Month: January 2023

I feel like my rate of loss isn’t as bad as my grandpas and line’s up better with my uncles. However they lost more overall than my great grandfather, which I attribute to their father’s influence. Neither of them were as bad as his though. I can’t tell if they had crown loss like I do, my uncles seemed to just recede from front to back while I started at the crown and eventually the temples. I believe my grandfather was a diffuse thinner.

Best case scenario is that I take exactly after my great grandfather, his hairline was fairly far back but it looked more or less like a full head of hair, kinda Richard Nixon territory. -but considering he started losing hair about… 100-ish years ago? There’s not many people I can query about regarding the rate it happened. Nor any pictures where I can see his crown.

Today, drugs like finasteride which slow down the loss were not available with your grandfather or other relatives, so you can modify your end balding stage and with a good hair transplant, you can bypass what happened to them. Look at yesterday’s post about a 10 year finasteride study, it shows that men with less severe hair loss, may gain hair with finasteride.

If you maternal grandfather is “dome” bald and your maternal uncle has the same appearance, but his maternal grandfather is not bald: does that mean such gene was inherited through the Y chromosome? Therefore, will my mother carry that on her X chromosome to me?

There is a 50/50 percent chance that you will get the genes from your mother’s or father’s side of the family. By the age of 26, you might know who you take after. Look through a lot of photos of uncles and grandparents and see if you can identify yourself.

Say the only person in my family with hair loss is my grandpa, but he mostly receded at the front and temples. If I inherited it from him, would I have the same type of hair loss? Also, my hair is nothing like his, it was straight, black and very thick before balding, whereas mine is light and frizzy much more like my other grandpa who had no hair loss.

Answer: The character of your hair is different from a genetic approach than the balding pattern which you may have inherited from your grandfather. If your pattern is the same as his pattern when he was your age, then it is likely that you will have his pattern of balding.

Dr. Rassman’s Comments: There is some good reading here for those interested in finasteride and the many finding of things that go wrong with this drug. One of the referenced article reflect a single case study and show DNA damage to sperm. From any single case study, one can’t conclude that the finding is attributed to finasteride as discussed by the authors. Another article address high grade prostate cancer risks with finasteride and found nothing to suggest that it is a cause and effect. Still, these articles are not authoritative and do not stand alone.

This is a follow up from

https://www.reddit.com/r/tressless/comments/f4hnuy/my_trip_to_the_derm/

Once again I am not a medical professional or giving advice.

Basically I’m in my late 20s and have had some thinning and recession, this has gotten worse despite several years of using minoxodil 5% with good compliance. I also use Ketoconazole 2% shampoo (usually daily). I think they both help, but it’s hard to prove.

So I’m looking into propecia/finasteride. I have the pills with a derm. prescribing 5mg stating that the higher dose is more effective than 1 mg.

I saw a urologist the other day about sexual and in particular fertility concerns prior to using finasteride. Honestly the fertility worries me more because I would like to have children down the road but fertility problems aren’t always known until one attempts to conceive. I feel that if one gets noticeable (like erectile dysfunction) side effects, discontinuing the drug is likely to lead to a recovery whereas keeping on the drug for years seems more likely to impair recovery. The Dr. seemed open and candid about side effects overall and discussed both sexual and psychiatric side effects. He stated that the causation of effects was hard to determine given the number of different reported effects and how many things could cause them. He seemed to think that for how often the drug is prescribed side effects aren’t super clear. He stated that fertility effects were “usually” reversible. He also felt that 5mg was too much and referred me to another derm. (who he said takes finasteride himself).

It says right on the finasteride pamphlet that fertility might be effected. I’ve read some studies that have shown a reduction in sperm parameters in some men, typically reversible. This one is probably best https://academic.oup.com/jcem/article/92/5/1659/2598215 , it states that;

” Some individuals (approximately 5% of the subjects on active treatment) demonstrated greater sensitivity to the effects of 5?-reductase inhibition, with decreases in total sperm count to less than 10% of their baseline values during treatment. “

and

“Partial to nearly complete recovery was observed during the follow-up period for total sperm count and semen volume. Of particular note, approximately 5% of individuals on active treatment showed dramatic declines in total sperm count during treatment, although they demonstrated recovery in the follow-up period. The overall impact of these findings on fertility is currently unknown. “

But even that doesn’t tell the whole story. In particular sperm can be visually (by microscope) OK but have damage to the DNA “fragmentation” that causes the cell the either self-destruct “apoptosis” (although I would think this happens early in spermatogenesis), lead to a miscarriages as the human body effectively aborts a fetus with problems, or result in a child carrying/with a mutation. The sperm (or mother through mechanisms I don’t understand well) can sometimes fix the fragmented DNA. I believe this fixing ability deteriorates with age.

