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Is Shock Loss Permanent?

In the interest of keeping things as private as possible, I have removed the Doctor’s name from this email I received…

Hi Dr. Rassman,
I read your recent comment about young guys under 30 years old who get an HT and are not on Propecia. I fit into that profile. I recently had a HT with [another doctor] and its 4 months post -op now. had a lot of shockloss of original hair post op and am really concerned now that I read your comment online [see: Hair Loss After Transplants]. Since I had sexual side effects when on Propecia, I had to quit it and cannot tolerate being on it.

I received a total of 3366 grafts in total. Am attaching Before Hair transplant pictures with this email and 6 weeks post op pictures. According to [my hair transplant doctor], he feels that the shockloss will mostly come back and eventually I will have good results. He recently asked me to take Saw Palmetto and see if I can tolerate being on it. Started taking 320 mg of Saw Palmetto twice a day recently.

Please advice what I can expect from the procedure. Do you think that I will permenantly lose a lot of original hair that has fallen due to shockloss for good? Or will it mostly come back?

I’m seeing growth in the 4th month but not sure if the shockloss hair is coming back or it is the new grafts that are growing in. To highlight my case, I mostly had diffuse thinning in frontal 1/4 of my scalp. The hair that was there was strong and had a thick shaft, there might be other miniaturized hairs, but looking at my pre-op pictures you will get an idea of the state of the existing hair follicle.

Thanks a lot for your time and effort.

My current regimen includes : minoxidil 5%, topical Spironolactone 5% cream from Lee’s, 3000 Mg of MSM, 2% Nizoral trice a week, Recently added : betnovate topical lotion, 320 mg Saw palmetto twice a day, Folligen lotion.

I have had an opportunity to review your questions and photographs. For our general audience who are reading this, I will summarize the salient points.

You appeared to have a large surgical session with dense packing based upon the number of grafts reported by you. The frontal area appears to have been shaved for the procedure and the growth of the hair does not reflect the normal growth that one would expect in 3 months. This is a case of hair loss transplant shock in a young man, just as my previous responsive email reported to another young man. There is a possibility that the hair that you lost may come back. Most likely though, it will not return. Other medications have not been shown to be effective (like Propecia). In people like you, I generally try to cover the short term transplant period with half of the Propecia dose, even if it causes some drop in sexual performance just to protect the hair.

The good news however is that the new grafts that you had done should (hopefully) more than offset any loss you may have. You will know reasonably well at about the 7-8th month by comparing the two sides. The left side that seemed to suffer more of the reactive hair loss needs to be compared to the right side. If the hair loss was reversed, the densities of the two sides will be the same. Please drop me a line or send me photographs at the 7-8th month and I would be happy to give you further insights. Good luck.


2005-04-20 15:38:33Is Shock Loss Permanent?

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Is the number of harvestable grafts a lot higher if the patient caught MPB early and immediately started taking action (anti-androgens)?

No, the number of harvestable grafts are fixed for your lifetime and depend upon your original donor density which the doctor can measure. That is why we are careful about what we take from the donor area when we do a hair transplant. As the limit for a typical Caucasian is about 7,500 grafts, then as this number is drawn down, it can’t be replaced and eventually there is no donor hair left. This is my concern in Turkey where they will take out 6000 grafts in a single session, leaving almost nothing left for future balding (which is almost a certainty) and they do it all with FUE, but most people can’t handle more than 3,750 FUE grafts before they start looking bald in the back of their head (see: https://baldingblog.com/collection-victim-photos-internet-harvested-depleted-donor-areas/.

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6 weeks minoxidil, finasteride and microneedling

I am 37 years old and had this balding for 10 years. I started using 1 mg PO finasteride daily 1 ml topical minoxidil twice daily 1 biotin vitamin daily, Saw palmetto shampoo, plus 0.5 mm micro needling at home 2-3 times per week.

I would increase the microneedling needles to 1.25mm and reduce the treatments to once a week. That depth gets to the stem cells that control the growth of the follicles to react to the wounds. You also might consider switching to oral minoxidil. Speak with your doctor. The photos suggest that the stem cells are still there and alive, so push the depth of the microneedling t where the stem cell reside.

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Is there an alternative to finasteride?

I’ve been on finasteride for 3.5 years. Without it l would be fully bald by now (25) and it’s allowed me to keep a good amount of hair. Generally doesn’t look like l am suffering from hair loss. A bit thinner on the top but decent overall thickness.

I’ve had enough of taking the drug. I have come off it several times during those 3.5 years and l feel remarkably better off it. I feel more significantly more virile and energetic. When l take Fin my libido drops, brain is foggier and l just don’t feel as good. My face is rounder and less defined as well.

Are there alternatives to Fin that work?

Oral minoxidil is an alternative but considering that you have excellent results from finasteride, why mess with the results and risk loss?

 

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7 months on dutasteride (photo)

This is a very nice reversal of frontal corner recession with dutasteride. He may have had the same result on finasteride.


2020-12-18 08:50:597 months on dutasteride (photo)

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Is this hairline too low? (photo)

A hair transplant surgeon is always motivated to meet his patient’s agenda. I have done such hairlines in men when pushed to do so. Many were actors that had an image that they needed. The fact that it could be done is critical and other than being very low, it still has a gentle V-shape and is found (at the mid-line) in his juvenile hairline position. Many people would find such a hairline too low. (taken from Reddit post)


2020-01-28 06:33:56Is this hairline too low? (photo)

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70 year olds with balding crown get hair growth

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ISHRS Australia Meeting 2005

I recently read on one of your previous blogs that you would be attending a international hair restoration conference at the end of the month and would comment further on avodart, mainly if you would begin prescribing it. I’m just curious if you have any further comments?

I apologize for not posting this response sooner. There were too many exciting events happening at the ISHRS 13th Annual Meeting for me to describe everything to you. For those that may not be familiar with this event, it occured in late August 2005 in Sydney Australia. I do recall there was some discussion about Avodart which may appear to have better result than Propecia. Unfortunately, there was concerns about whether Avodart persists for a significant amount of time in semen, which may have an unwanted affect on development in the male fetus. Currently, there is no FDA approval for Avordart to treat male pattern hair loss. I am somewhat perplexed about why GlaxoSmithKline, the drug company producing Avodart has suspended further tests for treatment of male pattern hair loss, but that would be a better question to ask the drug company.


2006-01-18 09:21:13ISHRS Australia Meeting 2005

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Over 8000 FUE grafts left this man almost bald in the donor area (photo)

Never ask for 8000 FUE grafts. Unfortunately, too many patients want more hair and forget that if they take it from the back and side of the head, what is removed to fix the balding front, top and crown will be gone forever. Now this man traded a bald look in the mirror (I am assuming that the transplant was successful) for a bald back and side of his head. Not Good!


2018-12-18 11:25:26Over 8000 FUE grafts left this man almost bald in the donor area (photo)