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In a recent issue of the Hair Transplant Forum, Dr. Jeff Donovan reported a review of the literature which showed that “Levels of total cholesterol, triglycerides, LDL cholesterol, and HDL levels were compared between those with AGA (genetic hair loss) and controls. Results showed that total cholesterol, TG, and LDL levels were significantly higher in individuals with AGA and HDL levels were lower.”

We have known for some time that men with AGA seem to have more heart disease than other men without genetic hair loss. It was particularly notable with men who had crown balding had more heart disease than the comparable genetic balding peers. In April 2012, baldingblog reported that heart disease was 32% higher in men with genetic balding (https://baldingblog.com/2013/04/08/in-the-news-balding-men-32-more-likely-to-have-coronary-heart-disease/).

My advise to balding men, particularly for those reading this on baldingblog.com, is that for those of you over 40 years of age and every five years thereafter, you should get a coronary artery scan for calcium (it is a CAT scan) which picks up early coronary aging. For 70% of men, the first symptom of heart disease is death, so take this advice and put it into your overall preventive health picture as you will never know that you had heart disease when you drop dead. All of my friends and family over the age of 40 have had this test at my insistence, including myself. What I learned about myself, will save my life and hopefully allow me to match my grandfather’s age, when he died, at 102.

Hair loss following a hairline lowering procedure, like any facial plastic surgery is a known risk. Many times, in men who get a hairline advancement surgery, it does not come back. If you lost hair at the advancement edge, the scar will have to be covered with a hair transplant. Usually women lose hair in the corners of their hairline and this is almost always permanent so a hair transplant will also address this as well. Hair loss elsewhere may reflect a dermatologic problem which should be diagnosed if you have one. The diseases such as FFA, LLP and other types of scarring alopecias need to be ruled out in the evaluation of your problem

Hello Doc, I’m 26 and taking minoxidil twice a day, finasteride, and doing microneedling twice a day. I take other medications as well. I will not quit medication because of the hair loss that I could get. Could you kindly tell from your point of view. What could be the reason of such an extremely fast diffuse thinning. I have developed a great deal of reversal from my Norwood Class 6 pattern of extreme thinning. Many of the hairs got thicker and new hairs grew out. Could the new regrowth cause the hair to thicken in next cycle? I know that is 6 months progress but maybe your experience give me more hope 🙂 Number of new hairs is quite big but they do not cover scalp completely. Is the diameter of each hair a key to success ? What can i expect ? Should I change finasteride to dutasteride or fin will be sufficient?

I saw your photos on a previous post on reddit and you indeed did partly reverse extensive thinning of the Norwood Class 6 pattern of balding showing before you started treating it. You asked a complex question. Hair growth (Anagen) seems to be induced by wound healing (microneedling) in early balding or thinning but without constant stimulus, I believe that these hairs are eventually doomed. I believe that ingrained in each hair is a biologic clock that dictates the number of hair cycles a hair has when exposed to DHT. This can be altered with drugs and certainly its environment (hormones). Estrogens, for example, when present in significant concentrations without large amounts of testosterone (most females), seem to dictate a different number of hair cycles (women don’t develop Male Patterned Balding). This is just one example. As many of the readers know, I am working with a major university on a solution that might maintain anagen (hair growth) keeping it in its normal cycle, and possibly re-induce the anagen cycle again to the same hair when it goes through telogen. In a male, a normal hair cycle might be 2 – 3 years, so it will take time for us to know. Until we try it in humans, I can’t comment further. We intend to use this discovery in a clinical trial sometime this year and from it, a new treatment for hair loss may arise.

https://www.theatlantic.com/health/archive/2019/07/hair-for-all/594826/?utm_medium=offsite&utm_source=yahoo&utm_campaign=yahoo-non-hosted&yptr=yahoo

All I can say is “Don’t hold your breadth!”

A new meta-study finds the following:

“Of 34 clinical trials, none had adequate safety reporting, 19 were partially adequate, 12 were inadequate, and 3 reported no adverse events. Funnel plots were asymmetric with a bias toward lower odds ratio for sexual adverse effects, suggesting systematic under detection…”

From Wiki definition: A meta-analysis comprises statistical methods for contrasting and combining results from different studies in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.[1] Meta-analysis can be thought of as “conducting research about previous research.”

The report is interesting but a Meta Analysis is only as good as the clinical trials it is analyzing. All studies have its advantages and pitfalls. If adverse or sexual side effects were being examined, I question why other (much larger and comprehensive clinical trials) of finasteride 5mg was excluded.

Dr. Rassman,
Thank you for providing this informative blog.

I have a question, I have been taking Propecia for 8 years now. But in just the last 3 months I lost hair noticeably in the entire area from the mid section to the front hairline. I think this is the result of stress, lack of proper sleep and not using Minoxidil since the beginning of the year. Can I “hope” that if I start Minoxidil 5% (I had used 2% for over 12 years), reduce stress and get more sleep, I may see some of that hair back? My experience so far is that once I lose hair, it’s gone, I just try to keep what is there.

I’m 48, male, and have had 5 transplant procedures over the last 14 years.

Thank you!

There’s no clear cause for the rapid hair loss you’ve seen in the last 3 months. Since you have had multiple hair transplant surgeries, perhaps you should follow up with your transplant doctor and get a good examination.

The hair loss could be stress related, but it can be anything. You can try getting your stress under control to see if that helps slow the loss down, but I cannot provide more input from such limited description.

This is an important article because it explains why I probably have never seen a case of post-finasteride syndrome in the thousands of patients who were prescribed the drug by me over the past 2 decades. When someone complains of ED, I either reduce the dose until the symptoms go away, or discontinue the drug. According to this article, it takes years on the drug to get PFS. Since I am responsive to recommending withdrawal of the drug, the incidence in my practice is non-existent. The article itself has limitations in its methodology and as a definitive statement about the existence of post-finasteride syndrome or a disclosure of the risks, so it must be taken with a grain of salt.

https://www.ncbi.nlm.nih.gov/m/pubmed/28289563/