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    Worried about PFS

    Mar 31, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    I have just stopped using finasteride after 1 year of it with sexual side effects.  I am worried about the long term effects.  What about those who don’t get better, doctor?  What is the chance that I will be ok after a few weeks or so?

    It could take a few months to get back to normal. Finasteride may stay in the tissues for up to 6 weeks.  For those who continue to have sexual and other problems after a few months, consider that you might have Post finasteride Syndrome (PFS).

    Then you rightfully should be concerned. Make sure that you don’t talk yourself into long term symptoms. There is a condition called Post Finasteride Syndrome. I have collected a series of articles, see here:
    • https://baldingblog.com/epigenetics-is-tied-to-post-finasteride-syndrome-article/,
    • https://baldingblog.com/post-finasteride-syndrome-is-most-related-to-the-length-of-time-finasteride-was-used/,
    • https://baldingblog.com/comments-on-post-finasteride-syndrome/,
    • https://baldingblog.com/https-www-sciencedirect-com-science-article-pii-s235228951930061xviaihubbib122/

    Finasteride in sperm and the fetus

    Mar 31, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Dr Stewart McCallum (United States) quoted 2 studies by Merck in which the levels of finasteride were measured in the semen of men taking 5 mg of the finastride:

    • Regarding the use of finasteride in men whose partners may be pregnant: It is a standard requirement for the FDA to ask for dedicated studies to look at drug concentrations found in semen. Merck performed 2 such studies, and the following is taken from the prescribing information. In 2 studies of healthy subjects (n = 69) receiving PROSCAR 5 mg/d for 6–24 weeks, finasteride concentrations in semen ranged from undetectable (<0.1 ng/mL) to 10.54 ng/mL. In an earlier study using a less sensitive assay, finasteride concentrations in the semen of 16 subjects receiving PROSCAR 5 mg/d ranged from undetectable (<1.0 ng/mL) to 21 ng/mL. Thus, based on a 5?mL ejaculate volume, the amount of finasteride in semen was estimated to be 50? to 100?fold less than the dose of finasteride (5 =?g) that had no effect on circulating DHT levels in men (see also PRECAUTIONS, Pregnancy). So the quantities of drug in the semen are 50? to 100?fold less than doses in serum which have been shown to have no effect on circulating DHT, and this is assuming that 100% of the of the finasteride present in the semen is absorbed by the female partner (which has not been confirmed). So the next question one would need to address is whether 50? to 100?fold coverage below doses that had no effect on circulation DHT is adequate. This is the risk benefit question that you need to address with your patient.

    Although the above comments reference 2 studies using a 5?mg dose, Merck () also measured semen levels of finasteride in patients taking a 1?mg dose. The men were treated with 1 mg for 6 weeks. The highest level measured was 1.52 ng/mL, and the mean level was 0.26 ng/mL. Using the highest measured level (1.52 ng/mL), women exposed to a 5?mL ejaculate per day would be exposed to 7.6 ng/d (assuming 100% vaginal absorption). Merck () found this level to be 750 times lower than the “no effect” level for developmental abnormalities in rhesus monkeys.

    In summary, a 1?mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

    In 2001, Merck used the slide below to discuss the risks of the fetus to a man who fathers a child while on finasteride

    FUE and Micro-needling

    Mar 31, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    So 4 years ago i received a Hair transplant. It went pretty good but in the end i would have wished to make it more dense. I started microneedling and minoxidil since the hair further back is a bit thinner. Nothing dramatic but i was wondering if hair could grow back on the spots of my transplant with this combo. I got a little bit thicker skin on the transplant area (from the FUE procedure) My question would also be if i need to microneedle that area with more depth ? Lets say 2mm. Right now i am needling with 1.5 mm.

    Did all of the transplanted hair grow? Did you get your expectations met? If you want more thickness, find a doctor who will be honest with you about expectations and another FUE may solve the problem. Microneedling probably will not work in the transplanted area.

    How do I style my transplant? (photo)

    Mar 30, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    You style your hair transplant as you would style your hair before you lost it, any way you want. Your picture is showing hair spiking, is that what you want?

    How common is balding?

    Mar 30, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Gerald Ford had better Hair at age 40 than many of the 20 year olds. Does this mean we are all doomed to be Bald?

    Only half of the population has the balding genes, the rest look like Ronald Reagan when he was very old but even though he had Alzheimer, he still had his hair.

    Why is HAIRCHECK better than miniaturization analysis?

    Mar 29, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Look at the video in my post. The HAIRCHECK test ( https://baldingblog.com/haircheck-test-how-it-is-done-video/) measures hair bulk (the sum of the thickness of each hair and the number of hairs per square inch). Hair loss is a bulk issue and when we lose hair we lose hair bulk.

