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Bernstein Medical In The News

Hims and Keeps: Hair Loss Solutions Explained

Hims Logo

On our Facebook and Instagram feeds, billboards, on the side of buses, and lining the walls of the subway, are ads of young, attractive men with voluptuous locks and titles saying things like “Hair loss is optional” and “Handsome, healthy you.” These are the ads for the millennial men’s wellness brand, Hims. Hims, and fellow start-up Keeps, offer hair loss solutions (that would normally be prescribed in-person, by a doctor) in one simple package to your home.

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Hair Restoration Answers

What is your Opinion of Nutrafol?

Q: What’s your honest take on Nutrafol? It is a product my dermatologist has recommended for my hair loss. — N.S. ~ New York, N.Y.

A: The traditional thinking is that that male pattern alopecia (androgenetic alopecia) is due to follicular sensitivity to DHT causing miniaturization and eventual loss of hair. The premise of Nutrafol is that hair loss is multi-factorial with an important inflammatory component and that it is important to address the inflammation as well as the DHT sensitivity.

This is a relatively new and important concept (I would like to stress this point!). However, the big leap is their conclusion: Since hair loss is multi-factorial, then broad, rather than targeted treatments would be most beneficial, and since naturally occurring “phytochemicals” are broader in action than targeted, FDA approved drugs (like finasteride and minoxidil), they should offer benefit in the treatment of hair loss and Nutrafol is the elixir that can accomplish this.

Although this makes sense in concept, there is no scientific evidence that Nutrafol can actually reverse or/mitigate androgenetic alopecia or any other type of hair loss. We need independent, blinded, controlled studies to show that Nutrafol actually works. Until then, it is very difficult to recommend this product and, more importantly, to recommend it over other treatments known to be effective.

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Hair Restoration Answers

Can I Have Platelet Rich Plasma Therapy Instead of Hair Transplant Surgery?

Q: It was recommended by the doctor that I have a hair transplant. Could I do platelet rich plasma (PRP) instead?

A: PRP will generally be inadequate for patients who are candidates for a hair transplant. PRP works to reverse (thinning hair) as do other medical treatments (Propecia, Rogaine, LLLT). Unfortunately, medical treatments do not grow hair back once it has been lost.

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Hair Restoration Research

New Research Shows Laser Therapy (LLLT) is an Effective Treatment for Male and Female Pattern Hair Loss

Given the large number of people who are affected by androgenetic alopecia and for whom traditional treatments, like surgical hair restoration or hair loss medications, may not be indicated, could low-level laser therapy be a viable and effective treatment option? New research published this year, 2014, in the American Journal of Clinical Dermatology, says yes.

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Hair Restoration Answers

Do You Recommend Azelaic Acid With Rogaine (Minoxidil) 2% Or 5%?

Q: Have you any experience with Azelaic Acid as a hair loss treatment — is this something you would recommend using with Rogaine (minoxidil) 2% or 5% solutions? — S.V., Short Hills, N.J.

A: Azeleic acid has no direct benefit in promoting hair growth. Azelaic acid (like retinoic acid) increases the absorption of minoxidil, but also the side effects, so I would especially not recommend it in your case.

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Hair Restoration Answers

Does Propecia (Finasteride) Work Long-Term?

Q: I have been taking finasteride for several years and I seem to be doing well. Does finasteride generally work long-term? — A.C., West University Place, Texas

A: With regard to efficacy, a recent long-term, uncontrolled study by Rossi et al. reported that the effects of finasteride were not reduced as time goes on and that a significant proportion of patients, unchanged after 1 year, improved later on. In addition these patients maintained a positive trend over time -– up to ten years. When comparing different age groups, they found that subjects older than 30 years showed a better hair growth in the long term than those who were younger. Of the 113 patients in the study followed for 10 years, only 14% worsened, whereas the remaining 86% had benefits.

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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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Hair Restoration Research

Propecia Causes No Statistically Significant Change in Sexual Function, Says 2004 Tosti Study

The central finding of a 2004 study led by Italian researcher Dr. Antonella Tosti, in which he and his team investigated sexual dysfunction in hair loss patients being treated for androgenetic alopecia, was that there was no statistically significant change in sexual function after four to six months of treatment with finasteride 1mg (Propecia).

Interestingly, the research team found that sexual side effects were actually less common than reported in the clinical trials of the drug.

