mahhong

I've been a lurker on these forums for what must be a good 6-7 years now. Started losing my hair around 26/27 and joined these forums then to get armed with as much info as possible. At the time I never did anything about the hairloss, largely because I was concerned about side effects from oral finasteride. I did try the drug briefly twice and both times felt I had mild but persistent side effects, which resolved upon discontinuation (could have been purely psychological). I do believe it's a predominantly safe drug for the majority of people and am not a naysayer or conspiracy theorist, but I am still not entirely comfortable with the idea of using the drug in that form. Anyway, the obvious result has been that my hairloss has progressed quite significantly in the last 6-7 years and I'm now pretty thin on top. I'm probably a NW5 and still have just enough on top to use some concealer and make the hair look at least half decent - but I'm most definitely getting to the stage where I really have to do something, and am planning my first HT within the year. The first port of call is, however - medication! I've noticed recently that Hasson and Wong have developed a topical finasteride solution and, whilst I'm unsure about the oral version, the topical is definitely something I'd consider. If it's true it lowers DHT in the scalp but has much less of an impact on circulating DHT, that sounds fantastic to me. My plan is to get a baseline DHT reading, start the drug and then maybe get a second DHT reading 2-3 months later and see for myself. Anyway, my story over, I have a practical question. If anybody uses topical finasteride out there (particularly the H&W variety) - how long does it take to absorb into the scalp? The reason I ask is I obviously use concealer daily now and have no plans to stop (my hair would look dreadful). But I'd obviously want to know the best time to use the topical and how long before putting my concealer on afterwards, so as not to compromise the finasteride or just get the concealer all messed up! I haven't really been able to find an answer so far! P.S. - I've been lurking so long it's clear I've forgotten how this forum works - please feel free to move to the Hair Loss Drugs section if more appropriate!

Looks great - I think the key is in the hairline. Some SMP results have ridiculously straight hairlines, like a 14 year old's hairline on a 40 year old man. Your hairline looks fantastic. It looks full and non-receded but very natural and appropriate - a true "male hairline".

I think there are a few reputable doctors in Turkey, but you do have to beware as there are a lot of hair farms with very low standards. I haven't kept up with the transplant industry (just getting back into research now!) but I've been fairly impressed by Erdogan and Doganay based on early research. I haven't read any of these negative threads, however, I'm just going off their websites and prior reputation. I think it's possible to have a good HT in Turkey but research is definitely needed - there are dozens and dozens of terrible hair farms cropping up and Turkey is developing a reputation for them, so do a lot of research before you make a choice.

I have a suspicion Rooney doesn't use finasteride and that's been the real problem for him. I read rumours he started it in 2009 but I just can't see that he would have continued to lose his hair that aggressively over the next 7 years had he been on it. When he got his first HT he was around a NW5a with plenty of miniaturised but present hair over most of the top of his scalp, with very receded temples and fair crown loss. That was in 2011. He had a second procedure in 2013 but, to my knowledge, none since. The problem is I think he's heading for a fairly advanced NW5/6 and I think most of the miniaturising hair across the scalp has gone, plus the borders have receded opening up his crown more. He looked to be balding pretty much from his early 20s and never looked to have the best hair characteristics either, so there was always going to be a limit to what could be achieved whatever money he could throw at the problem. But I suspect the real issue has been he hasn't been on finsteride or hasn't kept up with the drug properly and so what he did have up top has basically gone. For my money I don't think it looks too bad, even though I'm confident he's got quite a lot of concealer over his scalp. It's definitely thin and sometimes harsh light or rain aren't particularly kind but for someone who I reckon is an out and out NW5+ now, he has decent coverage and can give the illusion of a decent head of hair with a bit of help. I'm pretty sure he'd be largely bald by now otherwise.

I think both seem like potentially interesting treatments - however it's important to note they haven't been rigorously tested in pattern baldness yet. Some men have reported anecdotal positive results from finding their own Seti or Bimatoprost, but there's a lot of testing to be done before they're guaranteed to be effective and the dosages etc. are established. I also feel that neither will be a cure, unfortunately - alone or together. I think the real hope is that these two will be of similar or slightly better efficacy than Propecia and minoxidil, but with an overall improved safety profile. Neither has any involvement with sex hormones, and overall they seem to be very safe. If they end up being as effective as the finasteride/minoxodil combination with less chance of serious side effects (and a fairly similar cost) I think that would be very exciting. Personally, I'm not sure I would wait until these two drugs are on the market. Firstly, there is no guarantee either will reach the market as pattern baldness treatments and, even if they do, there is no definite timeline. It could be 2 years, 5 years, 8 years or longer - although I would expect it to be less than 5 years if they do prove effective. And, of course, nobody has any idea what the cost would be - it could be the same as finasteride, it could be 10x more expensive. I am not on finasteride, out of some of the same concerns most other people have - but I am also realistic that there is no guarantee these newer treatments will be effective or available any time soon - though let's hope they prove as exciting as they seem.

