This is a very unusual balding pattern in a 23-year-old male, but nevertheless, he succeeded with two medications oral minoxidil and finasteride
https://www.healthline.com/health-news/microrna-breakthrough-hair-loss-treatment
I am always skeptical. This is a new idea, that stiff hair causes balding, and softening the hair can address the balding problem. The hairs above the surface of the scalp, are already dead. Treatment below the skin, as the new hairs are being formed, would be necessary if this theory made any sense. We have seen developing hairs that are miniaturized, most of these hairs become soft because they lose bulk. I have oversimplified the premise, but you should read it to draw your own conclusions.
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.
With Dupa and Age related thinning, does every single follicle on the scalp miniaturize? And do the miniaturized follicles in these conditions eventually miniaturize to the point where they fall out and stop growing altogether like in AGA, resulting in a totally bald scalp (including the donor area)? Or do they miniaturize just to an extent but then stabilize and continue to grow at that level?
The best insights I have into this great question are from women who have it. They are often older, and they usually do not bald from it. I believe that these DUPA patients tend to be stable; however, since I interfere with the normal course of the disease with drugs like finasteride, I don’t frankly know what would happen if we just did nothing for these patients. I remember one woman who came to me with almost complete balding (donor area as well as the rest of the head), and she had DUPA’ however, since I never saw her when she was younger, I can’t comment on her disease progression. She did report that the thinning was noticed after menopause. There is, of course, no comparable analogy for men.
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.
Getting 2500 grafts from an FUE doesn’t mean that it will be aesthetically pleasing or successful. This is an example of a failure on both ends of the FUE process from a Turkey clinic. To make matters worse, 2500 grafts that were taken from the donor area are lost for future hair transplant work. When needed. Fortunately, this can be fixed, but there is no bargain when you pay for it twice.
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.
Some men inherit a strong forelock and then bald around it as is the case in this man. The forelock was not genetically sensitive to his DHT but not the hair around it nor behind it. He is lucky that these impacted hairs responded to finasteride and minoxidil.
This is a good response to topical minoxidil
Some men hide their faces and even their entire hairline to hide their identity. I often wonder why they post at all. They want feedback on the benefits of their treatment, even congratulations for emotional support, yet the photo so poorly reflects what they want to show, the process is self-defeating.
It doesn’t matter when you take these pills. You can take them together if it is easier to remember to do it.
I just had a hair transplant and my doctor did not give me a widow;s peak which I always had before losing my hair. Is that usual?
The doctor could have put a Widow’s peak in your reconstructed hairline but unless you ask for it, it is normally not done. Why didn’t you ask for it?
I have seen this only a few times in thousands of surgeries. The pink color will eventually go away. Some people put hydrocortisone 1% on it (can be purchased over the counter, but only apply it twice a day for 5 days and then stop it). If it doesn’t go away, maybe a dermatologist can prescribe a more potent anti-inflammatory drug or you can wait it out. I doubt it is a low-grade infection, but maybe if you don’t respond to the hydrocortisone cream, see a dermatologist.
Hi doctor.Are your patients mostly recovering from sexual sides of finasteride when they quit? For example,my penis lost its girdth after 18 months of finasteride use.Will it become better If I quit this drug?
I have not really understood the complaints about a reduction in penis size as a side effect of finasteride. My patients, thousands of them, have never brought up that subject with me. I can’t help you with this one