mahhong

Hi webapp, I would assume that a small rise in your DHT isn't going to be make a huge difference to your hairloss. It sounds like you had pretty low DHT anyway (in line with your T) so that extra 5 (considering an additional 45 to your DHT would still put you in the 'normal' range) probably isn't going to cause a drastic impact. Ultimately it's a case of monitoring your hair, though. If you notice a severe increase in hairloss then you may have to consider either finasteride or some other way forward. I would imagine, however, if it makes any difference one way or another that difference will be pretty marginal.

Yes, as Swimmy says, it differs. The trials were only carried out five years, so beyond that point nobody really knows in precise detail how propecia pans out. The assumption is it continues to work in much the same way but people report different things; some claim it's working for them 15+ years on, others claim it stops working anywhere after +5 years. I definitely wouldn't recommend increasing your dose of propecia. It won't help your hair anymore and the risk of side effects is increased - around 1mg is seen as the optimal dose, give or take.

You pictures do suggest you've had quite severe hairloss in a short space of time. This can be MPB but it can also be something like TE and, given the family history, I would say TE seems at least equally as likely at this stage (though I am not a doctor, so I can't offer any proper opinions, just my own uniformed one). Getting on the Rogaine was a good idea and let's hope that clears it up. Vitamins/healthy eating and generally keeping yourself well will also help if it's TE. You might also want to look into over-the-counter stuff like Biotin, which is useful in keeping hair healthy and hair growth (though you'll have to do some research on the forums and the internet about if and how to use biotin just to be on the safe side). It could potentially be stress accelerated MPB as well, so that couldn't be ruled out. I haven't seen such severe thinning in a long time but believe me MPB has been accelerated in the last 4 months by stress (though I am older than you - 26 - and my thinning has not been so severe, but it is fairly similar to yours). I don't know how feasible it is given your financial circumstances and current lifestyle but it might be worth visiting a second hair specialist if that's possible (perhaps one of the doctors recommended on this site)? The dermatologist should not be so quick to suggest you are lying or incorrect about the short time span this has occurred in. As you rightly say, whether she is right or wrong, she should be sympathetic to the problem and at least trust what you are saying. A hair specialist would be a better option again, but I appreciate that's a more difficult consultation to set up. An HT, as you say, is not an option at the moment, for both financial and medical reasons. Without knowing what's going on or waiting to see if the hair grows back an HT wouldn't even be thinkable, and at this stage is also not worth considering from your perspective. My gut instinct, but it is purely an instinct, is that this isn't an entirely normal case of hairloss. Unfortunately I think the only things you can do are eat well, take good supplements, use the rogaine and maybe look into any further supplements (such as biotin) that may aid hair growth. Other than that only time will tell how this situation resolves itself. It's not a good answer but I don't think there is much else that can be done in the short term because it needs to be established whether this is MPB/TE or temporary/permanent. Only once you have that info can further options be considered. Concealers, as I think I mentioned in my previous post, are also worth considering short term. Although your hair is thin you still have good coverage and concealers might get you through the next few weeks until you can start to get a clearer picture of what is going on. The rogaine usually takes at least a few months before it can start making any real impact unfortunately, so it's a waiting game. I hope you get a good resolution to this problem, but these forums will be a source of information and inspiration whatever happens, so I hope you'll keep everybody updated and if you have any other questions obviously just ask away - if I can answer them I'll try but, if not, someone more knowledgeable than me will be able to offer some help.

Very exciting but, as usual, best to see it in the longer term rather than wondering which day to book off next week to get the procedure done! This definitely sounds like one of the more exciting developments to have come about in the last few years, and is made more exciting by the fact that it offers a potentially 'full' solution to the problem of hairloss. Current drugs and surgeries, whilst fantastic, are essentially making the best of a bad situation. This sounds like, if it can work, the first genuine "cure" for hairloss in the making. That having been said this seems to be at least a short way off being a usable procedure. The major concern is whether it works in the long term. I am just listening to the presentation as I'm typing this but one issue I don't think has been covered yet is whether the follicle continues to be susceptible to DHT? I am talking purely as conjecture now but one problem I can imagine is that the follicle is essentially 'restarted' so that it grows thick, healthy hair but upon telogen and new anagen growth the hair gets progressively weaker again. I have zero science so I'm talking purely in terms of my own thoughts, but I could see that would be one problem that may or may not be present. The major issue is being able to accurately test the efficacy of this over time. That could, in theory, take a while, so whilst this is a genuinely exciting new avenue (and it's not very often we can say that) I think a bit of time is going to have to transpire before we can seriously start talking about this as a usable procedure. This stuff is amazing though, not just for hair but in general. It's truly of huge importance in surgery and it's very exciting indeed! There are, of course, many people with worse conditions than hairloss that could be getting huge benefit from this in years to come, so the double whammy here is what's good for us baldies is also very good for people with serious medical and cosmetic conditions!

