Transplantation without propecia?

[For_Indai]

Hi All,

 

I have side effects from propecia and stopped using that. I am using minoxydil 5% every night.

If I am not taking propecia due to side effects, will this make me not suitable for hair transplantation?

I am ready for the future transplantation [can I have a surgery after 10 years of my fist one?]

I prefer a conservative hair line [not lowered, and hair loss behind the hair line doesn't bother me, if I have a natural looks]

Does my thought seem to be reasonable?

Experts please give your opinions

[For_Indai]

Hi All,

 

I have side effects from propecia and stopped using that. I am using minoxydil 5% every night.

If I am not taking propecia due to side effects, will this make me not suitable for hair transplantation?

I am ready for the future transplantation [can I have a surgery after 10 years of my fist one?]

I prefer a conservative hair line [not lowered, and hair loss behind the hair line doesn't bother me, if I have a natural looks]

Does my thought seem to be reasonable?

Experts please give your opinions

[Bill - Seemiller]

For_Indai,

 

Propecia is not required for transplanted hair to grow. Propecia however, is potentially beneficial to help combat against future hair loss of your natural hair. Without it, your natural hair loss pattern will progress to whatever nature has programmed for you.

 

Select a quality Coalition hair transplant surgeon and start worknig out a long term hair restoration game plan.

 

Best wishes,

 

Bill

[Dr. Michael Beehner]

For Indai,

When my new transplant patients ask me whether or not they should also go on finasteride, I use the following two scenarios to explain thedifference:

Imagine that you and I have a brief consultation visit in around 4 years to see how your hair is doing; If you have both the transplants AND go on finasteride, we will see the ADDITION of two things: the transplanted hair PLUS the increase in hair mass that occurs in a majority of finasteride-treated patients. On the other hand, if you only have the transplants, then 4 years from now we will be looking at a SUBTRACTION, namely, the positive effect of the new transplanted hair, MINUS the progression of male pattern baldness that occurred during that time. There is an enormous visual difference between those two scenarios. The ironic part is that in the first scenario the doctor gets more credit than he deserves for his transplant efforts, whereas in the second scenario, the patient often blames the doctor for having had NO EFFECT on his hair loss with the transplants!

There are exceptions to the above: If the man is of a reasonably mature age, say 38 or 48, and is shiny bald on top with his side fringe borders pretty well set, which means that male pattern baldness has essentially reached its end-stage, then finasteride is unlikely to make much difference. The more "native" hair that exists on top and the younger the patient is, the more beneficial and important is the combining of transplants along with finasteride treatment.

The majority of patients who benefit from finasteride treatment have a net gain in hair mass (increase of hair shaft diameter and increase in the potential length hair can grow to) in the first 4-5 years of therapy. After that there is usually a very gradual diminishment in hair mass, such that many patients end up ten years later around where they started. So the medication "buys" 10 years of time, usually during socially critical years of a young man's life. If you are destined to someday have a Norwood VI or a Norwood VII level of baldness, finasteride therapy taken your entire life will not prevent that, it will in most cases greatly delay the day when it happens. There are obviously individual variations in how any one man will respond to finasteride treatment, but the above picture describes the great majority of the men I have treated over the past 10 years. As others have stated many times on this Forum, Rogaine (minoxidil) topical therapy along with finasteride does have a synergistic effect. Unfortunately, castration is about the only therapy that will almost completely arrest your hair loss, and there understandably aren't many men lining up for that.

Mike Beehner, M.D.

[Dr. Michael Beehner]

With regard to the point you made about having side effects with Propecia, you might want to try a much smaller dose regimen, which is likely to still help you prevent hair loss, and at the same time possibly reduce or remove the side effects. I have had many male patients of mine, especially those over 45, use a half tablet every other day. This averages out to 0.25mg/day. Merck's own research showed a 62% reduction of DHT with only 0.2mg/day.

Mike Beehner, M.D.

[Byehair]

Thanks for the very detailed answer Dr. Beehner

 

I have been taking Propecia/Proscar for many years. For about the first 5 to 6, I had great results. Then it seemed to lose its effectiveness. The last 2 years have been a real downer. I don't even feel like I am a transplant candidate because of the continual loss going on.

What are the options for a guy in my situation?

[For_Indai]

Thanks Bill for your reply.

Dr. Beehner, It was great to read your detailed post. Thanks for your time.

I understand the importance of propecia ,and would love to take that. But I am an unfortunate guy having side effects [like decreased volume of ejaculation,decreased libido , breast enlargement]

I will still try the reduced dosage as you suggested. I have a question about cutting the tablet [this might be a stupid question],Should I cut all the tablets together and keep it or cut only when I am taking. I am not lazy to do this every day ,but I read somewhere that propecia particles are not good for women?]

 

My expectation about hair transplantation are realistic. On observing my family pattern[both sides] I will be a noorwood 3a[4 but no visible loss in vertex and top] in my fifties.

