I recently met with a hair transplant doctor from Asia who confided with me that the results from those doctors who use the Choi implanter are generally poor. For reasons unclear to me, it seems that many of the doctors in Asia have not mastered the techniques for manual preparation and the placing of grafts. Many Asian doctors depend upon the Choi implanter to perform the task of implanting the grafts. Because the Choi implanter requires very closely trimmed grafts for the grafts to fit inside the small needles, I would assume that the failures of hair transplants to grow reflect damage produced by very close trimming of the grafts and the longer periods of time that the grafts are kept out of the body. The skinny grafts produced for the Choi implanter can dry out fast and the grafts can die in a matter of 10-20 seconds when they are exposed to the air. I’ve written about Choi failures in the past. Of interest, there are very few North American doctors using the Choi implanter.

Apparently the public’s perception of the quality of results are well known in some of these countries and many patients flee to the United States and Canada for higher quality hair transplant services. Because I need to protect the identity of my informant physician, I will not report even the name of the specific countries he was talking about, but I have heard of this problem at the annual medical meetings from other sources as well. Do your research and keep this information in mind if you’re considering a transplant and always ask to see patients who have had it done.

Dr. Rassman,

I was given a single dose of oral testosterone by my endocrinologist and I had not taken my daily Propecia. I’m afraid that the DHT surge did some damage by “tagging” follicles. Is there truth to the DHT “tagging” myth? In otherwords: does DHT “tag” hair follicles and activate within them some sequence of irreversible self-destruction? Or, does fresh DHT need to continually bind to receptors on a follicle to cause it to lose function? Or, is the DHT binding cumulative? Does a hair follice only begin to lose function once a certain number of DHT receptors have been bound with DHT?

Castration is rumored to halt balding. Therefore, wouldn’t this indicate that the effect of DHT stops once the DHT is gone? However, their hair does not regrow. So, is DHT “stuck” to the follicles, or are the follicles just not able to revive?

DHT does not stay in the hair follicle for a long time, as the body will metabolize it. If you were to stop taking your daily Propecia (finasteride 1mg) and took testosterone at about the same time, I expect that more hair loss will occur. Each genetically impacted hair follicle has a number of hair cycles which is usually less than genetically non-impacted hair follicles. That is why we lose hair in different parts of the scalp and different points in our lives. The DHT will not stick to the hair follicle beyond a week or two, so those hair follicles that are not due to undergo apoptosis (cell death) will most likely live until their time to die comes.

1. I have heard that another hair transplant firm injects something into your scalp that swells your scalp before inserting the grafts?
2. I also want to get eyelid surgery. Should the eyes or hair come first? How much time should elapse before the second surgery? It would be nice to heal from both at the same time.

1. I do not inject anything into the recipient area to swell the scalp. The doctors who do these injections think that by stretching the scalp with saline, the grafts can be put closer together. I do not believe that this is the case.
2. It might be better to do the hair transplant before the eye surgery, because if swelling occurs after a hair transplant and the eyes were freshly done, that could cause more discomfort. I’d give it about 2 weeks after your hair transplant before you undergo the eyelid procedure.

Snippet from the article:

While Chris Rock’s new documentary, Good Hair, is certain to get laughs, it’s sure to leave the audience talking. And that’s the point, the comedian says.

“When you talk about something with some weight to it, like hair, even when it’s over, you’re still in people’s heads,” Rock said. “That’s what I wanted with this film.”

The movie, which opened Friday, examines the issue of hair in the African-American community and the pressure to straighten or lengthen naturally coily hair.

Read the article and interview with Chris Rock at Chron.com.

I believe hair is important to people of all races, but Chris Rock explores the issues that black women have with their hair, including the use of chemical straighteners, weaves, wigs, and other things I’m sure I’m forgetting. The movie trailer looks hilarious and I’m interested in seeing it at some point.

I understand what you’ve said about side effects from Propecia taking a few weeks to go away because of tissue fixation. But what if the patient has been taking Propecia for a long time, such as 10 years? Would it take several months for side effects to go away in your opinion?

Tissue fixation is a few week phenomenon. Some men talk about the disappearance of side effects in a week or less, and some talk about side effects lasting up to a month. I can not comment on what to expect.

Hello,

Thank you for putting time into this website. It has proved helpful. I had a few questions about finasteride.

