This is an interesting twist from what I normally have read. The article in a very prestigious journal, analyzes the connects between 5-alpha reductase inhibitors to possible benefits on psychosis

https://www.nature.com/articles/npp200839

My Grandmother told me that in Sicily where she grew up it’s widely held that artichokes cause hair loss. I’m not sure what to make of this. Any thoughts?

There is no connection between artichokes and hair loss that I know of. Sometimes I laugh at myself as I put in some quick research to be sure that there are no connections between hair loss and the variables presented to me on this blog time after time. Every once in a while, I am surprised that I actually find an informative connection that makes me wiser and more humble.

Objective: The effects on scalp and serum dihydrotestosterone (DHT) of different doses of a novel topical solution of 0.25% finasteride (P-3074), a type 2 5?-reductase, were investigated in men with androgenetic alopecia. Methods: Two randomized, parallel-group studies were conducted. Study I: 18 men received 1 mL (2.275 mg) P-3074, applied to the scalp once a day (o.d.) or twice a day (b.i.d), or 1 mg oral tablet o.d. for 1 week. Study II: 32 men received P-3074 at the dose of 100 (0.2275 mg), 200 (0.455 mg), 300 (0.6285 mg), or 400 (0.91 mg) ?L or the vehicle o.d. for 1 week. Scalp and serum DHT and serum testosterone were evaluated at baseline and treatment end. Results: Change from baseline in scalp DHT was -70% for P-3074 o.d. and approx. -50% for P-3074 b.i.d. and the tablet. Serum DHT decreased by 60 – 70%. The doses of 100 and 200 ?L P-3074 resulted in a -47/-52% scalp DHT reduction, similar to the 300 and 400 ?L doses (i.e., -37/-54%). A -5.6% inhibition was observed for the vehicle. Serum DHT was reduced by only -24/-26% with 100 and 200 ?L P-3074 and by -44/-48% with 300 and 400 ?L P-3074. No relevant changes occurred for serum testosterone. Conclusions: The novel finasteride 0.25% solution applied o.d. at the doses of 100 and 200 ?L results in an appropriate inhibition of scalp DHT potentially minimizing the untoward sexual side-effects linked to a systemic DHT reduction.

This is an article I wrote that was published in the Hair Transplant Forum International (volume 19, number 5), the official publication of the ISHRS. I’ve become more and more outspoken about the problem with ethics among some hair transplant doctors, and have written a number of posts about it on this site. I was pleasantly surprised that the ISHRS made my article the lead story on the front page. Here is the text of the article as I originally sent it to them:

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I am disturbed that there is a rise in unethical practices in the hair transplant community. Although many of these practices have been around amongst a small handful of physicians, the recent recession has clearly increased their numbers. Each of us can see evidence of these practices as patients come into our offices and tell us about their experiences. When a patient comes to me and is clearly the victim of unethical behavior I can only react by telling the patient the truth about what my fellow physician has done to them. We have no obligation to protect those doctors in our ranks who practice unethically, so maybe the way we respond is to become a patient advocate, one on one, for each patient so victimized. The following reflects a list of the practices I find so abhorrent:

1. Selling hair transplants to patients who do not need it, just to make money. I have met with an increasing number of very young patients getting hair transplants for changes in the frontal hairline that reflect a maturing hairline, not balding. Also, performing surgery on very young men (18-22) with early miniaturization is in my opinion outside the “Standard of Care”. Treating these young men with a course of approved medications for a full year should be the Standard of Care for all of us.
2. Selling and delivering more grafts than the patient needs. Doctors are tapping the well of the patient’s graft account by adding hundreds or thousands of grafts into areas of the scalp where the miniaturization is minimal and balding is not grossly evident. I have even seen patients that had grafts placed into areas of the scalp where there was no clinically significant miniaturization present. Can you imagine 3,000-4,000 grafts in an early Class 3 balding pattern? Unwise depletion of a patient’s finite donor hair goes on far more frequently than I can say.
3. Putting grafts into areas of normal hair under the guise of preventing hair loss. There are many patients who have balding in the family and watch their own “hair fall” thinking that most of their hair will eventually fall out. A few doctors prey on these patients and actually offer hair transplantation on a preventive basis. This is far more common in women who may not be as familiar with what causes baldness and do not have targeted support systems like this forum. They become more and more desperate over time and are willing to do “anything” to get hair. They are a set-up for physicians with predatory practice styles.
4. Pushing the number of grafts that are not within the skill set of surgeon and/or staff. The push to large megasessions and gigasessions are driven by a limited number of doctors who can safely perform these large sessions. Competitive forces in the marketplace make doctors feel that they must offer the large sessions, even if they can not do them effectively. A small set of doctors promote large sessions of hair transplants, but really do not deliver them, fraudulently collecting fees for services not received by the patient. Fraud is a criminal offense and when we see these patients in consultation, I ask you to consider your obligation under our oaths and our respective state medical board license agencies to report these doctors.
5. Some doctors are coloring the truth with regard to their results, using inflated graft counts, misleading photos, or inaccurate balding classifications. False representation occurs not only to patients while the doctor is selling his skills, but also to professionals in the field when the doctor presents his results. Rigging patient results and testimonials are not uncommon. Lifestyle Lift, a cosmetic surgery company settled a claim by the State of New York over its attempts to produce positive consumer reviews publishing statements on Web sites faking the voices of satisfied customers. Employee of this company reportedly produced substantial content for the web.