Hi Dame, Sorry to hear about your hair problem, but you've come to a good place to get advice and help! This doesn't really sound like MPB, but it couldn't be entirely ruled out I suppose. Nevertheless for your hair to thin so much in 3 months is incredibly unlikely if this was mere genetic baldness and the fact you're diffusely 'thinning' rather than just receding/crown thinning would also add weight to the idea this was something other than MPB. TE is a possibility. Stress and illness related hairloss can occur and is relatively common and if your job and illness broke you down that much it could very well manifest itself as TE. I'm afraid I'm not in a position to give any specific advice but you've done the right thing in going to your doctor and getting some tests done. Although people on the internet can give you good, even great, advice, a proper diagnosis is important. If you don't get much joy with your doctor ask to be referred to a dermatologist who can give you a more thorough diagnosis and more information on how to proceed once you know what's up. The other advice, hard as it will obviously be, is to try and relax a bit and keep your stress levels down. Although I don't know much about TE I know that it doesn't have to be permanent and, indeed, your age and general health (I presume?) would go in your favour for being able to regrow your hairs. The main thing is to diagnose and get the best advice on how to treat your condition. There are a lot of options out there so try not to freak out about worst case scenarios as you have a lot of positive ways forward too, and you've made a good start by getting the test. In the short term (perhaps on the advice of your doctor) you could try a product like Toppik or Nanogen, which basically camouflages thinning hair. It can be used virtually undetected if you have a decent amount of hair (even if it's thinning) and might help you get through the next few weeks as you get diagnosed and sort out how to proceed. I'd recommend discussing that with your doctor just to make sure it'd be alright, but many people use these concealers and they're very safe. It's not an ideal solution but if this is a temporary problem they may help to cover up the thinning for a while. It definitely sounds like you need a bit of rest and just to get over your difficult summer. This could just be acute TE and there is every possibility you might see your hair growing back soon. Whatever the outcome, your doctor is the only person that can really take things forward in the first stage, especially because what is causing the problem is unknown. In the meantime you're able to post pictures of your hair up if you want people to take a look (there are some doctors on this forum that might be able to take a look; they won't be able to officially diagnose you but they might be able to offer a more objective eye than most of us). It's also worth finding out about any history of baldness in your family. This doesn't sound like MPB but knowing if and how your family lost their hair might help in any diagnosis. Apart from that try to eat well, sleep well and keep yourself as physically well as you can. Maybe get a good multivitamin and keep your diet clean and wholesome for the next few weeks, and exercise a little bit if you don't already. It's by no means a definite way to get your hair back but it can only help whilst the diagnosis continues! Hope everything works out well for you and I'm sure you'll have plenty of options once you figure out what's up. Let us know how you get on!

Hi Wolfgard, It's worth perhaps going to the doctor to discuss this as it does sound a little odd. Did you buy your propecia from a new place or obtain a new brand of propecia? This may have had an effect, or perhaps even another medical condition or physical issue is causing further hairloss? It is possible for propecia to stop being as effective as it once was. Propecia works by lowering DHT in men and, as a result, the follicles get less effected by DHT and thus are not 'damaged' as much over time. There will always be, however, DHT in the body (as this is necessary) and so over a prolonged period of time your hair follicles will continue to be affected by the DHT. To that extent it could very well be the case that propecia has lost its effectiveness for you, but it's really worth speaking to a professional before coming to that conclusion. Four months seems quite a quick period of time and if you started seeing major hair loss very quickly that seems a bit at odds with the way propecia works; though it's not impossible that it's simply the fact propecia has lost its effectivness. So yes, I would double check to see if the brand of propecia has changed (could be a suspect brand or problem with the drug itself?) and also see a doctor before making any decisions as they might be able to give you more information, diagnose if there is another problem or generally put you in the picture a bit more; they can also do blood tests to check DHT and other potential causes. If it is a case that propecia has simply lost its effectiveness as your hair follicles have succumbed to the remaining DHT then I don't know what choices are available to you (although I'm sure there are some): a doctor or, better yet, a hair restoration doctor would be able to tell you how best to proceed, although starting on rogaine is probably a good bet. Also, rogaine can cause increased shedding before you start to see positive results and this increased shedding can last for several months. I would imagine you'd have to keep on rogaine for at least another 3-6 months before you could potentially see any positive effect. I mention this because in the short term it might be making your shedding worse but could, in the longer term, be doing your hair good!

Hi snowguy, Sounds like you might be getting some growth in the hairline! It's not entirely uncommon for these drugs to improve your hairline (especially if you're fairly young and the hairloss has only been active within the past 5 years or so) and these usually starts as "peach fuzz" and then grows into darker and more substantial hair as the fuzz matures and the health of the follicles improves. In trials Minoxidil and Propecia were only studied in respects to their effects on the crown/vertex area. Because of this the drugs can only be advertised as having an effect in these areas, because officially there is little or no concrete data on the effects at the hairline. In reality, though, a lot of men post positive feedback about growth at the front of their hair and in the hairline so it's certainly possible you're one of them. In general these drugs tend to be 'not as effective' in the hairline/frontal areas as in the back, due to generally unknown reasons (though there are some theories), but I have seen very good results from propecia/minoxidil in the hairlines and frontal regions so stay optimistic and keep up with the treatment and hopefully in the next 6-12 months that peach fuzz will develop into much more susbtantial hair!

I believe most surgeons would tell you to take it indefinitely so long as you don't have any adverse side effects or problems with taking the drug. I know of some surgeons who have personally used the drug for a decade or more and will continue to keep using the drug, so I would imagine they would offer you the same advice.

Yes, this is very true. In some ways I think a good analogy is ivy and a tree in a forest, with a tree being a hair follicle and ivy being DHT. If you reduce the amount of ivy in the forest then the trees have a chance to stay healthy and grow properly for longer. They are, however, still being strangled by the ivy that's left and that means in time they will succumb to the ivy all the same. Finasteride works on a similar principle; it reduces DHT and therefore allows hair to grow stronger and for longer, but it's arguable and in fact somewhat inevitable that the DHT will win out eventually. For most men this is perhaps not an issue; it's possible the DHT will be kept at bay for so long that they'll spend the majority, if not the rest of their lives, seeing at best minimal disruption to their hair. Some men, by contrast, find finasteride barely works at all for them; their hair is so susceptible to the negative effects of DHT that even reducing it does very little for them. To that extent finasteride is, unfortunately, a makeshift (but nevertheless effective) treatment of MPB. It's really about symptom management rather than having any sort of curative intent, but it has offered a lifeline to many men and is probably the best recognised drug we have for hairloss.

