I take propecia, which has halted my hair loss and re-grew some hair at the crown and top. If a better drug or a cell-based/cloning procedure comes along, would that mean I could get off propecia to start the new therapy, or will I always have to take it to keep what I got back?

Thank you

If another DHT blocker comes along with less side effects, you will be able to switch as long as it does block DHT. Dutasteride will retain benefits seen from finasteride (Propecia), but safety is still a concern of mine with dutasteride. Propecia is non-surgical (daily pill), and when hair cloning comes to be practical sometime in the future, it will almost be a surgical process of some sort. They’re entirely different processes, and if you stop the blocking of DHT from the drug, you’ll lose those benefits you saw.

Would an untreated ailment such as an exposed pilonidal cyst cause chronic telogen effluvium?

Anything is possible, but likely improbable. Sometimes people try to link one ailment with another. This may be valid in some cases, but often difficult to prove or correlate.

I would like to share my experience with latisse. I am 27. I am prone to balding as we have the genes in our family (father, uncle, and grandfather are bald!). However, I have not experienced any balding since I use propecia regularly (only a half a pill every day or every other day) and also use latisse on my scalp every other 2 days. My hair is thick, dark, youthful, and excellent. My hairline is still practically a juvenile hairline and rests at the upper crest of my brow. These combo of meds (propecia + latisse) seem to be protecting my juvenile hairline even into my late 20s.

Most people in their late 20s are unable to retain a youthful hairline. I started using propecia at only 22, and have added bimatoprost in at 27 years of age. I also use the latisse on my eyebrows every once in a while for the heck of it and my eyebrows are thick and dark as well. I have had absolutely no side effects from the latisse other than my hair becoming darker. It may be a cure/preventative measure to gray hair possibly.

Thanks for sharing! It sounds like you started on Propecia as a preventive treatment not for obvious balding (which I don’t generally recommend) and then added Latisse just for kicks years later. Since there are two medications in use, it would be difficult to pinpoint which of them (or perhaps both) are keeping your hairline intact. It could be possible that the MPB gene skipped you altogether, as it can skip generations. I’m not sure why you’d think Latisse could cure of prevent gray hair, as you’re not likely to see a lot of gray hairs anyway at 27 years old…

But this is interesting, and I do appreciate your 2 cents. If these treatments are working for you and the costs can be afforded, it is tempting to ponder a more extensive study, which I hope is already underway. I am happy that you’re not seeing any side effects. I hope you’re meeting with your prescribing doctor to keep track of your progress, particularly with using Latisse on your scalp, which I’d classify as experimental at this point.

Hi Doctor,

I had a 1500 FUE session 7 days back. My donor and recipient sites has healed well. Everything looks normal. But since the 3rd day, I have been having a lot of pain in the donor area. Its a burning pain. For some reason it gets better at times and worse for no reason. The whole area, although well healed and looks normal from the outside, is sensitive to touch and a bit numb too. Is this normal? I talked to my doctor. He asked me to keep taking the pain killers and give it more time. Is this something to be worried about? Is it going to get better? How much time would it take? Can this be a nerve damage of some type? Is that a possibility? I would appreciate any info/help on this. I was told there is almost a zero chance of nerve damage in FUE.

Thanks.

Pain is subjective and it certainly is reasonable to have post-operative pain as many small nerve endings were traumatized. There is always some degree of nerve damage when you cut through the skin (that is why it hurts). The main issue could be major nerve damage that runs along the back side of your scalp. These are the greater occipital and lesser occipital nerves. My recommendation is to follow up with your doctor and have him/her examine you.

By the way, not all follicular unit extraction (FUE) is the same; each doctor can use a slightly different technique and different instruments. So I couldn’t say how slim your chances were of having a complication, because I don’t know how the procedure was done. You’re not alone though, as I had a similar question posed here.

Hello Doctor,

My hair loss pattern is probably a NW3 and I have little to no miniaturization. I am in my early twenties. I went for a consultation about 7 weeks ago and was told to hold on to take Propecia. My hair loss keeps getting worse. I keep losing hairs and are not growing back. Also, on the sides there does not seem to have the same fullness as years before. I would like to know if I should start taking Propecia even though I do not have miniaturization?

Thanks

I’m not sure how I can help you. A doctor who examined you did not recommend taking Propecia. If you want a second opinion, you need to see another doctor. I am sure if you look hard enough you will find a doctor who will prescribe you Propecia, but I don’t think that is the issue here.

You point out you have “little to no miniaturization“, but consider yourself a Norwood class 3. Some men will recede without noticeable miniaturization, so Propecia could bring value to you. I would disagree with your doctor if you, in fact, have recession beyond just a mature hairline. Without an exam though, I’d have no real way to know that.