    How do you tell if finasteride is slowing or stopping the hair loss?

    Mar 29, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    It is sometimes hard when you have slowing or stopping because it compares it against what would have happened had you not taken it.  Take good photographs.  if you have a doctor with the HAIRCHECK  system (https://baldingblog.com/haircheck-test-how-it-is-done-video/) which will give you a number for hair loss and hair gain if your drugs are reversing it.

    What is the difference between DPA and DUPA

    Mar 28, 2022/by William Rassman, M.D./0 /Hair Loss Causes
    DUPA is Diffuse Unpatterned Alopecia while DPA is Diffuse Patterned Alopecia which is often associated with genetic balding. DPA in men, can be treated with finasteride which is probably the best known drug for this condition. DUPA is not the same entity, but sometimes it does respond to finasteride making it, on occasion, slightly improved. There is no real treatment for DUPA today. If you want a hair transplant, it will largely fail if you have DUPA. DPA most often happens with age as genetic balding appears and the genes are present in almost half of the male population of almost all races except for the American Indian whose ancestors came from Alaska.  This post may help you understand the thinning issue better: https://baldingblog.com/age-related-thinning-art/

    What is wrong with my hair?

    Mar 28, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    From the gross picture, it looks like Diffuse Unpatterned alopecia (DUPA) but I would have to examine you with a trichoscpe to make the diagnosis and what I would see is significantly more than 20% of the hairs miniaturized in the back and side of your head.  Am I correct that you have not had FUE surgeries?  See here for photo of DUPA: https://baldingblog.com/do-i-have-dupa-photo/

    Is this Shock Loss from FUE? (photo)

    Mar 25, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    The way you will find out is to give it some time.  Shock loss will usually reverse in under 6 months while permanent changes will not

    5 month Progress on Finasteride and Minoxidil

    Mar 25, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    5 month Progress on Fin and Min. Hopefully the progress continues!

    Great results. I suspect that when you get a year out, the crown will also fill in completely. Congrats

    FUE Grafts

    Mar 25, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    This photo contains Follicular Units that were excised from the donor area using two different techniques.  The graphic at the top identifies all of the elements of a single Follicular Unit. This particular follicular unit has two hairs, one is what I am calling a ‘telogen’ hair (shorter hair below the skin is either starting to grow or shrinking down (more likely). On the rows of Follicular Units (grafts), you can count the number of hairs in each graft. On row two, the grafts were removed using a punch with subdermal tumescence. Note here in row two, that the hairs are surrounded by fat, especially prominent at the bulbs on the bottom of the grafts. Row three shows Follicular Units excised with a different punch. These grafts do not have much fat at the bottom and the three follicular units on the right have no fat at the bottom at all. Because there is no fat to protect them from drying once they are removed, they can not be exposed to the air for more than a few seconds without a risk drying and death.  If these three grafts are placed with forceps, they might likely be damaged as the operator will have to use the forceps to squeeze the grafts at the bulb, possibly damaging the grafts. Placement with implanters, solves this problem.

    Combining FUE and SMP

    Mar 24, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Im not a huge fan of this look, but I know people with no hair loss who shave the sides of their heads to the skin and then grow out the top a bit. I generally do more of a fade rather than complete shaving, but would consider this look if I don’t have a choice. I don’t know a ton about transplants because I am new to this, but I don’t see why someone couldn’t simply take all the donor hair they have and then put it up top. Other than money, I don’t know why this wouldn’t be a possibility.  Combine SMP with FUE, doesn’t that make sense?

    Good planning on the surgeon’s part allows the surgeon to estimate the donor supply and match it against the recipient needs. If there is not enough hair (a mathematical calculation), then SMP can be added as shown in this article I wrote: https://newhair.com/wp-content/uploads/2018/11/Combining_Follicular_Unit_Extraction_and_Scalp.98621.pdf

    Necrosis of frontal hairline (photo)

    Mar 23, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    It is rare to see necrosis (cell death) in the frontal hairline of a hair transplant. Here we see three areas of necrosis healing each one marked by an arrow. It reflects a technical defect.

    Costs and limitations of topical finasteride

    Mar 23, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    I’m looking at topical, how much is 0.1% fin to mg in tablet. Are there pros and cons to topical fin?

    In the US at Costco, I was able to buy a year supply of generic finasteride for $30. Topical Liposomal Finasteride costs about $60/month. The limitations of the topical, is that it only works where you put it so if you are losing hair all over, then the amount of topical finasteride will increase significantly along with the costs.
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