I’ve been on Propecia (finasteride) for 10 months now, and I’m not seeing any improvement with regard to my hair loss. How long should I take the medication before I know it isn’t working? Should I keep using it? Could I still be experiencing some sort of shedding phase?
Although everyone is different, it’s usually recommended that you try Propecia/finasteride for approximately 1 year before determining whether or not the medication is working. The first few months (3-4) are usually associated with an increased shedding phase , and it can technically take up to 6-12 months for the drug to take “effect” and produce visible results.
Frankly, the most common piece of advice I’ve heard is to try Propecia for one full year before determining whether or not it’s effective, and, although Propecia is a proven, preventive hair restoration therapy, it seems like your particular physiology may not be responding as expected.
Altogether, you should probably undergo a thorough examination with a dermatologist or hair restoration physician, and wait the full 12 months before making an assessment and determining whether or not to discontinue the Propecia.
To date, Propecia, which contains the active ingredient finasteride is considered the most effective drug for men in stopping and even reversing the effects of androgenic alopecia (male pattern baldness). However, much like other drugs, risks of potential side effects exist. The ones that concern men the most include decreased libido, difficulty in achieving and maintaining an erection, and a decrease in the amount of semen. But are these sexual side effects permanent? Or will they disappear after stopping the use of the medication?
Propecia’s website reports that these sexual side effects went away in men who stopped taking Propecia because of them. Their website also reports that for those who continued with Propecia, these side effects decreased to 0.3% or less by the fifth year of treatment. However, a new study published in the Journal of Sexual Medicine suggests that long term or even permanent sexual side effects may be associated with Propecia (finasteride). The study however, is not without its problems and is cause for some ambiguity.
To view the study and determine for yourself whether or not Propecia may come with risks of persistent or even permanent sexual side effects, visit “Does Propecia (Finasteride) Cause Permanent Sexual Problems?” To discuss this important topic with other hair loss sufferers and expert physicians, visit the discussion topic, “The Developing Truth About Finasteride“. You are encouraged to share your input and personal experience with Propecia.
Dr. Panine, his surgical technique, and patient results were carefully reviewed by our patient based online hair loss community. To view the highlights of this review, click here.
I understand the point of a trichophytic closure during a follicular unit transplantation (FUT) procedure is to allow hair to grow through the “strip scar” and make it less visible. However, I’m curious as to how well this actually works? Are the scars virtually invisible? How closely can I trim the back of my head and still hide the hair transplant scar?
The human eye is very good at noticing color differences. A scar is almost always a slightly different color than the skin beside it. Even a 1 mm wide scar with hair growing through it will be visible if the hair is shaved right down.
It is more important for the scar to be narrow than hair-bearing, but a narrow hair-bearing scar is easier to hide with shorter hair than a narrow bald scar. I routinely do 2-layer trichophytic closures, but tell my patients to expect to have to keep their hair at least 1 inch long for the first 6 months until the pinkness fades, then at least 1/2 inch long afterward.
A number 4 clipper cuts hair 1/2 (4/8) inches long. Occasionally, patients are comfortable going down to a #3 clipper (3/8 inch) but they are the exception and not the rule.
At what age and degree of hair loss is it appropriate to transplant a patient’s crown?
The crown has been described as the “black hole” of the scalp. Based on that, I believe a very large percentage of patients seeking hair restoration should avoid grafting into the crown region, especially young men in whom it is often impossible to determine how far the pattern will progress. This recommendation is based on the finite nature of donor supply and on the progressive nature of male pattern balding, i.e. there is an imbalance between supply and demand. The fact of the matter, however, is that despite prolonged and detailed consultative discussion relating to the risks and limitations of grafting the crown, many men are still adamant about obtaining some crown coverage. Although it is difficult to predict with absolute certainty everyone who is a rock solid candidate, it is possible to weed out the majority of poor candidates and to institute a safe grafting strategy which will avoid future problems for most patients
For years, a number of hair loss sufferers have claimed that Propecia (and all finasteride based hair loss medications) causes irreversible sexual side effects including erectile dysfunction (ED) and a decreased libido or sexual drive.