DNA fragmentation is associated with older fathers and I believe is why they are associated with offspring with disorders like autism, Down syndrome, and schizophrenia. A high rate of DNA fragmentation is associated with overall difficulty in conceiving and there are at least a couple of case studies of men who discontinued finasteride and had fragmentation levels improve dramatically.

(Articles below)

So, my opinion is that finasteride might effect fertility and this effect is likely reversible. I do feel however that there is a real risk. If I’m one of the 5% with a huge drop in fertility and I take the drug for I dunno 10 years, maybe it’s not so reversible, or some of the less detectable factors don’t fully reverse. It seems odd to me that fertility isn’t a bigger concern with this drug when prescribed to young men.

https://link.springer.com/article/10.1007%2Fs11255-012-0315-9

Herein, we present an unusual case of secondary infertility after prolonged use of low-dose finasteride for androgenetic alopecia in a 40-year-old man. We detected sperm DNA damage in the patient. Despite such a long-term use, we observed that impairment in semen parameters and sperm DNA fragmentation index regressed after the drug was discontinued. Consequently, pregnancy occurred and resulted in live birth.

https://www.ncbi.nlm.nih.gov/pubmed/21292254

To report a case of low-dose finasteride-induced secondary infertility with associated elevated sperm DNA fragmentation index (DFI) and otherwise normal semen parameters.

Case report.

University hospital.

A 48-year-old man on low-dose finasteride and his 37-year-old wife with normal menses and normal gynecologic exam.

Determination of sperm DFI and discontinuation of low-dose finasteride.

Sperm DFI.

The sperm DFI done a year earlier was 30%. This value was unchanged when repeated 2 months later. The patient was advised to stop finasteride. Three months after discontinuing the finasteride, the DFI decreased to 21% and subsequent DFI after another 3 months improved to 16.5%. To date, there is still no documented full-term pregnancy or live birth.

The significant reduction in DFI within 3 months of finasteride cessation and continued improvement suggests a causal link between finasteride and sperm DNA damage. We hypothesize that low-dose finasteride may exert a negative influence on sperm DNA integrity, resulting in increased pregnancy losses. We suggest that in infertile men using finasteride, sperm DFI should be measured in addition to semen parameters, and a trial of discontinuation of finasteride may be warranted.

Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

ive been on Fin for a couple months with great regrowth. 1 month ago i started noticing some scalp inflammation, and it got really bad last week. Although i couldnt see alot of hairshedding, some parts of my hair took a big hit, and thinned out really fast. Anyone know how long it will take to regrow after ive adressed the inflammation?

See your doctor. This is important to understand and get the right advice.

I am a cosmetologist and have been so for over 25 years. I’ve been doing extensive research on hair loss for several years. Recently I’ve been experiencing hair loss myself. I have rosacea, the kind that results in acne like bumps. It creeps into my scalp also. After finding out that I have an inflammatory condition found in my lungs, it’s all starting to make sense. My pulmonologist is drawing lines connecting imflamation in my skin and scalp to this. Many people who have acne or other inflammatory conditions also experience hair loss. This is believed to stem from inflammation brought in by either infection, autoimmune disease or allergic response. I have rosacea and hairloss. I’ve not taken any oral antibiotic for this although it has been prescribed (minocyline) . This drug is used to treat inflammation, not so much as an antibiotic. I’ve used metrocream on my face with no great results. My dermatologist switched me to soolantra andnit and is working wonders on my breakouts and redness. She says this cream works to fight against the allergic response to skin mites. So interesting that the inflammation is due to an allergy. It’s probably also in my scalp too. If you have an inflammatory skin condition you most likely also have the same in your scalp. Because the cycle of the hair growth and shedding, you might be experiencing the loss a while after the inflammation began at least 6 months or so. I’m curious how many of you have experienced other inflammatory problems like IBD, joint pain, high blood pressure.

Thank you for writing. There has been microscopic evidence that some inflammatory process is present in female hair loss. We also have seen many autoimmune conditions such as FFA, LLP, Alopecia aerata, etc. that are known inflammatory autoimmune diseases that attack the hair. I would not be surprised that the presence of other inflammatory conditions could overlap to the hair follicles. Unfortunately, our clinical science is not there yet.