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Bernstein Medical - Center for Hair Restoration
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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Hair Restoration Answers

Why Am I Shedding From Higher Dose Of Finasteride?

Q: I have been taking one tablet of Propecia daily for the past 5 years, with good results, until May of this year. At that point I started to experience some hair loss and so you recommended that I switch from Propecia to generic finasteride and increase the dose to 1/2 of a 5 mg pill per day. I started taking the 1/2 tablet of finasteride daily one month ago, and for the past 2 weeks I have seen a lot of hair in the bathtub and on the towel after taking a shower. I have not made any other changes in my diet or my shampoo, and I do not have any conditions on my scalp. Please advise me on what needs to be done. — C.C., Floral Park, New York

A: Just continue the medication at the higher dose. Either the finasteride hasn’t started working yet or you are getting temporary shedding from the medication (which means that it is working).

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Hair Restoration Answers

Could Finasteride (Propecia) Remove Unwanted Body Hair?

Q: I’m concerned that finasteride might result in unwanted body hair on the arms, back, etc. Is there any truth to this? My thinking is that since finasteride blocks the enzyme 5 alpha-reductase which converts testosterone to its more active form, DHT (dihydrotestosterone), is it possible that it might actually have some effectiveness in ameliorating unwanted hair? — P.P., Stamford, CT

A: Yes, finasteride does have some ability to decrease body hair, since growth of body hair is stimulated by DHT. However, the effects of finasteride are mild and not observed by everyone, so if you have unwanted body hair you will probably need some other means to remove it such as waxing, laser hair removal or electrolysis. The important thing is that finasteride doesn’t increase body hair.

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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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Hair Restoration Answers

Will Propecia Cause Or Inhibit Chest Hair Growth?

Q: I am currently 28. I have been taking Propecia for 6 years and recently began to grow sparse chest hair for the first time in my life. Is the Propecia causing these effects? — H.L., Gowanus, Brooklyn, NY

A: DHT causes male pattern baldness and stimulates the growth of body hair. The use of Finasteride, a DHT blocker, will permit scalp hair to grown and inhibit the growth of body hair, not stimulate it.

However, the effects on body hair are quite small, so your natural tendency to grow chest hair over time is probably not being blocked by the treatment.

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Hair Restoration Answers

Cutting Up 5mg Finasteride Tablets

Q: Hey doc, you told me to cut up 5mg finasteride into four parts. Why not five, so that it will be equal to Propecia which is 1mg? — H.F., Eastchester, NY

A: For several reasons; 1) you will lose some in the cutting process, 2) the generic dose can be slightly less than the brand, and 3) it is too difficult to cut into five parts – four is hard enough. Note that due to the fact that finasteride stays in the hair follicle for a long time, the pieces do not have to be in four equal parts.

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Hair Restoration Answers

Will Someone Taking Propecia For One Year Experience Any Further Regrowth?

Q: I have a friend who has been using Propecia 1mg a day for twelve months without having any regrowth. Is he likely to experience regrowth at this stage? — S.S., Long Island, NY

A: Your friend is unlikely to get any significant regrowth after one year, but that doesn’t mean that the medication is not working. He may have had even more hair loss without the medication.

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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

When Should Hair Transplant Be Considered For Thinning Area?

Q: At what level of thinning should the hair transplant be done? — V.K., London, UK

A: A hair transplant should be considered in an area of thinning when:

  • The area has not responded to medical therapy (finasteride 1mg a day orally and minoxidil 5% topically for one year).
  • The thinning is significant enough that it can’t be disguised with simple grooming (i.e. is a cosmetic problem even when the hair is combed well).

Other factors that are important include:

  • the age of the patient
  • the donor supply
  • whether the thinning is in the front of the scalp or in the crown
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Hair Restoration Answers

Is Nioxin An Effective Hair Loss Treatment, And Is It Safe Or Advisable To Use?

Q: I have been using Rogaine and Propecia, but recently purchased a bottle of Nioxin Cleanser/Shampoo. However, I am reluctant to apply it because I have noticed that the Nioxin website recommends against mixing Nioxin products with Rogaine products. Do you think that it is safe or advisable to use the Nixon shampoo? Is there any indication that this product is even effective? Any advice?

A: Nioxin has no active ingredients that can grow hair. There is an increased incidence of scalp irritation when used with Rogaine – i.e., the likely reason for their warning. I would stick with the medications that are proven to work, i.e. finasteride and minoxidil.

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Hair Restoration Answers

Is Propecia Effective In Young Patients?

Q: I know that Propecia works in only about half of patients. Are younger people more likely to be helped by this medication? — V.C. Greenpoint, Brooklyn

A: The main studies by Merck looked at men between the ages of 18 and 41. The five year data (which, in my view, is most important) showed that 48% of men had an increase in hair growth and 42% had no change over baseline. Thus a full 90% held on to their hair or had more over a 5-year period. This compares very favorably to the placebo group where 75% lost hair over the 5-year period.

