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Since they kept on growing for a month after the hair transplant, before the shedding period started, that should mean the grafts survived well, doesn’t it? If it is this way, then I know I have nothing to worry about, but I can’t seem to find any information to confirm this.

The normal state for grafts is that they appear to grow immediately after a hair transplant but are not actually growing because what looks like growth is really the body pushing out the hair from the grafts to their full length, usually between 5-8 mm plus the length of the hair above the skin at the time it was taken. So the apparent length depends on how long the surgeon kept your hair length when he did the FUE. After they shed, they restart growth in sometime between 2-4 months after the shed.

Do you know a good dosage for liposomal? I have a 0.1% fin 5% min liposomal gel that I custom ordered, applying 1ml every day. But I’ve seen some places sell the liposomal gel at fricken 2.5% fin. I had an online pharmacist explain that the liposomal mechanism means this higher dosage is effective and safe, but as someone who got sides from just 0.25 mg of oral fin EOD, it seems like an absurd risk. Any insight? At the end of the day I just don’t want to be dicking around with the 0.1% liposomal gel if it’s ineffective and I’m still losing ground.

From my research, 82% of the topical liposomal finasteride stays in the skin. You can calculate that if 18% goes systemic, what the equivalent dose would be for the liposomal preparation. That is the reason I titrate upwards when I prescribe it assuming that 18% of the dose might go systemic, so that would be 18% of the 0.01%. My experience so far is that one out of hundreds of my patients developed sexual side effects. I have written a series of post on https://baldingblog.com/ addressing topical liposomal finasteride which you might want to read.

This is my original post: https://baldingblog.com/finasteride-is-a-risk-in-pregnancy-with-unprotected-sex/

In this study (https://www.ncbi.nlm.nih.gov/pubmed/29855987), the women, aged 39, was taking 2.5mg of finasteride daily alongside her partner during the entire gestation period. The male baby was healthy with no deformities of the genitals.

I can’t put it together but I did note the article. The report from the patient indicated that the scrotum and its support structures develop in the male fetus at the end of the first term or beginning of the second term of pregnancy. In this study, the woman only took the finasteride for the first 5 weeks of her pregnancy but her partner appears to have continued using it. Cause an effect is difficult to impossible to pin down in this troubled man.

What about wanting to have a child while on finasteride, should we stop medication? And for how long?

I have to think about this. The half life of finasteride in the blood stream and extracellular fluids is about 6 hours which means it should be out of your fluids in a day or two at most. I also know that it stays in some tissues, possibly everywhere, so I really don’t know any science that informs me how to answer your question. When your partner gets pregnant, you can resume protected sex with no problems and that is absolutely safe.

Well that’s rather concerning. Along with your conclusion, I’m assuming this also means that if you are trying to conceive you should not be on finasteride/dutasteride. Would you agree with that, Dr. Rassman?

I would leave that to you. As I said above: “The half life of finasteride in the blood stream and extracellular fluids is about 6 hours which means it should be out of your fluids in a day or two at most. I also know that it stays in some tissues, possibly everywhere, so I really don’t know any science that informs me how to answer your question.” I am no longer able to think through this problem at this moment.

Isn’t it kind of far fetched to link such statistical ‘tail event’ to the use of finastride in this scenario? The causal link imposed could very well be due to total randomness.

Could be!

I didn’t know this, and my wife is currently 25 weeks pregnant… we used a condom for the most part but I’m still terrified.

Statistically, the odds are in your favor and you should be fine. There are very few reports like the one brought forward by the man I referenced, but for all the men who read this going forward, they should engage in protected sex if they are on finasteride.

The miniaturized hairs evident on the patient’s right side of the before picture show miniaturized hairs which are not clearly evident in the after picture. If it were not just a set of pictures sent to me, I would ask him if these miniaturized hairs grew before he went on finasteride. I suspect that they were stunted as most miniaturized hairs just don’t grow when they are at the end of their miniaturization cycle. I would like people to take the same view with the same lighting of their hairline so that the viewer can tell the difference.

Dr. Rassman,

Does running your hand through your hair have any effect on the rate of hair loss? I have a habit of running my hand through my hair frequently (possibly 50 times) each day, and being a 20 year old male with my genetics against me, I am beginning to wonder if this may be encouraging hair loss to occur (although no loss, other than slight recessions, is visible yet).

Also, when sleeping, does it matter whether I sleep on the crown of my head verses the side of my head? Specifically, does sleeping on the crown help to encourage hair loss in the crown area (eg. the bald spot), and should I attempt to sleep on my side more often, or does it not matter whatsoever? Once again, no hair loss is visible in my crown as of yet, other than the small spot I was born with.

Thank you!

There is no real risk to running your fingers through your hair, unless you are pulling on your hair. Running your fingers through your hair is not causing your hairline to recede, I can tell you that much. Sleeping positions do not impact hair loss.

You spoke about the cardiac problems that could be associated with oral minoxidil in the podcast. Does Topical Minoxidil (5% or 10%) have any adverse cardiac effects associated with short or long term use?

Yes, the higher the dose or topical, the more the absorption and the greater the risk of cardiac side effects. More is not always better.