Finasteride and Balding Problems

I have been taking finasteride for 10 years now, and I have been slowly losing my hair since, though at a much slower rate. I was wondering, will I eventually become slick bald in a class six pattern if that’s what my genetic fate is, even if I continue to take the medication? Does hair have to miniaturize to the point of completely not being visible anymore, or is it possible for the process to stop in an intermediate stage of miniaturization?

Look at the miniaturization pattern and try to predict your hair loss. Or, better yet, see a doctor like me with specialization in hair loss who might be able to answer your questions after a detailed examination of your scalp. Hair does not have to miniaturize for balding to occur, and most patterns can be predicted after a man is 26 years old.


2018-06-21 06:12:01Finasteride and Balding Problems

Speed of Hair Loss

Once miniturization of the hair begins, how long does it take until a person notices his hair is even slightly thinner ?I go back a year ago and it was still good and today less dense. A year seems pretty fast, but doesn’t it take longer?

The hair loss process varies with the individual and his/her genetics. There are no rules here. Some people take a long time to lose the hair while others can lose it in a year or two.


2008-08-11 14:13:08Speed of Hair Loss

Does Finasteride ever lost its ‘effectiveness’ after a while?

From a practical point of view, yes it does lose effectiveness as the genetic balding process advances beyond what finasteride can help. This often takes time, but even though it may lose effectiveness, it still has value and if you should stop it, you will see that you may undergo significant loss, not only what you gained, but what you would have lost had you never taken the drug.


2018-05-20 13:40:45Does Finasteride ever lost its ‘effectiveness’ after a while?

Standard of Care Consultation for Hair Transplantation

I just had my consultation at your office last week. I want to congratulate you with a professional way of managing your practice.

This blog entry is a little lengthy, but it is important to retell this man’s tale as he told it to me. For the purposes of privacy, I’ll refer to him as Joe.

Joe had received three opinions from different doctors over the past few months. The one with me was the last of the consultations. After receiving the nice note from him, I asked him for a competitive analysis. Joe had planned to get multiple opinions over a three month period and he had already attended one of our open house events prior to seeing me privately.

He had some comments about our practice, some of which were not flattering. He criticized the quality of our video as tired and out of date (it is 14 years old) and our brochure was not nearly as fancy as the ones that he had seen elsewhere. He might not have been aggressive at pursuing us if it were not for the generally less than professional presentation of the other two practices. With the two previous groups he had met, both were front-ended with a professional salesman who went through well-scripted processes, each recommending what the salesmen thought Joe might need to address his balding problem. Both of these groups applied considerable pressure to get him to schedule a hair transplant. At one of the two clinics, the doctor came into the office, but spent very little time with him, only confirming what the salesman told Joe about his needs. When he left each of the two previous groups, he was somewhat impressed, but skeptical of their sales process. Later, he did some internet research and found considerable legal problems with one of the groups and many generally negative comments on internet chats. Both groups were eventually crossed off his list.

Our office was his third stop. He came by an open house event and met with many patients that had been through the same thing he was now facing. Three patients came in without notice and they showed results that he felt were normal looking. He was impressed with the openness of the patients attending the open house. He met two patients with the exact balding pattern that he had, both in their 40s and they had Joe’s hair and skin color as well.

Joe went into the operating room and talked to the outgoing fellow who was having the hair transplant that day. When we eventually met, he was impressed that I had committed a full hour to the interview. The night of the consultation he went to the internet and found that every claim that NHI had made on its website (reflecting their authority as a pioneer in the field) was easily validated. This was quite different than the claims made by the other groups which he felt were over-hyped in their representations. The very next day, he got an email from me with what he said “was an amazing and thorough summary” of the conversation we had on his visit the day before. I had included a full fee schedule for the quoted estimate of work. None of the other transplant office took the time to produce such a document, not even the doctor who performed surgery on his broken nose a few years ago.

I developed my hair restoration practice as I did when I practiced a more traditional ‘general surgery’. I’ve always believed that a medical practice should be classy and that means to me that the doctor should take every effort to provide what he would want to see if he or a member of his family were a patient — and that would include an honest, open communication. Unfortunately, too many medical groups who are now dominating the field of hair transplantation, have applied heavy sales tactics (which I believe is either immoral or unethical). The patient can easily become a victim if critical information is held back. As a case in point, throughout this blog, I discuss the need for assessments with mapping of the scalp hair for loss looking for miniaturization, and even with multiple articles written by me on this subject, the metrics in this field have not been incorporated into the standard of care. I would never transfuse a unit of blood without knowing the hemoglobin of a patient who was bleeding, nor would I use potentially toxic medications without understanding the working efficiency of the liver or kidneys, yet many hair transplant doctors seem to constantly offer extensive hair restoration surgery without measurements of the patients existing hair status or in giving the patient some help in predicting his future hair loss.

We need a standard of diagnosis for the consultation process and we need to exclude the salesmen who dominate the process and make recommendations that should be in the exclusive domain of the doctor. We need to incorporate such processes as mapping of the scalp for miniaturization, in order to give the patient a fighting chance in understanding what he is agreeing to when he undergoes a hair transplant. We need to provide educational material about what the patient may experience, including all of the risks (not sugar coated) associated with a transplant process. If we don’t do these things, then I will continue to speak out about our standard, hoping that the consumer will press those in this industry to discard shoddy sales tactics.

