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Making Sense of Hair Loss Drug Stats

Dr. Rassman, you have said before that minoxidil works for about half of men. The box says that minoxidil has only been proven to work for men experiencing hair loss at the apex/top of head and not for men that are balding from the front. Are these clinical studies made up of men that are already “good candidates”, meaning they have the right kind of balding for the drug to work? Or are all types of balding patterns included in the trials?

I am 34 years old, been on finasteride for a year and noticed that it slowed things down, but didn’t stop it completely. I have since added minoxidil. I would appear to be a perfect candidate from what I have read. I caught it early, I don’t think most people would even realize I am losing my hair, it is still pretty thick. I am losing my hair at the apex/top of head area, my hairline looks good. Is someone like me almost guaranteed to get a good result? Or am I still just a 50/50?

Thanks so much, your site is a huge help!

There is no guarantees in life (other than death and taxes). If it works for you it’s 100%. If it doesn’t work for you it’s 0%. Statistics do not apply when it’s you… and you won’t know until you try. That being said, I’ve found that these medications tend to work best in the early stages of hair loss. So while I’m hesitant to “guarantee” anything from the medications, I’d suspect you’d have a better chance at seeing benefits than someone that started the medication after losing hair for 20 years.

Selective patients for these studies would discredit the studies. Minoxidil is very effective in about 15% of patients and mild benefits can be seen in half of those who are thinning in the crown (more stats here). With regard to the frontal area, the reports indicate it is less effective than when used on the crown.

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Anti-Graying Pill — Go Away Gray

Hi,

I have recently come across with this product: Go Away Gray

Your remarks will be appreciated.

I have no experience with Go Away Gray (and this is the first I’ve read of it), but I invite my readers to comment if they do have experience with this pill that promises to make gray hair disappear. What I could find on it (aside from a ton of sites trying to sell it) was that the pill contains catalase, and a study from last year did find that gray hair was caused by the body’s lack of catalase production as we age. That isn’t enough to convince me just yet, but I am open to learning more about this and reading some actual reviews. You can read more about last year’s gray/catalase stories here and here.

CBS stations around the US picked up the story and ran it in their local markets, causing at least one TV critic to dig a little deeper into why the product is getting all this publicity (see here).


2010-05-14 06:40:20Anti-Graying Pill — Go Away Gray

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Man dies of a ‘heart attack” in Turkey having a hair transplant

https://www.dailymail.co.uk/news/article-9989033/Italian-man-mysteriously-dies-heart-attack-hair-transplant-operation-Turkey.html

I hope that when his body is home, that the cause of death will be identified. It is easy to call it a heart attack, when it could have been something else. There have been other deaths during hair transplants, one in Los Angeles was due to an overdose of an anesthetic drug, for example. Many of the Turkey clinics don’t have a doctor who understands dosing anesthesia medications.

The article reports that the body was covered with blood. The body covered with blood? That doesn’t happen with FUE unless you don’t use the right medications that contains epinephrine which constricts the blood vessels and allows clotting to occur. Maybe he bled out? Alternatively, let’s say it was a heart attack in a young man. This can happen but the surgeon (if there was one) should know how to resuscitate such a patient. This is basic stuff! Without an expert making autopsy results known, we can only guess.


2021-09-16 11:03:28Man dies of a ‘heart attack” in Turkey having a hair transplant

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Any Patients Take Propecia and Still Have Shock Loss?

Just wondering as you have said a few times that being on propecia will decrease your chance shock loss after a hair transplant if you are under 30.

Have you had any patients under 30 who have had shock loss after being on propecia for a considerable period of time? And if so to what extent was the loss? Thanks

When I saw the great majority of shock loss cases, it was before the availability of Propecia (early 90s). Since that time, most of my patients take Propecia to protect themselves from shock loss, and there was far less of the fall out after the surgery… but it did still occur for some.

I don’t have statistics on the extent of loss or precise age, though.

