Tell me about post finasteride syndrome (PFS)

/by William Rassman, M.D./0 /

Please tell me about post finasteride syndrome, is it real? Is taking finasteride worthy it? Can you havd pfs for taking one to two months of using finasteride? your experience from finasteride? Thank you

If someone complains about permanent sexual side effects, to him it is real. Many doctors doubt the existence of PFS, but from the patient’s perspective, it must be recognized as a risk factor when taking finasteride for any reasonable length of time. I tell young men who have reported sexual side effect that it can’t be fixed with a lower dose, to stop taking the medication and as a result of this advice, I have never seen this in my practice patient population.

What should I look for when taking minoxidil?

/by William Rassman, M.D./0 /

Minoxidil common topical side effects are:

  • severe scalp irritation

  • unwanted growth of facial hair

  • chest pain, fast heartbeats

  • swelling in your hands or feet, rapid weight gain

  • a light-headed feeling, like you might pass out

  • headache, dizziness, confusion

  • flushing (warmth, redness, or tingly feeling)

  • Allergy, flaking of the skin, dry skin

Necrosis (from Turkey Patients)

/by William Rassman, M.D./0 /

The one photos that is labeled one month old, shows the area beyond the necrosis where maybe the scalp skin will survive, but the hair most likely will not.  The necrotic center of this lesion looks ‘angry’ to me which means it might have some infection around it.  The second patient shows a more extensive necrosis and I would expect all of the skin will not survive and be replaced by scar without hair.  Both men will need more work to fix this terrible complication which I believe reflects poor surgical management and anesthetic management with too much epinephrine

Dosing finasteride

/by William Rassman, M.D./0 /

Hi Dr. Rassman, best regards. I recently did a blood test as per recommendation of my doctor before starting fin. I have 0.41nmol/l of DHT (pre fin). Should I reconsider my usage of fin based on these results? 

The blood level of your DHT should not dictate the dose of finasteride that you take.  The dose curve shows that 1mg is the best dose, 1/2 mg is 80% as effective, and .25mg is 50% as effective as the full dose.  See the graphic that demonstrates it here:  https://baldingblog.com/finasteride-competes-with-dht-at-the-receptor-graphic/

7 months after FUE (photo)

/by William Rassman, M.D./0 /

This patient clearly had too many grafts removed from specific areas of the back of the head.  Even long, curly hair doesn’t cover it which is unusual.  You can imagine how bad it would look if his hair was straight and fine. His donor area is damaged and depleted

Terrible SMP (photo)

/by William Rassman, M.D./0 /

I felt terribly sorry for the poor man who went to a provider to get Scalp Micropigmentation as shown in these photos.  Hopefully, they can be removed with an appropriate laser.  Be sure that your provider knows how to do SMP by asking to see a few of his patients.

Microneedling question

/by William Rassman, M.D./0 /

Hello Doctor, may I ask if microneedling could induce hair regrowth in an area of the hairline that is completely bald?

I believe that it may be associated more with how long it has been bald there. If you are under 26 years of age, then the balding area might still have active stem cells but if you are 60, the stem cells might have died off by now.

Calling men “Bald” is Sexual Harassment in UK

/by William Rassman, M.D./0 /

Calling Men ‘Bald’ Counts as Sexual Harassment, UK Tribunal Rules – Bloomberg

https://www.bloomberg.com/news/articles/2022-05-12/calling-men-bald-at-work-counts-as-sexual-harassment-uk-judge

Rassman Opinion:  I believe that the context of the use ‘Bald” is the main issue.  If it is used as part of other derogatory smears, then it may be clearly used as part of some ‘harassment’. Many men use the ‘balding’ term as part of their conversations with me and I likewise, will use it in a medical or social context as part of my work and would not consider it sexual harassment when I ask a man for his family balding history.  Men use it as well, often in conversation without mal-intent.

7 months finasteride, minoxidil and microneedling

/by William Rassman, M.D./0 /

As promised I am entering in the 7 months with complete photos took each month.

Routine:

  1. finasteride 1mg every morning when i wake up

  2. minoxidil twice a day 

  3. zinc + D vitamin 3 months cure After dinner

  4. cafein + kératin 3 months cure After dinner for better absorption

  5. microneedling once every 2 weeks at 0.5 to 0.75mm with 16 needle dermapen . If i go more than 0.75mm = bleeding which i do not want

  6. 15mn head massage twice a month

  7. t gel shampoo once a week max.

  8. essentiel oil shampoo that i have made (Cedar + ginger oil)

Amazing!  This is strongly the work of microneedling  plus help from everything else.

 

 

11 months finasteride & minoxidil

/by William Rassman, M.D./0 /

I am very impressed with the results, especially the new growth that is evident over the past 2 months since he added minoxidil (you can see the 2 month growth because the hairs are short). He added minoxidil just 2 months before the last picture was taken and he is clearly a minoxidil responder

Body Keloids

/by William Rassman, M.D./0 /

This man developed keloids or extreme hypertrophic raised scars possibly from some infection on his chest hairs or some injury like a burn.  This is highly unusual in a Caucasian.  Nevertheless, there are treatments for this which he will need to seek out.

Doctors who perform hair transplants must be aware of the keloid or hypertrophic tendencies of their patients as this would be a terrible complication on the scalp from a hair transplant impacting either the donor or recipient area.  A small series of test grafts in an area where it can’t be seen, might give the patient and the surgeon comfort that a hair transplant will not produce such scars on a large scale if there is a history of such scarring.

How many FUE grafts are too many?

/by William Rassman, M.D./0 /

If I was to get a hair transplant but my hairloss progressed to the point I had to shave my head how visible would the scarring be at the back? Would I have visible white dots on the back of my head or do they fade

Scarring from FUE is inevitable; however, the amount of scar may not be enough to see it or make the donor area see-through. The scarring that you can see or the see-through donor area is the result of too many FUE grafts being harvested. If you think about the average donor supply having 12,000 follicular units (grafts in a surgical sense), then if you remove only 3000 of them, you are only removing 25% of the total donor supply. In a medium weight hair, that can be tolerated provided that the punch size used is not too large. But if you extract 6,000 FUE with FUE, then the numbers reduce by 50% and problems may arise, especially if your hair is fine in character.