Bernstein Medical Blog
Was Propecia Originally for Treatment of Prostate Enlargement?
August 21st, 2006Q: I heard that Propecia was being used originally for shrinking the prostate, is this true? — M.D., New Hyde Park, N.Y.
A: Propecia (finasteride 1mg) is not a prostate medication that was serendipitously noted to have a side effect of re-growing hair, it is a medication that was known all along that it might be able to slow hair loss and/or to grow hair.
Although finasteride was first approved for the treatment of prostate enlargement, the researchers at Merck knew, at the outset, that there were families whose members were deficient in the 5-alpha reductase Type II enzyme and that the men in these families neither developed prostate disease nor went bald. In addition they had no long-term problems from the lack of this enzyme.
Merck used this natural model to develop a medication that could block the 5-alpha reductase Type II enzyme – the result was finasteride. Because the only approved treatment for symptoms related to prostate enlargement at the time was surgery, Merck developed finasteride as a medical treatment for this condition prior to developing finasteride as a potential treatment for men with male pattern hair loss.
This also meant that Merck would understand the safety profile of finasteride, and have it approved for a medical disease (symptomatic prostate enlargement), before developing it for a cosmetic condition.
The drug was first submitted to the FDA for the treatment of prostate enlargement as Proscar (finasteride 5mg) in 1991 and it was approved for this use in 1992. The drug was submitted for the treatment of men with male pattern hair loss as Propecia (finasteride 1mg) in 1996 and was approved for this use in 1997.
Posted by Updated 2017-12-11Can Women Experience Hair Loss from Hormone Replacement Therapy with Testosterone?
August 18th, 2006Q: Dr. Bernstein, a lot of older women are taking testosterone to restore libido, but are they going to suffer hair loss as a consequence?
A: They can. In women there is a delicate balance between the androgens, i.e. testosterone and estrogens. Estrogen is protective to some degree against hair loss in women, which is why most women don’t experience such severe hair loss as do men.
When a woman takes testosterone supplements it upsets that balance and can cause hair loss. However, hair loss in post-menopausal women is usually due to age related changes. Typically, the hair decreases in size in a genetically determined progression that seems not to be directly related to changes in the levels of hormones.
For more information, please see the Causes of Hair Loss in Women page on the Bernstein Medical – Center for Hair Restoration website.
Posted by Updated 2015-07-29How Does Densitometry Help Diagnose Hair Loss?
August 17th, 2006Q: Dr. Bernstein, I was reading about a densitometer on your website. What is it and what is it actually used for? — Z.A., Westchester, NY
A: The hair densitometer was introduced to hair restoration surgeons by Dr. Rassman in 1993. It is a small, portable, instrument that has a magnifying lens and an opening of 10mm2.
To use it, the doctor clips the hair short (~ 1-mm) and the instrument is then placed on the scalp. The doctor counts the total number of hairs in the field, looks at the number of hairs per follicular unit and assesses the diameter of the hair, looking in particular for abnormal levels of miniaturization (decreased hair shaft diameter caused by the effects of DHT).
The densitometer can increase the accuracy of the diagnosis of genetic hair loss by picking up early miniaturization.
It can also better assess a person’s donor hair supply, thus helping to determine which patients are candidates for a hair transplant.
Densitometry has helped us define the conditions of diffuse patterned and unpatterned hair loss (DPA and DUPA) and help to refine the diagnosis of hair loss in women.
Posted by Updated 2017-12-12Can Hair Loss be Caused by Thyroid Problems or Fluctuations in Hormones?
August 14th, 2006Q: One of the things that I have noticed as a person who has needed to take thyroid medication for a long, long time, is that when my thyroid gets a little bit out of balance – when I’m not getting quite enough, I begin to notice is that my hair starts falling out. What about the role of thyroid for hair loss? — T.K., Mineola, NY
A: Both increases and decreases in thyroid levels can cause hair loss and changes in the levels of thyroid hormone can change the consistency of one’s hair. Elevated hormone levels cause scalp hair to be fine and soft, with diffuse thinning being relatively characteristic.
When thyroid hormone levels are low, the hair becomes dry, coarse, and brittle. Hair loss can be either patchy or diffuse (involving the entire scalp).
Posted by Updated 2017-12-12How is Rogaine for Women Different from Men’s Formula? [2020 Update]
August 11th, 2006Q: What is the difference between Rogaine for men and Rogaine for women? — G.K., Hawthorne, N.Y.
