JohnS

IMO, Dr True is the best transplant doc in the NY area. I suggest you have a consultation with him and see for yourself.

Looks great, wear it in health!

I just love Dr Wongs work! He keeps a low profile, but can really deliver results.

Very nice work, something we have all to expect from H&W. Good luck.

Hope all is well. My best.

Been through all this before, tried a lot of stuff. The epidurals should really help a lot, they did for me. I once had 6 done before it resolved. The best supplements I have found to help were Zyflamend and Cosamin DS. The Zyflamend is a very potent herbal Cox-2 inhibitor that will reduce the inflammation over time. Also begin using the Cosamin DS, this will help rebuild the disc, there even was a study done a few years ago showing its benefits. It will take time, but it works. Once you heal enough to go to the gym begin using the lower back machine religiously. I start off each workout with it.

I would have to agree, use of dutasteride is a very tricky situation, there may be possible long term issues in its use, namely neurological implications. There is no long term model as with finasteride. Best to play it safe and avoid it.

The transplanted hairs will not regress when stopping minoxidil applications, since they are not prone to miniaturization, though the surrounding hairs might regress to their former state if they were prone to miniaturize. In a small study, minoxidil used within 48-72 hours following a transplant avoided the normal shedding of transplanted hairs in a number of participants and in others that did shed, growth began earlier than normal, using within a month or so. IMO, there really is no downside in early minoxidil applications.

Maybe you should try melting the foam before applying it. In small studies with the macaque, the foam was melted before application and worked. Put it into the cap and let it melt by using a small amount of heat from a blow dryer, then apply it will a dropper. This will get it directly to your scalp and it dries just as quick as in the foam state.

Absolutely no problem, infact it will help against hair loss by binding to the androgen receptors making it harder for the existing DHT to do so.

I suggest you look into the supplement, Diindolylmethane, commonly called DIM. Dim is a phytonutrient derived from cruciferous vegetables such as broccoli and cabbage. Testing has found that is a potent hormone disrupter, being both a androgen receptor and estrogen agonist. In basic terms DIM competes with DHT for the androgen receptor (good for hair and prostate) and also rebalances estrogen metabolism by converting estradiol to the more harmless estrone (good for estrogen dependent growths, ie gyno). From my experience one of the most potent brands on the market is by Source Naturals. It is definitely worth a try in lieu of the more common anti-aromatase drugs commonly prescribed. Hope this helps.

Small studies have been done concerning the use of minoxidil before and after a hair transplant. The concensus of data suggests using minoxidil up until the transplant and reinstating minoxidil use as soon as possible following the transplant, in most cases 48-72 hours if possible. Using it in this manner reduced the fallout of newly implanted hair and commenced early growth.

Actually Retin-A alone will promote hair growth in 58% of participants, through reversal of perifollicular fibrosis and vascular proliferation. Some speculation exists that a stem cell influence may also exist. Undoubtally most subjects employ it's use in combination with minoxidil. One other point, using Retin-A separately would be advisable since some data exists that the two may react when combined over long term, also using it separately allows users control on customizing its application to regulate individual reactions to the drug. Just wanted to clarify the point. Bazzano GS, Terezakis N, and Galen W: Topical tretinoin for hair growth promotion. J Am Acad Dermatol 15:880-883, 1986

Unfortunately once daily is not equal to twice daily. A crossover study was conducted comparing subjects who switched from twice daily to once daily, all subjects lost hair. If you wish to utilize a once daily regimen, consider also adding Retin-A to your routine. A study has proven that this is equivalent to twice daily applications.

A study was run comparing 1mg to 5mg Finasteride over a period of one year. Maximum hair counts were not increased in the 5mg subjects, but they did reach their end point sooner. Finasteride has a nearly straight line dose curve ranging from 0.05mg to 5mg.

