Hi,
I just want to ask How to make garlic gel? Where can i buy garlic gel if there is any?Thank You!
We wrote about garlic gel being used in small studies as an alopecia areata treatment, but I’m not sure where you can buy it and I don’t have a recipe for it. Perhaps you should check your local pharmacy or health foods store.
Hello Dr. Rassman,
One of your patients just checking in to say hi and ask a simple question:
Its been 10 years since your famous article on FUE (you link it frequently on this site)
How have your transection rates improved since then?
Back when we originally defined this procedure and published it in a peer reviewed journal (see here), we classified patients in 5 different categories defining the difficulty in doing FUE and the transection rate. These groups still apply and there are occasional patients (under 10%) who are still not good candidates for FUE. In other words, the human physiology has not changed over time.
Some patients may NEVER be good FUE candidates. We still strive for improvements, and with Dr. Pak’s engineering and clinical background we have changed our technique with a much better instrument that we pioneered to minimize transection. We recently received a patent on this instrument. When we made the breakthrough years ago, we called it the FUE2. This technology combines injecting fluid into the wound around the punch simultaneous with the extraction. The actual instrument has an injection needle welded to it. This has allowed us to decrease our transection rate in most of the patients years ago that we called “FOX negative”. The instrument design also allows us speed in the extraction process. Thanks to these innovations, the procedure is more practical, more efficient, and just plain better than most other instruments available (at least in our hands). Note the quality of the grafts in this link. The grafts are beautiful shaped and clearly show no transection.
Transection rates of under 10% should be the norm and when the transection rates go up above this number, we address with each patient who is impacted by a less efficient process. We still occasionally perform our infamous FOX test, which is essentially a test of up to 10 grafts extracted and the transection rate examined in this test group so we can anticipate the transection rates in advance. Unfortunately, not many doctors offer this test and the world continues to believe FUE is the best way to go about surgery (without taking transection into the equation).
Worse still, many doctors may misrepresent their transection rates and claim numbers that are unrealistic in their hands, but for marketing reasons they make claims suggesting they are as good as the best doctors out there. I know of a few doctors that live in an illusion which reflects technical skills that are way beyond their reach… and we see their patients frequently in the office for a second opinion.
Hi Doctor William Rassman. I was on a forum called hairloss talk, asking a question regarding my situation, and most of the users there told me to email and ask Doctor Rassman, as you are very prominent and reputable in hair restoration.
I recently visited my dermatologist regarding my hairloss, and after checking my hair he said I am showing signs of AGA, and said if I don’t treat it it will progress. From my research on the net, I figured he will put me on propecia. In fact he put me on avodart. When I told him its not fda approved for hairloss, and propecia is he said avodart is better and brings DHT down more, and propecia is nothing next to avodart. He told me to take it everyday for 2 weeks, then every other day from then on as it has a long half life. From researching on the net, many hair restoration doctors, rarely prescribe avodart for hairloss due to some dangers. whats your opinion on this?
I would love to come see you, but I live in Canada. do you think I should go see another doctor and get propecia? do you prescribe avodart to your patients? or propecia? in fact is avodart that much better than propecia?
Thanks doc, I would really appreciate a reply on your opinion. I know medical advice is not given over the net, but I just want your master opinion.
Propecia (finasteride) is still the right drug of choice in this situation mainly due to the FDA approval, and the lower side effect frequency than Avodart (dutasteride). I have prescribed Avodart in select cases before, but usually only to poor responders to Propecia.
I don’t know where the dosage info your doctor came up with comes from (14 days of daily use, then every other day), as the dosage for hair loss treatment hasn’t been clearly defined. Avodart does have a long half life, so if you do experience side effects they will take much longer than Propecia would to leave your system. If you’re concerned about the prescription your doctor gave you, you can talk to another doctor for a second opinion.
I am very impressed by your site, a unique thesaurus of scientific knowledge and experience about hair loss and related subjects.
I want to ask Dr Rassman the following question: By your experience, have you noticed (statistically) that there are periods in a man’s life that he is more likely to be affected by hair loss if he carries the the gene(s)? Or “age factor” is a completely random thing?
it is said that men who grow older than 30, have indeed some hormonal changes. Macroscopically, body hair and facial hair can be more thick, regarding, of course the genetic factor
Is this a myth or something more? Thanx in advance
Genetic balding takes most of it toll on men under 30. The advanced balding patterns often start in the late teens or early 20s and often these patterns are obtained prior to the age of 30. We occasionally see late onset of balding in men past 50, or we see balding appear when severe illness occurs. We know that drugs like Propecia can change the course of balding (slowing it down or stopping it completely), but it is still uncertain if the advanced patterns in the Norwood class 7 patients can stop the process if it is picked up early (age 19-22).
