This young man found that the finasteride restored his forelock but not his hairline. The forelock is independently genetically from the surrounding hair, including the lateral hairline
1 year of finasteride. but in the past month, I am noticing my hair density is decreasing. I think it’s a seasonal shed. Thoughts?
Humans have asynchronous shedding, unlike most mammals in the animal kingdom who have synchronous shedding. That means that we did not shed to cycles of the weather, or for that matter, for any external factor
The younger you are, the more likely there will be regrowth, especially in the frontal hairline. The crown is easier to regrow at most ages with drugs like finasteride. Microneedling may change the game on regrowth, worth a try at the least.
I am 22 years old, and will turn 23 in September. I have been experiencing hair loss since I was 20 years old & losing all my hair is my biggest fear. Getting a hair transplant is something I think I’ll have to get eventually..but before I do that, I have been contemplating starting finasteride 1mg daily for quite some time now but before I do that I wanted expert’s advice on the same.PS: I have some pimples/inflammation on my donor region (back of my head) & am treating the above already using the keta 2% shampooIn short my questions are:
1- What supplements (Multi-Vitamins/Biotin etc..) I should start with?
2- Should I start consuming finasteride 1mg daily now? and start minoxidil too??
Questions on Finasteride:-
1- If I start taking Finasteride, do I have to keep taking it forever?
2- Read online about “shedding phase” that people experience once they are on finasteride
3- How often does it happen, is it something that will repeat itself over and over again?
Finasteride daily is the best medication for genetic hair loss in a young man. A few men might get shedding when starting it (not uncommon), but that subsides in a month or two and doesn’t repeat. Medications for genetic balding, like finasteride, are a lifetime commitment. I don’t think that most Western men have problems with malnutrition if they eat a reasonable Western diet, so vitamins are not critical for hair loss prevention; however, Vitamin D may be important to men who do not get enough skin, so make sure your vitamin D level is normal, it it can be a cause of hair loss.
I saw in one of your posts on your blog where you said somebody who is 35 years old with a Norwood 3A pattern has a worst case scenario of reaching a Norwood 5A. How do you know that? I thought the extent of hair loss can’t be predicted and in all of your posts you say that hair loss is progressive. Also, if you live long enough, will a Norwood Class 3 become a Norwood CLass 7 pattern?
Everyone with balding genetics has a hair loss pattern that will evolve in their lifetime at an age determined by the genetic clock in each hair follicle. That pattern depends upon your inheritance and the progressive nature of hair loss reflects the movement to this “Unknown” pattern that you have. I developed general rules of thumb over 32 years in this business that give me insights into the statistics of patterned hair loss as it reflects the age and circumstances of each patient I examine. Some balding men, for example, with a Class 3A pattern of balding, may never progress further, so a Class, 6 or 7 pattern for that person, may not be a genuine concern for me with some probability predictions made by me. Every person I examine is different. For the ‘victim’ of balding, they worry about developing a Class 6 pr 7 pattern, which may be familial, so they rightfully worry.
About your second question: No. If you don’t have the genes for a Class 7 pattern, you will not develop one even if you live to 100. The problem is that there is no way to tell what genetics you inherited and how that genetics is expressed in your body. That is why a doctor with great experience, like me, brings some value but still can’t predict the pattern 100%. My grandfather lived to 102 and retained his juvenile hairline and a full head of hair. This proved to me that hair loss is not inevitable for men. My Grandmother lived to 114, and she retained her juvenile female hairline throughout her life.
This study proposes 0.2% concentration as being nearly as effective as 5% minoxidil
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804833/
This astute 23-year-old male examined his donor area through a hand microscope purchased from Amazon after reading some advice I gave on Reddit. He was suspicious about having DUPA based on his view of his donor area, so he sent them on to me for an opinion. Both Dr. Bernstein and I believe that this is a case of DUPA. Note that the dark thick hairs are normal terminal hairs, while most of the other hairs have a smaller diameter, some are even thinner than the rest, and those hairs don’t have much color to them. These thin hairs are miniaturized. I can’t say how long they will survive in the donor area, but I suspect his progression will be slow. If he were to use it for a hair transplant by a doctor who is ignorant on what DUPA looks like, his hair transplant likely will fail, and the shock to the donor area could accelerate the disappearance of hair there (I am speculating). CLICK TO ENLARGE
This is an excellent photo showing that you have a very high donor density of about 2.7 hairs/follicular unit. The normal Caucasian person has a donor density of 2.2.
