olmert

7 hours ago, 12345 said:

To treat scalp fungal infections, you must keep it on for 20 min. That is why I keep it on for 20 min. I don't think any topical shampoo can be left on the scalp for only 5 min to have any desired effect.

Doctors like to say the absence of evidence is not evidence of absence. In other words, most things can't be tested. It is just too expensive. So you rely upon anecdotal evidence. So you prescribe drugs off label. In other words, just because we don't know everything does not mean we should pretend to know nothing. 

Now, if the quoted words above were accurate, they would be anecdotal evidence that ketoconazole for 20 minutes is better for hair loss than ketoconazole for 5 minutes. 

But the clinical trials showed that 5 minutes of ketoconazole works for dandruff and fungus. So at least something is getting in there. If there was much evidence that 20 minutes would do more, they might have aimed for a leave in spray. 

19 minutes ago, 12345 said:

I am referring to the instructions on 2% ketoconazole to treat tinea versicolor. That was the 15-20 min I was referring to, not seb derm.

Prescription bottles in the united states have one pre-printed instructions. They don't have different instructions for different disorders. The pre-printed instructions on every bottle of 2% ketoconazole in the United States says 5 minutes. The pharmacy can manually type in words like "use as directed," as pharmacists sometimes do. 

3 hours ago, 12345 said:

the 2% which needs a prescription says 15-20 min on the bottle. 

I just looked at my bottle. In the United States, the bottle says the same thing the FDA instructions say: "DOSAGE AND ADMINISTRATION Apply the shampoo to the damp skin of the affected area and a wide margin surrounding this area. Lather, leave in place for 5 minutes, and then rinse off with water."   https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/019927s032lbl.pdf 

1 hour ago, 12345 said:

I can feel the systemic effects if I use 1% keto shampoo left on the scalp for 20 min a day.

Are there a  lot of people leaving keto shampoo on for 20 minutes? I think the FDA instructions say 5 minutes. Are there people reporting 20 minutes helping? 

I got a message about this recent follow up post. Oh, it brings back so many memories about when I was obsessed about getting a few extra grafts. I don't want to belittle those going through the same process. I'm just old, in my 50's, with other obsessions at this life stage,

Which company does @mustang think gives the best bang for the buck with topical dutasteride and with topical finasteride?  

For people who have side effect from finasteride, what does @Melvin- Moderator think about taking Saw Palmetto, either with or without micro pills of finasteride? Not enough data on it? That Indian doctor Dr. Bhatti recommends it. Then again my impression is Dr Bhatti's approach is tailored toward the patient who is willing to try things that have relatively small chances of working. 

I was on Saw Palmetto. I had sexual side effects. I have no idea whether these side effects were from Saw Palmetto, oral finasteride, or my blood pressure med. I just changed my blood pressure med to try to rule out the former one as the culprit. 

It is tough when I  have three possible culprits and at the same time have to decide whether to add in a fourth possible culprit, topical finasteride.

1 hour ago, Melvin- Moderator said:

If cost is an issue, micro-dosing on oral finasteride

1. Is it possible that the hair benefit is exactly proportionate to the sex effect, so there is no real bargain? (In other words, micro-dosers just kind of fool themselves and suffer a sex effect too--a small one to accompany a small hair benefit.)

2. What evidence is there that micro-dosing Finasteride stops ANY hair loss?

I ask this because Dr. Damkerng Pathomvanich told me he did a study with .3 mg/day finasteride, and it found no benefit to hair loss. He told me "save your money," when I told him I wanted to micro dose. 

He told me this like 7 years ago. I haven't found the study. I'm sure the study was small. It does seem to be logical that micro dosing stops some hair loss. I've seen some other doctors recommend it, though they were relying on logic, not any study. 

@12345, have a lot of people here reported side effects to topical finasteride? 

Most new products fade away. A few stand the test of time. Minoxidal pills have stood the test of time. PRP may or may not. The only way to know for sure topical finasteride is good is to wait a few years. 

That being said, Xyon's dutasteride at $129 is just not practical for 99% of people. That comes out to $60,000 over a 40 year period, which assumes the price stays the same. (It will only go up.) If I start now, I am sure to keep with it for 40 more years, so I see the cost as $60,000. 

A hair transplant seems more cost effective, if you have to choose.

Maybe one of the cheaper $60/month topical finasterides is better bang for the buck. I would love a post listing out the cheaper topical finasterides/dutasterides. I haven't found such a post.  

I do have a prediction. I think Xyon will go down to $60. They had no way to know the pricing point that would maximize their revenue. All the research is already done, so there is no reason not to pick the pricing point that will maximize their revenue, even if it was so expensive to develop that they end up losing money. I don't think there is demand at $129/month, which factors in both the evidence of efficacy, and how rich people are. 

