Hair Restoration Blog

Q:

My doctor put me on propecia at 21 when I told him about the hair loss and I took it for about six months but it had no effect on my hair loss. I also started to use rogaine around age 23/24 for a couple of months but stopped because it made my hair loss worse (before rogaine the majority of my hair loss was in the front area of my head and after using rogaine I started to lose hair on my crown as well). My hair loss has been pretty stable over the past 2-3 years and I have continued to lose some hair but nowhere near the amount I lost initially.

I wash my hair every 2-3 days and only notice about 20-30 hairs lost compared to the hundreds I lost early on. My hairline has not really been effected at all and my hair loss doesn’t seem to match any on the norwood scale, it is just diffused loss throughout and matches the description of many accutane users who have lost hair. I have also been using the ProThik concealer spray for the past 3 years which works great because my hair loss is diffuse and makes it unnoticeable, but the process of applying it in and combing through it causes my hair to get tangled and pulled out so I think over time that has also contributed to my hair loss. I lose far more hair putting in the concealer than I do washing it and combing through it naturally.

For the first 2 years of using it I would wash my hair and re-apply it daily, although over the past 6-8 months I have gone 2-3 days between washing and reapplying it and only lose 10-20 hairs when I comb through it in the morning. I am not sure how much of my hair loss in recent years has been caused by this but I suspect that is has had some effect, especially during the time I was applying the concealer every day.

A:

Many young hair loss patients may start taking finasteride or minoxidil when they see the signs of active hair loss in their early 20s.  That is the time most people lose hair at its maximum speed.  Medications such as finasteride or minoxidil are only to prevent hair loss or even in some cases slow down the process.  They are not to bring your hair back to where it was before you started the process of hair loss.

I recommend you visit a hair specialist who can perform microscopic evaluation of your scalp (miniaturization study).  That can give you more information about the type of your hair loss and the treatment methods. Having regular follow up visit with your hair doctor helps you to know whether or not your hair loss medication works.  You may also need a hair transplant when the time come and the time and type of the restoration surgery could be discussed with your hair transplant surgeon.

Q.

Hi Dr. Just got back from my vacation in XX, had a good and relaxing time. While I was gone for 2 weeks all the scabbing from my hair transplantation is pretty much gone in the donor scar and the implanted areas. Also I noticed that I did lose hairs as you mentioned would most likely happen. the hairs that fell that looked like the grafts were just the hair shaft that I saw fall. I did not see skin attached to the end of the hair shaft so I assume the follicle survived in the skin where it was implanted. not all have fallen but I did notice a good amount. I also notice small dark hairs sprouting in the implanted area. I assume these are coming from where the originial grafts shed?
 
Its almost a month post op and I feel no pain and have all feeling back on my scalp. I pretty much wash and style my hair as usual.
 
Is all this normal progress after the surgery?
Thanks.A.

It is good that you had a nice vacation! 
 
One month after hair transplant surgery is the general time which you should have lost most of your transplanted hair shafts.  The follicles are now part of your scalp and will be growing new hair in 2-3 months.  Your inflammation should be subsided on both the transplanted and donor areas.  Minor itching might be noticed at this time which is a good sign of the scalp wound healing.  You may have lost or will soon lose some of the bulk of your existing hair due to the shock loss.  Using finasteride can significantly minimize it.  You will be noticing new hair growing in 2-3 months from now and the hair shafts will continue getting longer and thicker till about one year from the time of your hair transplant.

Q:

Permanent shock loss- in the front center mostly and also areas in the temples. Is it likely from your experience that hair like mine will survive?

A:

Although  could be seen in some patients for the first few months after surgery, taking finasteride will minimize or, in most cases, eliminate that risk in the majority of patients.  However, if you do experience shock loss, it won’t be for more than 2-3 months and after that time, your transplanted hair will begin to re-grow. It is by then that your hair should look much better than it did before.

