This is an excellent article discussing the safety and effectiveness of oral minoxidil. “Systemic adverse effects were infrequent and only 1.7% of patients stopped the treatment due to adverse effects.”

https://www.jaad.org/article/S0190-9622(21)00418-7/pdf

This second article reviewed 10 published papers addressing oral minoxidil use for alopecia in men and women: https://pubmed.ncbi.nlm.nih.gov/32516434/

Results: Ten articles were included for review comprising a total 19,218 patients (215 women and 19,003 men). Oral minoxidil dose ranged from 0.25 to 5 mg daily to twice daily. The strongest evidence existed for androgenetic alopecia and alopecia areata (AA), with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement. Successful treatment of female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy-induced alopecia was also reported. The most common adverse effects with oral minoxidil included hypertrichosis and postural hypotension.

Conclusion: Oral minoxidil is a safe and successful treatment of androgenic alopecia and AA. In addition to its therapeutic benefits, practical advantages over topical minoxidil stem from improved patient compliance.

Dr. Rassman:  In my opinion, oral minoxidil is a reasonable second line drug for those men who can not use finasteride

These articles published in peer reviewed journals, suggest that there are long term effects on using finasteride and dutastertide.  It is important for anyone taking these drugs for long term use, to understand what these articles are implying.

https://pubmed.ncbi.nlm.nih.gov/32202088/#:~:text=Finasteride%20and%20dutasteride%20are%20frequently,and%20in%20men%20with%20AGA.&text=We%20suggest%20that%20long%2Dterm,disease%20and%20potential%20kidney%20disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701851/

If this woman has another hair transplant it will also fail. The doctor should be able to make the diagnosis of Frontal Fibrosing Alopecia (FFA) which is an autoimmune disease which will kill off the transplants.  This is why you need to have a knowledgeable hair transplant surgeon evaluate your hair loss, to first and foremost make a proper diagnosis.  From these pictures alone, I can tell she has either Frontal Fibrosing Alopecia or LLP.

I would want to perform a trichoscopic examination of these hairs on the sides to make sure that you don’t have DUPA.  An examination is critical to making intelligent decisions however, I would want to evaluate all of your hair donor area as well.  Here is an example of DUPA:  https://baldingblog.com/do-i-have-dupa-photo/

https://ventsmagazine.com/2021/02/24/man-dies-a-day-after-his-hair-transplant/

I remember a 33 year old marathon runner that dropped dead at the peak of his health.  Nobody knows why it happened. One can suspect that his heart had an ectopic beat that came in a particular part of the cardiac cycle and induced Ventricular Fibrillation (no heart beat).  I knew a 40 year old close friend of the family, who died in a field 100 feet from his house.  Nobody knew why.

There are reports of death after having your dentist give you Xylocaine for a local anesthetic.  It happens.  One of my patients had a heart attack the evening before his hair transplant. It could have happened during the transplant I feared.  The key for good doctors is to know how to respond to the unpredictable.  For those of you who go to Turkey and have a clinic without a doctor, beware as who would address any catastrophe?

In the above magazine example, I saw them mention that this man had significant facial swelling and was hospitalized suggesting something strange happened after the surgery. Could it have been an allergic reaction to a medication he was given?  I don’t know why it happened but lack of blood tests for healthy men is the standard of care in the US today for all ambulatory surgery done under local anesthesia in young healthy surgical candidates so I would be critical of that complaint by the writer of the article.   I always get a medical history on my patients before the surgery and make sure that they are healthy without complaints or on-going medical conditions.

For those of you not actively seeing dermatologists or have prescriptions, how do you get yours? I see sites like ‘all day chemist’ but they ask for an upload of files… yet you can skip this part i think. I’m not sure if they’ll call or email you afterward asking. Also found a thailand pharmacy site that doesn’t require paperwork. Anyway as the title says, what’s the easiest way to get a hold of some? Thanks

This is a prescription drug when given orally. See an expert doctor. An old saying says: “If you treat yourself, you have a fool for a doctor”.

Medications don’t always work, but it is important as you explore these medical options, to be realistic, knowing that they may not work.  Your genetic balding could be too strong and not responsive. With regard to finasteride, over 90% of men on this drug get at the least, some slowing of the hair loss. This has been well documented, but slowing from what?  That is a hard question to answer.

The hair transplant option is a good option for those of you who are not responders to medications or microneedling. The best part of a hair transplant is that once it is done on a person who has stabilized their hair loss (usually someone over 25), they can get their hair back and stop worrying. This is what my patients tell me over and over again. It is worth considering and saving up enough money to do it with the right doctor, the right plan and as said in the title of this post, setting realistic expectations.