Hair Restoration Blog

Hello, Dr. Mohebi.

I used the Propecia prescription you gave me.  It cost me over 80$ to get 30 1mg pills, since it’s not covered under my insurance.  I looked online to see if I could find it cheaper and found a number of sites selling it for much less.

Do you think it’s not a good idea to buy Propecia online?  The site I found doesn’t require a prescription or anything and I can actually get 270 pills for almost the same price I just got the 30 pill refill for at the pharmacy.

Could you check out this link out and tell me if it’s not a good idea to buy it? It seems to me that the pharmacies can charge whatever they want for it, but 80 dollars for 30 pills just seems outrageous to me…  I wonder if $90 for 270 1mg pills is for generic finasteride, and not actual propecia.

I just want to know what your opinion on buying propecia online is.  Sincere thanks.
See you soon.

A:
I have heard bizarre stories about online medications that are sold to patients. There are many stories about affordable hair loss treatments as there are for affordable hair transplants.  I generally don’t approve buying Propecia or any other medications online.

Think about it, the current medical system closely supervises all stages of production, distribution and sales of the medications. Everything is highly regulated and controlled to minimize the chance of mistakes.

Online medications for hair loss or any other conditions, do not have this regulations and if something goes wrong or you get a product that does not contain the medication at all, you have no control on it and no one will be responsive. The fact that prescription medication is sold online without the doctor’s script is risky too.
You can shop around to find the best price for Propecia or finasteride, but I cannot support online shopping for medication from non-supervised resources.

Q:
I am 30 year old man with male pattern baldness. I have been on Propecia for two years. I have been feeling hot flashes in the last month to the point that I cannot tolerate them at night. My doctor thinks that I have to stop Propecia, but I am hesitant to do so because I have seen good results from Propecia in last 2 years. What do you think I should do?

A:
Hot flashes are seen in some hormonal imbalances. More commonly it is seen in pre menopausal women and in men following castration or using anti-androgen medications. Hormones such as FSH, LH and lactogene are responsible for hot flashes. None of the Propecia studies did prove association between those hormonal levels and Propecia use.

Since you have been on Propecia for about 2 years, but only experiences hot flashes in the last month it may not be related to Propeica. There are many other medical problems that can produce hot flashes such as other hormonal disorder like thyroid diseases.

You need to be seen by an endocrinologist and be evaluated for other medication problems, which can mimic hot flashes. Many of those conditions could be easily diagnosed by a simple lab work. Some medications can also be responsible for hot flashes and need to be considered.

One simple solution is to stop taking Propecia for a short period of time and see if your hot flashes get better. If that is the case then you have the option of switching to other medications that can help your hair loss but don’t give you hot flashes.

Q:

I have read an article on the active half life of finasteride, which is a few hours, but you mentioned in one of the posts that its side effects may last up to 5 days after discountinuing the drug. How do you explain that?

A:

Finasteride (Propecia) functions through blocking the enzyme, 5 alpha reductase. The enzyme five-alpha reductase is responsible for conversion of the male hormone, testosterone to dihydroxytestosterone (DHT), which is the form of the hormone affecting hair follicles and causing hair loss. That is true that finasteride gets eliminated from our body in a few hours, but its blocking effects on the enzyme 5 alpha reductase continues for a long time. If you ever experience side effects of finasteride, you can stop the medication and its effect will be gone in 5 to 6 days.

Intercytex has recently released some information on its hair multiplication experiments in a new article in the Journal of experimental dermatology. The title is “A graft model for hair development” and the article discusses what is done so far for hair multiplication experimentally. Intercytex has been involved with hair stem cell, hair culturing and hair multiplication, which is also known as hair cloning.

In this article follicular cell implantation (FCI) is discussed as an experimental cell therapy for the treatment of hair loss that uses cultured hair follicle cells to induce new hair formation. The process of culturing hair cells is based on the demonstration that adult dermal papilla cells (DPC) retain the hair inductive potential that they acquired during hair morphogenesis before birth. To obtain FCI, the investigators isolated hair inductive cells from scalp biopsies and then propagated them in culture media in order to provide adequate cells to generate several new follicles from a few hair follicles.

Following expansion of cells in culture, they implanted those cells into the scalp where they induce the formation of new follicles below the level of skin. They describe a consistent, reliable method in which they can test hair induction. Since the process relies on the ability to retain the potential for hair induction during the expansion of DPC in culture.

They go over a simple graft model that supports hair morphogenesis. In this experiment, they combine dermal cells with embryonic mouse epidermis that provides the keratinocyte (one of the skin cells) component of induced follicles. The grafts are placed under a protective skin flap in the host athymic mouse (a special mouse without capability to reject the transplanted grafts from human) where the cells will form a skin graft with hair if the dermal cells are hair inductive DPC.

Using the assay freshly isolated and cultured mouse embryo dermal cells as well as cultured dermal papilla cells from other species all induced hair formation. They also showed that induced hairs were aesthetically indistinguishable from those of the epidermal donor in length, thickness, and pigmentation. The investigators stated that the newly formed hairs were histologically normal and could resemble a complete natural hair.

We at Los Angeles hair transplant surgery centers of US Hair Restoration will closely follow up with the progress of hair multiplication and cloning techniques. Although the result of the cultured hair on animals has been released before, the current released article is interesting and elucidates more on the characteristics of cultured hair during the process of hair multiplication so called hair cloning. It seems like we still have a long way to go till we can practically use hair multiplication techniques in restoring human hair.