Q:

I was told that a spot has opened up for my hair transplant surgery. I told them to slot me in, but now that I’ve jumped into the deep end I’m a bit nervous. My nerves don’t have to do with what it will look like six months or a year from now, but for the weeks following the surgery.
I need to take the next day to really meditate on this. Although my hair loss does bother me, it’s not as if I’m noticeably bald. So I’m deciding if this is something that makes sense for me.

A:

It is completely normal to have a touch of nervousness prior to this elective surgery. Since it is an elective procedure, it is common to have questions and/or
reservations. We need to remember that it is simply hair and not some life threatening procedure! Many patients have this reluctance and there is never a clear or definitive answer aside from your intuitive feelings.

Your particular situation is for the enhancement and detailing in order to complement what you already currently have. Your hair loss is probably going to progress in the future but again, it depends on when you want to address the issue.

Having experienced seeing many other patients who had similar feelings before their hair restoration procedure, I think you will very happy you did it!! Either way, I support whatever decision you make. US Hair Restoration is always going to be a resource for you with whatever questions or concerns you have regarding hair loss and the treatment options available.

Meditate  on that assurance and clarity will present itself!

Dihydrotestosterone (DHT) is a byproduct of the hormone testosterone, which is formed in different areas such as the prostate gland and hair follicles.  Hair follicles which are susceptible to genetic male patterned baldness contain DHT receptors.  Over time as males produce more and more DHT the molecules affect hair follicles and cause them to become decrease in size, and eventually fall out permanently.

DHT and having the gene of male pattern baldness are the primary contributing factors for male pattern baldness. Women with female-pattern baldness, unlike men with male-pattern baldness, are usually not characterized by increased production rates of DHT due to their low levels of testosterone.  However if for any reason a woman has increased testosterone, she may develop female patterned baldness just like a man does with the same mechanism.

Hair in the areas that are prone to male patterned baldness such as corners, top and crown areas are loaded with DHT receptors in men with Androgenetic Alopecia.  However, the hair on donor areas such as back and sides do not have as much DHT receptors.  This is why hair is more permanent on the sides and back as opposed to the top and front.

The distinction in hair quality on different areas (donor vs. recipient) allows a hair transplant surgeon to remove hair from one area and transplant it to the balding portions of the scalp.  These transplanted hairs are permanent and won’t be affected by circulating DHT. Finasteride (Propecia) is a drug that blocks the conversion of testosterone to DHT by blocking the enzyme alpha reductase.  DHT levels in hair loss patients decrease when they are on Propecia and this helps maintain healthy hair, and this helps some of the miniaturized hair become stronger.

We recommend medical treatment with DHT blockers in many of our patients who undergo a hair transplant procedure to help maintaining their own hair in addition to restoring the balding areas with hair restoration surgery.

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.

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:

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:

Good Afternoon Dr. Mohebi,

My body trainer recently recommended that I go on a medication for body building purposes.  The medication that I am planning on taking is ANAVAR (an anabolic steroid), so I just wanted run it by you to make sure it would be OK to take it along with the Propecia I am currently taking.

I appreciate all you help, Thanks!

A:

Anavar (oxandrolone) is a weak androgen and is considered an anabolic steroid.  It is indicated as adjunctive therapy to enhance weight gain after weight loss due to an extensive surgery, infectious disease, trauma and so on.  Anavar has also been prescribed to some patients who for no reason fail to gain weight despite of proper nutrition and work out schedules.   It may also be used to maintain normal weight or to prevent the catabolism due to prolonged administration of corticosteroids.

There have been some online reports of hair loss with Anavar’s use and some exagerated hair loss reports in patients who take both Propecia (finasteride) and Anavar (oxandrolone) in conjunction. Although my personal searches in medical publications have never revealed any studies supporting this information, reports can be found online by its claimed users.

My general recommendation is, unless there is a strong medical indication for its use, those people with any evidence of male patterned baldness should stay away from anabolic steroids.  Although you may find some anabolic steroids over the counter, your family doctor should always be involved and aware of any anabolic steroids that you take as part of your body enhancing plan.

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.