Finasteride attacks the cause of the hair loss by blocking the enzyme 5AR at the hair follicle level. Minoxidil produces hair in anyone who applies it topically, some time just fuzz, sometime some hair. The drug finasteride is a better and a more assured way to slow down or stop the hair loss.
This is an interesting question. I have had the opportunity to try to count all of the grafts that I put in. Even with good photography, it is difficult. I had a patient a while ago who paid me to count the 6100 grafts that he had done. I took 3 hours, with grids drawn on his head. I counted only 1900 grafts, nothing close to the 6100 grafts he claimed he got. If I was off on my counting, I don’t believe for a minute that I would have been off by ~4000 grafts in my count. This patient came back 8 months later and I counted the grafts that grew. Mu original estimate was close to what grew.
The internet has spread a great deal of information and misinformation about Propecia (finasteride) which is much over-blown. You need to put the decision in perspective. The risk of these sexual side effects are between 2-4% depending upon the sources you read. My son has been on this drug for 15 year and found an increased sexual drive, not a decreased sexual drive which his girlfriend appreciated very much. How often do you hear about an increased sexual drive? Answer: very, very rarely.
If you were one of the unlucky men to get the sexual side effect, 99+ % of these men find that the side effects go away within 2 weeks upon stopping the drug. Some very small percentage report long term sexual side effects; however these risks are very, very infrequent (less than 1% of the 2-4% people who get negative side effects that persists). Many of the people who reported these sexual side effects may have had sexual dysfunction (normally present in 30% of men 40, 40% of men 40, 50%+ in men over 50) so it is easy to blame this drug for sexual side effects when reduced sexual drive is unfortunately, a sign of aging in many men. Rarely do we see this in 19 year old men, however, you can have a placebo effect if you believe you will be one of them.
The real decision before you, of course, is the problem of progressive balding which this drug is very effective in treating in men of your age. It even reverses the hair loss in many men under 20. You are clearly in the drivers seat, so be careful about what you read and put everything you research into a proper perspective.
We are clearly more informed today that previous generations have been so today’s young people think that balding should not happen today when in our father’s time, it was just an accepted fact. In reality, Dr. Otar Norwood published his balding patterns in in early 1980s. What he said is that men bald in patterns and these patterns of genetic patterns that we inherit. The few balding men who have very advanced balding patterns (Class 7 patterns), usually, but not always, have them by the time they are 26 years old. Many of the less advanced patterns take years to occur. The reality is that each hair follicle has a ingrained number of hair cycles in its life time. If you have a 3 year hair scalp cycle for example, and you have an advanced Class 7 pattern of balding, the number of hair cycles that are ingrained in the hair follicles are about 7-8 cycles, at which time the hair follicles die out (called medically Apoptosis). Drugs like finasteride (Propecia), alter the length of these hair cycles and that is why they have become very popular.
Stress does add to the causative factors for hair loss. We see this in stressed college students and/or people who have romantic relationships that fall apart so managing stress is important to hold on to your hair. I do not believe that today, we see more balding than 30 or 100 years ago. Balding is genetic.
Dutasteride has been shown to be about 85% effective in blocking the enzyme 5-alpha reductase which is the active enzyme where DHT causes hair loss. Finasteride (Propecia) is about 70% effective. If you decide to take Dutasteride instead of Finasteride, don’t take the two together, no need. There are more side effects from Dutasteride than Finasteride. Initial shedding has been reported with both drugs but the shedding rarely lasts more than a few months and reverses the hair loss when it occurs. As hair takes time to grow out (1/2 inch per month), you don’t see the regrowth very quickly.
I have published a post on baldingblog in the past which shows that Saw Palmetto has poor responses for people with BPH (Prostate problems) here: https://baldingblog.com/2012/01/26/2006-study-says-saw-palmetto-does not improve-bph-symptoms/
Body builders are at the same risk for sexual side effects as the general population from the drug finasteride (Propecia) which is between 2-3%. They are at more risk for hair loss if they take anabolic steroids regardless of the use of Propecia (Finasteride)
It is a known fact that hair has cycles between telogen (rest) and anagen (growth). The growth cycle of scalp hair is different than body hair. Scalp hair grows for between 2-4 years on average and rests about 6 months on average. Body hair grows 6 months on average and rests 6 months on average. Younger people have longer scalp growth cycles than older people so they can grow their hair very long. When Propecia works at its best (completely arresting the hair loss from genetic hair loss, not common but more common in young people), their hair loss from telogen returns to its normal cycle. Calculate that the average Caucasian has 100,000 hairs on their head (Asians 80,000 hairs). If they have a 3 year growth cycle, then they will cycle about 100 hairs per day which will fall out (most never seen as they come out through the day in the wind or in a shower, etc..) and they will regrow through out the day at a rate of about 100 hairs per day. These new hairs get buried in the forest of hair on your head so you never see them.
If the hair grafts are taken exclusively from the donor area (permanent zone), they will ?have hair that is resistant to males hormones. The wreath of hair around the side and back of the head, is permanent on 99+% of men no matter what they have inherited from the ancestors, these hair will last their lifetime. Although this is the written rule, occasionally we see some patients that may lose their transplanted hair and if they do it may result from: (1) miniaturized hairs in the donor area (often called DUPA or Unpatterned Alopecia), aging of the donor area (seen in men over 50-70 years old a condition that unfortunately bares the name ‘senile’ alopecia, in many women whose hair around the side and back of the head is susceptible to female genetic balding and for other unknown causes we doctors call the ‘X’ face, which means we don’t know.
When strip surgery is performed and it strip incision is placed in the lower border of this permanent zone, these hairs will be lifetime hairs. If however, a doctor pushes the number of harvested grafts and extends outside of the permanent zone to push up revenue as they charge per grafts which are worth more to the doctor, these hairs may not be permanent.
African American’s fall into two categories of hair types, somewhat related to where their ancestors came from. Those from East African (Ethiopia for example) have curly hair but not kinky hair while many from the Western part of African have a kinky hair. Kinky hair has the ‘kink’ extending below the skin so that unlike Asians and Caucasian hair which is straight below the skin. some of the African people with very kinky hair, when transplanted, create a challenge for the surgical team. For strip surgeries, when the follicles are dissected under a microscope, it is easy in skilled hands, to navigate the ‘cork screw’ appearance of the heavily kinky hair below the skin as the grafts are prepared under a high powered microscope; however, when FUE is performed, the procedure is somewhat of a blind procedure where the dissection occurs while the hair is in the scalp. As drills are most often the instrument of choice and as always they are very sharp, a ‘cork screw’ hair follicular group may get transected (cut) as attempts to core it out is done with a sharp drill. Some surgeons use special types of punches that do not use a sharp ‘drill’. We use, for example, a serrated punch without rotation as it is hand help. We FEEL the punch as we navigate the coring process. Others use dull rotating punches of different varieties that can often, but not always, manage successful coring without damaging the hair follicles while it is in the scalp. The ARTAS robot uses two punches, a sharp rotating drill for penetrating the skin and a dull rotating punch for the deeper dissection limiting the depth to avoid cutting the ends off of the hairs.
I have heard this from some patients that they feel that the generic drugs are not working as the original brand drugs worked. Generic finasteride drugs (Propecia or Proscar) are regulated by the FDA. Dr. Ready Pharmaceuticals, for example, is a major suppler of generic finasteride and I have check that the drugs that they produced are manufactured according to the FDAs Good Manufacturing Procedures. As a buyer, you can always use the more expensive brand name if this does not work for you. I am not equipped to tell what is the difference between two samples of finasteride. I know that there are, unfortunately, many counterfeit drugs on the market purchased through the internet without FDA overview.
You have to deal with your mother and possibly bring her to a consultation with a doctor who has experience with this drug to discuss the difference of opinion between yourself and your mother. If I were your doctor, I would encourage her to join us in a consultation. Maybe she knows more about you that is relevant to her concern, maybe she does not understand the real risks. Only a one=on-one meeting between your doctor and your mother with you present, is the way to manage this problem.
We are the doctors who first wrote about DUPA. About half of the men who have gone on either finasteride or dustasteride have had benefit of their DUPA (Diffuse Unpatterned Alopecia) so don’t give up and find a doctor willing to follow you with this routine.
William Rassman, M.D.
Depending upon your bone maturation, it may not be unreasonable to use the drug finasteride, but first where you are on YOUR growth curve (e.g. bony maturation) plus other factors relating to your hair loss are critical to understand. I belong to a group of 60 doctors who share a common email and the subject of young boys 15 and up and the use of finasteride has come up. With proper doctoring, this can be an option. The HAIRCHECK test is a critical first step in evaluating the degree of hair loss that you have. Many doctors may not want to use this drug on you so it is a careful discussion with you, your parents and your doctors that is critical in making such decision.
William Rassman, M.D.
I would suggest that you stay on the drug finasteride. If you stop it you will lose all that you gained and it may NEVER come back. Many of my patients who did just that, regretted it. You are one of the fortunate people who reversed on finasteride.
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