I’m thinking of starting weekly microneedling, but my hair is buzzed down to about a 3 and the hair on my crown is super thin so my scalp is quite visible. I’m concerned about having visible redness or scarring while at work. If I needle on Saturday morning, would it heal by the time I go in on Monday morning?

Everyone reacts differently from microneedling in terms or the pink color of the skin. Some white person’s skin may be ultrasensitive to redness, and in these men, the redness can last weeks or months. Most white people will see the pink color disappear in a few days. The darker the skin, the less noticeable the color distortion; for example, my skin is tan and doesn’t show redness very well

https://pubmed.ncbi.nlm.nih.gov/12647000/

It is difficult to project these rat studies to humans on finasteride. I would only mention the findings in Group C of the Rats with the report that there was a “reduction in smooth muscle fibers in the trabeculae of corpus cavernosum”.  I would like to see some clinical documentation in this area which is probably very difficult to obtain.  I look at this as just a rat study for the moment.

This is a very unusual balding pattern in a 23-year-old male, but nevertheless, he succeeded with two medications oral minoxidil and finasteride

For men that experience AGA, does every single hair follicle in the respective balding area (based on their Norwood level) always eventually miniaturize and stop growing, leaving that area total hairless and bald? Or, in some people, can just a percentage of the follicles in those respective areas be afflicted while others in that same area are DHT resistant and never miniaturize? So like, for instance, let’s take someone with a Norwood 3 Vertex pattern; in the crown area, is it always a guarantee that every single follicle in that area will stop growing and leave a totally slick bald crown? Or can some of the follicles remain unaffected based on the person’s genes leaving just a thinned looking crown as opposed to a completely bald one? I ask because usually when I see receded or bald men, even elderly men with a Norwood 7, their bald areas usually aren’t totally hairless and slick bald. There’s still some remaining terminal hairs to various degrees in those spots.

You are astute in your observations:  Some men with Class 7 patterns may have a few remaining hairs right in the middle of the balding area.  I remember one man I transplanted who actually knew that there were 7 hairs in his balding pattern and gave names to each one of them.  Those with a Class 3 Vertex pattern may not develop complete balding of some of the crown, but most do, not necessarily enlarging the balding crown with a complete “Friar Tuck” look.  If I remember correctly, OJ Simpson’s attorney had a small completely Friar Tuck bald spot, seen from behind.  These Norwood patterns described are usually complete, but it may take years to get there.

Infection is very common when synthetic hair is placed into the scalp.  This process has been outlawed by most Western Nations, but somehow the companies that sell it get someone to put them in the scalp on some balding men.  I am told that initially, the implants look great and can make a bald man look like he has a full head of hair, but in time, these artificial hairs get infected.  The infections are persistent and don’t respond to antibiotics.  These or foreign bodies and the patients develop severe scars.  Even if these hair could be removed, which is very, very difficult, the infections often remain.  In this man, the infection went down and exposed his skull.

I was on finasteride for 5 years when I stopped it and then lost all of my hair.  Fortunately, I restarted it and it all came back. 

Some men who stopped it and waited too long were not as lucky as you were in getting all the benefits back.  I hope others learn from you but don’t expect the same result. 

This is a good response to topical minoxidil