This may not be thinning. If a person with an average hair thickness was to bundle all of the hair (like a pony tail) on the head, it would make a circle about 1/2 inch thick. Now spread that out all over the scalp, and that is the coverage one gets. Short hair, a bright flash and straight hair can make a normal person look like this. To find out if you are balding, a HAIRCHECK test will tell you that (see here: https://baldingblog.com/haircheck-test-how-it-is-done-video/)
So I started fin about 10 months ago. The last two months i’ve started to notice a lot of new hairs sprouting at the front of my hairline and it has moved forward a considerable amount. The only problem is that behind my hairline, the hair in front has only begun shedding more and is now very thin. Can I expect my hair to fill in where I see regrowth, or will I likely only maintain or lose more density?
It is hard to predict what will happen. Give it a full 18 months and then you will know
AT 19 years old, you should be fully grown and not see an impact of finasteride on your height.
I had a patient stand on his head for two hours a day for 6 months to get more circulation to his scalp. He did 1 hour in the morning and one hour in the evening. He still developed progressive balding and did not grow any hair. I ended up transplanting him and he was quite happy.
https://www.nature.com/articles/s41598-020-80624-3.epdf
This article is highly technical and discusses hair cycling and identified some of the mechanisms for this process.
I’m sorry to disturb you with this message, but I’m really confused about something and I was out of options… I have been using Minoxidil for more than 9 months and finasteride for 8. I have read somewhere that I could never stop minoxidil because I started it before Finasteride and so that my hair was already dependent on its effect and that finasteride would not really work well too because of it. Is that true ?
I’m sorry if my question is stupid… Have a good day, Sir.
There is a lot of confusion out there. Minoxidil develops minoxidil dependent hairs when it works. Finasteride reverses miniaturization and possibly brings back the hairs when it is almost gone. These are independent so one can be used without the other although the two are complementary to each other.
Before i started fin my hair was okay, diffuse thinning but i could hide it really well. After i got on fin, my hair got way worse, especially after a month of using it. People started making comments, stuff i never used to hear. I started thinking the drug was making my hair worse. Now i’m 2 and a half months in, and my hair is sooo much better. I don’t even have to try to hide my hair anymore, or do any special hair styles to hide my thinning. I’m excited to see what my hair will look like 6 months in. Don’t lose hope
The key with this drug is persistence. Stay the course and most people see value either with slowing the hair loss, stopping it and occasionally reversing the hair loss
I had drug induced TE from Depakote. I stopped the medication almost 2 years ago. My hair has grown back and I don’t have MPB. But my hair is miniaturized all over. Is it normal and permanent? Thanks.
If you are saying that the hair, when it came back, was of a smaller caliber, then this may be a permanent effect. I would have to see you and examine you with a trichoscope to understand the problem you pose
Im considering another beard transplant but am worried it will leave scars on my face – can this be fixed to look more natural? will it leave scars on my face if the hair angles get re implanted? Alternatively im also considering Laser HR on my face but im worried there will be noticeable scars when fully removed? advice please?
You can remove each beard hair and replace it in the proper position. This shouldn’t scar the face if performed with a small punch. A laser would also work but then you would waste the hair
Hi Dr. Rassman, I found this man’s photos with what looks to be a sharp NW2 or mature hairline at age 30, but he and others in the comments believe it will worsen and he’ll “get more bald without finasteride.” I’m asking because I’m 22 and can kind of see my hairline is starting to turn to this sharp shape. So if you had to guess without a haircheck test, what would you say? Mature hairline or MPB? Thanks
The balding pattern if each male is predetermined by genetics. The problem is second guessing it before it starts to become apparent. There is no guarantee that the picture of the man showed will eventually lead to balding. A good doctor building a Master Plan with him and using the tools of trichometry and the HAIRCHECK test might be able to tell before it becomes obvious. That is what I do.
This is an excellent article discussing the safety and effectiveness of oral minoxidil. “Systemic adverse effects were infrequent and only 1.7% of patients stopped the treatment due to adverse effects.”
https://www.jaad.org/article/S0190-9622(21)00418-7/pdf
This second article reviewed 10 published papers addressing oral minoxidil use for alopecia in men and women: https://pubmed.ncbi.nlm.nih.gov/32516434/
Results: Ten articles were included for review comprising a total 19,218 patients (215 women and 19,003 men). Oral minoxidil dose ranged from 0.25 to 5 mg daily to twice daily. The strongest evidence existed for androgenetic alopecia and alopecia areata (AA), with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement. Successful treatment of female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy-induced alopecia was also reported. The most common adverse effects with oral minoxidil included hypertrichosis and postural hypotension.
Conclusion: Oral minoxidil is a safe and successful treatment of androgenic alopecia and AA. In addition to its therapeutic benefits, practical advantages over topical minoxidil stem from improved patient compliance.
Dr. Rassman: In my opinion, oral minoxidil is a reasonable second line drug for those men who can not use finasteride
Can you explain what hair weight actually means? Is it the thickness of individual strands of hair or the hair bulk altogether?
The experts call it Hair Mass Index, which reflects the value of the thickness of the hair shafts of your hair. It runs in simple terms, fine, medium or coarse. Fine hair has the least coverage value on its own. The article shows that men with miniaturized hairs may reverse miniaturized hair with a thicker hair shaft with finasteride but the thickness will only go as far as your normal hair thickness. A new publication by Dr. James Harris, he uses a simpler term “Hair Diameter Index”.
These articles published in peer reviewed journals, suggest that there are long term effects on using finasteride and dutastertide. It is important for anyone taking these drugs for long term use, to understand what these articles are implying.
Dr Rassman, quick question for you…obviously this guy had hair follicles which he was able to ‘wake up’ with medication….some people might have gone straight for a transplant to fix the recession. If follicles are transplanted then aren’t they just being placed on top of follicles that maybe could have been reawakened if they’d have tried treatment? Is there a danger that by going for a transplant before trying medication that you kill off follicles that could have come ‘back to life’, so to speak?
I have seen a patient who had 3000 grafts and never had balding. I used the HAIRCHECK instrument (https://baldingblog.com/haircheck-test-how-it-is-done-video/) to determine if there was more hair in the transplanted area than the donor area. What I found was that the 3000 grafts grew and increased his hair bulk as expected so I can conclude that damaging hair with a hair transplant doesn’t stop new or existing hair from growing. Of course, you ask why would a man who is not balding get 3000 grafts, well the answer is he had a scummy doctor who made him believe he was balding because his father was bald and the doctor saw him as $$$ for his pocket. Deplorable behavior.
If this woman has another hair transplant it will also fail. The doctor should be able to make the diagnosis of Frontal Fibrosing Alopecia (FFA) which is an autoimmune disease which will kill off the transplants. This is why you need to have a knowledgeable hair transplant surgeon evaluate your hair loss, to first and foremost make a proper diagnosis. From these pictures alone, I can tell she has either Frontal Fibrosing Alopecia or LLP.
