Epigenetics is proposed to be tied to Post-finasteride Syndrome (article)

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

https://ec.bioscientifica.com/view/journals/ec/aop/ec-19-0199.xml

“Roberto Cosimo Melcangi, Ph.D. at UniMi’s Department of Pharmacological and Biomolecular Sciences, led a team of 10 researchers from six institutions who performed methylation analysis in blood samples of 16 PFS patients and 20 healthy control-group patients, and in cerebrospinal fluid (CSF) samples of 16 PFS patients and 13 controls. “For the first time, we demonstrate a tissue-specific methylation pattern of SRD5A2 promoter in PFS patients,” writes Prof. Melcangi. He concludes that methylation of the SRD5A2 promoter in PFS patients “could represent an important mechanism of neuroactive steroid levels and behavioral disturbances previously described in PFS.”
This is a three-year study, in which 16 men with PFS and 25 control patients were evaluated, also uncovered evidence of neuropathy of the pudendal nerve among those with severe erectile dysfunction. More date needs to be gathered before drawing conclusions on what appears to be a non-statistical valid study.

A very personal story of a great man I worked with in Vietnam and in the United States

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

Dr. Nghi, a surgeon in South Vietnam worked with me as I volunteered to assist South Vietnamese Civilians and wounded soldiers while I was in Vietnam. He was fortunate to be evacuated and ended up in Camp Pendelton when I was able to connect with him in 1975. I sponsored him and his family of 8 others including his wife and two children, plus other relatives including his wife’s father and mother. He joined me in my Surgical practice in Vermont, working as a physician assistant while studying for his examinations to get a license to practice medicine in the United States.  After 9 months, he took the examination and passed it on the first round. With some help by me, he went onto to Dartmouth in Hanover New Hampshire and studied Anesthesiology for 3 years. When he left Dartmouth, a special award was created for him to recognize outstanding service while he was there and was offered a faculty appointment. He decided not to take the appointment and moved to Pittsburgh where he has been practicing anesthesiology every since. He has been active in helping Vietnamese refugees resettle and has been invited to the white house twice to be recognized as an outstanding community contributor. His family now extends to more than 40, all highly successful and integrated into American life. He has four children, an OBGYN doctor, a PhD researcher, a district attorney and a pharmaceutical Vice President. He told me that America gave him and his entire family the opportunity to succeed through hard work. He loves America. Below is this presentation posted by the History Museum in Pittsburgh just this week to honor Dr. Nghi and his family.

Does finasteride make a man more feminine?

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

I’m a gym bro, have healthy testosterone levels and considering fin. As I understand it. Fin increases testosterone, increases estrogen and decreased DHT, it’s the last two I’m worried about. Talks about ED and gyno, although rare, make me worry for my “manliness”. Can anyone speak to muscle building, voice tone, behavior/deamenor while on fin?

No, the dose of finasteride is far too small to overcome the impact of all of your male hormones.

How do you determine your Donor Density?

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

If you take a photo of your cut hairs like this with either a hand video microscope (available on Amazon) or a good camera with a zoom in feature, you will see the follicular groups. The average Caucasian density averages 2.1 hairs per Follicular Group so if you count the number of groups and the number of hairs, you can know for certainty what your donor density is. In these pictures, the circles in C and D have higher than normal donor densities as the average number of hair in each Follicular Unit averages significantly above 2.1 hairs per Follicular Unit. That means that the person who has the higher donor density has more hair to transplant and if they want to do FUE, can do certainly more grafts based upon the chart here: https://newhair.com/resources/#tab-id-4

How common is body hair when using minoxidil?

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

My dermatologist said he “isn’t convinced” I’m balding (fingers crossed), sees no miniaturization and said if it is MPB it’s very early, but because I’m still shedding hair he’s told me to start using an ointment with minoxidil/finasteride and see how it goes.

One of the side effects of minoxidil is increased body hair and I’ve read stories of people getting huge amounts of (possible permanent?) back hair and so on which for me would be equally as bad as balding. How common is it? Should I just go back and ask for finasteride only?

It is common in women who use it. My best friend’s wife used it and shortly stopped taking it because it produced facial hair that she did not like. I can’t advise you on the finasteride as that is between you and your dermatologist

The clinic is offering me 6000 FUE grafts, what do you think?

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

As the doctor who pioneered the FUE, I can tell you with authority that 6000 FUE grafts will deplete your donor area and produce a see-through donor area. This is not a fixable situation as once the hair is moved, it will not regrow there. What is the doctor’s plan other than to get your money? What happens if you continue to bald over time, what then? Have you thought through this process?? If you are under 25, then you are about to make a terrible mistake.

I had a failed 5000 graft FUE, can I have another FUE surgery?

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

You can have a second hair transplant if the donor area has a reasonable amount of hair left. Failures are usually the result of technical problems at the time of the surgery. If the first surgery was with FUE, the second surgery should not use FUE or you will have balding in the donor area.  Your available donor area depends upon your original donor density that you had prior to the first hair transplant. Did your doctor measure it?

I have been on minoxidil and finasteride for over a year and now am shedding very fast

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

Is there a way to tell the difference between a standard min/fin shed cycle and min/fin no longer being effective? I’ve lost a ton in the past 3-4 weeks after being on fin and min for over 14 months, and am terrified min/fin are no longer effective and that this shedding won’t stop.

If you have been on finasteride and minoxidil for 14 months are are now seeing shedding, you most likely are experiencing an acceleration of your balding. You might want to see your doctor and get an opinion. If you were my patient, I would have had a HAIRCHECK test done on you a year ago and would repeat the test to confirm new hair loss and to what degree. That is the value of the HAIRCHECK test when you start treatment.

Do you think that my 800 grafts were an adequate number?

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

Can you give me an analysis of what you see?

Ask yourself: How many hair would have been in this area had you not lost the hair? Normal hair density ranges between 1000-1250 hairs/square inch depending upon your race. To get a reasonable density from a hair transplant when you hair is brown, skin is fair, and hair is of a medium thickness, you need to restore about 20-40% of the original hair density. There are many gaps in your hair transplant and the frontal hairline is a straight line when it should be soft, non-linear and the grafts random and to make matters worse, your doctor put another straight line of hair grafts behind the frontal line.  I am worried about the nature of your frontal line grafts, as they must be single hair grafts or your hairline will look pluggy.  You will, I am sure, need another transplant but I wouldn’t go back to that doctor again