I am rather surprised that you would not be aware of this, but I am more than happy to provide you with several references. I hope this information can enable members to make a more informed decision in their determination of the appropriate treatments. One should research hair loss protocols with the same fervor as one does hair transplant surgeons. Those that do reap the benefits, those that don't accept the dissapointment. Mitchell AJ, Douglass MC. Topical photochemotherapy for alopecia areata. J Am Acad Dermatol. 1985 Apr;12(4):644-9. Lassus A, Kianto U, Johansson E, Juvakoski T. PUVA treatment for alopecia areata. Dermatologica. 1980;161(5):298-304. Li LF, Fiedler VC, Kumar R.The potential role of skin protein kinase C isoforms alpha and delta in mouse hair growth induced by contact dermatitis. J Dermatol. 1999 Feb;26(2):98-105. van der Steen PH, Boezeman JB, Happle R. Topical immunotherapy for alopecia areata: re-evaluation of 139 cases after an additional follow-up period of 19 months. Dermatology. 1992;184(3):198-201. Rokhsar CK, Shupack JL, Vafai JJ, Washenik K. Efficacy of topical sensitizers in the treatment of alopecia areata. J Am Acad Dermatol. 1998 Nov;39(5 Pt 1):751-61. Shapiro J. Topical immunotherapy in the treatment of chronic severe alopecia areata. Dermatol Clin. 1993 Jul;11(3):611-7. Rauch H. The effects of topical applications of chemical agents on hair development. Physiol Zool. 1952; 25: 268-272. Chase HB, Montagna W. Relation of hair proliferation to damage induced in the mouse skin. Proc Soc Exptl Biol Med 1951; 76: 35-37. LI L.-F.; FIEDLER V. C. ; KUMAR R.; Department of Dermatology, University of Illinois; Induction of hair growth by skin irritants and its relation to skin protein kinase C isoforms; British Society for Investigative Dermatology Annual Meeting, Cardiff , ROYAUME-UNI (07/04/1999) 1999, pp. 783-810 (26 ref.)

You just said the magic word, "irritated". PPG is a known irritant, something that everyone who has used it finds out at one point or another. Skin irritants can cause hair growth. This has been proven time and time again in trials with Alopecia Areata. In fact dinitrochlorobenzene, one the most potent skin irritants, is used to treat it. Another skin irritant, retinoic acid, aka Retin-A, works in a similar manner.

Anti Freeze sounds novel, I don't believe it's been tried, maybe it does work! Hopefully someone can run a trial on this also.

Exactly! You hit the nail right on the head! Good!

Well...yes and no. PPG is a very important carrier, but serves many other purposes also, something the glycerin, the carrier of choice in the foam, cannot approach. One important note, many people may not realize it but PPG should be considered as an active ingredient, as is minoxidil, since it contributes to hair growth also.

As a matter of fact, the target area in both studies was exactly the same, one inch. You have to understand these are abstracts, not the full study, so they include only certain excerpts. My employer has a subcription to various online services so I was able to view these for further evaluation. You are free to do the same to satisfy your inquisitiveness. As far as a study pitting Rogaine Foam to Rogaine Liquid, that would never happen, since it would be financial suicide to Johnson and Johnson if it appeared their new product was relatively ineffectual as compared to their older product. They had good reason to release this product, but that is a whole different thread.

That is easily explained. The foam acts as a thickening agent, this I am sure you noticed when using it. It simply makes your hair look thicker, quite in contrast to the liquid when makes it look worse, at least until it dries. But as you can see, the hair count increase averaged only 4 hairs in the specified area, definitely not enough to notice.

