FUE2014

I reckon he could have done with another 1500 grafts personally, could the patient not afford more grafts or was a joint decision made to go for a conservative hairline?

I recall reading somewhere years ago that dut can cross the blood brain barrier which always put me off it. That aside, I'm not convinced that the potential of small gains (compared to fin) is worth the added risks from obliterating all the dht in my body. It is an extremely powerful drug that stays in your body for a long time and, correct me if I'm wrong, does not have the same long term safety profile as fin. For me the bottom line is this. Is the thing I am taking for my hair loss something I would feel comfortable taking for the rest of my life? For me, Fin and minox are both a yes. Dut, though, is a resounding no.

Eggs are fully of biotin so that's one, any others?

That is some encouraging early growth Better late....hope it continues & good health to you.

No reason to stop caring about your appearance when you get to 50 (or any age for that matter). You also have the advantage that your hair loss is more likely to have stabilized. Only thing worth mentioning is that older patients do apparently heal slower than younger patients which can correlate to slower gains.

We all know that, generally speaking, fast growers get better results than slow growers. But at what point (weeks/month) post op would it become apparent do you think that you are a fast grower? Would you expect to see good growth from the third month or even before?

Any pics?

Thanks very much for your response Dr Josephitis.

is there *any* physical trauma, such as cuts, bumps, burns, clipper use etc, which could damage or dislodge them and affect growth?

That's awesome news Blake, congrats and good luck to you.

Hi mate, congrats with the results. Show em off man!

KgCan't comment on the US, but in Europe the docs who charge the most that I know of are, in no particular order, Feriduni, Lorenzo, Bisanga and Reddy. I think you could also make an argument for these four being the best, or near to the best, in Europe as well.

Couldn't agree more with Shadow and Magnum, if you can get away with it, don't tell her. It reaks of insecurity, and girls that age (I'm assuming she is a similar age to yourself) are much less forgiving than women in their 30's and beyond. As Shadow said, don't be an over sharer, and don't expose your weaknesses if you don't have to.

Save your money for a small HT procedure to boost the crown. These LLLT gadgets have very poor reviews generally and all these companies do is give people false hope with their clever marketing and pseudo science. Care to show a picture of your crown at all?

:cool: Who is your doc mick?

Great write up, you had me chuckling away a few times, also killer result already @ five months.

Hey buzz how is your hair looking, any pics? What has the clinic said? Also is it true Dr Doganay can't speak English, seems a bit iffy to me.

You lucky bastard ;-)

