Dr Stewart McCallum (United States) quoted 2 studies by Merck in which the levels of finasteride were measured in the semen of men taking 5 mg of the finastride:

• Regarding the use of finasteride in men whose partners may be pregnant: It is a standard requirement for the FDA to ask for dedicated studies to look at drug concentrations found in semen. Merck performed 2 such studies, and the following is taken from the prescribing information. In 2 studies of healthy subjects (n = 69) receiving PROSCAR 5 mg/d for 6–24 weeks, finasteride concentrations in semen ranged from undetectable (<0.1 ng/mL) to 10.54 ng/mL. In an earlier study using a less sensitive assay, finasteride concentrations in the semen of 16 subjects receiving PROSCAR 5 mg/d ranged from undetectable (<1.0 ng/mL) to 21 ng/mL. Thus, based on a 5?mL ejaculate volume, the amount of finasteride in semen was estimated to be 50? to 100?fold less than the dose of finasteride (5 =?g) that had no effect on circulating DHT levels in men (see also PRECAUTIONS, Pregnancy). So the quantities of drug in the semen are 50? to 100?fold less than doses in serum which have been shown to have no effect on circulating DHT, and this is assuming that 100% of the of the finasteride present in the semen is absorbed by the female partner (which has not been confirmed). So the next question one would need to address is whether 50? to 100?fold coverage below doses that had no effect on circulation DHT is adequate. This is the risk benefit question that you need to address with your patient.

Although the above comments reference 2 studies using a 5?mg dose, Merck () also measured semen levels of finasteride in patients taking a 1?mg dose. The men were treated with 1 mg for 6 weeks. The highest level measured was 1.52 ng/mL, and the mean level was 0.26 ng/mL. Using the highest measured level (1.52 ng/mL), women exposed to a 5?mL ejaculate per day would be exposed to 7.6 ng/d (assuming 100% vaginal absorption). Merck () found this level to be 750 times lower than the “no effect” level for developmental abnormalities in rhesus monkeys.

In summary, a 1?mg dose of finasteride does not appear to adversely affect spermatogenesis. In addition, the level present in the ejaculate of patients taking 1 mg appears to be negligible. Thus, there does not appear to be any need to stop 1 mg of finasteride in those patients trying to conceive or in those whose partners are pregnant.

In 2001, Merck used the slide below to discuss the risks of the fetus to a man who fathers a child while on finasteride

You style your hair transplant as you would style your hair before you lost it, any way you want. Your picture is showing hair spiking, is that what you want?

Look at the video in my post. The HAIRCHECK test ( https://baldingblog.com/haircheck-test-how-it-is-done-video/) measures hair bulk (the sum of the thickness of each hair and the number of hairs per square inch). Hair loss is a bulk issue and when we lose hair we lose hair bulk.

The way you will find out is to give it some time.  Shock loss will usually reverse in under 6 months while permanent changes will not

This photo contains Follicular Units that were excised from the donor area using two different techniques.  The graphic at the top identifies all of the elements of a single Follicular Unit. This particular follicular unit has two hairs, one is what I am calling a ‘telogen’ hair (shorter hair below the skin is either starting to grow or shrinking down (more likely). On the rows of Follicular Units (grafts), you can count the number of hairs in each graft. On row two, the grafts were removed using a punch with subdermal tumescence. Note here in row two, that the hairs are surrounded by fat, especially prominent at the bulbs on the bottom of the grafts. Row three shows Follicular Units excised with a different punch. These grafts do not have much fat at the bottom and the three follicular units on the right have no fat at the bottom at all. Because there is no fat to protect them from drying once they are removed, they can not be exposed to the air for more than a few seconds without a risk drying and death.  If these three grafts are placed with forceps, they might likely be damaged as the operator will have to use the forceps to squeeze the grafts at the bulb, possibly damaging the grafts. Placement with implanters, solves this problem.

It is rare to see necrosis (cell death) in the frontal hairline of a hair transplant. Here we see three areas of necrosis healing each one marked by an arrow. It reflects a technical defect.