Finasteride Interactions?

Hi Dr.,

I am a big fan of your site. I get to read your new posts everyday by subscribing to your RSS feeds. My question is, given that I take 1 tablet of 1mg Propecia everyday, will it interact with other supplements or even certain food?

For example, here’s a list of supplements that I take daily (i take throughout the day, separate times):
1. vitamin b complex and biotin
2. vitamin c
3. vitamin e
4. multi vitamin
5. omega complex
6. co-q10
7. methatione (gluthatione)

Or how about foods:
1. coffee
2. green tea w/ honey
3. soy milk
4. fiber (like wheat bread, fruits)

Just wondering if trying to be health by consuming these will counteract w/ Propecia or vice-versa? Hope this is a valid inquiry.

I have been getting these sorts of questions quite frequently lately. The supplements and foods you’re consuming shouldn’t have any negative interaction with Propecia. The only interaction I can think of with food is with grapefruit, which causes problems for a variety of medications.

The following 16 drugs are listed as having a moderate interaction with finasteride (Propecia): bosentan, diltiazem, diltiazem/enalapril, efavirenz, efavirenz/emtricitabine/tenofovir, fluconazole, fluvoxamine, itraconazole, nefazodone, nelfinavir, posaconazole, rifapentine, saquinavir, sirolimus, tacrolimus, and voriconazole. And there’s 1 drug that has a mild interaction: terazosin. These are the generic names, and for a more complete list (including brand names) see Drugs.com.

Stem Cell Bank Now Open in UK

For those of us in the field of hair restoration, we have waited for the day when stems cells could be used to activate hair. In my previous post, I linked an article on Progenerator cells and their role in hair regeneration. With the opening of this Stem Cell Bank in the UK, the access to stem cell lines may accelerate the development of solutions for hair loss. Read here:

https://www.the-scientist.com/?articles.view/articleNo/49155/title/First-Clinic-Ready-Stem-Cell-Repository/&utm_campaign=NEWSLETTER_TS_The-Scientist-Daily_2016&utm_source=hs_email&utm_medium=email&utm_content=50176304&_hsenc=p2ANqtz-8s5kMWttlyETUROd55IBcDNPnyw5I3qwuBFwEb3FIExWjK-_fnAKMRXolTwLJSwD82pJJlCOcxljKw3-wlRj_FGybjzg&_hsmi=50176304


2017-04-07 14:49:57Stem Cell Bank Now Open in UK

Finasteride, minoxidil and microneedling for 9 months

There does appear to be short hairs about an inch long (see arrow) suggesting that these are new hairs brought on by your Finasteride, minoxidil and microneedling approach.


2020-08-23 15:39:09Finasteride, minoxidil and microneedling for 9 months

Still Shedding Hair After a Year on Propecia

I’ve been on propecia for almost a year now and I noticed that I’ve started shedding hair after 2 months into the medication. Its almost a year now and I am still shedding hair, it looks like its becoming worse. The hair that is shedding has also become finer than usual. You mentioned that shedding usually occurs for a while and we should carry on for at least a year. Its a year now, so should I continue the medication?

It seems that your genetic predisposition may be winning the battle over Propecia. You should see your doctor who prescribed you the medication and discuss your options. You may consider adding Rogaine or even increasing the Propecia dose* (but again, discuss it with your doctor first). You may even consider having the HairDX Test for Finasteride Response done, which may explain a failure to respond to the drug. Have you had the status of your miniaturization compared with your pre-Propecia status? That would give you a great deal of information if you had that test done as miniaturization should have decreased on the drug.

* I have recently blogged of increasing the dose of Propecia on select few patients. This does not mean it works necessarily but for those few patients who have no side effects and are continuing to lose hair it may be worth a shot. Keep in mind there is no clinical study to suggest this approach is the solution.


2009-07-01 10:28:00Still Shedding Hair After a Year on Propecia

Finasteride results from Brazil provided by Dr. Tony Ruston (photos)

They say a picture is worth a 1000 words. He is one of the best surgeons in Brazil and he learned SMP here at our office. In addition to learning, he was one of our patients and we repaired some very old work of the plug era hair transplants. The SMP he had done wiped out all of the scars he had from the old surgeries.

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Stopping finasteride, a readers comments

I figured I would offer my opinion here since the reader asked for a reply from somebody who had a similar experience and the response doesn’t really answer the question. I used Propecia about a decade ago and developed general sexual dysfunction (not just ED) that continues to this day.

Unfortunately nobody can provide you with the reassurance that you say you desperately need. You won’t know for sure if the side effects will be permanent unless you stop taking the drug. The doctor highlights that you risk “catch up hair loss” which provides an incomplete picture to the decision you need to make. On the other hand, if you continue taking the drug you risk “catch up side effects” because the side effects can get worse than they are today. You need to think about what is most important to you and how much you value your general health versus your hair in order to make a smart decision. There is uncertainty in making a decision like this which is stressful but the right decision is different for everybody.