I believe the official study was conducted over 5 years and found the vast majority of finasteride users (specifically Propecia, as it was a Merck commissioned study, though the results are likely true for all brands) saw either no further loss or minimal loss in those 5 years. Long term data isn't well documented and is pretty much anecdotal, though there are many individuals that claim finasteride has maintained their hair for many years over the 5 years studied - such as haircut above! I have read a fairly mixed bag of comments from people who have taken fin for 5+ years - some claim it has lost its efficacy the longer they use it, others say that have been on the drug a decade or more with no appreciable change. I think so long as you're on the drug and happy, you might as well continue to use the drug for the long term. Finasteride works by lowering DHT so if you stop using the drug your DHT levels will return to normal and any further hairloss will probably happen much sooner (even if ultimately it was going to happen anyway). With any luck finasteride will continue to work flawlessly for you for many years to come!

I am recalling from memory here and not a doctor or professional (in other words don't take my word as gospel!) but I believe that men taking propecia should tell their doctor before having a PSA. The doctor can factor in the fact that propecia lowers the PSA (and I believe they have a fairly good idea of how much propecia lowers the PSA) and can adjust the interpretation of the results accordingly. In other words as long as the doctor knows you're taking propecia or finasteride in general you should still be able to get accurate screening. As for the grade of cancer and a link to propecia, I'm not so sure. It would be very hard to set up a useful trial/research group that could accurately verify whether propecia was the cause of a general trend in higher grade cancers (but a lower trend in cancers overall). For example the higher grade cancer may be caused by factors not usually associated with 'normal' prostate cancer - in other words propecia is not causing anything at all, but that these men are developing higher grade cancer due to other factors (genetics, biological predisposition etc.). I would hazard a guess that propecia doesn't cause higher grade cancers but that those cancers develop through different or further means that propecia cannot guard against. In other words, these men were unfortunately at a higher risk of developing high grade cancer and the propecia had no additional negative impact on that. Of course I'm not a doctor and this is an uninformed hypothesis, but statistics and trials often reveal trends that look as simple as "this" may cause a higher incidence of "that", but in reality the cause and effect are much more complex and the trial/research is simply demonstrating an anomaly rather than causing it. Anyway, I'm rambling again! In short, propecia shouldn't make it harder to screen for prostate cancer and there is no evidence linking propecia to higher grade cancer that I know of (several trials have noted a correlation, but that is not evidence).

It could possibly be an early maturing hairline. Genetic balding essentially happens when genetically susceptible hair follicles are sort of "strangled" by DHT and other chemical and hormonal culprits. What happens is over time the follicle produces progressively weaker and usually smaller hair until eventually it might stop producing any hair at all. Seeing tiny "vellus" hairs in the hairline would indicate that's what's happening to those hairs. Most men - even those who don't go bald - end up with a slightly receded hairline. It's possible that your hairline has just receded at quite a young age. If you see no signs of loss in the back or any other thinning then perhaps that's all it is. Although in the last couple of years I have started thinning when I look back the hairline at the temples started to recede slightly when I was probably only 18-20. It didn't notice at the time (because I wasn't concered I was going bald) but in reality that was probably just my 'maturing' hairline (unfortunately my body has decided it wasn't mature enough and has kept going!). To some extent I think that was separate from my actual pattern baldness because I went between the ages of 18-25 without any appreciable further hairloss. Hairloss is complex but I wouldn't worry too much at this stage, just be vigilant. Feel free to post some pictures if you want more detailed opinions and, of course, get to a doctor if you want further examination. Although your Dad didn't start balding until his 40's you may not necessarily take his genetic traits with hairloss and you may experience more hairloss than him (or less, it's equally possible). Do you tie your hair back or keep it pulled taught in any way? There is the possibility it could be traction alopecia or something similar, though that doesn't sound like it's the case. Ultimately I'd say keep an eye on how things go but don't worry about it - chances are you're just maturing and your hairline is showing it, perhaps at a younger age than most. If it gets any worse or causes you too much concern, see a doctor and talk options!

