when the T increase as we know is it possible to trigger hairloss more ???
Finasteride does not trigger hair loss under any circumstance that I know of.
This patient had a hair transplant many years before. The surgeon clearly didn’t understand the hairline or the balding potential for this poor man. He is now stuck with a terrible frontal hairline presentation and an isolated hair transplant in the front and top surrounded by his balding scalp. He needs to have a real expert manage his problem today and it will not be inexpensive.
How does one know if a follicle has gone dormant, and can produce a new hair or is dead?
There is no way to tell other than the timing of its disappearance. Recent hair loss often has some active stem cells trying to find the ‘missing link’ to grow out a hair follicle. After years, these stem cells are thought to be inactive or possibly dead, but nobody knows for sure because we can get them to wake up so we assume the worst. If there is anything there, a small miniaturized hair left, medications might reverse it. Some people feel that microneedling might induce the recently hair that disappeared to come back. This is a microwounding process that causes the release of many kinases that can cause hair regeneration. When adding minoxidil to the process, results are even better. I referenced a review of mixroneedling here: https://baldingblog.com/review-of-microneedling-extensive-thorough-from-reddit/
If you use a Macro-lens on your cell phone (https://www.amazon.com/gp/product/B07S5YPPQX?pf_rd_p=ab873d20-a0ca-439b-ac45-cd78f07a84d8&pf_rd_r=CCSSMZGDS79G6AG31TT9) or purchase a digital hand microscope from Amazon (https://www.amazon.com/Microscope-Magnification-microscope-Compatible-Microscope/dp/B08HX42NCB/ref=sr_1_6?dchild=1&keywords=hand+microscope&qid=1634397365&sr=8-6), you can take a look at your donor area and calculate your donor density and your total available grafts or hairs for hair transplants for your lifetime. The key to getting photos like the ones shown below, is to closely cut an area (doesn’t have to be large) but the size of the lens you are using. These hairs were cut almost to a shaved level. I have counted the hairs in the field for you in two of the three photos shown here. Each number reflects the hair count per follicular unit (or graft).
In this example (photo #1), the total count is 140 hairs found in 56 Follicular units (or grafts) which means that this person averages 2.5 hairs/follicular unit (or graft). As the average Caucasian hair count is 2.2 hairs/follicular unit, this means that this man has 20% more hair in his donor area than an average Caucasian man. This will translate into more than 20% more grafts (logic will be presented another time) available in the donor area. With significantly more hair per graft, it means that over his lifetime, he will have more harvestable grafts to use for hair transplants. More grafts leads to a fuller look. You need to do this calculation for your donor area (the back and sides of your scalp). If your donor area has 1.7. hairs per follicular unit (or graft) as shown in the second patient photo, then it would mean that your donor supply is not capable of producing a lot of grafts for treating an advanced balding pattern. These patients run the risk of a see-through donor area if they get FUE performed with any significant numbers, especially if they have a medium-fine or fine hair.
The total number of Follicular Units on the entire hair baring scalp is 50,000 for an average head size. To calculate the total number of hairs that you were born with and using Follicular Unit Density from the back of the head (permanent zone) just multiply the average number of hairs per follicular unit times 50,000 and that will give you a total birth hair count. Example, if your average donor density is 2.2 hairs/Follicular unit, then the total hairs on the hair baring scalp is 2.2 * 50,000 = 110,000 hairs (which happens to be the average hair count for a Caucasian Male). From that calculation, the surgeon can determine your lifetime GRAFTS availability of the donor area. The donor area has 12,500 grafts (26,000 hairs), which is 25% of the 50,000 total follicular units on the head. Usually, the surgeon limits his harvest to leave enough donor grafts for (1) future use as balding progresses and (2) for increasing the fullness of the hair transplant with further hair transplants. Enough hair has to be left behind in the donor area so that it doesn’t become visibly depleted (see-through). In men with medium weight hair, between 3000-3600 grafts can usually be safely harvested, but with fine hair, harvesting 3000-3600 grafts with FUE produces a see-through donor area so the number of FUE grafts that are safe is usually substantially less than 3600 grafts and that is where the experience of your surgeon comes into plan. When a person has a coarser hair, the number of grafts that can be transplanted goes higher than the 3000-3600 graft limit of the 50,000 total follicular units. This illustration shows how the individual hair thickness impacts the overall look one gets with a hair transplant: https://baldingblog.com/hair-thickness-vs-density/
There is a warning here for those of you going for FUE. If your hair is fine in character, harvesting a lot of grafts from the donor area will produce a see-through donor area that appears to be balding. This is not a concern for a man with a coarser hair.
