Hello Dr., I have been using minoxidil lotion for two months now. I do not suffer from any systemic side effect as yet. BUT, every time I apply it I have noticed that I ,almost immediately, with in minutes experience a little bit of strain on the skin under my eyes. When I look in the mirror it appears that I have developed dark circles. With continuous use I notice fine lines and dryness on my face. Now to avoid this I have started applying the lotion in supine position while rubbing the tip of the dropper on my scalp. I stay in that position at least for next 20-30 minutes. This is to make sure not even a trace of medicine flows down on my face. But still I have the same sensation on my face. All these effect however disappear even if I discontinue the medicine even for two days. This has been a repeated experience. Any comments?!! Do other patients also complain about the same problem?

This is the first time I have heard anyone report this. I can not understand it unless the medication is actually landing on the skin of your face or around the eyes. There are reports of local skin reactions to minoxidil that ‘irritate’ the skin. Some of the medication can be absorbed through the skin and drop the blood pressure a little and this is a transient effect that does not last long. Maybe this medication is not worth the trouble it is causing you. Clearly if you stop it, it goes away. Is there are real benefit worth the problems you are experiencing?

Your office is not that far from the famous Muscle Beach. Do you get many of the hardcore bodybuilders in for hair transplants? And taking all of those steroids…wouldn’t it be courter productive or should I say maybe a waste of time to get the hair transplant for those prone to baldness anyway or do they just take of more and different drugs of the estrogen blocking nature?
The reason I ask is that when I was in my younger days when I first really started loosing my hair( after two knee surgeries by the way???)I started weight lifting/bodybuilding to conpensate for my emotions concerning my hair loss, I had a rough time dealing with it. So I was tempted to take them (back when they were legal)but after reading about the hair loss side effects I changed my mind. Does the transplanted hair suffer from heavy steroid use or does it stay protected? Thank you

I believe that the permanent zone hair (the hair we transplant) is protected from steroids. The other hair that is not the rim hair around the sides and back of the head can be ‘killed off’ with steroids in those genetically prone to balding.

Yes, we see many, many weight lifters who have accelerated their hair loss and like you, panic when they see it falling out. The high they get from the steroids and the benefits in the sport, seem to offset the liability for most of them.

What is the growth success in 100 grafts that are transplanted?

This is a good question. We really do not know exactly. I suspect that the growth rate success in our hands is over 90%, but it is almost impossible to count the transplanted hairs and compare their numbers to what was moved.

I have had opportunities to transplant a limited number of hairs in a scar, or an area of the head that was easy to separate from the rest of the areas and when I counted them, they all grew. I do test grafting in people with Alopecia Areata when I believe that the disease is inactive. In those patients who have inactive disease, I put in about 20 grafts into various areas of a bald patch of scalp. If the disease is really inactive, all 20 grafts are counted after some 6 months. I do the same for some burn patients where the scars may not support the grafts. When the scars can support the grafts, all grafts are then counted and if one grows, they all grow. This experience does show what is probably the case in our typical hair transplant sessions.

What we stress is a quality control process to minimize those factors that can cause hair loss in the transplant process. For the natural hair that is still present, we use drugs like Propecia before surgery. Various technical systems are enforced which guarantee that the grafts do not dry out (the leading cause of graft death), gentle handling (the second most common cause of graft death) and very experienced technicians (we have no turnover of clinical staff). A good transplant with a high success rate depends upon good team work with employees that know how to work together. Just like a good football team, every player in every position must work at peak efficiency to win the game. Winning the game in hair transplantation is a combination of 100% growth and good esthetics. This is why we show off our patients after their procedures at our open house events and also have a live surgery so that you can see, first hand, what will happen to you both in surgery and then 8 months later.

a short while ago, you answered a question on the use of Propecia in women. It was your feeling that this drug is not indicated in women, yet some doctors are using it in women. Are there any indications for female Propecia use?

There is no long term studies on safety in women for Propecia, but there are certain conditions that cause a woman to make a great deal of male hormones and as such, may actually develop a male patterned hair loss. In these diseases and only in a woman past child bearing years, a trial of Propecia may be indicated, but the patient must be made aware of the possible appearance of conditions that ‘theoretically’ may develop which could impact the breast, uterine and ovarian organs. For example, cancer risks have never been studied when a women is placed on Propecia and those women who are genetically prone to breast, uterine or ovarian cancer may find themselves at greater risk.

Are doctors still using the plugs that I see on the street, in the malls and at airports all of the time?