The truth is nobody really knows, not even the company themselves. The early trials have been interesting but not spectacular, but a Phase II trial is needed to really get a sense of how well it works. Replicel/Shiseido have been talking up the product as being a potential complete solution for hairloss, but it's important to note a few things: First, it's too early to truly say. The data just isn't there and won't be until a proper Phase II trial is underway. Second, all companies talk up their products, particularly in the R&D stage, when investment and partnership opportunities are being sought and shareholders need to be kept engaged and satisfied. Judging from the limited Phase I information available, and a general understanding of how complex androgenetic alopecia is, my instinct is this will almost certainly not be a cure. It may help keep what is there and possibly introduce some regrowth or thickening of thinning hair - but I don't think NW7s will become NW1s anytime soon. That having been said, we really don't know. Something amazing could happen - but science usually progresses by baby steps and not giant leaps. Worst case scenario is the Phase II results are underwhelming and it doesn't even look as good as minoxidil or Propecia. I think the most realistic "best case" is that it is a safer, slightly more effective and cost-efficient treatment than any currently available treatments.

I think that's the proverbial nail getting hit on the head. It's all conjecture and opinion. Not baseless or uninformed opinion, but opinion nonetheless. Clearly there are a good many reputable doctors out there who feel FUE is a safe, reliable and effective treatment in their hands that can deliver good yield and large sessions, and who would appear to have the results to prove it. Clearly there are some doctors out there who believe the risk/reward ratio of FUE isn't up to their personal standards, making strip the preferred method in their opinion and perhaps relegating FUE to a procedure more suited to smaller sessions and more modest ambitions in their eyes. The only way any debate could be resolved or factually continued is scientifically - with data. As in a proper study of multiple FUE/FUT cases and a corroborated investigation into yields, graft damage etc. etc. with photos and factual reporting. I don't think this debate can progress from this point without more being brought to the table scientifically. All I know is that there are good results and high regard for Dr. Feller and the same for Dr. Bhatti, and that both are achieving them with a difference of opinion over which procedure they prefer.

It is a such a shame that things have descended to virtually all-out hostility. The bottom line is Dr. Feller's original post, whilst I believe well-intentioned and containing a lot good information, doesn't quite hold up in its entirety. That FUT is more popular than FUE I think is still fair - but that it is "by far" is more debatable. Plus, rightly or wrongly I think the popularity for FUE is rising exponentially, and I don't think that can be disputed. The other assertion that "no doctor can overcome the three detrimental forces", whilst again I can somewhat appreciate, is not verifiable unless scientifically studied. It is very clear the top-FUE clinics are getting pretty great results on a consistent basis (yes they may cherry pick the best results for publication; what clinic, FUT or FUE, doesn't?). It is simply not possible to state without reserve that a patient who had a good FUE result would have had a better result via FUT. And then of course you get into all kinds of muddy waters - who is to say a patient wouldn't have had a better result if they went to, let's say, one FUT doctor over another? All surgical outcomes are somewhat variable - I don't think it's fair to act as if FUT will always trump FUE. Then of course there are the other factors. Whatever the medical elements of FUE/FUT scarring, I think it's without doubt that the best FUE scarring blends more seamlessly than the best FUT scarring. This could be a major factor in the decision of an individual patient - the option to shave done, for whatever reason, may be something a patient values highly. Whatever Dr. Feller may feel about FUE vs. FUT scarring, the very fact he has developed mFUE is testament to the fact that the customer base for better aesthetic scarring, and the case for developing tools to achieve that, is clearly there. I think what is indisputable is that FUE and FUT can both produce great, life changing results - and both are (in the hands of the right doctor) capable of grafting a large number of donor hairs to varying sizes of recipient sites. There's no doubt that the best work of doctors like Lorenzo, Bhatti et. al compare with top level FUT doctors - I just don't think that can be argued with. You can assert, perhaps even with a degree of confidence, an FUT procedure would have achieved the same or better results with less risk to grafts, but you cannot prove that save compiling a large amount of data from a range of clinics. After all, 3,000 grafts from one FUT doctor may look very different than 3,000 grafts from another FUT doctor - it's not just about comparing FUT/FUE, it's also about comparing one individual procedure to the next. I think Dr. Feller made some good points, but I don't think anything was really proven. There are clearly doctors in both "camps" who feel they are capable of producing excellent results with either procedure, and proving that through their photo and video documentation. I don't know what else there would be to say - patients always have made their own decisions and always will. I don't think either camp has really come out "victorious" - and it's a shame in the meantime a lot of bad blood seems to have boiled over.

