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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

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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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

What are the Most Common Causes of Hair Loss in Women?

Q: What are the most common causes of hair loss in women other than genes?

A: The most common causes for localized hair loss in women are traction (due to tight braiding) and alopecia areata (an autoimmune disease that produces smooth round patches of hair loss).

Other than genetic (hereditary) thinning; generalized hair loss is most commonly caused by medications, anemia, and thyroid disease.

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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.

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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

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 Answers

Allergic Reaction to Rogaine Liquid but Not Foam?

Q: Our dermatologist originally suggested our son use the 5% Rogaine and he developed an allergic reaction to it. Allergy tests confirmed it was the propylene glycol causing the reaction. I understand that Rogaine foam has 5% minoxidil in it but no propylene glycol. Is that correct? — B.M., Lower East Side, N.Y.

A: In addition to minoxidil 5%, Rogaine Foam contains: butane, butylated hydroxytoluene, cetyl alcohol, citric acid, fragrance, glycerin, isobutane, lactic acid, polysorbate 60, propane, purified water, SD alcohol 40-B, stearyl alcohol — but no propylene glycol.

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Hair Restoration Answers

Do You Recommend Loniten as Hair Loss Medication?

Q: Is Loniten good for treating hair loss? — N.V., East Hills, N.Y.

A: Loniten (oral minoxidil) is not useful for treating hair loss. The reason is that it stimulates hair growth all over the body (hypertrichosis) and has a number of serious side effects.

Even when used to treat blood pressure, for which it is FDA approved, it is a medication reserved only for severe hypertension, used after at least three other types of blood pressure medications have been tried and are unsuccessful.

In addition to increased body and facial hair growth, it can cause fluid retention and heart disease. When used topically (topical generic minoxidil or Rogaine) the medication generally does not cause any significant problems other than local skin irritation and occasionally increased facial hair (which can be real nuisance for women).

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How is Rogaine for Women Different from Men’s Formula?

Q: 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.

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Hair Restoration Answers

Can Women Use Propecia to Treat Hair Loss and Does Their Age Matter?

Q: 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.

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Hair Restoration Answers

Is Propecia Necessary for Hair Transplant?

Q I am 35 years old and have been using Propecia for the last 3 years, waiting to save enough money for a hair transplant. I no longer feel comfortable using it due to side effects. Can hair transplantation still be effective even without continuing to take this drug afterwards? — Y.C., Matinecock, New York

A Many people choose not to take Propecia or choose not to take it due to side effects and the surgical hair restoration is just as effective. The only difference is that medications can prevent further hair loss whereas surgery cannot.

Medications are not needed for the hair transplant to be successful or the transplanted hair to grow and be permanent.

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