Based on all the available evidence (with 1-4% of people getting PFS who take finasteride), the most likely etiology of PFS is that the gene for 5a-reductase type 2, SRD5A2, is epigenetically silenced in key tissues responsible for sexual function, including in the brain, through DNA methylation. Gene methylation is a well-described process that is known to occur with many genes and with this particular gene as well. If the right conditions are met, methylation can happen in seconds in millions of cells throughout the body. A single pill of finasteride can definitely trigger such a reaction.

The reality is that men complain of PFS, so vaid or not, it is real to those men who experience it; however, since neither I nor many of my colleagues have seen it, the frequency seems less than the 1-4% that you have referenced. If you think about it, why would I continue to prescribe finasteride as I don’t make any money from doing it and if I didn’t more of my patients would become surgical candidates and I would make more money from doing their surgeries. The answer is obvious, that the drug works for many men with minimal or no side effects and I care about the patient’s welfare. Impotence is common in men without finasteride on-board, about 20% in men in their 20s, 30% of men in their 30s, 40% of men in the 40% and so on. I appreciate the time you took to write this post to me, but although I believe that PFS does occur, but it may not be as prevalent as you state.

This is an interesting abstract with a link to an article on the subject:  https://pubmed.ncbi.nlm.nih.gov/23766606/

Article here:  https://onlinelibrary.wiley.com/doi/10.1111/jdv.17731

I am using Fin for past 5 month with no sides. I had usual shedding phase for a month which stopped after that. But the problem is, I am losing my hairline fast after starting Fin. My hairline has been constant for past 3 -4 years. But in these 5 months my temples became easily visible as my hairline went high. Is this expected? Why is this happening?

Finasteride will not always stop a receding hairline

The dot size is controlled by the operator (hold time in the skin and how deep they were placed) as well as their skills and the size and needle configuration in the hand piece of the device; however, many of the dots spread because of the size of the pigment particles themselves dictate the spread.  The new laser tattoo device has even more precise control over it, if the operator is not as skilled and doesn’t have the years of experience, see here: https://newhair.com/wp-content/uploads/data/docs/pubs/Tattoo%20Pigment%20Delivery%20with%20a%20laser_final.pdf

I hear that question all of the time.  The answers often vary from 1000 to as high as 6000 grafts, sometimes regardless of the balding pattern.  We focus on the number of grafts because more grafts move more hair into the balding area.  But the real numbers depend upon

• hair thickness,
• the balding pattern,
• the color of your skin and hair,
• the character of your hair, the thickness of the hair shafts (fine, medium or coarse)
• and most important, something about your donor supply capacity to support the balding pattern at the time the question is asked.

Note that I am putting in a time factor, because balding is a progressive process and how bald you are today, might be distinctly different than how bald you will be tomorrow.

Some young men fly to Turkey, get 5000-6000 grafts for minimal cost. Then they come home to wait and watch it grow.  Assuming that the clinic did it right (not the case in many Turkey clinics that don’t have a doctor but sell grafts (like potatoes were sold to the Irish at the time of the famine in the 1800s), they may run out of grafts (or potatoes) before they finish balding.

Hair transplants need to be part of a Personalized Master Plan that incorporates how you are going to manage fixing the balding problem against a progressive balding process. If you use up all of your donor hair before the balding is complete, you may end up looking freaky for the rest of your life.  I hear the young man tell me that they are not worried about their hair loss when they get to 30, or 35 or 40.  I speak with many 30, 35 and 40 year old men and they ALL CARE about what their hair looks like.  Poor planning is almost always a disaster for sometime down the road.  All doctors are not equal.  Some doctors are in it for the money, so selling more grafts means making more money.  You have to identify those doctors and make sure that you don’t get one of them. I always say that a good decision today is a good decision tomorrow.

So to answer the basic question “How many grafts do I need?”, take it easy, digest what you read above and the look to some of the following links below:

• https://baldingblog.com/i-am-19-and-may-be-balding-what-do-i-do/
• https://baldingblog.com/go-why-do-we-need-a-master-plan/
• https://baldingblog.com/wp-admin/post.php?post=34268&action=edit
• https://baldingblog.com/hair-thickness-vs-density/

I don’t have experience with dutasteride but as I know it is about 15% more effective, that means that there must be 15% more side effects, logically