When do I decide on a transplant?

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

After using topical minoxidil for about 6 months, I switched to 1mg finasteride daily due to palpitation problems. It has been more than 1 year in total. The shedding has decreased a lot (thank God) but there is no new hair growth from the shedding areas. Bald areas are covered with feather-like hair but there is no progress. I am 44 years old and now I am seriously considering hair transplantation. Do you think it can be improved with medication or should I turn to transplantation?

If you have developed a Personalized Master Plan with your doctor and you are over 25 without effective medical treatment and more progressive balding, then maybe it is time to have a discussion with a good hair transplant doctor who cares for his patients above making a ‘transplant sale.’

Protein identified for controlling hair death

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

Researchers at the University of California Riverside (UC Riverside) have identified a single protein that seems to control when hair follicles die. Armed with this new information, it might eventually be possible to reverse the process and stimulate hair regrowth.

The protein in question is known as TGF-beta, a signaling protein that regulates the division, growth and death of cells. As such, it plays major roles in important jobs like wound healing, and seems to be hijacked by cancer cells to allow uncontrolled growth. In this case, the team found that TGF-beta extends its work to the cells inside hair follicles.

Read more here:  https://newatlas.com/biology/hair-loss-baldness-regulator-protein/

Asymmetrical beard and hairline

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

I seem to have less hair on the right side of my face in relation to the left side, but yet nobody else in my family has this issue. What is usually the cause of this and is a hair transplant the only solution?

Some men develop asymmetrical beard growth. If you are just starting growing your beard in the past year, don’t worry. Also the transition from a juvenile hairline to a mature hairline is also often asymmetrical as well.

20 years after a hair transplant

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

There is no doubt that this man, now in his mid-50s, looks younger than his balding before state. I did his surgery 20 years ago and it is always a pleasure seeing my older patient.  He maintains his hair situation from progressing by taking finasteride which he has been taking since 2002. He has no side effects. I want those of you who are looking at his hairline and see if you can see that this man had a hair transplant.  I can’t tell even today.  His hair transplant shows the value of a 1/4 inch transition zone made up with around 350 single hair grafts in front of the 2 and 3 hair grafts that bring on hair bulk. This shows that the hairline is not a ‘line’ and it should never be.  The transplant does not need the finasteride to hang in for his lifetime because these hairs came from the back of the head where the hair is lifetime hair. 

Minoxidil plus finasteride 18 months (photos)

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

June 2021 vs. today (11.2.2022), 1.5 years on 1mg fin every day, Niz 3x per week, and 1 month on 2.5mg oral min every day.

Nice improvement. Stay on your routine and it will only get better. It may take another full year to see more value of what you are doing and it is even more likely that it will get better if you add weekly microneedling to your routine.  If this is not enough and you are over 25, then a hair transplant will give you a normal hairline, something to consider.

Alternating topical and oral minoxidil

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

My idea is to use topical once every other day and and oral every other day as well, like

Monday : topical

Tuesday : 2.5mg oral

Wednesday : topical

and so on…

I’m using topical min since 1.5 years now and would like to add oral min to increase effectiveness. It’s also getting really tiring to apply the topical everyday.  Topical min was really good for me but I feel like it lost its efficiency. I’m also on 1mg finasteride for 2 months.

This makes no sense to me. If you are on the oral minoxidil, stay on it and forget the topical. You don’t want to overdose this medication because of heart side effects. 

Recently Recovered from Telogen Effluvim

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

I’m currently going through TE and I might be tested positive with covid, will I 100% go through another round of TE cause of this?

There are no certainties in predicting what you are asking me; however, overlying Covid after having TE, I would suspect that your risk of another episode of TE is high

Class 7 pattern planning

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

Is my donor area too thin to use for a hair transplant?  I have sent the same pictures to a doctor who said we could do 5000 grafts, with permission to use around 800 grafts give or take from my beard, but I am concerned they just want my business.

I don’t know your age, but you clearly are developing a Norwood Class 7 pattern of hair loss. That means that you MUST develop a Personalized Master Plan to get hair back and always look normal. A good hair doctor will measure your donor supply and your hair mass index and when you believe that a hair transplant is the right approach, the plan must take these two factors into consideration to make sure that you always have hair and always look normal. I believe that if your hair is fine, that 5000 FUE grafts taken from your donor area will be a disaster. Take a look at this man who followed his class 7 pattern from the age of 30 and has always kept hair.  We developed a strategic Personalized Master Plan for him to be able to keep up with his hair loss.  What is significant about him, is that he had about 250,000 birth hairs on his head (Caucasian is usually 110,000) and his hair was medium coarse and wavy which was highly desirable. His ability to get 11,000 grafts was unusual, but for him, it fit his personalized PLAN: https://baldingblog.com/norwood-class-7-pattern-patient-received-11000-grafts-plus-smp/

5mg oral minoxidil vs 2.5mgs

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

5mg oral minoxidil once a day or 2.5mg oral minoxidil twice a day, which would yield better results?

The issue at hand is not the blood levels achieved. A dose of 5mgs runs heart risks not worth taking for a healthy man. The point is at what level will the hair effect happen. The answer is a 2.5mgs daily, good results are seen and it is safe from severe cardiac side effects which is very rarely reported.

Minoxidil and hair transplants

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

My question is, should I be using topical liquid min on my frontal area where I’ve had hairs transplanted? I never do as the box says it only works on the crown area, but is this different for the transplanted hairs?

Hair transplants do not need minoxidil and minoxidil will not stimulate hair transplants to grow as they grow regardless of medications used. By all means, use it in the crown where it may work well.

Finasteride side effects went away

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

I started fin 13 months ago 1mg /daily. At first I had sides, loss of sex drive, runny ejac, and shitty boners. I’m a vain man, I work in sales and I figured this was all worth keeping my head of hair. Fast forward 3 months and they went away. I was hesitant to celebrate but it’s been 9 months and they haven’t come back. Fin not only stopped my balding dead in its tracks, also got some regrowth. I’m 31 so hair loss is pretty normal at this age but I still get the “you lucky bastard” comments from the less hairy lol. This might sound dramatic but good looks are an insane advantage in our society and finasteride saved my life lol.  

This is a positive story, something about side effects one doesn’t hear often

23 wanting a hair transplant

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

Should I get a HT ? Im 23 i used minoxidil for 2 years and did nothing just stopped the shedding so what you advice me to do ?

I am against surgery in someone your age because you might progress to a full Class 7 pattern and if you did, without careful planning, you might run out of donor hair. You need a personalized Master Plan for your hair loss with a good doctor who knows how to build one, see here:https://baldingblog.com/creating-a-personalized-master-plan-for-present-and-future-balding-photos/

Maturing hairline

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

Maturing hairline vs recessions:  I believe that a “Maturing hairline” is the same as MPB receding hairline. Someone people just recede more slowly than others or have their hair loss isolated to their hairline.

That is not true.  A maturing hairline is the normal evolution of a juvenile hairline that disappears in most Caucasian men between the ages of 18-29