Hello Dr Rassman, I’ve had a lot of anxiety over finasteride not haunting my loss, it’s been 14 months since I started treatment and I’m unsure but do feel like my hair is worse than earlier this year.  What can I do?

Finasteride works, I believe, in 100% of men by either slowing, stopping or reversing hair loss. Your genetic balding may be moving faster than the finasteride is slowing it down.  That is a difficult analysis to make.  See an expert in hair loss like me or another hair transplant surgeon or dermatologist that has an interest in this problem.

Fantastic reversal of miniaturization. Because you are 18 years of age, your hair is very sensitive to the benefits of finasteride which easily reverses the miniaturization shown in your photo.

I have had well over 1000 patients on finasteride for more than 20 years. It holds onto their hair. I know that because a small handful of these men stopped finasteride, and within three months, they lost significant amounts of hair. Before stopping the drug, they had no further hair loss.

I have been taking 1mg finasteride tablets for the past couple years. I recently experimented with breaking the tablets in half (I have the white octagonal tablets), and my side effects went away. However, my hair also began falling out after 2 weeks. Does breaking the tablets in half affect how they are absorbed? I am not sure if these tablets have coating or not (it’s hard to tell, unlike the red tablets, which appear to be coated), but if they do, does the coating help the drug get absorbed in a more effective manner? Is it possible that by breaking up the tablet and exposing its internal non-coated portion, some of it is going to waste and I am not getting the full .5mg? If there is no absorption issue, is there any risk pertaining to the tablet contents not being dispersed evenly throughout the volume of the tablet?

If you reduce your dose from 1mg to 0.25 mgs, that will reduce the effectiveness of finasteride and could cause hair loss, as in your case.  Cutting the pills frequently is the way to go, so that cut pills are kept in an air tight sealed container and only done for a few day supply.  Never cut in advance for a month, for example.  

The only instrument I am comfortable with is the Dr. Pen device. It oscillates rapidly and I advise people who use it to (1) get the one with the most needles – i.e. 36 needles, (2) go to a depth of no more than 1.25 mm, (2) hold it in each position for 10 seconds. The goal is to produce a wound that goes below the epidermis to the top of the hair follicles, where there are stem cells that this process can stimulate. Once a week is adequate. I would expect bleeding when held for 10 seconds.

This is an older man, as you can see, because of his gray hair.  Finasteride works nicely in some older men. A 74-year-old friend of mine grew his hair back similar to this man’s hair growth when his doctor put him on Proscar (5mg finasteride) for his prostate.  Proscar is 5mgs of finasteride. 

Going to test this out – currently on oral min (just started) topical once a day and oral fin. I have a .5 derma roller in my cart but thinking that isn’t enough. I am nervous that a 1 will be too much for someone new to this but also want the best results. Any insight is greatly appreciated!

Microneedling is better than the dermaroller because you deliver a controlled injury, which will be therapeutic if you do it the proper way. The injury should be 10 seconds in each area and repeated every 7 days. I recommend the Dr. Pen device with 36 needles and 1.25mm depth. The body reacts with a healing cascade, which starts with bleeding, platelet aggregation, macrophage infiltration, new blood vessel formation, and stem cell growth, which stimulates the hair cells to regenerate.