Not as a rule. The old plugs that gave this industry a bad name in the 1970-80s have largely been replaced with small grafts that are called follicular units. But there are some doctors that use ‘combination grafting’ which is a mixture of larger small grafts and naturally occurring follicular units. Only the follicular units are undetectable in bright light or close inspection.

What is the best product for thinning hair and small spot on the top of my hair. Thanks

If there are many small spots of balding, then a visit with a doctor is critical because you may have a medical problem that requires expert insights. If you are a man, I am assuming that you are talking about male pattern ‘genetic’ balding. Both Propecia and Minoxidil may work. Minoxidil, applied to the balding area like a lotion, can be purchased over the counter in many stores. Propecia, a daily pill, requires a doctor’s prescription. Propecia, made only for use by men, can stop and even reverse the hair loss in some of the younger men.

How long will it take to find out if Minoxidil will work?

Minoxidil usually produces hair in about 4 months, peaking at possibly a year.

A BaldingBlog reader named Greg originally posted this as a comment to a blog entry, but I’ve formatted it to make it easier to read and have reposted it here.

The FDA has found Avodart to be safe (for BHP). The side effects were very simliar if not a tad less then Proscar 5mg, which also was cleared by the FDA many years ago. I think Avodart should be indicated as a off label prescription in some instances.

  1. non-responders to Propecia
  2. When the loss of efficacy of Propecia becomes bothersome to a indivdual

One other interesting point is that the age group the FDA studied on Propecia (18-42) was quite younger than what Proscar/Avodart (50+ median age 66 approx) so the chances of sexual side effects will inherently be larger in this age demographic as opposed to Propecia… meaning the side effects are probably even closer then one thinks/ Propecia versus Avodart. The one draw back with Avodart is that there is no “human model” with type 1 suppression so there is a question on “long term” safety as with many drugs. As long as you dont have any side effects with Avodart, the long half life can only be beneficial with Androgentic Alopecia and the phase 2 studies show this. People held onto the hair they gained (even grew more) 12 weeks “after” the the medication was discontinued (0.5 mg/ 2.5 mg only). Proscar users saw a sharp decline in this time frame. I hope these facts are helpful in some way.

Thank you for your insight. I believe that what you said makes good sense. I would hope that I could adopt a similar view in an ethical/legal framework.

I just want to remove my grafts as they grow. Do you think it is reasonable to have it done with laser treatment. My scar has not healed all the way, but I guess I’ll have to live with it.

The good news and the bad news about hair transplants, is that they are permanent. With that said, they can be removed with three types of surgical procedures. If there is no skin deformity associated with it (common in the older types of plugs), then the removal process may be easier.

Lasers have a high failure rate when used to ‘kill’ scalp hair and they will not deal with skin deformities associated with the older type of hair transplants. Be very careful about laser removal of scalp hair from hair transplants. The effective frequency used by lasers is more suited to less skin thickness found elsewhere on the body. The transplanted hairs may go too deeply into the scalp to be impacted by these lasers. If you look to our repair section in our patient photos and the articles we published in the journals on our website, you can see the various before and after pictures of the repair process and much of the details of the surgical repairs.

Part 1 of “How Much is Enough Hair?” showcased a patient in his mid-20s. The patient below in part 2 is in his mid-50s and achieved wonderful results.

The change in my appearance in just 8 months has been remarkable. From a balding man that I hated to look at in the mirror, to a younger man who looks like he has a full head of hair has changed my life. My friends can’t get over it and even though everyone knows that I have had a hair transplant, no one believes it when they look at me. The back of my head is still bald. Can I expect to fill that in as well?

I loved seeing you the other day. Every time I see one of our patients with the right hair and skin color and the right hair texture, I feel that the work we do in restoring hair is almost like God’s work. Another session will probably suffice to fill in the back and when done in combination with some styling effort, you will look like a man with a full head of hair. I recommend another 3000 or so grafts be placed into your crown. Thanks for allowing me to use you questions and picture for my blog.

When looking at these pictures, please note that the hair line is not a line but an irregular zone of hair. It does not have a start point and you can not connect the dots. Note that behind this zone, the hair is thick and you can not see through it, while in the zone, the hair is subtle in its appearance and does not hit you like a wall when you look at it. There is a smooth transition from the forehead (without hair) to the thick lush hair sitting back about 1/2 inch behind the transition zone. That means that you can not tell that it is a transplanted hair line, just like mine or other normal people that do not bald.

This first set below are his before photos (Norwood Class 5), taken in December, 2004.

The following are his after photos (one procedure of 2,773 grafts), taken in August, 2005.