I will tell you that doctors opinions vary considerably on this limit of harvestable graft numbers. Some doctor increase the number, extending the donor area above the 3 inch height limit, possibly harvesting 5000 or more grafts of the 50,000 follicular units, but those who do that, are going to harvest grafts that may not last the lifetime of the patient because they were taken outside of the safe donor area zone. If the patient develops an advanced balding pattern (like a Class 7 pattern of balding), harvesting outside of the true donor area will show significant scarring of the scalp left behind from the FUE punch. A competent doctor will put this into perspective for your Personalized Master Plan. Every balding man who things that some day he may get a hair transplant, must understand how to do these very simple calculations and understand what I have said in this post.
High Donor density
Here are two different patients with low donor density, one with my counted numbers and the other without numbers at all. Both of these two lower photos reflect lower than average donor densities.
So basically what I learned is that people who don’t recover from sides after quitting fin are bound to get them regardless, propecia just accelerated the what will happen to them. Because of that how tf do I know if I’m getting ED or whatever in the future ? The doctor said that people who have low testosterone or diabeties have that chance but I have no idea if I have low t levels. I mean I have lots of body hair and some facial hair and I’m south Asian sooo
I don’t know if your doctor knows what he/she is talking about. There is no association between diabetes and PFS. I don’t believe that anyone knows what causes it, but I know that we don’t see it in our practices because we don’t maintain young men on finasteride who have ED, especially if it doesn’t respond to time and/or a reduced dosage.
Is this a common symptom because of finasteride? It also aches a lot when I lift heavy in the gym, especially when doing squats. My left testicle also got bigger than my right testicle, is this normal? My right testicle doesn’t ache at all, only left.
Pain in a testicle can be from many causes, and if it is swollen it would worry me even more. You should see a doctor as some of the causes can be threatening to the testicle.
I really don’t want to go on fin because of the sides, but I need another way of getting the DHT off of my scalp. Has anyone ever been successful at scraping it off? Any help is appreciated.
The DHT is in your blood and hair follicles, so it can’t be taken off of your scalp.
This is a publication from the Kaiser Wellness Journal written by my son Sean Rassman, an orthopedic surgeon moved by a motivational speaker
Woe is me vs. Wow is me – what’s your take?
Published July 9, 2015
By Sean O. Rassman, MD
Department of Orthopedic Surgery, Fontana
Of all the physician off-sites and speeches I have attended in the last nine years, the personal life story told by my colleague, Dr. Kent Miyamoto, had the greatest impact on me. I am sure each physician who heard him speak that day took away something different. What touched me most about his story was not what one may think — the precariousness of life — but what he felt as a patient. He said that he had tried to thank his doctor for saving his life and his gratitude was met with, “I was just doing my job.” He indicated that he actually felt a bit dismissed and cheated by the response.
This made me rethink all of my patient interactions. What we do is more than just a job to the people we treat. I may see up to 40 or more patients on a clinic day, each scheduled for 15 minutes. In reality, I may have even less time than this, due to my seemingly always overbooked schedule. Many days I go through clinic stressed. I work straight through every lunch and often stay an hour or more after my clinic to finish up and then respond to patient messages. I will admit that I have felt frustration and even anger towards patients who try to extend their 15-minute appointment into 20, 30, or sometimes 45 to 60 minutes. I have thought too many times, “Don’t they know how busy I am and how many other patients are on my schedule?”
There was something about Kent’s story that made me realize, although we may only spend 15 minutes with a patient, that 15 minutes is amplified in so many ways.
Often, patients wait weeks or months to see me and may drive for an hour or more in each direction. They may give up several hours of a day for a 15-minute appointment with me. It is likely that all of their family, friends, and perhaps even coworkers have heard about that upcoming appointment. Many patients have likely spent hours thinking about it, discussing it, trying to anticipate what the doctor will say, and, after the appointment, may spend additional hours trying to make sense and summarize that 15 minutes with all of those in their lives.
I realized I had the choice to see these appointments as something that I needed to get through or 30 to 40 opportunities to make a tremendous impact in people’s lives and the hundreds of friends and family who are impacted by that illness. This is both an honor and a weighty burden.
I asked myself, what would happen if I tried to use the 15 minutes not just to “satisfy” or placate patients, but what if I could use that time to wow or amaze them with by showing them that I not only understand their problems, but that I care about them?
Switching to this attitude resulted in a mental shift and I began to look forward to my clinics more as opportunities to make daily, meaningful impacts and perhaps even amaze a few people.
This mindset is something to which I must frequently rededicate myself, particularly when dealing with difficult patients. Whether they are abusive or manipulative, they can contribute significant stress and one or two difficult patients can ruin a physician’s entire day.
