Today I will discuss Propecia otherwise known as Finasteride and it’s role in preventing hair loss. Propecia works by inhibiting type 2 5- alpha reductase which converts testosterone to DHT. DHT is what binds to the receptors in susceptible hair follicles and causes them to fall out. By inhibiting the formation of DHT we are decreasing the amount of hair loss. Propecia works especially well in the crown and mid scalp and not as well in the hairline.
Unfortunately many people have reported sexual side effects from the use of propecia. Numerous blind studies seem to show not much difference between the sexual side effects caused by placebo versus the actual medication but despite this the complaints persist.
In my practice I give all my patients a detailed information packet that describes all the benefits of Propecia and the possible disadvantages of using it. I recommend it to my patients but ask them to clear it with their personal physician prior to starting.
I also tell my patients that propecia will not affect the transplanted hair, as this hair is immune to genetic hair loss, but it will allow you to keep the native hair longer, and in some cases bring miniaturized hair that is on its way out, back to life. This will extend the time between procedures and make the overall hair appear denser for a longer period of time.
If you decide to stop propecia after taking it, you will lose any benefit that the medication afforded to you.
Some of the most common questions I get from prospective patients are “can I only do one procedure?” and “how many procedures will I need?” These are excellent questions which I would like to address. To begin with, androgenic hair loss, otherwise known as male patterned hair loss, is a progressive condition and one which continues throughout your life. Is it true that as you age, the amount and degree of loss can slow down and even stabilize, but every patient must understand clearly that they will continue losing hair throughout their lives. Younger patients with more severe loss may lose their hair more quickly than older patients with mild to moderate loss but it can still vary from individual to individual. Usually in the course of a consultation I will discuss with the patient other family members (father, grandfathers, uncles, etc.) who experienced similar loss at their age and ask them how that person’s loss progressed. Sometimes that can offer some insight into how quickly and severely the individual’s hair loss will progress. There are other factors on examination, like miniaturization of existing follicles, that can provide some insight into how the individual’s hair loss will progress. Miniaturization is the process where a healthy hair follicle becomes a small, fine, almost “baby- hair”. This is typically the last step before the hair follicle falls out forever, and extensive miniaturization can be a precursor to extensive baldness. Medical treatments for androgenic alopecia include Rogaine and Propecia (Finasteride). Both of these medications can help not only to possibly regrow some hair, but to turn miniaturized follicles into healthy follicles again and to slow the progression of hair loss. Also, the studies have clearly shown that patients who use both Rogaine and Propecia together have a better result than patients who use either independently. Researchers are not sure why, but apparently there is some synergistic action between the 2 medications. Propecia is a pill which is taken once a day in a 1mg formulation and Rogaine comes as a foam or liquid is concentrations of 2% and 5%. I typically recommend the 5% foam formulation as it is easier to place on the scalp and is less greasy. Also, Rogaine has only shown results in helping hair loss in the crown region. Usually younger patients who are in line to experience much more hair loss are going to get the most benefit from using these medications. Another factor in determining the number of procedures is the severity of hair loss. Patients who have severe degrees of hair loss (Norwood 6 or 7) are usually confronted with a choice. Since I do not believe in transplanting many more than 3000 follicles in a single session (I will address my reasons for this in another blog), a severely bald patient will have the choice to either cover their entire head with a lower density of hair follicles, which may result in them wanting a secondary procedure for increased density throughout. Or to cover the entire hairline and mid scalp with higher density and leave the crown alone and then possibly cover the crown in a secondary procedure. Either way, in a severely bald individual, this is going to be a decision the patient will have to make. Finally, what I tell patients is that everyone who has the procedure, sees the difference, loves the difference, and wants more. The typical patient will undergo 2-4 procedures in a lifetime. I usually won’t consider performing a second procedure until around 8-9 months after the initial procedure. This allows me to see the new hair growth and also allows the donor area to relax, thus making it safer to harvest a strip from again. Every patient is different and must be individually evaluated in order to formulate a comprehensive plan tailored to them.