1. Have DPA young patients (Early 20´s) more oportunities with finasteride in comparasion with a MBP who have a normal patron (NW 6).
2. Have you ever seen a early 20´s with DPA who have a good response to finasteride for a long time (10 years)?

I am a 21 years old and I have taken finasteride since I was 18 years.. My dermatologist prescribed it to me.

Here you have photos of mine when I start the treatment (2012) and now
(2014).

You have my permission to publicly use it.

Diffuse Pattern Alopecia (DPA) is basically the same as Male Pattern Balding otherwise known as Androgenic Alopecia. DPA, as the term implies, shows up as diffuse hair loss that occur in a “pattern” such as you see in male pattern balding but the permanent zone on the back and side of your head not impacted.

Finasteride (Propecia) is used for the treatment of this condition (DPA, AGA, MPB – they are all the same).

There is another condition called Diffuse Unpatterned Alopecia (DUPA), which may be genetic, but does not respond to the drug finasteride (Propecia). DUPA is uncommon; however, it is critical to have your doctor make this diagnosis before being considered a candidate for hair transplant or medication. These DUPA male patients often get a failure of the transplant, even if on the drug finasteride.

I cannot make a diagnosis with your photo and this blog is not a place for making diagnosis. I also cannot predict what will happen in 10 years. I am not a fortune teller. I have seen men in their early 20’s start finasteride for male pattern balding and has kept most of their hair. I have also seen them lose their hair rapidly despite being on finasteride as their genetic predisposition overtook the drugs ability to slow things down. It doesn’t mean that the drug didn’t work.

After 5 years, this patient came to see me to show me the transition of his new look. Considering the degree of balding he had when he came in, his results were spectacular. He did comment that no one ever noticed the change from a bald look to this hairy look. That is what surprised him most. The two pictures tell the story without words.

Hi, I went to see a ISHRS physician 7 months ago because I was concerned about family history. He told me he didn’t see anything but told me to come back in 6 months. I recently went back and he examined my crown and mid scalp and found miniaturization, however I am still a NW1. He confirmed I have MPB, and gave me Finasteride. My question is, provided finasteride works, can I expect to keep this hair for a while? My thinning is unnoticeable to the naked eye but is present on a microscope.

I think you should ask this to your doctor since they examined you. If you have signs of male pattern balding (MPB), then finasteride 1mg (Propecia) is a medication to treat this condition. The thinning may not be detectable to the naked eye but it may be present under a microscope with signs of miniaturization. This is why we have always advocated the miniaturization (microscope) test. You can also consider a Bulk Measurement as well which is fairly accurate in detecting very early balding using the HAIR CHECK instrument. It is not necessary if you already have the diagnosis, but it can still document the progress of the hair gain or loss.

I’ve checked out Dr x’s website, and he claims that he can perform an FUE surgery with a transection rate of under 3 percent. I’ve read your article on FUE which was written near the end of 2007. In that article you mentions that “the transection rate by our NHI surgeons are still well within the 10% range for FUE and we make no pretenses that it is better than that routinely.” With Dr x’s experience and latest tools, has he overcome a major flaw within the FUE procedure?

Also Dr x is marketing a new device which he created to improve the FUE procedure.

Some doctors have big egos. Some claim to have a better mousetrap. I can not and will not comment on another doctor’s claims. There are now robots doing FUE with good success and low transection rates that are evaluated by independent third parties and trusted researchers. There are no independent judges or observer who can verify claims. You are stuck to doing your own research and then trusting that the doctor you selected was honest with you.

The transection rate with FUE depends upon the skills and experience of the doctor, the instruments used and in many cases, the tissue make-up of the patient’s collagen. where the doctor (or robot) has no control. In the later case, it is individual PATIENT dependent.