I have looked into hair transplants time and again but have been scared off by the horror stories of bad HTs. FUEs sound good to me. Where do I go to get evaluated? I am losing hair in my temple areas and am 36 years old. Also, do I have to be on Propecia? I was on it for a year, didn’t see any results in hair but did notice problems with sexual activity (i.e. hard to keep an erection) I like it a lot better without it. So, if I had a HT, would I have to be on propecia?

You do not have to use Propecia after a hair transplant. However, by not using this drug you will not have any protection against the progressive nature of hair loss, assuming you are still losing hair and not totally bald. With regard to your sexual problems, almost 40% of men of your age have some difficulty maintaining an erection. One of the erectile dysfunction (ED) drugs can solve that. Taking Propecia for your hair and ED pills for your erection may give you both a better sex life and hair at the same time.

You indicated that you are based in Colorado. I would be happy to evaluate you for FUE, but my offices are in California. To find a FUE surgeon in your area, please visit ISHRS.org, but please note that there are not many of them out there that have the reputation and experience you may want.

I am 28 years old, and I have had the unfortunate expierence of losing my hair for the past 2 years.
I had a consult with a Bosley representative, and reccomended that I go on Propecia for about 9 months in order to retain my hair to be a good risk for hair transplantation. I would like to know, if this is a good reccomendation, and is the risk of side affects worth the effort? I have been on propecia now for almost 3 weeks, and I have had some side effects. In fact, I feel like I’m losing more hair due to propecia…Is that possible? With all this drama and money involved with going bald, I am about to resort to just shaving my head. It seems all the effort is in vain. It’s hard to beat genetics with a natuaral look.

It is almost always a good idea to try Propecia if you have genetic hair loss, especially at your age, BEFORE you go through a surgical hair transplant. You may decide that after 9 to 12 months, you are happy with the results and do not need surgery.

I suspect that in the past three weeks, you have spent more time looking at your hair, watching for growth or hair loss, than you have in the past two years. It may take up to 12 months to see results from Propecia, and by watching your hair very closely and very often, you may miss some of the subtle growth that will hopefully be taking place. As far as side effects, erectile dysfunction, decreased libido and ejaculation disorders were reported about by .5% more men taking Propecia, than those taking the placebo- according to Merck. If the side effects are greatly impacting your life you will have to make the decision if you want to continue Propecia.

You sound like you are conflicted about your hair loss and solutions that are open to you. My suggestion is to take your time and research all of your options before you make the committment to surgery.

You have mentioned that Avodart is not yet approved by FDA. Do you know what the status is on them approving it? Is it in its beginning trial stages or are the trials mostly complete and the FDA is just evaluating all of the research before making a decision. Or have they rejected it all together?

Avodart was approved by the FDA for treatment of benign prostatic hyperplasia (BPH), in 2001. While I do not know which stage the trials are currently in, I am sure that the manufacturer of Avodart is doing all they can to speed up the FDA approval process for use in hair loss, if it is even at trials to begin with.

Im suffering with alopecia areata universalis. due to it i lost my hair totally on my scalp, eyebrows & eyelashes. Is hair transplantation possible for me? please give me a reply. thank you.

A hair transplant requires a sufficient amount of donor hair taken from the back of the scalp, to be moved to the balding area. Unfortunately if you do not have the donor hair to accomplish your goal, then hair transplantation is not an option. You can discuss your choices with a good dermatologist, and the National Alopecia Areata Foundation has a very extensive and informative website for those suffering with your condition.

i am 32 years old/ my hair has been receeding slowly for 10 years. my entire life has taken a different course then what i would ever would have imagined. my life is one of boring structure and panic, this disease has ruined my youth and the saddest part/ nobody knows but me.

Many balding men suffer in silence. I remember a psychologist that I transplanted in two sessions with about 4500 grafts in total. He told me that he had been in analysis for his balding problem for over 15 years. It made no sense to him that he was so devastated over his hair loss, but it nevertheless made him suffer. He had taken some medications as well to deal with his depression.

After the transplants were finished, he said that he could not understand why he had not done it sooner. He thought, in hindsight, that had he transplanted his hair 20 years ago, he would not have had to suffer with the problem for all of those years. But the reality was really something different, because only the newer technologies would have given him a normal head of hair. Had he chosen surgery 20 years earlier, the results would not have been a walk in the park.

Aside from that anecdote, it is still important to find out why you feel that your hair loss has ruined your life. It might be worth talking to a good therapist and explore how hair loss has affected your life. You are in control of your life, so take charge and do something about getting it together and stop suffering in silence. Look for help.