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Dr. Jerry Cooley

Dr Cooley 3,933 grafts 5yrs later

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This patient is in his mid-40s and wanted to address his hairline and fill in the rest of the scalp. We started him on finasteride and performed FUT of 3,933 grafts (7,275 hairs, 1.85 hairs/graft). He didn't return until 5 years later. Overall, he was very pleased but noted that he thought his hair looked thicker a couple years prior (ie 3 years after the procedure). I explained that the grafts were not thinning but that he was seeing the natural progression while on finasteride. I see this all the time, and unfortunately patients sometimes think this means the medicine has 'stopped working'. Referring to the chart, the 'average' patient who starts finasteride will see thickening for about 5 years and then will begin to decline below where they started, but they are always much better than if they had never taken it, the difference becoming greater with every year. Options at this point include: adding minoxidil (if they are not already using it), doing another transplant, and/or doing a PRP/ACell procedure to regain some of the thickening. It is important to have an understanding of this process to set realistic expectations and make a long term plan.

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Thank you Dr Cooley for this insight.

 

Would / could up his dose of Fin on the 3rd / 5th year be worth trying for this Pt.

Just wondering if that could be effective.

 

I understand that you practice PRP / Acell but IMHO is only a short term fix & have to come back in for more treatments every 1 or 2 yrs.

 

Thank you again.

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Finasteride only lowers DHT 65-70% because it only blocks one of the enzymes converting T to DHT, regardless of how often it is taken. Most people (not all) get the same results taking it every other day as they do every day and there is no significant benefit taking more than 1mg. Rather than increasing the dosage of finasteride, I will consider putting the patient on dutasteride which can lower DHT by 94%.

 

Regarding the PRP/ACell, you're right that it is temporary. How long it lasts depends on 1) genetically how fast someone is balding and 2) what other hair treatments they are on (e.g. fin/min). It might need to be repeated yearly for some patients, but may last 3-5 years in others. It is not a miracle treatment but it can be very helpful in certain situations: Many females who are not or are just barely surgical candidates; men with early crown thinning; young men (<23yrs) who should usually put off doing surgery. The results can be variable but as part of an overall treatment plan, it can be very useful.

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Dr. Cooley,

 

What is your opinion about the efficacy of taking Propecia twice weekly? For example, .5 mg twice weekly? In other words, does the efficacy of Propecia decrease significantly when the dose is lowered?

 

Thanks in advance.


I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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Dr. Cooley,

 

What is your opinion about the efficacy of taking Propecia twice weekly? For example, .5 mg twice weekly? In other words, does the efficacy of Propecia decrease significantly when the dose is lowered?

 

Thanks in advance.

 

Good question. Dosing studies show that 0.5mg finasteride is almost but not quite as good as 1mg in suppressing DHT. I think everyone is different so some people will do well at this low dose. They haven't done large studies on hair loss with different dosages/dosing intervals so we have to base our opinions on how the drug is metabolized. We know that a single dose of finasteride reaches peak DHT lowering after 3 days and the DHT doesn't come back to normal till after 7 days. So twice weekly dosing of 0.5mg will keep DHT suppressed significantly and inhibit hair loss for most people. How does it compare to 1mg every day? No one knows but it might be 70% as good, just a guess, and a whole lot better than doing nothing. Over the years, I have had patients who have had side effects at 1mg daily who did not have side effects with lower/intermittent dosing and still seemed to benefit in terms of their hair.

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Thank you very much Doctor.


I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

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