Hair Restoration Blog

Q:

Hi doc I have a question.  I really need to get an answer towards this.

I am a propecia (finasteride 1mg) user for hairloss.  I just read an article regarding how the FDA recently(yesturday) rejected finasteride for use as a prostae cancer prevention due to the fact that finasteride sometimes increases high grade prostate cancers in  individuals who take it.  I am a bit scared since I am a healthy 25 year old who has been taking finasteride 1mg for a while and plan to to take it for hairloss.  Is it possible that finasteride can cause prostate cancer for someone who takes propecia for long term?  please help.  the article really freaked me out. I will post the link to the article below.

http://www.nytimes.com/2010/12/02/health/policy/02drug.html

A:

Finasteride is a DHT Blocker that is used both for prevention of male patterned baldness as well as prevention of prostate cancer.  There are several studies that evaluated the rate of prostate cancer in patients who take Finasteride long term.

The reported data from a recent Food and Drug Administration advisory committee evaluates available data on DHT blockers and whether or not the labels should stat that they decrease the rate of prostate cancer.

They evaluated results from two large studies of the drugs. GlaxoSmithKline’s study involved 8,000 men at risk for prostate cancer because their PSA (prostate specific antigen) tests had found elevations of PSA. The men also had prostate biopsies, but at the start of the study none had received a diagnosis of prostate cancer.

The Finasteride study, sponsored by the National Cancer Institute, was done on 18,800 healthy men over age 55 who were randomly assigned to take either the drug or a placebo.

Both above studies indicated the drugs reduced the overall prostate cancer risk by about 25 percent which is a significant improvement.  However, both studies also found small increases in the incidence of higher-grade, riskier cancers, in men taking the drugs as compared with placebos.

There are two suggested reasons for the increase in these numbers.  One is that the drugs reduced the size of a man’s prostate, making it easier to find lethal cancers on biopsies.  Also, both medications reduce the levels of PSA in blood making early diagnosis of prostate cancer in those patients difficult.

In summary we know that DHT blockers such as Finasteride (Propecia or Proscar) reduce the rate of prostate cancer, there are some reports on some slight increase in the higher stages of prostate cancer in patients who were on those medications.  Finasteride (1miligram) is still recommended for prevention of male pattern baldness.

I generally ask the patients who are over 50 to be tested for PSA before they start taking Finasteride.  I also stress that their family doctor be aware of the medication they are using so any slight increases in PSA are able to be taken more seriously (as opposed to people who are not taking the Finasteride medication).

Q:

hi doc I have another question for you. I was wondering…when a person begins taking Finasteride, they go thru an accelerated shedding period that lasts roughly 3-6 months. After this initial period of shedding, just say that the Finasteride works and stabilizes the loss. Does the person end up growing back the hair that was lost during the accelerated shed? What if it doesn’t grow back? Is this the price that you must pay to halt or slow down loss with Finasteride? Do you have to take your amount of hair a step down in order maintain whatever’s left?

What if you fall into that 20-25% category of users who don’t respond to Finasteride in terms of hair stabilization? You could end up just accelerating your loss for those 6 months for no reason at all. Whether you stay on it or off, after this period, you will continue to lose. This is a big risk for people thinking about taking meds.

A:

Hair shedding is not equivalent to hair loss and shed hair will regrow as normal (especially in long and thick hair that is not miniaturized).

People who take Finasteride may have increased levels of hair shedding possibly due to increased hair cycling within the first few weeks or months of taking Finasteride, but the initial hair shedding should resolve within a month or two from the start date. Final effects of Finasteride should be assessed after at least 6 months from the time the medication was started, but can be seen as late as 12 months from when you start the medication.

For more information on this topic, please feel free to check out an earlier blog post below:

http://ushairrestoration.com/blog/2008/05/hair-shedding-after-starting-finasteride/

Q:

Dr. Mohebi,

I would like to thank you for the time you spent with me during my consultation.

You were thorough, knowledgeable and willing to spend as much time with me as was necessary in order to answer all my numerous questions.

I would also like to thank your office staff for their friendly and courteous treatment.

I have a  question regarding the prescription for Finasteride.  Am I to begin this prescription regimen immediately, just prior to surgery, or after hair transplant surgery?

I am certain you directed me at the time, but with all the info I had to digest, I somehow forgot whatever it was you said regarding the prescription.

Thanks in advance for your time in addressing my question.

A:

I am glad you had a good experience with our office.  I always enjoy having patients who present educated questions.  Below are my responses to your recent questions:

We are prescribing finasteride to you in order to prevent shock loss in the areas at the edge of your balding area following hair transplantation.  I generally recommend starting this medication about a week before surgery so it is locked in your system and shock loss could be prevented.  You should then continue this mediation for the fist 8 months following surgery, which is the time that you are most at risk for losing hair due to shock loss.

It does not matter what time of day you use Finasteride, as long as you are sure to take it once every day.
We look forward to see you soon.

Have a great weekend

There are several studies that suggest ketoconazole (Nizoral Shampoo) to be beneficial for men with male patterned baldness.  Ketoconazole has been compared with minoxidil in a research in 1998 that (ketoconazole 2% vs.  minoxidil 2%  in men with typical male patterned alopecia.  The study indicated improvement of hair density and growing hair with both medications.  Both 1% and 2% solutions and shampoos reported to benefit patients with male patterned hair loss.  The shampoo however needs to stay on scalp for at least 3 to 5 minutes before it is rinsed, which is not always easy in our today’s life.  Ketoconazole shampoo is used for treatment of seborrheic dermatitis or hair dandruff.

