Does fiansteride stop working over time?

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

I’ve been on 1mg finasteride since early august so over a month now. I’m 18 years old and I stared seeing results within weeks of starting it. My hair felt more full and thick and it showed clear signs of improvement.

Why do I feel like the effect has stopped. It feels like my hair reverted back to how it was before I started fin. Is it possible for fin to work well in the beginning and then suddenly lose effect in the span of a month? Am I doing something wrong?

Finasteride always works to slow or stop hair loss. Reversing it is another issue; however, if it looks like you are losing the benefits of finasteride, it may be that your genetic balding is accelerating. Finasteride is a competitive inhibitor effective at about 70%, so that action at the 5 alpha reductase level, doesn’t change as your hair loss gets worse. Dutasteride blocks the same enzyme at better than 90%, but that might or might not make a difference, so switching to dutasteride does not guarantee that your hair loss problems will be solved. Alternative medications such as oral minoxidil sometimes help as it is a different mechanism of action

Why would you have to take medications after a hair transplant?

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

Im acting a bit dumb in the title. I know that you should stay on medication after a hair transplant because otherwise the remaining hair might thin and fall out leaving you with patches of hair. But I also often hear that the transplanted hair will also fall out. Now this does make a little less sense to me when you follow the common opinion that the hair on the back of your head is more resistant to DHT. If that’s the case, shouldn’t they last forever like they do with most people (even with aggressive hair loss there remains the beloved „horseshoe“). This would only make sense to me if there was indeed another difference between the back and top scalp. Not to indulge in bro science but it seems to me that DHT sensibility isn’t the only thing here.  Am I missing something?

Although the hair around the back and sides of the head is generally thought to be lifetime hair, that may not be correct as people age.  This lifetime hair often reduces in numbers with age and hair thickness (Age-Related Thinning).  Now, from a practical point of view, the problem is not the hair transplants in a 10-20 year horizon for a young man having a hair transplant; the problem is with the residual hair as hair loss is progressive, so medications treat your remaining hair that may be impacted by the progressive nature of hair loss. 

Female hair loss reversal (photos)

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

I’m age 38 and started to use minoxidil 2 times a day as well as 1 mg Finasterid daily. I also do derma rolling with 5mm needles 2 times a week and take keratin vitamins daily. I wear my hair long and made huge progress.

This is an amazing reversal. I congratulate you for your persistence.  For my readership, pre-menopausal women must not get pregnant if they choose to take finasteride, or their baby may have sexual identification issues.  I would advise you to reduce your dermaroller depth to no longer than 1.25mm.  Longer, like the ones you are using, will likely cause deep scarring in the dermis. 

Some men suffer as they start to bald

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

 I’m 23 and in the past 4-5 months my hair got extremelly thinner all around, especially on the top of my head. I notice it when my hair is wet or when light shines onto it. My temples also arent doing great. My hairdresser and family say it isnt that bad at all, but i think they might be lying to not hurt my feelings. I try to convince myself that it is because of stress (i had a pretty rough year) but considering my fathers part of the family it might not be the case. Honestlly i have no idea on how to deal with this at 23, i know that i cant. It is already hurting my confidence big time, and while i already had a really hard time dating, it will now only get harder as my confidence will drop. I know that there are way worse things in life and many people go bald, but i just cant see myself adapting to being bald in the near future. Sorry for bad english or if this was a bit long.

With properly used medication, you can reverse your thinning at 23 with generally good success.  As a doctor, I do understand the self-image issue that is so critical to someone of your age: however, the good news is that you don’t have to experience balding with today’s many good treatments.  Most men don’t appreciate the easy reversal of balding at 23, so when they get older, the regrets often appear.  I hope you will not fall into this category of men and take advantage of today’s many good medications. Remember, only you are in charge of your future, so act now.

Finasteride and depressions

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

I have started taking Fin 1mg for the past 20 days. I was suffering from mild depression, nothing serious but last few days I am having more depressive thoughts. Does finastride cause or increase depression?

Yes, men who have depression might consider not taking finasteride and try oral minoxidil as an alternative drug, as finasteride can induce more depression.

Am I on too many medications?

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

I’ve been going to a doctor for treating my baldness. They prescribed me finasteride, some pills, some shampoo and asked me to test for vitamin D deficiency (I was deficient and prescribed me vitamin D pills). Next time I went to the doctor they asked me undergo Biotine PRP for each month for 4 months. Both meds prescribed so far and biotine PRP didn’t seem to work. So my doc prescribed more finasteride, some other pills and some kind of solution that I was supposed to apply on my scalp. Those too didn’t work. Then they gave me 5% minoxidil and 0.1% finasteride topical solution and it worked! My baldness is almost gone. My question is why did my doc prescribe me all the meds that didn’t work? Where they trying to see which one would work the best for me or were they trying to make some extra money for their clinic?

