Stopping finasteride after 10 years, what happens?

/by William Rassman, M.D./0 /

let’s say you bald at 20 (nw2) and so on needlessly to say you start taking finastride, fast forward 10 years, you become 30 with a wife you are trying to impregnate, you don’t know if fin will cause any problems so you stop taking it.  anyhow what i’m trying to ask is, what would happen to your hair if you stopped taking finasteride – would it continue to bald at the same rate as if you were 20 years old and never started taking finasteride, or would the accumulated hair loss over ten years result in a more advanced stage of balding, possibly Norwood 4?

The answer to that question is that you will play “Catch up hair loss,” which means that in 3-4 months, you will have the amount of hair loss you would have had if you never took finasteride. That means, of course, that your results will reflect your genetics

Studies on Rat Penis looking for Pyronies disease

/by William Rassman, M.D./0 /

https://pubmed.ncbi.nlm.nih.gov/12647000/

It is difficult to project these rat studies to humans on finasteride. I would only mention the findings in Group C of the Rats with the report that there was a “reduction in smooth muscle fibers in the trabeculae of corpus cavernosum”.  I would like to see some clinical documentation in this area which is probably very difficult to obtain.  I look at this as just a rat study for the moment.

Breakthrough claimed in hair loss treatment

/by William Rassman, M.D./0 /

https://www.healthline.com/health-news/microrna-breakthrough-hair-loss-treatment

I am always skeptical.  This is a new idea, that stiff hair causes balding, and softening the hair can address the balding problem.  The hairs above the surface of the scalp, are already dead. Treatment below the skin, as the new hairs are being formed, would be necessary if this theory made any sense.  We have seen developing hairs that are miniaturized, most of these hairs become soft because they lose bulk.  I have oversimplified the premise, but you should read it to draw your own conclusions.

 

What happens with early balding in different Norwood Classes?

/by William Rassman, M.D./0 /

For men that experience AGA, does every single hair follicle in the respective balding area (based on their Norwood level) always eventually miniaturize and stop growing, leaving that area total hairless and bald? Or, in some people, can just a percentage of the follicles in those respective areas be afflicted while others in that same area are DHT resistant and never miniaturize? So like, for instance, let’s take someone with a Norwood 3 Vertex pattern; in the crown area, is it always a guarantee that every single follicle in that area will stop growing and leave a totally slick bald crown? Or can some of the follicles remain unaffected based on the person’s genes leaving just a thinned looking crown as opposed to a completely bald one? I ask because usually when I see receded or bald men, even elderly men with a Norwood 7, their bald areas usually aren’t totally hairless and slick bald. There’s still some remaining terminal hairs to various degrees in those spots.

You are astute in your observations:  Some men with Class 7 patterns may have a few remaining hairs right in the middle of the balding area.  I remember one man I transplanted who actually knew that there were 7 hairs in his balding pattern and gave names to each one of them.  Those with a Class 3 Vertex pattern may not develop complete balding of some of the crown, but most do, not necessarily enlarging the balding crown with a complete “Friar Tuck” look.  If I remember correctly, OJ Simpson’s attorney had a small completely Friar Tuck bald spot, seen from behind.  These Norwood patterns described are usually complete, but it may take years to get there.

DUPA over time, what happens?

/by William Rassman, M.D./0 /

With Dupa and Age related thinning, does every single follicle on the scalp miniaturize? And do the miniaturized follicles in these conditions eventually miniaturize to the point where they fall out and stop growing altogether like in AGA, resulting in a totally bald scalp (including the donor area)? Or do they miniaturize just to an extent but then stabilize and continue to grow at that level?

The best insights I have into this great question are from women who have it.  They are often older, and they usually do not bald from it.  I believe that these DUPA patients tend to be stable; however, since I interfere with the normal course of the disease with drugs like finasteride, I don’t frankly know what would happen if we just did nothing for these patients. I remember one woman who came to me with almost complete balding (donor area as well as the rest of the head), and she had DUPA’ however, since I never saw her when she was younger, I can’t comment on her disease progression.  She did report that the thinning was noticed after menopause. There is, of course, no comparable analogy for men.