On 3/24/2023 at 9:42 PM, NikosHair said:

Have you tried stopping the fin for a couple of weeks and seeing if your sides disappear?

The side effects disappear whenever I go off fin for 10 days. 

@NikosHair, if I will get my DHT measured, I probably need a baseline. If a droop .25 mg/day, how long should I  wait to get a baseline DHT? Then how long on .25 mg/day should I be before re-testing?

But also why do I even need to know my DHT? All that matters is the sex side effects that I notice. 

I’ve been micro-dosing finasteride for years. If I take .25 mg per day, the loss of libido is tolerable. There is a loss, but I can live with it. Now and then, I try to raise it to .32 mg per day, and the libido effect is extreme, so I go off it entirely for a few weeks. Then I start again with .25 mg per day.

I figure Minoxidal works best by pill, but also works a little topically. So I think there is a good chance finasteride/dutasteride will be the same.

I think I can get better hair if I supplement my .25 mg per day finasteride pills with topical dutasteride. If the topical worked well, I might even drop the pill part to reduce sex effects.

But Xyon’s topical dutasteride is $129/month. That is just too much money for me, when topical dutasteride is not clinically proven to stop hair loss, and when SiloxysSystem is also not clinically proven to be a better delivery system. I agree there is solid logic that they work, but I got to factor in the cost, and the alternative of other  topical dutasterides and the alternative of just sticking to the .25 mg per day pill.

@NikosHair, I believe that topicals will do a lot less than pills. Everyone knows topical minoxidal is not as good as minoxidal pills. But topical minoxidal is clinically proven to do at least something. So I figure topical dutasteride probably will too. I agree with you that $129/month is simply not worth it unless you are rich. I don’t know if I can criticize the doctors charging so much. I don’t know if they are getting rich. You need economies of scale for a pharmaceutical. Maybe you have to charge a ridiculous amount for a product that will only be bought by people obsessed with hair, people like us.

@Melvin- Moderator , Dr. Damkerng Pathomvanich told me micro dosing finasteride will do nothing. He did a study that found no benefit to .3 mg/day. I micro-dose anyway. I figure his study was probably small.  Logically, it seems to me a little finasteride should do a little good, though I don’t entirely rule out complicated biological processes where a lot does a lot, and a little does absolutely nothing—perhaps you need a lot to penetrate some barrier to start working at all? I know, Melvin, that you rely upon the topical finasteride study that showed topical finasteride resulted in blood finasteride of only 1% of twhat came from finasteride pills. Meanwhile, this 1% lowered DHT by an enormous 34%, which suggests micro-dosing a pill helps baldness. But this seems to contradict Dr. Pathomvanich’s study.

For now, I decided to supplement my .25 mg/day of finasteride with some kind of topical dutasteride.

So what cheaper topical dutasteride alternatives is there to $129/month?

One problem with this forum is a lot of people treat cost as no burden. Maybe everyone is rich. Maybe everyone wants hair and nothing else in the universe. 

Ten years ago I asked for a recommendation for an affordable hair transplant doctor. 

I got angry responses. No one recommended any doctor. Instead I got vicious posts saying I should not get any transplant at at all, if I am dumb enough to consider cost a factor. Everyone said I should ignore cost and seek the best doctor. 

Anyway, let's assume I'm not rich and want to consider price as a factor. Which topical dutasteride should I get?

Also, I am reviewing Dr Mwamba's topical dutasteride and comparing it to  Xyon. But I am stuck. I can't get Dr. Mwqamba to to tell me how many mL's come in a bottle. The problem is the one answering emails barely speaks English. Does anyone know? 

@1978matt, where are you getting this 80% retention rate for FUE and 90% retention rate for FUT? Doesn't @Melvin- Moderator bring a video from Hasson saying his FUE has a higher retention rate than with FUT? 

Is a supposed higher retention rate with FUT the entire reason some believe you can get more with a combo FUT/FUE than with only FUE? 

1. I just saw Dr. Hasson's video that says he gave up on FUT. Does this mean you can maximize your number of grafts with FUE alone, without FUT? Do you still need to do both to get the maximum grafts? I remember a post here from a year ago. The moderator said you need FUE and FUT to max out. 

I've had 3 FUT's.  I can probably do 2 more FUT's and then FUE. (I have enough laxity for 2 more FUT's.) But I would prefer to do only FUE's going forward.  

2. Also, if you need to do both to max out, can you do an FUE before you do your last FUT? (I'd prefer putting off FUT's and doing an FUE now.) 

