Category: Uncategorized

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How does finasteride work?

I know how it works chemically. I mean in practice. I’ve been on finasteride for 4.5 months now and haven’t noticed any regrowth and my hair is starting to shed quite a bit again. I obsess over this every day and it’s destroyed my confidence. My hair is about an inch long right now so i think it would be difficult to notice subtle regrowth anyway. Most of the hair fall I’ve been experiencing lately has been pretty short hairs. Maybe about a centimeter on average. I know finasteride takes time to strengthen miniaturized hair follicles but I guess my question is, is it common for hair to start growing back and then just fall right back out? I’m wondering if maybe it can take a couple of growth cycles for the hair to actually be strengthened enough to grow out and stay without falling. Anyone have any insight?

Hair cycling between growth and rest, is mediated by an enzyme called 5 Alpha-Reductase which is present in small amounts and converts testosterone to dihydrotestosterone (DHT). Testosterone affects lean body tissue, muscle size, muscle strength, and sexual function in men. In men who are genetically predisposed to develop androgenetic alopecia (AGA; male pattern hair loss), endogenous androgens alter scalp hair follicles, resulting in production of vellus-like, miniaturised hair, rather than cosmetically significant terminal (normal, full bodied) hair. This change leads to a progressive decline in visible scalp hair density, readily perceived by the patient as thinning and, eventually, baldness. The benefit to finasteride occur over from 6 months to 2 years.

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When are the hairs in the head truly dead?

We generally think that people who have developed advanced balding and the skin has become ‘atrophic’ which means very thin with no fat (almost tissue paper thin) for many years, that the hairs that were originally there are no longer alive. We believe that the stem cells that produced hairs have died off in these people. But if you are under 35, you may not be in this category. The presence of miniaturization is very hopeful with the right medication and possibly new medications on the horizon


2020-08-08 09:54:32When are the hairs in the head truly dead?

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How Fast Does Hair Loss Occur?

Hi Dr. Rassman,

First, thank you for making this blog available. It’s great and tremendously helpful. Here’s my situation: I am 25 years old. My 65 year dad has major baldness and my mom’s brother have had issues with balding too, so my future is not good. My hair was normal until a year ago, when I graduated from university and got a job that’s stressful. Since then, my hair has been disappearing. The crowns are rising and my thick hair has become thin… losing about 40% in volume already.

Does balding happen this fast? And is it all this stress that I’m dealing with? I thought I’d have normal hair until my 30s, but I have to deal with this now unfortunately.

Thanks

If you have genetic hair loss, you should map out the scalp and hair for miniaturization and then (assuming you are genetically balding) go on finasteride (Propecia), which will slow down and possibly even reverse the hair loss you are experiencing.

There’s no one true answer to each of your questions. Everyone loses hair at different rates and stress can certainly accelerate it. Seek out medical attention, as the earlier you start treating it, the better will be your future with the hair you still have left.

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When Is a Good Time to Switch to Avodart?

Amazing website. I have been on finasteride for the past 12 yrs or so. It has held on to my hair quite well but I have noticed my temple areas and front part of my hairline thinning out recently. The crown is still slightly thick.

I want to know when is a good time to switch to avodart since I have noticed the front part of my scalp thinning out. Should I switch ASAP? I know its not approved for MPB and the risk could be slightly higher etc etc but I know a few of the people who comment on here have switched and are having excellent success even in the temple and hairline which is not very common.

Avodart must be prescribed off label (unless you have prostate issues), so it’s up to your doctor if he is willing to prescribe it to you.

The decision to switch from finasteride to dutasteride (Avodart) is one that you must reach with your prescribing doctor. Some people report better response with Avodart, but you must realize that the risks may be greater for sexual side effects and the possibility of sterility. Unfortunately, the information on this is not clinically available in younger men for treating hair loss, so it is a gamble.


2013-07-05 10:54:51When Is a Good Time to Switch to Avodart?

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How Long Do I Need to Wait After Injury Heals to Transplant Into It?

