Finasteride Results - 1.5 Years

[HLPToronto]

I would also recommend you to stay the course. Also, I strongly feel that you initiating rogaine, continued using it religiously and all of a sudden stopped has something to do with the shedding cycle ( some contribution could be there ) 

 

let  us know what your dermatologist says, could be a scalp skin related issue

[AssaultedByDHT]

2 hours ago, Dr Blake Bloxham said:

Hi PA, 

So just to be clear: you started 1mg finasteride in July of 2018, and seemingly did not see any sort of initial shedding phase? By around 4.5 months post-op (November), your hair looked great and you appeared to be an excellent responder to finasteride. Then from November until now, you experienced gradual and worsening thinning to the point where you believe you have pretty much lost all gains? 

Typically people experience a shedding phase for the first 3-4 months; the follicles are somewhat "shocked" into a telogen phase (which lasts around 3-4) and then wake up and begin functioning better -- and growing stronger, healthier terminal hair as a result. If we presume that you did not experience an initial shedding phase but did experience one starting in November, it would likely end around March or so and should start exhibiting noticeable improvement by June or July. 

If you were my patient, I would probably tell you to wait 6 months from when the transition from Telogen (rest) to Anagen (growth) occurred. If we say the resting cycle ended in March, you would maybe want to wait until September before declaring that you have experienced no benefit from the finasteride. 

Now, how likely do I think this is? Probably not too likely. However, I have seen stranger things when it comes androgenic alopecia. 

I also think there is another possibility; and fair warning here: I do not think my experience and opinions when it comes to finasteride are necessarily as "main stream," but I feel pretty confident in what I have seen thus far interacting with thousands of hair loss patients over the past 5 years. 

I personally believe finasteride is a "kick the can down the road" type medication. In the end, androgenic alopecia is genetic. It is like your height, eye color, or any other inevitable physical trait based upon your genetic code. In the end, your genes are going to win out. You take a drug like finasteride and put someone on it while they still have a lot of their own native hair, and it may help them hold on to this hair or hold on to a greater portion of the hair for a longer period. In the end, however, they are still going to get to the same point. It just may take a little longer on finasteride. When you get to a certain point where you have already lost a good portion of hair or maybe the "horse is out of the barn" a bit, the drug tends to do less. You specifically may have been further along in the process, and there was just simply less that the drug could do. Maybe an initial "bump" was all that was possible before your body started making more DHT or expressing more DHT receptors in the follicles because that is its coded mission and there was not much you could do to slow it at this point in the mission. I know this is not the rosiest of theories, but I often find it holds water. While preventive medications are great and I always have a detailed discuss about using them with patients, they do have limitations and they cannot overcome what is hard-coded in your programming. Does this mean you should give up on it if you are not experiencing side effects? No, not necessarily. But it may be time to research other adjuncts (surgery possibly being one of them) to help. Just remember to play it safe and try to stick to tested and approved treatments. 

Again, the above is my educated opinion based upon my experience with the medication and hair loss patients. Other doctors may feel differently and they are absolutely entitled to their own conclusions based upon their experiences. I also say the above not to discourage anyone from using preventive medications; I do think they are useful adjuncts and recommend that all hair loss patients research and consider them. 

 

He is nowhere near baseline. His crown has pretty much filled in. And the density on the top is at least three times that of baseline.

[bonkling]

3 hours ago, Dr Blake Bloxham said:

Hi PA, 

So just to be clear: you started 1mg finasteride in July of 2018, and seemingly did not see any sort of initial shedding phase? By around 4.5 months post-op (November), your hair looked great and you appeared to be an excellent responder to finasteride. Then from November until now, you experienced gradual and worsening thinning to the point where you believe you have pretty much lost all gains? 

Typically people experience a shedding phase for the first 3-4 months; the follicles are somewhat "shocked" into a telogen phase (which lasts around 3-4) and then wake up and begin functioning better -- and growing stronger, healthier terminal hair as a result. If we presume that you did not experience an initial shedding phase but did experience one starting in November, it would likely end around March or so and should start exhibiting noticeable improvement by June or July. 

If you were my patient, I would probably tell you to wait 6 months from when the transition from Telogen (rest) to Anagen (growth) occurred. If we say the resting cycle ended in March, you would maybe want to wait until September before declaring that you have experienced no benefit from the finasteride. 

Now, how likely do I think this is? Probably not too likely. However, I have seen stranger things when it comes androgenic alopecia. 

I also think there is another possibility; and fair warning here: I do not think my experience and opinions when it comes to finasteride are necessarily as "main stream," but I feel pretty confident in what I have seen thus far interacting with thousands of hair loss patients over the past 5 years. 

