Confused about my hair loss

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

I’ve been relatively stable on oral fin and topical min for past 6 years but noticed increased temple and hairline recession in the past year. Thought dut was next best step but not only did I have testicular pain (which I had on fin) but pain in penis which I’ve never had before on fin so it scared me considering the strong half life of dut. Is oral min my next best step? I have no idea if topical min has been effective for me since I started at same time as fin.

Treating yourself doesn’t sound good to me. Now with dutasteride on board (that is what I think you said), it may take 4-10 months to lose the side effects, unlike finasteride which is much less time to reverse as the half life is only 4-6  hours rather than 5 weeks as with dutasteride. A reasonable alternative may be oral minoxidil, but the real oral minoxidil, not taking drops of the topical and sallowing it. You might consider getting a real doctor to manage your hair loss.

Finasteride side effects?

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

How long after stopping finasteride did it take to recover from sides?

Everyone seems to take a different amount of time to reverse finasteride side effects when stopping the drug. The range in my experience relates to how long you have been on the drug. The range is between 2 – 16 weeks.

Trichotillomania and microneeding

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

Some people see regrowth from microneedling coupled with finesteride. If somebody’s hair loss is not entirely related to dht then would just microneedling have a better chance of working then for somebody who has dht related loss? For example some women experience this trichotillomania related hair loss issue and they most likely don’t have dht related loss. Do you think it’s worth a shot to try only microneedling? I already started but I wanted to know what you think.

At the end stage, trichotillomania causes traction alopecia and it is usually permanent. IF the person still has growth potential, all they need to do is to stop picking on the scalp and then wait for 6 months, when the hair will usually grow back.  Adding microneedling to this might accelerate the growth of hair that is not ‘dead’ but will come back normally after 6 or so months

How important is hair, really?

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

I’ve been using finasteride and minox for years and it saved my hair. Ofcourse I am happy with that, but comparing it to earlier, when I was super obsessed with my hair, it seems less important today. Do you think you’ll continue treatments for a long time, even into old age, or at one point not really care anymore?

I just did 3000 grafts on a wealthy and successful businessman who actually didn’t want to do the hair transplant; however, his best friend who I transplanted last year, looked so good, he got pressured into it by this friend. Now that the surgery is over, he told me this story and also told me that the procedure was a delightful day away from his pressures at work and home. He was happy that he did it.

In my experience, with thousands of hair transplants under my belt, I found that 100% of the men who underwent the transplant, found that they felt better about themselves when they look into the mirror, regardless of marital status or independent wealth.

18 years old, what to do?

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

I have have a really bad, receding hairline with dense hair and no crown problems. I was going to start minoxidil and add finasteride in 2 to 3 years since I still haven’t finished my puberty. I really want to try to recover my hairline, the thing is, I am okay with getting a HT in a few years.

I often prescribe finasteride to 18 years old men. This drug often works very well with a high degree of reversal. If after one year it doesn’t reverse, add oral minoxidil to your routine and worst case, add microneedling 6 months after than it it doesn’t work. Actually, I don’t think that the first or second will fail.  A hair transplant is out of the question for at least 7 years and by that time, if you don’t treat it now, you may bald far more than you see now. 

Microneedling at less than 0.5mm depth

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

Does microneedling at <0,5 mm depth really increase minoxidil absorption?

The epidermis of the scalp is 0.5mm thick so if you microneedle at that depth or less, the epidermis has no blood supply so speak of and mainly contains keratin. There will be no benefit and no absorption at 0.5mm depth or less of any medication other than what normally works its way through the scalp. The purpose of microneedling is to get to the stem well that resides about 1-1.5mm below the scalp surface and produce wounds that force healing and hair regrowth.  Microneedling depths of 1=1.5mm is ideal. 

SMP on short hair?

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

 Right now i am just dermarolling for 6 months with my short hair. If i do smp, will it be realistic or look artificial?

SMP is an art form and some people do great SMP and too many others do not. Just make sure that you meet patients that had it done before going forward with a particular provider.  All people who do SMP are not equal.

Are microneedling results long lasting?

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

If I microneedle weekly and use minoxidil and finasteride, when I get results, can I stop the microneedling?  How often is best for microneedling?

The problem with microneedling results is that we don’t know if they will stick around after the microneedling ends and if so how long. Most people using microneedling are using it weekly.  I suspect that at most, it will last a single hair cycle which could be 2-3 years in a young man. 

Post Finasteride Syndrome from Dutasteride

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

I have taken Dutasteride for 2 years and for the last 6 months, I have had lost my interest in sex and have complete ED. I had a girlfriend and I think that she left me because of it. I am now off of it for 5 weeks and don’t care about my hair anymore. The hair is falling as if there is no tomorrow. my beard is getting fuller and I am feeling more energy since I stopped the drug 5 weeks ago, but my ED is still there and my interest in sex is still there.  Can you help me?

You have been on dutasteride for 2 years and have gotten side effects on libido and ED.  You have noticed improved beard growth and more energy since you stopped taking the drug 5 weeks ago.  Since it has been only 5 weeks that you have to be off dutasteride, it may take 6 months or more for the symptoms to resolve.  Some people may take a year or so to get the symptoms to go away.  With dutasteride half-life of 6 weeks, you have to wait it out and even after the blood half-life extends into many more months, there are tissue levels of dutasteride (in the hair follicle and elsewhere in your brain and penis) which I don’t believe that anyone understands. Reach out to me when these symptoms disappear or in a year, whichever comes sooner. 

shock loss question

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

Had a 2200 FUE with a US-based surgeon 2 months ago. Mostly hairline and frontal/mid scalp. I was a moderate diffuse thinner before and you could easily see my scalp from the side. I have been on Min for 8 years and Fin for 1.5 years. Fin halted my thinning but I really havent seen regrowth with either. Post-transplant my crown area (which was thin) now has a much more distinct horseshoe. Maybe my hair is shorter so it’s more prominent, but its definitely more pronounced now. Can I get shockloss in a non donor or recipient area? Chance this recovers? Can I expect fin to do more after a yearish? I switch to oral minoxidil in SEPT. I want to avoid Dut due to its half life and unknown safety profile for hairloss He used a lot of Lido with epi but not close to the max amount ( I am in anesthesia, so I am aware of the limits).

As you were on finasteride, I generally don’t see shock loss in most men.  If it should occur, it usually reverses in the normal hair area, but the areas that were miniaturized may not come back.  As you are only 2 months out from the surgery, give it another 3-4 months and hopefully you will see it reverse.