Finasteride Not Working? Let Me Explain What's Really Going On With Your Hair Growth

You have been taking your tablet every single day. You have been religious about your dosage. And yet here you are, months later, still seeing nothing but scalp in your mirror. This might be you, but don't worry, you are definitely not the only one.

Finasteride is probably the most popular medicine used against male pattern baldness, and yes, in some situations, it does actually work. But again, "in some situations" covers so much ground. The vast majority of people feeling disappointed in their experience with this medication were not meant to see any positive changes from it to begin with. And, usually, it all boils down to a couple of factors that were never quite made clear to them.

So, let me explain.

I Have Taken Finasteride for Several Months. How Come I Am Still Losing My Hair?

First of all, it's important to note that finasteride is actually very simple medicine. All it does is reduce DHT levels in your body – the hormone responsible for miniaturising hair follicles due to genetic sensitivity. And thus it stops or at least slows down this process. That's it.

That being the case, there are several possibilities for why your hair loss continues even months into treatment. It could be that the follicles you wish to preserve are beyond saving. There may be other factors contributing to hair loss rather than hormonal issues. You may just have a different reaction to the medication than what is prescribed by the textbooks.

Are You Starting Your Finasteride Therapy Too Late?

It is definitely the main point and the biggest mistake.

Finasteride can help those who have their follicles alive. It will not be able to revive any follicle which has already undergone complete miniaturisation and stopped working while losing all its blood supply. There is nothing more to do. Nothing any medicine can do for you in such case.

But here comes the point that most people forget about. There is an optimal period when you take your medicine and when it works the best. For example, at the point when your hair remains thick but starts falling out in a heavy manner; when your hairline moves just a bit; when your crown looks a little sparser than usual during some strong sunlight. This is the very moment you need to start your treatment.

Once you delay starting finasteride for even one year or more after the first signs of shedding, you've made a huge mistake.

Does Finasteride Really Cause Hair to Grow from Bald Areas?

Not at all. And that misconception shatters more hopes than anything else does.

There are many men out there who begin taking finasteride thinking that it will help regrow new hair from the bald areas of their heads, similar to fertilizer revitalizing the bare patch of ground. In fact, the medication cannot cause growth of hair on a bald head. It does not make a balding area covered by a lush hair layer.

The reason why this myth lives is obvious. There are pharmaceutical companies out there that are willing to take advantage of those men who lose their hair and misrepresent the product they advertise using photoshopped before and after pictures. When the reality does not fit the advertisement, the blame falls onto the treatment. But that wasn't the problem.

Why Doesn't Finasteride Work Equally Well for Every Man?

Even taking into account impeccable timing, there are those men who just respond less effectively, and the science behind it is actually fascinating.

The thing about finasteride is that it inhibits the activity of only one of the enzymes that create DHT. Namely, it is only type II. However, DHT formation takes place in two ways. The other one is Type I, thus, even though the medication decreases DHT in general, DHT formation on the scalp is never truly stopped, making dutasteride more efficient for non-responders because it inhibits both pathways.

Additionally, there are cases where certain men have hyper-reactive DHT follicles. No matter how hard you try to suppress DHT levels, these follicles remain sensitive and keep losing hair anyway. Furthermore, finasteride works much better on crown hair than hair located on the frontal scalp, so any man experiencing recession of the hairline would be convinced that the treatment has no effect on him despite saving his crown hairline.

Last but not least, there are those cases when some of the hair loss factors are non-hormonal such as low ferritin, thyroid problems, stressful conditions, or improper diet.

Case Study of Harun Korkmaz: When Finasteride Isn't Effective

Harun Korkmaz is a director of movies, one whose name people in Turkey recognize from the various movies he has directed and produced. When he came to our clinic, his problem was not only the fact that he was almost bald, having lost 40% of his hair but also the fact that despite using finasteride for 14 months, it had done nothing to stop the problem.

From our analysis of his condition, two major issues emerged.

First, most of the follicles that had lost their growth ability were already dead and were in no way responsive to any drugs, thus making the usage of finasteride useless. Secondly, just like most men, he had the idea that finasteride would help him regrow hair in the areas where he already had none. It won't.

And now for the really important part about Harun's case. Despite the fact that Harun seemed to have an almost fully bald scalp, his donor hair was in great shape, and this can largely be attributed to the effects of finasteride. This is because not only did his donor hair look great, but well over half of his transplanted grafts consisted of triple hair follicles, which is quite remarkable. Using Manual Sapphire FUE and our 3-Skip-1 technique, we transplanted 7,300 hair grafts into Harun over two separate procedures spaced six months apart.

Finasteride vs. Hair Transplants: Are They Opposites?

This should be the change in mindset that all patients make when coming into our practice. Instead of seeing finasteride and surgery as two things that cannot happen at the same time, they see them as two parts of the process. The truth is, the best results come from using both finasteride and surgery.

Short-term application of finasteride will make your hair stronger and, more importantly, your donor area as well. A strong donor area guarantees better quality of the grafts we'll harvest, thus increasing the number of double and even triple grafts rather than single ones. After surgery, finasteride can help preserve your remaining native hair. And in the case of Harun's donor hair, that was exactly what happened.

Why Do We Recommend Medication That We Don't Even Sell?

Here is an interesting fact. If the patient arrives at our clinic during the true finasteride window with micro-shedding or only thinning, then we do not advise surgery. On the contrary, we instruct to avoid it for now, and to begin with finasteride, PRP, and mesotherapy.

Let us be completely transparent about our motives. First of all, about 90% of our clients arrive to us from other countries – Europe, the UK, and the US. Therefore, we neither offer nor perform PRP, mesotherapy, nor sell finasteride in Istanbul. This means that there will be absolutely no financial benefit to us in recommending this treatment. Therefore, if we recommend medication, it is because we believe that it is truly best for the patient.

In case you have doubts whether finasteride works for you, the first question to ask yourself would be the following. Is the timing incorrect, or perhaps your expectations were too high? Otherwise, perhaps it is simply time for a hair transplant. Only an accurate diagnosis can reveal the answer to this question.