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    Microneedling and Minoxidil (photo)

    Mar 24, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    This is a 39 year old male who used microneedling weekly and minoxidil both for 4 months.  Sometimes I wonder how old you can be to get results from microneedling.  It seems that 39 is not too old yet.  There is clearly some filling in of his frontal hair. 

    I’m 21 and want a hair transplant

    Mar 24, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    I noticed my hairline receding at the temples about 2 years ago. I started taking dutasteride injections in to my scalp 1 year ago along with minoxodil. My goal was to at least stabilize my hair loss before I get my hair done, although it didn’t get better, it actually got much worse. If I fix my hair by transplant, will I be needing another one after some time? Im guessing if hair loss didn’t stabilize then that is the case. I have no history of family baldness.

    Please don’t get a hair transplant until you are at least 25. You will not know where your balding is heading at the sage of 21. A hair transplant in someone of your age, has a high likelihood of producing shock loss and significantly more hair loss than maybe you have now. Getting a hair transplant now may mean transplants every couple of years and a full depletion of your donor hair possibly before you complete your balding. The only one benefiting may be the surgeon who makes more money each time he/she does a hair transplant.

    Interesting article on finasteride and DHT

    Mar 23, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Click here: https://www.ncbi.nlm.nih.gov/books/NBK513329/#:~:text=Upon%20discontinuation%20of%20finasteride%2C%20DHT,hair%20count%20within%2012%20monthshttps://www.ncbi.nlm.nih.gov/books/NBK513329/#:~:text=Upon%20discontinuation%20of%20finasteride%2C%20DHT,hair%20count%20within%2012%20months

    When will I get reactive hair loss if I stop finasteride?

    Mar 23, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Finasteride stays in the hair follicles for over a week. Withdrawing it may cause reactive hair loss as early as 3 weeks after stopping finasteride.

    Steroid injections for hair regrowth

    Mar 22, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Doc gave me a few injections today at hairline as I shed hair on Oral Minoxidil which I stopped because of sides. Doc said steroid should stimulate some regrowth but I think it’s used more often for other types of hair loss. Should be interesting to see!  

    Unless you have an autoimmune cause of hair loss, I wouldn’t expect any results from steroid injections into the hairline.

    What is the Helsinki formulae for growing hair?

    Mar 22, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    https://www.ftc.gov/news-events/news/press-releases/1997/02/court-order-brings-close-ftc-lawsuit-against-makers-helsinki-formula-its-baldness-cure-claims

    Fixing up hair in a Bouffant on Reddit.com today

    Mar 21, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Morning routine feeling when the bathroom light hits you hard in front of the mirror from tressless

    Post Dutasteride Syndrome Suffer Speaks His Mind

    Mar 21, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    3 years ago, we exchanged a friendly conversation on my troubles with Post-Finasteride Syndrome. I followed your advice back then and went to several specialists, who couldn’t help. Since then, I am still suffering tremendously (numb deformed genitals, zero arousal, severe ED, other physical symptoms such as a thinning beard…) after exposure to 5ARi treatment.

    I’m honestly baffled that knowledge about this condition readily exists and NOTHING is happening to help those people who are suffering from it. My life ended when I developed PFS and I have been left to rot by the medical community.

    Would you be willing to raise awareness about this rare iatrogenic condition in the medical/dermatological community or publish a case report as to bring PFS in the medical literature? I don’t think this would damage reputation anymore since some credible studies have been published since, and, sorry for being so candid, I personally believe it’s your responsibility to help those who’ve been harmed by a drug you are promoting online.

    I don’t mean any offense or disrespect. But I’m only trying to give a voice to thousands of young man who have been severely harmed by this drug and have lost all hope. Last year, we lost a young man to suicide, because he couldn’t bear the bodily destruction anymore that PFS has wrought.

    Please, consider helping us bringing awareness to this rare iatrogenic disease. We have a moral obligation to not turn a blind eye to those in need.

