I have been following your blog avidly and I see that you are very doubtful about LLLT therapy.

I have two questions. First, somewhat recently two double-blind randomized control trials for LLLT have been published (https://www.ncbi.nlm.nih.gov/pubmed/24474647, https://www.ncbi.nlm.nih.gov/pubmed/25124964) and they provide some evidence that the treatment seems to work. These are company sponsored trials but they are published in (reputable?) journals. Have these articles in any way changed your opinion about LLLT efficacy?

Second, if someone is already on Propecia and Rogaine, do you think LLLT has sufficient evidence in favor of it that it might be worth their while as opposed to seeking no further treatment?

If you want to try LLLT, it is your prerogative and my opinions should not really matter. If you are trying to change my opinion on the LLLT, then I would really need to see the results first hand or read a well done study.

I have written about the studies you mention above in the past HERE, and HERE.

Propecia and Rogaine work in different ways. If someone wants to add LLLT to their treatment regimen, then it is up to them.

Hair transplants breed a new type of tourist in Turkey

In Turkey, revenue from popular procedures adds to country’s $7B medical tourism industry

By Nil Köksal, CBC News

“There is a new way to spot tourists in Turkey or in Iran, and it doesn’t rely on catching a glimpse of selfie sticks, maps or cameras slung around their necks.

Instead, look for the black terry cloth headbands and a telltale triangle of red spots on their scalps.” (hair transplant)

Doctors in Europe are feeling the pinch from competition from doctors in Istanbul Turkey and Iran who have set up hair transplant mills. This is similar to what the Russians did in the 1990s when setting up Cataract Mills for eye surgery. These are all FUE procedures and I doubt the ladies performing the FUE are all licensed doctors. It seems they are offering travel packages that cover air fare, hotel and the surgery for a 3 day stay. Of course, there is no guarantee of quality and there is no recourse if something goes wrong when these people return home after the surgery. Infections, if you get one, will have to be treated by a local doctor and if the procedure was not done right, the patient will not know for 8 months, which is the time that it takes for the hair to grow after a hair transplant. I suspect that the quality of the work ranges from good to poor, depending upon the clinic that is chosen. It is a bit of a gamble. Stay away from politics in either country or your stay may be longer than you planned.

I am 23 years old. I would like to know if the shedding phase associated with Propecia is a real thing. I was on Propecia for 2 months when a shed began. I was losing about 3 times as much hair as usual. I read on some online forums that Propecia can have a “shedding phase” where you lose a bunch of hair but it then stops and grows back. So I stayed on Propecia for an additional 2 and half months after the shed began. During this time the shed never relinquished so I stopped Propecia. My hair loss returned to its baseline rate within a few days. When I talked to my dermatologist he had never had a patient experience this “shed.” Also, on the forums it appears that for many people the shed never actually stops. For these people it just continues to fall out. This led me to believe that maybe the Propecia is causing a chronic telogen effluvium that does not cease until the drug is discontinued, as can occur with other medicine. I was considering trying Propecia again. So my question is, have you ever actually seen someone go through this shedding phase and then it stopped and they experienced no more hairloss? I would like to know if I should have stayed on the drug longer or if I just simply did not respond to it appropriately.

There is no shedding of hair associated with Propecia. There is however, natural genetic hair loss that still persist even while taking Propecia. In other words, Propecia does not completely stop hair loss. Propecia does not cause more hair loss. Internet forums are a collection of opinions from its members. It does not necessarily mean it is a definitive source or the correct source of information. If you are seeking a personal medical information, please see a doctor.

Thanks for your great blog. It’s really helped me be informed about hair loss. If I am shedding many short, thin hairs that are tapered at the end, not the root, is this an early sign of male pattern balding? I assume that my hairs growth cycles are shortening and falling out before they can get long. Any advice would help. Thanks.

Many readers ask about the morphology of their hairs falling out and how it relates to Male Pattern Balding. We can lose about 100 hairs a day and the morphology of each hairs are variable. The miniaturized hairs are skinny and thinner as the hairs may be going into the telogen phase. Some hairs that fall may be bulky and thick and may have been just pulled out inadvertently. Some hairs may have white waxy substance known as sebum on its ends. Many readers or websites may try to correlate the hair morphology with some disease process but for the most part all of these are normal part of the hair cycle. When it comes to Male Pattern Balding, it is about the PATTERN you see in the balding pattern. If you want to take it one step further, you can put a microscope to your scalp to see if there is a variation in the diameter of hair at different locations to establish a “pattern” of miniaturiation. The very fine hairs should not constitute more than 20% of the hairs that you are looking at. This is what I often refer to as a Miniaturization Study.

This patient came in today to ask for Scalp Micropigmentation to make his hair appear thicker. It was a pleasure seeing him today. He still remembered the upbeat environment that the surgery was performed in 22 years ago! In addition, he sent a friend after he had it done.

This patient had some old plugs prior to meeting me which I camouflaged at the time of the 1993 surgery with great success. We discussed the ‘standard of care’ for hair transplants at that time and I may have been one of the few doctor who did not perform plugs then (I never performed plugs), something that he knew and appreciated. Today, we still see patients with the old plugs and I love to help them deal with it. After he has his Scalp Micropitmentation done, I will share his ‘after’ picture with you.

I was reading about minoxidil and finasteride as I am wanting to start one or the other but am curious about something.

According to the wikipedia article for minoxidil, the reason minoxidil gains are lost when treatment is stopped is that DHT is then able to re-shrink the follicles unimpeded. But if finasteride inhibits or blocks DHT, shouldn’t one be able to keep minoxidil gains longer if they switch to finasteride with a, say, 6 month overlap of the two? Everything I’ve read indicates you lose everything from minoxidil if you ever stop it no matter what.

Despite how many seek information in the Internet, Wikipedia is not always a definitive or correct source of information.
Propecia (finasteride 1mg) and Rogain (topical minoxdil) does not have the same mechanism of action on hair growth. They work in different ways. Both medications will lose effectiveness once you stop using the medication. In other words, you will lose the hairs you gained when you stop the medication. Overlapping the medication or switching from one medication to another does not mean it will sustain the effects of the former medication.

A new meta-study finds the following:

“Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic under detection…”

From Wiki definition: A meta-analysis comprises statistical methods for contrasting and combining results from different studies in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.[1] Meta-analysis can be thought of as “conducting research about previous research.”

The report is interesting but a Meta Analysis is only as good as the clinical trials it is analyzing. All studies have its advantages and pitfalls. If adverse or sexual side effects were being examined, I question why other (much larger and comprehensive clinical trials) of finasteride 5mg was excluded.