The hair transplant physician community has developed wonderful technology that could never have been imagined 20 years ago. The results of modern hair transplantation have produced many satisfied patients and the connection between what we represent to our patient and what we can realistically do is impressive today. Unfortunately, a small handful of physicians have developed predatory behavior that is negatively impacting all of us and each of us sees this almost daily in our practices. Writing an opinion piece like this is not a pleasant process, but what I have said here needs to be said. According to the American Medical Association Opinion 9.031- “Physicians have an ethical obligation to report impaired, incompetent, and/or unethical colleagues in accordance with the legal requirements in each state…”

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Download the article as it was published in the Forum magazine, which includes quotes from other doctors (PDF file)!

Has there been any definitive studies done on which genes have an effect on post-finasteride syndrome (side effects that persist after discontinuation of Fin)? ARTICLE: https://www.smoa.jsexmed.org/article/S2050-1161(16)30075-7/abstract

Very interesting. I just read the full article and I will quote the last of the result analysis and the conclusion of the article. My interpretation suggests that the ability to detect men who might get PFS is not understood by any of the genetic findings of this report; however, there are some influences of symptoms reported by men who take finasteride as summarized below:

” A general limitation of this study work is that some symptoms reported by patients with PFS could not be objectively determined. Furthermore, the retrospective design of our study did not allow a clinical assessment of these men before finasteride use. Future studies are necessary to assess the AR genetic profile and testosterone levels in subjects who developed PFS compared with subjects who did not develop adverse symptoms after using finasteride against AGA. CONCLUSION Causes and predisposing factors responsible for the development of long-term adverse side effects in young men who used low-dose finasteride against AGA remain an enigma. Several symptoms were in common in more than 70% of patients with PFS, but a plethora of other disturbances was reported by a minority of patients, with some clearly related and some not to androgenicity. Our study showed that the length of two trinucleotide repeats in the AR gene contribute to the frequency of some specific symptoms reported by patients with PFS. The (CAG)n and (GGN)n polymorphisms were involved in two specific symptoms (ie, scrotal discomfort and increased skin dryness); for other symptoms, only one of the two polymorphisms was involved, which is likely a reflection of the complex modulation of AR activity.16,40 Our investigation using a precision medicine approach suggested genetic implications in symptoms of patients with PFS. Much more genetic and non-genetic research is necessary to elucidate the pathophysiologic pathways leading to the onset and persistence of adverse effects in former finasteride users.”

https://www.hopkinsmedicine.org/brady-urology-institute/specialties/conditions-and-treatments/prostate-cancer/prostate-cancer-questions/finasteride-are-the-risks-worth-it

This article certainly put the notion that finasteride may prevent prostate cancer into question. Worth reading from a famous medical institution.

The authors show that the blood flow in the scalp with less hair is less than with more hair. This is because the hair requires a great deal of blood because it has a high metabolic rate. The body pumps blood to the scalp to meet the need to support the high metabolic hair organ system. The reduced blood flow, long held as the cause of hair loss, has never been proven. This is an issue of cause and effect, less hair produces less blood supply not the other way around.

Subcutaneous blood flow in early male pattern baldness