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Statistics on FUE (Follicular Unit Extraction) / FOX Negative Patients

What are the statistics of FOX test negative patients ? Is any ethnicity ,age , hair color or hair character more prone to be more FOX negative ?

Follicular Unit Extraction (FUE) when it was popularized in 2002 at the ISHRS meeting (Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation) did not have a popularized name. We thought FUE (“foo-yee”) was not a very sexy name. Thus we called it FOX (FOllicular unit eXtraction). We identified many patients where FUE or FOX techniques did not work. We published the problem in 2004 with “FUE Megasessions – Evolution of a Technique“.

Over the last 10+ years many doctors have (and continue) to improve the FUE method but the FOX negative patients still remain a challenge. Some (patients) are not the best candidate for the FUE method of donor hair extraction with a high percentage of transection. This is true with even the new ARTAS (robot FUE). Techniques and instruments may improve but the patients are still FUE-negative where their transection rate is too high.

There is no firm data or statistics we keep. There is also no collective data of information by doctors in the hair transplant field. In fact, many would say they don’t really have FOX negative patients for the sake of their reputation and marketing.

In my private practice, our techniques have improved and we have our own proprietary instruments. We also have the ARTAS system. There are still FOX negative patients and we still do the FUE/ FOX test to screen patients before surgery.

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Statistics on Balding Men Who Seek Treatment (From Reddit and the 2010 Census)

I am not surprised about these numbers. Most men deny their balding, and I believe that almost all men care about it and would prefer to have hair. You can see the embarrassment of Donald Trump about the facts that he takes Finasteride, and this is not an unusual issue for being embarrassed. Men, unlike women, don’t like to recognize that they are vain. Accepting that they are going to treat their hair loss makes men uncomfortable. Assuming that these statistics are real (they seem too low to me, but may be correct), the number of men who seek hair transplants is probably 2% of the 5% who actually get proactive. There were ~160,000 hair transplants in the US in 2016. Considering that hair loss is present in 50% of men over 45, and probably 30-40% of men over 25, and considering that the number of men between 25-44 years of age are 49 million, 44-54 years of age are 30 million, and 54+ are about 32 million as of the 2010 census, there are a total of roughly 133 million men in these brackets in the US, half of which have male pattern balding at some level. Considering that there were only about 165,000 hair transplants in the US, that means that only about 0.00124 % of men has had a hair transplant in 2016.

Only 5% of balding men see a doctor about it and a minority of them (28% of the 5%) try to treat it. from tressless


2018-05-23 08:51:49Statistics on Balding Men Who Seek Treatment (From Reddit and the 2010 Census)

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Statins do not cause cognitive decline

One of the great unsubstantiated claims that when treating high cholesterol blood levels with cholesterol lowering drug that these drugs caused premature dementia or a generalized reduction of congnition (memory function). A new study in 1000 people in Australia reported here:

Australian investigators followed more than 1000 older adults over a 6-year period, assessing memory and global cognition at 2-year intervals. They used MRI to evaluate total brain volume, as well as the volumes of the hippocampus and parahippocampus.

They found no difference in the rate of decline in memory or global cognition between statin users and nonusers, nor did they find differences in brain volume changes.

This is important because it addresses concerns about the safety of Statin Drug from various sources.

Source of Data: Medscape Medical News

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Starting to Lose Hair at Age 19

Hello, I am 19 years of age. Over the past year I have found that I have lost alot of hair. All my life I have had thick hair. my whole family has relatively high hairlines, even my 13 year old brother. I have always had one although there was always alot of hair around the hairline. In recent months my hairline has been receeding noticably and I have found that hairs have come out when showering, sometimes just randomly in the day, and I find them in my mouth. There are no patchy bald spots. However the hairline is extremly thin and around the crown it has also thinned out. Even the hair at the sides do not feel half as weighty as they used to. I used to badly need a haircut every two weeks, now although I still do at times, it is more in the vain hope it will make my hair look better. It is whispy looking on top also. I also find my scalp feels odd although this could be in the mind. It has all happened suddenly.

You need to have your scalp mapped out for miniaturization to determine if you have genetic balding. If you do, it will follow a pattern much like those shown on the Norwood chart, as your hair starts to thin in these patterns before it becomes bald. Over 50 years ago, General MacArthur said, “Old Soldiers never die, they just fade away”. I will rework his quote by saying, “Hair never dies, it just fades away”. Some day, when hair cloning starts up or we figure out the missing link in the pathway that stops the hair from cycling in the normal manner, we might be able to revive those hairs that are present even in the baldest of men, but at age 19, lets start to crawl before we walk. Don’t live in fear of what may not be. Get a good doctor to diagnose you and then treat you appropriately, if treatment is needed.

