I Found the posts that you referenced from your galleries very informative. Can you show more such illustrations that show the balance between balding patterns and the various hair types in hair transplant patients and scalp micropigment patients?

Thanks for the comment. I realize that showing is more believable and more educational than talking about these point that we so often covered in baldingblog over the years.

Blonde woman with very fine hair and thinning corners after one procedure. A second procedure was done just after these photos were taken: https://baldingblog.com/2014/09/05/female-hair-line-lowering-rounding-surgery-temple-recession-correction-with-photos/

One large session (2678 Grafts with medium weight hair and a Class 5A balding pattern): https://baldingblog.com/2014/08/06/one-session-of-2678-graft-hair-transplant-with-photos/
Note that this patient’s average hair weight reflected twice the hair bulk per hair as a person with fine hair. The thicker the hair shafts, the more likely a single session can address the presenting balding pattern.

I had a hair transplant of 2900 grafts 14 months ago, but my his is too thin. The doctor recommended that I have another procedure of about the same size to address the thinning look that I have. Is this the right thing to do?

I am going to assume that you have fine hair. As you did not send pictures with this email, I went into our picture file and found two people who had fine hair and a single large session, one younger man has a single 3226 graft procedure with us and the second older man had a large single session. This younger man was happy with his thin looking results, and although he could have done another procedure to thicken it, he decided (for financial reasons) to hold off doing it again for the moment. The second older man was fully satisfied with his results. In both procedures one more procedure could have addressed the thinning problems and I am assuming that your results are similar to the shown results of these two men if the growth was 100% of what was transplanted.

Fine hair and large balding patterns require more grafts to get a thicker look than people with average weight or more coarse hair. Graft counts can rise in the 4000-6000 graft range and it is not unusual for such people to get 2-3 sessions to see ideal results. Of course, more transplant sessions are expensive and many people just don’t go for more surgeries for financial reasons. In 2009, we developed scalp micropigmentation which adequately addresses a ‘fuller look’ on such patients without further hair transplants. In our gallery site (scalpmicropigmentation.com), we have many examples of such patients on this site. One good example of SMP addressing a post hair transplant result with thinning hair can be seen here: https://scalpmicropigmentation.com/gallery/. The cost of SMP is far less than hair transplantation and is a good alternative, but it is a look of fullness, not the reality of it. Is is an option worth considering for you as a non surgical alternative to address your problem and it would be a good option for those patients with thinning hair that we referenced above.

hello. I had a question about hairs that fall out of my scalp. Occasionally I see a hard skin bulb on the end of the hair shaft.. This can easily be pulled off and is just dry dead skin cells.. Could this be accelerating my hair loss?

The white substance you are referring to is likely a collection of dead cells mixed with the oils produced by your sebaceous gland.

It has no significance or correlation with genetic baling or acceleration of hair loss.

Non-balding men and women get it. But if you are rapidly losing hair due to inherent male pattern balding or obsessed and preoccupied with the idea that you are losing hair, you will obviously notice more hair falling and notice more of the white bulb and will search the Internet for answers. In doing so, the cleaver marketing agents will take advantage of this curiosity and insecurity and claim it may be a sign of bad hygiene or some disease process and offer their product for sale.

The old wives tale that garlic can prevent the common cold may have some support. According to MPR “In a recent review published in the Cochrane Library, researchers were only able to find one study that met their inclusion criteria. In this trial, 146 subjects were given either a garlic supplement (180mg allicin content) or placebo once daily for 12 weeks. In the garlic group, there were 24 occurrences of the common cold (111 days of illness) while in the placebo group there were 65 occurrences (366 days of illness).” Recovery periods were no different between the two groups. Garlic was believed to have antimicrobial and antiviral properties and this limited study supports this. The common cold is common as “children have six to eight colds per year and adults have two to four”. There is a substitute for Garlic called Allicin dosed at 180mg although I never prescribed it.

Curr Opin Endocrinol Diabetes Obes, 2014 vol. 21(6) pp. 493-8 5?-Reductase inhibitors in androgenetic alopecia Yim, E; Nole, KL; Tosti, A

PURPOSE OF REVIEW: The authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5?RIs) for androgenetic alopecia (AGA).

RECENT FINDINGS: The 5?RI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5?RI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility. Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website. To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5?RIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy.

