This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY. Dr. Beehner is one of our recommended hair restoration physicians. His professional answer is below.
I’m doing some research on hair loss and wondering if a DHT blocker is still required after a hair transplant for androgenic alopecia? If not then how is this possible if it is considered genetic? Surely the excess production of DHT will attack the new hair follicles?
“Attacking” is probably not the best way to think about what is happening. A better way to picture it is that the presence of DHT (which virtually every man has) PERMITS the genetic expression of each individual follicle to occur. The follicles on the sides and back of our heads have no genetic programming for miniaturization and eventual loss, whereas the follicles on the top of the head of men with hair loss do have this genetic programming. An experiment was done around 50 years ago, I believe by a Dr. Hamilton, in which he followed the paths of around a dozen pairs of identical twins, one of which was institutionalized and castrated (yes, those things occurred back then!) and the other was mentally normal and out in the world. The twin who was not castrated went on to lose all his hair on top, but the twin brother in the institution kept all of his hair because he there was no DHT present, since the testicles which produce testosterone, which breaks down into DHT, weren’t present. My recollection is they then gave testosterone to the institutionalized twin (cruelty on top of cruelty) and he then went on to lose his hair.
Regarding the question of whether a man who has had surgical hair restoration is better off taking finasteride after his transplant or not, I believe he is – providing he has native hair on top that can still be salvaged and reversed from hair miniaturization. If he is middle ages and a class VI on the Norwood Scale of hair loss (shiny bald on top), then I generally don’t advise taking it. I don’t believe good proof has ever been shown that transplants do better with Propecia (finasteride).
A good way to picture the benefit of adding finasteride to the hair loss treatment package along with transplants is this: imagine two men with a similar hair loss pattern have a hair transplant and then return to see their doctor 4-5 years later. One takes finasteride and the other does not. The majority of men using finasteride, in my experience, have a net gain of hair mass during those first 5 years of treatment. When the doctor and the patient who had transplants plus finasteride looks at his results, he is looking at an ADDITION of two things: the newly moved transplanted hair PLUS the increase in hair mass from the medication. The other fellow who didn’t take finasteride is instead looking at a SUBTRACTION on his head: the addition of the transplanted hair on top MINUS the increase in male pattern baldness that occurred during those years. That difference is a huge one. The man who doesn’t take finasteride often unfairly blames his hair surgeon for not bringing about the transformation he envisioned, whereas the patient who did both often gives undeserved credit to the transplant for creating such a great result when half of the credit is probably due to the finasteride.
Mike Beehner, M.D.
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