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Does this look like 1200 grafts from hair transplant 3 weeks ago? (photo)

This doesn’t look like about 1200 grafts; however, it is almost impossible for me to tell at this stage as some of the grafts may have already fallen out. Ask your doctor for the graft count in your surgical record. Many patients send me such photos and want to to check up to see if their doctor was honest. This is sad, because of the doubts that people like you have about being cheated. Hopefully, you will get your post operative pictures and a copy of your surgical record and be more comforted by what you learn.

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Risks of finasteride in pregnancy (from:reddit.com 6/11/2020)

This is a compilation of information gleamed from a Reddit poster who put together a series of articles which may point to risks brought on by finasteride in pregnancy. I will quote the entire post and all of the references for you to draw your own conclusions. I have commented on two of the references. Many of the articles are controversial. We have known for some time, that finasteride can impact the fetus on sexual identification. Many hermaphrodites come from women who have ingested finasteride or any similar compound during the first trimester of pregnancy, so items #1-6 have to my knowledge been previously identified. But to develop such abnormalities women were required to have significant exposure to finasteride with some of it being absorbed in their body during pregnancy. In my own practice, I have seen hundreds of men father normal children while they were on finasteride, so there is no 1:1 relationship when a man is taking finasteride and abnormal children and have not seen any patient come to me complaining of an abnormal child while they conceived a baby while on the drug. Of course, that is just my experience and does not guarantee the safety of this drug. I leave that up to the FDA. The rest I will leave for you to judge after reading the material below.

Risks of Finasteride Exposure in Pregnancy

Finasteride/Dutasteride

Finasteride, Propecia and Duasteride labels warn that pregnant women must not be exposed to the drug. This includes by taking it, touching a tablet, or by being exposed to semen from a man who is taking it.1

This is because if the active ingredient in Finasteride is absorbed by a woman who is pregnant with a male baby, it can cause the male baby to be born with abnormalities of the sex organs. Finasteride blocks DHT, which is necessary for male baby organs to form and grow. Prenatal Finasteride exposure has also been shown to affect cognitive function in both male and female babies.

What are the specific problems? According to the research they include:

  1. Higher rates of miscarriage

  2. A small penis

  3. Hypospadias

  4. A small underdeveloped scrotum

  5. A prominent midline raphe (scrotum doesn’t join normally)

  6. Ectopic testicles (which don’t reach the scrotum)

  7. Cognitive problems in both males AND females

  8. Memory problems in both males AND females

Three sources detailing these effects are provided below.

Source 1: S. Prahalada (1997) Effects of Finasteride, a Type 2 5-Alpha Reductase Inhibitor, on Fetal Development in the Rhesus Monkey2

In this study pregnant female monkeys were orally given 2mg/kg/day. Every single one of their male babies had genital birth defects.

“The male external genital anomalies were characterised by hypospadias which were confined to the glans penis (5/6; 83.3%), preputial adhesion to the glans (6/6; 100%), a small underdeveloped scrotum (6/6; 100%), a small penis (5/6; 100%) and a prominent midline raphe (6/6; 100%).”

“An apparent incidence in the fetal loss rate was observed in the 2mg/kg/day (23.1%) and the 800ng/kg/day (20%) finasteride treated groups when compared to concurrent controls…”

Source 2: Christopher Bowman, et al (2003). Effects of in Utero Exposure to Finasteride on Androgen-Dependent Reproductive Development in the Male Rat3

In this study Finasteride is shown to impact testicular descent: “Prenatal finasteride exposure significantly impaired testicular descent. Approximately 3, 23, and 73% of the adult males displayed ectopic testes in the 1.0, 10, and 100 mg/kg/day dose groups, respectively… The data from the current study suggest that the conversion of T to DHT in the developing gubernaculum is necessary for normal testicular descent.”

Even in the smallest dose of 0.01 mg/kg/day in the last stages of gestation there were genital issues affecting anogenital distance (AGD) of the males after the rats were born. “Late gestational exposure to finasteride significantly decreased AGD of male offspring in a dose-responsive manner… the AGD of male offspring displayed significant decreases of 8, 16, 23, 25, and 33% in the 0.01, 0.1, 1.0, 10, and 100 mg/kg/day dose groups, respectively.”

“The dose-response curves for finasteride-induced malformations fell into two groups. External structural changes such as decreased AGD and increased nipple retention had similar dose-response curves. These external changes were almost linear over the entire dose range (0.01 to 100 mg/kg/day) and approached 100% incidence by the highest dose.”