SUMMARY: Sexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5?Rs including hydroxypropyl chitosan and liposomal and nanoparticulate systems.

The following is a comment from one of our readers:

…”I think the following recent review in a respected, high-impact journal night be of interest to your readers. It underscores some of the points previously made by your reputable bloggers related to an issue of continuous concern: that sexual side effects from finasteride are uncommon and that reports of permanent effects after discontinuation are essentially case reports (or letters to editors) with significant methodologic problems.“

Hello i have been following in the background for a while about methods of treatment of hair loss. A few years ago we had quite a few biotech companies looking at researching hair loss. There was intercytex, aderans, histogen, follica and replicel. Many of these companies no longer exist or else news of hair loss treatments and their pipeline after phase 1 have faded and other products have replaced them. I was basically wondering since i have been away for a year or two from heavy research into this. Has all this research faded now? are there any companies coming in to replace these ones or are we seeing that this sort of application is perhaps more difficult than we expected and as such people have given up on it? Sorry to be fatalistic.

Bosley’s parent company Adarans, stopped funding one of the very promising solutions for hair loss a couple of years ago. A few other companies have dropped their hair research efforts. Intercytex seems to have nothing on their website that indicates activity in the hair arena. It does seem that the failures to achieve good hair loss solutions have thwarted some of the research. I really cannot comment on the biotech companies aside from what you may find on the Internet and speculations. It does seem that the ‘cure’ for hair loss is not as easy as one may have imagined.

Hey doc! I’m a longtime reader and follower of your blog and I highly trust your advice and recommendations. I want to thank you in advance for taking your time to provide your insight to my question. I’d first like to provide a short description of my hairloss observations and results from treatment:

I’m nearly 23 yrs of age and have been on Proscar daily (cut into quarters) since January 2006. The efficacy of the pill peaked by the time I turned 21 and so far, all its been doing is maintaining my existing hair. I’m more of a gradual diffuse thinner than a genetic balder. Ever since last year, my head has become rather itchy and I’ve always felt a sore burning spot right in the centre of my vertex. It became quite unbearable to the point where I shaved my entire head last November just to make it stop.

By December I started using Nizoral 2% and Head & Shoulders everyday (I currently use them every other day). Although some soreness is still present, it has subsided quite a bit and the itching and flaking isn’t as bad anymore. What’s interesting is that my hair has gone from relatively sparse last year to a lot more fuller and abundant this year. I believe that, from my observations, I’ve regrown perhaps 80% of previously lost hairs due to genetic balding. I’ve also noticed that, from continued use of Nizoral, Head & Shoulders and T-Gel plus Proscar for maintenance, I’ve seen individual hairs reverse in miniaturization (hairs with thicker roots and thinner ends)

Am I seeing things or could I be responding well to inflammatory shampoos? My hair is about 6 inches long and tends to get very oily overnight.

My other question is,
In my crown area, especially near the spot where I feel a sore/burning sensation more often than naught, my scalp produces thin hairs and although cosmetically it looks as if there’s no sign of genetic baldness present in that area, I would like to tackle this problem before it does become apparent. I was wondering if you would recommend using a lotion which contains copper peptides to compliment my regimen? I would rather not use minoxidil due to cost issues as I’m still a student.

Thanks again!

It takes at least 2 years to maximize the value of finasteride. That may explain part of your experience with hair regrowth. Also, there are some reports that ketoconazole (Nizoral) may help with treating hair loss, but the studies are limited and I personally have not seen patient results to be convinced. If you’re seeing these treatments work, that’s great!

There is been no proven benefits of copper peptides in the prevention of balding or regrowth of hair. That does not mean that it does not work, but it means to me that the value has not been proven scientifically. If you have used minoxidil and then you stop, it will cause a reversal of the benefits (if the drug produced value) and as hair that was lost is known to be minoxidil dependent, stopping the drug can cause hair loss. The thin hairs that you see in the crown are the result of genetic balding and they can get thicker from finasteride. The younger you are, the better will be the result of finasteride. Men in their 20s like you, get much better results overall from finasteride than men in their 30s and 40s. Men in their 50s and 60s often have no response from the drug. My patent attorney, went on Proscar for prostate problems (it is finasteride) and he grew back quite a bit of frontal and top hair. He showed me the hair with a Cheshire smile. I told him that he had unusual response but congratulated him nevertheless.