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Hello,

Could you please explain why propecia does not stop hair loss a lot more quickly? I thought it lowers the dht levels straight away so surely this should stop the hair loss.

Reversing the balding process takes time as the drug works slowly on the hair generating mechanism. Even if it fully worked in a day (ridiculous as this sounds), the hair grows from the scalp at a rate of 1/2 inch per month, so to see benefit for hair that is 2 inches long, you would have to wait at least 4 months.

Assuming that each month adds strength to the follicular generating system, and the delays in the time for the hair to grow out 2 inches, I would not be surprised to see the reports that it takes between 1 year to maybe even 2 years to see the full benefit of the process. This is, of course, what we see.

Have you done any SMP cases for the nape area or for patients with retrograde alopecia?

We have not performed SMP to the nape of the neck. We can grade the size and shade of the pigment to blend so that the nape of the neck will appear finer than the scalp hair. I see no reason why it would not work as long as the haircut can match the buzzcut look.

Hi, Dr. Rassman!

I am of asian race, and I’m experiencing great progress with finasteride, greater than in most of cases I’ve read. Since almost all users of finasteride I know are white, I wonder: Does finasteride work better in asian men?

I wouldn’t assume finasteride response is related to race. Based on what I have observed for over a decade of treating patients with this drug, there is no pattern on race.

Would you perform SMP on a young patient with a receded hairline just to fill in the receded corners, if he still wish to keep his hair longer? I mean to the point where these areas are covered anyway, to allow the option of shaving the head in future, or just to provide more coverage if the comb forward isn’t cutting it? I’m talking no more than an inch of recession either side.

If you are considering Scalp MicroPigmentation (SMP) then you should be prepared to keep your hair cut short (buzzcut with no guard). If the bald area is covered anyway, I’m not sure why you’d want to have it done. If it’s not covered, the hair should be kept clipped short to keep the pigmented area from looking abnormal. This might not be the solution for you, since SMP does not usually look as good in the hairline with hair kept long. It may work in certain case by case individuals, but it is not intended for the frontal hairline unless it is worked in conjunction with hair transplants.

SMP is not for a simple quick fix because as a young man, you need to consider more corner recession and possibly significant recession as you get older. This should should be considered permanent, so you would be committed to get more SMP procedures as you continue to bald.

Hi I have been on Propecia for over 5 years with little side effects except a little decreased semen. I missed dosing for over a week because I lost some of the meds. I started shedding alot but restarted my regime. Now I have premature ejaculation and a depressed mood. Is this temporary could stopping for 10 days and restarting have negative effects? Is it normal to shedding that fast from stopping the meds for 10 days? I was getting hand fulls

Your experience of these new side effects and hair loss is very strange only after 10 days of missing the Propecia dose. This drug, although out of the blood stream in 24 hours, remains ‘fixed’ to the tissues inside the cells for as long as a week. I have no answer to your question based upon how I know this drug works.

I would recommend that you follow up with your doctor.

Is blood in a person’s stool a possible side effect of taking finasteride?

No. Finasteride does not cause internal bleeding or blood in your stool. In general, blood in a person’s stool can be anything from hemorrhoids to cancer. I would follow up with your doctor.

Snippet from the case report:

The significant reduction in DFI within 3 months of finasteride cessation and continued improvement suggests a causal link between finasteride and sperm DNA damage. We hypothesize that low-dose finasteride may exert a negative influence on sperm DNA integrity, resulting in increased pregnancy losses. We suggest that in infertile men using finasteride, sperm DFI should be measured in addition to semen parameters, and a trial of discontinuation of finasteride may be warranted.

Read the rest — Finasteride-induced secondary infertility associated with sperm DNA damage

This is a single case report published earlier this year in Fertility and Sterility about a 48 year old man that shows a casual link between finasteride and sperm integrity. It summarizes that some negative impact of finasteride on sperm’s DNA fragmentation index (DFI) which was reversible with stopping the medication.

I’m asked all the time about finasteride and fertility, and all I can go off of is what is in the literature and from what my patients have told me. I’ve had many male patients with no problems getting their wife/girlfriend pregnant, but perhaps for men who are taking finasteride that wish to conceive children, they should talk to their prescribing physician about discontinuing the medication during the period of the female’s cycle between 11-21 days from the onset of menses. There is no assurance that such a step will address the problem identified in this article or that you will have such an issue to begin with.

In response to a recent post about stress hair loss vs genetic causes:

Dr Rassman,

What if it’s both? Then does it take one year still to see atleast a little reqrowth? You say a year, but in other posts you have said 6-12 months. Are you talking about how long it takes to first start growing, or how long it will take for the hairs to reach their previous length? Thanks

These numbers of 6 or 12 months are in the ballpark of what we see. It’s an educated guess based upon experience over a long time frame. Either number works, but clearly, if you see regrowth in 6 months then you’re on the lower end of the spectrum. Some may see regrowth sooner than others, but there’s no exact date one can mark on the calendar.

If you have stress induced hair loss AND genetic male pattern baldness, the stress might speed up the existing genetic loss. I really have no way to know if there will be regrowth (or how much) after your stress is under control if you have MPB also at play.

Do you have any recommendations for talented FUE surgeons in the New Hampshire area? Thanks so much!

I don’t have any personal recommendations for New Hampshire or anywhere in New England. The only hair transplant doctor I can endorse in the area is in NY.

Dr. Robert Bernstein, who I have personally worked with for over 15 years, is one terrific surgeon. He informed me that he just purchased the ARTAS hair restoration robot that we’ve written about.

Snippet from the article:

A hat may no longer be the only answer for baldness. Researchers at Yale University have found new clues to the causes of hair loss in the fatty skin cells of mice.

Studying cells from the fatty layer, the researchers found that signals from these fat cells were needed to stimulate the stem cells at the base of hair follicles, which are dormant in baldness. These cells could help scientists identify how to treat hair loss in humans.

“The fat cells are important for hair growth. If they’re not there, the hair won’t grow,” said Valerie Horsley, the lead author of the study.

Horsley said her team will now work on identifying the cells in humans that do the same thing.

Read the rest — Going Bald? The Fault May Lie in Your Cells

It’s another mice study, but it’s at least a place to start. As the article points out, hopefully it’ll lead to new discoveries not only for hair loss, but wound healing and skin tumors.