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Hair Restoration Answers

Before and After Photos of Medical Therapy Look Too Good To Be True!

Q: Are the “result” photos from taking Propecia and using Rogaine legitimate? Some of the after photos look too good to be real and a few patients looked like they combed their hair to look like they had more coverage. — T.Y., Darien, Connecticut

A: The before and after photos of patients using Propecia and Rogaine are my patients. All photos on our website are un-retouched. Often, when patients have a good response to medical therapy, they have more flexibility in how they can groom and style their hair. This is reflected in the photos.

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Hair Restoration Answers

Persistent Side Effects From Propecia

Q: You prescribed Propecia for my hair loss. I was wondering if the new news report on Propecia side effects has altered your opinion regarding the safety of this drug? — N.D., Belle Meade, Tennessee

A: It has not changed. I believe you are referring to Dr. Michael Irwig’s study at George Washington University published in the Journal of Sexual Medicine. I was already aware of the study when I prescribed the medication for you and we discussed the risk of persistent side effects at your consult.

Although all types of data should be considered, it is important to realize that this was not a scientific study, but a survey. It had very significant selection bias. From this type of study, one can’t prove cause and effect relationships or even get a sense of actual incidences. These were patients who were recruited because they already had persistent sexual dysfunction. Since it is not clear if their persistent problems were directly due to the medication or from other factors, and since these patients were selected, rather than randomly assigned, the additional information can be gained from the report is very limited.

That said, the reporting of persistent side effects should not be taken lightly, but should be viewed in the context of all available data. It is extremely important for us to continue to be vigilant, as this is a very significant issue, but it is equally important not to make decisions on data sensationalized in the media. As a result of the finasteride data, some are presenting surgery as a more reasonable alternative than medication. For a young person, that is usually not the case.

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Hair Restoration Answers

Does Propecia Stop Working After Five Years?

Q: I heard that Propecia stops working after five years. Is this true and why in five years? — B.P., Stamford, CT

A: That is not correct. Although the effects of Propecia (finasteride 1mg) will diminish over time, it does continue to work. Using finasteride long-term will still be better than stopping it at some arbitrary interval. In clinical practice, I often increase the dose of finasteride, after someone had been on the medication 3 to 5 years, to help maintain its effectiveness.

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Hair Restoration Answers

Can Propecia in Semen Harm Fetus upon Conception?

Q: Although I was prescribed Propecia, I have not yet started to take it. I would like to take it now, but my wife wants me to wait until after we have our second baby so as to avoid having the drug in my system when we conceive. She’s concerned that if it’s so harmful to pregnant women, that having it in my sperm is an issue. — L.V., Bellmore, New York

A: There is no evidence that if you take the medication it will affect the fetus. However, your wife should not ingest the drug or handle broken pills during pregnancy.

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Hair Restoration Answers

Is Nizoral An Effective Hair Loss Medication?

Q: I use Nizoral for my dandruff. Does it work for hair loss too? — M.D., Danbury, CT

A: The active ingredient in Nizoral is Ketoconazole. This medication, originally developed to treat fungus infections, has slight anti-androgen action. It is supposed to work in hair loss by inhibiting the action of DHT on hair follicles. Although, in theory, it should be useful for androgenetic hair loss, there have not been conclusive scientific studies to show that it works to treat balding when used as a topical application for balding.

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Hair Restoration Answers

Are Propecia Side Effects Irreversible?

Q: I heard that the sexual side effects of Propecia are irreversible. Is this true? — L.R., Parsippany, NJ

A: The sexual side effects of finasteride (Propecia) begin to subside soon after the medication is discontinued. This would make sense since the drug finasteride is a reversible inhibitor of DHT. Although it is possible for side effects to be persistent after stopping the medication, this situation seems to be very uncommon and a cause and effect relationship is still in question.

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Hair Restoration Answers

Can Body Hair Transplant be Negatively Affected by Finasteride?

After trading anecdotes with fellow hair loss physicians about how finasteride can reduce body hair in some patients, Dr. Sharon A. Keene asked whether finasteride might have a negative effect on patients who have body hair transplant (BHT) procedures. While the current research is inconclusive, her review sheds light on how to avoid any possible negative impact that finasteride might have on patients who have body hair transplant procedures.

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Hair Restoration Research

Latisse Drug as Hair Loss Treatment? Trials Under Way on New Formulation of Bimatoprost

Latisse, the brand name for the drug bimatoprost, is commonly used to promote eyelash growth in women who want their eyelashes to be longer, thicker, and darker, typically for cosmetic reasons.