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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

Is a Hair Transplant to Recreate a Dense Hairline Too Good to be True?

Q: It’s a question that greatly concerns me because I’m investigating getting a transplant sometime next year. I’m 28 and thought I started balding at 26, but photographic evidence suggests it had started somewhere around age 24. I’m roughly a Class 2 now, and thanks to finasteride, I’ve stayed almost exactly where I was at 26 with some improvement (not really cosmetically significant though). However, I am convinced I have some crown and top of the scalp thinning too, but not to a visible degree.

These people getting these miraculous jobs from Canada – it is a trick, right? They can’t honestly expect to be able to get away with what they’ve done over the course of their entire lives, can they? — L.M., Great Falls, V.A.

A: I think you have better insights into hair loss than many hair transplant surgeons. ABI was the “rare” patient who seems to be a stable Class 3. I made that judgment due to: almost no miniaturization at the border of his Class 3 recession, no crown miniaturization, and his unusual family history. He had several older family members who stayed at Class 3 their whole lives.

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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

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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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

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

Can Hair Loss be Caused by Weight Lifting and Increase in Testosterone Levels?

Q: My son, 25 years old, is seeing hair loss around the hairline. According to your website, he is probably a stage II. He may have a little hair loss at the vertex; right now it is hard to tell. He is very muscular and loves weight lifting, but no drug enhancement. Is there a relationship between weight lifting and hair loss, since I have read that weight lifting increases testosterone levels? — G.S., Pleasantville, NY

A: Yes, weight lifting does increase testosterone, which in turn increases DHT. This can accelerate hair loss, although the effect is generally very slight.

Rather than modify his exercise program, your son may want to consider taking finasteride (Propecia). This requires a doctor’s prescription.

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Hair Restoration Answers

Can Hair Loss Be Induced By Acne Medication Accutane?

Q: I have hair loss due to a treatment of Accutane. I have been off this medication for about a year and a half now, yet my hair has not recovered. The texture of my hair has completely changed. Given the fact that there is no family history linking me to male pattern baldness, I attribute my hair loss exclusively to Accutane. What should I do? — H.F., Eastchester, NY

A: If the texture alone has changed there is nothing you can do except to wait. The texture should improve over time even though it has already been 18 months.

If there are signs of genetic hair loss (i.e. male pattern alopecia), then finasteride should be considered.

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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

Does a Hair Transplant Affect the Quality of Your Hair?

Q: I would be so grateful if you could give me some idea on how the quality of the hair that is transplanted is affected by its new ‘home’ and the native neighboring hair. — D.C., Flatiron, N.Y.

Is it likely all the hair that is going to be able to come back to life with Propecia will also mature fully eventually? At the moment there is a big visual difference between the front section and rest of hair. (I understand hair count per cm2 may differ more drastically- I’m thinking here just of the hair shaft thickness.) Also, when I have hair transplants – as I intend to when Propecia has done all it can – will the hairs from the back of my head (thick) stay that thick regardless or will they take on the properties of the new surrounding hair?

A: Hair that responds to Propecia doesn’t always regain the full character of the original hair, so the area may still look thin.

The transplanted hair, however, will look like the original hair and maintain, over time, the same character as the hair in the donor area (where it came from).

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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

Does Propecia Affect Beard Growth?

Q: I am a 21 yrs old male having serious hair loss over the last few years. I also have very little facial hair. Since Propecia is a DHT blocker can it inhibit beard growth? — E.M., Astoria, N.Y.

A: As you suggest, it would be reasonable to assume that since DHT stimulates beard growth, blocking DHT (with finasteride) would tend to inhibit its growth. In practice, this does not seem to be the case, i.e. we don’t find that Propecia has any effect on facial hair. The reason is not clear.

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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

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

What are Pros and Cons of Laser Therapy at Home vs. Doctor’s Office?

Q: I heard that you can buy a laser for hair loss and use it at home. What are the advantages or disadvantages of doing this?

A: The advantages of home use are convenience and that it is generally less expensive than going to a doctor’s office for treatment.

The main disadvantage of using laser treatments without a doctor’s supervision is that a more effective treatment for hair loss may be available and you may not know about it. By spending time using the laser, the window for a more effective treatment may be missed. A good example is the 20 year old male who has extensive hair loss in his family and is just starting to thin. It is very important for this person to start Propecia (finasteride) as soon as possible, since the long-term benefits of using this medication are well established.

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Hair Restoration Answers

Could Low Level Laser Therapy (LLLT) Benefit Women?

Q: I am a 33 year old woman and have been told my hair is too thin on the sides for me to have a hair transplant. Could I benefit from laser treatments?

A: Although the long-term benefits on hair growth are not known, Low Level Laser Therapy (LLLT) is able to stimulate hair to become fuller in appearance in the clinical trials that have been carried out for six month periods.