I would guess that normal transection rates still vary in the hands of good, experienced and honest surgeons, number less than 10 percent transection rates. The transection rate is not the critical element in an FUE procedure, rather it is the experience of the team in managing the grafts. Even with the Artas® robot, other than the coring of the grafts, the rest of the process is manual, so manual quality control processes determines the success or failure of graft growth. I have recently seen a patient who had FUE with the Artas® robot, and the procedure largely failed. Even if the transection rate was very low, the detail in the manual management of the grafts may have been an issue. Did you know, for example, that if a graft is left open to the hair for as little as 10 seconds, it will die. That death, will not be seen until 8 months after the transplant surgery is finished.

I’ve seen Dr. Pak’s FUE surgery and his transection rate is not infrequently less than 3%, however, on the rare patient who has ’tissue’ differences in their collagen, the transection rate may go up to as high as 10%. We could ignore this singular result and report transection rate of under 3%, but that would not be honest. Our efficiency with FUE using our own internally developed tool is higher than most doctors in the world. It is not unusual for us to extract FUE grafts at the rate of 1,000-1,500 grafts/hour. We run an ‘open shop’ (open door policy) here which means that we hold open house events every month where our patients, happy or unhappy, can come to meet with people like you. Few doctors are that open with their patient population.

I realize for marketing purposes and advertising to the public these numbers and stats would seem important, but I would rather that your ask to meet some of his patients and get the doctor’s results from the patient’s own mouth as well as see the results with your own eyes.

I have been taking Propecia since my early 20’s and I am now 39. My crown was thinning back in the day and that’s what inspired me to start the drug. My brother is totally bald but my frontal hairline seems to be in near perfect shape all these years later. I am considering stopping taking it because I’m worried about the long term effects and I think as I age my hormones may change and I’ll develop issues from it. In your humble opinion at this point do you believe propecia is keeping my hairline intact? I’ve read that propecia rarely works on hairlines and I’ve heard you say it’s a tug of war between genetics and propecia. I just think I wouldn’t experienced some form of loss by now. The crown is ok but not what it was 6-7 years ago. You thoughts?

Please speak with your doctor for these issues. In general if you stop Propecia you can ‘have catch up hair loss’ where the hairs you kept or regrew over the time you took Propecia, may fall out on stopping the medication. Long term use of Propecia from studies show no adverse effects. There was a study that show high dose (finasteride 5mg) can even lower the risk of prostate cancer and many doctors believe that this benefit extends to the 1mg dose, but this particular point was not studied and is just conjecture.

Hey doc. Love your work!!

1) Why so sceptical over PRP when there are so many pics, videos and documents online supporting it as part of the overall treatment for baldness. Heck there’s even an article on the ishrs.org website so I’m guessing there must be something in it.

2) Assuming all the research into PRP was true then would it make a good proscar replacement for people with ‘side effects’.

3) Depending on the baldness scale / category one fits under is it possible that you might never have to take drugs again? I guess what I mean is that if your body is always producing dht does that mean after a while all your hair will eventually get effected or is some hair safe?

4) I once spoke to a guy at a Clive Clinics who said if you don’t take proscar each day it’s a waste of time. The doc who prescribed it countered his opinion by saying although it might not be perfect less dht is being produced by your body so it must slow down your hair loss. I take it twice a week What do you think?

Thanks heaps!!!

PRP (Platelet Rich Plasma) is hype without good science behind its value on hair growth. Doctors make money offering it. Photos or videos on line do not prove anything. There’s documents, photos, and videos of aliens here on Earth but that does not mean it’s true. I need to see good science before I recommend it and try to cash in on it. It’s not that I’m a skeptic, but maybe it an ethical decision. I am just maintaining a scientific approach in expressing my opinions on BaldingBlog. I have been known to use Google and read Wikipedia for information but I also know that what I read may not be accurate. I encourage our readership to do their own research. But if you’re asking for my opinion on hair loss topics, I attempt to give you a sound clinical, scientific based answers.

Stopping Propecia for something that does not work does not seem like a reasonable choice to me, but you are in the driver seat with the decisions you make. I do not believe that what you said as ‘gospel’.