In a publication on ClinicalTrials.gov, Allergan, the pharmaceutical company that produces Latisse, has announced a new study on the safety and efficacy of a new formulation of bimatoprost for use as a topical hair loss treatment for general baldness.

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Hair Restoration Answers

Can Propecia Cause Groin Pain?

Q: I started using both Propecia (finasteride) and Rogaine for roughly the past 15 weeks. In the last month I’ve been experiencing pain in my left testicle area. At first I thought this may be due to Varicocele; however, after some quick internet searches I thought it may also be the Propecia. The pain doesn’t seem to be in the testicle itself as much as the surrounding veins on the left side. What should I do? — B.L., Houston, TX

A: Your symptoms are the classic ones of a varicocele, namely pain on the left side that is adjacent to the testicle. Symptoms of finasteride would more likely be bilateral, although the discomfort does not need to be in the testicle itself. If your symptoms are worse at the end of the day when you have been standing, and less in the AM when you first arise, these suggest a varicocele.

In your pain is consistently worse towards the end of the day, I would see a urologist, as surgical intervention might be warranted, particularly if it is affecting sperm counts – which should be checked as part of the evaluation.

If this is not the case, then stop finasteride for a least a month and see if the symptoms subside. If they do go away off finasteride, I would not take the medication again. If the symptoms persist off finasteride, I would still see a urologist.

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Bernstein Medical In The News

Men’s Health Magazine Features Dr. Bernstein in ‘Hair Health’ Spotlight

Men's Health - Hair HealthMen’s Health has published a new spotlight, called “Hair Health.” The multi-article spotlight is featured on the magazine’s website homepage and covers a wide variety of topics related to men’s hair loss and hair transplantation. Dr. Bernstein was asked to contribute to the series of articles, including an “expert advice” feature which answers five commonly-asked questions about hair loss myths.

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Hair Restoration Answers

Can Propecia Or Rogaine Restore My Original Hair Density?

Q: You mentioned that the hair at my crown and other areas where I now have baldness hasn’t really fallen off but has thinned to a great extent and that taking Rogaine and Propecia might help increase their thickness. If the medications do restore the hair thickness, I’m curious why you said that I could look like how I was 1 to 2 years ago. Technically, shouldn’t I be able to regain much more of my hair (and look like how I was longer than before that) since the follicles are all still there? — H.D., Park Slope, NY

A: Although Propecia is much more effective than Rogaine, even when used together, the medications are just not that effective in reversing the miniaturization process. They may bring you back to the way you were a few years ago, but will not restore your adolescent density.

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Hair Restoration Answers

Will Taking Propecia Improve Donor Area Density Enough To Allow Hair Transplant?

Q: Is it recommended to wait for 1 year after starting Propecia, when the effect of the medication kicks in and improves density of donor area, and then perform the surgery? — Z.B., Bergen County, New Jersey

A: Propecia will not affect the donor area, as this area is generally not impacted by the miniaturizing (thinning) effects of DHT –- the hormone that Propecia blocks. The purpose of waiting the year is to possibly regrow hair in the recipient area. If regrowth is significant, a hair transplant may not be necessary. If a person’s hair loss is extensive and there is little chance that Propecia will grow a significant amount of hair back to give a satisfactory improvement, then waiting the year is unnecessary.

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Hair Restoration Answers

Could Taking Finasteride Or Minoxidil Make A Hair Transplant Possible If My Donor Area Is Thin?

Q: You said I was not a good candidate for a hair transplant because my donor area was too thin. Since finasteride and minoxidil can increase the thickness of the hair, could it make a hair transplant possible?

A: Unfortunately, the medication will not affect the donor area and, therefore, not make a person with low donor density a candidate for a hair transplant.

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Bernstein Medical In The News

ABC News Report On Hair Loss Features Dr. Bernstein, Consumer Reports Hair Loss Survey

WABC-TV Eyewitness News; channel 7 in New York, NY; featured Dr. Bernstein in a special report on hair loss and hair loss medications. In particular, the report, by ABC correspondent Kemberly Richardson, asked Dr. Bernstein about the effectiveness of Propecia/Finasteride and Rogaine/Minoxidil in the treatment of male pattern hair loss. Watch the report.

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Hair Restoration Answers

Can Finasteride Change the Consistency of My Ejaculate?