I personally believe finasteride is a "kick the can down the road" type medication. In the end, androgenic alopecia is genetic. It is like your height, eye color, or any other inevitable physical trait based upon your genetic code. In the end, your genes are going to win out. You take a drug like finasteride and put someone on it while they still have a lot of their own native hair, and it may help them hold on to this hair or hold on to a greater portion of the hair for a longer period. In the end, however, they are still going to get to the same point. It just may take a little longer on finasteride. When you get to a certain point where you have already lost a good portion of hair or maybe the "horse is out of the barn" a bit, the drug tends to do less. You specifically may have been further along in the process, and there was just simply less that the drug could do. Maybe an initial "bump" was all that was possible before your body started making more DHT or expressing more DHT receptors in the follicles because that is its coded mission and there was not much you could do to slow it at this point in the mission. I know this is not the rosiest of theories, but I often find it holds water. While preventive medications are great and I always have a detailed discuss about using them with patients, they do have limitations and they cannot overcome what is hard-coded in your programming. Does this mean you should give up on it if you are not experiencing side effects? No, not necessarily. But it may be time to research other adjuncts (surgery possibly being one of them) to help. Just remember to play it safe and try to stick to tested and approved treatments. 

Again, the above is my educated opinion based upon my experience with the medication and hair loss patients. Other doctors may feel differently and they are absolutely entitled to their own conclusions based upon their experiences. I also say the above not to discourage anyone from using preventive medications; I do think they are useful adjuncts and recommend that all hair loss patients research and consider them. 

 

Dr. Bloxham, given that inevitably the medication can give way to genetics over time, do you think this could be an issue for those headed to a NW 6/7?

As in, for those with prospective aggressive hair loss, is a transplant without medication enough to secure a long-term result?

[Dr Blake Bloxham]

8 hours ago, AssaultedByDHT said:

He is nowhere near baseline. His crown has pretty much filled in. And the density on the top is at least three times that of baseline.

Apologies. Glad to see that he has obtained some benefit. I must admit that I have not followed the entire thread since the beginning. I was asked to review and comment yesterday, so I was playing "catch up" a bit and may have missed some of the gains. I still stand by the rest of my post, but I am glad to see there is some improvement from the medication. 

[Dr Blake Bloxham]

6 hours ago, bonkling said:

Dr. Bloxham, given that inevitably the medication can give way to genetics over time, do you think this could be an issue for those headed to a NW 6/7?

As in, for those with prospective aggressive hair loss, is a transplant without medication enough to secure a long-term result?

When I evaluate a patient for hair transplant surgery, I always do something in my mind: 

Regardless of how much or little hair loss the patient has or how adherent they are or are not with medications, I imagine they are going to progress to a NW VI and I will need to rebuild the entire front to back using only what they have in the donor area. In my opinion, it takes around 5,000 - 6,000 grafts to do this convincingly, and the average patient can do this via a combination of FUT and FUE. By imagining the patient will essentially lose all of their hair and I only have what is available in the true safe donor area, I can plan accordingly and not take any action that will put the patient in a bad position down the road. If we rely on things that may not be used or may not even exist commercially yet, we may get ourselves into a bad situation. If we "plan for the worst and hope for the best" and act in a conservative manner, I believe the average patient who theoretically will progress to a NW VI can be satisfied with surgery alone. I have done this on patients many times, and it works. So, I do think it is very possible and quite common to achieve satisfactory coverage for a high NW patient using only surgery. But it is imperative that we act in a smart, conservative manner and use the donor as efficiently as possible. 

[Sky_walker]

You are a very good responder to finasteride ,not always works so well.Great improvement 👍

[hairlossPA]

17 Month Update:

I am happy to announce that my hair is rebounding. Since August, I have seen significantly less shedding (if any at all), and my top is getting denser by the week. I will state that I started oral minoxidil August 1st. I am not sure if that is contributing to the regrowth/rebound or if its just a coincidence in timing of my finasteride shed ending. Personally I dont think its responsible for ending my shedding and giving me regrowth. I contribute it to the finasteride still and the hair growth cycle. I can't express how happy I am that things seem to be turning around. It really is an up and down roller coaster.

Pics attached below. 1 pic from July which was the worst point of the shedding. And some from before any medical treatment. You can really seem the improvement since July til now. I am still not where I was a year ago at the peak of my journey, but I am hoping I get there in the next couple months if this regrowth continues.

[hairlossPA]

Simple table to summarize my journey.

[AssaultedByDHT]

On 11/23/2019 at 7:07 AM, hairlossPA said:

17 Month Update:

I am happy to announce that my hair is rebounding. Since August, I have seen significantly less shedding (if any at all), and my top is getting denser by the week. I will state that I started oral minoxidil August 1st. I am not sure if that is contributing to the regrowth/rebound or if its just a coincidence in timing of my finasteride shed ending. Personally I dont think its responsible for ending my shedding and giving me regrowth. I contribute it to the finasteride still and the hair growth cycle. I can't express how happy I am that things seem to be turning around. It really is an up and down roller coaster.