I need a natural looking receded hair line. If I lost some amount of hair behind the transplant [say after 10 years] ,will that still look natural? If not Can I have another transplant after 10 years which should also take care to provide a natural looking even after I loose hair [after my 2nd transplant].

Sorry If I Confuse you, I tried max to express my question

 

Thanks again for your time

[Dr. Michael Beehner]

Byehair,

What you are describing with finasteride treatment, namely increase of hair the first 5-6 years followed by some decrease, mirrors the timetable I described above. You are still better off staying on it, as the "curve" or rate of hair loss almost certainly would be greater if you abruptly went off it as opposed to staying on it for a few more years. As to whether or not you would be helped by transplants, this is almost always the case, as long as your expectations are not unrealistic. The decision on how much can be tackled on a man like yourself depends on two things primarily: your AGE, and the PROJECTED RATIO OF "SAFE" DONOR HAIR COMPARED WITH THE EVENTUAL BALD RECIPIENT AREA. Even in extreme projected Norwood VII patterns of hair loss, a frontal forelock pattern frames the face nicely and appears almost like a full head of hair from most views.

For_Indai,

With regard to breaking Propecia tablets in half, you use an ordinary "pill cutter" (around $3.20 at Wal-Mart or any drug store). The official line you will sometimes hear is that the medication is not evenly distributed throughout the 1mg (or the 5mg) tablet, so the dose is not predictable, but I think this is overdone, and, besides, most doses are probably more than you need and do work to suppress tissue DHT for nearly 3 days, so I wouldn't worry about that. You are right: women cannot take this medication, because of the danger of a male infant having birth defects and also because it really doesn't work for most female pattern hair loss.

If you indeed will never be worse than a Norwood IV, then your hair surgeon can certainly be a little bit more aggressive. Normally, the area transplanted is not only the bald or very thin areas, but the surgeon projects over the next 10-20 years where the edge of the hair loss will probably recede to and places FU's into this area too, so that when the day comes that your native hair is gone there, these transplanted hairs will already be there growing to prevent a bald "stripe" of scalp from showing. And Yes, many men do come back 10 or more years later to fill in areas of new male pattern baldness that were not evident earlier, especially with a pattern like you have.

Mike Beehner, M.D.

[Janna]

Originally posted by For_Indai:

Should I cut all the tablets together and keep it or cut only when I am taking. I am not lazy to do this every day ,but I read somewhere that propecia particles are not good for women?

 

 

No, you should not cut all the propecia pills at once. Cut one pill as you need them. The pill itself can lose potency.

[For_Indai]

Thanks Dr.Beehner for your answers. It eliminates lot of my unwanted worries and gives peace of mind.

Janna, thanks for advice about cutting the pills. I was unaware of this!!!

[notgoing2gobald]

Dr. Bheener,

 

thanks for so much detailed information. It's great to see doctors such as yourself give us some very interesting insights into propecia. I was unaware that it typically worked well for ten years and then began to lose its efficacy after this window. I don't think this is discussed enough and I think many people have some false assumptions or misunderstandings regarding propecia; as if it will halt hair loss for the remainder of their life. Your input presents a very different scenario. I would like to quote your entire posting and put it on the propecia poll thread.

 

..."unfortunatelly castration is about the only therapy that will almost completely arrest your hair loss"...

 

Just another experiment we need to have our associate Publisher undergo.

 

So, Eunuch's never lost their hair? These guys were overlooking all of the sexy concubines in harems and they had big beautiful mops, but they couldn't even touch the women? What a waste of hair!!!

[Bill_the_bald]

So Dr. Beehner, for those patients of yours who are still attached to their hair, but have reached the point where Finasteride is no longer effective, would you recommend something more potent, like Dutasteride, to further delay the inevitable?

[Dr. Michael Beehner]

If you recall, I didn't say that finasteride didn't work at all after 4-5 years or after 10 years. It is still helping; the rate of hair loss is still s trickle compared to how much would be being lost if a man stopped using it. It's just that you are on the "down-curve" instead of the "up-curve" regarding the amount of "hair mass" on your head. You're still helping yourself staying on the medication; it's just that the dramatic response of the first 4-5 years won't still be there.

As to Dutasteride, I know that a lot of my colleagues have used it on their patients and I have seen some photos showing impressive results. I am a little more conservative than most with new drugs like this. Dutasteride can raise the testosterone level in some men up out of the normal levels. If side effects, such as libido or erection problems, occur, they can last for months because of the long half-life of the drug. It is true that you can sort out these people who will have problems by first having them take Propecia and seeing how they respond to that. The FDA hasn't approved dutasteride for hair loss for another thing. Lastly, it suppresses DHT almost too well, over 90%. I'm one of those docs that believes that most of the hormones and chemicals floating around in our body have a purpose for being there, for the balanced health of your body. To put a young man on a new drug for the next 20 years of his life without the knowledge of what might happen down the road while suppressing this body chemical that happens to also work in our brain tissue, is a leap I'm not comfortable taking. That having been said, I am pretty sure it works a little better than finasteride in working against hair loss.

