Author: Dr. William Rassman

So somebody who continues to take finasteride and does not stop like in the example you gave, it will often continue to provide it’s benefits in retaining hair and won’t necessarily lose its effectiveness?

Correct; however, hair has its own agenda with genetic codes for Apoptosis (cell hair suicide) which is delayed by finasteride but not always a guarantee that each hair may take its own course. Generally, finasteride slows this process down for the time you take the drug. I have had patients on finasteride for 25 years. When they stopped it along the 25-year history, they always lost hair. This tells me that finasteride works if you take it for anyone losing hair.

I’m a 19 year old male who started Finasteride in January 1 because I had a receding hairline. In the past four months or so, my hairline has significantly receded and is becoming really noticeable, particularly around my temples. I thought I’d be able to maintain and hopefully regrow a little given that I’m young, but it seems to have had the opposite effect. Is this a shed? Is there a chance Finasteride is making my balding faster? How long should I wait to see the full effects of finasteride? Reading on websites is hard because most articles are written by companies that either sell Fin or say fin doesn’t work because they offer hair transplants.

You should stick to the finasteride and any shedding phase will pass. Finasteride may not slow down the recessions as sometimes, especially in a maturing hairline, finasteride will not work. Transplants are out of the question at your age. See a an expert like me who will tell you want is going on. See here: https://baldingblog.com/haircheck-test-how-it-is-done-video/

This is an excerpt from the FDA website from 2010 on finasteride (https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788s018lbl.pdf). Dr. Ed Epstein, from the Bosley Medical Group is a urologist by training and has kept up on the latest information on the impact or lack of impact of the drug finasteride on risks for an unborn fetus. “I am not aware of new studies on amounts of finasteride in semen or vaginal absorption data” that reflect increased risks for fetal abnormalities induced by finasteride other than what is written in the FDA white paper referenced above.

Some doctors are concerned that patients who go on finasteride should get semen analysis to keep track of semen levels in case these level dropped while a patient was on the drug finasteride. Dr. Epstein said: “Concerning getting semen analysis on child bearing age men starting finasteride, I totally disagree. Typically a male infertility workup is suggested after one year of unprotected intercourse. The subgroup of men who have low sperm counts on finasteride are those with preexisting conditions and appear to respond to discontinuation of finasteride.”

In other words, he feels that a young man should not worry about either low semen counts caused by finasteride, but that they could always stop the drug and if there was a causal relationship, it would reverse. He also suggested than men with low sperm counts while on finasteride, probably had it before they started the drug and should get any low sperm count evaluated by an expert.
The FDA while paper referenced above showed that studies on semen in sperm were either not present or when present were so low as it not cause a risk to a pregnant woman or a woman who is expecting to become pregnant. “Semen levels have been measured in 35 men taking finasteride 1 mg/day for 6 weeks. In 60% (21 of 35) of the samples, finasteride levels were undetectable (<0.2 ng/mL). The mean finasteride level was 0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using the highest semen level measured and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal absorption would be up to 7.6 ng per day, which is 750 times lower than the exposure from the no-effect dose for developmental abnormalities in Rhesus monkeys and 650-fold less than the dose of finasteride (5 ?g) that had no effect on circulating DHT levels in men”

I am 33 years old and I have been on Finasteride since 2006 (I took a 10 month break in 2009) and have had great success. In the last 10 months, I have been losing ground though. My hair has started thinning a lot as the result of two massive sheds. I was wondering how you go about assessing whether an increase in dose is appropriate when Finasteride starts to lose effectiveness? I have also been looking at Rogaine foam as an option — but as I am constantly traveling for work, pills are much easier to fit into my routine.

You can try to increase the Finasteride dose and see if that helps. I tend to view the use of Finasateride as a tug of war – the genes and the stressors on your life pulling on one side, and the drug Finasteride pulling on the other side. Maybe an increase in Finasteride dose will weigh more on the pulling against the genes and stress side.

This 23 year old male had taken finasteride and minoxidil for 4 months. This is a remarkable benefit in just 4 months; however, the hair length is clearly longer in the photo on the right.

Finasteride, minoxidil and dermaroller in 4 months but some of the benefits shown in the photo are related to hair growth.

It is my best interest to continue with finasteride, Rogaine and microneedling however, I’m a bit concerned as to whether fin is losing efficiency or so. I am wanting to get a hair transplant in the nearby future. It is my intention to have the FUE procedure and have SMP to add to the density once the results had healed.

On average how long do you think hair must’ve gone if Fin even has a chance of regrowing? Like would it only have the possibility of regrowing hair lost in the few months before starting Fin or could it also grow areas that have had minituarized/bald areas for 2 years?

Finasteride in some people reverses miniaturization. It can take up to a year to see the value