Q: I’ve now been taking finasteride for just over 5 months. I have noticed that my semen quality has changed just in the last 3 months, and it seems now much less in quantity and is quite watery and clear in color. I think the current problems are due to the finasteride, what do you think? — S.F., Rolling Hills, California

A: Finasteride, the active drug in Propecia, can change the quality of the semen, since it is decreasing the component of seminal fluid that is secreted by the prostate. You may want to consider having your sperm counts checked, as finasteride can lower this. If the symptoms are not bothering you, and your sperm counts are normal, it should be OK to continue the medication. If you were having difficulty conceiving, then I would stop the medication.

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Hair Restoration Answers

Will Propecia Work Better if Taken at Night or with Food?

Q: What time should I take the Propecia? Does it work better if I take it at night as opposed to the morning and should I take it with meals? — B.J., Garden City, N.Y.

A: It doesn’t matter what time of day you take Propecia and the time can very each day.

The absorption of Propecia (finasteride) is not affected by food, so it can be taken without regard to meals.

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Hair Restoration Answers

Why Do You Shed Hair in First Months of Treatment with Rogaine?

Q: I started thinning and saw more hair in the tub. I began Rogaine and stopped shampooing every night and is seems that there is now more coming out every time I shower. What is going on? — E.U., Short Hills, NJ

A: Rogaine can cause shedding at the beginning of treatment (i.e. in the first 3 months) but this is expected as it causes some hair to begin a new cycle of shedding and re-growth. This means the medication is working.

Another reason for your apparent shedding is that the less you wash your hair, the more will be lost each time. Go back to shampooing every day and see what happens.

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Hair Restoration Answers

Which is Preferred: Rogaine Foam or Liquid Formula?

Q: Do you think there is a difference in the efficacy between the 5% Rogaine foam or liquid formula? — N.N., Dallas, TX

A: In theory, the foam should be as effective as the original solution (liquid). However, an important part of the efficacy is getting the medication directly onto the scalp – rather than just on the hair.

For patients who are applying the medication to areas with a significant amount of hair, using the solution with a dropper applicator enables the medication to best reach the scalp. Because of this, I prefer that patients use the solution with a dropper applicator if they are using the medications in areas with a significant amount of hair. If patients find the solution irritating to the scalp (or too messy) and the foam less so, then using the foam is better than nothing.

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Hair Restoration Answers

After a Hair Transplant Can I Replace Hair Loss Medication with Laser Therapy or Herbs?

Q: I am interested in a hair transplant, but am turned off by the apparent side effects of follow up Propecia. Could herbs serve the purpose of Propecia? Regarding laser treatments, do they work on their own, or do you need drugs to supplement? Can laser damage in some cases, rather than benefit? It seems odd that laser therapy has been undertaken in Europe for 10 years, yet there are no published studies on the results. Might this be because it doesn’t work in the longer term? — D.D., Richmond, U.K.

A: Finasteride is the best medication. Herbs are not particularly effective for hair loss. You should consider trying finasteride.

If you are in the 2% group that has side effects with Propecia, just stop taking the medication. If you do not experience side effects, then there is no problem taking the medication long-term. Hair transplant surgery doesn’t prevent the progression of hair loss. That is why it is used in conjunction with medication.

Click here to read the rest of the post.

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Hair Restoration Answers

Will Intermittent Use of Rogaine Stop My Hair Loss?

Q: Medical information suggests that Rogaine works for about 50% of the men who try it. Does Rogaine actually worsen hair loss in some men? The Rogaine website states that during the first three weeks of use Rogaine causes increased shedding. If true, would intermittent use of Rogaine make hair loss worse even in men for whom Rogaine would work if applied daily as directed? — V.C. Greenpoint, Brooklyn

A: Rogaine, the brand name for the drug Minoxidil, does not worsen hair loss, but can cause initial shedding (which actually shows that the drug is working).

The medication should be used on a continuous basis for the long-haul. Intermittent use of the drug, or pulsing, makes no medical sense.

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Hair Restoration Answers

After a Hair Transplant, Should I Use Propecia or Rogaine or Both?

