What does DUPA (Diffuse Unpatterned Alpopecia) look like?

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

There are two pictures, one of the back of the head and the other magnified. The magnified picture shows an arrow pointing out the only normal non-miniaturized hair in this man’s donor area. If this man was to be transplanted (a dishonest or incompetent doctor might do this) they would make him balder and scarred from the surgery. That is why a doctor must make the proper examination of each and every patient before considering a surgery. Most DUPA patients are not this bad, but having this condition is a contraindication for any surgery. Scalp Micropigmentation, on the other hand, may make this man look look much hairier. The arrow points to the only normal hair in the entire field of view. All of the other hairs are miniaturized and if transplanted, will most likely fail to grow.

Guys who have gotten hair transplants, how has it impacted your dating/social life?

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

I’m 24, considering getting an FUE procedure sometime soon. Have you gotten more attention from women with the new hair? Do you feel more confident and has it eased the psychological burden of hair loss for you? Would you say overall it was worth it?

What my patients tell me is that they get more confidence in themselves and that shows in how you relate to people. Many big celebrities told me that after I did their hair transplant, their careers took off, probably because of improved self-confidence.

Finasteride sexual side effects gone in a month

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

Looking back at my times with fin I just realized how different everything is without it now . I thought my only side was the constantly lower libido but if I think about it my memory was a lot worse, and I was actually kind of lifeless a lot of times , but I don’t wanna connect this to the drug.  The sexual sides tho… You can only understand this if you experienced IT. It’s just the most humiliating and terrible experience that a man can experience. For one month my dick was completely lifeless , didn’t have any connection with my mind , took 10 minutes to get semi hard and it stopped like that . Since then I made some real good improvements tho and now I can say i’m like 90% . IM a REALLY VAIN PERSON especially when it comes to looks.  

At the ISHRS meeting this past week in Bangkok (the largest meeting ever for educational purposes), the subject of finasteride was discussed by an expert in the field and the subject of sexual side effects has come up again as it does frequently at the meeting. After a review of the literature, the expert felt that many of the sexual side effects were placebo effects (backing up the original Merck study which showed sexual side effects down to less than 2% when the placebo effects were subtracted). Also for many of the men in the study, their experience was like yours, with a return of normal sexual function after a month or so, or after reducing the dose to half a pill. This is a report of the findings at the meeting and not a comment on the existence of the Post-finasteride syndrome which has been the subject on this forum for the past year.

Most of the Transplanted hair was lost 10 years after the hair transplant (photo)

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

This is a condition called Lichen Planopilaris (LPP) which is a form of a scarring alopecia that destroys the hair follicle and then replaces it with scarring, resulting in permanent hair loss. The skin is shiny and mottled (this does not show well in the photo), and the hair ostea have some plaques around them. All this is typical of this disease.  This man is 62 years old and had two hair transplants (1994 and 2006 totaling 2300 grafts in the frontal hairline).  Three years ago, he had a nice frame to his face and a good hairline, but that hairline slowly disappeared.  I am concerned than another hair transplant will likely fail. I recommended that he see his dermatologist and get an appropriate biopsy which will likely confirm the diagnosis.  These biopsies require a skilled dermatopathologist in the microscopic evaluation of the biopsy.

If the patient has LPP, then any hair transplant would fail.

Two studies on ketoconazole in balding men

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

At the recent ISHRS meeting last week in Bangkok, the value of ketoconazole shampoo was also echoed by one of the guest experts in the field of hair loss.

https://www.tandfonline.com/doi/abs/10.1080/09546634.2019.1573309?scroll=top&needAccess=true&journalCode=ijdt20

In a 21-month study for 39 male patients aged 21 to 33 years with Hamilton Grade III AGA, treatment with 2% KTZ shampoo two to four times weekly resulted in progressive increase in pilary index (defined as hair shaft diameter in µm 1.5 cm from bulb obtained from computerized MOP Videoplan Kontron image multiplied by percentage of hairs in anagen phase obtained from trichogram) while unmedicated shampoo demonstrated slow linear pilary index decrease. 61 In another sixmonth study on 150 patients aged 18 to 65 years, 1% KTZ shampoo two to three times weekly increased hair shaft diameter significantly, but did not significantly modify mean hair density.45 A final study described the Accepted Manuscript Page 9 of 33 comparison of oral finasteride 1 mg/day only and 2% topical minoxidil only to combination therapies of oral finasteride with 2% topical minoxidil and oral finasteride with 2% KTZ shampoo for a year in 100 male patients with Hamilton Grades II to IV AGA. Oral finasteride with topical KTZ demonstrated significant clinical improvement compared to oral finasteride or topical minoxidil alone (p<0.01) and was comparable combining oral finasteride and topical minoxidil (p=0.3).

http://libgen.lc/scimag/ads.php?doi=10.1080/09546634.2019.1573309

So 20 years after the 1998 study, and we only got 2 more studies. Not super duper definitive, but very promising. I’m basically convinced to ad it to my routine.

I am a 33 year old famale, can anyone help me? (photo)

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

Yes, you have female genetic thinning.  If it is in the female family line (fathers or mothers side) aunts, grandmothers, sisters, mother, cousin, etc.. then it most likely is female genetic hair loss. This is best treated cosmetically with scalp micropigmentation (https://scalpmicropigmentation.com) which shows other women like you and their results with the treatment. Our women patients love the results.

Can I take Bicalutamide instead of fin for my hair loss?

/by William Rassman, M.D./0 /
Bicalutamide is a therapeutic chemotherapy agent with the following side effects. Why would you not take a safe and effective medication like finasteride approved for hair loss by the FDA
  • hot flashes;
  • pain in your back, pelvis, or stomach;
  • swelling in your hands, ankles, or feet;
  • increased night-time urination;
  • weakness, dizziness; or.
  • nausea, diarrhea, constipation.