Mike Beehner, M.D.

[Janna]

I'm one of those docs that believes that most of the hormones and chemicals floating around in our body have a purpose for being there, for the balanced health of your body. To put a young man on a new drug for the next 20 years of his life without the knowledge of what might happen down the road while suppressing this body chemical that happens to also work in our brain tissue, is a leap I'm not comfortable taking. That having been said, I am pretty sure it works a little better than finasteride in working against hair loss.

Mike Beehner, M.D.

 

Dr Ron and Dr. Paul Shapiro are pretty much in line with Dr. Beehner's concerns on Dutasteride.

[nw2]

Does anyone of you believe, that fin can lead to a frontal thinning.

 

I started fin and saw a big shedding after one month in the frontal part. so i quit it. many people talk about a normal shedding, and this hair will come back stronger.

 

but there are many people who suffered the same.

and not only after a few month. they used it over a year or more, and the hair which was shedding never came back stronger as all people promise.

 

so do you believe that fin can make hair worse than before?

 

i am really scared of start it again. i take fenugreek tabletts at the moment and topical spiro.

[nw2]

any recommendation for me regarding my last post???

[Bill - Seemiller]

nw2,

 

There is no evidence that I have seen that finasteride will cause hair thinning in the front or anywhere. There can be an initial hair shed the first few months of use, but this is a good sign of the medication working. the hair that has shed due to Propecia will grow back thicker and stronger.

 

Bill

[Janna]

hi nw2,

 

Sorry if you felt ignored. I don't think there are any guarantees or promises when it comes to getting positive results from the meds. It works on many patients, but not all. I've never heard of patients experiencing more hair loss with Propecia, except for the temporary shedding at 1 month after the initial start date. So from my experience, no, I've not heard of fin making hair worse than before.

[nw2]

Thanks, i will do a hairtransplant in march, and i think i will start again with fin now.

 

I had a great shed after 6 weeks taking fin in august, i have curly hair, and i was on holiday in egypt, everytime i went out of the sea, taking a shower many hairs went out just of one curl. so i got afraid and stopped.

 

sorry for my bad english description!

 

so the status was worse than before because the shed hair didn?‚??t grow again.

[Janna]

Good luck with your transplant in March. Can I urge you to use rogaine since you're starting propecia again? Use the rogaine for all over instead of just the crown. They are every effective together. Best wishes!!!!

[KulMD]

Dr. Beehner,

I quadrisect 5mg of Finasteride and have taken approx 1mg daily for the past 4 months with side effects discussed.

 

I have been contemplating the following dosing options:

 

1 0.5mg daily (difficult to cut pill into 1/8).

2. 1mg Mon- Wed- Friday

 

Have you seen any difference in either of these alternative dosing schedules in terms of efficacy or decreased libido?

Thanks

[Dr. Michael Beehner]

KulMD,

When you say "with side effects discussed," I assume you are experiencing some sort of sexual side effects and are looking to reduce your dosage in hopes that you will not have the side effects but still get some benefit from inhibiting DHT.

In men over 30, my commonest dosage regimen is 1/4 of a 5mg tablet M-W-F. If you are having side effects at that does (which is 1.25mg every 2-3 days), then I would advise that you switch to Propecia 1mg tablets and cut them in half and take a half a tablet every other day for a month or so and see whether things get better. Remember that studies with as little as 0.2mg per day showed significant suppression of DHT. I agree with you that if the goal is to use these lower doses, you can't be cutting a 5mg tablet into fragments, as it is impractical. You still will have significant cost savings in comparison with the usual recommended dose.

Mike Beehner, M.D.

[KulMD]

Thanks Dr. Beehner. I appreciate your recommendation.

[blowdry]

Hi Kul, the first three months I used 1 mg of propecia. Now I cut them in half and use 1/2 a pill a day.

 

Hope you find some regimine that works for you.

 

Once you switch to a different regimine, stay on it for a couple of weeks to see if the sides go away....

[Ailene]

If you add Rogaine or minoxidil as Janna is suggesting there are a few things to keep in mind. This medication does not have the same function as Propecia and in no way replaces it. For lack of a better way to describe what it does, it kind of acts like a fertilizer. But it has properties that syncronize the growth phases of hair growth so it is something that should not be started and stopped. Your hair is kind of like a cat with 9 lives and if you fertilize and make it go into an active growth cycle and then remove the fertilizer it gets confused and can shed, a lot..... and once gone may not come back. So the message is be committed.

 

The company will tell you that you need to use it twice a day and if possible this is the recommendation but can help used once a day, BUT, use it everyday.

 

Dr. Cooley does not like to split Propecia. He does agree with Dr. Beehner about the need to dose daily. His approach is the pill is small, not made to be split and if split the amount of med in each piece may not be equal. He recommends every other day one pill. It seems the DHT is surpressed for much longer than 24 hours so taking it daily may not be necessary.

 

Ailene