Snippet from the article:
Patients with rapidly progressive alopecia areata (RPAA) tend to show favorable prognosis regardless of treatment selected, according to research published online Sept. 24 in the Journal of the American Academy of Dermatology. Over a three-year period, Masaki Uchiyama, M.D., from the Tokyo Medical University, and colleagues retrospectively analyzed 1,030 patients diagnosed with AA.
The researchers found that patients with regenerated vellus hairs showed a significantly higher improvement or cure rate regardless of AA severity. Lower rates of cure and higher rates of relapse were significantly associated with early onset and lengthy duration. Regardless of treatment utilized, RPAA patients tended to show a good prognosis.
Read the rest — Rapidly progressive alopecia shows favorable prognosis
You can read the study abstract at the Journal of the American Academy of Dermatology.
This was a question posted in the comments of this post about FUE failures:
Dr…You mention the many small dot scars with FUE – does this just come with the territory or can a good DR minimise this? I have very fine hair which I like to clip quite short and as such would never want a strip procedure. I assumed that an FUE would be ok.
It comes with the territory. All FUEs produce punctate scars. Just as in strip scars, there are some people who heal better than others. Some of these people will stretch the punctate scars. In those that stretch the scars (particularly in people with fine hair) the larger the punctate scar, the more detectable it is with a close buzz cut. Fine hair just does not hide the scars as well as a coarser hair would. With these statements, I can not state with 100% certainty that the larger scars are strictly the results of the differences in healing.
There is another variable here that should be mentioned — the size of the punch. I believe that the smaller the punch used to extract the graft, the less likely the scar will stretch. The range of punches used today are from 0.5mm – 1.5mm. I believe that the punches which are under 1mm will usually scar less than those over 1mm; however, with that said I don’t have personal experience with punches over 1mm.
Dr. James Harris, who uses 1.25mm punches with the ARTAS FUE robot, tells me that the scars are not worse than those produced by using punches under 1mm, so as I respect his opinion, I report it here for you to judge. We use 0.9mm punches with our FUE procedures.
Sir John Gurdon, the Nobel Prize winning biologist has the most remarkable head of hair I have ever seen on a 79 year old man. His hairline is better than mine despite being 50 years younger. He is known as “the godfather of cloning”. Is his incredible mane a coincidence or does he know something we don’t?
Albert Einstein and Ronald Reagan had great hairlines present throughout their lives, and Bill Clinton still has a beautiful head of hair in his mid 60s. Reagan’s hair looked great into his late 80s (I can’t find photos of him in his final years, but his hair might’ve even been the same into his 90s). Einstein’s hair is mostly known for being a wild mess, but the photos show he had good hair through most of his life. These smart people had enough blood supply to their brains to overflow into their scalp. That is what happens to very smart people.
Of course, I’m kidding. I doubt Sir John Gurdon has been hiding the fountain of hair youth, but his genetics allow him to maintain his hair well into his life.
Snippet from the article:
Some men—and women—believe that receding hairlines, thinning manes and smooth craniums lend an air of dignity. For those who don’t, there have always been plenty of baldness treatment and prevention options available, albeit with highly variable levels of effectiveness. Find out about some of the weird and wacky ways people have attempted to curb or conceal their hair loss over the centuries.
Read the rest — 9 Bizarre Baldness Cures
It would probably be impossible to compile a complete list of every crazy hair loss “cure” sold over time, but the article lists treatments from ancient Egyptians and Greeks, plus briefly mentions the history of toupees, snake oils, and teas. And for the curious, there’s even a photo of an old hair plug surgery (which is quite different from today’s standards and results).
I went on Propecia and Ketokonazole 2% eight months ago to stop my corners from thinning further. The deep recession (thinning in the midscalp) has already been completely reversed, and I still have baby hairs in the corners, longer and darker than vellus hairs but shorter than normal hair. I would of course love to see these grow bigger, but just keeping those baby hairs as such for a few years would increase my stakes at benefiting from future treatments. I’m looking for solutions to help me just keep the baby hairs, even if such solutions might have no effect on the persistence of fuller hairs.
The growth of ‘baby’ hairs from propecia do not usually become full ‘terminal’ hairs and the formation of full terminal hairs is very rare in the leading frontal edge. You should, of course, watch it for up to a year and maybe you will be one of the exceptions to the rule for frontal growth.
Dear Balding Blog,
I know fertility studies have been closely examined in relation to propecia usage at 1mg per day; however, my question is whether the doctors at balding blog know of anyone (patients) who have personally conceived whilst on propecia? I would like to hear anecdotal evidence, rather than clinical, and their experiences in relation to birth defects etc.
Thank you.
I am certain that some of our patients on Propecia have achieved pregnancy with their wives/girlfriends. There’s a couple of commenters on this site that have posted in the past about conceiving a child while taking the medication. Some patients ask us about this and we generally give the go-ahead, but we do discuss the theoretical risks.