Q: I recently had a hair transplant about a month ago. Currently I’m on Propecia and I am a stickler to taking it at the same time every day. I don’t, however, use Rogaine namely because I fear the irritation it can possibly cause will halt graft growth and because I’ve heard that the grafts and post-surgical shock loss hair will return without its use. Is it ok to use only Propecia post-surgically? Or would adding Rogaine be of any significant benefit? — L.B., Rye, NY

A: I would definitely stay on Propecia and, if you like, you can add Rogaine – it may have a little additional benefit. The 5% foam formulation is less irritating and can be started a week after the hair transplant.

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Hair Restoration Answers

What Medications are Used During a Hair Transplant and are they Safe During Pregnancy?

Q: Is it necessary to take medications before, during, or after the hair transplant? Will these medications affect pregnancy? — V.M., Fairfield, C.T.

A: It is not necessary to take any medication for a hair transplant other than the local anesthesia used during the procedure.

Although I would not have a hair transplant during pregnancy, the procedure will have no effect on future ones.

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Hair Restoration Answers

Which is the Preferred Treatment for a Young Patient: Hair Transplant or Medication?

Q: I am 25 year old who just started going bald. My doctor confirmed that I have pattern baldness and put me on Propecia and Rogaine. I don’t want to go bald at any age. So, instead of prolonging the process for 5-10 years and then having a HT, isn’t it easier to let the hair loss continue and then have a HT, so, that I can save the money on drugs for years. — Z.B., Greenwich, C.T.

A: It is far better to keep your own hair. Keeping your own hair will generally look fuller than a hair transplant, since a hair transplant just re-distributes existing hair (until hair cloning techniques are available).

The medications (i.e. finasteride and minoxidil) are relatively cheap if you get the generic forms.

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Hair Restoration Answers

What Hair Loss Medications are Effective DHT Blockers and are they Sold Over the Counter?

Q: Are there DHT blockers that are sold in the pharmacy over the counter? — C.C., — Fairfield County, Connecticut

A: The only effective DHT blockers are finasteride (Propecia, Proscar) and dutasteride (Avodart).

These medications require a doctor’s prescription and are not sold OTC. Nizoral is a topical shampoo for seborrhea (a type of dandruff) that is sold over the counter, but it is not effective in treating hair loss.

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Hair Restoration Answers

Do You Recommend Avodart (Dutasteride) Hair Loss Medication?

Q: I heard that there is a new drug on the market called Avodart for prostate enlargement which might help with hair loss as it blocks the conversion of testosterone to DHT better than Finasteride and is more effective than Propecia. Do you recommend taking it and if so what is the dose? — Y.B., Orlando, Florida

A: I am currently not recommending that patients take Dutasteride for hair loss, although it is more effective than Propecia, finasteride 1mg. (Dutasteride 0.5, the dose generally used for hair loss, seems to be slightly more effective than finasteride 5m in reversing miniaturization.)

The reasons that I am hesitant to prescribe it at present are outlined in the Hair Restoration Answers question, “Is Avodart Safe?

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Hair Restoration Research

Dutasteride vs. Finasteride

In the study, 416 men with male pattern hair loss (MPHL) ages 21 to 45 years old, were randomized to receive dutasteride 0.05, 0.1, 0.5 or 2.5 mg, finasteride 5 mg, or placebo daily for 24 weeks. The results of the study showed that dutasteride increased hair counts in a dose-dependent fashion and dutasteride 2.5 mg was superior to finasteride 5mg at 12 and 24 weeks.

[…]

Concerning possible sexual adverse events, there was no evidence in the present study that either dutasteride or finasteride was associated with impotence. However, 9 men in the 2.5-mg dutasteride group complained of decreased libido, compared with 1 man in the 0.5-mg dutasteride group and 3 men in the finasteride group. As with previous studies with finasteride, this adverse event was characterized as either mild or moderate in severity and often resolved with a continuation of the medication. In the 4-year follow-up of the phase III trials in BPH, dutasteride (0.5 mg) was well tolerated and the incidence of the most common sexual adverse events was low and tended to decrease over time.

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Hair Restoration Answers

Will Increasing the Dosage of Propecia Stop the Miniaturization Process?

Q: I have been using Propecia since it was released to the public in 1998 and have found it to work very well. Recently, its effectiveness has stopped and my hairs are miniaturizing again. I am going to increase the dosage to 1/2 a pill Proscar every day. How long will the increased dosage take to stop the miniaturizing process? — T.U., Chappaqua, N.Y.

A: It seems to take the same time to work as when you initially started Propecia.

