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https://pubmed.ncbi.nlm.nih.gov/10495374/

https://pubmed.ncbi.nlm.nih.gov/26636418/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969473/

All three of these research papers discuss the impact on scalp and systemic DHT. Dutasteride reported a low incidence of sexual side effects 1.7% but although this number is thought to be low, if you subtract the placebo group from the sexual side effects group on finasteride it comes out about 2%.

Just wanted to ask you a question about dosage. Most drugs become more effective when the dosage is increased. I assume that’s why doctors start their patients off at a small dose and increase it if the patient isn’t responding to treatment.

However, I believe you’ve mentioned that increasing the dose of finisteride wouldn’t give better results. Wouldn’t that statement contradict the fact the as dose increases so does effectiveness? For example 5& minoxidil is more effective than 2%. So it would follow that a 5mg dose per day of finisteride would give better results than a 1mg dose.
Please correct me if I’m wrong.

Drugs are not always more effective with increase in dose. So your presumption is wrong. There may be a maximum effective dose and anything above that is a risk for unwanted side effects.

Propecia is finasteride in 1mg strength. It has been determined by studies that 1mg is just as effective as 5mg. Taking more will not improve its efficacy on treating androgenic alopecia. Increasing the dose will likely cause more side effects.

 

The hairline advancement surgery is limited by the tightness of your scalp and usually an inch is the limit for most people; however, a hairline lowering hair transplant does not have that limitation (see here: https://newhair.com/female-hairline-lowering/). Also, note that the corners in many of these women were receded, and when this happens, a hairline advancement surgery can’t address this like a hair transplant lowering surgery.

Hello from France Doctor. Firstly, I’d like to tell you that I appreciate your work ethic. I’ve been studying many topics since I start about AGA, hair transplant, medication etc, focusing on studies, facts, expertise and science, since I started suspecting a beginning of thinning. Your work was a great help and always a pleasure to read. I have a few questions mostly about medication, but here is my case. I’ve been diagnosed with aga today -what I suspected 4 month ago. It’s barely noticeable since I have very long hair (10 inches) and it’s the beginning, but I suspected it because I always paid a huge attention to my hair. There is : a 0.2 inch recession on temples, and subtle thinning / density loss on the top, especially on the mid scalp and following the hair-parting.

I plan to use the Liposomal Finasteride gel from Parati, already have a prescription after asking it from my doctor. I’ve read that you were also prescribing it to your patient. The doctor I consulted was really “expeditive” and unfortunately not really open to the dialogue. Here are the questions :

** – What would be the most efficient concentration for the gel ? ** I was about to order it at 0,1% because 1mL means 1mg, but i’ve also read some case using it at 1% or even 2,5%. I’m lost about this point since i will apply it all on the top and not only on a small zone, so quantity and concentration are important.

** – What is your opinion about the systemic absorption ? ** I know the liposomal formulation is made to avoid it as much as possible, I’ve read the absorption is “18 times less than oral finasteride” but I’m curious about precise serum/scalp DHT reduction. I couldn’t find studies about the liposomal formulation, only about that “P-3074” solution which uses a different vehicle.

– What is your opinion on the efficiency time of that gel ? Could it be efficient “forever”, considering its power on scalp DHT ? Can we count on it for like 10 years or more, like many oral finasteride user ? Would it be different for a diffuse pattern user ?

This is a lot of question, excuse me if it bothers you. I plan to do the things right, and will testify my case and experience with the gel in a few months.

Thanks a lot Doctor, and take care of you.

I generally recommend 0.1% Liposomal topical finasteride. In the past year, I have had two out of about 100 patient develop sexual side effects. If the gel works for you, you must stay on it for life otherwise you will lose all of the gains plus what you would have lost had you not taken it.

Back when I had hair girls used to flirt with me and tell me how good looking I was. Now women see the bald head and don’t give me a second glance. It’s as if their minds are seeing my head and picturing their children with me coming out bald with a Norwood 6. Before I didn’t have to say more than 3 words to get a woman interested in me, but it takes so much effort now.

Society has always discriminated against men with balding. It goes back over 2000 years when tuberculosis was running rampant producing balding men because they were sickly. That set up a connection between balding on one side with a sickly man, and a healthy vibrant hairy man on the other side. So the norm has been propelled for centuries and it is somehow ingrained in our culture. Men wore wigs or hats to hide their balding so women wouldn’t be able to tell. Met wore top hats in the late 1800 and early 1900s. Today we wear baseball caps. We are still victims of this culturally, unfortunately.

We received a lot of emails about last week’s post — I’m Suicidal Over Losing My Hair at 18 Years Old! — and I wanted to share this one with the rest of the community.

