Out of curiosity, why do some men wait until they are in quite an advanced stage of male pattern baldness before they decide to do anything about it? Do you think it’s primarily down to fear over conventional treatments (e.g. finasteride side-effects), or do you think it’s just a failure to be proactive and not dealing with the problem until it’s staring them in the face? I’m of the opinion that the most effective way to combat male pattern baldness is to get on finasteride at the earliest sign of recession or diffuse thinning, but this doesn’t seem to be all that common.

This is a great question. Men exercise denial much of the time with their hair. That denial sometimes lasts into old age, as seen by combovers (https://baldingblog.com/wp-admin/post.php?post=36158&action=edit). We have seen many forms of Combovers, clearly starting early in the balding process. When I initially saw these men, I wondered if they saw what I saw and how ridiculous it looked, but then I realized that they never saw the change over the years. Some young men are more observant and willing to address balding early in their lives. Some men 16-18 may even be overly concerned, But at least they are aware of the possibilities, possibly because someone in their family has advanced balding, and they held this fear early in their life. Today’s facts of life (concerning hair, that is), is that if a man picks it up early, they can ALWAYS slow or stop it, possibly even reverse it. Denial is the enemy here.

To the people that affirm high DHT in the scalp is not a cause but consequence of AGA, why does lowering it throught medication seem to give positive results in most men?

The genes for hair loss are in both men and women; however, men produce significantly more testosterone than women. The testosterone is metabolized into DHT and DHT works on the genetically impacted hair follicle to cause loss. Finasteride blocks 70% of the activity of DHT on the hair follicle receptors, so it works well. If you gave a woman the amount of testosterone that a man makes daily, and she had the genes for hair loss, she would go through something similar to what you are now going through. The older she is, the worse the hair loss would be for her, as it might be for you if you (and she) have inherited an advanced balding pattern.  For premenopausal women, their Estrogen protects their hair from the DHT effect; however, when they pass menopause, they don’t have the estrogen protection and, therefore, might see hair loss, a common finding in ~50% of post-menopausal women. 

I’ve been on fin for 5 years now. My wife and I were blessed with the birth of our son yesterday. However something happened after he was born and the doctors went to check for any abnormalities. They said he was perfect and there’s nothing wrong with his junk! I’ve read so many random posters fearmongering over the years trying to connect a rat study that causes some issues to being a reason people should get off fin for months when trying to have kids. I spoke with multiple fertility clinics and physicians and none of them ever were worried about fin having an effect on fetal development. I asked multiple clinicians at the hospital about it as well after birth and they simply laughed it off.

I now have 2 kids that have been conceived on fin and I never took a day off. Please don’t go down the Reddit rabbit hole of listening to anonymous posters and go ask actual physicians if you’re ever worried. People try to correlate and spread fear, think for yourself and use common sense.

Today, doctors can’t advise a patient to follow your advice because, statistically, someday, some newborn baby will have some defect, and the father will blame the doctor who prescribed finasteride and the drug for the abnormality in his baby, regardless of your experience. I would rather refer men who ask me to read your post. Thanks for your openness.

I went to a dermatologist, and he did a biopsy after examining me.  When I came back to see him, he said I had scarring alopecia.  I am also balding and was considering a hair transplant to address my balding crown.  Can I go ahead with a hair transplant as the area he biopsied was in front of the crown, and it was very small.  

There are many causes of scarring alopecia including folliculitis decalvans, lichen planopilaris, and pseudopelade of Brocq, and many others.  You can expect that this small area may grow larger. Scarring alopecias kill hair follicles so transplanting your scalp is setting you up for a potential disaster.  Some of these conditions can be quite difficult to treat so stick with your dermatologist and stay away from any hair transplant surgeon that offers you a deal.

Good doctors look for problems when they examine patients. Any good hair transplant surgeon should come out where your dermatologist was.

Hi doc, sorry for bothering you but would be thankful for a reply. Do you think there is any credence to the theory that minoxidil causes premature signs of aging in the face?

There is no evidence from various research studies to suggest that minoxidil impacts collagen anywhere in the body, including the face.

If you’re a nonresponder to topical minoxidil, are you just clogging your follicles by applying it?

Your focus should be on switching to oral minoxidil as 40% of men are nonresponders to topical minoxidil.  Clogging your follicles doesn’t happen. 

Finasteride works as long as you take it.  It doesn’t always bring back the hair but it will slow or stop the hair loss if it doesn’t reverse it.  Your hair loss may be accelerating, so see a good doctor.