Indian Dermatology Online Journal Search Article Search Users Online: 19 Print this page Email this page Small font sizeDefault font sizeIncrease font size Indian Dermatology Online Journal Home| About us| Editorial board| Ahead of publication| Current Issue | Archives | Submit article | Instructions | Advertise | Executive committee | Contact us |Login Click here to view optimized website for mobile devices Journal is indexed with PubMed Share on facebookShare on twitterShare on citeulike Share on googleShare on linkedinMore Sharing Services Table of Contents ORIGINAL ARTICLE Year : 2015 | Volume : 6 | Issue : 1 | Page : 17-20 Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride BS Chandrashekar, T Nandhini, Vani Vasanth, Rashmi Sriram, Shreya Navale Department of Trichology, CUTIS Academy of Cutaneous Sciences, Bengaluru, Karnataka, India Date of Web Publication 8-Jan-2015 Correspondence Address: B S Chandrashekar # 5/1, 4th Main Road, MRCR Layout, Near Veeresh Theatre, Behind Godrej Interio, Vijaynagar, Bengaluru - 560 040, Karnataka India Login to access the Email id DOI: 10.4103/2229-5178.148925 Get Permissions Abstract Background: Finasteride acts by reducing dihydrotestosterone levels, thereby inhibiting miniaturization of hair follicles in patients with androgenetic alopecia (AGA). Oral finasteride is associated with side effects such as decreased libido, sexual dysfunction, and gynecomastia. Aim: The aim of the following study is to assess the efficacy of maintaining hair growth with 5% topical minoxidil fortified with 0.1% finasteride in patients with AGA after initial treatment with 5% topical minoxidil and oral finasteride for two years. Materials and Methods: A retrospective assessment was done in 50 male patients aged 20-40 years with AGA. All the patients had been initially treated with topical minoxidil and oral finasteride for a period of two years, after which the oral finasteride was replaced with topical minoxidil fortified with finasteride. Five of 50 patients had discontinued the treatment for a period of 8-12 months and were then resumed with only topical minoxidil fortified with finasteride. The patients' case sheets and photographs were reviewed by independent observers and the efficacy of minoxidil-finasteride combination was assessed. Results: Of the 45 patients who underwent a continuous treatment for AGA, 84.44% maintained a good hair density with topical minoxidil-finasteride combinatio. Of the five patients who discontinued oral finasteride for 8-12 months, four demonstrated good improvement in hair density when treatment was resumed with topical minoxidil-finasteride combination. Conclusion: Topical finasteride can be considered for hair density maintenance after initial improvement with oral finasteride, thereby obviating the indefinite use of oral finasteride. Keywords: Androgenetic alopecia, maintenance of hair density, oral finasteride, topical finasteride, topical minoxidil How to cite this article: Chandrashekar B S, Nandhini T, Vasanth V, Sriram R, Navale S. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J 2015;6:17-20 How to cite this URL: Chandrashekar B S, Nandhini T, Vasanth V, Sriram R, Navale S. Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride. Indian Dermatol Online J [serial online] 2015 [cited 2015 Mar 27];6:17-20. Available from: Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride Chandrashekar B S, Nandhini T, Vasanth V, Sriram R, Navale S - Indian Dermatol Online J Introduction Top Androgenetic alopecia (AGA) is the most common form of hair loss experienced in genetically predisposed individuals. It occurs due to the stimulation of genetically susceptible hair follicles by dihydrotestosterone (DHT). DHT causes follicular miniaturization, resulting in decreased hair density. Finasteride reduces DHT level by inhibiting type II 5α reductase, [1] the enzyme responsible for conversion of testosterone to DHT, thereby inhibiting miniaturization of hair follicles. It also promotes the anagen phase of hair growth. Oral intake of finasteride reduces DHT levels in the blood and causes side effects such as decreased libido, erectile dysfunction, etc., These side effects are temporary and normalize with continued use. [1],[2],[3] Once oral finasteride is stopped, the DHT level rises and reverses its effects, thereby resulting in less dense hair. This accounts for an indefinite period of oral finasteride treatment. [4] Studies show that topical finasteride appears to have results equivalent to oral finasteride in AGA, [5],[6] and has better tolerance. Therefore, the we conducted a study to assess the efficacy of topical minoxidil fortified with finasteride in the maintenance of hair density post- treatment with oral finasteride. Materials and Methods Top A retrospective assessment was done in 50 male patients with AGA. The photographs and case sheets of AGA patients with Hamilton grading 5a and 6; and Ludwigs pattern II and III