Category: Uncategorized

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Finasteride after transplants?

For the post-op users that did the fue transplant and were prescribed finasteride, is the prescription supposed to be taken forever or just for a few month? I am 90% on board and about to book but I’m hesitant bc I don’t want to take a pill forever and I was reading about the side effects and I that pushes me away from it. I know the answer is probably on here but I want to hear from actual, firsthand users.

Thanks for your replies in advance.

If you don’t get sexual or other side effects, then since genetic hair loss is progressive, I generally advise patients to stay on it for life. It has the advantage when you are older, of reducing the risk of prostate cancer by 25% in addition to slowing down the hair loss that is almost always progressive.


2020-12-07 11:03:10Finasteride after transplants?

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SMP for High Contrast Scalp and Hair

Dr. Rassman,

For patients who have high contrast scalp and hair (ie. dark hair and fair skin). Wouldn’t a combination of SMP and surgery help minimize some of that contrast and maybe achieve a more fuller look?

Yes! It would be advantageous to complement the scalp micro-pigmentation (SMP) with a hair transplant for a full and realistic (3-dimensional) look. No one treatment is perfect. Hair transplantation can never give you the complete fullness you once had, since it is just rearranging what you currently have. But hair transplants can give you a good hairline, adequate coverage, and even almost normal densities if the area covered is small.

SMP can give you the look of fullness but it will not be real hair, since it is like using concealers (think DermMatch or Toppik) but without the daily applications because it is permanent.

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Finasteride and minoxidil 3 months (Photo)

Finasteride and minoxidil have been used for 3 months with good results; however, this man has not shown comparable photos so it makes the case less compelling


2020-11-02 10:26:38Finasteride and minoxidil 3 months (Photo)

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So, if I replace my receding hairline, what happens in another 5-10 years when I continue to recede? Answer: A Master Plan with a good doctor who measures your Hair Bank!

I have been doing hair transplants for 29 years and started off doing Follicular Unit Transplants (which I pioneered) with large sessions of follicular units rather than the old type of plugs as well as FUE which I started doing in the mid-1990s. I first published the idea that a Master Plan is critical for every person and it must take into account the limited hair in the donor area. I discussed looking at the donor area as a bank account, but rather than money, it is hair in that account. The unique thing about a donor area bank account is that there are never deposits, only withdrawals. So the doctor MUST ALWAYS document how much hair is in the ‘donor bank’ and with each withdrawal, he must plan to leave enough to satisfy the patients initial needs and his long term needs as more hair is ALWAYS lost over time. I have transplanted patients over the 29 years, keeping up with the progressive balding process to keep them hairy. I have always been honest if compromises are necessary. Today, too many doctors think short-term because it is better for them financially if they move a lot of ‘bank hair’ out earlier. Also, the patient frequently thinks short term, and doesn’t appreciate the problems he may run into in the future. But the doctors who want to get your money now are not the doctors you want. Always be sure that your doctor talks about your donor supply (bank) as he depletes it with FUE or FUT because you know what is going to happen WHEN you lose more hair in the future (a guarantee so read this: https://baldingblog.com/need-master-plan-think-hair-transplants-photos/). Here is an example of one of many of my patients who have stayed ‘hairy’ despite continued hair loss: https://baldingblog.com/norwood-class-7-pattern-patient-received-11000-grafts-plus-smp/
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Finasteride and the Swedish Medical Products Agency

This is continued from my response an hour ago about finasteride and the Swedish Medical Products Agency (MPA). The question was:

What is your opinion about the Swedish Medical Products Agency 2008 study that supports permanent side effects from the use of finasteride?

As I said in my earlier response, “If you believe in the study, do not use Propecia. Many of the reports that I read are on bulletin boards which are suspicious.”

What that boils down to is that I’m not going to try to convince people to use a medication if they’re already so convinced it’ll do them harm. I’m not a sales rep and it isn’t my job to make guarantees about medications or provide incentives for you to take it. It’s an elective medication. You don’t have to take it if you don’t want to. If you’d rather believe message boards than published reports in medical journals, then by all means that is your choice to make.

But I’ll elaborate more with some interesting tidbits from the Swedish Medical Products Agency (sources: here and here). Some key points I found:

  1. In clinical studies, single doses of finasteride up to 400 mg and multiple doses of finasteride up to 80 mg/day for three months (n=71) did not result in dose-related undesirable effects.
  2. Drug-related sexual undesirable effects were more common in the finasteride-treated men than the placebo-treated men, with frequencies during the first 12 months of 3.8% vs 2.1%, respectively. This means 3.8% of men taking Propecia had undesirable sexual effects and 2.1% men taking a fake sugar pill had undesirable sexual effects. The incidence of these effects decreased to 0.6% in finasteride-treated men over the following four years. Approximately 1% of men in each treatment group discontinued due to drug related sexual adverse experiences in the first 12 months, and the incidence declined thereafter.
  3. People that are up in arms about the Agency listing “persistent difficulty having an erection after discontinuation of treatment” as a possible side effect should also realize this is listed under the “frequency unknown” section. In other words, they received complaints about it (how many hasn’t been established), but it is not a proven effect.
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“Something I hate about the hair market” from Reddit

Every once in a while, once a month, I simply search “hairloss treatments” to see if anything new happened, or maybe a new treatment, but all I get is recent articles like “does ___ cause hairloss?” “can vitamins help with hairloss?” “can saw palmetto halt hairloss?” Bull**** articles like these make me pissed off, not because of the articles themselves, but because they are repetitive articles that i see every month when I search this shit. What happened to Breezula? WAY-1001? Guess we’ll never have a good safe, non-fearing treatment. Guess everything comes with a price.

