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Hair Loss Drugs Share your opinions and experiences regarding drugs like Propecia (finasteride), Minoxidil and others.

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Old 04-24-2011, 07:49 PM
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Question How important is it to take Propecia prior to hair transplant?

Hi, I am a 27 yr old male. I am learning about Shock loss and very concerned, any help would be greatly appreciated.

I just 2 days ago had a hair transplant of 3,000 grafts which seemed to go very well. I was told my donor hair was excellent. I had around 2,500 placed in the front half and 500 to reinforce my crown which is still in pretty good shape.

I still have most of my hair so most of the transplants went in between existing hairs. My existing hairs have not 'overly thinned' but are thinner in the front than they were 5 - 10 years ago.

I was not aware until after the procedure that it was a good idea to take Propecia prior to having a Hair Transplant.

The doctor was highly recommended from many sources so I trust him but I do have 4 big questions. (He also seemed to do a great job, but will have to wait and see!)




1. How beneficial would it have been to take Propecia prior to my HT?

2. I started taking Propecia the day after the surgery, will this help to prevent shock loss?

3. I used Rogaine for at least a year prior to the surgery, will that help prevent shock loss?

4. Is hair lost to Shock Lost gone forever? Meaning will I lose perfectly good original hair?


Any feedback would be really great.
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Old 04-24-2011, 08:04 PM
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John,
Most of the docs I consulted with suggest getting on meds after ht to help prevent future loss. I'm not sure if there's any evidence that meds will prevent shock loss however. As for #4, they say that sock loss will usually only be temporary in most cases especially as it relates to healthy hair. Hair that was not healthy may not recover. I had some shock loss and as far as a can tell the hair has grown back. Best of luck to you
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Old 04-24-2011, 08:48 PM
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Shock loss can happen in the donor area and in areas where transplanted hair is in close proximity to existing hair.

Usually, shock loss is temporary, but as been mentioned, it can be permanent if the hair that falls out was on its last legs.

Another form of permanent shock loss relates to transection. This can happen in two ways-- one is where the transplanted hair follicle has been damaged due to poor harvest methods and/or handling.

The second form of transection applies to existing follicles that have been damaged during the surgery-- this can happen when placing implanted hair between existing hair.

However, with a good surgeon and a well trained staff, transection damage should be low.

I hate to say it, but you are at greater risk for some type of shock loss because of what you describe in your post.

First, you sound like a diffuse thinner. You state you had grafts placed in between existing hair. That's very likely to cause some sort of shock loss.

Second, you state that you just started meds in the form of propecia.

Propecia, if it works, can cause shedding. What happens is that some existing hair sheds, goes in to a resting phase, and then hopefully grows back thicker. It usually takes several cycles (about a year to 18 months) to see full results.

I can't read the future, but I have seen guys in your situation before. I don't mean to alarm you, but you most likely are going to have a lot less hair than what you started with prior to the transplant-- at least in the short term.

The recently transplanted hair should shed and the follicles will go in to a resting phase in the next three weeks or so.

Because of the placement of new hair, you may have some sort of shock loss that will kick in around the 1 month mark.

Because you you just started taking propecia, you can expect some shedding of hair about the three month mark-- right when some of your newly transplanted hair starts to begin growing again.

It's a rough ride. A year from now everything should be ok if you had a good transplant and if the meds kick in for you.

But short term? sorry. Most likely a lot less hair than what you started with.

Personally, I'm not a fan of starting meds in conjunction with a transplant. I feel you should start either a year before or year after.

Meds just muddy the waters and make it hard to tell what's going on in the tough period right after a HT-- is is shock loss? shedding? is it permanent? the list of questions go on.

Besides, is it really wise to start playing with your body's chemistry right after the surgery when your scalp is trying to heal?

The time to take propecia was about 12 months ago or longer-- that's when it would have done the most good for your recent HT.

JMO.

