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Updated Propecia Info Says There’s Erection Difficulty After Discontinuing Treatment

Dr. Rassman

You have always been against the idea that propecia side effetcs may be permanent, and I saw you telling many people that the side effects as released by Merck are temporary and have been approved by the FDA. now it seems that there is an updated Prescription Information for Propecia. you can check it yourself at this link

among the most important changes are (in section 4, “Possible Side Effects”): “Persistent difficulty having an erection after discontinuation of treatment.”

Anything to comment? Thanks

Interesting, but the information lists that under the heading “Frequency unknown“, which leads me to believe it must be extremely rare. I have no information on this and have never seen it in my practice. I wonder about psychological impact on those that are affected.

The PDF you linked to appears to be for the Austria, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Portugal, Spain and Sweden markets… and Merck doesn’t seem to have the same information in their US pamphlet. I really could only speculate as to why that is the case, though.

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Hair transplant ideas for a 28 year old man

Here are some considerations I’ve had before jumping into the HT route and wanted to share these with the community to get feedback and possibly provide some additional options for those in a similar position:

Background on me: 29M diffuse thinning throughout top of head. Finasteride/Minox for the last ~6 years that has slowed, but not stopped hair loss. When I first began noticing hair loss, I always considered a HT a possibility, but now my hair has progressed to where I think it may be appropriate to start considering it as an real option.

Everything you’ll read on the hairloss forums essentially boils down to the fact that getting a HT is a one way street. In almost all cases (especially if you are young) you will need a total of 2-4 surgeries. You will need to be financially and mentally ready for that. Even after that, you may not get the results you were really targeting.

The biggest hang-up for me, and undoubtedly for some of you, is that there’s not really any going back from the HT route. Regardless of if you go FUE or FUT, there will be scarring. If you get an unsatisfactory result, you will not be able to completely shave your head down without exposing those scars.

Here is the plan that I’m circling towards and may offer an avenue for some of you as well (I think this may be partiucularly suited for diffuse thinner like myself):

  1. Go for an initial moderate-large size FUE procedure (2.5K-3.5 grafts). I’d really only go with this if you have the funds to go with a top surgeon

  2. Enjoy your denser hair for 5-10 (hopefully!) years and then go for a second FUE procedure as age takes its toll and continues to take your native hair

  3. At this point, in all honesty, you really won’t be able to shave your head with all the FUE scarring. If you still have areas that you’re not happy about, I think it’s wortwhile to look at SMP (maybe temporary at first) into both the FUE scars and in the transplanted recipient area. This helps boost the illusion of density even if you are out of available donor grafts.

I think having a plan for that 3rd step is crucial because there are so many results on here and the forums that end in regret and the person gets stuck because their result is sub-optimal AND they can no longer shave their head due to the scarring.

Hoping to discuss this plan with all you on here perhaps give me something else that I had not considered.

The Master Plan I always discuss with my patients is what happens now for the near and distant future. If hair transplants are in the future for you, you absolutely must know your donor density (a number) which will will deplete with each hair transplant. For FUE, the limit is half of the number as for a strip surgery and if you are not aware of this, then you could end up deformed as I often discuss on this site.


2019-04-08 13:24:38Hair transplant ideas for a 28 year old man

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Using Apple Cider Vinegar After a Hair Transplant

Is it safe to use Apple Cider Vinegar on the scalp after Hair transplant. I had hair trasplant two months ago, and I love to use it because it makes my hair soft and eassy to manage. Does it damage my new hair follicles that were implanted? Hope to hear from you soon. Thanks

I tell patients that after a week or so following a hair transplant procedure, you can do whatever you like with your hair and your transplants. For those that are curious, apple cider vinegar is apparently used as a holistic “cure” for a wide variety of ailments, including allergies, acne, high cholesterol, flu, arthritis, and acid reflux.

It likely won’t benefit your hair transplants, but I doubt it will hurt them either. I certainly don’t subscribe to the idea that vinegar will cure all of your troubles, but you can read more about it here.

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Using Minoxidil After a Hair Transplant

Hi,
My concern is about minoxidil use hair transplant post-op. I have searched online and have come across concerns about red irritation on the hair transplanted area with the use of minoxidil but haven’t come across an answer if i should stop or not.