A: Rogaine for men is 5% minoxidil and Rogaine for women is 2%. Another difference is that the 5% solution has propylene glycol in it whereas the 2% is alcohol based. The propylene glycol helps the minoxidil penetrate the skin better and makes the medication more effective. Although both the alcohol and propylene glycol based preparations can irritate the scalp, propylene glycol can cause actual allergic reactions in those who are sensitive.
Propylene glycol is greasier to have on the scalp than the alcohol based formulation. For patients who complain of the greasiness, we advise Minoxidil 5% at bedtime and 2% in the AM.
Posted by Updated 2020-04-09Is a Hair Transplant Painful and What Kind of Anesthesia do You Use?
August 10th, 2006Q: Dr. Bernstein, is a follicular unit hair transplant, the way you perform it, very painful? — M.C., Laguna Niguel, C.A.
A: We perform our hair transplant procedures using long-acting, local anesthesia, so after the initial injections, the patient doesn’t experience any pain or discomfort.
The local anesthesia (a combination of Lidocaine and Marcaine) lasts about 4-5 hours. For long sessions, we give additional anesthesia before the first wears off.
Posted by Updated 2017-12-01What is Best Hair Transplant Density and do You Measure Maximum or Overall Hair Density?
August 9th, 2006Q: Dear Dr. Bernstein, a full head of hair averages ~100 FU/cm2. To achieve the appearance of fullness with a hair transplant 50% is required. In one of your articles you say that you recommend 25 FU / cm2 to your patients. Is that the density per one session or the final one? If that is final density, then it is far below the 50%. Please explain as I am profoundly confused. — W.N., Easton, C.T.
A: If a person is to become a Norwood Class 6, the hair that we have available for us to transplant is only about 12% of what was there originally. This, of course, will vary from patient to patient depending upon one’s donor density and scalp laxity and a host of other factors.
We make the hair restoration look good by restoring 25-50% in the front, and proportionately less in the back. Logically one cannot restore 1/2 of ones original density to an entire bald scalp with only a thin strip of donor hair – there is just not enough hair, even with multiple sessions.
I transplant 25-35 FU/mm2 in one session, but this is the density created in the front, not overall.
Due to follicular unit graft sorting (placing the larger follicular units in the forelock area) this provides even more density than the actual numbers suggest. If someone is relatively certain to have more limited hair loss, then the numbers can be increased, but it is risky if you underestimate the degree of eventual hair loss.
Posted by Updated 2017-12-01Can I Treat Hair Loss Using Rogaine and Propecia Together?
August 7th, 2006Q Do Rogaine and Propecia work synergistically? — N.W., Chappaqua, N.Y.
A: They are synergistic, since the mechanisms of action are different.
Rogaine directly stimulates hair growth, while Propecia is permissive for hair growth by blocking DHT, the byproduct of testosterone that causes hair to miniaturize and eventually disappear.
The important thing to remember, however, is that for most people, Propecia is far more effective.
Posted by Updated 2017-12-11Can a Hair Transplant Repair a Large Scar on the Scalp?
August 4th, 2006Q: Hi Dr. Bernstein. My question is: if you have a surgical scar or incision on your head that is relatively large, is it possible to do a hair transplant into this scar?
A: Hair can grow well in a scar. Since scar tissue generally has a somewhat lower blood supply than normal tissue, we have to make some adjustments in the technique.
When we perform a hair transplant into a large scar, we place the grafts into the perimeter first i.e. the outer edge of the scar. This allows new blood vessels to develop and permits additional hair to be added more centrally at a later date until the whole area is filled in.
If the scar is small or thin it can be transplanted as with normal tissue.
Posted by Updated 2016-11-23Can Women Use Propecia to Treat Hair Loss and Does Their Age Matter?
August 3rd, 2006Q: I have early thinning on the top of my scalp and I was told to use Propecia, but I heard that is was only for men. What do you think? — T.G., Staten Island, NY
A: Women can’t take Propecia during the child-bearing years because, if ingested, it can cause birth defects in male offspring.
In post-menopausal women, where we see the greatest frequency of hair loss, it doesn’t seem to be effective.
In pre-menopausal women who do not plan to become pregnant or who already have children, we are still cautious about using the medication, since there effectiveness has not been proven and its long-term safety in this population has not been tested.
Posted by Updated 2017-12-11Updated: 2019-03-27 | Published: 2014-02-11
