This man must have been very sensitive to both finasteride and minoxidil to get such good fill in just 4 months. The corner hairline hair loss reversal is dramatic.
After a month of taking iron, my iron level normalized and my hair has continued to thicken up in much of the top (to where the barber thinned a section for the first time since ~2006). Not really the left corner and not the crown or back, though all that looks stable now and very little hair comes out in the shower. I do not have celiac. Invasive examination so far hasn’t found anything that would affect hair or absorption.How long should I wait to see if any regrowth in the problem areas happens?
Always give hair changes 6 months to kick in a significant number of new anagen cycles (about a quarter of men have a two year growth cycle). Then you will know much more and we should meet then
It will only be a problem it the minoxidil produced hairs dependent upon it. In that case, those hairs that are minoxidil dependent would fall out
When I had hair, I always had a high hairline. Should I put my hairline high as it was when I had hair?
There are two ways to determine where the midline hairline belongs. (1) one finger width above the highest crease of the furrowed brow and (2) balance the distance between the nose and chin to the grove above the nose to the hairline (that is what Michelangelo did). When designing a hairline, I always use these rules and if the forehead has always been high, then these rules allow you not to have a huge forehead for the rest of your life. Attractive people are always in a balance with their facial features.
Thank you this is helpful. Logically speaking wouldn’t it follow that if oral minoxidil were dangerous at these doses, we would have case reports correct? I imagine you have a portal as a physician that lets you check of any such case reports? Is there any retrospective data that shows what the minimum, average, median doses are for severe side effects? Hopefully I’m making sense here but i could only find one case study of a woman with kidney disease in her 60s having a cardiac effusion at 0.625 mg. Wasn’t shown to be causal. She had several preexisting conditions and poor health to begin with but used the min for lowering BP it seemed.
I guess my main issue is that I have yet to see literature where a cardiologist is closely following patients on low oral minoxidil over a period of 2-5 yrs +. I really would like to take oral minoxidil but this is my limitation.
The cardiologist, I don’t believe, use minoxidil for high blood pressure anymore as there are much better drugs. The dermatologists and hair doctors look out for Cardiac Effusions reports and when they see them, they look to see the dosage that caused it. From the research I did, this particular complication has not occurred with doses of 2.5 mgs or less in a healthy person.
From what I’ve read, the underlying theory for advanced classes not responding as well is due to scalp fibrosis, however that is understood to be reduced by an increase of bloodflow and microneedling. If scalp fibrosis is the culprit as to why NW6~+ don’t respond as well then hypothetically in time, enough microneedling and enough of an increase in bloodflow should result in an increase in hair growth right? I’m certainly getting vellus growth in my hairline at the sides and towards the middle front.
That being said, after almost an entire year on my regimen, I’m having what seems to be my first shed and it’s almost exclusively my intermediate hairs that have grown from vellus in my frontal mid scalp region. What has me excited is that I’m not getting any bulbs pushed up like when you lose hair so it seems like this is an expected healthy shed. I’m excited to see what replaces them in the next 3-6 months!
When an area of the head has been bald for quite a while, it loses its blood flow as the body regulates blood flow where it is needed. Normally, hair is a high metabolically active organ, so it commands blood flow. When the hair dies off with apoptosis (hair cell death as we believe it does), then the body figures that the blood flow can be better used elsewhere. This means that the skin of a older bald area, becomes atrophic and looses all of its support infrastructure for the hair which includes blood vessels and fat.
Hi Dr. Rassman. Hair loss has consumed my life recently and I’ve opted for SMP. My only worry is that my scalp is considerably paler than my skin and the last time I buzzed my hair it really stuck out. Thanks so much for what you do, have a good one. Thoughts?
I have seen many young people get SMP. The problem with SMP is two fold: 1) the inks often spreads so that the dots must be very small to account for this and 2) the color of the dots may change with time (become gray). Make sure you don’t get a black ink because those take on the color or blue or green and stay out or prolonged exposure to the sun (wear a hat) as sun causes the inks to fade.
Lifting weights supposedly makes you release more testosterone, which means more dht, which means more miniaturization? Is this true to any extent?
No, working out does not increase hair loss. It might help by reducing stress.
What part of the process of their transition actually stops and reversed hair loss? I have heard that people who go MTF are able to regrow a full head of hair even if they started balding prior. So I’m curious. Is it the hormone blockers? And do you think that a baldness cure could come from scientists looking more into how MTF people can completely reverse their hair loss?
If you take testosterone out of the equation (chemical or surgical castration) and add estrogen, and the hair loss is recent, hair may yet grow from the balding area. The fall back position is hair transplants which is a common surgery with MTF.
I’m showing clear signs of MPB and have started Fin, Min and Biotin. I’d be happy with maintaining my current hair and will only hope to see some thicker hairs and maybe revitalize some dormant follicles along the way.
But I did notice just this year that the thinning was happening very quickly. I have pictures from just 5 months ago where I have much thicker hair front to back. I have short hair too, so it’s noticeable now. Around the same time earlier this year I went to an urgent care facility when I was feeling extremely strange with my heart. They ran a few tests and said I was OK. Since then, almost everyday I have spurts of faintness, lightheadedness, dizziness, etc. Especially if I have caffeine, after I exercise or getting up and down a lot. I’m going to the doctor this week as I had written off all the symptoms since I showed normal test results when I was concerned last time, but now want a bit more of an answer and treatment.
So, I’m just wondering if abnormal (low) blood flow to my head may have accelerated hair thinning and loss.
The scalp has an extremely high blood flow because actively growing hair has a high demand for oxygen and other nutrients. As hair start to miniaturize or fall out, the demand for blood flow decreases and your body is smart enough to redirect that blood flow elsewhere. When you look a men with long standing balding, their scalp is very thin (no fat or hair follicles) so the blood flow is significantly reduced to this scalp. The good news is that when it is transplanted, this process runs in reverse, building back blood flow to nourish the newly transplanted hairs. The other parts of your questions need to be addressed with your doctor.
Indeed, but this decrease in testosterone over the years does not seem to have an affect on the amount of hair loss, which is somewhat counterintuitive.
Not at all. Genetic hair loss has ingrained in each follicular unit of the scalp, a biological clock that limits how many growth cycles it has. The fewer the growth cycles, the more the balding. The hair on the back and sides of the head have no limit on hair cycling. Even with this explanation, the hair loss process is very complex and many factors determine the number of cycles each follicular unit has besides the genetics.
If this was true, maybe he would have no donor hair left if is was done by FUE unless he was one of the rare men with extremely high donor density. May be he actually got 7000 hairs not grafts.
Both procedures are good; however, FUE for medium weight hair should be limited to about 3000-3600 grafts. For fine hair, the numbers are much smaller sized sessions as see-through donor areas occur frequently in fine haired people after too many FUEs. If your hair is coarse, you have far less limitations and either surgery works well.
This is an excellent result from using finasteride and minoxidil for 7 months. It is not unusual for the crown to respond to these two medications.
Dr. Wrassman, to clarify, are you expecting that this is a normal outcome? I get bleeding and worry that I am going too hard and perhaps should consider less time or a shorter needle length? Quite frankly, it’s been tough to pin down an optimal needle length in the literature. I was considering restarting at 1mm with the dermapen assuming the 1.5mm rollers prevalent in literature only penetrate 1 – 1.25mm.
The stem cells lie under the epidermis which is 0.5mm below the scalp surface. The 1 or 1.5mm reaches this depth. Either should be fine. The key is to get wound healing that reaches the stem cells.