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Hi, Dr. Rassman. Thanks for answering all of our questions.

My question is, How likely is it for someone to “settle in” to a level of hair loss (Norwood 3A, for example) and not see any more rapid loss for a period of time (years, for example)? Do some people get to a certain level of hair loss beyond a mature hairline and stay that way without medication? Or is your fate essentially sealed after you reach a certain level?

Let me clarify what I see as your misunderstanding. The Norwood chart is not to be seen as a progression of hair loss chart, but rather the final patterns seen in a large male population.

Some people do seem to go from a Norwood class 3 to a 4 and then to a 5 pattern, but you may just “settle in” to your Norwood 3A state, as an example. There is really no 100% certainty, but a good doctor with a good miniaturization study and examination can give you a better assessment of what hair may go with time. Here’s the Norwood chart so we’re all on the same page:

Your “fate” was sealed in your genetic code when you were conceived many, many years ago. Very few patients become a Norwood class 7 pattern, and even the balding patients who start as a class 5 may not go much further, even at the age of 100 or so. So for example, there’s no “point of no return” that says if you reach class 4 by this certain age, you’re guaranteed to be a class 7 later in life.

I have a question concerning today’s blog post. you mentioned that “exclamation point” hair is a sign of a disease but isn’t that what happens when miniaturization occurs in general? doesn’t the shaft get smaller, generally at the root first? that’s what’s happened to me. does this mean i have a disease? i doubt it. i got my thyroid checked when i first noticed hair loss and everything seems fine. i guess what i’m asking is, what’s the difference? thank you!

The term “exclamation point hair” is a term of medical art (see more info and a diagram at American Academy of Family Physicians). You are correct that as the miniaturization progresses (it would have to be rapid progression) one could theoretically see the reduction of shaft size, which is normally a very, very gradual process. It rarely can be picked up visually as you report.

With regard to sexual side effects, we have been led to think that topical Finasteride is safer than systemic Finasteride (the pill). However, from this post, that is clearly not the case. Stopping the medication should solve the problem. From what I gather reading your post, you are still using topical Finasteride. I would call your doctors and ask them about it.

How to and how long to recover from fin sides. from tressless

I am sure that this possibility was discussed in your informed consent document, and it should have been discussed with by your doctor. If it does not come back in 12 months or so after the eyebrow transplant, I would assume that it is lost. If I were your surgeon, I would bring you back to surgery and make it right with you at no charge, as I always attend to complications that occur as part of any surgery I do.

This is a photo of hairs that have shed. The hairs take on a J shape which means that the grafts were kinked when then were placed by the surgical team. There is always a question if these grafts will grow out as normally as those without the kink.

I had 2000 grafts into my two corners and now, 8 months later, it all looks thin. Is this a failure of the surgery?

Certainly, if each side received 1000 grafts, then this is not reflective of such a number of grafts. I would return and see your doctor as most doctors will ‘make things right’ and redo the hair transplant assuming that you still trust the doctor

I also experienced shock loss behind the native grafts (even with using Fin before, during, and still on now as a preventative measure). I think this hair is growing back, but there is still significant shock loss apparent. Online I’ve seen reports that shock loss hair should come back anywhere from 3, 6, 9, to even a year after. Should I still be optimistic that this shock loss hair will grow back, if there still needs to be more regrowth at 7 months out? Thanks.

The hairs that are lost from the shock loss depend upon what type of hairs. Those hairs that were miniaturizing will usually not return even at a year. If you are on finasteride prior to the transplant, shock loss can often be prevented, but normal hairs that might be lost will come back usually in 6-8 months.