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.