Hair Restoration Blog

Avodart (dutasteride) and Propecia (finasteride) have recently been in the news for the report of some studies regarding their role in increased or decreased risk of prostate cancer.  Avodart and Propecia are both 5-alpha reductase inhibitors (5-ARI), which help prevent production of DHT (dihydrotestosterone).  This class of medications is indicated for the treatment of benign prostate (BPH) hypertrophy.  These DHT blockers also help with the prevention of male patterned hair loss and have been recommended and prescribed for hair loss treatment, for many years.

On one hand, several studies have indicated that DHT blockers could decrease the rate of prostate cancer.  On the other hand,  there are some studies that indicate they may increase the incidence of high-grade prostate cancers.  Those studies performed on both finasteride (7 years study) and dutasteride (4 years study).  It has been concluded that the patients who take DHT blockers should have prior knowledge of whether they have a lower risk of prostate cancer.  However, if the patient gets prostate cancer it might be in a category which is more advanced.

Doctors should be aware DHT blockers can decrease the levels of PSA artificially, so a small increase in PSA levels might reflect a higher activity of prostate tissue in comparison to patients who are not on DHT blockers. Overall, it is good practice to make sure all patients age 50 and older have a baseline PSA reading before they get started on finasteride.  This will determine their PSA levels before they begin taking medications, and the doctor will be able to monitor changes in PSA with greater precision.

Minoxidil (Rogaine) is one of the two proven treatments for hair loss along with hair transplant. Although minoxidil mechanism of action for hair growth is not fully understood, there have been several suggested mechanisms such as:

• Nitric oxide chemical agonist effect impactig scalp blood vessels
• Potassium channel opener causing hyperpolarization of follicles cell membrane
• Vasodilation possibly due to its nitric oxide effect

This new study is done in Department of Immunology of Kyungpook National University in Korea. The result of the study was published in The Journal of Dermatological Science shows a new mechanism for minoxidil as activator of β-catenin pathway in human dermal papilla cells, one of the two stem cells involved in development and growth of hair. The investigators announced that this mechanism could be an explanation for anagen prolongation effect of minoxidil.

The length of the actively growing hair in anagen phase (growth phase) is responsible for hair length. The investigators indicated that maintenance of β-catenin activity in the dermal papilla cells (DPCs) enables hair follicles to keep growing actively. Minoxidil or Rogain promotes hair growth in male patterned baldness suggesting that minoxidil can prolong the growth phase in hair life cycle.

The study is done in mouse model with application of 3% minoxidil for ten days. DPCs were transfected with β-catenin responsive TCF reporter plasmid. They showed that extension of anagen phase was significantly promoted after minoxidil application. The researchers concluded that minoxidil extends the anagen phase by activating β-catenin activity in the DPCs and that can be one of the main pathways in its hair growth or hair loss prevention mechanism.

Studies like this increase our understanding of hair loss and hair growth and over time can help hair restoration field to have more options to fight hair loss in a more efficient way.

Faculties: Drs. Suddleson, Mohebi and Perez in OLSW-17

Orlando Live Surgical Workshop (OLSW 17) of International society of hair restoration surgery (ISHRS) was held one more time in beautiful city of Orlando last month.  Hair transplant surgeons participated from different parts of the world.  We had many great lectures from the leaders of hair restoration surgery to cover basic information about hair restoration methods for new hair transplant surgeons and to refresh and update the more experienced ones.

We had lectures every morning and in the afternoon went to surgery center for hands on procedures to teach the techniques of hair transplant surgery.  I have to congratulate the the whole staff involved with this workshop for the great work they have done this year, coordinating a large group of doctors from all over the world and putting together a great set of lectures to cover a wide variety of subjects about modern hair restoration procedures and medical treatments.

Dr. Mohebi and Dr. Leavitt in OLSW-17

We had lectures about new methods of hair restoration surgery such as robotic hair transplant surgery.   The most updates on robotic surgery was shown to the audience.  There is a hope that the practical model of robotic hair restoration be available within a few months.

There is a woman behind every successful EVENT - Dr. Mohebi and Valarie Montalbano

I had two lectures that were both emphasizing on the techniques of removal of follicular units in hair transplants with large number of grafts using Laxometer.  I also demonstrated the applications of Laxometer in sequential strip removal techniques in live surgical workshop.

