How Slowing Hair Thinning with Finasteride Depends on Severity of Hair Loss, and Other Factors


Thank you for your question.
You submitted your question without a photo. And you state that you’re 18-years-old and
you noticed some receding. And you’re asking can finasteride stop hair loss for life or
for at least 20 years. Well, I can certainly understand the basis
for your question and I can share with you a more global treatment strategy that I provide
my patients when I meet with them who are concerned about hair loss.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers. This
is a system we developed evolving out of hair transplant surgery using a material called
extracellular matrix with platelet-rich plasma (PRP) and we have been doing this since 2011
and have treated patients from around the world and have developed an algorithm. And
ultimately, have impacted the way hair loss is treated in helping patients who have previously
were limited to pharmaceuticals and surgery. So I would say that from our experience and
further just to describe what we have done, basically the concept of regenerative medicine
is being applied to help stimulate hair growth. And what we’ve learned over the many years
of doing this is to look at patients in a way that have to do with variables to help
us predict a responsiveness to this treatment. When we saw that in some patients after transplant
where we were using this material to help heal the donor area better, to help the hair
grafts survive better that thinning hair became thicker. From that, we were starting treating
patients of different ages, different degrees of hair loss both men and women and made a
lot of observations as to the relative responsiveness of different patients and ultimately came
up with an algorithm and a system of classification of patient profiles.
And essentially what I do is I look at patients from a perspective of gender, age, age of
onset of hair loss, degree of progression, rate of progression, other medical variables
and other previous treatments. And essentially, I look at what I think I consider in males
as a relative DHT sensitivity. So when you ask a question like you’re 18 and you’re
starting to recede, the question really is at what rate and are you still going to progress.
You have to understand also is that hair loss is not cured and so finasteride is not a cure.
It is a treatment strategy for managing the rate of progression. It is common for me to
see patients who have been on finasteride for 10-15 years since the drug has been made
since 1997 and they can look very good. And for them, in my mind, their rate of progression
is considerably slower intrinsically. They were put on finasteride, they stayed on finasteride
and what would have been a more significant progression, they were able to slow down.
Other people progress more quickly and they can look like they have very advanced hair
loss and yet they were also on finasteride for the same amount of time. So what’s the
distinction? The distinction is that the genetic pattern and the program is different between
those two patients. The strategy that I employ in my practice
to help people who come and seek attention because they don’t like the way they look
because of the amount of hair they’ve lost is to strategize particularly for men who
have anything beyond moderate to advanced hair loss or in that range is to use finasteride
when appropriate to reduce the DHT level and thereby improve the longevity of the hair
growth cycle. Further, since the goal is to maximize scalp coverage, what I have seen
is that being on a DHT blocker alone may keep the hair around but when we use Hair Regeneration
then that hair becomes thicker and therefore the synergy is actually quite significant.
So finasteride to reduce the DHT, Hair Regeneration to stimulate hair growth. Yes PRP, Acellular
matrix does have an impact on hair growth lifespan and certainly there is a potential
synergy in that respect and much of our patients are not on finasteride and have done very
well with the injection alone. However, when you look back at the work that
we have been doing, I’m talking about my own reflections on the many different patients
I’ve treated over these several years, I would say that it is clear that there are
going to be people who have a higher DHT sensitivity or whose hair is more impacted by DHT compared
to other people. And so look at anyone who is younger like yourself. I always think about
how aggressive that hair loss progression is going to be. And it’s very difficult
to anticipate that even with a family history. So I think that if the question is will finasteride
keep your hair forever, well the reality is that it depends on what your particular genetic
profile is. But I would say that it is important to recall
the original finasteride studies where when finasteride was given in one group and a placebo
was given to another group, when the study was actually stopped early because it was
obvious which group was getting the active drug, the placebo group got the drug but never
caught up in terms of hair count with the group that had the active drug. So the lesson
there is the earlier you start someone on finasteride, the better it is. Now of course,
that is with the understanding that a lot of people are afraid to take the drug and
that’s a whole other conversation that is in my opinion has not changed except this
growing perception of fear of sexual side-effects which is in my practice and in the practices
of my colleagues whom I discuss this with worldwide, essentially remains pretty much
the same. So I think it’s important to understand
everything, all the variables, and understand further that hair loss is managed. The introduction
and what has now become a growing practice of the use of PRP and Acellular matrix for
hair loss is another tool in the armamentarium of the physician who is trying to help patients
with hair loss. Remember, hair loss is being managed. It is not being cured.
So meet with a doctor. Discuss this situation and learn what options seem right for you
and then take it from there. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

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