Category: Hair Transplantation

Hi Dr. Rassman,

I regret to inform you that after recently undergoing a v. successful hair transplant I was prescribed 1.25 mg of finasteride every Mon, Wed and Fri. This is all good news but the bad news is that when I got to my laptop I got on the internet and started researching the drug and found the scaremonger sites about permanent side effects. Although I’m skeptical and like you believe more in scientific research plus I am impressed at your responses to people who ask about the drug, it has still planted a seed in my head. I’m going to make a decision on whether to take the ‘risk’ soon but first have some questions that I cant find the answers to.

1. Does ANY reduction of DHT i.e. any amount (1.25mg every other day-5mg daily) of a suppressant like finasteride result in a shrinkage of the prostate? Or is it possible to suppress the hormone enough to slow hair loss but not interfere with the prostate?

2. I took Avodart 0.5mg for a year and got slight ED. I was prescribed it for hair loss in the UK which I’m sure is not ethical. I stopped taking it but that was about 2 years ago, I’m 25 now and as finasteride is weaker is it logical to assume that the sides if I get them may not be as bad even though I’m older and my neuro endocrinal system and gonadal system (I think that’s right) could be at a different stage to when I was 22?

3. If you have looked at some of the YouTube videos and forums for the men who claim to have permanent side effects from the drug, although you haven’t seen their medical records or examined them and I know you are professional in that you don’t like to jump to conclusions, if you made an educated guess what would you assume has done this if it isn’t the drug?

I know that the decision is mine to take, but I am worried about the stuff I have read. I feel that your answers to these questions could help me make my decision. Thank you

I am curious about your research on the Internet. As you found your “scaremonger” sites on finasteride, have you researched the “scaremonger” sites on hair transplants? Because you will find many and it will be a double whammy for you since hair transplants are permanent (side effect from finasteride are not).

To answer your questions:

1. Finasteride in 5mg is used for certain prostate conditions. Finasteride in 1mg or 1.25mg should have little or no impact on prostate health, but the inferences are there.

2. Avodart (dutasteride is the generic name) works in a similar way as Propecia (finasteride is the generic name) by blocking DHT production. Side effects from dutasteride and finasteride are similar, but with dutasteride being a stronger medication, it’s difficult to suggest you wouldn’t experience any side effects from finasteride. No matter how similar they are still different.

3. I have seen some of the YouTube videos, but you highlighted what many of these videos tend to be with a single word: “scaremonger”. I can’t begin to hypothesize what those people are going through, but there is clearly an agenda. They do not like finasteride. That doesn’t mean finasteride is the cause of their problems, but some people simply aren’t willing to look past that to see if there is something else going on.

You decision should be made with your doctor (not me).

Hi Doctor Rassman, first let me start off by thanking you for running the balding blog the way you do. Its the only real source for hair loss questions/answers that I trust in terms of reliability and i would be lost without it.

I am a 23 year old male who noticed a bit of a “wider part” and “larger cowlick” around 2 years ago. I’d wager I’ve thinned a bit since then, but i still have full coverage with no pure bald spots, thinning primarily noticable in the crown region. I took propecia for 8 months and then, like an idiot quit the medication out of fear it was doing nothing and i was throwing money away. approx. 4 months later I realized the thinning sped up so now I am taking the medicine again. I don’t really trust my prescribing doctor’s knowledge…he recommended using the laser comb and rogaine before I attempted propecia but I was persistent.

my questions:
1. Who can map my hair for miniaturization in my surrounding area?
2. assuming I will end up a norwood 6(like my father)what type of coverage could a transplant offer me if we assumed I had average scalp laxticity and average hair density?
3. Do you believe there will be breakthroughs in the next decade that will prevent most of my generation from being forced to live their lives as bald men?

Thanks again for this site

We have written in the past about the LaserComb — basically, we don’t feel it works for treating hair loss. Rogaine, however, is an option if you are persistent enough to apply it twice a day, everyday. In my opinion, most men are horrible at keeping to a regimen and it is a factor you must consider when starting any daily routine like this.

Thank you for sharing your experience on Propecia. It seems that you experienced “catch up” hair loss after stopping the medication. While you will not gain what you lost, restarting the medication was probably a good idea.

Now to answer your questions —

1. On the east coast, I would trust Dr. Bernstein in New York. He was with New Hair Institute until he branched off to start his own clinic and he’ll be able to map your scalp for miniaturization.
2. Coverage really depends on your hair character + hair/skin color contrast. If you’ve got black hair, white skin, and a very fine hair character… you won’t have good coverage. If you’ve got thick blonde wavy hair, you’ll have better luck.
3. Certainly there is work being done and there is a huge market for it, but what you’re asking about is essentially a cure for hair loss. While I do hope something happens within the next decade, I really have no way of knowing if the current work being done is the answer we’re all looking for. Keep your fingers crossed, but your expectations realistic.