This looks like DUPA to me. Get a doctor to look at the microscopic appearance of the hair and he/she should see this: https://baldingblog.com/do-i-have-dupa-photo/
It seems like hair clinics in the US are losing a lot of business from people traveling to countries such as Turkey, etc. Is there a good reason why they cost so much here? I’m saving for a transplant and I could technically afford one right now in one of those countries, but the task of traveling to/navigating in a country I’ve never been to get a medical procedure seems so daunting to me. I would understand if they costed like 50% more here or something, but it’s like 2-4x the price. I don’t understand it
Many of the cheap transplants in Turkey are performed by clinics owned and operated by technicians that came out of legitimate hair transplant clinics. I have been told that 95% of the clinics in Turkey have the surgery performed not by a doctor, but by a technician who was trained only in the manual/technical aspects of the treatment. They may or may not know much about anesthesia, Your risk of death is not insignificant compared to having it performed by a licensed doctor (Turkey or the US). Read here and view this video: https://baldingblog.com/seminar-hair-transplant-black-market/
DUPA (Diffise UnPatterned Alopecia) is fairly uncommon. The diagnosis is always made by examining the hair in the back of the head with a hand microscope (Trichoscope). Here is an example of what it looks like: https://baldingblog.com/do-i-have-dupa-photo/
Please look carefully at this picture. You can see that the donor density is clearly less dense than in the upper left corner, an area that was not harvested. People always ask me what is my total donor supply; well, this picture shows that with enough harvesting, the donor area becomes so thin that one can call it depleted of hair, thin enough to be visibly observed. FUE thins the donor area 100% of the time; however, there is some grafts that can be removed that will not cause significant visual depletion, as shown in this man. How many grafts can be harvested before the donor area looks depleted, like in this man? That depends on at least two major factors and some minor factors as well.
1- Major Factors:
a) Remaining hair follicles. The average Caucasian man has 27,500 hairs in his donor area or about 12,500 grafts. If the hair count is reduced by over 50% in an average-weight hair (50-micron thickness), then depletion starts to appear the more the hair count goes down.
b) Hair thickness: The coarser the hair, the more hairs can be removed from the donor area. A person with a hair thickness of 75 microns can probably lose 60-70% of their hair before donor depletion is an issue; however, if the hair thickness is 30 microns, then the loss of 50% of the donor hair will certainly look depleted.
2- Minor Factors:
a) Hair vs skin color. The closer the hair color is to the skin color, then more hair can be safely removed from the donor area; however, when the contrast is high (black hair against white skin), then the number of hair left behind must be higher than 50%.
b) Character of the hair: Straight hair may not be as good in coverage, especially if it is fine in character, while wurly or kinky hair covers well behind each single hair shaft.
Here is an example of a man who had too many hairs removed from his donor area. The only want to treat this is to (1) grow the hair longer in the hope that longer hair will act like shingles to cover the spaces where it used to be or (2) use SMP to change the color and of the spaces in the donor area with what appears to be cut hair follicles.
If you switch from fin to Dut, do you still have to wait ~12months to see progress?
Switching from finasteride to dutasteride just increases the effectiveness by 15% at most. Usually, you will see any benefits in about 3 months if you have been on finasteride for at least 6-9 months at the time of the switch. That is not saying that you will see any benefits regardless of how long you wait.
I have heard that over and over again in my 30 years in the hair practice. Finasteride is always working, it may just be slowing the hair loss down less than it did before because your balding became more progressive. Unfortunately, to prove that I am right, you would have to stop finasteride and you will see massive hair loss, what I call catch-up hair loss. Too many men have done this and they regretted it.
You need your donor area examined with a video microscope and get a hair count and a measurement of the thickness of your hair. You want to make sure that you don’t have DUPA which can be diagnosed with the hand microscope. If you want to know your original donor density and your Hair Mass Index along with your total available donor graft supply for your lifetime, see an expert in the field. I wrote extensively about this here: https://baldingblog.com/donor-density-is-counting-hairs-with-macro-lens-on-cell-phone/
Amazing response!
Hello doctor, thanks for your time. Doctor a question, in YOUR clinical experience, NOT in studies, only in your experience… what percentage of your patients get side effects from Finasteride that you suspect is NOT Nocebo?
I think that the sexual side effects in my patients over the age of 30, is about 4%. Many of the younger men are getting their information from forums and blogs that emphasize sexual side effects as almost expected. In these younger men, the incidence is higher.
Will starting minoxidil worsen my natural hair? Do the minoxidil supported hairs steal nutrients from weaker non minoxidil supported ones – meaning if you stop minox you’ll be bellow starting baseline or am I mistaken? I am already on 1.25 fin EOD so in theory my existing hairline should maintain/not effected by MPB.
Thank you in advance!
From what I’ve seen, it seems like hair miniaturization progresses over several hair cycles and happens after a hair sheds. Is this the only way that it can occur? I have semi-long hair and I’ve noticed that the hair I shed appears to get thinner over time, as in it tapers from thick to thin towards the root – is this hair miniaturization? If so, what makes this different from “normal” miniaturization?
Yes, a miniaturized hair can regrow again and then undergo further miniaturization. I have seen single hair shafts that are thinner at the exit point in the scalp then they are at the long end.
I see a lot of people who use derma rolling/stamping. Creating small holes in my head feels like it mainly creates damage. Can somebody explain me what it is used for and how it should improve the hair situation?
Reddit posted a full ‘How to Do Microneedling’ here: https://www.reddit.com/r/tressless/wiki/microneedling/
When microneedling is done correctly (controlled damage performed at least 10 seconds in each spot you need the hair to return). The Dr. Pen device offers the best product (see Amazon) as you can get the 34 needle type, length 1.25mm and use it from place to place until you cover your entire area that you are hoping to get your hair back. Once a week seems to be the most effective timing. The wounds that are created, are near the stem cells that trigger hair cycling. These cells don’t like the constant wounds, so they react with wound healing, a component of it impact the stem cells to trigger hair growth as part of the cytokine response by the body to the healing process.
So I started oral min like a week and a half ago. After like 10 months on topical min. Seeing tons of new hairs around my eyebrows and even some baby hairs on my hair line. Does this mean my hair in my head is also growing ? Can you get new body hairs but no regrowth on ur hair ? I can’t tell but I’m seeing a ton of growth everywhere hopeful for my diffuse thinning problem?
Did you take before photos to compare now vs 10 months ago? How bad was your balding? If it was only some thinning, maybe you might not have recognized hair growth. The fast that you got hair growth elsewhere suggests that you should have seen in in the scalp.