(Male)
Why does finer/flatter hair tend to become greasier over a short period of time compared to more full hair? the third day after i wash my hair it becomes greasy. I have tried to limit the amount of times i wash it but it makes no difference

I will have to guess on the answer to this question. If a person with coarse hair and a person with fine hair put out the same amount of sebum from the glands of the hair follicle, then there would be more wax around the hair shaft simply because the fine hair shaft would be smaller. That might appear to be very greasy to you. More frequent washings and using a shampoo for greasy hair may be better for you in solving the problem.

First off, great site doc. Very helpful.

My question is about hair density and thickness. Say one buzzes their hair, should they expect the density and thickness of the hair to be the same over the whole head or are the backs and sides of the head thicker than the top of the scalp, generally?

Thanks, doc!

If you’re not balding, the density should be the same all over the head. If you are balding, density will vary with the pattern of genetic balding. Of course, there will be normal variations as well.

An article written by Dr. Michael Beehner in the most recent issue of the Hair Transplant Forum (print newsletter published by the ISHRS) discussed survival of hairs in a hair transplant. He had done a study where he created five 1cm square boxes of grafts on a human volunteer just in front of the crown of the head. He separated grafts into each box focusing upon how the grafts were harvested and trimmed. One and two-hair grafts were studied. The tests followed the growth as long as 19 months. He showed that one-hair grafts which were trimmed very close and skeletonized had a 48% survival after 19 months. It was also shown in other publications, that grafts that are allowed to dry when out of the body also fail to grow. Grafts are out of the body when they are put into recipient sites, so the skill and experience of the staff clearly relates to the end results one expects to see.

Of interest, he noted that there was a significant increase in hair growth between the 14th and the 19th month of the study, reaffirming my own view that the transplant results get better over time. Doctors who create “chubby” grafts and leave the sebaceous gland with the grafts and a good fatty cover to the hair shafts, get growth in the 98% range at 19 months (up from 66% at 14 months), according to the study. Chubby grafts will also leave behind telogen hairs within the grafts that in some previous studies reported hair growth that exceeded 100%. There is a clear difference between the number of hairs that survive the transplant and the number of graft that are transplanted (as each graft can have more than one hair).

Lately, quite a number of our readers have written me about poor growth from their hair transplants and we’ve posted quite a few of those here. I have always directed these people back to their doctors and suggested that if they do not get the answers they want and need, they should get a second opinion. The main bit I hope you learn from this is that there’s really no substitute for a team consisting of a knowledgeable surgeon and an experienced, skilled staff. You don’t want to have your time, money, and available donor grafts wasted by a surgeon or his/her clinical team.

Dear Dr. Rassman,

My question is regarding the non-approved use of minoxidil for frontal balding. In your response here your thoughts were that it might work to some degree. My question is whether there is a physiological difference between balding at the hairline and on the crown? If not, is there some other reason why minoxidil might be less effective at the hairline, or is it simply the case that Pfizer didn’t test it there, and if not, why not as it would surely increase sales.

The drug PI in fact specifically says not to use it for receding hairline, do you believe that it’s possible that it may have negative effects? Further, is there a likelihood that minoxidil use by a man who in fact wasn’t balding but only having a maturing hairline would have negative effects (other that normal drug side effects)?

Many thanks

You raise an interesting question, but no one really knows why minoxidil or finasteride work better on the crown area. There may be a physiologic difference of hair follicles in the frontal area versus the hair follicles in the crown area, or it could be that hair loss in the frontal area is more rapid and medication works better when the hair loss is earlier with more miniaturized hairs. I do not think there is a danger or negative consequence of using the medication for the frontal area, though. In fact, many of my patients do use these drugs for the frontal area with some success.

I really do not know why the drug companies did not study the effect of the medication on the frontal area of the scalp. My cynicism would tell me that their initial results were very weak and they’d rather not publish poor results, but I actually believe that it was too complex for a good science study to show the type of results seen in the crown.

From the study abstract published in the Archives of General Psychiatry:

Results: Subjects with BDD showed relative hyperactivity in the left orbitofrontal cortex and bilateral head of the caudate for the unaltered own-face vs familiar-face condition. They showed relative hypoactivity in the left occipital cortex for the low spatial frequency faces. Differences in activity in frontostriatal systems but not visual cortex covaried with aversiveness ratings of the faces. Severity of BDD symptoms correlated with activity in frontostriatal systems and visual cortex.

Conclusions: These results suggest abnormalities in visual processing and frontostriatal systems in BDD. Hypoactivation in the occipital cortex for low spatial frequency faces may indicate either primary visual system abnormalities for configural face elements or top-down modulation of visual processing. Frontostriatal hyperactivity may be associated both with aversion and with symptoms of obsessive thoughts and compulsive behaviors.

Read the full abstract — Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder

Body dysmorphia is a problem for a few patients that I have seen with balding. At times I make this diagnosis so I found this particular study very interesting. CNN also just published an article based on the same study here, which might be a little easier to digest than the study abstract.