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How many FUE grafts in a Megasession are too many FUEs grafts and how does one know what the safe limits are?

THIS IS A VERY IMPORTANT READ FOR ANYONE WANTING TO HAVE FUE; I wrote this article in the past issue of Hair Transplant Forum (Volume #27, #2, May/June 2017) which I believe defines a very important guideline for determining how many FUE grafts are safe. This is illustrated well in the previous post below. We are seeing doctors from around the world performing FUE grafts in the thousands without understanding the limits of this surgery. The goal for many patients, is to get all of your hair back in a single hair transplant FUE session. But that goal is not reasonable for many patients with FUE especially when the donor density is low like most Indians, Asians, South Americans, and people from the Middle East. Europeans or Russians often have higher donor densities. The article poses a formula the the doctor can use to actually calculate the safe number of grafts for any particular individual. You have a responsibility to research what your doctors are going to do for you, because if you don’t and if your doctor removes too many FUE grafts from your donor area, you will become bald in the donor area, a bad exchange from balding in the front or the top of your head. You must realize what the risks are and if the safe limits of FUE are exceeded. Many patients who end up with a depleted donor area like the previous post, have little choice on how they are to manage their new balding problem as they may become bald in the back of their head. This article addresses this problem and suggests ways doctors and patients can guarantee that the safe limits for FUE are not exceeded.

full-forum-fue-article CLICK TO ENLARGE

 

 


2017-08-31 09:27:04How many FUE grafts in a Megasession are too many FUEs grafts and how does one know what the safe limits are?

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Applying the Rogaine Liquid is Difficult!

My boyfriend has just started using the generic Rogaine from Costco in liquid form, and I have been helping him since depositing a dropperfull of liquid on the bald spot is not an easy thing to do alone. I use the dropper to distribute the liquid around the spot, but no matter what we do it seems that much of it runs off down his neck or forehead. The rest sits in the few hairs he has left in little droplets.

My questions:
– are we doing this wrong somehow?
– should I be putting on a latex glove and trying to spread the solution around with my fingers?
– would the foam work better? He has the typical bald spot at the crown of the head, with just a few fine hairs and mostly just scalp. But I have found in my research that an awful lot of guys say the foam just melts from your body heat and runs off anyway…

Suggestions or pointers to articles would be much appreciated!

Your problems are well shared by many users of liquid minoxidil, thus Rogaine Foam was created so that the medication stays on the area you want to treat. It may “melt” and run off as you say, but it is better than the liquid in my opinion. If you still want to use the liquid (or your boyfriend does, more precisely), you can apply the liquid with a gloved hand. That might be best anyway, since you’re not using the medication.

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Massaging My Scalp Causes Hair Loss!

Hi,

My hair has been thinning and falling for a few years now (I’m probably too late in asking for help), and now I can see that the hairline has receded quite a bit and the scalp is easily visible. The loss/thinning is limited to the top of my head in a horse shoe pattern. If I massage my scalp on the top, hair falls out. If I massage the side of my scalp, nothing falls out.

I also suffer from a very oily scalp/ face….

The question is, can I treat the situation or is this genetic? Is oily scalp a culprit? It does feel like hair falls out faster when my scalp is oilier.

thanks

Oily scalp is not the reason for your loss. Genetics are. It is likely not too late to start on medication like Propecia, which can help to halt the hair loss and possibly regrow some.

If you rub the side of your head and no hair falls out, yet when you massage the top of your head you’ve seen hair loss, this sounds like a classic situation of male pattern baldness (MPB). The sides and back of your head retain your hair permanently (which is why you see so many men with the “horseshoe” of hair) and will not come out like you describe with a massage, and it sounds like when you put any traction on the top of your scalp, even gentle massaging, it’s causing those weak hairs on top to fall out faster.

You indicated in your email form that you were in the San Francisco bay area. I have an office in San Jose and you should consider making an appointment with either Dr. Pak or myself by calling 800-NEW-HAIR for a consultation.


