The Bernstein Medical Hair Transplant Blog
Welcome! This Weblog is devoted specifically to topics related to surgical hair restoration. Entries in the Blog represent answers to commonly asked questions of Bernstein Medical. They cover a wide variety of subjects including new hair replacement techniques, repair of hair transplants, medical therapies and diagnostic problems.

Q: I am 25 year old who just started to get bald. My doc confirmed its pattern baldness and put me on Propecia and Rogaine. I don’t want to go bald at any age. So, instead of prolonging the process for 5-10 years and then having a HT, isn’t it easier to let the hair loss continue and then have a HT, so, that I can save the money on drugs for years.

A: It is far better to keep your own hair. Keeping your own hair will generally look fuller than a hair transplant, since a hair transplant just re-distributes existing hair (until cloning is available). The medications are relatively cheap if you get the generic forms of each (i.e. finasteride and minoxidil).

Q: I have a quite a bit of hair on my chest, back and legs. Is that an indicator of future baldness?

A: Although, bald people joke around that they wish the hair on their body (and ears) was on their head, body hair is not an early sign of baldness.

Q: My son, 25 years old, is seeing hair loss around the hairline. According to your website, he is probably a stage II. He may have a little hair loss at the vertex; right now it is hard to tell. He is very muscular and loves weight lifting, but no drug enhancement. Is there a relationship between weight lifting and hair loss, since I have read that weight lifting increases testosterone levels?

A: Yes, weight lifting does increase testosterone, which in turn increases DHT and this can accelerate hair loss, although the effect is generally very slight. Rather than modifying his exercise program, your son may want to consider taking finasteride (Propecia). This requires a doctor’s prescription.

Q: Didn’t you do free consults in the past?

A: Yes. It had been in response to the policy of the larger chains. Patients coming to our practice are evaluated by a board certified dermatologist, trained in diagnosing the causes of your hair loss with expertise in both medical and surgical management. Our consults are not just screens for surgery.

Q: Is genetic testing performed on all patients that come in for a consultation?

A: In the majority of patients, the doctor can predict future hair loss by a physical exam and by using densitometry to check for scalp miniaturization. In cases where additional information is needed, a genetic test will be recommended. Of course, the test can be performed on any one who requests it.

Q: I’ve heard about a genetic test that can tell me if I am going to lose my hair. Does it work?

A: Most medical conditions can best be addressed with early diagnosis. Genetic hair loss is no different. The genetic test to which you are referring is called HairDx and while it is not a substitute for an examination by a physician experienced in the diagnosis and treatment of hair loss. It offers one more bit of information that, in the context of other data (such as hair loss pattern, scalp miniaturization and family history) can, in select cases, help guide you and your doctor to formulate an appropriate treatment plan.

Q: I have hair loss due to a treatment of Accutane. I have been off this medication for about a year and a half now, yet my hair has not recovered. The texture of my hair has completely changed. Given the fact that there is no family history linking me to male pattern baldness, I attribute my hair loss exclusively to Accutane. What should I do?

A: If the texture alone has changed there is nothing you can do except to wait. The texture should improve over time even though it has already been 18 months. If there are signs of genetic hair loss i.e. male pattern alopecia, then finasteride should be considered.

Q: I have thinning hair and have heard about low level light therapy for hair loss. I know that I can either buy a machine over the internet or go to a doctor’s office or medical spa for treatments. Which one should I do?

A: The advantage of the in-office LLLT systems are that the units are more powerful and that the delivery of the energy is the same each time. The treatment is also not dependent upon the patient having to remember to do the treatment and does not require the person to spend 15 minutes each time concentrating on using the hand-held machine correctly. It also had the important advantage of requiring an initial evaluation by a physician who can diagnosis the hair loss and make sure that it is the genetic type that may respond to this type of therapy. And the effectiveness of the treatment can more readily be monitored over time.

The disadvantage of the office- or medispa- based system is that the treatments are significantly more costly than the home machine and require periodic visits over an extended period of time – a nuisance for working people, or for those who do not live close to a facility offering this service.

The advantage of the hand-held system is that it is much less expensive than the office based machine and it is much more convenient to do the treatment at home than to go to a doctor’s office several times a week. There may also be a potential advantage for patients that still have a significant amount of hair. In these people, the hand-held system (that is able to part the hair) may allow the laser light to more effectively reach the scalp.

The major disadvantage of the hand-held device seems to be with patient compliance as people get tired of having to run the instrument through their hair for 15 minutes several times a week. It is also hard for the person himself to judge if the treatments are working, how to taper the treatments and if and when to stop.

Q: I heard that there is a new drug on the market called Avodart for prostate enlargement which might help with hair loss as it blocks the conversion of testosterone to DHT better than Finasteride and is more effective than Propecia. Do you recommend taking it and if so what is the dose?

A: I am currently not recommending that patient’s take Dutasteride for hair loss, although it is more effective than Propecia, finasteride 1mg. (Dutasteride 0.5, the dose generally used for hair loss, seems to be slightly more effective than finasteride 5m in reversing miniaturization.)

The reasons that I am hesitant to prescribe it at present are outlined in the Blog question Is Avodart Safe? In addition to the reasons that I listed in that response, I would also consider that: Dutasteride, unlike finasteride, decreases sperm counts, it can result in persistent decreased sex drive and the incidence is greater than with finasteride. Finally there are a significant number of alpha-type 1 receptors in brain, those affected by dutasteride, but not finasteride.

However, since Dutasteride is approved for older men with prostatic disease, using it for hair loss in this age group (usually in a lower dose) is reasonable.