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As the doctor who pioneered the FUE, I can tell you with authority that 6000 FUE grafts will deplete your donor area and produce a see-through donor area. This is not a fixable situation as once the hair is moved, it will not regrow there. What is the doctor’s plan other than to get your money? What happens if you continue to bald over time, what then? Have you thought through this process?? If you are under 25, then you are about to make a terrible mistake.

Dr Rassman,

My question is: does finasteride play any role in maintaining minoxidil dose-dependent hair?

I got started on 5% minoxidil topical in early Feb, 2009. My derm prescribed Finasteride oral 1mg/day too, but I did not pursue that medication due to the usual side-effects related concerns. There was an initial minox-induced shed: not a massive one, but scalp showed. Things started looking up 4 months later but then again in July/August a bout of minor shedding ensued. Survived that too. In November yet another shed started and this one was bad; short fine hairs all over the pillow in the morning. Scalp showed yet again, as bad as after the first shed in March. In December, I panicked, decided that Minox wasn’t working for me, and got started on Finstaride 1mg.

By mid-Feb this year, there was a sort of minor miracle on the top of my head. My hair is looking its best in maybe two years. I hope you agree with me that it’s unlikely that Finasteride started growing hair within 10 weeks of beginning its use. My (semi-literate) guess is that Minox first grew “peach fuzz”, which gave way to intermediate hair, which then was replaced by terminal hair. I suffered synchronized sheds, the last one being the shedding of intermediate hair. Maybe more sheddings are in store for me, maybe not.

To get to the point, I am so pleased with the result that I’ve gotten greedy: I want Finasteride growth too. No sexual side-effects so far. I’d like to press on with Fin, and reserve the option of discontinuing it in future if side-effects show up. I understand that that would result in catch-up loss, but then probably I’d be content with the hair that Minox grew for me.

Hence the question: do minox and Fin have a cumulative beneficial effect on the same hair follicle? Will minox-dependent hair too be lost in catch-up loss if Fin is stopped? If the answer is in the affirmative, I’d probably be better off stopping Fin right away, since I’ve been using it only for 3 months.

Thank you for a patient reading, and thank you for your time.

You would have to poll each hair follicle and ask them what they liked better. If you can not communicate with them, then you are like me who frankly does not know the answer to your question. My best guess though (keep in mind I could be mistaken) is that because the medications work in different ways and finasteride will not keep hair grown from minoxidil and vice versa, that the benefits are independent of each other. Many men do use both medications concurrently, and as long as you can afford both (and maintain the regimen) I say go for it! It’s ok to be greedy and want your hair to look as great as possible. If the meds work well for you, that’s great news!

While it is unlikely that any major hair growth you’ve seen in just 10 weeks occurred from finasteride, you could’ve seen benefits from the medication that have helped your hair look better overall. The two drugs work differently. Minoxidil will grow new hair but the quality of the new hair varies in individuals from thin and poor, to strong and good (less than 15% of people). Finasteride probably does not grow new hair, but most likely works on the miniaturized hairs that we see in male pattern balding as it progresses. This is why finasteride (Propecia) will have no effect on the new minoxidil produced hairs. Minoxidil has not been shown to work on miniaturized hairs, at least that is what is presently understood.

In my general surgery practice, I met a man who had burns on his chest during an examination for an elective surgery. I asked him about it. He said that he got fainting spells with heart palpitations and one day he fell against the electric fence and it reversed the fainting spells and the heart palpitations. That was in the 1940s, so he put electric fence wires around his property and through his house and every time to had a ‘spell’ he would shock himself. I believe that this man actually discovered cardio-conversion before the medical profession did. The burns were from the electric shocks and his entire chest was covered with old and fresh scars. Don’t laugh at the value of electricity, it might save you life and your hair.

Doctor,

I had a hair transplant in July 2009. The physician completely re-constructed my anterior hairline. There was no hair growing there before he transplanted some. In September of 2009 I began monthly injections of 1ml of testosterone. I noticed my hair really filling in from the transplant until about 6 months ago. Since then I have noticed a definite thinning of my hair including the reconstructed frontal hairline which was exclusively transplanted hair. Is it possible that the testosterone treatments have caused the transplanted hair to fall out? I have been taking 1mg of Propecia religiously since the transplant, but it doesn’t seem to be making a difference. Thank you.

It is possible that the testosterone impacted the transplanted hair and almost certainly may have impacted the native hair that is present. If the hair transplants are falling out due to the testosterone injections, it might even suggest that the hairs used in the transplant didn’t come from the donor area (permanent zone in the back of the scalp). You need to discuss this with your surgeon, as he has the insights into your case and I only know what you told me above.

I realize you indicated that you’re not in the Los Angeles area, but if you make it out this way I would be happy to examine you.

The use of testosterone supplements is on the rise. The medical profession does not understand what this hormone does for men if they have a normal testosterone level but somehow, the male audience seems to think it has value (I do realize the body building community seems to see the value – at least in their marketing.). Certainly for the half of the population that has genetic balding, added testosterone will probably accelerate the hair loss picture for that individual. For this reason, I revisited this older post from a few years ago.

