Hair Restoration Blog

Q:

Hi Dr. Mohebi,

I am a male to female transgender patient of yours.  I was doing some research and I wondered if I should use Dutasteride in the form of Avodart instead of Finisteride in the form of Proscar. Here is the link I found: http://en.wikipedia.org/wiki/Dutasteride
This wikipedia artical inidicates that Dutasteride inhibits both isoforms of 5-alpha reductase, Type I and Type II, while finasteride only inhibits Type II.  Some early studies showed that Dutasteride is more effective.
I’m curious to know your opinion of taking this drug, and if it will have any effect of regenerating any of my lost hair?  While Finisteride seems to have mostly abated hair loss, I haven’t seen any kind of re-growth.

Thank you so much

A:

Dutasteride has been studied for its effect on hair loss prevention and prevention of miniaturization process.  The studies show that Dutasteride is more potent for hair loss treatment in comparison to finasteride.  Having said that, dutasteride (Avodart) has never been approved by FDA for hair loss treatment partially due to its side effects that are more commonly seen.

Dutasteride is FDA approved for Benign Prostate Hypertrophy (BPH) treatment.  It might become approved for hair loss in the future, but until then I do not prescribe it for my patients on a regular basis.
Since you are a transsexual person and you are going through medical treatments and sex reassignment surgeries and until you have your testosterone, you can use dutasteride instead of finasteride for a more complete male hormone blockage as long as you understand that you may have a higher risk of experiencing the sexual side effects.

Why FUE?

Follicular Unit Extraction (FUE) also known as FUE transplant is another version of Follicular Unit Transplant (FUT).  It is a newer method of harvesting follicular units that eliminates the appearance of a linear scar and it is much more comfortable during the post op period of a hair transplant surgery.  Although FUE transplantation may be the answer for many hair loss patients who do not want any scaring on their donor area, it is not the answer for everyone.

Who can use FUE?

The number of available grafts in FUT transplants can be limited.  So, candidates who require a large number of grafts in one session and traditionally may have needed several sessions of (FUT) hair transplantation are now able to acheive the same number of needed grafts through traditional methods of FUE. In order to be approved as a candidate for a FUE hair transplant procedure, one must attend a complimentary in-office consultation with Dr. Parsa Mohebi and have the FOX test performed to show eligibility.  

Automated FUE

The good news is that the efficiency of FUE transplants have increased as newer automated techniques are developed, thus allowing hair transplant surgeons to remove follicular units faster than what was possible in the past.  US Hair Restoration is a center located in Southern California and known for its ability to perform quality FUE procedures in its Encino, Beverly Hills and Orange County offices.  We at US Hair Restoration have added automated FUE methods to our armamentarium of hair restoration techniques.  Automated hair restoration surgery with FUE techniques has increased the number of hair grafts able to be harvested from the donor area and transplanted within one day.

Additionally, we are also offering special promotions for candidates who are interested in participating in our ongoing FUE study that is designed to compare different methods of FUE procedures both qualitatively and quantitatively.  Please do not hesitate to contact US Hair Restoration’s office at 1-888-302-8747 anytime for more information.

Every now and then I see patients in my office that have no sign of baldness whatsoever, yet they are extremely concerned about losing their hair.  Some of these patients have even previously received hair transplants from other clinics.  Body Dysmorphic Disorder (BDD) or body dysmorphia is a type of mental illness in which a patient is always preoccupied with his or her appearance and cannot stop thinking about one or several problems in their face or body.  This problem may be an exaggerated preexisting problem or it may be totally imaginary.

People with BDD often have significant anxiety and do not want to be seen by anyone if possible because they think their appearance seems too shameful.   BDD could be seen in both men and women and it is estimated that 1–2% of the world’s population meet all the diagnostic criteria for body dysmorphic disorder (Psychological Medicine, vol 36, p 877).

People with BDD are intensely obsessed over their appearance and their body image, often for many hours a day or even to the point that it affects their life or work. They may ask for several cosmetic procedures in an attempt to improve their perceived image, however they are never satisfied and their perceived image cannot ever be met. If the doctor seeing this patient cannot diagnose the problem and agree to pursue with a cosmetic procedure, he or she will also tend to be blamed for some (or at times all) of the problems that they imagine they have.

Diagnosis of BDD

1. Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)

In research carried out by Dr. Katharine Philips, involving over 500 patients with BDD, percentages of patients concerned with the most common problem locations of their bodies were recorded and hair problems were reported in as high as 56% of patients as the second most common problem (after skin) that these patients express having.

Treatment of BDD

Treatment of body dysmorphic syndrome involves cognitive-behavior therapy which includes education about BDD and its treatment, and specific treatments to deal with faulty thoughts.  In some patients, medications may be needed as well.

Q:

I am a man with male patterned hair loss and I have been using Propecia for 2 years now.  My wife and I are planning to have children.  What are the effects of Propecia on fertility?  Can it affect the unborn child?

Thanks,

A:

Propecia (finasteride) can reduce the volume of semen slightly in 1% of the patients, but it does not affect the sperm count or chances of fertility.  Nor does the use of finasteride in men decrease the chance of pregnancy in their partners.

Propecia can be secreted through all body fluids, including semen, but its amount in semen is very minimal.  The amount that is absorbed into the mother’s body is so minimal that its risk to the baby is considered negligible.  Thus, it is not recommended for men to discontinue Propecia when their wives are pregnant, or trying to get pregnant.