Hello dr. Rassman, I was wondering if its a good idea to treat thinning crown hair with exosomes and 1mg fin ED? I have no hairloss anywhere else and the crown thinning started like 1 year ago.

The problem with exosomes is that there needs to be clinical scientific evidence that expsomes work in treating hair loss. Currently, there is none. You end up paying a lot of money for it. Indeed, the doctor makes money, but you may get nothing from the treatment.  Recognize that it may not work. 

What are exosomes: Google defines it as: “extracellular vesicles generated by all cells and they carry nucleic acids, proteins, lipids, and metabolites. They are mediators of near and long-distance intercellular communication in health and disease and affect various aspects of cell biology.”  Every cell in the human body secretes about 20,000 exosomes each day. These exosomes ‘chemically’ communicate information from one area of the body to another. Even cancer cells secrete exosomes and, as such, contain the genetic codes for the cancers. 

What has been reported to me in addition to what I read are the following impacts on men’s semen: 1- change in consistency, 2- decreased volume, and 3- reduced sperm count.

Men wishing to have a baby should check their sperm count. If they find that they have a problem impregnating their partner they may consider stopping the drug with a risk of losing the hair you gained from it. I have seen some scattered reports that some men have seen such a radical reduction in sperm count that they would be considered sterile; however, stopping the drug supposedly increases the sperm count over time. 

I started noticing diffuse thinning when I was around 14 and four years later it has gotten more noticeable. I have been taking finasteride and minoxidil for 3 months and still waiting for progress. As I started thinning very early on, I’m curious to know if that affects my potential to see growth or my chances of responding. Anyone else have a similar case?

It is rare for significant balding in the form of recession and the development of a Norwood Class 3 pattern of balding or greater to be seen in a man under 18. Then, if you are on-top of it, you have a good chance at stopping the balding in its tracks.

I recently discovered that Dutasteride has a half life of 4-5 weeks. I am considering getting off of Dutasteride (daily usage for about 3 years) completely because I feel like it is heavily contributing to my anxiety (timing is very similar). I am on no other hair loss remedies currently but have had one temporal area hair transplant. If I discontinue Dutasteride or take it less frequently, what therapies seem to be working for people nowadays? With such a long half-life, couldn’t Dutasteride hypothetically be taken once a week or potentially less and maybe still have similar results?

In theory, you are correct; with a long half-life, one would expect that a once-a-week dosing might be enough, but for reasons I personally don’t understand, dosage recommendations have been more frequent.  As the FDA has not cleared dutasteride for hair loss use, this is a real problem for doctors, i.e. to find the correct approved dose.  The blood levels may have a half-life of 4-5 weeks, but the tissues in which the dutasteride is embedded have a much longer presence in your body that could go up to a 1/2 year or more. That means if you get side effects, it may be a long time to get rid of them because dutasteride is in your tissues 6 or more months. 

I take finasteride 1mg every other day for a year and just recently noticed that the hairline is thining.  What you would think it the best thing I can do now?

I would increase your dose to daily rather than every other day.  See if that makes a difference with the finasteride. You could add microneedling weekly.   

My hair is medium-coarse. I had two sessions totaling 5500 grafts.  Do you think that it too many grafts from my donor area? 

The men who most tolerate 5500 grafts excised from the back of the head are men with a coarser hair. That puts you in this category, so I would worry less, assuming that the FUE was done correctly with good spacing and no donor area shock loss.