I have irritation and it gets red and kind of hot as if i am having an allergic reaction to it. I have discontinued the use and it seems to go away, but will it stop the growth of my hair? PLease help… i can’t seem to find an answer anywhere.
Thanks

Minoxidil does cause a pink discoloration to the scalp, as it is a known irritant in some people. Stopping the minoxidil will not stop your newly transplanted hair from growing.


2006-02-13 11:11:07Using Minoxidil After a Hair Transplant

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Hair transplant, no artistic feel, not normal looking hairline (photo)

This is an unfortunate example of a young man who had a hair transplant by a doctor who did not have a sense of either art nor a sense of what constitutes a normal hair transplant. The grafts are all lined up and they appear equal in size. What should have been done is that the grafts should be more randomly placed and the leading edge should have been created with single hair grafts (usually 400 or so) to create a transition zone in front of the hairline so that the patient ends up with a no-hairline hairline instead of a discrete hairline as this unfortunate person will have. This is easy to fix but it requires another small surgery.


2020-09-01 10:00:49Hair transplant, no artistic feel, not normal looking hairline (photo)

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Using Smaller Needles in FUE?

Hi Dr. Rassman.
Why doesn’t the surgeons use a small needle? I have seen needles reported down to 0.4-0.6 mm. This should be good for less scarring in the donor area.

One doctor proclaims that he does hair multiplication and he also claims that he uses less invasive surgical instruments.

Thanks

Be careful not to believe everything you read. A 0.4mm punch for follicular unit extraction (FUE) is very difficult and I would doubt repetitive in each grafts. I would like to see the results he gets and examine the grafts before I believe what I am told. I have done this on a number of occasions, and you would be amazed at what I found.

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Hair Transplants with Scalp Micro-Pigmentation (with Photos)

This is a hair transplant patient who wanted his hair thicker, but had depleted his donor supply so that more transplants would not be productive. Many doctors would try still another procedure, but this was not my approach. Instead, I put pigment into the areas where he wanted more thickness. He loved the results of his transplants for his Norwood class 6 pattern and over the years he received a total of 6,905 grafts for that pattern, but as with many patients who have advanced hair loss, the supply did not eventually sustain the demand for hair.

With the addition of scalp micro-pigmentation (SMP) to augment the fullness, he felt that the results were exceptional. After his first SMP session he used a hat, but slowly and cautiously he showed off his shorn scalp to his friends without creating much fanfare. In a social setting, his friends saw the new look and all he got was compliments on how good he looked with his new hairstyle.

The first photo (left) is of the patient’s hairline after all of his transplant work (last procedure was almost 4 years ago); The next photo (middle) is immediately after shaving his head; The last photo (right) is 2 weeks after his first SMP session. Click the photos to enlarge:

 

He came in for his second touch-up SMP procedure, but this time we went a little denser with the pigment. The key in the plan I put together was that the SMP would be placed in behind the leading frontal hairline that we created with transplants so that he could let his hair grow out whenever he wished. As the interval between the first and second procedure was 2 weeks, he let his hair grow out over that time to sense what it would look like when he let it grow out long. He could not have been more pleased with the result! I’ll post some photos of the results in the coming weeks.

Since my post from last week, I have come under fire on some forums and even on this site for changing my stance on scalp pigmentation (from being somewhat negative in past posts to my current enthusiasm). Really, the change in my view reflected a better command on the art, something that I hadn’t previously seen when I made my earlier comments about the tattoos that I saw in my office over the years. I realize now that I should’ve been more open-minded to possible advancements.

Nothing is perfect in this world. This patient would have rather gone the transplant route or have taken a magic pill that would get him his hair back, but it was not a reasonable option for him… so as a second best option, SMP more than met his goals. Now I must note that due to his nearly 7000 grafts that were transplanted, he does have a linear scar in the back of the head. We’re still working with him to cover it with SMP and will post resulting photos soon.

—

Update Mar 8, 2011: More photos here!


2011-03-08 13:08:05Hair Transplants with Scalp Micro-Pigmentation (with Photos)

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Value to Saw Palmetto in preventing hair loss?

I have recently started oral minxodil, are there any adverse effects to combining saw palmetto and OM? Would I see no change or could I possibly see improvement with them in tandem?

Saw Palmetto has no value as a DHT blocker and, thus, in preventing hair loss.

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Hairline Advancement Surgery Scar (photo)

This patient had a hair line advancement surgery to move her hair line down. It will require hair transplanted grafts to bury this scar, so it will not be seen.


2018-06-22 10:33:18Hairline Advancement Surgery Scar (photo)