Your hair loss questions, answered daily.


If you have real benefit from minoxidil, the hair is usually dependent upon it. When it is withdrawn, these dependent hairs often fall out in about 2-3 months. Stopping this drug will not impact hair that is not-dependent upon minoxidil.


The data from the original studies on finasteride suggested that 1/4 strength (0.25 mgs) is effective at about 50% of the full 1mg dose.  So if you find that you can not tolerate the 1mg dose because of sexual side effects and that the 0.25mg solves the sexual side effect problem, then it is reasonable to take the drug at the 1/4 dose.


No. The real impact from finasteride comes not from blood levels (relatively short in hours) but from tissue fixation at the hair follicle level (at least a week of holding effectiveness). So actually the daily dose is not as important as the summary of a weeks dosage.


We see this type of result when men have large FUE sessions.  There is little doubt that this is a vascular problem induced by the FUE technique. The good news is that we can treat this very successfully with scalp micropigmentation, but the hair will never come back so the patient must style his hair appropriate with the treatment (i.e. very short or very long hair). The scars will not show after the SMP is done.


moth eaten scars following FUE megasession


“In a randomized trial of 138 older men with age-related low testosterone levels, those who received testosterone gel (AndroGel, AbbVie) for a year to attain youthful testosterone levels had a 20% greater buildup of noncalcified plaque in their coronary arteries than those who received a placebo gel[1].  These findings from the Cardiovascular Trial—one of the seven National Institutes of Health (NIH)Testosterone Trials (T Trials) examining different clinical outcomes in older men with age-related low testosterone levels who receive testosterone or placebo—were published in the February 21, 2017 issue of the Journal of the American Medical Association“.

Many men in our practice test their testosterone levels and find them low.  They then go on testosterone, most often in a gel (as reported above) and some of these men add growth hormones as well. Both of these medications make these men feel better, more vigorous and younger (they report this to me).  “Previous studies found that testosterone treatment in older men may help improve sexual function, mood, depressive symptoms, and possibly walking distance, but not vitality”.

“Men taking testosterone therapy face a significantly increased risk of blood clots in the first 6 months after starting treatment, warn researchers who say that previous studies may have missed the risk due to methodological issues. The research, which was published online in the BMJ on November 30, shows that the risk of venous thromboembolism (VTE) is increased by 63% in the first 6 months after starting testosterone therapy, corresponding to an additional 10 cases per 10,000 person-years.”

There is a reason why the body drops testosterone and growth hormone levels as we get older. When we take these medications, we are trying to be smarter than what our genetics and our physiology normally dictates. Is that really smart?


Most side effects go away when you stop finasteride, particularly the sexual side effects which might take a few weeks to go away. Rare patients report persistent sexual side effects but this seems very rare.  Sterility, is not a high priority on the list of side effects, but it may be real. Breast nodules and testicle problems often need to be addressed by a doctor


No, finasteride will not produce man-boobs, or in medical terms gynecomastia although the appearance of this problems does occur in about 1:1000 people taking the drug in the form of breast lumps


I have been asked over the past 20+ years if there is any dietary supplement that can be taken to treat Genetic hair loss. I have always said the answer to this question is NO.  Now a recent article in the Journal of Cosmetic and Aesthetic Dermatology published a pilot study suggesting that maybe there are things we can eat that will address our balding problem. The study is very limited so drawing conclusions is not warranted at this time; however for those of you who want to give it a go, here is the recommended dietary study.

On doctor in our field gave the following caution:  ‘The article states nutritional supplement contains botanical 5a- reductase inhibitors which they may need to disclose, perhaps active ingredients that would be classed as a “drug” versus nutritional supplements?  Also green tea has been associated with altered iron absorption, hence anemia, which can give an effluvium, so the ingredients need to be scrutinized more and stated specifically as they are generalizing the ingredients, which is of concern’.

It is also important to note that the authors have an ownership interest in the company (i.e. the product) so the author has to be a bit prejudiced in this report.  Click to enlarge!



It is important for people just starting with hair systems to know that hair systems, depending upon the mechanisms of attachments, often cause more hair loss.  Almost all forms of attachment cause hair loss, particularly glues which kill the hair in the area where the glue is placed, and with clips that cause traction alopecia unless that clips are constantly moved around.


Senile alopecia (a very bad name) is what you are talking about. I believe that every hair follicle on the body (scalp, beard and body hair in general) has  known life span. When it reaches this, a condition we doctors call Apoptosis (cell death), the hair may very well fade thinner and thinner over time. The good news is that you have to live a long time to see it happen. That is, of course, better than the alternative.


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