Hi hairtopik, There is every chance that you could be a good candidate for an HT, but this is of course dependent on a lot of factors. The fact that you're unable to take propecia is something that would have to be strongly considered. As we all know an HT can replace some of the lost hair in balding/thinning regions but it cannot stop further hairloss from happening. In the world of hairloss you're relatively young at 28 and so, although nobody can say for certain how much hair you'll lose in your lifetime, there is theoretically a chance you could continue to bald for many years to come. It is possible (and in reality probable) you'd need multiple HTs over your lifetime to replace lost hair and, even then, with current technology we only have a limited amount of donor hair which needs to go around. In short the more natural hair you can keep the better, and propecia/rogaine are still the only two drugs really proven to have an effect. You don't need to be taking propecia to have an HT, but a doctor would have to plan for the possibility that your donor hair would one day have to be used to cover most of the top of your head. Issues such as density then come into play; if a doctor only has to fix a mildly thinning/balding head then they can possibly aim for higher densities in transplantation, but if the doctor is unsure how much further work you'll need they will need to plan conservatively in case in 5 or 10 years time, for example, you need a 2nd and possibly more HTs. In terms of recommended doctors there is a 'coalition' of recommended doctors on this site and that's a great starting point. You can get information such as their location, see their work and find out what techniques they use to make a choice about who to visit. They will give you expert and honest advice about what you can do and the results you can expect. Both FUT and FUE are good options with different pros/cons but as a general rule of thumb I would say the following applies to FUE: * It's usually more expensive (though don't make cost your main consideration - an HT is for life and needs to be right!). * The procedures tend to be smaller. These days FUT (strip) procedures can transplant thousands of grafts - maybe 3-6,000 in a single procedure. To my knowledge (though I am not an expert so best to research) FUE tends to be smaller procedures at a time, so you may need more procedures through FUE than FUT. * FUE is not scarless. I only say this because a common misconception is that FUE produces no scars whilst FUT produces big scars. It's probably true that an FUT produces a more obvious strip-like scar (though this is hidden by hair and, in the hands of a good surgeon, very thin and clean) but FUE also produce tiny, mottled-texture scars. These tend not to be quite as noticeable since they look more textured than scar-like, but make sure you're aware a scare is inevitable with HT whatever current method you use. These days scars are not a big issue; many people can shave their hair very short and not show either FUE or FUT scars. But they are always present and must be considered. Goals are also important. It's a harsh but simple fact that current HT techniques cannot restore a full head of hair and can, at best, usually only give somebody between 30-50% of their original density. In most cases this looks fine and patients are happy and a combination of good surgery and good styling means, to 90% of people 90% of the time, nobody notices and the illusion you have a good head of hair is maintained. But it is an illusion; if you run your hand through your hair, style it poorly or see a transplant in harsh sunlight it becomes clear you don't have a full head of hair. I only say this because I personally feel the first psychological step on the road to getting a successful HT is to face up to the fact you're not going to have a full, thick head of hair like you did when you were 15 or something. You need to be comfortable with the idea that, rather than regaining a nice thick head of hair, you're actually only getting an 'acceptable' cosmetic look. I don't say that to be harsh or undermine HTs (which can and often do look amazing). All cosmetic surgery is based on similar principles: you're not truly fixing the problem, you're very successfully creating the visual appearance you've fixed the problem. If you can deal with that, you might be a good candidate! Often, though, potential patients are disappointed when they start to realise an HT isn't going to actually take them back to 'how they were before'. What's probably more upsetting than losing your hair is not reaching your goals when you try to fix it. It's all about being realistic I guess. Of course we don't know what future treatments lie around the corner, and maybe the future is bright and restoring more hair at higher densities is going to be an option. But until the fantasy becomes a fact, we need to plan as if this is as good as it gets! Anyway, I have digressed a lot sorry, but for good reason. You actually have a decent head of hair at the moment. Yes, it is thinning and yes a HT would very likely improve it, but you need to weigh up a lot of factors to make a proper decision: how much will it cost, how much will your hair improve, what's the likelihood you will need further work, what are the implications of setting down that path etc. This forum is a great starting point but find a good doctor local to you (or somewhere you're happy to travel to) and get their advice. Make sure you can achieve what you want cosmetically and make sure you understand both the good and the bad. I'm not suggesting there are "bad" elements to a HT, they're very safe and very effective. But they do have limitations and our brains can trick us into thinking "once I get this HT I'll look perfect and be happy and it'll be worth the cost and the effort". The reality is there is a lot to consider and a good doctor will give you the truth and let you make a decision you won't regret, one way or another. Hope this helps a bit. Overall I'd say you definitely have a good chance of being a candidate for HT but go see a doctor, go see what you can expect to achieve and discuss your personal situation and make the best decision for you.

Excellent work! An undetectable result, which is about the highest praise you can give to a hair restoration physician! The patient must be thrilled with his new hairline!

Hey Guys, Just thought I'd throw this out there as I haven't seen it on these forums and thought some people may want to take a look. There is a company called Wellman who sell a range of multivitamins and general 'wellbeing' concoctions across the UK (I don't know if they are international). I noticed recently one of the products they sell is called Wellman Prostate. This is of course supposed to be a concoction of vitamins and herbs targeted at maintaining a healthy prostate but I decided to check the back of the pack, knowing that prostates and hairloss have quite a lot in common when it comes to human biology! The list of stuff in each tablet can be found on this site: ** link removed - please research the ingredients ** Interestingly it was pretty much a 'who's who' of reported alternative hairloss drugs: saw palmetto, lipoic acid, l-carnitine, l-arginine, green tea extract, pumpkin seed extract and many more. In terms of amounts found in each tablet there is information, but currently I haven't done much research about how much is in each tablet compared to suggested doses from hair loss sufferers. Anyway I thought I would bring it to the attention of the community since I figured it might warrant further exploration. Of course none of these herbs/vitamins have a proven effect on hairloss but given the link between prostate and hair loss, and given it really is a concoction of the most common alternatives to propecia and minoxidil, I figured it would be worth posting up. You don't need a prescription to buy or use them of course, and whilst I don't know much about Wellman they're a fairly popular and well advertised/funded multivitamins company here in the UK - certainly not a couple of guys operating out of a bedroom or anything. I can't vouch for them except to say I used their 'immunace' multivitamins for a pretty long time without any side effects or problems, which doesn't really count for much one way or another. Anyway I'm going to do a little research and maybe consider using them for a 3-6 month trial just to see what happens (I'm not currently using anything for my hairloss). I really wanted to post up here to see what people thought and particularly if anybody has a more scientific or researched opinion on whether there is a possibility they may be useful. It's clearly not a hairloss drug but I would hazard a good guess they're one of the higher quality, safer concoctions you could hope to find. Look forward to seeing if anybody has used them or done a bit more research on them. I'm on the fence but thought the list of ingredients was interesting enough to warrant further discussion!