Great post. A lot of guys on here advise shaving down at least once and seeing how you feel about it, before taking the plunge into the world of hair restoration. I think it's brilliant advice - hair will always grow back (at least what hair you have left!) so for any man losing his hair (even those that aren't), it's probably worth trying the shave or slick bald look once. It works great for some guys and quite a lot of men say they finally feel free from the constant worry about how their hair looks, which can be a great feeling. Hair transplantation/medical intervention are wonderful tools, but they are not a panacea for hair loss and they are a commitment. Once you start the journey to hair restoration, it's very hard to go backwards and, for all the wonderful results and lives changed, there is a lot to consider and a lot to potentially dedicate yourself to (the cost, potentially a lifetime of medication, further surgeries, management of expectation etc.). I don't say that to put people off - it can still look great and it's still the right option for a lot of men, but understanding the ups and downs is vital. Shaving your head, on the other hand, is quick, easy, simple and cheap and can look great for some guys. It's low maintenance too. I think some guys think, before they try it, it might feel like defeat of some kind. But actually it's refreshing how many guys feel great about it once they get used to it and get comfortable about it. As others have said, it is about confidence. Plenty of guys out there will full heads of hair who have the same insecurities or lack of confidence about themselves as guys with no hair - and similarly there's plenty of guys out there slick bald, enjoying life, doing well and who are a force of nature when it comes to their own existence. The problem with balding is that, psychologically, it's such a weight for some men (even if it's nowhere near as big an issue for everybody else). They become more crippled by how they feel rather than how they look. Sometimes a simple shave of the head can restore that confidence and esteem, just by virtue of the fact that you're owning what you have (one of the most important lessons a man, or woman, can learn). Congratulations!

I was going to say the same thing! If you ever felt like it, SMP along with the transplants would look excellent on you (it looks excellent even after the first transplant). Looks like a great procedure, so I'm sure it'll grow out nicely and look great.

I don't think anybody is necessarily trying to say your fundamental forces argument holds no weight. It stands to reason there is the potential for more stress on the follicles. The point of contention is, are there doctors who have the skill and experience to overcome these? I think what Dr. Bhatti is trying to say, rightly or wrongly, is that there are surgeons out there who feel confident enough in their abilities and their results to claim these fundamental forces are not an overly detrimental factor in their performance of FUE. I think on balance FUT is still the more likely to produce consistent yields - but how MUCH more likely, I am less than certain. There are a few FUE-only surgeons whose work I admire greatly. It may be they are cherry-picking their best results and hiding the rest, but I am not in a position to judge that. I don't think it's that people can't follow the details, although as an out-and-out layman I fully admit I have no experience of either procedure. As I say, broadly speaking I am on your side - except that I do not think the discrepancies between top-FUE and top-FUT are as wide as you perhaps feel, and I do think FUE is becoming exponentially more popular and, even if that's not a good thing, it is something every surgeon will have to think long and hard about in the future (and ultimately, that was the title of the topic). Also, I'm not sure there has been any 'cover-up'. As Dr. Bhatti says, the original video is still online and linked multiple times in this thread. I can see where your suspicions are coming from but I think it's a bit full-on to accuse the doctor of an out-and-out conspiracy. I know you have disagreements and those are healthy, but you're both doing consistently good work, so it's a shame if what could be a constructive debate ends in out-and-out acrimony.

Let me start by saying I'm a fan of both Dr. Feller and Dr. Bhatti's work. This has been an interesting and at times informative debate, but it's also a sort of circular one. I think it's clear that Dr. Feller's assertion that FUT likely produces more consistent yields and exposes grafts to less potential problem is true - that's almost self evident. However it is also equally true that the "fundamental forces" argument doesn't hold up quite so well. It's clear that talented FUE surgeons are mitigating these issues and producing great results and good yields. Consistently as good as FUT? That's almost impossible to know short of a genuine scientific study of various clinics and their outcomes. I think it's also clear that FUT and FUE are much closer in popularity, with FUE seemingly on the rise and FUT possibly on the decline (at least as a ratio to FUE). Whether or not this is a good thing is another difficult aspect of this debate to draw conclusions about, but I think Dr. Feller's postulations do not quite hold up to scrutiny here. I applaud Dr. Feller for researching and designing the mFUE technique. Regardless of its eventual place in the clinic, any doctor willing to look at ways of pushing the envelope should be applauded. I too have some questions about its function, particularly as FUE scarring would appear to be one of the negatives according to Dr. Feller. One must ask the obvious question - if FUT is so clearly the gold standard, why attempt to innovate this way? It's a shame this thread has derailed somewhat, both between doctors and layman posters. It's very clear a back and forth discussion isn't going to conclude the issue. Every doctor has reasons to believe in their position regarding FUT/FUE and we must simply conclude that all the top recommended doctors are producing fairly consistent and quality results regardless of whether they perform FUE and/or FUT. The only way to try and advance this discussion meaningfully is scientifically. Some sort of blinded or controlled study would actually be very interesting and probably very useful too. I have no doubt this would be difficult to achieve as it would require funding, impartiality and cooperation from a plethora of clinics, but I cannot see how the argument could be settled otherwise. At 128 pages it would appear nobody has really budged and for obvious reasons - there is no data to back up assertions. Each doctor feels confident they are producing consistent results and offering the best to their patients. I think David, the moderator, makes a good and obvious point - there is no best. There is no right or wrong. There may be generalisations about yield and scarring and practices to be inferred but there and pros and cons and, like it or not, it's easy to see why FUE is growing in popularity whatever the outcomes. I do not think FUE would be growing in popularity at this rate if the results were consistently sub-par or undesirable. Perhaps we need a few more years to see what really happens? At the risk of sounding glib, I think those on either side must agree to disagree. From what I consider an impartial perspective, I cannot see how this debate could move forward.

