A picture is worth 1000 words. This is Scalp Micropigmentation (SMP) done by someone possibly off-the-street. He has a straight line across his head. Whoever did this had no idea what a hairline should look like.
I will use hair fibers when I go out, and if I take a quick shower before going to bed, there would still be some fiber that I didn’t get out. I wake up and notice black fibers under my nails which means I’m actively scratching my head during sleep. I am planning on doing my surgery in a few months and I’m worried about scratching while I’m sleeping. What can be done to stop this? Other than tying up my hands I can’t think of anything else
Discipline! Realize that if you scratch your grafts out, you will lose a lot of money and possibly introduce infection. I have seen this just twice in 16000 surgeries. Both men were told to wear mittens.
Very nice. If you look carefully, you can see hairs that are about 1/2 inch in length suggesting that there is one month growth in them. This means that you are very sensitive to finasteride in a good way.
Hello Doc hope you are well. Just wanted to get your take on something. I’ve been taking finasteride for about 2 years with decent results , mostly maintenance. However I’ve seen considerable progress microneedling my scalp. I’ve been doing it for a over a year and it is still yielding positive results. I would attribute most of my regrowth to microneedling in fact. Since this is a natural treatment I was wondering what your thoughts were in regards to the possible longevity of this treatment. If I’m happy with where I’m at , could say a microneedling routine once a month maintain these results? Love to get your thoughts on this. Take care.
I know a little bit about the research done when injuries like microneedling induces hair growth. These hairs may need to be ‘kicked’ with another short course of microneedling, possibly every 6 months. We are not clear what will happen to the hair follicle when it goes into telogen (rest) cycle and then must come out of it into Anagen (growth) for the new hair to develop. I believe some ‘kick’ should occur periodically and I am guessing about every 6 months or so. We are learning more as we go forward.
Will changing dose of finasteride from 1mg to 0.5mg per day reduce the risk of sexual side effects?
Yes, if you have aside effects, reducing the dose to half will reduce the side effects in many men.
hey dr. wrassman, i know there’s probably no chance you respond, but i wanted to just look for advice.
i’m 19 years old, about to turn 20 in january. my hair has been thinning and i’ve been a diffuse thinner for years, so the thinning is making it slightly worse as time goes on. i want to take finasteride so badly but the side effects scare me. i know they’re present in about 4% of men, but the recent reveal about merck lying about their side effects claim freaked me out as well. would you mind helping me calm down and explaining everything to me?
Most of the guys who take finasteride think that they are just taking their daily vitamins. That is my experience as I take it now and my son’s experience as well. This is completely your decision. If you don’t talk yourself into side effects, then if you get them you can just stop taking it. I don’t believe that PFS ever appeared in a normal person taking finasteride for a short time and then stopping it.
This patient took finasteride just 2 months. You can see the short hairs growing as a result of the finasteride in the corners on this photo.
So I went to a GP as I wanted to get a prescription for Finasteride. Of course the doctor had never heard of the drug and apparently he had never had anyone come to him about hair loss. He started reading about the drug online and asked if I had tried minoxidil. I told him that I have been on minoxidil for two weeks but I wanted to use both treatments together. He responded to this by telling me that I should only use one treatment at a time and that I would have to choose which one I wanted to use. I told him I’d choose Finasteride and he wrote me script for it. I’m still considering using the two treatments together as I can’t find anywhere that says there’s something wrong with using these two treatments together. Has anyone else heard of this before and do you think that I should still use Minoxidil and Finasteride together anyways?
Brief History: I’m a 21 year old male, started noticing my hairline receding 2 years ago, it has been receding very slowly ever since but my hair loss has progressed to the point where I need to stop it before it becomes too noticeable. No hair loss on the crown and all my hair is still very thick.
If you have a balding or thinning area already, using minoxidil on it in addition to finastetide is something I often recommend. I like to get a HAIRCHECK test on all of my patients to be able to measure the progression or the reversal of hair loss while you are under treatment.
Some of the symptoms include: chest pain; irregular or very fast heartbeats; dizziness or lightheadedness; or fainting. Minoxidil is a hypotensive agent original designed to treat high blood pressure. Minoxidil is a direct-acting arterial vasodilator. The most dangerous of the complications is pericardial effusion reported with minoxidil treatment both in patients undergoing dialysis and those with normal renal function. Pericardial effusion can be large and result in cardiac tamponade in some cases and if untreated can rarely cause death.
I understand thank you once again. I was simply asking if oral min was generally considered safer in the long term then fin?
The answer for the drug finasteride and oral minoxidil is that if you don’t develop complications from the drugs, then they are safe for you. For example, oral minoxidil has a very rare cardiac side effect that is dangerous and must be picked up early (fainting, heart palpitations, allergy).
these are known complication of this drug so should you eliminate taking it because of this potential, even if it is rare? If you get sexual or other side effects from finasteride, then speak with your doctor and see if you should still take it. A few people believe that if you get sexual side effects and you stay on the drug, these side effects will continue (Post Finasteride Syndrome)
Finasteride, when it brings back the hairline, it is usually in a younger man (under 25) but I have seen it in a 33 year old as well. This is not common and the published literature suggests that it is rare and not to expect return of frontal hair with finasteride.
The doctor recommended 10 sessions of PRP at $500/session. I would guess you might purchase a good used car for that $$ amount. So if you were shopping for a car, you would research it, right? Doubt that you will stop your hair loss with PRP and reversing it is another story! Some doctors are just not honorable. I can tell you that I would doubt that you would get much value from this PRP package.
I was wondering if you have an opinion on hair systems, or if you ever recommend them to patients with advanced balding? I know that most people prefer to keep their natural hair, but I feel like people with very advanced balding (NW5+) would look much better if they just wore fake hair rather than try to stretch out their limited donor supply over their entire scalp. I’ve noticed that people who try to get a transplant as a nw6/7 almost inevitably have to choose between a sky-high hairline, a giant bald spot surrounded by a ring of hair, or just very thin hair all over.
Different strokes for different folks. Hair systems work and work well; however they are very expensive (see here: https://baldingblog.com/why-not-a-hair-system-instead-of-a-hair-transplant/) and once your on them, you are hooked on them because the attachment mechanisms cause permanent hair loss and makes the balding worse. Even from a cost perspective, a hair transplant is generally less expensive unless you are a Class 7 man. In that case, a hair system is like putting on a hat, but you have to wear it all of the time and over time they start to smell and fall apart, requiring washing and replacement frequently. Also, unless you can afford the best like Donald Trump has, your system may be detectable to almost everyone. Nobody likes that.
I have a scar from my hair transplant, why did it happen, did my doctor do something wrong and what can I do about it? (photo)
You had a strip surgery and clearly scarred worse than many people do. I had three surgeries in the same place and have no significant visible scar. It is not that I had a better surgeon, I just healed better than you did. I am sure your surgeon did the surgery right. The best way to deal with the scar is to have scalp micropigmentation which covers up the scar nicely. Your picture is on the left, a worst case scar is shown on the right before and after scalp micropigmentation (https://scalpmicropigmentation.com/). There is hope!
The sexual side effects from finasteride can appear at any time. It may be caused by the drug. See your doctor and discuss this with him. I generally tell my patients to reduce the dose to one pill every 4th day for 3 weeks, then one pill every 3 days for 3 weeks and then end up with one pill every two days and stay on the lower dose if that dose helps the side effects.