2009-02-11 12:52:19Massaging My Scalp Causes Hair Loss!

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Are Dutasteride side effects less?

I’ve read many times before that libido improves in people who quit finasteride and use dutasteride. I think there was a study on this. I have also observed this myself. Has anyone noticed this before? Could Dutasteride be more tolerable? (I use it every 2-3 days)

Dutasteride is more potent then finasteride by about 15%. Logically, there should be more side effects. There are less publications on dutasteride side effects in men of hair loss age than finasteride by a long shot

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Matthew McConaughey and Hair Transplants

Dr. Rassman, I am concerned that your post about Matthew McConaughey is misleading. Do you honestly believe he had transplants? Here are two reasons why I think it is unreasonable to think so. First, he had a full head of hair in movies before and directly after the picture (showing hairloss) was taken. The only way he could have had transplants is if his hairloss was sudden and his regrowth was extremely quick. Second, the results are be too good to be transplants even if used in conjuction with drugs or anything topical. I’m sure transplants can make make a big difference, but not that big of one. If he did have transplants then the pictures of your work appear to pale in comparison to the kind of work that can be done. I don’t think your work is substandard to anyone. I think he uses a hairpiece. Are you worried at all that passing his improvement off as a transplant will give people unrealistic expectations as to what hair transplants can do and perhaps unduly persuade people to get hair transplants. Also, do you think hair transplant doctors may be attributing Matthew’s results to hair tranplants in fear of losing people to the hairpiece business?
Sincerely,
Concerned

Just to be clear for the readers of this blog, your question is in reference to the post I made back in May regarding Regenix and the role it may have played in the hairline restoration of this actor.

I have no first hand knowledge of Matthew McConaughey. From photos I have seen of him, there is obviously a big change in his hairline between the older pictures and his current presentation. If the change reflected a hair system, then it is a good one. In the movies, this is done quite often for balding actors, and there are people primping and grooming the hair piece just before they are on film to achieve the best possible look. If the change reflected a hair transplant, then he had a good hair transplant surgeon. Photographs show us what the photographer wants us to see. A hair piece (a wig) would be instantaneous, while a hair transplant would take 8 months to grow out.

As far as expectations, look at the change a hair transplant made in broadcaster Steve Hartman, as featured on the NHI website. The results were at least as good as a great wig, but since it is his real hair growing from his head, he doesn’t have to worry about the costly maintenance or smell issues associated with hair pieces.

I’ve posted links to these photos before, but they are worth reposting to show the dramatic change in Mr. McConaughey’s hairline.


2005-12-20 14:07:37Matthew McConaughey and Hair Transplants

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Are There Excellent Scalp Micropigmentation Companies That Do Believable, Subtle Work?

I think most micropigmentation looks silly and fake. I don’t understand why anyone would make that shit as dark as they do. Even the stuff that looks reasonable i hate. WHat happens if someone feels your head, expecting peach fuzz, but OH WAIT that’s your goshdang scalp. It’s a joke. I think the absolute best micropigmentation work I have seen is the incomplete phase, where the hairline is light, the color is light. It looks like hair COULD grow there, but you’ve shaved your head completely. Kratos from the new God Of War has a head that looks bald, but if you look very very closely, you can see that he shaves.

I also would NOT want a perfect hairline, that makes it look even more cartoonish and atrocious . Anyways, any pigment people that do this kind of stuff?

I teach Scalp Micropigmentation at international conferences for doctors every year, and have written many journal articles on it. Here is a video from one of my patients: https://baldingblog.com/newhiar-medical-patients-speaks-about-scalp-micropigmentation/ Additionally, here is one of the articles I wrote, which you should read because it will educate you about this process: https://newhair.com/wp-content/uploads/2018/11/Journal-of-clinical-and-aesthetic-surgery-Article.pdf


2019-11-22 15:47:09Are There Excellent Scalp Micropigmentation Companies That Do Believable, Subtle Work?