falling in the age group of 20-40 years were selected for this assessment. The patients had undergone treatment with oral finasteride and twice daily application of topical minoxidil 5% for a period of two years. After a considerable improvement in hair density was noticed, the patients were advised to discontinue oral finasteride and were shifted to topical minoxidil 5% fortified with 0.1% finasteride. Forty-five of 50 patients had resumed the treatment with topical finasteride and minoxidil without interruption. Five of 50 patients had discontinued the treatment for a period of 8-12 months resulting in a decrease in hair density to the initial level. These patients were then started only with topical minoxidil fortified with finasteride; oral finasteride was not represcribed. The patients were followed up once every four months for a period of 12 months. At each follow up, the patients' photographs were taken and side effects if any noted. Photographs taken at baseline, i.e. when oral treatment was stopped, and the 4 th month, 8 th month, and 12 th month of topical medication were assessed [Table 1]. The assessment was done by the investigator and an independent observer to avoid bias. Table 1: The assessment of hair density maintenance after replacing oral finasteride with topical minoxidil and finasteride combination Click here to view Results Top Of the 45 patients (on continuous treatment), 25 patients' hair density was moderately maintained, as given in [Table 1]. These patients when shifted from oral to topical finasteride initially experienced some hair loss and then reached a plateau phase. They had no further hair loss and the hair density was well maintained [Figure 1]a-d. Seven patients had a slight decline in hair density when shifted from oral finasteride to topical treatment alone as seen in [Figure 2]a-c and 13 patients did not experience a decline and even showed an improvement in the hair density. Figure 1: (a) Initial stage before starting treatment, (b) Improvement after oral finasteride treatment at eight months, © Initial decline in hair density when oral finasteride was stopped, (d) Plateauing of hair loss with well maintained hair density Click here to view Figure 2: (a) Initial phase before starting hair fall treatment, (b) Improvement noticed after oral finasteride treatment, © Decline in hair density after switching from oral to topical finasteride Click here to view Five of 50 patients had stopped all treatment for hair loss and showed a decrease in hair density over a period of 8-12 months [Figure 3]a-c after stopping treatment. All these patients improved when started with topical minoxidil fortified with finasteride as seen in [Figure 3]d. Four of these patients had a good improvement in hair density after one year of follow up [Table 2]. Figure 3: (a) Initial phase before starting treatment, (b) Improvement noticed after oral finasteride treatment, © Decline in hair density after stopping the treatment for a period of eight months, (d) Good improvement in hair density after restarting topical medication Click here to view Table 2: The improvement of hair density in patients who had discontinued the treatment for a year and started with topical minoxidil and finasteride combination Click here to view Discussion Top AGA is an androgen mediated event and is the most common type of alopecia in men. It is genetically inherited and keeps progressing. The main cause is the androgenic hormone DHT. The scalp DHT level is higher in a bald scalp when compared to a hairy scalp. [7] The Food and Drug Administration approved treatment options for male AGA are topical minoxidil and oral finasteride. 5α reductase causes conversion of testosterone to DHT and finasteride is an inhibitor of type II 5α reductase, thereby reducing the formation of DHT molecules. [1] Hence, patients on oral finasteride have lower concentrations of DHT in blood, thereby a reduced DHT level is noticed in the scalp. This in turn reduces the follicular miniaturization and increases the anagen: telogen ratio. [3] A study conducted by Kaufman et al., determined the effect of oral finasteride treatment for two years and the effect of withdrawal of treatment after one year. The results showed that the effect of oral finasteride was much better than the placebo group and there was reversal in the hair density after withdrawing the oral finasteride. This was because of the increased levels of DHT once finasteride had been stopped. [4] A study to compare the efficacy of oral vs topical finasteride conducted by Hajheydari et al. says that the efficacy of topical finasteride was at par with that of oral finasteride. [5] However, the penetration of topical finasteride is a matter of concern. Therefore, minoxidil, a vasodilator and a potassium channel opener was used in combination with finasteride to aid in better absorption. A study conducted by Tanglertsampan comparing the efficacy of 3% minoxidil alone and a