Am I required to take and continue on Propecia (finasteride) in order to undergo hair transplant surgery? Why or why not?
This question was posed by a hair loss sufferer on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.
When my new hair transplant patients ask me whether or not they should also go on Propecia (finasteride), I use the following two scenarios to explain the difference:
Imagine that you and I have a brief consultation visit in approximately four years to see how your hair is doing. If you have both the hair transplants AND go on Propecia (finasteride), we will see the ADDITION of two things: the transplanted hair PLUS the increase in hair mass that occurs in a majority of finasteride treated hair loss patients. On the other hand, if you only have the hair replacement surgeries, then 4 years from now we will be looking at a SUBTRACTION, namely, the positive effect of the new transplanted hair, MINUS the progression of male pattern baldness that occurred during that time. There is an enormous visual difference between those two scenarios. The ironic part is that in the first scenario the hair transplant doctor gets more credit than he deserves for his hair transplant efforts, whereas in the second scenario, the patient often blames the doctor for having had NO EFFECT on his hair loss with hair restoration surgery!
There are exceptions to the above: If the man is of a reasonably mature age, say 38 or 48, and is shiny bald on top with his side fringe borders pretty well set, which means that genetic hair loss / male pattern baldness has essentially reached its end-stage, then Propecia (finasteride) is unlikely to make much difference. The more native hair that exists on top and the younger the patient is, the more beneficial and important is the combining of hair transplants along with Propecia (finasteride) treatment.
The majority of hair transplant patients who benefit from Propecia (finasteride) treatment have a net gain in hair mass (increase of hair shaft diameter and increase in the potential length hair can grow to) in the first 4-5 years of hair loss therapy. After that there is usually a very gradual diminishment in hair mass, such that many patients end up ten years later around where they started. So the hair loss medication “buys” 10 years of time, usually during socially critical years of a young man’s life. If you are destined to someday have a level VI or level VII on the Norwood scale level of baldness, finasteride therapy taken your entire life will not prevent that, it will in most cases greatly delay the day when it happens. There are obviously individual variations in how any one man will respond to Propecia (finasteride) treatment, but the above picture describes the great majority of the men I have treated over the past 10 years. As others have stated many times on this hair restoration forum, Rogaine 5% (minoxidil) topical therapy along with Propecia (finasteride) does have a synergistic effect. Unfortunately, castration is about the only therapy that will almost completely arrest your hair loss, and there understandably aren’t many men lining up for that.
Mike Beehner, M.D.
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