Whilst I don't necessarily agree with ES's concept of depression I think he is raising a few points that are valid and need to be addressed with being honest about finasteride use and its potential (but not proven) link to depression. There is no doubt that depression linked to finasteride has been reported enough times to at least raise the possibility that there is a direct medical link between the two in certain cases. But there is also no doubt that depression can be more complex, and depression that seems linked to finasteride can in fact have different causes. If you start taking finasteride and start feeling depressed that doesn't necessarily mean finasteride causes depression. Just to take an example (not a particularly likely one, but to illustrate a point): let's say you are taking several tablets or have an undiagnosed medical problem and finasteride interacts with the medicine of problem to cause depression, most people would say "finasteride caused me to be depressed" and strictly speaking they'd be right. However, the cause of the depression may not be finasteride, but the combining of finasteride with another event or medication. To that extent, the depression is caused equally by something else and in most people finasteride may not cause the same problem. My point above isn't common as far as I know, but it demonstrates something; determining the root of depression (or the root of anything, for that matter) isn't simple. If you add "this" to "that" and get "X" result, that doesn't necessarily mean the formula is that+this=X. I understand this sounds pedantic, but its important in finasteride discussion because finasteride gets labelled by some quarters as a sort of devil's brew, but scientifically this has not been proven. Paracetamol can cause rashes in some people, but nobody suggests that paracetamol will cause you to have a rash. That's because in reality the cause of the rash is caused by a whole series of things, of which paracetamol acts as the trigger. Another problem is that tablets, especially tablets which induce a strong change in people, can be used as a psychological crutch on which to blame other problems. I'm not for a moment suggesting the link between depression and finasteride is psychosomatic, but I am suggesting it is a possibility in some cases. You meet countless people who, for example, may start taking a drug which can potentially alter moods. They may have a random bad day after they start taking the drug and instantly worry they are being adversely effected by it. This worry leads to a downward slope; suddenly they find themselves withdrawn from social situations by their concern and begin to get deeper into a funk. Then they start to become convinced there is a link between the drug they are taking and the way they are feeling. When they stop taking the drug they psychologically feel proactive and like they are shedding the problem; lo and behold their attitude changes, the enthusiasm returns and they get out of their situation. I'm not suggesting this is the root of all fin problems, but it's a possibility that, scientifically at least, has around equal merit to the idea that fin is a cause of depression. The simple truth is the situation is not black and white. Millions of men use fin without a single change either physically or mentally which by default proves that, at least alone, fin is not directly responsible for any one side effect alone, otherwise all users would be hit pretty equally and consistently with the same problems. In the same way that not all men receive equal benefits from fin, similarly not all men receive equal problems and, indeed, in the majority of cases, most men suffer from very mild or no side effects. It boils down, unfortunately, to personal belief and decision. If you feel fin is causing intolerable problems and that it is the root of the problems, then getting rid of it is a logical choice for you. I would urge people, however, to look at their lifestyles, perhaps their general health and other factors that may be changing the way fin works for you. There may be cases in which changing something else can get rid of problematic side effects without stopping fin, who knows? So, whilst I certainly don't agree with ES's opinion that depression is a bi-product of an 'industrial society (depression is found outside of the human species and, indeed, is a chemical imbalance that can affect many animals), he does make a point that the causes of depression are manifold and difficult to pin down. Quite often people find themselves getting depressed without any obvious reason and, it's only when they really analyse a situation, they begin to see a rich tapestry of problems that have culminated in very small steps towards depression. Finasteride may indeed, in some people, be capable of inducing a chemical depression without cause - but the science does not currently support that view and, indeed, the problem is not a pandemic that goes hand in hand with finasteride use. Most men do not suffer when they take finasteride. That makes it no less problematic for those that do, but it does suggest that there may be a delicate balance of many things that determine whether finasteride causes side effects. The jury is still out on fin for a lot of people, but I would urge everybody to be open and honest about the drug. My problem with propeciahelp is that it treats fin as some poison everybody on this planet would do well to avoid. This is an unfair assessment on a drug that, for many, has had excellent results with no appreciable negative effects. Similarly propecia is not some miracle in pill form - it causes hormonal changes to your body and no matter how calculated or understood, we mess with nature at our peril. Fin, however, is essentially no different to taking antidepressants, paracetamol or even good multivitamins. All cause changes in our body, all have the potential to be dangerous to susceptible people and all affect us individually depending on the makeup of our bodies and general health.

Depression is unfortunately an 'unofficial' but documented side effect of finasteride in some people. Of course, the debate stems from the fact that a link between depression and finasteride hasn't been scientifically proven in any great capacity, so from a strictly logical perspective it's difficult to say for certain fin is the problem. However many people swear it is and, of course, each individual probably knows their body and mind best. That having been said maybe there is the possibility for you to take fin but at a lower dosage? I'm not necessarily advocating you go back on it unless you're comfortable but I think that perhaps one of the key issues with finasteride is the 'blanket dose' that is recommended. If you take half the recommended dose, or even 2/3rds of it, you may find benefit to your hair without the side effects. It may just be a case of balancing it in your system. I think that labelling fin as black or white isn't very useful. Like all medication dosage, personal tolerance, lifestyle choices and many other factors play a big part in the effectiveness of the drug and its effects on each individual. The problem with finasteride is people tend to label it the devil or a miracle in pill form. In truth it changes your body depending on the dosage, and some people experience good effects, bad effects or both. To the original poster, I think the main thing is that when you stopped taking fin your depression went away. To that extent maybe (and it's a personal decision) altering your dose could find a happy medium? It would seem, worse case scenario, you try to find the happy medium, fail and then get rid of the fin and go back to normal. Both mindless negativity and positivity for finasteride aren't really useful to people looking for an informed decision. I agree that propeciahelp is a site to use with caution, not because I don't believe in the people who post on it, but because it has labelled finasteride a poison and refuses to budge on its position. Similarly people who post up saying they take 5mg of finasteride a day and suggest you put it in your tea and use it as a bath salt and snort it and so on are doing an equal disservice to the drug. Every individual will have a unique response to the drug and should maybe think of it as a give and take situation rather than an outright it does/doesn't work for them. As the moderators point out, I think being objective and rational is more useful than falling on one or another side of the fence and looking to snipe at every available opportunity. The truth is millions of men use finasteride and a large proportion of them seem to cope just fine with the drug. It has to come down to a personal decision on whether to ditch it, but maybe you could look into a different dose and just see if that makes a difference.