Technician training: Patrick Tafoya teaching hair transplant technicians

My second lecture was on Scalp Scars and the methods to revise them.  The lecture was focused on making surgeons more familiar with the proper techniques of scar revision and indications of each particular technique.

I went over trichophytic closure methods for a variety of different scars.  I discussed the implications of Follicular Unit Extraction (FUE) to revise scalp scars.  I presented a variety of several scalp scars treated with FUE methods.  I went over the pros and cons of FUE to revise scalp scar and provided a guideline that hair transplant surgeons can decide what method should be used for each type of scar.

Hair loss is a common side effect with some types of chemotherapy and can be experienced by both men and women.  Chemotherapy medications attach rapidly to proliferating cells and hair follicles are some of those cells responsible for the continuous growth of the hair.

What do you need know about hair loss after chemotherapy?

Hair loss can typically be seen in the first few weeks after the start of chemotherapy and usually becomes worse with time.  It may be several months after the end of chemotherapy treatments before you notice that your hair growth is getting better.  The new hair may have a different color or texture than you are used to, but it will gain its normal characteristics back over time. 

Unfortunately, there is no known medication to completely prevent hair loss after chemotherapy.  It may take months for the hair to get back to normal following the end of chemotherapy treatments. While many patients will experience stabilization or regrowth of hair after completion of chemotherapy, some patients will experience accelerated hair loss that they were to have regardless.

If your hair growth is not back to normal after 2 years from completion of your chemotherapy, you are recommended to be evaluated by a dermatologist or hair specialist for hair loss medical treatments (hair transplantation is possible and eligibility should be determined for you by a quality hair transplant surgeon).

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

Q:

Quick question for you doc.

I was wondering, will I need to buzz off all my hair before a hair transplant surgery? It really doesn’t matter, but I just want to know what I’m getting into. I imagine that my remaining hair, while very thin, obscures the scalp too much for comfort.

A:

You do NOT need to buzz off your hair before a hair transplant.

While some patients with significant miniaturization of their existing hair may be asked to cut it short or clip it, we typically are able to do this in office before the procedure if they are OK with it. Clipping hair is not mandatory in any way. However, it may increase our precision in some patients and we do it for them only if they have no problem with having very short hair for a while after hair transplant.

Q:

Thank you for your reply to my previous e-mail Dr. Mohebi. I’m getting close to being ready for this, but I still have some concerns that I would like to address prior to booking.

I realize I won’t come out of this looking like Brad Pitt, but can I expect some decent density in the area you’re going to operate on? I’ve seen a lot of pictures of “great” results that were little more than thin whiffs of hair lying limp over shiny, conspicuous scalp. I’d like to be able to style it in the youthful way, showing off my hair line. I suppose that depends on the number of grafts?

A:

The number of transplanted grafts and extent of your balding area are two very important factors in the final thickness of your hair. However, because you have fine hair, even with using the maximum density, you may not achieve the original fullness that you once had. Some patients with the same circumstances as yourself may need more than one surgery to develop maximum density close to that of their original coverage prior to losing hair.

The growth cycle of hair follicles differs between each individual.  For that reason, transplanted hair grafts also may not follow a universal pattern.  We generally schedule follow up visits for our hair transplant patients on the day 1, day 10, month 5 and month 10 following their hair transplant surgery.  Our five month follow up is to make sure patients are having a smooth early growth without any problems or complications.  In most cases, early growth is seen at five months post op.   In some people who started growing hair earlier we may even see something close to their final result.  However, we have had some cases that we did not see impressive results at month five and patients experienced delayed growth of their transplanted grafts following the procedure.

Delayed hair growth after After a hair transplant procedure - Class VI baldness - Before (left), five months (middle) and ten months (right) after hair transplant with US Hair Restoration

Most of these patients do not have anything wrong with their transplanted hair and will only have to be more patient with their hair growth.  We bring all hair transplant patients back in month 10 after their surgery and the results at that time are much better.  This group of patients may see their final result more than 10 months from the time of their hair transplant and it may take 12 to 18 months to see full result.  If the results are still poor at month 10, more diagnostic tests such as a scalp biopsy may be needed to rule out other causes of hair loss that might have been involved with the growth of their transplanted hair.