You make some good points, but one of the important factors to bear in mind about these things is that there is a major difference between research and the products they may or may not eventually turn into. I think you're right in that a lot of the fundamental knowledge necessary to re-awaken dead follicles or to create new ones is there in principle. Although there is still work to be done, researchers like Jahoda and the team at Replicel and various other institutions have shown limited but promising progress in a whole variety of techniques - growing new follicles, stimulating old follicles etc. This research is by no means complete, but you get the sense the foundations are now firmly in place for several much more promising strategies to treating hair loss. The problem is, as usual, money. And not just money in the sense of funding research. Any promising new treatment has to be able to demonstrate several things: It has to be better, ideally substantially, than anything else in the marketplace. It has to be safe and demonstrate long term efficacy (no point having great hair for 6 months). It has to deliverable and cost effective in the marketplace as a product. The latter point is the issue that a great amount of promising research has trouble with. Some of the technology/research that looks promising in the lab just won't make it out as a product for a long time. That's not just because they have to go through trials, it's also because of the cost of rolling out a product and creating a workable profit margin that will give investors a decent return. After all if Replicel is 15% better than finasteride but costs $20,000 - well, you can see the problem. And the creation and implantation of new follicles would, even if it were possible, at this point in time simply be un-affordable as a product. Investors would quickly suss out there is simply no business to be done for a while. It's the same reason there are quantum computers hundreds or thousands of times more powerful than your desktop that you won't be able to buy for another 10 or 15 years. The technology in theory exists and is even being used in some senses, but as a product that could be sold at reasonable margins in a way that makes economic sense, we are a way from that. I don't mean to be pessimistic, and in fact I'm not. But that's where I think the word "cure" is to be used with caution I feel. I do believe that hair loss research is at an exciting point and I do think we could see improvements to what is available fairly soon - and frankly even a 15-25% improvement in available medical treatment could, when combined with surgery, be very exciting. But I don't think we're particularly close to injecting a full head of hair, unfortunately! Also, I don't really subscribe to some of the other suggestions by other posters that there is some kind of conspiracy to suppress a cure so surgeons can keep making money. Those kind of theories are always pushed - that doctors don't want to cure cancer or create exciting new stuff because it would jeopardize their practice. Things will move forward and progress will be made, but it takes time to turn ideas into research, research into workable treatment and, crucially, workable treatments into sellable products (whether we like it or not that's what everything has to end up being, particularly in cosmetics). Hair surgeons will be around for a while yet, but it's not down to any nefarious meddling on their part.

It's an interesting question - but if decent density can be regrown (either by creation of new follicles or the "reawakening" of dead follicles) I don't think having had a HT would make that much of a difference. If you think that HTs usually replace maybe 1/4 to 1/3rd of the original density, then essentially that's still around 2/3rds to 3/4s of your scalp that remain "untouched". Somebody posted the math up once (I believe it was from Dr. Rassman's Balding Blog) and, essentially, the chances of destroying a dormant/dead follicle were pretty low. If you're talking about how would you deliver the treatment in such a way you didn't end up with "too much" hair (imagine that!), I'm not sure, but ultimately I can't see it being a major factor. I have the slightly less optimistic hope that within the next 5-8 years we may see a couple of treatments that do the same or slightly better than finasteride/minoxidil but with a reduced side effects profile. Of course, I'd love a cure, but I think honestly hair transplantation will remain a necessary part of the restoration process for many years to come. But of course if we can find a way to generally halt hair loss and maybe get better regrowth than we do currently (let's say 20-30% regrowth on average), that would still be a massive step forward. Being able to halt hair loss and regrow, combined with hair transplantation, could essentially be a "cure" for men in the lower Norwoods, and produce cosmetically excellent results even in higher Norwood men. It might also, in the long term, open up debates and opportunities with things like expanding the donor zone, meaning more grafts available for transplantation. Either way I do hope and think within the next 5-10 years we'll be in a better place, but I'm trying not to think in terms of cure/no cure - I think it's more likely we will see gradual improvements and a better range of options, but I think men will still need to employ multiple strategies to achieve their goals - surgery likely remaining a part of those strategies for a while yet.