Although these claims were vocal and backed by legitimate patient experiences, they were met with opposition from hair restoration experts for two reasons: first, the objective, research-based evidence presented to the Food and Drug Administration for finasteride approval (the FDA requires two legitimate scientific studies before officially approving a pharmaceutical for mass production) disagreed with these claims and found that sexual side effects only occurred in 2-3% of individuals and reversed after stopping the medication.
Second, the claims of permanent sexual side effects were merely anecdotal, were not proven as a direct result of the finasteride, and were never validated by scientific research. However, a new study claims this may no longer be the case.
In a recent study published in the Journal of Sexual Medicine, a research team recognized the lack of scientific research backing the permanent sexual side effect claim and conducted a study to investigate whether or not Propecia (finasteride) causes permanent sexual side effects in men utilizing the treatment for baldness. The conclusion: physicians prescribing Propecia to patients for male pattern baldness should discuss the potential risks of persistent sexual side effects associated with finasteride.
Roughly translated, the conclusion of the study claims that Propecia/finasteride can cause permanent sexual side effects.
I’ve noticed during follicular unit transplantation (FUT) surgeries a strip that can be over a centimeter wide is removed from the back of the scalp. Because of this, I’m wondering if closing this significant incision site can potentially pull the hairline back further and make the scalp tighter?
Most of the “pull and stretch” associated with scalp laxity and the tissue removed during the hair restoration surgery comes from the back of the neck area and not the forehead. Unfortunately, you will not get a face lift in addition to the hair transplant.
Some patients in time can almost return to normal laxity, meaning the “looseness” of the scalp is almost the same as it was before the procedure. However, in many cases after a hair loss patient has had several procedures there is a decrease in laxity of the donor area (meaning the scalp could be a bit tighter, but unlikely noticeable to the patient).
Scalp stretching exercises can be used in tighter scalps to improve laxity in the donor area prior to having hair transplantation surgery to potentially avoid some of this issues.
Today’s surgical hair restoration techniques in the hands of a skilled surgeon are so refined that many patients can achieve a full, totally natural looking head of hair in just one or two procedures. In fact, hundreds of hair transplant patients have shared their results and photos on our popular hair loss forum and have created their very own patient websites. To view more examples of what skilled surgeons can achieve with hair restoration surgery, visit our hair transplant photo gallery.
But what good are new lustrous locks on top of a balding scalp if hair transplant surgery leaves evident scarring behind? Is there a way to restore a natural looking head of hair and keep scarring concealed from your friends and family? Below, Coalition member Dr. William Lindsey discusses how the trichophytic closure technique can significantly minimize the appearance of scarring and make it virtually undetectable.
The trichophytic closure is a technique used by many hair restoration surgeons to close the donor wound after removing the hair for transplanting. The primary benefit of this technique is that hair will grow through the scar after only a few months post-op. By beveling the cut, the hair roots are preserved to grow out and in front of the scar, camouflaging it. Below are two examples of patients who had undergone brow procedures with and without the trichophytic closure.
If a follicular unit graft is damaged during a follicular unit extraction (FUE) hair transplant procedure, will it grow back in the existing scalp or in the implanted area?
One of the biggest challenges associated with follicular unit extraction (FUE) is avoiding follicular unit transsection, or an accidental cutting of the graft. Because the hair follicle and visible hair shaft (usually) grow at different angles, following hairs down to the scalp and attempting to remove them via extraction in this manner can result in an accidental cutting or transsection of the graft.
Whether the remainder of the graft is left in the scalp or removed and implanted in the balding areas, it is usually damaged and will not grow as effectively as before. In most cases, the degree of transsection dictates how the graft will continue producing hairs, but it’s very likely that the graft is no longer functional and will not grow.
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Although everyone is different, it’s usually recommended that you try Propecia/finasteride for approximately 1 year before determining whether or not the medication is working. The first few months (3-4) are usually associated with an increased shedding phase , and it can technically take up to 6-12 months for the drug to take “effect” and produce visible results.
