Q: I have early frontal thinning and was told that I am a Norwood Class 4A. I have been taking Propecia for several years. I recently went to see a doctor who told me go off Propecia and consider a hair transplant, since there is “no scientific evidence that Propecia works in the front of the scalp.” What should I do?

A: We have seen many patients who have had early thinning in the frontal scalp and who have re-grown hair (as evidenced by visual thickening) using Propecia. The indication for Propecia does include treatment of frontal hair loss. There are published data by Leyden et. al. in the JAAD in 1999 demonstrating improvement in a controlled clinical trial of men with frontal hair loss.

The fact that DHT causes frontal hair loss and that Propecia blocks DHT gives a logical explanation for these effects. Of course, if there is no hair in the area at all, the medication is not going to work.