Say one starts taking propecia once minor thinning is first noticed in a young male the age of 19-20. Say propecia reveres the minor thinning and maintain the hair until your 50s. Is it possible to get off of propecia at 50 since Androgen levels are at their highest in our 20s-30s? I’m a 20 year old male with my juvenile hairline but with very minor crown (literally unnoticeable only to me it is) thinning…I’m hoping that could be the case for me and others in my situation. Also…is it likely propecia will work very well in my case?

Since the medication hasn’t been available for 30 years, it’s easy to see why there is no 30 year study available on Propecia (finasteride 1mg) to answer your question with any certainty. If I had to guess though, I would say:

1. Propecia will not usually stop the balding process over a 10 year time frame (let alone a 30 year timeline)
2. If it did stop the hair loss for 30 years and the genetic pattern was substantially more than you have now, then stopping the Propecia (even after 30 years) would cause accelerated hair loss

As to whether the medication will work “very well” for you, I couldn’t say for sure, but if you start taking it when the loss is early you have a great shot at seeing benefits, particularly since your loss is in the crown. Propecia tends to work best in the crown and for young men with early loss.

Hi Dr and thanks for your time.

I am a 34 year old male and have been thinning for roughly 12-14 years. I feel I used to shed ridiculously bad- I would tug at the hair kind of obsessively and lose around, I dont know, 100-200 per day. This went on for 10+ years but I have since slowed the loss to tolerable levels, say 5-25 hairs per day with improved diet (which I swear had a lot to do with it) and minoxidil 5% 1X per day. My main thin spot is on the vertex, or top of the head, not bald, but somewhat thin, where I really want regrowth. For the past 6-8mos I have been applying minoxodil 2X per day, and recently I decided to take propecia at .5 mg every other day.

I know people say it is hard to regrow hair lost years ago, but I have read of people who do it using finasteride and minoxidil. Have you witnessed this and if so what is the oldest hair lost you have seen men regrow? I have heard of people in their 40s doing this from 5-10 yr old hair loss… I am aware that all meds work better on people who have lost hair recently, and are younger. Also, if the placebo effect worked in some finasteride trials, (even if slightly) what is the power of positive thought here? Thank you very much.

I believe in positive thinking, but I can not say that I have seen it grow hair lost years ago. I think that everything you did has worked for you a little here and a little there — and by that, I mean the medication you’re using and when you stopped the pulling on your hair.

As for the oldest regrowth from finasteride that I’ve seen, well, I have a 79 year old friend who went on Proscar for his prostate and had the great unexpected cosmetic benefit of hair growth when taking a medication for his health. Generally speaking, this is a rarity.

A few days ago there was a post on your blog, the question was asking the effectiveness of finasteride in the time of a year, at the end of the first paragraph of your responce you talk about how effective it is in men at a young age unless they are headed for NW3 by age 23. Why is it different for men of that extreme case and what can they expect from taking finasteride? Is it pointless for them?

If there was confusion, allow me to clarify. Propecia should work better in men who are actively balding and have progressive miniaturization of their hair. The thicker the hair shafts are in the miniaturization process, the better the Propecia will work. People who have ‘twigs’ for hair (those at the end of the miniaturization process in the affected areas) or those who have completely lost their hair in the impacted pattern, are unlikely to get regrowth or thickening of the hair shafts, which is probably the way Propecia works anyway.

This drug may not work as well if you are heading to a Norwood Class 6 or 7 with existing balding areas, particularly if the miniaturization process is nearing the end of its process. For the very young man in his early 20s, advanced balding patterns are indications of an aggressive balding process and the drug may be less effective than those with mild (Class 3) balding patterns. If you lost all your hair in a Class 6 or 7 pattern or have been a Class 3 for years with little change, for example, Propecia probably will not be much benefit, because the hair is long since gone. Moreover, for reasons unknown, Propecia is reported to work best in the top/crown areas, not over the frontal areas.

My question is for Dr Rassman: I have a 15 year old son who seems to be losing his hair (from the crown only – mpb in the family). I understand that Propecia is not suitable until he is 18. Is it worth using Rogaine until then and at what strength? Based on your experience how successful do you think it would be in retaining the hair he has until he is old enough to try the Propecia?

I know you have to deal with many questions but I would be so very grateful for your reply.

A worried mum.

I am reluctant to recommend Propecia (finasteride) for someone that young, but I and many other doctors have done this provided that your family doctor goes along with it. I have allowed my young patients to use Rogaine (minoxidil), starting off with 2% and moving up to 5% in the crown, if his family doctor does not want to use Propecia.

One thing to keep in mind — benefits from minoxidil are not kept by finasteride and vice versa. In other words, if he sees positive results from Rogaine and then decides years later that he wants to take just Propecia, it won’t maintain what Rogaine has kept.