combination of 3% minoxidil and 0.1% finasteride topically in the treatment of AGA revealed minoxidil and finasteride combination to be better than minoxidil alone. [8] In our study, 84.44% patients maintained the density well, showing the effectiveness of the combination in maintaining hair growth. In five patients who had discontinued the treatment, it was noted that 80% of patients had good improvement in a year upon restarting the treatment with topical finasteride in combination with minoxidil. This shows that the topical medication alone is beneficial in maintaining hair density as well as improving hair growth. Oral finasteride is known to cause side effects such as erectile dysfunction and decreased libido due to decreased in blood DHT. [4],[9] Though this occurs in a minority of patients, we noticed that most of our patients were apprehensive about using oral finasteride on a long term basis. The case sheets of the five patients who had discontinued treatment, when reviewed, revealed that they were averse to taking oral finasteride because of its side effects, and hence had discontinued treatment. The patient compliance was good with topical finasteride. However, the limitation of this study is that the serum and scalp DHT levels could not be obtained. Conclusion Top A majority of patients in this study who discontinued oral finasteride and adopted topical minoxidil fortified with finasteride showed a minimal decline in hair density reaching a plateau phase, after which there was no further decline in the hair density. Furthermore, it was well tolerated with no psychological fear of oral medication and good compliance. The five patients who had discontinued the treatment for a period of 8-12 months when resumed on topical minoxidil and finasteride combination showed good improvement in hair density. The combination of topical minoxidil and finasteride can thus be considered as a beneficial treatment strategy to maintain hair density after achieving initial improvement with oral finasteride, thereby obviating the use of oral finasteride indefinitely. References Top 1. Aggarwal S, Thareja S, Verma A, Bhardwaj TR, Kumar M. An overview on 5alpha-reductase inhibitors. Steroids 2010;75:109-53. Back to cited text no. 1 2. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, et al. Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol 1999;40:930-7. Back to cited text no. 2 3. Van Neste D, Fuh V, Sanchez-Pedreno P, Lopez-Bran E, Wolff H, Whiting D, et al. Finasteride increases anagen hair in men with androgenetic alopecia. Br J Dermatol 2000;143:804-10. Back to cited text no. 3 4. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 1998;39:578-89. Back to cited text no. 4 5. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol 2009;75:47-51. Back to cited text no. 5 [PUBMED] Medknow Journal 6. Mazzarella F, Loconsole F, Cammisa A, Mastrolonardo M, Vena GA. Topical finasteride in the treatment of androgenetic alopecia: Preliminary evaluation after a 16-month therapy course. J Dermatol Treat 1997;8:189-92. Back to cited text no. 6 7. Dallob AL, Sadick NS, Unger W, Lipert S, Geissler LA, Gregoire SL, et al. The effect of finasteride, a 5 alpha-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. J Clin Endocrinol Metab 1994;79:703-6. Back to cited text no. 7 8. Tanglertsampan C. Efficacy and safety of 3% minoxidil versus combined 3% minoxidil/0.1% finasteride in male pattern hair loss: A randomized, double-blind, comparative study. J Med Assoc Thai 2012;95:1312-6. Back to cited text no. 8 9. Arca E, A?ikg?z G, Taştan HB, K?se O, Kurumlu Z. An open, randomized, comparative study of oral finasteride and 5% topical minoxidil in male androgenetic alopecia. Dermatology 2004;209:117-25. Back to cited text no. 9 Figures [Figure 1], [Figure 2], [Figure 3] Tables [Table 1], [Table 2] Top Search Similar in PUBMED Search Pubmed for Chandrashekar B S Nandhini T Vasanth V Sriram R Navale S Search in Google Scholar for Chandrashekar B S Nandhini T Vasanth V Sriram R Navale S Related articles Androgenetic alopecia maintenance of hair density oral finasteride topical finasteride topical minoxidil Access Statistics Email Alert * Add to My List * * Registration required (free) In this article Abstract Introduction Materials and Me... 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Damn, Dr Doganay has a lot to answer for. What has happened to him? At one point a couple of years ago I thought he was one of the best, but there have been so many dissatisfied patients recently with little growth and now you with FUE scarring. Not good.

Sorry friend, but there is nothing anyone here can do for you then.

Dr Feriduni has some fantastic results with female patients, I would strongly encourage you to contact him.

Great read. Happy growing and look forward to your updates in the months to come.

http://www.hairrestorationnetwork.com/eve/148161-what-exactly-hair-transplant-growth-timeline.html

Fair comment.