Unfortunately it's impossible to say. They used to say you had to look at your mother's father to see what hair you'd end up with, but that's not entirely true either. The genes for balding can come from any side of the family and would also appear to be able to skip generations. I'm no scientist, but I think the general consensus is nobody really knows exactly what's on the cards. All you can do is look at all the males in your family history and get a general sense - if everybody was a Norwood 1 or 2, there'd be a fair (but not definite chance) you'd be similar, if everybody was a Norwood 6 or 7, there'd be a fair (but not definite chance) you'd end up somewhere in that area too. My mother's father was a very advanced NW6 by the end of his life (virtually a 7, but I don't think he'd be officially classified as one). My father is a strange one - sort of a NW6 but with quite high sides, extensive crown loss but still a relatively intact forelock. His father would probably still count as a NW4 - he has a NW5 pattern but still has a fair amount of diffused hair atop his head. As for me, I'm certainly going to be a NW5 but, at 32 years of age, that could go further or could stabilise. I may keep some of the diffused hair on top like my father's father did, but ultimately who knows! Although none of these things guarantee in the slightest you can work out your hairloss pattern, here are some of my own anecdotal observations: I could be completely wrong, but I would say if you follow the genetic pattern of one side of the family more than the other, that might be a fair indicator of where your hairloss comes from. I am more like my father's side (broad, put on weight easy etc.) and I would tentatively conclude my hairloss is a bit like theirs too. If you have any old photos of your dad, grandfather, great grandfathers etc. have a look. For example my mother's father (the NW6/7) looked to have significant temple erosion by his mid-twenties, and quite extensive loss by his late twenties/early thirties. By contrast my father started to lose his hair more gradually around 25-26 (similar to me). His father looked to have a fairly good head of hair throughout his 30s and 40s, though was always slowly receding and getting a balding crown. It's frustrating, but the truth is nobody can tell you for certainty where you will end up, not even a professional unfortunately. A professional can maybe examine your hair and family history closer and give you some indication of what might happen based on where they see the hair thinning under a microscope etc. but even then they won't stand by their words too strongly. Hairloss is unpredictable and sometimes it can slow down, speed up, stabilise or seemingly restart after being stable. The best anybody can give you is an approximation. The more advanced balding in your family, broadly speaking the higher chance you will go the same. If it's a mixed bag of advanced balding and no/minimal balding, it becomes harder to say - your age, current level of balding and other factors may give a few clues but that's about it.

Never an easy question to answer and one which plagues many men (myself included!). I think it's worth starting by saying a great number of men take finasteride and see no significant side effects, or find the side effects to be manageable and non-important. However, I think it's also worth saying there is a growing body of evidence (admittedly mostly anecdotal, but not entirely) that the effects of finasteride can sometimes be far more serious than first thought, and appear to be long-lasting in a small minority of men. Whilst there may be a placebo/nocebo effect going on in some men, I think it's safe to say not every story can be attributed to this. The bottom line is, finasteride would appear to have a rare but real chance of affecting an individual quite badly, sexually and neurologically, and the long-term use of the drug and its various side effects have not been fully explored. That having been said, either the inability or refusal to take finasteride leaves you with a very real alternative scenario to think about - things could go a couple of ways eventually: You're lucky to have a very minimal balding pattern and a strong family history that suggests advanced balding is unlikely to be in your genes. You've already balded quite heavily and the hairloss appears to have stabilised for a period of years. I think the truth is for the vast majority of us in our 20s/30s considering hair transplants, the latter is the more likely scenario over time. Most of us are, in the fullness of time, likely headed somewhere towards the higher end of the Norwood scale, and there is no reliable test or examination that can say for certain which follicles will be affected and which won't. Now, it is of course possible to have one or more HTs without finasteride, but I think the frank reality is most good surgeons will be upfront about the facts: You will likely continue to lose hair over a period of months or years. That may mean repeat HTs and it may ultimately mean you end up with more demand than supply (i.e. it becomes impossible to truly give coverage and/or density to the whole of the balding scalp). Which leads on to: A conservative plan must be adopted that takes into account these considerations. No 60g/cm2 dense packing or low, straight hairlines, with a heavy emphasis on the framing of the face and a less radical approach for the mid-scalp and, particularly, the vertex. I think if both the surgeon and the patient are really in tune and aware of the realities, surgery without finasteride is possible. But everything becomes riskier - the chance of shockloss, the chance of multiple surgeries being required, the chance that more modest goals must be agreed upon. I'm in this very boat at the moment - I'd love to consider a HT but have tried finasteride briefly for two times a few years ago and both times experienced mild but persistent side effects that resolved after discontinuing the drug. Although I was fully aware it could have just been "in my head", I felt ultimately it wasn't a gamble I would take - especially considering it was a lifetime drug and to want or need to come off it at any stage would probably mean I'd lose any gains or maintained hair anyway. Of course, I've lost a lot of hair as a result of my decision. Now I'm looking into the possibility of one or more HTs to deal with that, but I also have to be realistic. I'm at least an NW5 and there would appear to be 6s and 7s in my family history. My educated hope is that I don't go quite down the same road (I say educated hope because my balding pattern doesn't seem to indicate that currently), but no doctor can say for certain my hairloss won't start creeping down the crown and sides in 2 or 5 years time. I'm sort of diffusing (with the crown and hairline the most affected), and there would appear to be a relatively stable horseshoe emerging out of that. I feel that if the horseshoe is stable, the chances of surgical hair restoration could be quite high and be successful. If the hairloss continues and my crown and sides erode further, suddenly that option becomes increasingly less likely to produce any outcomes I would consider satisfactory. So, no, you don't need fin. But just because I or anybody else says that, it doesn't detract from the reality that without fin you could continue to bald and bald extensively. And that your plan would need to consider all outcomes and contingencies - which may mean less coverage, less density or a more conservative approach to the design of the hairline. It's not easy weighing all these things up. The people who have a good experience with fin (probably most of those who have taken it) will tell you to jump on it and that's fair enough. However there is another side to that coin which would appear to be fairly tragic, rare though it may be. But that doesn't stop the reality from happening - without finasteride further loss is pretty likely, so you need to really think through how you plan your hair restoration if you're going to go on without finasteride.