If you think about it, millions of young men are on the drug and some must have achieved pregnancy. If birth defects were to occur (ambiguous genitalia) lawsuits would be common. The incidence of ambiguous genitalia is one in 2000 births so it would be difficult to connect the appearance of this problem with the drug finasteride. Play with the numbers — assume 2,000,000 young men on finasteride, that would produce 1000 cases of ambiguous genitalia.
How would one relate the drug impact with the natural incidence of this condition in the general birth populations? I don’t know the answer to this question.
Hello Doctor,
I have been using Minoxidil 5% for one and a half years and have seen some effect in terms of reduced hair shedding and some hair growth on the frontline. It’s not thick but I can notice it. My hair is sparser on the right temple and I think it has also progressed a bit on the top. My question is can I use Minoxidil 10% in the area where the hair is sparse and continue with the 5% on the other areas?
Thank you for such a great site and providing information that makes real sense.
You should be managed by a good doctor and you should get some scientific measurements on the results of this treatment modality that you are proposing.
I have heard about some doctors mixing minoxidil to 15% concentrations and it is possibly more effective at the higher dose, but beware of complications that are more likely to occur. The higher the dose, the worse and more common the side effects of minoxidil. Also, I wouldn’t expect great results from minoxidil at the frontal hairline / temples regardless of dose.
I left Propecia in the car for a few days. It was extremely hot and humid, and it looks like the coating of the pills melted a little. Is the medication still ok?
The suggestions for storage temperature are standard for drugs. You will always take a risk if you store the pills in a very hot and / or humid environment.
Propecia should be kept in a dry place at room temperature… and if you are concerned that your medication may be ineffective due to leaving them in the car, talk to your pharmacist about replacing the pills.
Snippet from the article:
Going thin on top? Or is your hair losing its colour? Your medication could be to blame.
Drugs for blood pressure, acne, depression — even common painkillers — can lead to hair loss, according to a report by scientists at the University of Melbourne. And other drugs can turn a brunette into a redhead, or make straight hair curly.
Doctors say it is important that patients see their GP if they notice any unusual hair loss (do not stop taking any medication without seeing your doctor). They can be switched to other drugs, if appropriate, or the dose can be reduced. In other cases, patients can be reassured the effects are unlikely to be permanent.
Read the rest — Bad hair day? Blame it on your medicine
The article mentions that some epilepsy drugs are linked to hair loss and hair curling, antidepressants are linked to hair loss, and some psoriasis treatments are linked to hair color and characteristic changes.
Hi Doc,
Had a couple of questions; Been following your blog for sometime now and had a few concerns. Hopefully you can answer them.
I have been on finasteride for approximately 3 months, till now I can say that maybe I have noticed some thickening at the most. Anyways I wanted to ask you if you think the generic version from pharmascience should be ok. I have attached a link of their website: Pharmascience.com.
The reason I ask is that I have read many entries on your blog, and some people seem to claim that they did not have results from the generic but then started using brand name and things changed. Is there a reason to worry or should I be alright with this particular brand of generic finasteride?? (again from the company pharmascience which to my knowledge is one of the biggest and reputable generic drug makers here in Canada)
Also you mentioned that some of your lucky few patients have had continued results/benefits for well over a decade. Were these patients SOLELY on finasteride?? and at what stage of balding did they begin to take the medication, and have you had any one with such incredible results who started in their mid 20’s? and have continued to see benefits??
thanks
Pharmascience is a large Canadian drug maker, and I’d expect their generic 1mg finasteride to be the same as the name brand Propecia. The excipients (fillers/binders/coatings) used in generics might be different from the name brand, but the active ingredient is the same. I can’t explain why some people believe they see results from the name brand and not the generic, unless perhaps the generic is fake or the power of suggestion is at play.
As for your 2nd question, some of the patients that come to mind that have been on Propecia with benefits for over a decade are solely on that medication. It’s possible they’ve tried other medications/treatments, but I can’t be with them every day and I have to take them at their word. Patients that have started Propecia when they have early genetic hair loss starting to show, often have had the best results.
Each person is different though, so if you’re fishing for some sort of confirmation that your results will be incredible, all I can do is send you good thoughts (and no promises). Talk to your prescribing doctor about what he/she thinks, and be sure to get your hair bulk analyzed before starting the drug, then follow up in a year or so for another bulk analysis to see what the finasteride has done. Remember, it takes a year to see reasonable results.
If I’m experiencing mild side effects from propecia, weaker erections, decreased semen, etc. is there a chance the side effects could subside with further use as my body adjusts to the med and lower DHT levels?
These are questions you should ask of the doctor who prescribed the drug to you. Yes, the side effects could subside with time… or there may be adjustments to the dose that would help you.
You could set up a private consultation over the phone with us if you are not in Los Angeles, sending pictures of your scalp ahead of the call, and I will be happy to discuss your problem with you. Keep in mind though, you should be able to communicate with the doctor that prescribed you this medication, particularly if you have follow-up concerns or questions.
