Post Hair Loss Questions and Get Answers

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Carlos Wesley:

Does Propecia (finasteride) work better on patients in their 30′s vs. other age groups?

According to a study of 118 men (range 20 – 61 years old) with androgenic alopecia (AGA) from 2011, patients over 30 years old with higher AGA grades demonstrated more improvement than their younger counterparts with a smaller degree of hair loss.

This is currently the longest investigation of finasteride 1mg (Propecia) efficacy. I should also mention that side effects were reported in 6% of patients (decreased libido and erectile dysfunction). Persistence of hair growth was not significantly less after ten (10) years versus after five (5) years of therapy.

Dr. Carlos Wesley
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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Technorati Tags: Propecia, finasteride, androgenic alopecia, AGA, hair loss, hair growth

This common question comes from a member of our hair loss social community and discussion forums: 

My father has an advanced balding pattern (likely a Norwood Class VI), and I’m wondering if this is how my hair loss will eventually progress? Will my balding pattern match my father’s? Is it possible to predict hair loss based upon balding patterns in other family members?

Hair loss sufferers (or individuals concerned about hair loss) often assume they will inherit their father’s, brother’s, or grandfather’s balding pattern. However, this is belief is not completely accurate.

Patterned hair loss (androgenic alopecia) is a complicated genetic and biochemical condition. However, most experts agree that the physical expression of the hair loss trait is “polygenetic with variable penetrance.” In laymen’s terms, this means that the genetic component of hair loss comes from a variety of genes and can technically be inherited from either your mother or father. Additionally, the term “variable penetrance” means that the hair loss gene is expressed differently in each individual. This means that one individual with the hair loss genes may exhibit a Norwood Class VI balding pattern, while another person with the same genes will only become a Norwood Class II or III.

Propecia (1mg finasteride) is arguably the most effective non-surgical hair loss treatment currently available for men with androgenic alopecia (genetic hair loss).

Androgenic alopecia is a genetic form of hair loss dependent on the hormone DHT (dihydrotestosterone). DHT is produced in the body as a result of the male hormone testosterone and 5-alpha-reductase enzymes coming together. Finasteride works to slow or even stop further hair loss and improve hair growth in balding men by inhibiting type 2 5-alpha-reductase enzymes, thus minimizing the amount of DHT in the body. Finasteride however, does nothing to inhibit type 1 5-alpha-reductase enzymes. A study conducted by University of Oklahoma Health Sciences in 1999 attempted to determine the effect of finasteride on scalp skin and serum androgens.

Along with finasteride (Propecia), minoxidil (Rogaine) is one of the only medications approved by the U.S. Food and Drug Administration for the treatment of genetic hair loss (androgenic alopecia). Although both drugs are proven alopecia treatments, many hair loss sufferers worry about the potential side effects; specifically, the reported sexual side effects associated with finasteride.

Most studies believe sexual side effects occur in approximately 0.3-3% of Propecia users, and agree that most dysfunction subsides after stopping the medication. However, unlike Propecia, the potential for sexual side effects with minoxidil usage has not been extensively studied. So, this leaves many individuals wondering: can Rogaine (minoxidil) cause sexual side effects?

To answer this important question, Coalition hair transplant surgeon Dr. Paul Rose researched the issue, and published an article about minoxidil and sexual side effects at our Hair Restoration Discussion Forums:

Dr Rose:

In the fall of 2012, researchers at Johns Hopkins University made a startling discovery: finasteride, known most commonly by the brand name Propecia, appeared to cause long term sexual side effects for a number of males who were using the prescription medication to treat hair loss.

Prior to the study, it was well-documented that finasteride could cause a number of sexual side effects during use. After the study, however, a small body of research indicated that males who take the popular hair loss medication could suffer with sexual side effects long after use was discontinued. The study analyzed only a small number of patients, and many hair loss professionals believe rigorous follow-up studies are needed to better understand the long term side effects of finasteride. Nevertheless, the study sparked concern among men and women who suffer with hair loss, particularly those who currently use a non-surgical method of restoration.

Just wondering; if balding is a progressive condition, why would patients opt for surgery (be it strip/extraction)? Won’t we have to deal with it once the hair falls out?

You are correct. Androgenic alopecia is a progressive condition and there is no hair loss cure. This is the very reason why hair transplants are not recommended for very young balding men and also why most hair restoration surgeons highly recommend medically stabilizing hair loss with Propecia (finasteride) and Rogaine (minoxidil).

The older we become, the easier it is to more accurately judge just how far on the Norwood Scale our hair loss will progress. This helps doctors and patients agree on a long-term plan that will make the best use of grafts in order provide for adequate donor hair to address future balding. Medical treatments can prolong the life of existing hair and, in some cases, even regrow hair. The right patient with the right plan can achieve a natural and aesthetically pleasing result that will last a lifetime.

It’s important to remember that not everyone is a candidate for surgical hair restoration. Patients have to find a skilled and ethical hair transplant surgeon that they trust to give them the best advice.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

I’m a 31 year old man and have been experiencing frontal hair thinning for the past year or so.  My hair is continuing to thin and seems to be getting worse at a quicker rate. I have also recently been experiencing a dry scalp. I have not lost any hair in the back (vertex) area or on the top of my head.  It’s only limited to the front, like a receding hairline. I have been researching hair loss treatments and have read that some treatments, like Rogaine, are only for the vertex or top-back part of the head.  Is there a recommended product for the frontal part of the head?  Thanks for your help.