If you have a relationship with a doctor, ask him this question. Be bold and direct! Remember, your doctor works for you, and that is why you are paying him for his advice. 

Problems with my hair medication

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

ever sinc i started minoxidil it felt like i’m going somewhere but in the past 13 months i feel like it made it worse im on fin worked immediately and i felt great but its feels like im the past months it’s doesn’t effect me like at the beginning any tipps? im thinking abt hair transplant but what if my hair falls out and i only have a hairline and still be bald

You need to work out a Personalized Master Plan with a great hair transplant surgeon whose goal should be to maximize the value of medications, which might postpone a hair transplant. That is the way I practiced hair restoration for the past 33 years, and I still do it the same way.

Brazilian police officer dies aged 32 after hair transplant

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

https://www.nationalworld.com/news/world/brazilian-police-officer-dies-32-hair-transplant-procedure-4991733

We know that local medications like Xylocaine and Marcaine, which are used by dentists, dermatologists, hair transplant surgeons, and almost all doctors, have consequences when you don’t understand the side effects of these medications and how to manage these side effects.  I am not saying that this Brazilian police officer died from the improper use of local anesthetics, but an investigation is now going on.  About 20 years ago, we had a death just miles from my office in Beverly Hills during a hair trasnplant on a healthy man with two children, from a probable overdose of Marcaine during the hair transplant.
Brazil has some very stringent laws for hair transplant surgeons.  They must be plastic surgeons (5-7 years of residency), and the surgeries must be done in certified hospital or surgical center facilities.  We have seen recent reports of deaths in India, Turkey, and other countries in a hair transplant procedure recently. Just know that there is no risk-free surgery.  Ensure your surgeon is well-trained and knows how to handle any health problem that might arise when you get your hair transplant. 

Turkey has over 5000 Hair Transplant clinics

/by William Rassman, M.D./0 /
Beauty
LifestyleFashion & Beauty

The world hair transplant capital is in Turkey, but is clinics’ golden age nearing an end?

Istanbul is a hub for hair transplants, with 5,000 clinics seeing patients from around the world. But competition from elsewhere is rising.

Patients after hair transplant surgery in Istanbul, a Turkish city that has become a global hub for hair transplants. Photo: AFP

Men with bloody, bandaged scalps are a striking feature of Istanbul’s bustling cityscape, whether they are strolling along the shopping streets or posing in front of its landmarks.

The Turkish metropolis straddling the Bosphorus waterway connecting Europe and Asia has become a global hub for hair transplants, and is home to an estimated 5,000 clinics catering to patients from around the world. However, opinions are divided on whether Istanbul can maintain its crown as the world’s hair transplant capital.

Winter is high season for Istanbul’s hair transplant clinics, which operate at full capacity. One such patient is Aydin Kesti, a 27-year-old from Zurich, in Switzerland. He is reclined on a treatment couch, slightly dazed from painkillers administered via a drip, while medical staff meticulously insert hair follicles into his scalp.

A close-up of a man at a hair transplant clinic. Winter is high season for Istanbul’s hair transplant clinics. Photo: Shutterstock
A close-up of a man at a hair transplant clinic. Winter is high season for Istanbul’s hair transplant clinics. Photo: Shutterstock

He is doing this for his ego, he says.  “Everything was great,” he says about his experience at the hair transplant clinic.  Kesti has paired his procedure with a mini holiday in Istanbul, drawn to the city not only for its reputation but also by a recommendation that led him to choose the AsMed hair transplant clinic.

The demand for hair transplants has increased enormously in recent years

Dr Serkan Aygin clinic

The city’s many hospitals are no longer just dealing with scalp hair. Beards, moustaches, eyebrows and sometimes even chest hair are also treated, various facilities report. In some places, a nose job or other cosmetic procedure can be booked in addition to the hair treatment. “The demand for hair transplants has increased enormously in recent years,” the Dr Serkan Aygin clinic states. Surrounded by a lot of art on the walls, it is almost like an assembly line. Shaven-headed men sit at the clinic’s coffee bar waiting for the next stage of their treatment. Others have already undergone the procedure, as their blood-dotted scalps reveal.