Hal

Last edited by Hal; 04-25-2011 at 12:04 AM.
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Old 04-25-2011, 07:02 AM
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Thank you for the frank response Hal, it is good to know some realistic expectations. My surgeon was highly recommended and from everything I could tell him and his staff did a great job. I did a ton of research on the subject and doctors before moving forward. The only thing I did miss was this shock loss thing. My doctor talked about it briefly but said it happened in less than 10% of his patients. I am going to speak with him today more on the subject.

I am curious if Dermmatch would be a good product to invest in to help mask my shock loss and propecia shedding once my scalp has healed.

Does anyone know anything about using Dermmatch in this type of situation? Obviously I would like to hide my increased loss of hair because prior to surgery my hair was still in above average state (for a hair transplant candidate) so quickly losing hair would be noticed.

I would also like to avoid losing all the hair just to have it rebound in the next 6-8 months when the transplanted hair and propecia both start to show hair growth at once.

Basically my question are:

Any suggestions to get me through the next year?

You mentioned shock loss occurs at 1 month and Propecia at 3 months right, is that fairly consistent among HT patients and Propecia users?


Again thank you Hal.

Last edited by john148; 04-25-2011 at 07:05 AM.
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Old 04-25-2011, 08:08 AM
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Dr. Rassman states that starting Propecia prior to a transplant does help prevent against shock loss. If the hairs are real weak then they are eventually going to be lost and probably aren't doing much for you cosmetically anyways. The theory is to take Propecia for a year to a year and a half prior and try to save as many hairs as you can prior to surgery. Of course it's better late than never to start Propecia, but definitely the earlier you start the better.
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Old 04-25-2011, 08:25 AM
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What would be considered a 'weak' hair? Are we talking about some that a incredibly thin (baby hairs) or some that are at maybe 60% of their original?

In my case my hair is still pretty thick (as in each hair is still pretty thick). Obviously there are no absolutes but I am wondering how likely I am to loss that hair permanently seeing as how it is still pretty thick and the procedure was done by a high quality doctor (assume no damage caused by incisions).
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Old 04-25-2011, 11:44 AM
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Quote:
Originally Posted by john148 View Post
What would be considered a 'weak' hair? Are we talking about some that a incredibly thin (baby hairs) or some that are at maybe 60% of their original?

In my case my hair is still pretty thick (as in each hair is still pretty thick). Obviously there are no absolutes but I am wondering how likely I am to loss that hair permanently seeing as how it is still pretty thick and the procedure was done by a high quality doctor (assume no damage caused by incisions).
Any hair that is miniaturized is "weak", but some of the less weak hairs may survive shock loss (or not be affected by it). You may find you'll keep some of that thinner (but still fairly strong) hair, but you should be prepared that you might lose some or all of it as well.

With a good surgeon the chances of shock loss will be minimized and a good surgeon will also have a solid plan in mind that will hopefully see you in good stead. I guess you have to be prepared that you may need one or more further transplants somewhere down the line, but that might not be necessary depending on how things go! Hopefully you'll be happy with this HT and your remaining hair will stay long, but I guess it's always better to hope for the best and plan for the worst.

Dermmatch/Toppik/Nanogen could possibly help cover your HT and any shock loss over the next 12 months, but you need to have hair for these products to work (at least a minimal amount of hair). I don't know anything about your current hair state, but if you do have a fair bit of coverage from your native hair these products can help give your hair a fuller look and mask the scalp pretty well, giving you a good illusion of having much more hair than you have! Don't try using these products if you have very little hair though; you'll just look like you have dirt or powder on your scalp! If you have some native hair though, results can be very impressive and practically undetectable!
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Old 04-26-2011, 05:20 PM
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Taking finasteride is probably the most important thing you can do, probably even more important than the HT itself for the long haul.

Unfortunately I feel many around here will have to learn this the hard way !

10 years will go by in a flash and feel like 1 year; then you'll look in the mirror one day and realize that you've advanced 2 full NW stages that you could likely have avoided by simply taking this pill every day. That equates to about 5000/8000 grafts lost.