The evidence does seem pretty clear that finasteride goes systemic even if applied topically. And because only a small amount of finasteride is needed to inhibit a relatively large amount of DHT, even a topical application would likely have similar effects to an oral medication. I think I'm right in saying applying finasteride topically MAY (repeat, may) make it more effectively locally (i.e in the follicle) and slightly weaker systemically - so there may be a slightly better balance. But I think that's mostly conjecture and, it doesn't stop the bottom line being that it will go systemic. Like Swooping said, I don't think a carrier will make much of a difference. Most drugs go systemic even when applied topically. What usually happens, though, is that the drug is much more active locally and its systemic effects are weaker (minoxidil being a case in point). Because finasteride is quite a potent AR2 inhibitor, it would appear not to make much of a difference. H&W have said those patients claiming they had side effects on the oral medication have not had side effects on the topical. This could be a placebo effect or there could be something in it, but I'm not sure they're going to look into that rigorously.

It's up to you, I guess. I think the general consensus is that Rogaine can produce some good results, but they're usually not particularly dramatic or as long lasting as with Propecia. Most people combine Propecia with Rogaine for the best results. I think if you've started using it, you should give it a fair go. If you really don't see any benefits in 6-12 months, then perhaps you could consider quitting it. Also, bear in mind often people go through a shed or a period where Rogaine doesn't really appear to be doing much. It could end up being more effective than it seemed at first.

That's how I felt after weighing it all up. I'm a lot more bald as a result, and it does make considering things like HTs riskier, but I figured what if I get on Propecia, get a HT or two a year later and it looks great, and then 4 years later find myself getting intolerable side effects from Propecia? I think it's fair to say most men don't have this problem, but some do. You do read a lot of stories about men having breaks, lowering dosages, having continued concerns etc. The only thing riskier than having a HT without Propecia is having a HT and then essentially being forced to stop taking it through circumstances beyond your control. It's important to say, though, from a hair perspective, it is a good drug, and about the only one we have at the moment that would appear to have a serious chance of slowing your hair loss down over a long period of time. I don't want to come across as hardcore anti-Propecia because there's a lot of men for whom the only effect is having a lot more hair. But the drug works by altering your endocrine system in ways that, ultimately, we don't yet fully understand, and that does concern me somewhat. I do think that solutions and answers will be found. As I say, I don't believe Propecia is a "poison", I just think some men have either a major susceptibility to endocrine imbalance or undiagnosed disorders that makes them extremely sensitive to Propecia. In the longer term though, I don't think that systemic DHT inhibition is the right answer to treating hairloss (local DHT inhibition is another story, but that's much more complicated). And, once again, Propecia is really a life-long, all or nothing approach. If I start it now, I could well be on it 30, 40 or even 50+ years later. I'm hoping that better solutions and less controversial targeted therapy will be available in the next 5-10 years. Nothing in the immediate future will be likely to seriously regrow lost hair, but if you can halt future hairloss, maybe regrow 10-30% of lost density with a safer treatment, and combine that with a good surgical strategy, it's not unfeasible to regain a good head of hair in the not too distant future. Of course, there are a lot of unknowns along the way, to see if we reach that point. Unfortunately, the only way to really save hair today is to get on Propecia.