Istanbul’s many hospitals are no longer just dealing with scalp hair. Beards, moustaches, eyebrows and sometimes even chest hair are also treated, various facilities report. Photo: Shutterstock
Istanbul’s many hospitals are no longer just dealing with scalp hair. Beards, moustaches, eyebrows and sometimes even chest hair are also treated, various facilities report. Photo: Shutterstock

Once a discreet procedure, hair transplants have become “mainstream”, the clinic notes. Patients now flaunt their new hairlines on social media, and many clinics collaborate with influencers to boost their reach. Women, too, are increasingly turning to hair restoration treatments, breaking a long-standing stereotype.  While Turkey’s hair transplant industry draws patient-tourists from across the globe, not every experience ends with picture-perfect results. Online forums reveal complaints about botched procedures: hair growing in the wrong direction, unsatisfactory density or transplanted follicles falling out after a few years. Still, Turkey’s reputation as a health tourism hotspot persists.

Plastic surgeons conduct hair transplant surgery in Istanbul. Photo: AFP
Plastic surgeons conduct hair transplant surgery in Istanbul. Photo: AFP

According to the state tourism association, 1.5 million health tourists visited Turkey in 2023, and hair transplants were the second most sought-after procedure. “There are as many good as bad clinics in Istanbul,” says Koray Erdogan, doctor and founder of the AsMed clinic. When he opened his clinic in 2001, removing whole strips of skin from the back of the head was common practice. At the beginning of the 2000s, the clinic began removing individual hair roots without removing parts of the skin and leaving a scar. It was a “revolution for hair transplantation”, says Erdogan.

The new method spread quickly in Turkey. In Europe and the United States, however, the trend faced scepticism. In 2011, when he presented his technique in the United States, he recalls that he was not taken seriously. “That worked in Turkey’s favour,” he says. Turkey’s willingness to embrace the innovation, combined with lower costs, gave the country a competitive edge.

Despite its pioneering role, Turkey’s dominance in the hair transplant industry faces challenges. Health tourism, once a booming sector, is not meeting expectations. Current figures are falling short of earlier projections, says the country’s Ministry of Health. According to the national statistics authority, Turkey earned around US$2.3 billion from health tourism in 2023 – this pales in comparison to forecasts from a decade ago, when the Tursab Tourism Association estimated revenues of US$21 billion to US$26 billion by this point.

Furthermore, Erdogan notes that hospitals in Europe now offer hair transplant procedures for around US$2,000 – a development that was unheard of just a few years ago. With affordable options closer to home, the need for patients to travel to Turkey is diminishing. “The golden age in Turkey is coming to an end,” he says.

Source: South China Morning Post

Female Hair Loss – What Causes It?

/by William Rassman, M.D./0 /
Our understanding of the pathogenesis of Female Pattern Hair Loss (FPHL) is still incomplete, and there’s ongoing debate over the role of androgens. Some researchers and clinicians argue that FPHL should not be strictly classified as Female Androgenetic Alopecia (FAGA) because, unlike in men, the direct link between DHT and follicular miniaturization in women is less clear. Here are some key points in the controversy:
1. Role of Androgens: 
a) Women with hyperandrogenism (e.g., PCOS) often experience hair loss, suggesting a role for androgens.
b) However, many women with FPHL have normal androgen levels, making some question whether androgens are the primary driver. c) Testosterone supplementation can accelerate hair loss in androgen-sensitive women, reinforcing the idea that even low androgen levels can trigger FPHL in susceptible individuals. 4
2. ) Finasteride & Dutasteride Efficacy:
a) Finasteride 5 mg daily has shown efficacy in treating FPHL, which implies that androgens may still play a role.
b)  Dutasteride, which is a more potent 5alpha-reductase inhibitor, has also been used in some cases with success.
c) The fact that Finasteride is now being explored for Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA) suggests it may have anti-inflammatory or other mechanisms beyond just DHT inhibition.
Ultimately, FPHL appears to be a multifactorial condition rather than purely androgen-driven, which explains why treatments like minoxidil, PRP, exosomes, or laser therapy can still benefit patients even when they don’t directly address androgens.
Dr. Ron Shapiro contributed the above post. 

Should I shave my head and forget about balding?

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

I’ve been thinking about shaving my head for a few years now. I’m 25 now. Earlier, I tried to save my hair with minoxidil, but I hated how it made my scalp drier and dandruff worse, and my hair constantly oily, so I gave up on it. So far, what has mainly stopped me from shaving my head is the strong opposition from my family (especially my mom and sister). My mom thinks I should be grateful as long as my hair is still growing, but I don’t feel comfortable with it. Especially since someone close to me reacted with a ‘Yuck’ when they saw it.

You may be a good candidate to reverse the hair loss you have with proper medication and a good doctor managing the process for you. You may only have one shot at this, so it is worth trying, rather than give up now. Eventually, a hair transplant may be an option as well as new drugs that may grow hair, which may eventually hit the market.