Some doctors are so orderly that they line up hair grafts like toy soldiers when they do a hair transplant. Sometimes these patterns show in the final result. Here are two photos 2 days (on the right) and 2 weeks (on the left) from the date of his hair transplant. He is rightfully concerned. Since I posted this photo, I was given new photos of him at 5 months growth. The hair that lined up at the time of the surgery, can be seen now when you look at him. He wants me to fix it, an easy fix as I have done thousands of these. I advised him to wait until he is 8 months out before undergoing a repair surgery with me.
Good morning, I came across your balding blog and think that it’s a great resource. Thank you for doing that. I see people ask you all sorts of questions and I wasn’t sure how to post on there and/or ask something anonymously so I figured I would email you. I had alopecia on my scalp into which I had roughly 3,200 FUE grafts transplanted into the scar to conceal it (not all at once but in smaller separate procedures). I uploaded a picture of about a centimeter or so of my donor area where grafts were extracted and was wondering if you can from the picture help me estimate roughly how many grafts I still have left in my donor in case I want future transplants. I counted 32 follicular units and 78 hairs so that comes out to an average of about 2.4 hairs per unit. I tried doing the math I saw you explain on one of your threads and here is what I got. The average donor area is 12,500 units X 2.4 hairs = 30,000 hairs. You need roughly 12,500 hairs remaining in the donor area to provide adequate coverage so 30,000-12,500= 17,500 movable hairs. 17,500 hairs ÷ 2.4 hairs per graft equals 7,291 available grafts that I could move. That would have meant that before I used those 3,200 grafts for the scaring alopecia that I would have had a total of 10,491 harvestable grafts in my donor. Is that even possible?
Your donor density is higher than average. What you didn’t take into account is your hair thickness, a very important factor in determining your harvestable donor area. Remember, that there are only 50,000 follicular units on the head of which 20-25% of them are in the donor area. If you are thinking that you take out more than half or 2/3rds of your donor area hairs, you will be in trouble if you have fine hair, which I believe is your situation.
How many grafts were removed totally? Answer 3200. Were these all follicular unit grafts? Yes? Subtract that number from 12,500 total donor supply and the remaining follicular units and you get 9,200 graft remaining. If your hair is fine, the actual number of grafts that are available will be significantly less than if your have a coarse hair. Medium is somewhere in the middle. You might still have a significant donor reserve based upon the hair thickness of the donor hair provided that you hair isn’t fine as I suspect it is. Does this help?
This patient had some small benefits in the bridge hair in the middle of his head, but most of the real benefits were in the crown, which clearly grew new hair. The frontal area did not respond to the microneeding, which is not unusual with long-term balding.
1) In a previous email, you stated that you’ve removed a strip of skin/scar from elsewhere on the scalp aside from the usual donor area and extracted grafts from it; we had been talking about the temporal region since I had a scar there with grafts placed into it. Strips that are removed from the temporal region, do they typically heal well with minimal scaring?2) If grafts from a second procedure were placed on top of grafts that have yet to surface from a previous procedure, what will happen?3) People with diffuse patterned alopecia, do they eventually lose all the hair in the areas that they are thinning and end up with a slick bald scalp? Or does the hair remain but just is thin?
1- Grafts placed into a scar often have a lower survival than grafts placed into normal skin
2- If a graft was placed exactly on top of the stem cell from a transplanted graft that had not grown yet, it will still grow as well as the original graft, possibly very close together
3- Diffuse patterns of balding may remain, thin further, or go completely bald based upon the cause of the balding process
Treating your badling with standard medications like finasteride and minoxidil and sticking to it get excellent results in many men without needing a hair transplant.
Any concern in SMP while on topical min fin? And what about a transplant with SMP on scalp?
Once the SMP is set (about 1 -2 weeks), the use of minoxidil is not a problem. if you had SMP and wanted a hair transplant, there should be no problem as any good surgeon should be able to work with SMP present.
Amazing, as this looks like full reversal of his recession.