Pics attached below. 1 pic from July which was the worst point of the shedding. And some from before any medical treatment. You can really seem the improvement since July til now. I am still not where I was a year ago at the peak of my journey, but I am hoping I get there in the next couple months if this regrowth continues.

Looks great! What dose of oral minoxidil are you on?

[hairlossPA]

9 hours ago, AssaultedByDHT said:

Looks great! What dose of oral minoxidil are you on?

thanks man. 1.25mg per day

[Lennney]

Thanks for update! That's great that your hair is rebounding, I too think that you just went through a shed, and now it's stable. I went through a similar shed around the 7/8 month mark with fin. I kept the dose and it seems to have gotten better. Your results are incredible from where you had started. Thanks again for documenting your journey.

[hairlossPA]

8 hours ago, Lennney said:

Thanks for update! That's great that your hair is rebounding, I too think that you just went through a shed, and now it's stable. I went through a similar shed around the 7/8 month mark with fin. I kept the dose and it seems to have gotten better. Your results are incredible from where you had started. Thanks again for documenting your journey.

Thanks man I appreciate it! I really hope it's stable, but I've read people going through multiple sheds before it evened out. Have you noticed another shed cycle?

[Mycroft]

I had a hunch it would stabilize eventually if you stuck with it. Any time I've started new treatment with any kind of efficacy the shedding has been insane, and definitely cyclical.

I suspect the minoxidil may have helped to speed up the regrowth process a bit although I wouldn't say it's the cause based on your previous postings. Great response.

[AssaultedByDHT]

On 11/29/2019 at 5:35 AM, hairlossPA said:

thanks man. 1.25mg per day

I have been on 5mg for a month. I'm sure it will kick in for you soon. You will soon experience the magic of oral minoxidil. Keep updating us.

[Lennney]

On 11/30/2019 at 6:03 AM, hairlossPA said:

Thanks man I appreciate it! I really hope it's stable, but I've read people going through multiple sheds before it evened out. Have you noticed another shed cycle?

I have only been on it since March, so only about 8/9 months. The shed occurred near month 4 or so. I'll post here if I have another. I feel like, maybe I'm wrong but, that was probably the worst shed I'll get. I can't imagine that there will be another shed that is so intense in such a short span of time (couple weeks). I agree with @Mycroft in that it's most likely due to starting a new treatment. I can't imagine another hair exodus matching what I just had.

[hairlossPA]

18 Month Update:

Coincidentally, as soon as I started feeling good about rebounding from my huge shed cycle, I am starting to shed again since beginning of December... hoping this isnt as bad and as long as the last one. I will keep this thread updated with how it goes but I have already noticed less density in the 1 month of shedding. And my hair never fully got back to 100% it was a year ago at its peak.

I've read about cyclical shedding and how the hairs are all on the same anagen and telogen timeline since being "rebirthed" and that is whats causing these big sheds and that it takes a couple years for them to gain their own independent life cycle to even it all out. Anyone have anything similar? Either way.. holding on tight to embrace this down-turn

Edited January 5, 2020 by hairlossPA

[pkipling]

On 1/5/2020 at 8:08 AM, hairlossPA said:

18 Month Update:

Coincidentally, as soon as I started feeling good about rebounding from my huge shed cycle, I am starting to shed again since beginning of December... hoping this isnt as bad and as long as the last one. I will keep this thread updated with how it goes but I have already noticed less density in the 1 month of shedding. And my hair never fully got back to 100% it was a year ago at its peak.

I've read about cyclical shedding and how the hairs are all on the same anagen and telogen timeline since being "rebirthed" and that is whats causing these big sheds and that it takes a couple years for them to gain their own independent life cycle to even it all out. Anyone have anything similar? Either way.. holding on tight to embrace this down-turn

I started experiencing (or noticing, rather) seasonal sheds in my crown/mid-scalp around 4 years ago - a year or so after my HT when I was taking Finasteride. I've definitely noticed that they've decreased over the past year and a half or so to the point that I've not visually noticed one in quite some time. However, I honestly have no idea why they seem to have stopped/slowed down. When I was experiencing them though, I do remember keeping in mind that it was most likely seasonal and that it would pass, and it did each time. Perhaps now mine have stabilized since the HT, perhaps I just haven't noticed it happening, or perhaps they were a side effect of the Finasteride. I'm not sure if I'll ever know the exact why, which is why formulas and explanations for these sorta things are tricky. Hope yours turns around. 

[hairlossPA]

Good to know. Thanks @pkipling.

I'm really interested to see how fast this shed stops/turns around. I recently got engaged and want to look good for the wedding planned for summer of 2021. I dont want the cycle to continue how it has (good in the fall/winter, bad in the spring/summer). I want to look good (obviously) for my wedding, so I am contemplating whether to ride it out, or get a HT this summer, to allow for 1 year to grow in.

