What is the timeline for balding?

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

Well to my dismay I am now a member of this community at 23. The idea of balding hadn’t even entered my mind until my mom mentioned my hairline receding a few weeks ago. Now i see it. Her dad was bald at like 30 so i guess it makes sense. Now i go around staring at dudes’ hairlines and guessing what their NW levels are.

My question is: what kind of timelines have people experienced? Does this ever start and then stop for a decade or is it all downhill from here? Do some people only recede a little or is everyone who experiences any MPB destined to become larry david? Id like to keep my hair at least thru my 20s so do i just need to get on finasteride immediately? Or wait and see a few months?

Balding is progressive in men as shown in this link: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/.

Is Platlete Rich Plasma (PRP) valuable and what scientific proof is available?

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

The International Society for Hair Restoration Surgeons meeting this year was in Bangkok, Thailand. I was on the teaching faculty and almost 1000 people attended making it one of the more successful meetings in the history of this teaching hair restoration society.  The subject of Platelet Rich Plasma (PRP) and its value was discussed by Guest speaker Ramon Grinalt). He reported his review of the entire literature on PRP subject material and said he could not find a single study that proved that PRP grew new hair or resuscitated dying hair.

He discussed some of the more well known studies.  When PRP was compared with microneedling using saline injections, any benefits that were seen with the PRP injections were comparable to the saline controls, when benefits showed up.  Various doctors in attendance did not necessarily agree with this conclusion based upon their personal experience; however, many of these doctors could not prove (beyond a shadow of a doubt) that PRP worked.

In conclusion, I believe that microneedling with saline injections will work as well as PRP, for far less money.

Johnny Depp Hairline

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

I see some guys who have buzzcuts where the hairline is actually inverted, so to speak. The hairline is SO thick that it actually bends down towards the temples as opposed to a normal curvature upward.

Take a look at Johnny Depp.  Clearly that is an EXTREME example, but he didn’t rapidly lose hair after that even though he’s recessed now.

He has some corner loss and a persistent frontal forelock which holds the look reasonably well

Chest hair and finasteride

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

I’m on Fin since 5 months

I’m often shaving my chest hair with a clipper and I’ve noticed that it has been a while but my chest hair hasn’t grow longer as usual

Some men get a reduction of body hair or body hair growth rate on finasteride

Doctor Rassman, there is evidence that Saw Palmetto works, see below

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

http://www.ncbi.nlm.nih.gov/pubmed/12006122

http://www.ncbi.nlm.nih.gov/pubmed/8142312

http://www.ncbi.nlm.nih.gov/pubmed/7577710

http://www.ncbi.nlm.nih.gov/pubmed/3218455

http://www.ncbi.nlm.nih.gov/pubmed?term=prager%202002%20saw%20palmettohttp://www.ncbi.nlm.nih.gov/pubmed/12477490

http://www.ncbi.nlm.nih.gov/pubmed/8922564http://www.ncbi.nlm.nih.gov/pubmed/6708534

http://www.ncbi.nlm.nih.gov/pubmed/8876706http://www.ncbi.nlm.nih.gov/pubmed/8922564

http://www.ncbi.nlm.nih.gov/pubmed/8876706http://www.ncbi.nlm.nih.gov/pubmed/20300369

Topical vs oral finaseride, how do they compare?

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

Would you say you’ve noticed good results with topical vs. oral finasteride? I just had a chat with my pcp today and he seemed to think topical was less effective.

The Golden standard is the pill which I suspect means that the topical is compared to it as how effective it is compared to the pill. I don’t think that is 1:1, somewhat less

How about doing a small hair transplant? Is this reasonable?

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

I don’t need a hair transplant now but maybe in the future I will. If that happens, do I start off with a small hair transplant and then get more as the balding progresses?  I’m curious if in the future I ever do need a small one. Whats the minimum amount of grafts you can have for a hair transplant or the minimum they would be willing to do (provided of course you only needed a very small amount obviously and had very minimal hair loss)

I always tell patients that a hair transplant should be part of a Master Plan for genetic balding that is a progressive state in all men. There is no such thing as being a ‘little bit pregnant’ so if you are going to do a hair transplant, plan it and take your time. A good decision today is a good decision tomorrow.

How do you tell if finasteride is impacting your brain?

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

I am about to get on fin but the one thing holding me back is I’m scared of suffering mental sides. How do you even know if you are suffering from them and not just… well… dumber?!? Makes me nervous cause of other things in my life. Curious if any fin users can add to this from their experience. Thanks!

People who have mental side effects generally don’t feel right. This is rare.

When is surgery a good time to do a hair transplant for a 27 year old male?

/by William Rassman, M.D./0 /
I’m a 27-year-old white male with a receding hairline. I’m afraid of finasteride sides, so I’m interested in having hair from elsewhere on my head put into the forehead area. However, will I just keep losing hair further up where it wasn’t implanted. And I read the hair loss should be “stable” to do this surgery, what does that mean? Thanks
Men develop a patterned balding and that pattern is set in your genetics and could be just frontal, or crown (like mine was) or almost all over your head. The first thing you need to do is to find a good, honest, doctor who will spend time with you to develop a Master Plan for your hair loss. Make sure that the doctor spends enough time to project where your future pattern might go (something I do often with a HAIRCHECK test – https://baldingblog.com/haircheck-test-how-it-is-done-video/ and a measure of your donor density https://baldingblog.com/i-am-trying-to-find-out-if-i-have-enough-hair-to-be-a-good-candidate-for-a-hair-transplant/ ). You have a limited number of hairs that can be moved around and you must command those precious reserves of hair that will probably never go through the balding process. In the hands of a good, experienced and honest (some doctors only care about money), you should work with your doctor to build a Master Plan for the rest of your life that will balance your short and long term hair loss against your limited permanent hair. I have been doing this on many men and as a result, my reviews in various forums are generally very good.

How do you find the best hair transplant doctor in North America? (From Reddit)

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

My boyfriend is balding and does not believe in hair transplant procedures. I’m looking for a top doctor/establishment in North America to have a consultation and hopefully change his mind about undergoing the procedure. Was wondering if anyone has any recommendations since I’m not sure where to start/go looking.

There are websites that rate hair transplant doctors including Yelp and realself.com. I always tell patients to check out the doctor’s experience and rule out doctors who sell their services through salesmen or saleswomen. For example, you can look me up here (resume and cv): http://newhair.com/doctors/rassman/ and you can check out my references on those websites. If you don’t want to travel, then check out the doctors in your area and see how they present themselves.