I will probably remember little of our motivational speaker from that meeting last year, aside from the fact he liked to climb mountains, but I will always remember Kent’s story and the impact it had on me.
In the past, I was often guilty of brushing off the compliments of grateful patients, because I knew I had a chance to reduce their 15-minute appointments and use extra minutes on difficult patients.
I used to focus on trying to get out by 5 p.m., but came to realize, if I focus on providing not only excellent orthopedic care, but also emotional and psychological care, even if it means I finish 30 or 60 minutes later, I would leave happier and more satisfied.
Now, I make it a point to try and own the difficult patient, even though I have to accept that I will not be able to positively affect each one. Coming up with ideas for dealing with the difficult patient are the things I struggle with most. Here are some that work for me:
1. Attempt to empathize. It may change your own perspective and reactions.
2. Make sure the patient knows that you are truly listening. Sometimes that is all you can do.
3. Make sure the patient does not feel brushed off; something the patient believes other providers have done.
4. Accept that you may need more time with that patient; that you may leave late and try to somehow see this as a positive challenge.
Sometimes, the angry, difficult patients can become the most grateful and sometimes the challenge and joy can be flipping them from angry to amazed.
Body hair transplants work, but the body hair has a short growth cycle. This means that for every 10 hairs that are transplanted, they will cycle about every 6-8 months meaning that only half of the hairs are growing at any one time as the sleep (telogen cycle) is also long. If you don’t have enough scalp hair, the beard is a better donor source, as its growth cycle is like scalp hair.
Yes, there is a very subtle change in the shape of your frontal forelock, suggesting it might be returning. I would stay on what you are doing as it seems to be working
I had amazing hair often when a teen and so on, i didn’t go about feeling great every day cause my hair was great, i still depressed about things and so on…..Its crazy how the mind works.
I can tell you from 29 years in the hair transplant business that men, of all ages and all professions, feel better about themselves with hair. Many actors who made it in the movies that I did surgery on, think that their hair improved their overall confidence to do their jobs better. That is across the board for all men I have worked with.
It looks like you went from a juvenile hairline to a mature hairline. The distance between your nose and your chin appears to be the same distance from the bridge of the nose to the frontal part of the hairline. You look good and hairy!
Eric Von Detten 20 year hair loss Progression from tressless
“As a professional consulting engineer, I have been trained over many years to appreciate the importance in the details. For example, when I decided to investigate hair transplant options for myself, I took my time; the overriding litmus test, was “A bad hair transplant result is far, far worse, than having no hair transplant at all, at any price”. That principal first led me to start at the very beginning… Who developed the first successful thousands at a time hair transplant procedure that was a completely successful result? Wikipedia will lead you directly to Dr Rassman. He was the original pioneer in this thousands at a time hair transplant procedure. I was hoping to find a doctor who had been trained by Dr Rassman; and to my surprise, I found Dr Rassman was still practicing! I immediately arranged to see him, for a procedure. He was hands on for the whole procedure, including his office staff professionally trained by him to totally exacting standards. Before this, my long term hair stylist for many years had cautioned me not to get the hair transplant; he had seen so many horrible results in the past. So it was with great surprise my hair stylist upon seeing me the first time after the procedure, couldn’t believe how natural my new hair line looked! That is the best feeling when I heard my hair stylist’s disbelief. Apparently, hair transplant results in North America are getting worse over these years, as more and more “Less than competent” doctors are doing unskilled procedures, only for the money. Do not allow yourself to become another billable bad example of what not to do. Thank you to Dr Rassman and your amazing staff.”
This type of comment made my day and warmed my heart. He had 2460 grafts.
The use of your turban with the pulling that is created from the tight wrap is the most likely cause of the hair loss. If the loss has been there for more than 8 months, it is probably permanent and the only good treatment is a hair transplant. We see this commonly in Sikh men and have treated this successfully with hair transplants many times.
Male, 19, Sikh… formerly had long hair, suffering from Traction Alopecia and created an account specially just to post on here and take your guys’ opinion on what should I do regarding this. Feel free to recommend anything although I think minoxidil would greatly help me. from tressless
So I have traction alopecia and I have for a while from wearing extensions for years. I have four big bald spots in the back of my head. I don’t have the confidence to not wear my extensions but i need help to grow my hair back if possible. I figured I can wear my hair in different styles to protect the bald spots then stop when it all grows back. I just ordered women’s rogaine and wondered if there were anything else I can do. I am white and use clip in extensions
Traction alopecia, if prolonged with the pulling, will produce permanent hair loss. See a doctor who specializes in both Hair Transplants and Scalp Micropigmentation to see if there is an easy solution for you.