If the finasteride has not solved the problem by this time in your crown and you have some hair present you have three options.
1- Do nothing and live with it
2- Get a hair transplant which may solve the problem as that is what I did. My bald crown is now full looking
3- Get Scalp Micropigmentation which will make your thin crown look full as shown in this website photo below (click image to enlarge)
If you have thinning along the sides and back of your head as well as elsewhere (thinning on front and top), there is a condition we published called Diffuse Unpatterned Alopecia (DUPA) which requires a doctor to make the diagnosis with a hand microscope showing miniaturization in the sides and back of the head hair.This is a difficult problem to treat and people like you who have DUPA are not candidates for hair transplantation.
This man lived under a hat and rarely went out for 14 years after he got the disease Alopecia Totalis. The Scalp Micropigmentation we did freed him up completely.
We have developed Scalp Micropigmentation and have been using it on men with alopecia areata (aa). Men with aa, can’t have a hair transplant because the disease will reject the hair transplant and the treatments used are not always effective at curing the problem. While you are trying successfully or otherwise, having Scalp Micropigmentation allows you to look normal so that the defects in the skin just don’t show up very well. We did one more session and there was no evidence of the disease after the last session but unfortunately, we did not get photos before he left.
Having gynecomastia from puberty does not make you more susceptible to the rare side effects that impact breast tissue in men. Good question.
I have hesitation in prescribing finasteride in women who are pre-menopausal because of the risk of pregnancy which may be an unexpected or unplanned pregnancy. There is a direct relationship between this drug and sexual anatomies in the fetus
Male pattern balding with recession is often asymmetrical. The side that is behind will often catch up with the more receded side.
Your biggest enemy is the progressive thinning leading to a balding pattern that is not evident at this point in time. The degree of thinning that you are experiencing would suggest that you should see a doctor who most likely will get Bulk Measurements of your hair to determine the degree of the thinning that you are presently having. If the diagnosis is early genetic hair loss (the most common cause of hair loss in young men), then the best treatment would be the drug finasteride which is highly effective in men of your age and may not only stop the hair loss but possibly reverse it. If you are developing a more advanced balding pattern the best test to get will determine the Bulk Measurements of your hair and this will show, over a one-year time frame, how effective the treatment will be. Once you know this information, then you and your doctor need to develop a MASTER PLAN which will define what you need to do over the years to come.
Breast pain and nipple pain has been reported with people using Propecia (finasteide). If this continues, you should see a doctor if that is why you are asking this question. Some people develop small painful breast lumps so an examination of a doctor is a good idea. When this happens (it is rare), the drug often needs to be stopped.
Depression is a known potential side effect from Propecia (finasteride). There are actions of the 5AR enzymes in many parts of the body and as it blocks the effect of this enzyme, the effects can be seen everywhere the enzyme exists which does include the brain. The dose of Propecia (1mg) is low so the effects elsewhere in the body is minimal. We see this drug used in the 5mg dose for the treatment of benign hypertrophy of the prostate (BPH) and most of the information we have on side effects come from the men treated with BPH. There are, of course, many causes of depression and depression itself needs to be addressed independent of the use of this drug alone.
As you get older your testosterone drops along with the DHT and then the finasteride is often less effective as you get older. What hair you have has stood the test of time which is an indication that much of it might stay; however without seeing you, I can’t make such a judgment.
In the 26 years since I practiced hair restoration surgery, I have never seen the drug finasteride make the hair worse. I have, however, seen the hair loss accelerate in what I believe is its normal loss process in some men with aggressive hair loss.
Almost all Caucasian males develop a maturing hairline. When recession occurs, it usually is associated with hair loss elsewhere on the head and scalp and that is why I perform a HAIRCHECK if I have any doubts on the distinction between a receded hairline and the appearance of a maturing male hairline. The HAIRCHECK instrument will show hair loss behind the hairline which always occurs when the hairline is receding. The picture of me below shows a V Shaped mature hairline that is 100% mine since it changed from the rounded hairline of my youth. This hairline was not transplant but my entire crown was transplanted with 2700 grafts. The second picture shows early hairline recession that was transplanted along with a replacement of the temple peaks. You can see that this hairline was ‘ratty’ in appearance which is essentially what often happens when the hairline starts eroding.
The official number is 2-3% but the placebo number are almost 2%. In my practice I think that the numbers may be higher, 4-5% range. The reason that you see a lot of complaints on the internet is possibly because you are only hearing from those that have the negative sexual side effects. One of my own family members, got an increased sex drive, a complaint I do here on occasion but seem to never read about it on the internet. The testosterone levels often do go up when this drug is taken. For those that need/want to take this drug it is a matter of choice for many of them. To paraphrase William Shakespeare, “To take the Pill of not take the pill, that is the question?” Balding may be the only alternative.
Crushing finasteride is ok, but dissolving it in a solution will not guarantee that it will work and you may inactive it by doing so, especially if you don’t drink it immediately.