I still have enlarged breasts and I am 18. I am also conscious about it, never going out without a shirt on. I never had it treated as my doctor thought I could live with it. My doctor told me that I would have to go through a surgery to fix the problem. My question is this:  If I take finasteride (Propecia) will this problem get worse?

Answer: Although the drug finasteride (Propecia) is know on rare occasions to cause gynecomastia or breast lumps that are painful, your risk for this is the same as anyone without the condition (over 1:1000 men run this risk). You will have to weigh out the value of holding onto your hair with this drug vs the very remote risk on increasing your breast mass or developing painful breast lumps.

 

Below are four patients (two of them are ours, two of them are not). The first reflects our transplant technique where we have focused heavily on what a patient would look like after they leave the office. This patient is just a few minutes after her surgery was performed. We wash the recipient site when she left the office as well as the day after so that no crusting or scabs form. Most of our patient have an undetectable hair transplant from the moment they leave the office. They can go back to work in a few days, sometimes even the next day without calling attention to their private decision to have a hair transplant. A hair transplant is no ones business but the patient.

This obsession with undetectable hair transplants by us is not always shared by other doctors who ignore the abnormalities shown in this picture where the grafts were left partly out of each recipient wound so that even a fastidious hair wash can not erase the visual reality that this patient had a hair transplant done for everyone to see (not our patient). The third picture shows a patient one week from his hair transplant with heavy crusting on his recipient area (again, not our patient). He should have washed off these crusts while they were forming so that he would look like the patient on the bottom of the screen (no crusting at 5 days). Now for this patient, he has problems with the remaining crusts which if pulled or picked will pull out the grafts. He must try to apply shampoo twice a day, leaving it on his head for 10 or so minutes each time he washes. Eventually these crusts will shed, accelerated by more aggressive washing but it is not as good as doing it the right way in the first place.

Just after  transplant with grafts showing                               The above patient is one week after a hair transplant

5 Days after hair transplant by NHI                                                      Same patient 5 days after FUE

“Hi Bill! I really feel remiss for not checking in with you sooner after my last procedure, but somehow during the 6 month period that followed there was not much to say other than that the recovery period was pretty much text book and as you described it, would be; and I didn’t want to bore you with minor stuff. During that first period, the growth of some new hair was there, but not that much, so there was nothing exciting to talk about. However, around the first of December 2016 (approx. 7 ½ months. after the procedure) my wife and I went to South America and returned at the end of the year. Between the time we left for South America and now, my hair growth has been remarkable. It looks almost as good as when I was 18 years old, quite unbelievable! The really unbelievable part is how you can do this and make it look so natural. Thanks again for your great work and the special care you gave to make this situation turn out so well.

If you have the time in the near future, I’d like to come by the office to let you see the results.”

I have always felt gratified in taking care of people and helping them with their problems. Hair is just one of them as is shown above comments from one of my patients, but the scope of satisfaction goes well beyond my role as a hair restoration surgeon. I remember many of my patients going back to the 1970s. One, I remember clearly, came from Vermont (where I was a surgeon) just to visit me, at my home in Hawaii. He was 95 and she 96 (I treated him for colon cancer and her for breast cancer 10 years earlier). The surgery is not the challenge once you master technical aspects of performing it, but the people that I have taken care of and the unique relationships I have developed with each of them, has made me a better man and it gave me the feeling that my life as a physician has and continues to be fulfilled. My patients know that they can call me about anything that bothers them, anytime and every one of my patients have my cell phone to reach me. I have responded to a myriad of health and social problems brought to me by my patients. I have modeled by career after my family doctor whose office was in his home and it was his wife, who enhanced the link between he and I.

This is one of the most amazing videos I have ever seen posted anywhere that shows a normal juvenile hairline evolving into a genetic pattern of hair loss. I can’t help but wonder what it would look like if this young man went on the drug finasteride.

See here: https://www.youtube.com/watch?v=szR3CfPkLOI&feature=youtu.be

We have become aware from the hair transplant community that the use of a specially designed tape, when placed at the mid-forehead, prevent swelling from going below the tape and given enough time, for those who wear the tape, to absorb the edema from the surgery through the scalp directly. Note the swelling above the tape which will not drop down below the tape. When combined with our traditional steroid use, we now can prevent swelling of the eyes and face as shown in the photo below who is two days following his surgery with much of the redness already gone.

To get a clean wound, we always wash the recipient area on the day of surgery and the following morning in our office, a perk for many of our patients. Many of our celebrities love the hair washes after the surgery so much, that they come in every day, something we are always happy to do for them.

Many men have successfully had children who were on finasteride. There is some concern, although not proven statistically, that the sperm count might actually drop while on the drug. We have seen sterility reports on the drug dutasteride, another more effective blocker, although this is apparently rare. What is proven is that when men take finasteride, the ejaculate during an orgasm does have a reduced volume in about 20% of men on the drug and the semen is more watery.