On 9/20/2021 at 4:09 PM, Spaceman said:

@olmert In the picture below, the skin is not being stretched, rather its being pinched to see how much laxity there is.  Note that you can cut this pinched piece out without stretching the skin to close the wound.  It is "extra" skin.  That is what happens in FUT. 

The surface area of your scalp is a larger than the surface area the outer skull, or pericranium.  If that was not the case you would not be able to move your head freely.

In your example, if the surface area of the pericranium is 100 square inches then the scalp covering it must be 110 square inches or more for one to excise a strip of 10 square inches from the scalp.  This extra 10 square inches of skin represents the laxity.

Here’s another way of looking at it: say I have a shirt and I need to make a repair on it but I have no more fabric. If the shirt is baggy then I can undo the  seams and trim off the extra fabric and then resew the seams to make the shirt more fitted without stretching the material.  Then I can use the extra fabric I cut out to make a repair somewhere else on the shirt.   But if the shirt is not baggy then it is not a candidate for this type of repair.

Here is what Spaceman can't seem to follow. He thinks that you can remove hair, without reducing the density of the donor region. This is mathematimatically impossible. It is like thinking 1 + 1 = 3.

The pinching picture confuses Spaceman because he doesn't understand how transplants work. 

Transplants do not create new hair. They only move hair. They give the illusion of creating hair. When hair loses 49% of its original density, you can't tell. The human eye is not good enough. You can google this number. This is why we do transplants. If you take 49% of hair from a donor region, it will become less dense, but you won't be able to notice (unless you have a magnifine glass). This is why in Spaceman's pic, you can pinch an inch of skin, and it looks like the surounding skin is no less dense. It is less dense, but it is not 50% less dense. 

6 minutes ago, TEXAN35 said:

Since we are not doctors probably we don't understand many aspects of body Physiology. Even how minoxidil works for hair is not 100% understood. Lots of time we hypothesize the cause after the result without certainty.

Having said that number 2 is not that nonsense though

Skin pressure causes tissue expansion and that in turn causes new cell generation (probably stem cells get stimulated ) The question is that those new cells which become part of scalp in donor area after FUT have any hair cells or no and what are its limitations.

Again this is something which probably a researcher can answer and we can just speculate.

As people who already have Multiple FUT and FUE combo are vouching for it , it may actually have some reality .

Tissue expansion - Wikipedia

In many years reading about hair transplants, I have never heard this theory that a transplant causes stem cells to grow new hair. If it were even a theoretical possibility, I would have heard it. Besides these stem cells would take time. The reports here is that the stretched FUT border area is immediately full of hair despite stretching. 

On 9/20/2021 at 8:27 PM, aaron1234 said:

Perhaps, but far less so than the overall density decrease with FUE.  As someone who has had both FUT and FUE I can attest to this.  

That is what Spaceman claims. But I don't see the logic. 

Assume you start out with a 3 inch by 10 inch section at the back of the hair. Say there are 15,000 hairs. Say you cut the middle inch out with its 5,000 hairs.    Then the remaining 2 inches stretches to 3 inches. And you have 10,000 hairs over 3 inches. 

Say instead you take the 3 inch region and pluck 5,000 FUE hairs out.  There should be 10,000 remaining hairs in the 3 inch region. 

Why would FUE take out more density? Maybe FUE hair is plucked inconsistently, so you get empty patches here and there. 

11 minutes ago, Spaceman said:

Good luck on your HT journey @olmert.  I wish you the best.

Thanks.

30 minutes ago, Spaceman said:

@olmert In the picture below, the skin is not being stretched, rather its being pinched to see how much laxity there is.  Note that you can cut this pinched piece out without stretching the skin to close the wound.  It is "extra" skin.  That is what happens in FUT. 

The surface area of your scalp is a larger than the surface area the outer skull, or pericranium.  If that was not the case you would not be able to move your head freely.

In your example, if the surface area of the pericranium is 100 square inches then the scalp covering it must be 110 square inches or more for one to excise a strip of 10 square inches from the scalp.  This extra 10 square inches of skin represents the laxity.

Here’s another way of looking at it: say I have a shirt and I need to make a repair on it but I have no more fabric. If the shirt is baggy then I can undo the  seams and trim off the extra fabric and then resew the seams to make the shirt more fitted without stretching the material.  Then I can use the extra fabric I cut out to make a repair somewhere else on the shirt.   But if the shirt is not baggy then it is not a candidate for this type of repair.

Anyone will tell you that you are not seeing logic. 

Let us take your numbers.  The original skin is 110 square inches, but it is basically scrunched (or baggy) so that it is covering a 100 square inch skull. After FUT, the scrunching stops. That by definition means the hair density is less. 