Dr. Rassman,

I read this blog regularly and when I read your post yesterday about a young man dealing with suicidal thoughts, I had to write in.

Young people out there need to understand that they have options but doing something drastic (like a transplant at 18) years old or worse (harming yourself) only eliminates options. I came to your office last year young, scared and anxious about hair loss myself. I was convinced that things were only going to get worse, but a year ago there wasn’t a hair bulk analyzer or A Cell. Imagine, just a year later and suddenly I am hearing about all these innovations. Maybe I overreacted?

It is amazing what happens when you take a deep breathe, research your options and gain a little perspective. I was given great advice by the doctors at NHI and they were words I needed to hear. Hair loss still bugs me but I now have every option open to me because I did not jump into a rash decision and young guys (I am 25 and empathize with you) need to understand that, just because you are not happy with what the mirror is showing, it doesn’t mean you can’t be happy ever again.

This is not the end of the world. Balding doesn’t rob you of your vision, your hearing or your overall health. This young man still has eyes to see the world, ears to listen to wonderful music and a capable body that can laugh, love and live. Getting a quality doctor to help you deal with your problem will keep you from being a slave to your hair and will help you get on with living.

While most of the emails (and comments) had positive messages of support, I felt the above email perfectly expresses what many compassionate people relate to. Thank you for writing.

The evidence I’ve compiled indicates that Donald Trump exhibits a Norwood Class 5-7 balding pattern (the Class 7 pattern is depicted below). It appears that he underwent multiple surgeries, leading to the relocation of much of his remaining hair to conceal the frontal and top areas, albeit with limited success. Since Propecia was not available when he underwent scalp reduction surgery in the early 1990s, most men undergoing such procedures or hair transplants before 1997, when Propecia first came to the US market, experienced accelerated hair loss progression. Unfortunately for Mr. Trump, this would likely result in the development of an advanced pattern, such as the Class 7 pattern illustrated in the following graphic.
“New York City-based cosmetic surgeon Gary Linkov believes that the politician may have undergone five separate hair-transplant surgeries” (https://www.newsweek.com/donald-trump-five-hair-transplants-gary-linkov-1832991). I know that Donald Trump received Scalp Reduction Surgery sometime in the early 1990s when this barbaric surgery was a standard treatment for hair loss found in the top and crown of the head. I know its barbaric nature because I had three of these procedures over 90 days. By its very nature, Scalp Reduction Surgery attempts to surgically remove the bald area, stretching and thinning the donor area (the rim of hair around the head). Add to that the claim by Dr. Linkov that he believes that Trump had 5 hair transplant surgeries, likely in 1990 (before FUE was invented), suggests that most of his residual native hair (that should reflect a rim of thick hair going around the back and sides of the head) was moved into the balding area, thereby depleting his natural rim of hair from his balding pattern.

Photos of Trump boarding Air Force One reveal that the back of his head doesn’t seem to have much hair, suggesting minimal hair in that area where he should have had a strong rim of hair 3 inches high. Additionally, recent footage this week shows exposure of his frontal hairline, a characteristic often associated with wigs (hair systems). It’s common for such hair systems to be secured using glues, weaves, and hair clips. Considering the cumulative evidence of (1) the lack of hair at the back, (2) the exposed scalp in the front as what appears to be the lifting of his hair system from environmental factors like wind, and (3) the use of clips behind the ears used to secure a hair system in place, (4) the effect of multiple hair transplants on a Class 5-7 patterned balding man’s rim of hair, and the difference in color of the side hair (gray) from the top hair (blonde), it’s reasonable to conclude that Mr. Trump likely uses an expensive hair system. This system may involve gluing it to his scalp, weaving it with residual native hair, and using hair clips to secure it on the sides, where most of his remaining hair is likely located. Such hair systems often require regular adjustments every 2-3 weeks to accommodate the growth of native hair and then reattaching them. The hair is synthetic or human hair used to make hair systems and is often fixed on a lace platform, which is then glued to the scalp. The effects of these ‘lace’ systems are very effective if you maintain them properly. I have seen him pull back his hair in front of a camera on a late-night TV program that looked completely normal, consistent with a lace hair system.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The above photo reference showing his frontal scalp, see here: https://www.msn.com/en-ca/news/politics/concerns-raised-for-trump-s-hair-after-it-is-seen-flapping-in-the-wind/ar-AA1nHveb?ocid=mailsignout&pc=U591&cvid=2dc0422ef6d34569b9baf6f70de0fac9&ei=32

 

Below are some other interesting posts on this subject: