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    Discussion: Balding men with fine hair

    Feb 28, 2025/by William Rassman, M.D./0 /Hair Loss Causes
    Can you help me?
    The photos reveal what I would expect:  a healthy donor area with no evidence of DUPA. There is a slightly better-than-average hair density; however, I suspect your hair is fine in thickness (I suspect in the range of between 25-35 microns (just a guess, but it should be measured with a micrometer) because I can see through the donor area to the scalp.  The rest of the photos show widespread miniaturization (not shown microscopically), which should be treated with finasteride, or you will likely lose all of the miniaturized hairs after any hair transplant surgery.  Finasteride will not only reverse some or many of your miniaturized hairs, but if or when you get a transplant, you will have the protection of finasteride, so you experience minimal shock loss. Men with fine hair and a large potential balding pattern will need at least two surgeries to address the pattern, as the hair bulk transplanted with one surgery may not be adequate. The higher-than-average donor density helps but is not enough to offset your fine hair thickness. Before considering hair transplantation, I would start you on finasteride and wait at least 9 months and then re-examine you. A transplant should not be a foregone conclusion for you. 
    When I transplant men like you with fine hair and an advanced balding pattern, I often discuss a good frontal reconstruction from the hairline to mid-head as a first step.  One or two sessions might be indicated, followed by SMP, which makes for a fuller-looking frontal head of hair, especially in men with fine hair. I would delay the crown reconstruction after reassessing the donor area and after the frontal area is fully stable to the mid-head. I have performed surgeries like this frequently with excellent results, but men with fine hair often don’t have the expectations of someone with coarse hair because they only know fine hair, even as a teen.  Men with fine hair may have to make compromises on their goals.  

    The Article speaks for itself (published 2/18/2025)

    Feb 28, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    Many articles have discussed the attractiveness of hairy men over balding men.  The most notable was a Mens Fittness article many years ago that stated that to be president of the United States (after Ike), you must have had hair.  Hair makes men appear more trustworthy, according to that article.  

    A cure for hair loss?

    Feb 27, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    https://search.app/cGeix3PyBDKKo3Gc7

    These researchers fond some unique stem cells in the upper part of the hair follicular sheath that could lead to hair growth in a bald man, so they suggest.

    Facial swelling from minoxidil

    Feb 26, 2025/by William Rassman, M.D./0 /Hair Loss Causes
    Minoxidil is not the right medication for some people. With swelling of the face as a known complication, I would ask your doctor about stopping your minoxidil. If you also have swelling in your feet, it could produce swelling around your heart, a hazardous complication called Cardiac Tamponade (https://en.wikipedia.org/wiki/Cardiac_tamponade)
    There are other medications, so just speak with your hair doctor. 

    I want to stop my finasteride!

    Feb 26, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    I’ve been on Fin 1.25mg for about 1.5 y, but for several reasons am hoping to stop taking it soon. How long after stopping it will I begin to notice my hair loss restarting? Thank you for your help

    Within 3 months, you should see “Catch-up” hair loss when you stop finasteride.

    I’m balding and medications just don’t work

    Feb 25, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    24 years old. Started oral min and fin almost 8 months ago. My hair is not getting better at all. It honestley works worse at this point. I still lose over 200 hairs every day just like i did before I even started using the drugs. Was a NW2.5 when i started. Feel like I’m bout to reach NW3.5.

    It would be best if you got an expert to evaluate you. I have heard many similar comments, but when I examined the person with those complaints and took a careful history, I found the solution to the problem. There is no substitute for an expert with years of experience; even the collective Reddit.com/r/tressless community doesn’t necessarily focus on YOUR problem.

    What some men call a Norwood Class 2.5 pattern, they need the correct diagnosis. Your hair loss may be from all around your head or, without disrespect, in your head. The average Caucasian male loses 100-150 hairs daily and regrows that same amount.  You never sent photos, so I will work in a Black Box scenario. 

    Does fiansteride stop working over time?

    Feb 25, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    I’ve been on 1mg finasteride since early august so over a month now. I’m 18 years old and I stared seeing results within weeks of starting it. My hair felt more full and thick and it showed clear signs of improvement.

    Why do I feel like the effect has stopped. It feels like my hair reverted back to how it was before I started fin. Is it possible for fin to work well in the beginning and then suddenly lose effect in the span of a month? Am I doing something wrong?

    Finasteride always works to slow or stop hair loss. Reversing it is another issue; however, if it looks like you are losing the benefits of finasteride, it may be that your genetic balding is accelerating. Finasteride is a competitive inhibitor effective at about 70%, so that action at the 5 alpha reductase level, doesn’t change as your hair loss gets worse. Dutasteride blocks the same enzyme at better than 90%, but that might or might not make a difference, so switching to dutasteride does not guarantee that your hair loss problems will be solved. Alternative medications such as oral minoxidil sometimes help as it is a different mechanism of action

    Why would you have to take medications after a hair transplant?