1. Does exercise have any effect on increasing or decreasing side effects?>
2. Does exercise have any effect on how well it would work?
3. What do you think of taking iron supplements to get finasteride to work better? (I am iron deficient, but I am not sure if it is enough to effect my hair. Going to a doctor soon to get my iron checked again.) Link
4. Since I am 21, I have the best chances of finasteride to work. Do you see it work with almost everyone my age, especially at the very beginning of MPB? What about how common the side effects are at my age?
5. I am going to see a hair transplant doctor soon. If miniaturization is found and the doctor is not willing to give me a prescription for generic proscar, can you? (Not sure of the legality of this. I hope I am not putting you in a bad position.)

Thank you for your time.

1. No. Exercise won’t increase or decrease side effects if you happen to get them.
2. No. Exercise won’t mess with the effectiveness of finasteride.
3. Get your iron checked and be under the care of a good doctor. I don’t see any value in trying to make finasteride work better, though.
4. Finasteride works well in young men, but a few who are destined to develop advanced balding may find it doesn’t work as well. Side effects are possible, but it is a very slim chance. There are reports on the internet that are overblown.
5. You should do a miniaturization study and take pictures of various parts of your scalp. The presence of significant miniaturization will indicate genetic causes of hair loss.
6. You aren’t putting me in a bad position by just asking, but let’s get a telephone consultation (call 800-NEW-HAIR) and see what’s happening. Any doctor can write the prescription so once you know the diagnosis (miniaturization pictures taken by you and sent to me), you can start finasteride if it is in your best interest. Your family physician will often prescribe it for you.

dr rassman
quick question regarding dht and hairloss. if dht was some how able to be 100 % blocked would that totally stop hairloss or is their more to it than that ?

We know that if the testicles were removed (as done in one of two identical twins in a study in the 1950s) that hair loss will not occur. We also know that once the hair has been exposed to dihydrotestosterone (DHT), the impact is dramatic in the speed of the hair loss. The twin that had his testicles removed for mental illness (a barbaric process) had a full head of hair, but was given testosterone and rapidly lost his hair. The other twin, with both testicles in tact, went fairly bald naturally.

With all that being said, the complete blocking of DHT might not be the only solution to eliminating hair loss. There could be other factors in play, such as various diseases… or even something else entirely that has yet to be discovered or proven.

Snippet from the press release:

The HairMax Hair Fibers incorporate cutting edge production which produces ultra fine natural keratin protein fibers that blend and statically cling to a user’s existing hair. This means that the fibers will not weigh hair down or clump on the scalp.

Read the full text here.

It’s a press release, so it’s filled with lots of patting themselves on the back… but it sounds like the field which has been dominated by Spencer Forrest’s Toppik now has some more competition (and as a reader pointed out in the comments below, similar products include Nanogen, Megathik, Mirage, Hair-So-Real, Super Million Hair). I haven’t seen this Hair Fibers product, but will certainly take a look at it.

Lexington International is the maker of this new product along with the LaserComb, of which I’ve had quite a few posts about in the past. Check out their site here.

Hi. My question is regrading accutane and hair loss. I took accutane when I was 15 at 40 mg for 6 months. I didn’t notice any hair loss at the time but a few years after I started noticing that the hair on the top of my head has been getting thin. Now at 23 my hairline has receeded somewhat particularly fast. I really don’t know what to think as I have been off of accutane for 8 years. I heard alot of people on the Internet talk about the effect it has on the hair. My question is could this hairloss be related to the accutane I took 8 years ago or could this be mpb?

I frankly can not tell you if you have a connection between drug-induced hair loss from years earlier or if you just have male pattern baldness from genetic causes. It is true that Accutane (isotretinoin) does seem to cause hair loss, but I can not comment on an 8 year gap between taking the drug and the appearance of the hair loss.

i decided to quit propecia after a 1.5 years of medication. today its the 8th month without any dosage. after quitting from drug, i have lost my crown area hair but not much. i have still got no bald patches until this time. my maturing hairline, frontal area has no change but i feel a itchy feeling on my crown area. i feel like losing hair from there, other areas of my scalp feeling good; no dandruff etc.

my question is the propecia still blocks me from losing hair? im 22 now and im slowly losing hair from my crown area. its most likely to my maternal grandfather, maybe as same as him.

thanks

Stopping Propecia will cause you to lose any benefits you had from taking it. It sounds like the benefits were mainly in your crown. Please be aware that you will undergo the natural hair loss your genes have ‘planned’ for you. Do you really want to experience progressive hair loss? I warn men about short term thinking so it does appear that you have some time to think this through.