Unfortunately, there is no non-surgical hair loss treatment proven to regrow a receding hairline. The clinically proven and FDA approved hair loss drugs Propecia (finasteride) and Rogaine (minoxidil) are very good at maintaining and sometimes regrowing hair in the crown but not particularly effective for frontal balding.

The best option to restore a receding hairline is hair transplant surgery. I highly recommend researching hair loss on our hair restoration forum where you can benefit from the combined knowledge of our patient members as well as many of the world’s leading hair restoration physicians.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

The long-awaited generic version of the hair loss drug Propecia (1mg finasteride) became available in the United States on January 3, 2013. Generic 1mg finasteride has been readily available for years in other countries but Merck’s patents in the US did not expire until October 2013, prohibiting the sale of generics and keeping prices sky high.

Until this year, balding men seeking an alternative to Propecia’s high cost ($70-$90 per month) needed to obtain a prescription for generic Proscar (5mg finasteride) and quarter the pill. This practice could bring the cost down as low as $90 for a four month supply. However, while substantially more affordable, cutting the tablets in fourths yields an average dose of 1.25mg (slightly higher than the clinically proven and FDA approved 1mg) and can also be a bit frustrating.

Unfortunately, men searching for a bargain on their medical hair loss treatments may have to wait a bit longer before prices become truly competitive. Dr. Reddy’s Laboratories, Ltd. inked an exclusive, 180-day marketing deal in the US, meaning that only their generic will be available for the first 6 months. One pharmacy quoted $80.95 for 30 generic tablets compared to $93.85 for name brand Propecia. Not the precipitous drop in price that many were hoping for.

To learn more about Propecia, its benefits and potential side effects, view the following articles from our Hair Loss Q&A Blog:

Is Propecia Safe? Dr. Robert Bernstein Discusses the Efficacy and Safety of Finasteride

I am planning to have a hair transplant to restore hair loss. Every doctor I’ve consulted with recommends Propecia (finasteride) after surgery. I’ve read about the side effects from finasteride but would like to know your thoughts.

I see that you are already aware that taking finasteride may result in certain sexual side effects. However, according to Merck, the manufacturer, less than 2% of males who use Propecia will experience sexual side effects and those sides will disappear upon discontinuation of the drug.

Having said that, there have been men who have complained that their side effects did not subside after stopping finasteride and that they have experienced permanent sexual dysfunction.

The decision to take Propecia for androgenic alopecia (male pattern balding) is a personal one. While many thousands of men worldwide have used the drug successfully, I recommend carefully researching before any drug before taking it. A great pace to begin is our Hair Restoration Forum and Social Network.

For more information, see the following articles:

Is Propecia Safe? Dr. Robert Bernstein Discusses the Efficacy and Safety of Finasteride

Merck Updates Hair Loss Drug Propecia (Finasteride) Sexual Side Effects Warning

Federal Consolidation of Lawsuits Against Hair Loss Drug Propecia (Finasteride)

Can Treating Hair Loss with Propecia (Finasteride) Lead to Permanent Sexual Side Effects?

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

I am only 17 years old and I am losing 50 hairs a day since the age of 14 after I had typhoid. My father began to go bald at the age of 35. Now, for the past week I am massaging my hair daily with olive oil but there are no visible results! My hair is not thinning out but every time I brush my finger through them I find my hairs coming out with a white bud at their root. So what should I do now?

It is perfectly normal to lose up to 100 hairs per day. If you are not experiencing thinning hair then you may have nothing to worry about. However, it never hurts to consult with a dermatologist or experienced hair restoration physician for an evaluation.

Rubbing oils in your scalp will likely do nothing to combat genetic balding and regrow hair. At your age, you are too young for Propecia (finasteride) but you can use Rogaine (minoxidil) if your doctor thinks it’s necessary.  These are the only two hair loss drugs that are clinically proven and FDA approved for the treatment of male pattern baldness (androgenic alopecia).

David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

Get Proven Treatments at the Best Prices by visiting our new online hair loss treatment shop.

This question comes from a member of our hair loss social community and discussion forums:

If I’m currently treating my hair loss with Propecia (finasteride), why should I also use Rogaine (minoxidil)? Do these drugs work differently? Do they work well together?

According to most hair loss sufferers and hair restoration experts, finasteride and minoxidil have a synergistic effect when used together.

This is likely because minoxidil and finasteride fight hair loss by two different and distinct mechanisms: finasteride decreases the levels of dihydrotestosterone (DHT) – the “hair loss hormone” – in the blood by blocking the 5-alpha-2-reductase enzyme responsible for converting testosterone to DHT. Minoxidil, though not fully understood, likely increases crucial blood supply to the follicles and provides the oxygen and nutrients necessary for proper growth and cycling.

Because both these medications are proven safe and effective (by the FDA) and attack hair loss differently, these medications usually work together to create comprehensive hair loss stabilization and prevention. Because of this, many hair restoration physicians do recommend that patients use finasteride and minoxidil together (in the absence of side effects). Additionally, if hair loss sufferers are interested in using both, or either, of these trusted medications to combat their progressive hair loss, a consultation with a trusted hair restoration physician is highly recommended.

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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum