I have published on the genetics of the persistent frontal hairline. This man could bald and yet keep his frontal hairline. For a hair transplant surgeon, that means that he will not have to get the leading edge of his hair transplant, saving the patient money and donor grafts. For him, it means that he will retain a frame to his face with a good comb-back of his hair for styling purposes.
Can you please expand on what you mean by saying hair transplants accelerate balding, especially in younger men? Thank you
Younger men often don’t see their final pattern, but it is often there if they look through a hand microscope and see a lot of miniaturization present. A hair transplant causes many of these miniaturized hairs to fall out, and they RARELY come back. Remember, miniaturization doesn’t necessarily mean thread-like hair, as it could be hair that has lost only 30% of its thickness, not easily seen without extensive hand microscopic evaluation. With a 30% loss of hair thickness in most men, they will not see thinning or balding. I have seen many 23-year-old men who get hair transplants and never knew they had significant miniaturization with a miniaturization pattern that suggests a more advanced balding pattern.
Young men (under 26 years of age) who have hair transplants may see a Class 3 pattern, but they might have a Class 6 or 7 pattern, which would be a surprise. I don’t like surprises, nor should the patients. So many young me are going to Turkey, where technicians are in charge of the business. In most of these clinics, such evaluations seldom occur except for less than a dozen good doctors that I know personally. Shame on the doctors who do these surgeries without looking for and quantifying the miniaturization before they collect your money and do the surgery. Too many of today’s doctors, even in Western countries, are in it for the money and forget the oath they took when they became doctors, which states: ABOVE ALL, DO NO HARM.
I recently met with a 23-year-old male who came to me after having three hair transplants in the US at different clinics by less-than-honorable doctors. His entire donor supply was depleted, and so was his bank account. The hair transplant doesn’t even look normal to me. All of these transplants were in the first 3 inches of his hairline. When I examined the hair behind the transplanted 3 inches of his frontal area, I saw signs of miniaturization that went back to the crown. The miniaturization was very early, possibly too early to have fallen out with the transplant. He was lucky because he took finasteride, which often stops the loss of miniaturized hairs associated with a hair transplant. As this was a recent visit, I can’t tell you how it will turn out. I suspect he will live with the transplants, even with the defects of an imbalanced hairline and a lot of 2-3 hair grafts seen in the frontal edge of the hairline.
What’s the consensus about microneedling/dermarolling without using minoxidil? Does it help or is it just a waste of time (and tears)?
Microneedling works on its own. Recognize that it works by creating a wound near the stem cells in the upper part of the hair follicle that may control hair cycling. It produces a healing cascade that stimulates the stem cells as part of the cascade.
Yea doc said just not to use it. My father used minoxidil as well and he got lots of side effects just as I did. Very disappointing considering there’s barely any other options
If that was topical, he and you might be one of the 60% of men who will not respond to topical but will respond to the oral.
Post-menopausal women (50% of the feml population) often develop hair loss or diffuse thinning. Finasteride works well in some of these women; however, when a pre-menopausal woman has this condition, it may not work very well. In addition, pre-menopausal women have significant risks with this drug if they become pregnant so they should not take it with that risk over their head.
Got the 5mg pill of Finastride and am thinking of taking 1.25mg on Monday, Wednesday, and Friday, skipping Saturday and Sunday and restarting the same routine
That is essentially taking 0.54mgs daily. Merck reported that 0.5mgs is 82% as effective as the full 1mg dose, so this plan is a reasonable plan. The benefits are not the blood levels for finasteride but rather the tissue levels which hang around for a few weeks after taking the drug,
Most posts I read on various hair loss forums like Reddit, seem to be from guys who’re in their late teens/early 20’s who were probably going to be able to grow beards anyway, but for whom the minox may have just accelerated the process. Any success stories from older guys? I’m nearing 40 myself and looking for some inspiration. Much appreciated.
Men react differently to hair loss at any age. The most common reactions involve opting for very short haircuts or even shaving their heads. This trend is noticeable in places like airports or shopping centers. Some men embrace this change and never look back.
Others take a different route, seeking ways to regain their hair. Many of them share their experiences and seek solutions on platforms like Reddit or various forums. Some younger men might become fixated on their hair loss due to familial experiences.
Then, there’s a group who prefer not to rely on medications and choose the hair transplant route. They seek an immediate solution, despite the significant cost involved. I’ve performed hair transplants on men as old as 92, driven by various reasons like wanting to appear younger for dating purposes. Typically, men between 35 to 55 years old make this decision. With today’s technology, unlike older methods, about half of men can restore their hair in a single transplant session.
The crucial question here is personal: Does hair loss bother someone enough to (1) commit to lifelong medication (assuming it works), or (2) opt for a hair transplant despite the cost?
There are numerous success stories addressing hair loss, many of which are shared on platforms like Reddit. Are you bothered enough to go through treatments such as daily medications or a hair transplant. Only you can answer this question.
Derma-rollers are something I’ve overlooked but seeing as how they’re so popular here I think I’ll give it a try. Thing is, I’m not quite sure how to tell if one is good or not. I did read that 0.5mm is the ideal starting size, used once a week, but other than that is there anything else I should know about? I’ve heard the titanium ones are better than stainless steel. Also, are the rollers better or worse than the derma stamps? I have large diffuse thinning, not just a local spot.
And does the brand matter? Any brand or model recommendations?
Microneedling is best done with a reciprocating needle device like the Dr. pen device, which has 36 needles and a depth of 1.25mm. Using once a week is the best way to go. You can hold it in a single area for a defined period, like 10 seconds, which delivers a known injury. This injury starts a healing cascade that brings in or activates the stem cells found in the upper part of the hair follicles or in the upper part of the dermis at a depth of about 1 mm.
Young men are very sensitive to finasteride and minoxidil as shown here in just 4 months of use. As he continues to use it, more new hair will likely appear.
Any reason why I get bad heart palpitations from 2% min foam? Rogaine brand if that matters
Heart palpitations are a side effect of minoxidil. You are absorbing it systemically despite the fact that you are putting it on your scalp. I would speak with your doctor about this. You probably should stop using minoxidil.
If finasteride can not cause thinning, why am I continuing to thin while on finasteride? I’m definitely not imagining this. Could it be that the dosage 0.5mg is not enough and the miniaturization is too aggressive?
Yes, it is possible that you need a proper dose of finasteride (1mg), or your thinning process is more active than the finasteride can manage.
Hi Dr. Wrassman, I had a quick question regarding microneedling. Can it cause a hair transplant to have a lower chance of success?
Microneedling has no impact on having a hair transplant or the success of the hair transplant. The needles with microneedling go only through the epidermis and not deep enough to negatively impact the dermis or the existing hair follicles.
Amazing change. The use of microneedling is most likely the stimulus for the speed of change that you saw.
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Syphilis Soars in the US |
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Syphilis cases in the US have risen to the highest level since the 1950s, according to new data on sexually transmitted infections released yesterday from the Centers for Disease Control and Prevention.
The US saw 203,500 syphilis cases in 2022 (the last year for which data are available), up 17% from 2021 and nearly 80% from 2018. The data also showed 3,755 babies were born with congenital syphilis in 2022, a nearly 31% change year-over-year and a 183% change since 2018. See an overview of syphilis here.
Meanwhile, new cases of gonorrhea in 2022 declined for the first time in a decade, down 8.7% from 2021. Health experts are not sure of the reason behind the decline. Cases of chlamydia, which accounted for roughly two-thirds of the more than 2.5 million total cases of sexually transmitted infections in 2022, were up 0.3% year-over-year but down 6.2% since 2018. See all CDC data here (w/charts). From 1440 Daily Digest |
I put this in my baldingblog because this blog is read mostly by men and many sexually active men should be aware of this epidemic, something that is not discussed as openly as it should be.
Microneedling should have a needle length of 1.25mm and the highest number of needles, like Dr. Pen’s system, with 36 needles. Keep the microneedling in the same place for 10 seconds. Move from place to place until you covered the area. Do this once a week. The purpose of the depth and the frequency is to produce a healing cascade from the microneedling wounds. This stimulates the stem cells close to the scalp surface and along the upper part of the hair shaft. They are located between 1-1.5 mm from the scalp surface with a good population of stem cells just under the sebaceous gland of the hair shaft.
I have seen microneedling reverse what we often think is irreversible hair loss. It is worth trying.