It's a tough decision to make. I think the truth is that Propecia is likely to be tolerated by the vast majority of men who are taking it. You have to remember there are probably millions out there who are or have taken Propecia who do not seem to have seen any short or long term effects or persistent side effects. However, there is a growing body of evidence that sexual and neurological side effects may be more common and more damaging than first thought in a small but significant minority of men, and that they may be persistent in some men too. It's important to note nothing has been conclusively established. To my knowledge there is further work being done to establish exactly if and how Propecia causes these seemingly bad side effects in some men, and if anything can be done to prevent them or identify the men at risk. The long-term effects are even less poorly understood, and of course it will take longer to establish if there are any. There have been men on the drug for over two decades who appear to be doing well with no significant problems, but that doesn't guarantee the drug could be considered safe over the many decades you would need to take it to maintain your hair. I think, as usual, the truth is somewhere in the middle. I do not believe Propecia is "poison", as some would understandably but, in my opinion erroneously, suggest. But I do believe it can, for reasons unknown, have a significant and possibly persistent negative effect on some men for reasons not yet entirely understood. After all, it does fundamentally alter the balance of your hormones, which are a very delicately tuned ecosystem of your fundamental biology. And there is no doubt DHT and 5AR are potent and essential elements of a man's biological system - reducing it does not seem to cause problems in most men, but it is certainly not inconceivable it could cause major problems in a few. Ultimately, I think the bottom line is Propecia carries a low but not insubstantial risk of temporary or perhaps persistent sexual and neurological side effects - and there is a growing understanding that its effects on the body are perhaps more complex and more serious than was first thought. But, to balance that, there are a great many men all over the world taking the drug as athletes, scholars, professionals and more - so it is not true that the drug is destructive in a total sense. I personally tried it twice and got minor and temporary, but worrying sexual side effects. They resolved after stopping the drug both times, but ultimately I have not been able to bring myself to try the drug again. This is a personal decision - I have lost a lot of hair as a result of my decision (which is frustrating), but I just wasn't comfortable with the idea of taking a pill every day for the rest of my life with the potential consequences, even if the risk was small. It's a big commitment and if at any point I felt I needed to stop the drug in the future, I'd lose all my gains or maintenance - it's sort of an all or nothing decision. Carry on with your research - there are hopefully some quality studies concluding in the next year or so which may shed more light on exactly the risks Propecia might pose, and why it might affect a small number of men so seriously. These may identify ways to make taking the drug safer, or suggest ways to screen men. There will also, hopefully, in the next 3-5 years be one or two more treatments that could become a viable alternative to Propecia. This is very much unknown, but there is some encouraging research into new drugs (PGD2 antagonists, Replicel, Histogen etc.). However it's important to note none of these will likely be a "cure" to completely reverse hair loss, or anything close - but they could in theory represent safer and/or slightly more effective ways to treat hair loss than the currently available treatments. There is no guarantee at all that any of these treatments will eventually prove effective, affordable or even come to market however - so it's important not to assume there will be anything new any time soon, although it does look likely something will be here within 5 years.

That's going to be the really difficult part here; finding specific evidence of finasteride's involvement in depression, neurological impairment and sexual functioning issues. It's very difficult because those symptoms can all be part of a very complex series of biological and personal conditions. Nevertheless I hope some progress can be made and some ways and means of identifying those likely to experience symptoms found.

Indeed, I think the evidence is fairly clear that 5ar inhibitors can and do cause problems with sexual and neurological function on occasion - not in every man, certainly. Perhaps only in a very small minority indeed. But there would seem to be growing evidence that some men are deeply affected by inhibition of 5ar and that those effects can be long-term. I think a sensible study and investigation into PFS and who might be susceptible is more than warranted given the mounting evidence over the years. It would be fantastic if we could figure out who might be at risk from taking the drug, or if there are ways or means of limiting potential downsides or treating negative side effects.

nimrod - Firstly try not to feel so down. If you are having no side effects then there may not be any reason to stop. It's a fact that millions of men are on Propecia, and it's also a fact that the vast majority of them appear to have tolerated the drug well, with no major or persistent side effects. Some of these men have been on the drug for 10 years or more. There is nothing to definitely say that damage has been caused. Some men appear to not tolerate the drug well, or develop side effects, but we do not know if this is purely down to the Propecia or if there are other factors at play. Many other men, including many on these forums (such as yourself), have seemed to tolerate the drug just fine.