[hairlossPA]

Almost 19 Months:

Still shedding a lot of hairs regularly. I know shedding doesnt always equal hair loss, but I can definitely tell in the density of my head that its weaker and weaker. A good haircut makes it feel better though. Some pics included. What do you guys think?

edit: having trouble uploading pics.. doesnt seem to be working..

Edited January 23, 2020 by hairlossPA

[hairlossPA]

[pkipling]

On 1/14/2020 at 2:55 PM, hairlossPA said:

I'm really interested to see how fast this shed stops/turns around. I recently got engaged and want to look good for the wedding planned for summer of 2021. I dont want the cycle to continue how it has (good in the fall/winter, bad in the spring/summer). I want to look good (obviously) for my wedding, so I am contemplating whether to ride it out, or get a HT this summer, to allow for 1 year to grow in.

Forgive me if I've overlooked this info, but have you had consultations with any top HT surgeons to get their input and guidance on how to best approach this? At this point, you have about 18 months before your wedding, so if I were you, I'd have at least 2 consultations with surgeons that you've vetted, researched, and feel good about and get their opinion on the best plan of attack... Getting more than one will also allow you to see if they recommend the same thing and are on the same page about the state of your hair and what's possible for you with hair restoration and how to make the best of your situation. Best case scenario, this is a seasonal shed and it all goes back to how it was when you felt good about it - but even if it doesn't, it seems like you have other options. (Congrats on the engagement btw!)

[hairlossPA]

@pkipling I had a consultation in August 2019 with @H & W Doug. Great guy and a lot of good information. This is when my hair was losing ground and at its lowest since having a great response. He said I could do either FUT or FUE. 3000+ grafts, rebuild the frontal 1/3, etc... He also had Dr. Hasson take a look at my pics and story. I feel very comfortable with H&W and the sort of results, patient care, and procedures they conduct.

I also had an in-person consultation with Dr Bloxham around the same time. He recommended strip, again in the 2500-3000 ball park. Another good surgeon.

It's just tough, because I don't want to get surgery if I don't have too, but the thought of killer results is always in the back of my head. I could look amazing at the wedding, or risk it hoping things level out with my cyclical shedding.

Edited January 25, 2020 by hairlossPA

[duchaine]

1 hour ago, hairlossPA said:

@pkipling I had a consultation in August 2019 with @H & W Doug. Great guy and a lot of good information. This is when my hair was losing ground and at its lowest since having a great response. He said I could do either FUT or FUE. 3000+ grafts, rebuild the frontal 1/3, etc... He also had Dr. Hasson take a look at my pics and story. I feel very comfortable with H&W and the sort of results, patient care, and procedures they conduct.

I also had an in-person consultation with Dr Bloxham around the same time. He recommended strip, again in the 2500-3000 ball park. Another good surgeon.

It's just tough, because I don't want to get surgery if I don't have too, but the thought of killer results is always in the back of my head. I could look amazing at the wedding, or risk it hoping things level out with my cyclical shedding.

I was in a very similar situation. I can tell you that HT is a pain in the ass, bro.

[pkipling]

On 1/25/2020 at 10:20 AM, hairlossPA said:

@pkipling I had a consultation in August 2019 with @H & W Doug. Great guy and a lot of good information. This is when my hair was losing ground and at its lowest since having a great response. He said I could do either FUT or FUE. 3000+ grafts, rebuild the frontal 1/3, etc... He also had Dr. Hasson take a look at my pics and story. I feel very comfortable with H&W and the sort of results, patient care, and procedures they conduct.

I also had an in-person consultation with Dr Bloxham around the same time. He recommended strip, again in the 2500-3000 ball park. Another good surgeon.

It's just tough, because I don't want to get surgery if I don't have too, but the thought of killer results is always in the back of my head. I could look amazing at the wedding, or risk it hoping things level out with my cyclical shedding.

The good news is you already have some solid consultations under your belt and they all seem to be relatively on the same page. That's reassuring. At this point, it's a matter of personal preference, weighing the pros, cons, and risks, and then trusting your gut and going for it. The only thing I would suggest in the lead-up to making a decision is doing whatever you can to be at peace with where your hair is now, so that should you choose to leave well enough alone at the moment and let things run their course, hoping for the best, that you'll be happy with the decision come wedding time. So much of dealing with hair loss (whether one pursues a hair transplant or not) is mindset, so focus there and I think you'll find yourself more confidently making a decision one way or another. 

[killa]

On 1/5/2019 at 12:09 AM, GrowNewHair said:

You don't need a hair transplant!!!!!

So glad for you. 😃👍

Depends on what hairstyle he wants to go for.

EDIT...

On the other hand it looks good as hell.

Edited February 4, 2020 by killa