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Bernstein Medical - Center for Hair Restoration
Hair Restoration Answers

Should I Start Hair Loss Treatment With Finasteride or Dutasteride?

Q: I recently visited my dermatologist regarding my hair loss, and after checking my hair he said I am showing signs of [Androgenetic Alopecia (AGA)], and said if I don’t treat it, it will progress. From my research on the net, I figured he will put me on Propecia. In fact he put me on Avodart. When I told him it is not FDA-approved for hair loss, and Propecia is, he said Avodart is better and brings DHT down more, and Propecia is nothing next to Avodart. He told me to take it every day for 2 weeks, then every other day from then on as it has a long half life. From researching on the net, many hair restoration doctors, rarely prescribe Avodart for hair loss due to some dangers. What is your opinion on this? — T.G., Darien, Connecticut

A: Although dutasteride (Avodart) can be more effective for male pattern hair loss, I would start with finasteride (Propecia) as many patients do great with it and the safety profile is better. The following are things I would consider before starting dutasteride:

  1. As you point out, dutasteride is not FDA-approved for hair loss.
  2. There is no data on its safety when used for hair loss. This is important since dutasteride has been only tested on an older population of patients (with prostate disease) rather than a younger population of patients needing medical treatment for androgenetic alopecia.
  3. These is no natural model for dutasteride’s combined blockage of both type 1 and 2 5-alpha reductase (finasteride blocks only type 2 5-AR and there are families that have this deficiency and have no long-term problems. This, by the way, is how the drug was discovered).
  4. The type 1 enzyme which dutasteride blocks is present in many more tissues of the body (including the brain) compared to type 2 (which is more localized to the skin).
  5. Although so far unproven, there is a concern that finasteride may produce side effects than can be persistent after stopping the medication (post-finasteride syndrome). It this does turn out to be true, the effects from dutasteride would most likely be significantly more persistent.
  6. If you start with finasteride and do have side effects, you will most surely have side effects from dutasteride; therefore, by taking finasteride first you will have avoided the potentially more problematic side effects from dutasteride
  7. You may respond well to finasteride, and so do not need to consider dutasteride
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Bernstein Medical In The News

‘Super Doctors’ List Has Dr. Bernstein As One Of New York City’s Best Dermatologists

Super Doctors - Key Professional Media - 2008 Edition CoverThe Super Doctors 2012 list, published by Key Professional Media as a special section in the May 20, 2012 issue of New York Times Magazine, has included Dr. Bernstein as one of New York City’s best dermatologists.

The list is a directory of the area’s best doctors that is derived from a thorough peer-nomination and evaluation process judged by performance on 10 criteria, including: years of experience, hospital appointments and fellowships, professional activities, leadership positions, academic achievements/positions, board certifications, publications and presentations, honors and awards, and other outstanding achievements in medicine.

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Bernstein Medical In The News

Hair Loss Articles Feature Dr. Schweiger

Dr. Eric S. Schweiger, board-certified dermatologist, is quoted in a few recent articles on the effects of chemotherapy on hair, genetic testing for hair loss, and caring for a bald or balding scalp. The articles were published in Energy Times and HairLoss.com. View the full post to read what Dr. Schweiger has to say on these topics.

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Hair Restoration Answers

Why Am I Losing Hair Despite Taking Avodart For Hair Loss?

Q: I am currently taking Avodart and have done so for around 8 months. Last night I had a significant loss of hair after taking a shower, nothing like I have ever seen before and found it very distressing. Can you tell me if this is hair loss or could it be something known as shedding and could you please tell me what is the difference between hair loss and hair shedding? — M.S., New York, NY

A: Hair loss is a very general term that can refer loss of hair for any reason. Genetic hair loss is caused by the effects of DHT on hair follicles that result in miniaturization -– i.e. a slowly progressive change in hair diameter that starts with visible thinning and that may gradually end in complete baldness. Hair shedding is more sudden where hair falls out due to a rapid shift of hair from its growth phase into the resting phase. The medical term for this is telogen effluvium. This process is usually reversible when the offending problem is stopped. It can be due to stress, medication, or other issues. You should see a dermatologist to figure out which process is going on. Dutasteride can cause some shedding when it first starts to work, but it would be unusual to do this after being on treatment for eight months.

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Hair Restoration Answers

Should I Start Propecia Before Hair Loss Consultation?

Q: I am a 34 year old male and my dermatologist prescribed Propecia for me today. Most of my hair loss is at the hairline, but there is some loss on top as well. It’s not bad, I just want to stay ahead of it. If I get a transplant I want to get it at your clinic, but I will give the Propecia a try first. I am going to be overseas for a couple of months starting this Sunday and I was wondering about the necessity or desirability of having someone measure my hair density prior to starting the Propecia. Would you advise waiting to start the Propecia until I come back in two months and having my density examined at your clinic? — M.R., Great Falls, Virginia

A: I would start Propecia as soon as possible. What is important for a hair transplant is the density in the donor area and this is not affected by Propecia (or minoxidil). Your donor density can be measured anytime at an evaluation prior to surgery. If you want to wait to see the effects of Propecia prior to the hair transplant, you really should wait a year; since growth, if any, can take this long. If you just want to have Propecia on board for the hair restoration procedure, or to make sure you don’t have side effects, then generally a month will do. If you would like to do a photo consult through our website to get some preliminary information about how many grafts you might need, you can do that at your leisure, but start Propecia now since the longer you wait the less effective it will be at regrowing hair.