Sounds good - long may it continue for you! I agree that there does seem to be too much emphasis on finasteride (especially given the rare but serious complications it can inflict and the way it works). That's not to say I don't see the importance of finasteride - clearly holding on to native hair is better, particularly if you have the "black hole" that is crown loss. But I don't see how you can really factor finasteride into the long-term planning of your hair restoration. If you started taking it when you were say 20, surely at age 50 there's a chance much of what you held onto would have degraded or disappeared entirely. At that stage there's really only a few options; either you have or have had one or more further surgeries to deal with ongoing loss or thinning, or you've got to accept full coverage is no longer possible and likely emphasise the frontal third/half and essentially leave the crown to its fate. But my point is - those things surely have to be factored in even if you're on finasteride and it's working? Any good plan must always work on a "worst case" basis, so if a doctor tells you that you have 6,000 grafts but you're looking likely, or even just possible, you'll be a very advanced balding cases, they won't (or shouldn't) do a temporary fix on your hairline at 65 grafts/cm2 because finasteride is working. They would either recommend not going the HT route or having very conservative goals and maybe transplanting at 20-40% density, if that, and managing patient expectations. But if your doctor tells you that you have solid donor, that you might have more like 8 - 10,000 grafts and a relatively clear balding pattern appears to emerging, and that you're not under say 30 or 35, then I think a conservative but robust plan could be developed that would give a patient a good head of hair even if they lost all their genetically pre-disposed native hair, either because medication ceased to be effective or it was never taken. I'm somewhat biased because this topic is very pertinent to my case. I'm 32, have been balding for about 6-7 years but I'm somewhat hopeful my pattern is emerging. Although I have definite MPB, the hairloss was fairly diffuse across the balding area, and the strong "stable" zone doesn't seem to have changed from aged 27 to age 32, even though I've thinned out a lot in the balding area. Although I've lost a good amount of hair, I calculate I have something around a 170-190cm2 area of balding. Even if every hair went from that area, if I could get something like 8 - 10,000 grafts over 2-3 surgeries (be they FUT and/or FUE) I would be reasonably confident that would equate to a pretty solid restoration that would meet my goals - by no means a full head of hair, but full coverage at a good enough density to look natural and full (assuming all other characteristics are good). Of course, if there was a good chance I was heading to more like 230-250cm2 of balding area (based on examination, miniaturization mapping etc.), and/or that my donor wasn't up to scratch, I don't think I'd start down this road even if I took finasteride and it worked wonders. Personally I couldn't rely on medication as part of meeting my goals - especially one as controversial as finasteride.

The other aspect of this I've never entirely understood is; surely a hair transplant plan has to be relatively conservative and factor in the possibility that finasteride will one day become reduced in effectiveness, or ineffective altogether? Don't get me wrong, I completely understand the logic of finasteride - the more native hair on your head the better, that's clear any day of the week. But let's say you're mid-thirties, a visible NW4 and seemingly progressing, but you take finasteride and it arrests your hairloss, maybe even thickens up your crown and mid-scalp a little again. If you see a hair surgeon, they're not going to suggest jamming 6,000 grafts in your frontal third because your hairloss has been halted by finasteride. The plan is still going to need to assume that further loss is likely at some stage in the future, and the restoration is going to have to take into consideration the need for further transplants so that coverage and/or density could be returned at a later date if necessary. I appreciate a surgeon would make each procedure "stand alone" so that further procedures weren't necessary just to look natural, but it's a fair bet most men would commit to the idea of future procedures to deal with continuing loss or to refine existing work. And of course finasteride could become ineffective after 3 years, 5 years, 15 years, 20 years. Nobody could look a 35 year old man in the eye and tell him finasteride will maintain his hair until he's 55 - to that extent it seems to me you must plan for the worst whatever the situation, most of the time, in anything less than very limited balding cases with very encouraging family histories. I'm not saying "why bother taking finasteride?", of course. I understand from the cosmetic perspective that it's an important part of hair restoration because any hair you can keep is important. But surely you must always be reasonably confident that you have enough donor available to deal with any eventuality? A man who has a good or likely chance of ending up with 275cm2 of bald scalp and 6,500 grafts over a lifetime would probably never want to head down the restoration route even if finasteride was working well for him, unless he was happy with the possibility of very thin coverage at some point down the line (could be aged 70, could be aged 40). But a man who has a more limited likely pattern, say 180cm2, and maybe 8,000 grafts over a lifetime may be much more amenable to the idea of surgical restoration because even if the "worst case" pans out he could still end up with a good head of hair from surgery alone. I don't know, perhaps I'm thinking wrong about this, but it's always bothered me somewhat. Personally, I don't think I'd want to start down the transplant road unless I thought my goals could be reached even if finasteride one day stopped producing measurable benefit. If there was a fair chance I was going to be a NW6.5 - 7 with not particularly great donor reserves and characteristics, I don't think I'd take a chance on finasteride keeping me stable for decades. I'm 32 and concerned about my hair loss, but if at 52 I had a thin smattering of hair from transplants and finasteride wasn't really doing an awful lot anymore, I'm not sure I'd feel better because I was older. I'd want to know that good coverage and decent density was possible through surgical means alone and finasteride was a good adjunct to that, than the other way around. Perhaps I'm not thinking about it the right way, though! It is a concern - I am reluctant to try finasteride again and am leaning towards not taking the risk. But I would like to consider the transplant route all the same at some stage in the not too distant future. I have seen some encouraging cases of patients having great transplants without the meds, but I guess to go that route you need to really try and figure out how bald you'll be and what donor you have to play with. There's no point going down that road if you're going to be an NW7 and can scrape 6,000 grafts out of a measly donor area (at least not unless you have very conservative goals indeed; most younger men would probably be more ambitious), but if you're NW5 and have 9 - 10,000 grafts through FUT and/or FUE suddenly that looks like a plan that might work even in the absence of medication.