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Robotic Hair Transplants & Hair Restoration
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Bernstein Medical - Center for Hair Restoration
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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Hair Restoration Answers

Do You Recommend Avolve Hair Loss Medication?

Q: My friend just came back from Paris and said that his cousin was taking Avolve for hair loss. Can you tell me what that is and is it available in the U.S.? — N.W., Portland, Oregon

A: Avolve is the European trade name for dutasteride 0.5mg made by GlaxoSmithKline for prostate enlargement. In the U.S. dutasteride 0.5mg, under the brand name Avodart, is FDA approved to treat prostate enlargement (BPH). It has not been FDA approved for hair loss.

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Hair Restoration Answers

Is Finpecia a Viable Hair Loss Medication?

Q: A friend of mine is taking Finpecia, is this the same as Propecia? — A.B., St. Louis, Missouri

A: Both Propecia and Finpecia contain the active ingredient Finasteride 1mg. Finpecia is manufactured in India by the company Cipla. It comes in packets of 10. Finpecia contains the same chemical ingredient as Propecia, i.e. 1mg of Finasteride, but it is manufactured differently and it is less expensive.

Indian patent law allows companies in India to make medications that are patented by drug companies in other countries, since Indian law protects only the processes by which drugs are made and not medication itself. Therefore, if an Indian company finds another way to make a drug, it can legally do so.

Cipla has not published any studies showing that their generic Finasteride is identical or as effective as Merck’s original product in treating hair loss. These alternative processes and drugs are not regulated by the FDA, so there is no assurance that the medication manufactured in India has the same biologic activity or potency as the FDA approved counterpart made in the United States.

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Hair Restoration Answers

Was Propecia Originally for Treatment of Prostate Enlargement?

Q: 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.

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Hair Restoration Answers

Will Rogaine Still Be Effective if Used Once a Day Instead of Twice a Day?

Q: If Rogaine is used only once a day will it still be effective? — I.P., Hempstead, Long Island, NY

A: Once a day topical use of Rogaine (topical minoxidil 2% and 5%) is probably almost as effective as using it twice a day. The reason is, although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin.

This suggests that once-a-day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.

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Hair Restoration Answers

When Can I Judge the Effectiveness of Treatment with Propecia?

Q: I was wondering why you chose two years as the amount of time one should wait to judge the effectiveness of Propecia. Have you had patients who only saw results after that long? Why does Merck say 3-6 months and Dr. Rassman at New Hair say 6-8 months? I know these numbers aren’t arbitrary, but I’m just wondering what the logic is behind this and how does this relate to planning a hair transplant? — I.P., Hempstead, Long Island, NY

A: The Merck data showed that over 90% of patients had peak response at 1 year and this has been my experience as well.

Most patients show the most dramatic response between 6 to 12 months with some getting additional benefit up to two years. Prior to 6 months, the results are quite variable and there may even be a net loss due to shedding during this period, as the Propecia stimulates a new anagen cycle…

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