    Thank you

    This syndrome, also identified with long term finasteride users, is devastating for those impacted.. Can you imagine giving up your sex life for the rest of your life?  There is presently not much understanding about these syndromes and certainly over the past decade, not much has been offered in effective treatments for these men.  The purpose of posting this man’s plight is to let you know that if you are on finasteride or dutasteride and have significant sexual side effects and/or impotence in the short term, speak with your doctor about stopping this drug.  From my experience, I am not aware that taking this medication for a short time and stopping the medication because of these side effects will produce this syndrome. 

    Which is better, topical or oral finasteride?

    Mar 21, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    There are two types of topical finasteride, the compounded liposomal version and the more common non-liposomal version. 82% of the liposomal version stays in the skin, but for the non-liposomal form, a great deal more leaks into the body. Generally, the pill is more effective as it addresses areas that are in the early phases of miniaturization which you might not see nor apply the topical to it.

    Minoxidil as a treatment for ED

    Mar 20, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Is it possible that oral min has an impact on prolactin levels and erectile dysfunction? I swear I started developing symptoms only on oral min and no fin, not able to sustain an erection.

    Yes, minoxidil can increase prolactin levels in women and impact their menstrual cycle. From what I read, it has no impact on testosterone and there are no reports that it can cause sexual dysfunction in men. In fact, the vasodilatation associated with minoxidil may be a reasonable treatment for erectile dysfunction according to some reports.  Maybe you are having a placebo side effect?

    Fynzur spray used in the EU for finasteride (photo)

    Mar 20, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    This Fynzur spray is used in the EU to deliver 50 microliters of finasteride ( 0.2275% Solution) to the scalp. After the spray is activated, the patient feels the moisture on the scalp, even with long hair.  Six months studied indicated that this does were equivalent to 1mg finasteride orally. This solution reportedly drops DHT levels by ~30%.

    Taking finasteride while trying to get pregnant?

    Mar 17, 2023/by William Rassman, M.D./0 /Hair Loss Causes
    I have often been asked about the safety for a female if the husband takes finasteride and they want to get pregnant.  The question is clear enough, “IS IT SAFE FOR THE MAN TO TAKE FINASTERIDE WHILE THE WIFE WANTS TO CONCEIVE?  The answers are clear as mud.  The official Merck literature for Propecia (https://www.medicines.org.uk/emc/files/pil.2194.pdf) does not place any risk for the pregnancy or the baby.  Generic finasteride information in the UK suggests otherwise: https://www.medicines.org.uk/emc/files/pil.547.pdf
    I will therefore, not answer the question for medical legal reasons and refer the person asking to the existing literature because all I know is what I read. What worries most doctors I have spoken to, is that there is a normal incidence of baby malformations out of every 100,000 births and if the man is on finasteride and they get a malformation while on finasteride, the man may become litigious against the doctor who prescribed finasteride setting up an association that may or may not be real.  That applies to almost any drug taken by a man or a women who gets pregnant and has the misfortune to have a baby with some congenital malformation.  

    1 year on finasteride (photo)

    Mar 17, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Good result from finasteride alone

    How mny grafts will I need. I am 33 years old (photo)

    Mar 16, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    Both sides have identical recession as shown here. 

    Assuming that you just want to fill in the corners and create a normal mature hairline, and assuming that your hair is at least medium in thickness in the back of your head, it would take about 1500-1700 grafts, depending upon where you and your surgeon place the exact location and shape of the hairline. A coarse, hair will drop the numbers while fine hair will increase the numbers. I have been doing hair transplants for 32 years and adjust the graft numbers to the donor supply, the balding pattern, the donor density the donor hair thickness and getting to know the patient and his expectations, so even the above estimate may change.

    SMP: How to pick the clinic

    Mar 16, 2023/by William Rassman, M.D./0 /Hair Loss Causes

    I am considering getting SMP for density at https://getscalpworx.com/ .What should I be looking for to ensure I have the best and safest experience? Thanks!

    Ask to meet patients that had it done and look closely at the work. If you can tell its SMP, then stay away from that clinic. Many clinics put large dots on the head and place them few and far between. The SMP stands out in those patients and doesn’t look normal.  Look at my SMP done with my staff: https://baldingblog.com/i-just-finished-my-smp-on-my-crown-area-today-see-before-and-after-photos/

    It’s good enough for me, so it might be good enough for you.

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