In other words before FUT:

100,000 hairs on 110 square inches of skin scrunched to cover only 100 inches of skull: this means 100,000 hairs are covering an area of 100 inches

Then FUT takes away 5,000 hairs and 10 square inches. After:

95,000 hairs on 100 inches of skin NO LONGER scrunched and now covering 100 inches of skull: This means 95,000 hairs are covering an area of 100 inches, which means less density.

13 hours ago, Spaceman said:

That’s just wrong. Let go of the stretching concept.

FUT surgeons try to avoid excessive tension during closure to reduce the chance of stretched scars.  

Surgeons use the term elasticity to describe what you call stretching. And patients with high elasticity are poorer candidates for FUT because they are more likely to have wide scars. 

Good FUT candidates have laxity which is define by normal-to-high glidability and normal-to-low elasticity. 

See this as a mathematical equation. It will show your illogic. 

Assume a scalp starts out with 100 square inches of space. Assume 100,000 hairs are on that space. 

Assume you cut out with FUT 10 square inches. 

1. After the cutting, do the 90 remaining square inches expand (or stretch) to 100 square inches? If you think not, then what precisely happens? Does the neck line raise? Does the forehead recede back? (Remember the skull remains the same size: you do not shrink the skull.) 

2. If 90 square inches stretches to 100 square inches, does less density result? 

1 hour ago, TEXAN35 said:

I always thought that FUT+FUE gets more but  I like your point that even with FUT if you take out a strip the neighboring scalp will stretch to cover the area hence the lowering hair density which should be similar to FUE.  If your overall donor scalp surface area remains same then reduction in density should be same in FUE and FUT but maybe there are some additional constraints which is causing the result which Dr Shapiro mentioned

1) FUE is causing more accidental transection of neighboring hair and doctors are ignoring that fact or it is causing more permanent loss of neighboring hair as it is spread across

2) In  FUT when neighboring  skin is stretching maybe the new skin cells are getting generated in the area which have some additional hair . Very unlikely though.

3) When performing FUT your overall scalp becomes smaller maybe the hairline near the neck gets stretched a little upwards . 🙂 

Just unproven hypothesis 🙂

 

#1 is no longer the case. It used to be true.  #2 is nonsense. #3 seems to me to be unlikely. The strip area used is normally far above the neck, and many docs say only the inch above and below the strip take the stretching. 

1 hour ago, Spaceman said:

FUT removes skin from the donor area and therefore reduces its size, but not FU density.

I think where you are getting tripped up is that FUT relies on scalp laxity, or loose skin that can be easily moved up and down with your hand. FUT surgeons are removing some of the excess skin that most people (but not everyone) have in their donor area of their scalp.

It’s not about taking a one inch strip from a 3 inch area and then stretching the remaining 2 inches of skin to cover the 3 inch area per your previous post.

FUT is about taking out the lax inch of skin. You need to have an inch of play in your scalp to take an inch out.  And if you don’t have that laxity then you will not be a candidate for FUT. That’s why FUT surgeons want patients to do laxity exercises ahead of surgery.

FUT can remove 1000s of FUs without significantly reducing donor density though of course it does reduce the overall donor area by an amount equal to the area of the strip. No free lunch.

I think where you are getting tripped up is that laxity is the same thing as stretching the skin that is not cut out. 

1 hour ago, aaron1234 said:

Because strip is localized and FUE extractions are taken from the entire donor region.  

Nonsense. FUT stretches the skin above/below the scar, so that hair density decreases. 

19 hours ago, aaron1234 said:

After just 1k FUE grafts I could tell that the overall density of my donor region decreased more noticeably than after the six strips. 

Why would FUE lower donor density more than FUT? 

28 minutes ago, aaron1234 said:

I got 7k grafts via strip before starting FUE.  There's no question that if I got around 5-6k grafts via FUE first, a strip would not be viable at that point because it would have no place to hide.  

That is doubtless true, but that begs the question why does FUT/FUE combo gives more than FUE alone. Melvin says it is conventional wisdom, but I can't figure out a viable logic. 

On 2/25/2021 at 5:24 PM, Melvin- Moderator said:

That’s because it will. It’s common knowledge that using both methods yields more hair, how much is debatable, but I personally feel a minimum of 1,000 grafts extra.

Melvin says combo get you 1,000 more grafts. He says it is common knowledge. Dr. Shapiro says the same. 

They must have some reasoning why combo yields more than FUE alone. I wish they would explain. 

I want to maximize my lifetime grafts. I would rather do it with FUE alone, but I feel compelled to max out FUT before starting FUE just to be safe. It is a real pain in the ass because FUT stops me from lifting weights for 6 months. Some doctors say you can lift weights after just 10 days, but I felt the strip stretching.