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Hi Dr I hope u are well

I have very thin hair on the top and front of my scalp, Ive been taking only Propecia since Feb 2008. Over the past 4-5 weeks I noticed an increase of the thinning but I havent stopped Propecia or done anything wrong. The only change was that I have been on a fast from Jan to Feb I havent been eating anything for most days just a small meal in the afternoons. Could that have affected my hair in any way? it is the only thing that has changed in my lifestyle. What can I do to get it back?

Thanks

You are asking a very general question. It is possible that your hair loss has to do with your diet and fasting. Malnutrition can cause hair loss. I would see your doctor and consider eating a healthier diet.

I am 25 years-old and had a hair transplant three months ago and all of my hair fell out that I had there before the transplant.

You developed shock loss after the surgery, a common event for young men. The prevention for this is the drug Finasteride which seems to work to prevent shock loss which can last almost a year after the surgery. Shock loss is an acceleration of the normal hair loss process and it is particularly dangerous for men in their 20s who have hair transplants.

Been to two different consultations now and want to decide between FUT and FUE. Both surgeons I spoke to didnt have a big preference between the two, which I was surprised by. They mentioned that with a skilled surgeon FUT scar shouldn’t be visible, as long as you care for it properly.

The cost difference is significant. For reference I have a really good donor area, NW4. If I have a thin scar in back i really don’t care, as long as it’s not huge.

Second question is that I dont want to take fin. I already have mild ED issues so I don’t want to risk it, neither does my soon to be fiance. Has anyone had success with HT and just minoxidil?

I have written extensively on my website about the differences between FUE and the strip surgery: https://newhair.com/. As the person who pioneered FUE, I am an authority on it. FUE is a great surgery if (1) you have a great surgeon doing it, (2) the surgeon who does it has good judgements on placing the distribution of the FUE excisions so that they are not clumped together and they don’t cause necrosis of the donor area and (3) they know how to handle the grafts to keep them viable for removal and until they are placed back in the head. Add to that, patient selection is critical as people with very fine hair and/or low density often make poor candidates for FUE. I believe that if you are going to develop a very advanced balding pattern, then the strip surgery is better because FUE causes donor site depletion when too many FUE grafts are removed from the donor area as shown here: https://baldingblog.com/collection-victim-photos-internet-harvested-depleted-donor-areas/

I have had 3 strip surgeries and I don’t have a scar that anyone can see. This man had about 4 strip surgeries and a few FUE surgeries and look at his donor area: https://baldingblog.com/norwood-class-7-pattern-patient-received-11000-grafts-plus-smp/. His scars were not very prominent but he had Scalp Micropigmentation just to be sure that nobody would be able to see them as the photos show.

Finasteride will prevent shock loss which is common in young men under 30.

If one opts for a transplant, is it still necessary to take Finasteride or any other medication?

Since hair loss is progressive, I generally recommend that a person having a hair transplant stay on this drug for life, provided that they don’t have negative side effects. In addition, the drug has value in reducing the risk of prostate cancer (the # one cancer in men) and also reduces the risk of heart disease by lowering cholesterol and possibly directly impacting atherosclerosis. To get the benefits of finasteride to avoid the shock loss, you should be on it at least 2 weeks prior to the transplant.

The first photo set is a woman who had her hairline lowered the day before these pictures was taken. Please note that the washing was so complete and the recipient sites so samll, that the recipient sites could barely be seen so I labeled the frontal view where a faint outline of the recipient sites show up. The hairline was extensively lowered which is the case when we often perform this hairline lowering for traction alopecia in the African American population. From the side view, there is almost nothing to see. Careful, small site recipient areas are critical to an undetectable transplant. For those who understand how difficult the African hair type is for a hair transplant (very kinky), the viewer should understand how beautiful these one day post-operative photos are.

The second woman is also one day after her surgery with a smaller distance for the hairline lowering surgery than the above patient. This was performed with an extensive restoration of her temple corners. Many women lose their temple corners as they get older and a rounded frontal hairline (which is a typical female hairline) is critical to achieving a very feminine look for many women, unlike men, on the other hand, who have high corner, V-shaped hairlines.

 

As a results of three trials, the American Heart Association and the American College of Cardiology (AHA/ACC) issued updated aspirin recommendations in March. They advise against routine aspirin use in people older than 70 years and those with increased bleeding risk. Routine aspirin may be considered in adults 40 to 70 years of age at high risk for CV disease with no increased bleeding risk, they state. “People may think that because it’s over the counter and it’s been called ‘the wonder drug’ for 30 years it must be pretty safe,” Susan Smyth, MD, PhD, told theheart.org | Medscape Cardiology. “Now we have to work to get the word out to talk to your doctor first before starting aspirin,” said Smyth, Gill Heart and Vascular Institute, University of Kentucky, Lexington, who is not associated with the current analysis. “As physicians, we are reasonably good at implementing guideline-directed medical therapy when we know something works. What we don’t do a very good job at is de-implementing when we learn that it maybe doesn’t work so well. De-implementation is much harder,” she said. However, she said, it’s equally important to remember that for patients at high risk and those with known coronary disease, aspirin remains a key component of lowering the risk of having a first or second heart attack or stroke. (Text taken from Medscape)

I am a 23 year old female with thinning hair in the front of my head. My mother and grandmother had it also. What can I do about it?

If the thinning is confined to the frontal part of your scalp and does not extend back to your crown, and if your donor area does not show significant miniaturization, and if you don’t have a scalp disease such as FFA or LLP, then I would consider you a reasonable transplant candidate as some women lose their hair in the front for genetic reasons. I would want to examine you first to make sure that you do not have other causes for the hair loss and that your donor area is healthy.