Month: January 2023

Hello,
i’ve recently had my second transplant and i’m almost 27, I had my first just before my 25th birthday. I have only had temporal recession mpb in the front, and I had figured that with such small areas to fill and such a good donor sample that I would be able to fill in the areas not fully but maybe 80% of the density it once was when hair existed there. I was semi happy with my first transplant yet wasn’t near the density I wanted maybe 20% with a random guess. I just had my second 4 months ago and from what I see hairs are growing in but it’s hard to tell at this point if it will get to the density where you won’t be able to see through my hair to my skin. I’m a bit skeptical. Also I am not positive but I think I have just a tad of shockloss, which I refused to take finasteride because of all these horror stories on the internet i’ve seen.

My question is where can I get the straight facts, not opinions but actual documented cases that the FDA uses in it’s analysis? I get conflicting opinions everywhere I go and it’s hard to decipher which is correct, based on fact, logical, and applicable to my situation. Now I’ve read posts on your shockloss and i’m a bit bummed I hadn’t atleast known that shockloss in men in their 20’s with an HT without using Finasteride is common. My Doctor said shockloss most of the time is temporary. Your posts say otherwise. Also I have seen posts on finasteride some saying side effects such as decreased libido or penis size is permanent, others say no. I can’t risk my sex life and would rather be bald then mess with it, but I do like having hair on my head as well. Which side do I take? It’s probably already too late to counter any of the hairloss 4 months after the surgery right? Sorry for the long question. Thanks.

I appreciate your situation, but your fear of Propecia (finasteride 1mg) makes no sense to me. If you took the medication and experienced a negative sexual side effect (1% of men), the drug will be out of your blood stream in 24-48 hours from the time you stop taking it. There is nothing permanent about it. Concerning your hair transplants, you need to have a Master Plan for what might happen to you. If you got 20% of what you expected, then do you have enough hair to follow your hair loss without Propecia as you lose it? Your doctor is just plain wrong when he tells you that hair loss from a transplant (shock loss) is temporary and I would challenge that comment if given the chance.

I agree that giving up sex is not an option, but where are you getting the idea that it is either sex without Propecia or no sex with Propecia? That is not what millions of men are experiencing today, including 99% of the men I treat with that drug.

This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).

E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:

“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].

In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”

We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.

The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.

I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.