Since the laser light serves to thicken fine, miniaturized hair, it is particularly suitable to areas of diffuse thinning, rather than areas of complete baldness.

Since hair loss in women commonly has a diffuse pattern, because women can’t take Propecia (finasteride), and the fact that women are less often candidates for surgery (as compared to men), laser therapy in females is particularly appealing.

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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

Can I Treat Early Hair Loss with Laser Comb and What Age Should I Start?

Q: If I’m 20 years old and haven’t lost any hair yet, should I start using a laser comb now?

A: One should not treat hair loss until it actually occurs.

That said, once there is clear evidence that a person is thinning, non-surgical treatments are best started early to prevent further hair loss.

It is important to keep in mind that finasteride (Propecia) is still the most effective treatment for early hair loss and has a good record for at least some long-term effectiveness. It is not clear what additional benefit the laser-comb will have.

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Hair Restoration Answers

Is Laser Therapy a Revolutionary Hair Loss Treatment?

Q: The makers of the HairMax LaserComb have claimed that it will “revolutionize the hair growth industry.” What do you think?

A: This claim is obviously overstated.

Since the Low Level Laser Therapy (LLLT) doesn’t affect the action of DHT on hair follicles, it doesn’t affect the underlying cause of genetic hair loss, and thus would be expected only to have limited effectiveness. The company’s own studies show that this is, indeed, the case.

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Hair Restoration Answers

How Effective is Laser Comb in Regrowing Hair?

Q: How effective is the HairMax Laser Comb?

A: It is difficult to tell since there are no long-term studies using the LaserComb.

From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.

The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.

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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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Hair Restoration Answers

Can Hair Loss Treatment with Propecia Affect Prostate Specific Antigen (PSA) Level?

Q: I have been on Propecia for approximately 5 years. What does Propecia do to your PSA level, lower it or make it higher? Also, what would you consider a normal level while on Propecia? — H.K., Long Island City, N.Y.

A: Finasteride 1mg a day lowers your PSA around 50%. Therefore, when patients are taking finasteride, the PSA reading should be doubled.

Finasteride does not appear to decrease the sensitivity of the PSA test to detect prostate cancer – its main purpose.

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Hair Restoration Answers

Can Hair Loss Increase on Propecia for Four Months?

Q: I believe I am an “early” IIIA or IVA. I am not losing any hair on the back of the scalp. There is no substantial hereditary hair loss on either side of the family, but I began taking Propecia four months ago and recently noticed a dramatic thinning of hair on the top (front) of the scalp, extending back to the rear of the head. — B.M., Lower East Side, N.Y.

A: Often people experience some shedding the first six months on finasteride as the new hair essentially pushes out some of the old. I would wait a full year before making any judgments about a hair transplant since you may see significant regrowth from finasteride in the second six months and may not need surgery at this point, particularly if the hair loss is early.

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Hair Restoration Answers

Should I Use Multiple Hair Loss Medications, Such as Both Avodart and Propecia?

Q: I’m 52 years old and have been taking Propecia (finasteride) for two years. It seems to maintain the status quo with no apparent regrowth. I am considering adding a dose of Avodart (dutasteride) once a week in conjunction with the daily Propecia. My question is twofold: (1) Since dutasteride blocks production of both enzymes (type I and II) that produce DHT from testosterone, is it redundant to take the finasteride that only blocks the type I enzyme? — Y.B., Orlando, Florida

A: It is redundant to take both.

However, you may not be taking the optimal dose of dutasteride which seems to be at least 0.5mg a day for hair loss.

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Hair Restoration Answers

Multiple Hair Loss Medications: Do You Recommend Stopping One if No Improvement?

Q: If I use the dutasteride for one year and do not see a noticeable improvement can I quit the Avodart, continue the daily dose of Propecia and expect to retain the same “holding pattern” I have now?

A: If Avodart is helping to maintain the status quo then you can expect to lose some hair, i.e. return to where you would have been if you had used finasteride alone.

Read more about Hair Loss Medication

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Hair Restoration Answers

Which is More Effective: Rogaine or Propecia?

Q: Will Propecia and Minoxidil reverse some of the miniaturization going on with someone with thinning hair? If I do need a hair transplant will I have to stay on these medications? — C.C., — Fairfield County, Connecticut

A: Yes, both minoxidil (Rogaine) and finasteride (Propecia, Proscar) affect the miniaturization of the hair follicles and help restore the shrunken follicles to cosmetically viable hair.

Minoxidil works by directly simulating miniaturized follicles to grow, whereas finasteride blocks DHT, the hormone that causes hair to miniaturize and eventually fall out.

Finasteride is much more effective than minoxidil in preventing or reversing the miniaturization process and it is so much more convenient to use that we generally suggest finasteride after a hair transplant procedure, but rarely recommend minoxidil.

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