I feel that in the not too distant future we will see maybe another website pop up where hundreds of guys who got HTs in their late 20s/ early 30s (but failed to stay on finasteride) will be in their early 40s and cursing the day they ever sat in the HT chair, wishing they could just go bald naturally !
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Old 04-26-2011, 09:06 PM
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Quote:
Originally Posted by EpilepticSceptic View Post
Taking finasteride is probably the most important thing you can do,


I feel that in the not too distant future we will see maybe another website pop up where hundreds of guys who got HTs in their late 20s/ early 30s (but failed to stay on finasteride) will be in their early 40s and cursing the day they ever sat in the HT chair, wishing they could just go bald naturally !
Personally, I feel that in the not too distant future Merck is going to be forced to revise their conclusions on the side effects of the drug.

The official position is that less than 2% of men suffer side effects and of those that do, stopping the drug will reverse the effects.

It seems clear that this is not the case-- more and more people including patients, doctors, and researchers are coming forward with direct and anecdotal evidence that the % of people suffering sides is a lot higher.

Additionally, its now emerging that some individuals who suffer sides continue to do so even after stopping the drug. In effect, the sides are permanent for a small minority.

Finally, there is real doubt about the safety of long term usage of this drug. I'm talking 15+ years. No one knows.

So in the not-so-distant future, I see a possible recall. Or at the very least, a drastic revision of the warning label.

It may very well turn out to be that in the future, some guys who have been on the drug for 10+ years may rue the day they ever heard of Propecia. That will most likely happen when the FDA finally releases the bad news about long term effects and the consequences there of.

To each his own, but to me, its really a matter of common sense. Do you really think you can play around with your hormones and body chemistry by inhibiting a vital natural process for 15+ years with no consequences down the road?

Hal

Last edited by Hal; 04-26-2011 at 09:14 PM.
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Old 04-26-2011, 09:57 PM
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Quote:
Originally Posted by john148 View Post
Thank you for the frank response Hal, it is good to know some realistic expectations. My surgeon was highly recommended and from everything I could tell him and his staff did a great job.
I am curious if Dermmatch would be a good product to invest in to help mask my shock loss and propecia shedding once my scalp has healed.


Basically my question are:

You mentioned shock loss occurs at 1 month and Propecia at 3 months right, is that fairly consistent among HT patients and Propecia users?

It's my understanding that shedding when taking Propecia usually occurs at around the 3 month mark and can last from 4 to 6 weeks.

If that happens, its usually considered that the drug is working for you. The advice is not to panic when this happens, as things should gradually improve with the final result being stronger, thicker hair about a year to 18 months in to treatment.

Shock loss usually occurs 3 to 4 weeks after surgery, according to the research that I have done.

It may be that in your case you won't experience any shock loss-- however, from what you describe in your post about your balding pattern and graft placement, it seems that it could be a very real possibility.

Certainly it seems that diffuse thinners who have transplants inserted between existing hairs report shock loss far more often than other patients.

It really depends on a wide variety of factors. You should ultimately be fine based on what you posted about going to a top flight doc and clinic.

As for concealers, there are quite a few options. Personally, I have tried them all and find that Pro-Thik (a spray) works best for me. Others swear by sprinkle on fibers like Toppik. Still others prefer Derm. Match or Couvre.

Each option has its drawbacks. For instance, to much spray product on your hair can make it look like straw and its sometimes hard to get a color match. Additionally, a spray simply gets EVERYWHERE, leaving a film on the bathroom floors, the counters, etc. I've learned its best to apply outdoors or in the garage if able. Depending on how your house is set up, that's less difficult than you might imagine.

I would order a few of the most common options if I were you and experiment a bit after your healing period (about 10 days at least post op).

In any event, I think you'll find that no matter what option your choose, concealers work best and are most effective if you have a core of hair to work with. Which very much sounds like your case.

You would be surprised what a bit of concealer can accomplish with just a little hair. Just don't over do it. What looks fine in the light of the bathroom mirror can look not so great under harsh overhead lighting or the great outdoors. Be conservative at first if you decide to use.

Hal
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