Can Finasteride stop hair loss for life?

Thank you for your question. You state you’re 18-years-old and noticed some receding. You’re asking can finasteride stop hair loss for life or for at least 20 years.
I can understand the basis for your question, and share with you a more global treatment strategy I provide my patients when I meet with them about hair loss.  A little 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) we have been doing this since 2011, and have treated patients from around the world with our developed an algorithm. We have impacted the way hair loss is treated in helping patients who were previously limited to pharmaceuticals and surgery.
From our experience, and to further describe what we have done, the concept of regenerative medicine is being applied to help stimulate hair growth. What we’ve learned over the many years of doing this is to look at patients’ individual variables to help us predict responsiveness to this treatment.
When we saw in some patients after transplant when we were using this material to help heal the donor area better, and help the hair grafts survive better, that thinning hair became thicker. From that, we started treating patients of different ages, different degrees of hair loss for 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.
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 previous treatments. I look at what I consider in males as a relative DHT sensitivity. 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 that hair loss is not cured, so finasteride is not a cure. Finasteride 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 was made since 1997, and they can look very good. For them, in my mind, their rate of progression is considerably slower. They were put on finasteride, stayed on it, and what would have been a more significant progression was slowed down. Other people progress more quickly, and they can look like they have very advanced hair loss, yet they were also on finasteride for the same amount of time. The distinction is that the genetic pattern and the program is different between those two patients.
The strategy I employ in my practice to help men who have beyond moderate hair loss is to use finasteride when appropriate to reduce the DHT level, and thereby improve the longevity of the hair growth cycle. Since the goal is to maximize scalp coverage,I have seen that being on a DHT blocker alone may keep the hair around, but when we use Hair Regeneration the hair becomes thicker, therefore the synergy is quite significant. So finasteride to reduce the DHT, Hair Regeneration to stimulate hair growth. Yes, PRP and Acellular matrix do have an impact on hair growth lifespan, and there is a potential synergy in that respect, and much of our patients who are not on finasteride have done very well with the injection alone.
However, when you look back at the work we have been doing, describing my own reflections on the many different patients I’ve treated over several years, it is clear there are going to be people who have a higher DHT sensitivity, or whose hair is more impacted by DHT compared to other people. Look at anyone who is younger like yourself. I always think about how aggressive hair loss progression is going to be, and it’s very difficult to anticipate that even with a family history. If the question is will finasteride keep your hair forever, the reality is that it depends on what your particular genetic profile is.
It is important to recall the original finasteride studies when finasteride was given in one group, and a placebo was given to another group, 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. The lesson there is the earlier you start someone on finasteride, the better it is. That is with the understanding that a lot of people are afraid to take the drug, which is a whole other conversation that in my opinion has not changed, except this growing perception of fear of sexual side-effects. In my practice, and in the practices of my colleagues whom I discuss this with worldwide, remains pretty much the same.
It’s important to understand 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 trying to help patients with hair loss. Remember, hair loss is being managed - it is not being cured.
Meet with a doctor, discuss this situation, learn what options seem right for you, and then take it from there. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Finasteride is one of the strongest preventatives. It is 90% effective for patients looking to hold onto their native hair and avoiding completing multiple transplants over and over again. Finasteride is amazing at holding onto the hair mostly in your crown. Hair loss is progressive so Finasteride is wonderful at slowing down hair loss and maintaining what you have. 

Dear friend. Finasteride like any other hair loss treatment only slow down the rate of your hair loss. Even when it significantly reduces hair loss, you will continue to experience thinning. I have seen that combining medication with other non surgical treatments for hair loss improves the results. Try combining it with either laser therapy or Platelet-Rich Plasma. I have seen great results