Back in the 1980s, there was a ‘product’ called the Helsinki Hair Growth Forumlae that may have been the first modern product claimed for the hair growth pitch to hit the US market for magic hair growth cures. As the first, it sold like ‘hotcakes’ and it took more than 10 years for it to lose its unique market position because the FDA dinged them for claims that could not be proven. I look them up, and they are still selling hair products, just no magic claims.
If you look at newspaper in the late 1800s and early 1900s, you will see a lot of products selling cures for hair loss like magnetic hats that you wear at home. People never liked the idea of being bald so they easily reached out to anything that was offered. Today, with the internet, we have the ability to discern the difference between fact and fiction, but many people have realities that they want to believe and will often buy into anything that sounds ‘reasonable’ with low risk and possibly low cost solutions for hair loss.
There are now many doctors who have become the salesmen for sometimes shady cures, but because they wear a white coat, or have the MD after their name, they become believable. I have to be careful how much I say about the doctors who are making promises that they can’t deliver on but I can tell you, the readership, ‘Let the Buyer Beware’ as there is no fast, cheap fix for hair loss that I know of.


2019-12-16 09:08:35“Something I hate about the hair market” from Reddit

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Finasteride Dosage and Body Weight?

Hi Dr Rassman,
I am a big fan of your site, and you have answered couple of my questions via your blog.

I am 24 and been using finasteride 1mg generic per day for the past 14 months. I have got a receding hairline and vertex and it is on norwood 3 vertex. After started fin, there is an increase in the hair density at the hairline but vertex is continuing receding. I am obese and weighing 124 Kg (273 lbs) and my height is 5 feet 10 inches (177.80 cns). So based on BMI, I am weighing almost double than that I should be. I have gone through your site to find is there any relation between finasteride dosage and body weight. But I was unable to find an answer. should I consider increasing the dosage to 2mg per day to hold the hair I have. Waiting for your suggestion. Thanks a lot once again.

There is no evidence or reason for adjusting finasteride to body weight, but there is no harm doing it provided that you do not develop side effects (which may increase with a larger dose). I realize hair loss is an important issue to most readers here and most readers want to maximize their treatment, but increasing the dosage does not always mean better results.

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St John’s Wort and Propecia

Hello Dr Rassman.

Want to start by thanking you and all the others who helped and contributed to this awesome forum!

I have been depressed for a while now. But then I’m very critical of antidepressants. So i have decided to test ST. John’s wort, who according to studies can be just as effective as antidepressants while it has much less side effects than conventional antidepressants.

But St. John’s wort has a tendency to affect the metabolism of other drugs.

My question is, do you know if St. John´s wort will affect propecia

I am not much of a herbal expert, but I do know that some herbs can interact with medications. In particular, St. John’s Wort is listed as having interactions with Propecia (finasteride 1mg), though I do not know if this will have a clinically significant affect on the efficacy of Propecia. You may run the risk of increase side effects, however.

I would consult with your doctor.

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Finasteride impacting beard growth

Here to ask a question I’ve never seen asked, or at least never answered on this subreddit or anywhere else on the internet despite my effortful and differently-worded google searches.

I’m 20. I started balding at 14, and I started fin at 17. Switched to dut at 19. Now I’m 20, and I still don’t have beard growth despite having the genetics for insanely aggressive baldness and insane beard density. This makes total sense because I’m taking a DHT blocker but my question is- will I never be able to grow a beard if I continue with my DHT blocking regimen? Am I blocking myself from ever being able to grow a beard, or am I just blocking it for the time being while I’m taking the DHT blockers? The idea of never being able to grow a beard terrifies me and I think I’d rather go bald and have a beard than never ever have facial hair as an option, but if I can wait until I’m 25-30 and then grow a beard after ceasing dut/fin, I’d rather do that. Thanks for any and all responses this gets.

Dr. Robert Bernstein answered this question as follows:
As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any effect on facial hair. The reason is not clear.
It is interesting to note that testosterone stimulates growth of axillary and pubic hair, but not scalp hair. Scalp hair growth is not androgen dependent, only scalp hair loss is.
DHT stimulates terminal hair growth of the beard, trunk and limbs, external ears and nostrils. Of course, it also is responsible for the bitemporal reshaping of hairline as one passes into adulthood and causes male patterned baldness (androgenetic alopecia).


2021-04-25 11:04:46Finasteride impacting beard growth

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Starting to Lose Hair at Age 19

Hello, I am 19 years of age. Over the past year I have found that I have lost alot of hair. All my life I have had thick hair. my whole family has relatively high hairlines, even my 13 year old brother. I have always had one although there was always alot of hair around the hairline. In recent months my hairline has been receeding noticably and I have found that hairs have come out when showering, sometimes just randomly in the day, and I find them in my mouth. There are no patchy bald spots. However the hairline is extremly thin and around the crown it has also thinned out. Even the hair at the sides do not feel half as weighty as they used to. I used to badly need a haircut every two weeks, now although I still do at times, it is more in the vain hope it will make my hair look better. It is whispy looking on top also. I also find my scalp feels odd although this could be in the mind. It has all happened suddenly.

You need to have your scalp mapped out for miniaturization to determine if you have genetic balding. If you do, it will follow a pattern much like those shown on the Norwood chart, as your hair starts to thin in these patterns before it becomes bald. Over 50 years ago, General MacArthur said, “Old Soldiers never die, they just fade away”. I will rework his quote by saying, “Hair never dies, it just fades away”. Some day, when hair cloning starts up or we figure out the missing link in the pathway that stops the hair from cycling in the normal manner, we might be able to revive those hairs that are present even in the baldest of men, but at age 19, lets start to crawl before we walk. Don’t live in fear of what may not be. Get a good doctor to diagnose you and then treat you appropriately, if treatment is needed.