Certainly looks interesting but, as Future HT Doc suggests, I would urge major caution with any new treatment. The website I visited (the clinic run by the people who developed this) doesn't have a lot of good photo evidence. Also, being cynical but also practical, it seems to offer a suspiciously large range of plastic/cosmetic surgery procedures in a lot of areas other than hair restoration. I'm a little bit dubious they'd be able to offer excellent service in such a wide range of procedures whilst finding time to cure the world of baldness. I know I'm being cynical, but cynicism does pay in the face of uncertainty. That having been said it could be a very exciting and, more importantly, working treatment; who knows? We have to remain optimistic and there is so much movement on the stem cell front one gets the general opinion that there is starting to develop a genuine momentum in this line of treatment. It says on the website they're preparing to get patented and being considered for publication and presentation on an international basis. My non-professional advice, for what it's worth, would be that anybody who is considering this wait at least a year or two and see how things pan out. If this is a safe, easy, cost effective and actually working treatment it won't take long for it to go public in quite a big way. If and when it's becoming established as a genuine and safe way to restore hair then it's time to start thinking about ways forward. I'm hoping they post up some more thorough examples of the results soon. I'm always a bit cautious when 'revolutionary' treatments post up 2 or 3 photo comparisons because my gut instinct would be if this was a thoroughly tested, approved and used treatment there would be dozens of photographs of various patients and results. Of course it's a fairly new procedure so I could be expecting a bit too much, but any reputable HT doctor, for example, will have dozens or often hundreds of photo results to browse through because the work is good and is genuine. What I'm most excited about, overall, is the general increase of activity from lots of different research and development companies on this issue of injectable stem-cell based treatments. Whilst it doesn't point to anything definite, you just get the feeling some of this procedures and new ideas must be showing promise in trialling. I reckon we're still at least a couple or so years away from concrete usable treatments, but I do get the impression within the next five years we're going to have two or three really good alternatives or compliments to HTs, finasteride and minoxidil.

Hi Swimmy, Thanks for all this stuff. I've started going through all the sites and sources you've suggested and there is a lot of interesting reading. I must admit I hadn't heard a lot of the alleged links between insulin and DHT and it does make for interesting reading. That's not to say I'm completely convinced, but it's an interesting and somewhat plausible path to look into alongside existing hairloss treatments. You've obviously done your research on this so I'm asking some questions/concerns I still have in the hope you'll be able to answer some of them: Firstly, do you have any reason why you site finasteride as being hazardous to your health but believe Saw Palmetto to be safe and effective? My concern with Saw Palmetto is that, due to it's nature as a fairly unprofitable naturally occurring substance the clinical testing on it has been, at best, scant. Sure there are lot of 'reports' on the web but the only really reliable sorts of trials (and then 'reliable' is not an easy word to use) are large scale trials involving hundreds/thousands of people over a long period of time with thorough examination. I've read the odd report here and there but it's usually restricted to tens of people at most, or animals. Whilst these reports might have their usage they can't really be used to assess efficacy across the population. I was wondering if you had good evidence to demonstrate SPs effectiveness and safety. Secondly, why do you feel finasteride is damaging? Yes, there have been some horror stories, but to my knowledge the best these qualify as is hearsay. Now, of course we can take the alarmist opinion that the corporations are doing their best to cover up the harmful aspects of their drugs and I cannot outright dispute that, but do we have any real and well reported evidence fin is a widespread problem with genuine repercussions? I continue to find it difficult to believe fin is having such problematic neurological effects. Who is paying for good trialling that discounts the safety of fin? In addition have these neurological side effects been accurately documented in humans? And why would it be that whilst one DHT blocker supposedly causes all sorts of problems a theoretically more potent DHT blocker (Saw Palmetto) is, in your opinion, safe? Finally, the insulin theories and treatments you have been citing - why have these not come into mainstream popularity and dermatologists/trichologists keen to take these ideas and treatments on board? I find it difficult to believe that insulin has been discovered as one of the major 'smoking guns' of hairloss with good treatments and lifestyle-based ways of solving the problem, but that professionals generally haven't it on board. This of course could be a genuine case of the mainstream being slow to take on the avant garde but something strikes me as being odd that I have heard of very few reputable doctors talking seriously about these theories and these treatments. And, as an aside, do you have any photo evidence that the regimens and supplements you're suggesting are truly beneficial? The theories do have an air of plausability, but I could say that about many theories that end up being bogus or ultimately ineffective. A good range of visual evidence would, I imagine, be available if this insulin reduction is taking off and proving to be useful. I am intrigued by what you've brought up but this is, like many industries, a very fickle and dangerous one. There are lots of desperate people out there who want to believe anything and I've seen all sorts of sensible, coherent people reduced to buying literally stockpiles of vitamins, herbs, ointments, believing all sorts of combinations are working out when they're really not. Whilst of course I'm not suggesting this is you (you certainly seem to have been thorough in your research), I'm keen to find out how solid the evidence is for some of the theories suggested. Whatever people say about finasteride or minoxidil there is strong and widespread evidence both can work well, even if the opinions on safety and efficacy can range. This insulin theory merits further research, but I'm keen to know if there really is a movement here with evidence and supporters, or whether it amounts to a few quotable reports and a couple of claims of success from the odd individual here and there. I'm of the common sense belief (rightly or wrongly so) that, ultimately, if something works (or even looks likely to work), everybody and his bald uncle will be hearing about it pretty quickly. I'm not a subscriber that there's weird concoctions of emu oil and saw palmetto and this and that which offer magic cures or hugely effective advancements but the general balding public are 'unaware' of them. Of course that could always be the case, but this is not an industry that could sit on such effective treatments so quitely (nor would want to). You can argue finasteride and minoxidil are pushed by greedy corporations keen to make an impression on their customers and this is the reason for their success; you might even be right. I however, am still yet to be convinced that the only reason fin and minoxidil are so popular is because ultimately they still offer the best chance overall at hair maintenance and regrowth. If there are safer or more effective treatments out there I'd be incredibly excited but I'm wary of the idea of not considering conventional treatments in favour of stocking up on ultimately poorly tested herbs, oils and natural treatments to give them a try, That having been said I'm certainly going to start changing my diet. Primarily for my own health, as obesity and related illnesses have been in my family. I figure it cannot hurt to partake in a healthier diet that is more conducive to lowering insulin tolerance and would be keen on documenting how my hair changes. Believe me, the only reason I'm being so suspicious and questioning so firmly is because I want your ideas and suggestions to be right. My experience is don't try to prove a theory by finding evidence for it; try to prove a theory by finding evidence that goes against it. If you get to the point you can't make a strong case against your believed theory, you might be on to a real winner. It's always easy to want to believe and pounce on any shred of positive research but we owe it to ourselves to be suspicious and hopefully be pleasantly surprised!