This patient had an FUE megassession surgery. When harvesting the FUE grafts, the surgeon must recognize the size of the donor area and limit the FUE extraction to the permanent zone as outlined in this FUE patient photo. The doctor who did the surgery on the patient in the photo did not understand the limits of the donor area.

The permanent donor area for a hair transplant begins at the bottom of the skull bone, known as the Occipital Notch, and extends upward two and half inches. This is the case for patients who will bald to a Class 7 pattern and sometimes to an advanced Class 6 pattern. This two and a half inch zone extends horizontally to just in front of the ear level. Hair was harvested for FUE from above and below this zone of permanent hair which in the long term will fall out by not standing the test of time. The hair below the permanent zone is neck hair and not scalp hair and this hair does not last.

QUESTION:

Why do doctors harvest hair beyond the permanent donor area as shown in the photo?

ANSWER:

(1) Because the patient wants a high number of grafts.

(2) Because the doctor makes more money by charging more for the larger FUE session.

(3) Everyone thinks it is safe and the hair will last a lifetime – Dead Wrong!

A word a of caution: some doctors will push the number of grafts within the permanent zone so much that the permanent donor area becomes a new bald area.

Buyer beware: it is your responsibility to keep the doctor honest and to make sure the doctor does what is in your best interest. This is why I shared this information with you. Good luck.

This man has shared some amazing photos of his 6 month course treating his hair loss. I suspect that if he keeps up on this the hair may all regrow. I believe that the microneedling was critical to the benefits he has seen here. He has used:

• microneedling 1x week @ 1.5mm
• .5mm fin (1x daily)
• minox (2x daily)
• peppermint oil (2x daily)
• keto shampoo 2x/week
• dht organic shampoo every other day or so.

The long term question that we don’t know is if the hair does all growS out, how long will it last? The experience is minimal for follow-up of this treatment in men, but I would guess, based upon human skin transplanted in mice with dormant human hair and microneedling, that the hair will last one anagen cycle and then fall out (an anagen cycle in a young man is about 2-3 years on average). At that point the treatment would have to start again, or alternatively a hair transplant may become an option if a restart of the treatment doesn’t work.

Is going bald even such a big deal. I know that many men could really care less about the way they look, the only reasons we keep our appearances up is for the ladies and for our professions. But there have been bald people throughout history, some of the sexiest men alive were bald. Do you think we are just becoming too vain and obsessed with our image?

Aging is a part of life and should be accepted. Today we here about older people taking anti aging creams, special diets, “get those 6 pack abs”, and so on. I think this is hurting us a lot and we many of us are losing our self esteem which is terrible. We should feel comfortable with ourselves.

Am i right? You Dr.Rassman are 67yrs old and look damn good for your age, there is nothing artificial to your image.

Why are we so self centered these days?

There are many reasons for this. History has shown that when men got sick (tuberculosis over the course of human history) they lost hair and died early, so when selecting a mate, women picked men who had good hair, because in the search for a husband they could not have a man would would die on them (not good for long term futures and babies). This had a great deal to do with prejudice against balding men. Men when they are in their 20s don’t yet have enough confidence in their manhood, so losing hair seems to exacerbate the balding problem. I’m not a psychologist or sociologist, but I am a surgeon that helps men improve their image… so maybe I’m the wrong person to ask a question like that.

Would it be safe to assume that you, the author of the above question, has no hair loss and no sensitivity to balding as a male problem? Do you think that George Clooney would look sexy as a bald man? If so, I have not seen him shave his head as an alternative style. I had someone on my staff do a quick Photoshop of what Mr. Clooney might look like bald and put it side-by-side with a typical look for the actor. Which do you prefer?

No, I don’t believe that there is any effort being made by the FDA or through the manufacturer of this drug to approve Dutasteride for use in hair loss. This would be a costly process for the drug company with great risks, considering that there may be more potential side effects than the financial rewards would yield.

I’m a 26 year old male, 157 lean, healthy diet, active lifestyle.

Many users may not want to hear this, but your lack of side effects may well be your ignorance of them. Finasteride affects your hormones, no argument—that is its entire purpose.

I used it for a year, and it 100% worked! Hairline strengthened, had a full head of hair, and even all grew faster. Body hair reduced as well for an added bonus. I was monitoring any immediate changes in mood/cognitive function/libido but sensed nothing different over the 12 months. This is only because they were so gradual.

I stopped taking it two weeks ago, I feel like I used to in college. It feels like I’ve always had a cup of coffee compared to needing to “wake myself up” before doing anything requiring thought or strength. I’m not sore as long after lifting, and I’ve already gained about 5 pounds of lean mass, as if my body was holding out on me all year. I’m sleeping completely through the night compared to waking up multiple times. I also am constantly horny again.

All these gradual changes I went through, I never noticed or completely rejected because I so badly wanted them to not exist. It worked, but just know you could be a better version of yourself (with less hair) if you hopped off fin.

Ignorance is bliss, however, and beauty is pain. I may start taking it again in the future, but I’m enjoying the DHT right now—it clearly serves a purpose in your body.

When you stop finasteride after getting good results from it, all of the benefits will be lost over a few months and if there was potential progression of the hair loss, you will see that too.