    Feb 24, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    Im acting a bit dumb in the title. I know that you should stay on medication after a hair transplant because otherwise the remaining hair might thin and fall out leaving you with patches of hair. But I also often hear that the transplanted hair will also fall out. Now this does make a little less sense to me when you follow the common opinion that the hair on the back of your head is more resistant to DHT. If that’s the case, shouldn’t they last forever like they do with most people (even with aggressive hair loss there remains the beloved „horseshoe“). This would only make sense to me if there was indeed another difference between the back and top scalp. Not to indulge in bro science but it seems to me that DHT sensibility isn’t the only thing here.  Am I missing something?

    Although the hair around the back and sides of the head is generally thought to be lifetime hair, that may not be correct as people age.  This lifetime hair often reduces in numbers with age and hair thickness (Age-Related Thinning).  Now, from a practical point of view, the problem is not the hair transplants in a 10-20 year horizon for a young man having a hair transplant; the problem is with the residual hair as hair loss is progressive, so medications treat your remaining hair that may be impacted by the progressive nature of hair loss. 

    Water Beading on hair follicles

    Feb 24, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    Does the water beading on the hair suggest something unique about my hair?

    No!  The observation may indicate that there was a conditioner or something waterphobic in your shampoo. 

    Female hair loss reversal (photos)

    Feb 21, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    I’m age 38 and started to use minoxidil 2 times a day as well as 1 mg Finasterid daily. I also do derma rolling with 5mm needles 2 times a week and take keratin vitamins daily. I wear my hair long and made huge progress.

    This is an amazing reversal. I congratulate you for your persistence.  For my readership, pre-menopausal women must not get pregnant if they choose to take finasteride, or their baby may have sexual identification issues.  I would advise you to reduce your dermaroller depth to no longer than 1.25mm.  Longer, like the ones you are using, will likely cause deep scarring in the dermis. 

    1 year on finasteride 1mg and topical minoxidil (photo)

    Feb 21, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    Amazing reversal to his normal, solid, mature hairline.

     

    Some men suffer as they start to bald

    Feb 20, 2025/by William Rassman, M.D./0 /Hair Loss Causes

     I’m 23 and in the past 4-5 months my hair got extremelly thinner all around, especially on the top of my head. I notice it when my hair is wet or when light shines onto it. My temples also arent doing great. My hairdresser and family say it isnt that bad at all, but i think they might be lying to not hurt my feelings. I try to convince myself that it is because of stress (i had a pretty rough year) but considering my fathers part of the family it might not be the case. Honestlly i have no idea on how to deal with this at 23, i know that i cant. It is already hurting my confidence big time, and while i already had a really hard time dating, it will now only get harder as my confidence will drop. I know that there are way worse things in life and many people go bald, but i just cant see myself adapting to being bald in the near future. Sorry for bad english or if this was a bit long.

    With properly used medication, you can reverse your thinning at 23 with generally good success.  As a doctor, I do understand the self-image issue that is so critical to someone of your age: however, the good news is that you don’t have to experience balding with today’s many good treatments.  Most men don’t appreciate the easy reversal of balding at 23, so when they get older, the regrets often appear.  I hope you will not fall into this category of men and take advantage of today’s many good medications. Remember, only you are in charge of your future, so act now.

    Finasteride in 4 months reversed this hair loss (photo)

    Feb 20, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    Some young men are very sensitive to finasteride, particularly men under 25.  This man is 28, so his hair stem cells are still fully available. This is an unusual rapid reversal.

    Finasteride and depressions

    Feb 19, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    I have started taking Fin 1mg for the past 20 days. I was suffering from mild depression, nothing serious but last few days I am having more depressive thoughts. Does finastride cause or increase depression?

    Yes, men who have depression might consider not taking finasteride and try oral minoxidil as an alternative drug, as finasteride can induce more depression.

    Am I on too many medications?

    Feb 19, 2025/by William Rassman, M.D./0 /Hair Loss Causes

    I’ve been going to a doctor for treating my baldness. They prescribed me finasteride, some pills, some shampoo and asked me to test for vitamin D deficiency (I was deficient and prescribed me vitamin D pills). Next time I went to the doctor they asked me undergo Biotine PRP for each month for 4 months. Both meds prescribed so far and biotine PRP didn’t seem to work. So my doc prescribed more finasteride, some other pills and some kind of solution that I was supposed to apply on my scalp. Those too didn’t work. Then they gave me 5% minoxidil and 0.1% finasteride topical solution and it worked! My baldness is almost gone. My question is why did my doc prescribe me all the meds that didn’t work? Where they trying to see which one would work the best for me or were they trying to make some extra money for their clinic?

    If you have a relationship with a doctor, ask him this question. Be bold and direct! Remember, your doctor works for you, and that is why you are paying him for his advice. 
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