When patients increase their dose, I rarely see re-growth, but rather the expectation is that further hair loss will be decreased. When it does work to actually re-grow hair, we sometimes see an initial period of shedding, similar to when finasteride was first started.

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Hair Restoration Answers

Can Avodart Hair Loss Medication Cause Shedding?

Q: I’m male, early thirties and in the early stages of hair loss, too early for hair transplants. I am experiencing extreme shedding. I took Avodart for 6 weeks, but because of the shedding I stopped. Now, it still continues as strong as ever. I’ve been losing about 200 hairs every day in the shower. 3 months ago I had so much more hair, what is going on? I heard that shedding can happen, but not like this. Could this have caused telogen effluvium, or something else? — M.M., Boston, Massachussetts

A: Since Avodart (dutasteride) is a more potent medication than Propecia (finasteride), the shedding (telogen effluvium) may be more dramatic. If you have made a decision to use Avodart, then you need to tolerate this short-term effect. It should subside within the first 6 months on the drug.

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Hair Restoration Answers

How Long After Hair Transplant Should I Wait Before Continuing Treatment with Rogaine?

Q: I stopped using Rogaine for my hair transplant, when can I start using it again? And would it be any different with the new Rogaine foam. — J.N., London, United Kingdom

A: I would wait at least 7 days to use Rogaine (minoxidil) in either liquid or foam.

The foam has less alcohol and can be irritating when applied to open wounds, but should be fine one week post-op.

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Hair Restoration Answers

Does Rogaine Only Work on Crown?

Q: I heard that Rogaine only works on the crown and not on the front or top of the scalp. Is this true? — D.D., New Haven, Connecticut

A: Rogaine (Minoxidil) has the potential to work where ever there is miniaturized hair, either the front, top or crown (however, it will not work in areas that are completely devoid of hair).

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Hair Restoration Answers

Can Propecia Cause Hair Thinning?

Q: I am 22 yrs old and I started shedding hair in a very limited form since I was 20. I have now been on Propecia for nearly 8 months. To date I have not experienced any benefit. In fact, I have seen my hair continue to thin. Is it possible that this thinning is a result of Propecia? — M.M., Boston, Massachussetts

A: Usually the shedding associated with finasteride will subside by 6 months.

If you are still losing hair at 8 months, most likely the medication is not working. Unfortunately, it is not effective in about 15% of patients.

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Hair Restoration Answers

Can Propecia Treat Diffuse Unpatterned Alopecia (DUPA)?

Q: I am 26 and I have been diagnosed with Diffuse Unpatterned Alopecia (DUPA) and realize I am not a candidate for hair transplants. I have been on Propecia for about 9 months. There have been periods of increased shedding throughout and I am still shedding what seem to be mostly very fine, miniaturized hairs. Do you think this is the Propecia speeding up the hair cycle and pushing out the old fine hairs, or do you think this is an increase in the pace of my genetic balding? I know that your post states that the accelerated hair loss generally stops by the 6th month. Does DUPA have any effect on the timeframe? Also, I have read that Propecia is only effective for about 50% of patients with DUPA. Do you find that to be true, or have you found a different experience? — T.T., White Plains, N.Y.

A: It is hard to tell at 9 months whether it is shedding from the finasteride or that the medication is just not working. Since there is no way to tell, I would stay on the medication for 2 years for any possible shedding from the medication to have passed and to see if your hair loss actually stops.

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Hair Restoration Answers

Do You Recommend Finpecia or Generic Finasteride?

Q: I am 26 years old and in the beginning of losing my hair and not ready for hair transplant surgery. It seems to have stopped now but 4 months ago I shed a lot of hair and can visually see that my hair on the scalp is thinning out. I have looked into and read up on taking Propecia or more exactly Finpecia (I’m a student so cost is a factor), but can I trust this generic drug? Have looked at the company (Cipla) website but I’m still a bit scared of taking something I don’t really know what it is. What is your opinion on choosing Finpecia over Propecia? — E.E., Midtown East, N.Y.

A: Finpecia is manufactured in India by a slightly different method than the way Propecia is produced in the U.S. Since finasteride 5mg is now available in a generic from in the U.S., I suggest that you use finasteride 5mg and quarter the 5mg tablet with a pill cutter and take 1/4 tablet a day. The parts do not need to be the same size. In the U.S., generic finasteride and Propecia (1mg) and Proscar (5mg) are all made the same way. Cipla is a large company, but is not under U.S. FDA supervision.

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