Are Lab Tests Required Before Starting Propecia?

Are Lab Tests Required Before Starting Propecia?

Q: I had a good friend get a transplant at your practice and it seems that your practice is the industry leader in hair transplantation. I may one day be looking for one. That being said, my friend said I shouldn’t trust anyone else. I wanted to know if you may be able to tell me what tests/specific labs you have your patients do prior to starting Propecia. I am having my doctor put me on it but he does not recommend any labs but I don’t trust this. So I’m not looking for medical advice, just what your practice may advise a patient to get (in terms of labs/blood tests) prior to starting Propecia. I’m really hoping you can help as I have already contacted a number of other sources and can’t seem to get an answer. — M.B. ~ Upper East Side, N.Y.

A: Blood tests are not required before starting finasteride and we do not routinely perform them. If a patient requests test then Total and Free Testosterone, DHT, and Prolactin are reasonable to obtain, but there is no consensus on what the appropriate tests might be. If a patient requests tests because he has symptoms (i.e. such as lack of energy associated with low T), he should see his internist, urologist, or GP. That said, patients 50 and over (40 and over in patients with a high risk of developing prostate cancer) should have a PSA before starting finasteride.

Read more about Propecia (Finasteride)

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What Is Saw Palmetto And Does It Prevent Hair Loss?

Q: What is Saw Palmetto? — R.P., White Plains, NY

A: Saw Palmetto is a dwarf palm plant native to North America. The active ingredients can be found in the plant’s brown-black berries. It is proposed that it blocks the enzyme 5-alpha-reductase that converts testosterone to dihydrotestosterone (DHT). There is little scientific evidence that Saw Palmetto is actually effective for hair loss.

Read about the treatment of hair loss in men

Posted by Robert M. Bernstein M.D.

Why Does A Hair Transplant Work?

Q: Why does a hair transplant grow – why doesn’t the transplanted hair fall out? — J.F., Redding, C.T.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp — this idea is called Donor Dominance. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear — a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

Posted by Robert M. Bernstein M.D.

Hair Loss Causes: What is Miniaturization and What is Effect of DHT on Hair Follicles?

Q: I have read that in the evaluation of a patient for hair restoration surgery some doctors use a densitometer to measure miniaturization – the decrease in size of hair diameters. I read that miniaturization is a sign of genetic hair loss, but when there is miniaturization of greater than 20% in the donor area, a person may not be a good candidate for hair transplants. Is this correct and does 20% miniaturization mean that 20% of the population of terminal hairs have become fine vellus-like hairs or that there is a 20% decrease in the actual diameter of each of the terminal hairs? — B.A., New Albany, Ohio

A: Miniaturization is the decrease in hair shaft length and diameter that results from the action of DHT on healthy, full thickness terminal hairs. The hairs eventually become so small that they resemble the fine, vellus hair normally present in small numbers on the scalp and body. Miniaturized hairs have little cosmetic value. Eventually miniaturized hairs will totally disappear. Twenty percent miniaturization refers to the observation, under densitometry, that 20% of the hairs in an area show some degree of decreased diameter.

In the evaluation of candidates for hair transplantation, we use the 20% as a rough guide to include all hairs that are not full thickness terminal hairs. Of course we are most interested in the presence of intermediate diameter hairs — i.e. those whose diameters are somewhere between terminal and vellus and are clearly the result of DHT. I don’t know if one can tell the difference on densitometry between vellus hairs, fully miniaturized hairs and senile alopecia. The partially miniaturized population is most revealing.

Miniaturization in the recipient scalp (i.e. the balding areas on the front top and crown that we perform hair transplants into) is present in everyone with androgenetic hair loss. Miniaturization in the donor area, however, is less common (in men). It means that the donor area is not stable and will not be permanent. Men with more than 20% of the hair in the donor area showing miniaturization are generally not good candidates for hair transplant surgery.

Read about Miniaturization
Read about Candidacy for Hair Transplant Surgery

Posted by Robert M. Bernstein M.D.