There's some interesting information in the articles you've posted Swimmy, but in my opinion there are some big issues in those presentations too. Firstly, I don't really see how Saw Palmetto could be a 'safe' DHT inhibitor. It has to border on common sense that if finasteride causes side effects it's the lowering of DHT itself which is the problem? The major difference between finasteride and Saw Palmetto is that SP decreases two types of DHT - including one found in the brain (it's exact usage is unknown but it's commonly concluded it must have a use if it's in the brain). To that extent Saw Palmetto would seem the riskier option to me - especially when combined with the knowledge that extensive testing has not been done on it. I also feel there are some problems with the studies you provided. Although they are interesting and I don't doubt there may be some validity in them, there are problems in the studies themselves. For example the study related to insulin looked at just fifty one men, all over the age of 65. That is nowhere near a big enough cross section to prove or disprove anything. And therein lies the problem with many of these studies. Just because a study 'finds' something that does not make it proven. Studies cost a lot of money over a long period of time. Most of these sorts of studies take the form of small sample studies, where under a 100 people are examined over a short period of time (maybe a year or so). Whilst these studies might find trends and might suggest ideas, they don't provide comprehensive data. The independent propecia study looked at 1,553 between the ages of 18-41 over a five year period. Again, we can debate whether the study really was independent (although I have no reason to suspect it wasn't) but the fact remains that it was a large, long term study looking at a broad cross-section of males. The vast majority of supposedly contradictory studies usually look at either animals (which, although can be useful, are not a like-for-like contrast to humans) or a very small group of humans. If a study is to be serious it needs to be much larger in scope. The other thing is Merck have tested many drugs in a similar fashion, lots of which have not become approved. Whilst I cannot prove one way or another that Merck have any influence on independent studies it's hardly like they're bringing out all sorts of weird and wonderful treatments for a range of issues. Propecia was legitimately FDA approved and we could theorise over conspiracies which can never been proven of disproven, but ultimately I think it unlikely Merck managed to release a dangerous drug into the international marketplace illegally. As I say, I'm not a finasteride apologist and am keeping an open mind about whether it does have darker side effects or more prevalent problems than often reported. I do know, however, for the millions of men taking fin, a very small amount of them report serious and irreversible problems. There is no pandemic of finasteride induced ED and infertility, although there are enough reported problems to think seriously about using it I do concede. The supposed link between MPB and insulin seems unlikely in my opinion. Although I admit I have not looked at the trials you posted in a lot of detail I fail to see a major link between insulin and MPB. I mean, for a start, surely diabetics with low insulin levels would fare better in the hair department? I know you say insulin isn't the only factor but if it was that important surely we would see a more obvious link. As I say, I do find these reports interesting but they don't really convince me. I have no doubt eating properly and good vitamin supplementation will help keep your hair healthy and possibly keep more of it but it strikes me as odd that some people are happy taking half a ton of herbs, oils, vitamins and turning their diet upside down but won't consider using finasteride. I know plenty of people who eat terribly, have awful skin and are greasy but have a thick head of hair and are in their 30's or 40's. I don't think the answer lies in that direction, personally.

Firstly, I apologise if it came across I was calling you a liar or a 'fin hater', which I wasn't! I was just speaking generally about the more unbalanced views on finasteride I come across, of which yours is not. I understand what you mean about the testosterone/estrogen balance now. Although it might not be the major factor in side effects/problems with fin, I understand why you think it might be involved now. The study conducted on propecia was in fact an independent study to my knowledge and not conducted by Merck (which I'm sure would not be allowed). Whether or not the term 'independent' is an honest one is a topic for further debate, but similarly I think there should be some general caution when assuming a pharmaceutical company is the 'bad guy'. Yes I agree they are profit motivated but,ultimately, I would still stand by the basic argument that finasteride is a safe drug, or at least that the risk of using it is within acceptable boundaries. Regarding the 'studies' that say finasteride can increase chances of cancer or bring about neuro-degenerative problems I would be very dubious. These allegations may of course be true, but who is conducting these tests? Who is paying large amounts of money to conduct proper, full investigations into the negative aspects of finasteride? In addition to that the fact that propecia has only be officially on the market for 13 years as a hairloss treatment makes me suspicious as to how these allegations can be verified. The accusation of increased cancer is a particularly suspect one. Rigorous testing would have to be carried out on an individual basis to prove definitively finasteride increased the chances of cancer and I don't see how that sort of testing could have been done on a full basis without serious funds. If you can find the test I'd be interested to read it but I'm really dubious about it overall. My main concern with the dismissal of finasteride is really the alternatives people go for instead. I see people who dismiss finasteride as poison but go taking ridiculous amounts of saw palmetto, spiro and lord knows what else; dosing themselves up with herbs and oils. Anything 'natural' can be just as dangerous and unpredictable as anything produced by pharmaceutical companies and the true effects and reliability of these alternative therapies have not been studied or documented thoroughly. I think it's fine to dislike or dismiss finasteride but not at the expense of pumping yourself with a lot of "natural" remedies that could be doing just as much or more harm. Out of interest the people that you know who have stopped their hairloss without fin or minox; would you mind sharing what you know about the techniques and products they used? I'm always interested in hearing alternative regimes and have an open mind about the possibility that there are other effective treatments out there so I'm interested to know more.

