I get this question often, too often. Young men send me pictures like the one shown below as if I have magical insight to offer. They are frightful because of the familial balding present in their families and project what they see upon themselves. My answer to this man is to purchase a hand microscope from Amazon and determine if significant miniaturization is present that predicts the balding process.
[If you have any questions, you can reach me at williamrassman33@gmail.com]
The arrow suggests where the hairline should be, so when he went on oral minoxidil it grew in the area where the arrow points. The growth will only get better.
I have been seeing more and more experiences as you showed here, as many men seem to be achieving the impossible, reversing a slick bald Class 6 pattern. The microneedling is clearly instrumental in this reversal. Adding oral minoxidil might help, but persistence over time is the key factor. You might even reverse the balding pattern in another 10 months. Congrats!
With that said, a group of older men have since developed ‘age-related thinning’, in which ALL of the hair on the head becomes thinner (including the transplanted hair). This has produced a thinner transplanted area so one reached out for another transplant just last month, as many others have done over the past few years. I told them about Age-Related Thinning in which hair transplants just will not work for them, as their donor area is impacted by the same thinning that brought them to me again. So, I am treating two of those men, both over 65 years of age, with Age-Related Thinning, by performing SMP on the previous transplanted area (on one man) and the other with SMP on his entire head. Both men still have most or all of their hair transplants present, but as their hairs thinned with age, they needed more fullness that SMP would provide for them.
Have you ever heard about a clinic in Canada charging $0.50/graft? Can’t find anything but they quote .50c per graft… That’d be cheaper than going anywhere else in the globe for Canadians –
This appears to be a hair transplant. This is so because the hairline is straight (reflecting a poor surgeon without artistic judgment), and there is no transition zone in front of this straight hairline. In addition, the hairline is more than 3/4 inch above his highest crease, and the hairline is solid. A receded hairline that goes up that high is always thinner. In other words, the surgeon didn’t put the hairline in the right position, just a bit too high.
I remember when I was on a jury, and when the judge first came in, I saw a straight, solid hairline that was probably 2 inches higher than the highest crease of the furrowed brow. This told me it was a hair transplant, just poorly positioned (too high). I couldn’t tell if the surgeon put a transition zone in front because I was too far from the judge but the judge just didn’t look normal. He was over 60 years old and his hair was probably died black.
I am a diffuse thinner and I started fin (1mg/day) 3 weeks ago and I am shedding hair like crazy. I would say about 300-400 hairs each day over the past week or so. Is shedding this much normal when starting fin?
If you are really shedding 400 hairs/day, this is unusually high. It might be a finasteride shed as you just started it, but it will last up to a few weeks. With that type of shed from finasteride, I would expect great results from the drug. You may not be accurate in your hair count, but it should stop shortly.
Note the early growth of what appears to be his mature hairline. I placed arrows where you should look to see where is filling in. The combination of oral minoxidil and finasteride is unbeatable.
Do you think I would be a good candidate for a hair transplant? I’m tired of being self-conscious of my hair and it blowing up in the wind, revealing my hairline. If I was to get a transplant, how many grafts do you think I’d need? I’m 28M and have been taking 1.25mg finasteride daily for 2 years
You have a Class 3 pattern of balding, At 28, you may not progress much more, so a hair transplant is a good option. When I do surgeries with men in their 20s, my cut-off on the low age end is 26. A t8, predicting your future hair loss patterns is easier to do. I recommend staying on the finasteride as it is a bit of a guarantee that your hair loss will not progress after the hair transplant. Have the doctor see if your hair behind the balding area is miniaturized and, if so, how far back it goes. This will allow you to look into your future. Also, get a measurement of your hair donor thickness and donor density as this will predict, to some degree, the result after a single surgery session. I see in the photo that your forelock almost touches the highest crease of your furrowed brow, suggesting that the number of grafts will not be very high. Depending upon hair thickness and the extent of the balding I can’t see, that number can range between 1300-2000 grafts.
In just three months, minoxidil, finasteride, and microneedling produced hair. I am sure if I stay on this treatment, it will just get better.
I spent years too scared to take fin because of all the insane posts on YouTube/Reddit and obviously forums like propeciahelp and the “PFS” crowd in general. Don’t wanna sound bitter but I honestly kind of am. That’s like years of my life and tons of hair I won’t get back, especially in my 20s of all years. I know at the end of the day it was my decision to avoid taking it but I was only doing so because I was seeing bad information online. Not just on forums but even some hair transplant channels and doctors were promoting the “PFS” fear-mongering online. Wish I’d just listened to my dermatologist years ago.
You are among thousands of men who took the information and extended it well beyond its relevance. I’d like you to focus on today’s problem. If you send me photos, I do offer a free consultation at williamrassman33@gmail.com, but do require good photos, one of which has your hair pulled back and your eyebrows lifted high so I can see the full hairline.
Why would I lose more hair when I take testosterone> I am on a lot of medications for my FTM hair loss already?
The more testosterone you take, the greater amount of DHT you will get which interacts with your balding genetics to cause MORE hair loss. Without enough estrogen to protect you, you behave like most men who take testosterone and have the genetics for hair loss which you clearly have.
I am not sure you can make such a broad statement. Minoxidil does give a relatively fast benefit within the first 3-6 months, but it might continue to add value after that time frame.
Some people think that there were too many grafts transplanted. Can you comment on this?
For most patients, I often transplant the frontal area and push medications to address the crown, which is usually successful. This reduces the costs (as I charge by the graft) and preserves the donor area for the inevitable future balding in young men who show crown balding. You received 2200 grafts to the frontal area and 1300 to the crown.
I find that the conclusions offered are not justified by the content in the following ways:
This leads me to conclude that 60% of men without the active enzyme in their scalp who were treated with topical minoxidil received systemic minoxidil through the skin.
William Rassman, M.D.