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Starting to Experience Side Effects After 17 Months on Propecia

Hello Doc,

I have been a frequent reader and an occasional poster on your blog for a while now. I have been on finasteride (1 mg) for the past year and a half with mixed results. The drug has definitely slowed down my hair loss to an extent and could have also initiated some regrowth in the crown area. Of late (for about a month now) , I have been experiencing some sexual side effects that I had never experienced during the past year and 5 months. Although I do not want to discontinue the medication (since it seems to be working) I am apprehensive about the long term ramification of these new developments. Under the circumstances, would you recommend reducing the dosage from 1 mg a day to 0.5? I might have come across a post on this blog, where you had mentioned about virtually no difference in the potency of the medication at dosages of 0.5 and 1 mg (I might be wrong). It would be great if you could respond to this query.

Thanks for your time and keep up the good work.

I am not your doctor and Propecia is a prescription medication that a doctor needs to prescribe to you. You need to ask this question to the doctor you get your prescription from. You should ask your doctor about changing doses in your medication. As for the reduced dosage, I’ve read a study that cites about 80% effectiveness with 0.5mg.

There may be other issues (not only the possible side effect from Propecia). Some men (even in their 20’s) experience impotence, decreased libido, etc, WITHOUT any medications. These issues are not discussed openly in public, because of their sensitive nature… but it does happen. Find out if your issue is due to Propecia or other medical or psychological issues.

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Starting dutasteride instead of finasteride

The safety of dutasteride in young men with hair loss has not been determined as this drug is not FDA approved. Start with finasteride which is almost as effective (70% vs 85% of the competitive inhibition at the hair follicle level)

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Starting the Drug Finasteride Slowly Over Week, Is That Reasonable?

Can I start building up the dose amount or frequency over time? e.g. I’ve heard of people taking it EOD at first, or of amounts much smaller than 1mg. But I don’t know what’s safe in that regard, or if there’s any point in, say, taking 0.5mg a couple of times a week at first before building up.

Yes, you can start on a single pill (1mg) every fourth day for two weeks, then every third day for two weeks, then every other day for two weeks. If you don’t see any side effects, go directly to one pill every day.


2018-06-21 13:24:17Starting the Drug Finasteride Slowly Over Week, Is That Reasonable?

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Starting and Stopping Propecia Multiple Times

Dear Dr. Rassman,
Thank you very much for maintaining this very informative and detailed website. I would sincerely appreciate your advice regarding my propecia therapy. I am 21 years old and have been taking propecia since July 2007. After the first 6 weeks on the drug, I noticed a complete cessation of hair loss. I subsequently discontinued the drug on the very poor advice of my father, an internist with little experience with finasteride treatments for MPB. I then restarted the drug about 2 months later, and again noticed complete cessation of hair loss within several weeks. I stopped taking propecia a second time, again on the advice of my father. Once again the hair loss returned within a few weeks.

I went back on propecia in late December, and have been taking it for the past 8 weeks. Unfortunately I have not noticed any change in the amount of hair I am losing. I am wondering if you would kindly explain the mechanism of this phenomenon. Have I induced resistance or tolerance to propecia in my hair follicles? Have I upregulated the expression of DHT receptors on the follicles? Is it possible that my estrogen levels or testoterone levels are relatively higher than they were when I started treatment several months ago?

I realize that I have committed a very grave error in discontinuing my propecia on two separate occasions. Have I irrevocably lost my responsiveness to the drug, or will it likely prevent further hair loss? Fortunately my hair loss is still not noticeable, and I would be happy simply to retain what I have.

With best wishes,
A stressed-out medical student.

It is often surprising how little doctors tend to understand about hair loss and its treatment. If you are playing with this drug, you allow the hair loss to continue its downhill course each time you stop taking it. The hair that you lose when you stop taking it may be lost forever, so stopping the Propecia intermittently may just set you up to a progressive lower hair count over time. Perhaps you were just in a rapid state of hair loss. Whatever is the cause of your situation, from a mechanistic point of view, you MUST continue on this drug for life. Stopping it allows you to play catch-up hair loss and eventually you will just progress further down the balding road.


2008-03-06 17:08:02Starting and Stopping Propecia Multiple Times

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Started Taking Finasteride When I Had No Hair Loss — Now I’m Scared to Quit!

First of all I would like to thank you doctors for allowing time out of your days to answer questions. I began shedding more hair than normal 3 years ago at age 22. I received the opinion of two dermatologists that I was not experiencing male pattern baldness. Even with these opinions I became paranoid based on the increased shed and my maternal grandfather and uncles baldness so I began using finasteride.

I showed no visible signs of hair loss then and do not now at the age of twenty-five. I am scared to stop using finasteride because if I am genetically predisposed I know I will lose what I have prevented the past three years. My question is, based on my age and beginning the treatment early do I have a good chance of keeping my hair well into older age and is it worth suspending the treatment just to see if I need to be taking the drug or not?

Paranoia is clearly not a good reason to take a prescription drug meant for treating something you might not even have.

At 25 years old, you still might see hair loss if you have the genes for it, but I have no way to know if finasteride is protecting your hair or if it is an unnecessary daily medication. I would see a doctor first and foremost, so that you can have an exam and any hair loss that is observed can be noted. Your doctor may decide to discontinue your medication and just have you keep your fingers crossed that there’s no loss that finasteride was delaying.