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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 :(

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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.

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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?

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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 is recommended by the Hair Transplant Network.

 

 

Hair restoration physician - Feller and Bloxham Hair Transplantation

 

Previously "Future_HT_Doc" or "Blake_Bloxham" - forum co-moderator and editorial assistant for the Hair Transplant Network, Hair Restoration Network, Hair Loss Q&A blog, and Hair Loss Learning Center.

 

Click here to read my previous answers to hair loss and hair restoration questions, editorials, commentaries, and educational articles.

 

Now practicing hair transplant surgery with Coalition hair restoration physician Dr Alan Feller at our New York practice: Feller and Bloxham Hair Transplantation.

 

Please note: my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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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. 

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Dr. Blake Bloxham is recommended by the Hair Transplant Network.

 

 

Hair restoration physician - Feller and Bloxham Hair Transplantation

 

Previously "Future_HT_Doc" or "Blake_Bloxham" - forum co-moderator and editorial assistant for the Hair Transplant Network, Hair Restoration Network, Hair Loss Q&A blog, and Hair Loss Learning Center.

 

Click here to read my previous answers to hair loss and hair restoration questions, editorials, commentaries, and educational articles.

 

Now practicing hair transplant surgery with Coalition hair restoration physician Dr Alan Feller at our New York practice: Feller and Bloxham Hair Transplantation.

 

Please note: my advice does not constitute as medical advice. All medical questions and concerns should be addressed by a personal physician.

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