I think some of your beliefs are a bit mistrued regarding finasteride. Firstly, I don't really know about where the idea of being estrogenetic (I assume you mean estrogenic?) comes from. Finasteride works by lowering (not removing) one type of DHT in your blood. This has the net effect of greatly reducing the rate of your hairloss and, with the case of some damaged but not dead follicles, maybe inducing new hair to grow. The best comparison I can think of is your hair being a tree and DHT being ivy. Finasteride removes a lot of DHT from your bloodstream and the net effect is the hair grows stronger and for longer. However, MPB is not that simple. Firstly there are lots of factors contributing to hairloss. There's two types of DHT, for a start, and the probability of numerous other hormonal and genetic issues that create hairloss. Lowering DHT does a great job of helping your hair but it doesn't stop balding. The truth is, however, DHT is still attacking your follicles, albeit in much less problematic amounts. Over time though DHT is still killing your follicles and if you start taking finasteride when you're 20 or 25, by the time you're 50+ it's likely you'll have lost some hair still (although not a guarantee, I must add). That's just mother nature, unfortunately. But your body doesn't build a tolerance to DHT or it has little if anything to do with more estrogen or anything like that. Your follicles are still getting damaged on a daily basis, but the extent of that damage is hugely reduced on finasteride and thus the sort of progress your balding makes in one year might take years longer on finasteride. Secondly, whilst of people have reported problems on finasteride, some extreme, we have no proof of long term of permanent problems strictly due to finasteride. In addition to this the percentage of people experiencing side effects in the real world is, frankly, unknowable. Think of it this way; if just 4 million people on this planet are using fin for hairloss (the figure, I imagine, is a lot higher) and the number of people experiencing side effects was just 2% (the rate Merck suggests) that would mean there would be 80,000 people with side effects. If just 20% of them voiced their concerns on the net (and I imagine the chances are it would be higher) that would be 16,000 people on the net with problematic sexual or other side effects. If you can find me 16,000 individual people complaining about finasteride on the net I'd be very surprised. That's not to say you're wrong, I'm just trying to bring some balance to the argument. Almost every reputable HT doctor on this planet is very happy (and indeed, insistent) to provide finasteride. People aren't dying because of it, or we're not seeing mass cases of infertility, ED or cancer (where you got the cancer idea from I don't know, the only connection between fin and cancer I have ever seen is that it lowers your risk of prostate cancer). I can't speak for the overall effectiveness or risk of using fin, but it is not "poison". I can understand why some people wouldn't want to use fin; it does carry risks (the severity of which are greatly debated) and it is a long term commitment someone may feel uncomfortable with. Many men have taken it for a long time with great results and minimal problems, however, so it is not a drug you can apply a blanket statement to. If you don't take fin, however, you're left with very little choice to combat your hairloss non-surgically. Minoxidil is useful but ultimately not as effective and other treatments (shampoos, spiro, herbs, vitamins, oils etc.) are not proven to have benefit - certainly none of them are going to turn you from bald to brad pitt in one easy move. If you have a HT without drugs you risk further loss in the short to mid term and that can negate the effects of an HT in the first place. I'm not "pro" fin, either. I am going to have to start using it soon but am, like many, quite worried about possible side effects. My concern, however, is a lot of the 'fin haters' come up with all sorts of weird and wacky myths and ideas about how bad it is and most of the time people who dislike fin end up coming up with some unproven or untrue reason why its so bad. The sort of hysterical hatred I see for it usually weakens the argument that fin is risky, not strengthens it. I know that for every one scaremonger who wants to tell the world how bad fin is there are 50 men out there who take the drug, live a normal life, and don't even know about the controversy surrounding it. Ultimately everybody is entitled to their opinion and I do understand yours, but I do feel that some of the "facts" around finasteride are not true and need to be cleared up, lest everybody believes it's some kind of sex drive assassin that only works for a year before turning you into an impotent baldy with no hope of a future.

I'd say there's every chance you may be a good candidate for an HT. You're of a good age with fairly minimal hairloss by some standards. I'm not a doctor though, so just stating my personal opinion! However I would imagine before you could seriously consider an HT you'd be best waiting at least 6-8 months (ideally a year) for the recently started propecia to kick in. You may find your crown fills in well and even your hairline could see a solid improvement. I would imagine a good doctor would want to see how you fare on propecia before really considering if a hair transplant would be of benefit. The other issue is how much an HT could make an improvement overall. Whilst you clearly have MPB style hairloss you've been relatively lucky, age considering, to not have receded and thinned drastically. A doctor may be happy to improve your hairline but I wonder if (especially without giving propecia time to kick in) the crown could be addressed. It would certainly be possible to add grafts into the crown but it may not be advisable or bring any extra visual density - the crown is a tricky one! I'm sure a doctor or more experienced patient will be able to give you a more thorough answer but my instincts would be you could potentially be a candidate, but waiting to see what the propecia does for you is pretty important. You may have staggering results on propecia and find you don't even need an HT (rare but it does happen). More likely you'll see a minor improvement to the hair and no further shedding, but it's important for a doctor to ascertain how propecia has worked for you before thinking about how they could transplant hair to improve cosmetic appearance.

Looks simply outstanding! And in response to the comments about effectiveness of propecia etc. I think the HT is primarily responsible for the transformation. Jo made a great point about how shaved hair can look very thin. David Beckham is an absolute prime example of that. His hair looks very thin when shaved but as it grows out it's pretty clear he has a full head of thick hair. This patient, to me, looks to be just the same. Of course propecia could have had an impact, but I think this is primarily down to fortunate patient attributes and world class surgery, with perhaps a bit of additional support from the propecia. Once again a great example of how to the best surgeons, formulate the best treatment plans and see them through as effectively as possible. This guy has truly incredible hair now, not just by 'HT' standards, but by any standards under which good hair can be measured!

I have read some incidents of using Nizoral causing shedding. How often are you using it? I think 2-3 times a week is the general recommendation but I believe Spex (a very knowledgeable guy in this area, his post is somewhere on this forum) has suggested maybe once a week or even a fortnight may be better (I don't recall his exact recommendations but it was substantially less than 3 times a week). Some men seem to get on fine with using it 2-3 times a week, others seem to be more sensitive to it. The good news is it would seem any shedding is temporary and you'll get it back no problem, but as with most sheds it might take a few months for the hair to go back to normal. Sounds like you may be a bit sensitive to Nizoral so if you use it maybe best to use it sparingly (maybe swap out the T-Gel for Nizoral once a week/10 days?). Overall though nothing to worry about, just one of those things unfortunately!