Hello Doctor,
Maybe a slightly unique question here… I have about an inch forehead scar in the hairline(above right temple side of head) I received from injury back in April, and had it revised with a scar revision procedure in June. Results are good (about 2 months into the healing/remodeling phase), but I’m facing facts here: I want the hair back where the incision-line scar is, no matter how less/ or barely visible the scar is overall…

My question would be at the 3 month mark here in September (if 3 months matters, as that is when I have my follow-up with the plastic surgeon who performed the revision at that time as well), would I be able go forward with the minor transplant without jeopardizing the healing scar? It’s primary (main) healing phase is already complete, right? So, would I be safe in getting the procedure done? Or could I jeopardize the scar or general healing phase of the area at all? Thanks so much for your help; I read your blogs frequently.

I would have no hesitation to transplant the area after 3 months have passed, but might be concerned at less than that time period. The basic scar healing should be complete by then. For those curious about the various phases of wound healing, check out this article.


2009-08-18 08:54:02How Long Do I Need to Wait After Injury Heals to Transplant Into It?

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When would I be a candidate for an FUE?

I have a few questions I hope you all can answer. What age would be reasonable for an FUE to be done? Do I look like a good FUE candidate? Where would I fall on the Norwood scale? My biggest question, if I was to have a procedure soon can I implant in my crown or just behind my widows peak (not purely bald area)? Thank you all so much!

At the age of 24, you may be too early for an FUE which I prefer to see in men over 25-26. I often recommend a year of Finasteride to see if it can be reversed (see here: https://baldingblog.com/2017/04/24/2-years-finasteride-young-man-early-20s/).

If you are a candidate for a hair transplant, find a good doctor who is honest and does not want to rip you off. Don’t let your doctor recommend a session that is too big. You can use me as a reference if you like to sound out the opinion. There are many good hair transplant surgeons but there are also too many who cause problems because they drive up the number of grafts for FUE and

(1) stress the donor supply;

(2) deplet the donor area; and

(3) cause problems in both the donor area and in the recipient area.

As the original inventor of today’s modern FUE surgery, I see many things being done out there that I don’t like. Consider sending me photos and we can establish a dialogue.

 

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How Long Will it Take from Consultation to Surgery?

Hey Dr.,

I’ve been a long time reader and you’ve even answered a couple of my questions on the blog in the past.

I’m 27, been on Propecia two years and am planning a trip to the LA area in the spring. I have a couple of questions, if you wouldn’t mind answering.

  1. If I set up an appointment with you and you deemed I would be a candidate for a hair transplant, how long would I have to wait before going in for surgery?
  2. In the same vein, what are the chances of being an ACell test subject? I know that it’s not fully proven, but I like the notion of it, and it seems less likely to leave a scar.
  3. If ACell is in the question, can you give a rough estimate of what the cost would be (I guess per graft).

Very much obliged for any answers.

Thank you for being a long time reader!

1. The time it takes from first consultation to surgery can range from the next day (rare) to one or two months. Patients who are candidates can set up surgery based on our open schedule. We have two pricing models. For those who want surgery at a specific date, they pay $6 per graft and can have surgery as soon as the next day (if the space is available). For those who are more flexible and can work with our schedule, they pay $5 per graft. If you are traveling from out of town, you can still take advantage of this by giving us a general time frame of your availability and we will give you plenty of notice to arrange travel and vacation time. We also offer a travel reimbursement program. For further info, you can read about our fees at our site or call (800) NEW-HAIR.

2. We are enrolling patients in an ACell auto-cloning study, but they need to be completely bald up top so that we can clearly document the growth. If you want to participate in the ACell scar minimizing study (where we put the ACell in the donor area) you are welcome to participate as well. If you don’t want to participate in the study but still wish to have ACell used in your surgery, you can just pay for the material cost of ACell itself ($600).

3. We do not have an official fee for ACell auto-cloning surgery, as we aren’t offering it to the general public (it is only a research study at this time). For the ACell scar minimizing surgery (NOT auto-cloning) we are charging for the material cost (see above).


2011-01-20 08:57:29How Long Will it Take from Consultation to Surgery?

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Why am I still balding with a low Testosterone?

When you have genetic balding, the genetically impacted hairs respond to DHT, is a byproduct of testosterone metabolism. Even a low Testosterone will still be converted by the liver into systemic DHT and working in combination with your genetics, you get the hair loss effect.