At this time, Nizoral Shampoo is not FDA approved for the treatment of hair loss and thus is not endorsed for this purpose for public.  We recommend finasteride for most men with active male patterned hair loss which has higher potency for correcting male patterned balding in comparison to minoxidil.  For more information on this topic, please visit our page discussing minoxidil vs. finasteride for hair loss.

Q:

Hello, I have a question, can you please help verify the answer to this. I am really stressed out regarding the situation. I can’t ask my doctor because he is on vacation for the next month.

I was prescribed propecia for hairloss, but I am reluctant to take it because of hyperandrogenicity from finasteride. Is there any truth to that? is there a chance that a person can develope hyperandrogenicity from taking propecia and making a persons hair loss even worse. By the way I also have acne, and I am scared that the hyperandrogenicity can make my acne worse and skin more oily.

Please help me. Can propecia(finasteride) cause hyperandrogenicity, or is it not true. Can the increase in testosterone from propecia cause more hairloss and make the situation even worse.

thanks in advance

A:

Finasteride (Propecia) is a 5 alpha reductase inhibitor. That means that it blocks the enzyme that converts testosterone (male hormone) to Dihydrotestosterone (DHT) in the body. The main cause of baldness is DHT and not testosterone in addition to having the gene of hair loss. When first getting started on Finasteride, some men may even have an increase in their testosterone levels because it is no longer being converted to DHT and therefore its levels goes up. However, please be aware that these changes are temporary. Some men may feel an increase in sexual urge due to the increased testosterone for a few days but it is temporary. Since testosterone does not directly cause hair loss and its effect is due to the production of DHT, elevation of DHT should not worsen your hair loss in any way.

The increase in testosterone levels can affect your acne. I am not sure how significant the slight elevation of the testosterone could be on your acne and for that you need be seen by a dermatologist.

Q:

Hi doc?  could Rogaine foam have adverse effect on hair transplant result? some say it helps for hair growth, some say it does not add to hair growth, but have you seen any where saying it might prevent hair growth on men with hair transplant? thanks.

A:

Rogaine (minoxidil) can be used after hair transplantation (only on the newly transplanted area) to protect the native hair and not to promote the growth of transplanted hair. Transplanted hair does not need any medication to promote permanence or grow and if chosen correctly it is considered to be a permanent hair loss solution. I personally recommend Propecia to protect patient’s existing hair against shock loss (losing native hair) after hair transplant on men. It is proven that this medication works better than Rogaine for shock loss prevention and has had remarkable results in those patients who have used it as directed. Women cannot use Propecia and I tend to offer them Rogaine as an alternative for the few months following their hair restoration.

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.

Q:

Hi Dr.,  I saw your TV show, and would like to ask you if it is ok for me to buy minoxidil and dissolve it in the shampoo?
Also there are products that says gradually will change the color of my hair to natural color, are they safe to use? wouldn’t they interfere with my scalp respiration?

Thanks a lot

A:

Minoxidil mixed with shampoo

Minoxidil is one of the FDA approved medications for balding prevention and hair loss treatment.  The recommended dose and method for its use is applying it topically on balding area twice a day and leaving the product without washing it off.
Although combination of minoxidil with shampoos are available commercially, I don’t believe you can get a complete result by using them because:
1.    Minoxidil would be diluted with shampoo and water and that will reduce its strength.
2.    The active ingredient (minoxidil) would be rinsed and it would not get enough time to have contact with the scalp skin.
3.    It would be less likely that it is used twice a day, which is the recommended method for its maximum result.

Hair product for white hair

To answer your second question, there are many products that are claimed to change the color of white and de-pigmented hair to a normal one.  Most of them are herbal extracts and there is just not enough long term studies that prove their safety that I am aware of.

Q:

hey doctor:

is it true i can lose hair by wearing a baseball cap a lot of the time? if that’s the case, then i guess baseball players are good candidates for hair transplants! =P. but really, is there any truth to that? I read that it doesn’t have an effect on a person’s hair, but i wanted to verify with an actually hair loss doctor.

A:

We can lose hair due to environmental trauma to the hair shaft and, consequently, to the hair follicles. The name of this condition is traction alopecia; it can be seen when people braid their hair very tightly. One type of traction alopecia is called turban alopecia, for people who wear turbans on their head for long periods of time and when they wear it tightly. Baseball caps are regularly used by people, and I have not seen it in those people who wear them. However, you can guess that a tight cap of any kind may mimic the turban effect and may cause traction alopecia in which hair follicles are being pulled over time, which destroy them eventually.

One time, a friend told me he was at a diversity conference and there was a man who came up to the podium to speak. He asked the audience, “what is the first thing you notice about me?” Someone yelled out, “BALDIE!” And subsequent laughter ensued (being an African American, it turned out he was hoping someone would say, “you’re black”).

Although the remark was taken as a joke, it’s unfortunate many people in our society notice physical appearances before anything else. There’s no shame whatsoever in losing one’s hair. The reality is that it’s not that person’s fault. It’s their genetic coding.

For those losing hair, there’s a socially acceptable solution: A hair transplant. Hair transplants have done wonders for all types of people, from big-name actors to prominent television sports anchors. It boosts self-confidence, makes a person feel less conspicuous in social settings, and may even increase the chance of a person landing a first date or better someone’s job prospects.

Hair transplants at US Hair Restoration are all-natural. Take a look at our hair transplant before and after photo gallery.  In a way, a hair restoration can restore your youth and help you feel at ease around people you’re meeting for the first time, making the experience of life better and more rewarding.

Much like narrowing a gap between teeth by getting braces, or correcting one’s near-sightedness by lasik eye surgery, a hair restoration can be a wonderful option for those who believe they may benefit from it.