Why do men lose hair with low testosterone?

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

Indeed, but this decrease in testosterone over the years does not seem to have an affect on the amount of hair loss, which is somewhat counterintuitive.

Not at all. Genetic hair loss has ingrained in each follicular unit of the scalp, a biological clock that limits how many growth cycles it has. The fewer the growth cycles, the more the balding. The hair on the back and sides of the head have no limit on hair cycling. Even with this explanation, the hair loss process is very complex and many factors determine the number of cycles each follicular unit has besides the genetics.

Class 5A pattern, FUE or FUT?

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

Both procedures are good; however, FUE for medium weight hair should be limited to about 3000-3600 grafts. For fine hair, the numbers are much smaller sized sessions as see-through donor areas occur frequently in fine haired people after too many FUEs. If your hair is coarse, you have far less limitations and either surgery works well.

Needle depth for microneedling

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

Dr. Wrassman, to clarify, are you expecting that this is a normal outcome?  I get bleeding and worry that I am going too hard and perhaps should consider less time or a shorter needle length? Quite frankly, it’s been tough to pin down an optimal needle length in the literature. I was considering restarting at 1mm with the dermapen assuming the 1.5mm rollers prevalent in literature only penetrate 1 – 1.25mm.

The stem cells lie under the epidermis which is 0.5mm below the scalp surface. The 1 or 1.5mm reaches this depth. Either should be fine. The key is to get wound healing that reaches the stem cells.

Humidity and finasteride storage

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

Hi Dr Rassman I don’t know what to do I keep my Finasteride bottle in a cool place always at temperature around 72 to 74F but now that I have moved to my new temporary home it’s set to 72F but the humidity is is what I’m really worried about it keeps going from 49% to last time I checked was 54% Relitive humidity I keep a desiccant in the bottle but I’m just nervous I don’t want to destroy Finasteride effectness. I looked up humidity level for Finasteride but the FDA only mentioned the temperature no mention of humidity. Should I be concerned?

Use an airtight bottle. The pharmacist near you will supply you with one. and if he doesn’t just give one to you, ask to purchase one from him/her

Turkey experience

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

This young man went to Turkey 3 months ago for a hair transplant because the fee was much lower than quotes near his home. He had a medium level balding crown and very small frontal corner recession. When he went to the clinic, the building was beautiful. He came in on the first day for the surgery evaluation and they suggested 4200 grafts. The next day he had the surgery and found the entire surgical crew unprofessional, ignoring him, laughing and chatting and not focusing on his surgery.  He found out that many of them were hired recently, “just off the street” and they were being trained on his head.  That day, he counted more than 20 patients having surgery at that facility.  He knows that this was a terrible mistake and I am going to work with him after he gets to the 8 month postoperative date when he sees where he is.  I am concerned about his donor site, which he believes has been damaged. 

Girlfriend dictates balding solution

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

Girlfriend just said to me “what if you started balding by shaving your head first” immediately followed by a “hair transplant”

This is not your girlfriends head, its yours. You should decide what you want as if she didn’t exist because whatever you do or don’t do, you will have to live with it.

Shaving head with FUE

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

If you decide to shave your head after a FUE hair transplant, will it look stupid/horrible (owing to all the scars in donor and recipient regions) and, if so, can this be countered with SMP?

You might see the white scars from the FUE punch. That would call attention to your hair transplant.

Hair systems and hair loss

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

I’m taking dut and oral min daily, and I’m waiting till I’m a bit older to get a transplant (age 21 nw3). In the meantime, I thought it would be a confidence booster to wear a hair system (wouldn’t stop taking meds). I’m trying to figure out if that would accelerate existing hair loss but I can’t seem to find any info online. Thought some of the guys here who’ve been wearing systems for a while might have some Valid input.

Yes, the glues and clips used to hold the hair system in place produces traction alopecia most of the time. These glues will produce a more advanced patterns of balding by the time you reach the hair transplant age. I would think this through carefully and maybe have a talk with your parents before you act.

How many grafts do I need?

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

I’m 24 and I want to get a hair transplant, so how many grafts will I need?

You need a Personalized Master Plan: https://baldingblog.com/go-why-do-we-need-a-master-plan/. You need to lay out what your worst case balding is and balance that against your available donor supply capacity before starting the hair transplant process. You will find many doctors willing to quote you 1500, 2000, 3000, 4000 grafts for your problem. Is your hair fine, medium or coarse in thickness? Could you respond to medications or other treatments such as microneedling and avoid a hair transplant and still get your hair back?  How do you tell which is right and when you should tackle it?

Juvenile hairline in adult (from Reddit)

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

I have seen these unusually low hairlines for a mature male. They are common in children but usually disappear as the male matures.  These hairlines are found more in the Latin and India countries than in Caucasians of European decent. Even for a juvenile hairline, this is low.  Note that there are no temple peaks because they are incorporated into the rounded hairline.

Needle size for microneedling

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

I started out 1.5mm, but now I’m concerned about scar tissue. I’ve heard 0.6mm might be better, but the redness goes away pretty fast. I started out doing once-a-week needling, but then I’ve seen people who did it twice a week at a lower depth followed by minoxidil that had great results

Microneedling depth should be able to reach the stem cells at the top of the hair follicles which lie about 1mm below the skin so 1 of 1.5 mm microneedles are about right. These stem cells have some cells that specialize in hair cycling so that when stimulated, the command goes out to the other stem cells to kick in the anagen cycle (theory at present).

Finasteride before Hair Transplant

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

I know you suggest finasteride after hair transplant to prevent shock loss. How long would you use finsateride after a hair transplant to prevent shock loss?

I generally like the man to be on finasteride at least 1-2 weeks before the transplant and until the transplanted hair has grown out.  That applies to men under 35 as a rule, but what finasteride protects, is loss of the native hair with miniaturization present.  As men get older, they may have less miniaturization and as such be less likely to get shock loss.