Cutis Verticals Gyrata (photo)

/by William Rassman, M.D./0 /

Cutis verticis gyrata describes a scalp condition with convoluted folds and deep furrows that resemble the surface of the brain. Cutis verticis gyrata is a progressive condition. It is mainly troublesome due to the cosmetic appearance. Rarely, it can be complicated by malignant melanoma developing within a melanocytic naevus. Cutis verticis gyrata occurs more commonly in males. The primary form of cutis verticis gyrata has a reported male-to-female ratio of 5:1. The incidence of cutis verticis gyrata may be reported as lower in women because longer hair may camouflage the condition (Ref: Dermnet NZ).

This is a cosmetic issue for those who have it. As you can see in this photo, styling the hair can be a problem.

Doctors confuse dosing of finasteride

/by William Rassman, M.D./0 /

I am a 21 year old male from India and I have been using the generic Finasteride 1mg for the last 1 year. I have had good results and almost no thinning in the past year. I have been to 3 dermatologists and they want me to discontinue Finasteride even though I have zero side effects. Upon asking the need to discontinue the drug, one said Finasteride should not be taken long term. Another doctor said once hair grows back on should stop taking it. Another doctor said, Fin has to be used 6 months ON and OFF. I am really worried about this sort of treatment protocol. They say side effects occur later if not now. How many doctors can I visit? Will it not be considered doctor shopping? It will be rude to ask a doctor to prescribe certain medication. On the other hand I definitely want to continue taking this medication since I am too afraid of losing my hair after such good results. Help me! Should I switch doctor?

Finasteride, when taken, should be taken every day and an on and off routine makes no sense to me. I think you are correct and if you feel it is working without side effects, stay on it.

Taking finasteride & hair transplant

/by William Rassman, M.D./0 /

26 y.o., I’m Norwood 2~3 with slight vertex loss. I’ve been on Fin for nearly 4 years and, as far as I can tell, it completely halted my hair loss. I don’t think I grew back any hair and it didn’t do a thing for my shedding for some reason, which I still have heaps, and I still have some miniaturized hairs along the hairline and vertex. But my hair seems to be in the same place as it was when I started taking the pill.

So I was thinking I’d maybe get a transplant eventually to get my hairline back to where it was, but there’s one thing concerning me: what if Fin suddenly starts losing effectiveness and my thinning resumes? Is that something that happens and have to keep in mind? Or even if it’s still receding at a very slow rate that I can’t really tell. I’m not sure I want to keep paying for further expensive transplants to play catch with my hairline.

Is there even a way to tell that it’s “safe” that your hair loss will surely be perfectly stable to get a permanent fix?

Finasteride continues to work, at least in slowing down the hair loss in most men. When getting a hair transplant, taking finasteride will prevent shock loss so you should continue to take it even after the hair transplant, possibly for your lifetime.

Vitamin D Deficiency, Should I Still Take Finasteride?

/by William Rassman, M.D./0 /
I got my blood test results and found out that my vitamin D was very low, my doctor said this could have lead to my excess shedding. Now knowing this info I’ve been taking fin for little over a week now and was wondering if I should stop taking it or be taking it just in case?

Should I just take vitamin d or take vitamin d and fin?

Does your balding reflect the genetics (Norwood type) or is it diffuse? If it is the genetic type, then even the Vitamin D deficiency might not reverse the hair loss.

I Am Going for a Free Consultation to Find out If I Have Dupa

/by William Rassman, M.D./0 /

 I’m going to talk to the doctor about my type of hairloss and why I am thinning on Dutasteride. I’m going in for a free consultation and I’ll see what they have to say, whether I have normal MPB, DPA, or DUPA. I’ll keep you guys posted.

DUPA (Diffuse Unpatterned Alopecia) was first published by me in 1996. When it occurs in men, it impacts the donor area and as a result makes these patients poor candidates for hair transplants. Back then, doctors transplanted these men when they were balding and most of the time the transplants were failures, often leaving these men with scars and hair transplant deformities. The diagnosis is made with a hand microscope looking for miniaturization in the hair in the back and sides of the hair which is generally immune to balding. It can sometimes respond to finasteride, but it is not predictable. The cause is unknown.

1 year on Minoxidil

/by William Rassman, M.D./0 /

I believe it is much better after a year. What do you think doctor?

Because your hair is curly and you can’t replicate the exact same hair style and hair length, you must use subjective evidence of the value of the year on minoxidil unless you were checked with the HAIRCHECK test (https://baldingblog.com/haircheck-test-how-it-is-done-video/) which will give you a clear measurement of what has happened to your hair over the past year.  Everyone who cares about their hair should do this if you are going to take the time and spend the money on saving your hair. See this post: https://baldingblog.com/follow-haircheck-test-5-years/

In an Fue Transplant, How Many Hair Follicles Are in a Graft?

/by William Rassman, M.D./0 /

I had a few questions about hair transplants (fue)

  1. In my donor area, does each graft contain several follicles?

  2. For the transplant area, does the doctor usually implant several follicles per graft? I had someone describe that for the first 3 rows, she would put 1 follicle each per graft. Then the following rows would be 3 per graft. She explains that it would look more blended in. How do most other surgeons do it? Do the follicles vary per graft to make it look more natural? thanks

As the pioneer of follicular unit transplantation and FUE, I have studied the follicular units for some time. Everyone has a different hair count in their follicular units. Caucasians from Europe usually have the highest hair counts (between 2-4 hairs per follicular unit), Asians or people from middle east like Arabia, have lower hair counts (between 1-2 hairs per follicular unit). Of course, cross breeding has changed it so that if you have a mixture of ancestry, the number of hairs per follicular unit can reflect an ancestor’s numbers rather than your ethnic average. If a doctor puts multiple follicular units in a graft, it will look pluggy (not normal).

Transformed (From Reddit)!

/by William Rassman, M.D./0 /

A little explanation of what I have done to make this happen.

Two years ago, I realized I was transgenger (MtF), and I immediately started doing whatever I could to try and get my hair back. I started finasteride in January of 2018, and started in using Minoxidil at the same time. In July 2018, I started feminizing hormone replacement therapy, which includes a testosterone blocker, spironolactone, and estrogen, estradiol. Then in October 2018, I switched from finasteride to dutasteride, since my body is still producing some testosterone, as everyone does. I have been growing my hair since just before New Year’s day, with a few trims to prevent any awkwardness. Some of the hair that has been revived has also come back blonde, which I think is a little interesting.

I just thought this was something that was miraculous, and while this sub is predominantly men, I figured this recovery would be appreciated. Yes the hormone therapy has been a huge part, but I still wouldn’t be at this point had it not been for the information I discovered on this sub.