This is the 5% Rogaine Foam study abstract submitted to the FDA for its approval. A Multicenter, Randomized, Placebo- Controlled Double-Blind Clinical Trial of a Novel Formulation of 5% Topical Minoxidil Foam vs. Placebo in the Treatment of Androgenetic Alopecia in Men Olsen, Elise;1 Funicella, Toni;2 Roberts, Janet;3 Kempers, Steven;4 Piacquadio, Dan;5 Wanser, Rita;6 Zhang, Paul;6 Kohut, Bruce;6 1. Duke University Medical Center, Durham, Northe CArolina, USA; 2. DermResearch, Inc., Austin, TX, USA; 3. Northwest Cutaneous Research Specialists, Portland, OR, USA; 4. Minnesota Clinical Study Center, Fridley, MN, USA; 5. Therapeutics, Inc., Lajolla, CA, USA; 6. McNeil Consumer Healthcare, Morris Plains, NJ, USA Although 5% topical minoxidil solution is safe and effective, a vehicle that does not contain propylene glycol and is more aesthetically pleasing to the consumer, would be a distinct advantage to consumers for use in androgenetic alopecia (AGA). Objective: To assess the efficacy and safety of 5% topical minoxidil when formulated in a new foam vehicle (TMF) for men with AGA. Method: Two-phase study: "?? Sixteen week double-blind placebo-controlled phase to evaluate the efficacy and safety of the 5% TMF. This phase was conducted on 352 men ages 20-49 with patterns IIIv, IV or V Hamilton Norwood with the primary efficacy endpoints of change between Baseline and Week 16 target area hair counts (TAHC) and Week 16 subject assessment of change in hair loss condition from Baseline. "?? Open-label extension phase to collect 52 weeks of safety data with 5% TMF. One hundred forty-three subjects continued on this phase of the study. Safety was monitored by taking intercurrent history, vital signs and scalp irritation assessment by both investigator and subject. Results: "?? Statistically significant increase at Week 16 compared to Baseline in TAHC with the 5% TMF group (170.8 to 190.8 hairs) compared to placebo (168.9 to 174.4) (p<0.0001). "?? Statistically significant subjective assessment of hair loss condition (p<0.0001) on 5% TMF (70.6% noted increased hair growth, including 47.8% moderate or marked hair growth) compared to placebo (42.4% noted increased hair growth, including 21.5% moderate or marked hair growth). "?? No significant safety concerns were raised and the 5% TMF was well tolerated over a one year use period. Conclusions: The 5% topical minoxidil product, formulated without propylene glycol and in a foam vehicle, is a safe and effective treatment for men with AGA. Only 20 hairs grew in 16 weeks... "Statistically significant increase at Week 16 compared to Baseline in TAHC with the 5% TMF group (170.8 to 190.8 hairs) compared to placebo (168.9 to 174.4) (p<0.0001)" Due to the fact that all the 5% minoxidil studies were evaluate beyond a 16 week trial, and it would be unfair to use them as comparison, I have submitted a sample 2-3% minoxidil liquid trial using the same 16 week time period... Use of topical minoxidil in the treatment of male pattern baldness. Savin RC. This 12-month, double-blind, randomized study evaluated the safety and efficacy of topical minoxidil in the treatment of male pattern baldness. Three formulations were compared: 2% minoxidil solution, 3% minoxidil solution, and placebo. After 4 months all placebo patients crossed over to treatment with the 3% solution. Of the 96 patients randomized into the study, 79 were evaluable at month 12; 25 of these were in the 2% minoxidil group, 24 were in the 3% minoxidil group, and 29 were in the placebo-to-3% solution switchover group. At monthly intervals a hair count was obtained within a 1-inch diameter area on the scalp vertex. In addition, a gross visual estimate of the degree of new hair growth over the entire balding area was made independently by the investigator and the patient. At the end of 4 months there was significant regrowth of nonvellus (terminal and indeterminate) hairs in the patients using the 2% and 3% solutions (p = 0.0001). The mean nonvellus hair count at month 4 was 162.8 in the 2% minoxidil group, 155.4 in the 3% minoxidil group, and 107.1 in the placebo group. The mean increase in the 2% and 3% treatment groups was 58.2 and 48.8, respectively, whereas the mean increase in the placebo group was 4.0. Total hair counts at month 4 demonstrated significantly more growth of hair in the 2% minoxidil group than in the placebo group (p = 0.013), with no significant difference between the 3% minoxidil group and the other two treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS) Bottom line..... 2-3% minoxidil liquid grew 48.8 to 58.2 hairs as opposed to 5% minoxidil foam's 20 hairs, that amounts of 2.5-3.0 times as much hairs, clearly the superior of the two. Please also note the in head to head trials, 5% minoxidil was clearly superior to 2-3% minxoidil at all data points.

All studies I have read indicate using minoxidil right up to surgery and resuming within a few days after surgery will increase the likelihood of graft survival and minimize shock loss to native and grafted hairs.

I really would not get involved with MSM, there have been so studies that point to long term toxicity. It is not worth the risk.