The authors note that “The lack of a no observed effect level (NOEL) in the current study was consistent” with the study by Clark (1990) which showed effects at doses down to 0.003 mg/kg/day. (DR RASSMAN’S COMMENT: THIS STUDY WAS DONE IN MONKEYS ADMINISTERED FINASTERIDE IN VARIOUS DOSES DURING PREGNANCY. THIS IS NOT THE SAME AS THE MALE MONKEY BEING ON FINASTERIDE WHEN THE FEMALE MONKEY BECAME PREGNANT)

Source 3: Jason Paris et al (2012) Inhibition of 5?-reductase activity in late pregnancy decreases gestational length and fecundity and impairs object memory and central progestogen milieu of juvenile rat offspring4

“Finasteride significantly reduced the length of gestation and the number of pups per litter…”

“Prenatal finasteride treatment significantly reduced object recognition, decreased hippocampal 3?,5?-THP content… inhibiting the formation of 5?-reduced steroids during late gestation in rats reduces gestational length, the number of viable pups per litter, and impairs cognitive and neuroendocrine function in the juvenile offspring.” (THIS STUDY WAS DONE IN RATS, AGAIN IN PREGNANCY AND DOES NOT CORRESPOND TO A MALE RAT TAKING FINASTERIDE WHEN THE FEMALE RAT BECAME PREGNANT)

While some of these research exposures were a lot higher than would be expected from semen exposure, don’t risk exposing a baby to any amount of this extremely dangerous US FDA pregnancy category X drug.5 Studies have demonstrated fetal abnormalities and there is positive evidence of human fetal risk.

Links:

1.https://www.drugs.com/pregnancy/finasteride.html#:~:text=-Finasteride%20is%20present%20in%20semen,wishing%20to%20conceive%20a%20child

2.https://www.docme.su/doc/1721148/effects-of-finasteride-a-type-2-5-alpha-reductase-inhibi…

3.https://academic.oup.com/toxsci/article/74/2/393/1716348

4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196810/#__ffn_sectitle

5.https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf&ved=2ahUKEwi5iY7a3_bpAhUvyDgGHVP2AIEQFjABegQICxAG&usg=AOvVaw1iQoISJACkyba4PNH1LzZM


2020-06-11 17:43:08Risks of finasteride in pregnancy (from:reddit.com 6/11/2020)

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Rogaine on the Hairline — Worth a Shot?

Dr. Rassman:

I recently met with a new dermatologist after I noticed significant and abrupt patterns of shedding. I am 30 years old, and I’ve been on Propecia for 10 years and was thrilled with it up until about a year ago. It was then that I noticed a ton of sheddin in the shower, pillow, etc, etc.

I asked my doctor about Rogaine, and told him I had been using on the crown of my head for about 8 months, as a preacautionay measure, in case Propecia stopped being effective for me. He said to use it on my hairline as well. He said that although Rogain is not FDA approved to be effective on the hairline, that doens’ mean that it isn’t. He said “its worth a shot”. What are your thoughts on this?

Thanks

There have been reports of minoxidil being effective on the frontal hairline, but they are few such observations with significant hair growth. I suppose it is worth a shot.


2009-08-04 09:50:45Rogaine on the Hairline — Worth a Shot?

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Search Results for “italian topical finasteride” | WRassman,M.D. BaldingBlog

Dr. Rassman’s Comments: I saw Dr. Insalaco present these findings at a meeting last month in the United Kingdom. About 200 hair restoration surgeons attended the meeting. Her results (combining Finasteride and minoxidil in a drug formulation) was very impressive, reversing hair loss in various parts of the scalp over an 18 month period of […]


2019-11-06 15:04:54The use of topical finasteride with minoxidil produces remarkable results in a study on 300 male patients with genetic balding (photos)

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Dr Bernstein’s Comments About SMP

Snippet from the article:

For readers that are not familiar with it, Scalp Micropigmentation (SMP) is a permanent cosmetic tattoo that mimics the very short hairs of a closely shaved scalp. I think that Scalp Micropigmentation (SMP) is a useful new adjunct to hair transplantation with interesting potential and I am pleased to see that doctors in our field, particularly Dr William Rassman and Dr. Jae Pak, are spearheading the development of expertise in the technique and promoting the technology to make it more widely available to patients.

One of the things that was apparent from their presentation at the ISHRS is that SMP is an “art” and that proper technique is extremely important in getting an aesthetically satisfactory result. This includes: the angle that the instrument is inserted, depth control, the amount of pigmented deposited, and color match – not to mention proper patient selection.

Read the rest — Scalp Micropigmentation at the 2012 ISHRS Scientific Meeting – Dr. Robert Bernstein Provides His Input

I meant to post this last month, but better late than never…

Our friends at the Hair Transplant Network posted a good bit of feedback from Dr. Robert Bernstein relating to his thoughts on SMP and our presentation at the ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting, including the applications and the planning that should be considered for those that are interested in having the technique done.