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    Can end-stage miniaturization be reversed?

    Aug 4, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Can “end stage” miniaturized hairs be salvaged with medication such as Finasteride/Dutasteride/Minoxidil. Or are those a lost cause once they reach that stage?

    We tend to look at these hairs as lost causes; however, microneedling may have changed that perspective. We don’t really know as proper research has not been done. I have seen finasteride reverse miniaturization on a limited basis, possibly when it is early.

    Microneedling and minoxidil

    Aug 4, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Do you apply minoxidil right after dermarolling? If so, why? Is it more efficient or just personal preference? Also what is the perfect derma roller size? 1.5mm or less/more. And how do you clean your derma roller? Sorry for all the questions, im just cautious

    If you apply the minoxidil immediately after dermarolling, then the medication may go through the skin directly making it more effective

    finasteride and risk of pregnancy

    Aug 4, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    I am using finasteride and me and my partner had unprotected sex whilst she was in her infertile stage of the menstrual cycle. This may sound stupid but I am worried that having unprotected sex whilst on finasteride will cause damage to the female’s reproductive ability / any egg cells. Is use of a condom specifically recommended if your partner is pregnant or could get pregnant? We are not looking to have children for another few years at which point I will quit using finasteride but just worrying myself that there will be damage caused by unprotected sex in the present

    If you are using any birth control, not a problem. The use of a condom is recommended if she it tying to get pregnant. Timing fertility (the actual point of ovulation by taking body temperatures) is not always accurate unless she is regular on her periods.

    Exercise and finasteride

    Aug 4, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Hi doc, in your experience, is finasteride less successful for people who are lifting weights in the gym? Currently on 3mg/week for almost 2 months and still lose some hair.

    I don’t see going to the gym as reducing the impact of finasteride

    Are blood DHT levels important before taking finasteride

    Aug 3, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Hey, so I’m planning to get a DHT test to check out the levels before starting finasteride. I’m wondering whether it is the amount of DHT or the sensitivity that matters when it comes to balding or other effects? Basically is it a waste of money to measure DHT levels if they don’t correlate with anything?

    I personally think that it is not worth doing. What you want to know is: will the drug work for me? Changing drug blood levels doesn’t tell you that information

    Why not go bald?

    Aug 3, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    At this point, I want to let it go. There are several reasons for that.

    1. All my male relatives have male pattern baldness. So one way or another, it’s going to happen. Feels like I’m fighting a losing battle.

    2. I feel pretty vain acting upon hair loss. Especially when you see others not caring at all. I want to feel good without being attached to my looks. Looks fade.

    3. The time invested in combating hair loss could be used for more productive stuff, especially knowing since my hair is ought to go anyway.

    Many men want hair because they are more attractive to themselves and more confident in themselves. I have performed hair transplants on many celebrities who all tell me that it improved their self-confidence. You would be surprised by this if I revealed their names. 

    Effectiveness of DHT blockers

    Aug 2, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    My question is; does finasteride and dutasteride lost effectiveness over-time in the body? Like, say in decades, would my body become used to dutasteride and it will lose its effectiveness and hair loss will resume or can I preserve my hair forever (until I’m a senior, theoretically) just from taking 0.5 mg of dut everyday for the rest of my life?

    Another question, will the hairs that grew back become thick like how they were before they fell out? Is there anything I can do to make them thicker or do I just have to keep taking the drug and wait longer?

    It is not the blood levels of these drugs that are important, but the tissue fixation that occurs after taking the drug. The tissue fixation of finasteride is about 7-9 days while the tissue fixation of dutasteride is about 6 weeks. These drugs generally do not lose effectiveness but the balding pattern is tied to apoptosis (cell death) which these hairs undergo over time. These drugs slow the process down but will not prevent the outcome, which is inevitable.

    In the early stages of use, when miniaturization is high and newly formed, the probability that these drugs will reverse the miniaturization process, making these hair stronger and less miniaturized, will be good.

    Do hard drugs promote hair growth

    Aug 2, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    I just watched the Andy Irons documentary (A Pro surfer) with Andy and his brother who are known to have used hardcore drugs and are perfect Norwood 0’s. David Bowie, Bob Dylan, Robert Plant, Comedians like Richard Pryor, Joey Diaz. Do you think hardcore drugs lower your Testosterone and DHT levels? When ever I hear people saying hair is a diet thing I think absolute bullshit. David bowie lived off of cocaine in the 80s with like a can of tuna fish and some peanut butter or some shit and had perfect hair.

    These guys are public. I doubt that their hair has anything to do with hard drug use.

    7 Months finasteride, minoxidil and microneedling (photo)

    Aug 2, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    Very nice regrowth with the combination of microneedling, finasteride and minoxidil. I believe microneedling makes all of the difference

    Considering shaving my head

    Aug 1, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    I am strongly considering a transplant, since I really am sad about my balding situation.

    It is such a slow progression and at the moment It is only frontal part that will need transplant. I am 27 now and cannot tolerate the AR5 inhibitors (tried everything, including all different dosages). Crossing fingers for future treatments !

    BUT I am afraid of the FUE scars (even with micro) if I eventually will have to shave it all off to the bare skin (if the balding continue, even on the side and back of the head). Can you share pictures of the FUE harvest area after a head has been shaven?

    Most of those men who shave their heads after hair transplant either had: (1) poor or no growth, or (2) poor planning without a Personalized Master Plan and with unrealistic expectations that result. Also, if you shave your scalp very close after an FUE, you will see a lot of white dots, the scars left from the removal of the grafts which happens in 100% of FUE surgeries.  FYI: any cut into the skin any place in the body will cause a visible scar. 

    Starting dutasteride instead of finasteride

    Aug 1, 2022/by William Rassman, M.D./0 /Hair Loss Causes

    The safety of dutasteride in young men with hair loss has not been determined as this drug is not FDA approved. Start with finasteride which is almost as effective (70% vs 85% of the competitive inhibition at the hair follicle level)

    Breakthrough on hair growth drug

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

    Dr. Rassma has been working with UCI for 4 years in the development of this breakthrough drug:  https://www.nbclosangeles.com/news/local/one-molecule-may-be-the-key-to-whether-or-not-you-lose-your-hair-uci-study-finds/2949359/

    Getting a hair transplant without using meds

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

    You can get a hair transplant without medications; however, if you are under 30 and/or had recent hair loss, then shock loss is a high risk without taking oral finasteride prior to the surgery.

    Early hair loss is the problem. Anyone whose hair loss is recent, will usually have miniaturization that is extensive. It is these early miniaturized hairs that fall out. Most men above 30-35 have already lost their miniaturized hairs. Finasteride holds on to these hairs in the face of a hair transplant.

    3 months microneedling, minoxidil and finasteride

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

    This is an excellent response to microneedling, minoxidil and finasteride over a 3 month course. Notice the left side of his crown has clear reversal which is consistent with the drugs alone.  This suggests that the other side will follow as well

    Microneedling, is it ever too late?

    Jul 29, 2022/by William Rassman, M.D./0 /Hair Loss Causes
    I believe for long term balding areas in men over 40 when the skin infrastructure has been gone for more than 10 years, microneedling will have a lesser chance of producing hair growth and I would not recommend its use in that situation.
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    Over 21 million women and 35 million men in America suffer from hair loss. For many of these people, the psychological impact on their life is debilitating.

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