Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon
A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.
I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.
For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).
If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.
Posted by Robert M. Bernstein M.D. 