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Bernstein Medical In The News

O, The Oprah Magazine Discusses Hair Loss In Women, Female Hair Transplants With Dr. Bernstein

O, The Oprah Magazine - March 2010O, The Oprah Magazine has a feature on hair loss in women in their March 2010 issue. Dr. Bernstein was consulted for the article and discussed female hair transplantation.

“Since female hair loss is often diffuse, only about 20 percent of female patients with thinning hair are candidates, says Robert Bernstein, MD, a New York City dermatologist who specializes in these surgeries.”

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Hair Restoration Research

Hair Cloning Shows Promise in New Stem Cell Study

A new study, using hair cloning therapy to regrow hair, shows promise for all individuals suffering from alopecia areata. The study — conducted by Marwa Fawzi, a dermatologist at the University of Cairo Faculty of Medicine, and reported on Bloomberg.com — used stem cells from the scalps of eight children with alopecia areata to regenerate their own hair.

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Bernstein Medical In The News

ABC News Hair Transplant Video Diary Features Dr. Bernstein’s Patient

Before Hair Transplant After Hair Transplant
Before / After Hair Restoration

What thoughts go through the head of your average hair loss sufferer before, during, and after a hair transplant?

The answer to that question may now be revealed. ABC News correspondent Cari Nierenberg and associate producer Ryan Stevenson take us directly into the mind and life of Bernstein Medical patient Adam Khoudja in a three-part video diary and feature on hair loss and hair restoration.

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Hair Restoration Answers

What Does Hair Transplant Evaluation or Hair Loss Consultation Cost?

Q: Didn’t you do free consults in the past? — N.F., Bronxville, NY

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.

Read more information on becoming a new patient on the Bernstein Medical – Center for Hair Restoration website. If you are ready for a hair loss or hair transplant evaluation, click here to schedule an evaluation with the doctor.

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Hair Restoration Answers

Is Asymmetrical Hair Loss from Telogen Effluvium or Androgenetic Alopecia?

Q: Over the past three months, my hair seems to be thinning more on one side. Is it common in male pattern hair loss for it to be more on one side? I had a lot of stress about three months ago and have heard that this could be the cause. Is this possible? Should I use Rogaine to treat it? — B.R., Landover, MD

A: Regardless of the cause, hair loss is usually not perfectly symmetric. This applies to male pattern hair loss as well.

In your case, it is important to distinguish between telogen effluvium (shedding that can be due to stress) and hereditary or common baldness. The three month interval from the stressful period to the onset of hair loss is characteristic telogen effluvium, but you may have androgenetic alopecia as an underlying problem.

The two conditions are differentiated by identifying club hairs in telogen effluvium and miniaturized hair in androgenetic alopecia. In addition, a hair pull will be positive in telogen effluvium (when a clump of hair is grasped with the fingers, more than five hairs pull out of the scalp at one time) and will be negative in common baldness. The hair loss diagnosis can be made by a dermatologist.

Hair cuts do not affect either condition.

Rogaine (Minoxidil) is only effective in androgenetic hair loss and only marginally so. Finasteride is the preferred treatment if your hair loss is genetic when it is early and a hair transplant may be indicated if the hair loss progresses.

Shedding from telogen effluvium is reversible and does not require specific treatment.

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Hair Restoration Answers

What Causes Patch of Hair Loss in Women?

Q: I am a 34 year woman with a patch of hair loss by my temple. I went to the salon to have my hair done and to my surprise my hairdresser told me that I have Alopecia? First time I’d heard of it, my G.P is not very concerned about it but having read so much about it on this site I am becoming a bit concerned. The rest of my hair is healthy any suggestions and diagnosis? — M.V., Williamsburg, Brooklyn

A: “Alopecia” is just a generic term for any kind of hair loss.

It sounds like you have a specific condition called alopecia areata. Alopecia areata is an autoimmune disease that presents with the sudden appearance of well localized bald spot(s) on the scalp or other parts of the body. The underlying skin is always normal.

The treatment is injections with cortisone. Hair transplant surgery is not indicated for this condition.

You should see a dermatologist to confirm the diagnosis and treat.

Other diagnoses to consider are triangular alopecia (which would have been present since childhood) and traction alopecia (that is cased by constant tugging on the hair).

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Bernstein Medical In The News

Hair Loss in Women the Topic in Dr. Bernstein ‘Early Show’ Interview

Excerpt from the interview:

Julie Chen: Dr. Bernstein, I want to go through all the options that are available for women, but what is the difference between female and male hair loss option-wise. What can we do to treat it?
Dr. Bernstein: The main difference medically is that women have hair loss often from hormonal changes and it’s due to an imbalance between progesterones and estrogens. That equilibrium can be reestablished with medication. Often birth control pills can do that.

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Bernstein Medical In The News

Hair Transplant Surgeon of the Month Award to Dr. Bernstein

Dr. Robert M. BernsteinDr. Bernstein receives the Surgeon of the Month award given by the International Society of Hair Restoration Surgery. Dr. Bernstein introduced the concept of “follicular transplantation” in 1995 through a publication in the International Journal of Aesthetic and Restorative Surgery, where he recommended that in all hair transplant procedures the implants should consist of only the naturally occurring follicular units. The anatomic follicular units, seen clinically as the patient’s natural hair groupings, are different for each individual, and these differences should be reflected in the transplant plan. He has been a strong advocate of using follicular transplantation for the best possible cosmetic result, and has encouraged his colleagues to use this approach in his writings and lectures.

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