A Los Angeles Hair Restoration patient asked me today about Kevis products for medical hair loss treatment in men the other day. His father used to use those hair loss products when he was in Europe and He recommended that he can use them as well. I had to do some research on the website of the company to find out what are the ingredients of this presumed hair loss medication.

Kevis products are claimed to be natural and chemical drug-free. They work through the biological compound, hyaluronic acid, which is found in eyes and joints in its highest concentration.

Kevis uses a high-molecular-weight product called HUCP, to address hair loss and follicular mal-nutrition. HUCP is claimed that it directly impacts hair follicles, cuticles, and shafts in a positive way, bringing about stronger, thicker, and healthier hair. HUCP also hydrates and balances the moisture levels in hair and the skin of the scalp.

Kevis hair loss prevention and hair care products gently clean hair and selectively remove residue from the scalp, encouraging follicular health and greater natural hair production.

It is all nice to have a product to help cleaning the scalp and the root of our hair and also to keep the moisture to the hair shaft, but neither dryness nor dirtiness of hair is the cause of hair loss. I could not find a significant research on the effect of any of those ingredients on the health and growth of hair. We at our Los Angeles hair transplant clinics of US Hair Restoration recommend products with solid medical research showing their effectiveness and safety.

Q:

I take Errin Tablets for a few months as a contraceptive. I have also been experiencing hair loss recently. I wanted to know if there is a correlation between losing hair and this particular contraceptive. I had a baby 4 months ago. I see thinning everywhere but it is more obvious on the front and top as diffuse thinning.

A:

Your hair loss could be related to your pregnancy and delivery of your baby. Human hair grows in cycles and goes to resting phase (telogen) between the growth cycles. About 95% of your hair is in growth phase (anagen) at anytime and about 5% of them are in resting phase. You may not see any hair growing from the follicles during resting phase. That is the reason we normally lose scalp hair on a regular basis. In fact losing up to 200 hairs every day is normal and part of the cycling of our hair. Some stimulants can put a large number of our hairs into telogen phase. This condition is called Telogen effluvium. Telogen effluvium (TE) can be seen in women after delivery of a baby. Telogen effluvium is especially seen between months one to five following delivery of a baby, when the load of estrogen is removed. It is usually seen in 40 to 50% of women after pregnancy, and like most of the changes in pregnancy, it is temporary. Wait 4 to 6 months and you should grow your hair back. Meanwhile, make sure you are taking sufficient minerals and vitamins on a daily basis.

Any other cause of imbalance in estrogen level may increase hair loss. Scalp hair loss is reported in users of oral birth control pills containing norethindrone and ethinyl esteradiol, like Errin tablets or other brands: Brevicon, Norinyl, Norethindrone. However the association of those contraceptives and hair loss has not been completely confirmed through medical literature. I women think their hair loss may be linked to the use of birth control pills, they need to stop the pill and use another birth control method after discussing that with their doctor.

Q:

Hey there!

How’s everything? I had a quick question.  What do you think about nanogen hair?  From the fibres to shampoo?

Thanks!

A:

Nanogen manufactures a group of products for hair loss treatment and balding camouflage. You can read more on their products on their website at http://www.nanogen.co.uk.  I will go over the two products that you asked in your question, Nanofiber or as they called it “Precision Cut Microfiber Camouflage System” and Nanogen hair loss shampoo.

Nanogen Microfiber is made from keratin that is also the substance that hair is make from. The fibers bind to the existing hair electrostatically adding volume to your hair shafts. Nanofibr is similar to the hair product, Toppik that has been around for a while in the United States and works through attaching to the hair shafts and increasing the volume of each hair.

Nanogen Shampoo is claimed to work through different mechanisms:

1. Inhibiting sebum output in the scalp that has been stated that can control the waxy build up and associated problems. We know sebum production does not have anything to do with male patterned baldness.
2. Reducing dandruff and associated flaky skin by treating the causes of dandruff. Dandruff is not necessarily the cause of hair loss of any kind.
3. Containing anti-fungal properties that can control the fungal outbreak in the scalp. Some fungal diseases of the skin used to be causing infectious balding in past that are not seen as often now with the increased levels of public health. Typical men hair loss definitely doses not have to do with fungal diseases.
4. Reducing irritation and inflammation in the scalp that has been claims that can restore the barrier function of the skin. Again I have to question the role of this mechanism on restoration of hair in men with men hair loss.

In the other parts of the site of Nanogen, the causes of having unhealthy scalp is states as a combination of sebum, fungus like malassezia furfur, dandruff, scalp irritation and problems with inhibiting the barrier function of the skin. As we mentioned before, none of the above is the real cause of typical baldness in men hair loss or male patterned alopecia.

Q:

Dr. Mohebi,

What do you think about Nioxin for hair loss treatment? Do you offer it in your Los Angeles hair restoration offices?

A:

We currently do not sell any products in our Los Angeles hair restoration offices. Nioxin makes different products such as cleansers (shampoos), conditioners, reconstructors, and other products for hair and scalp. They are in the market and could be purchased from beauty salon. Nioxin shampoos are popular, but there appears to be nothing in them that will cure hair loss. I have had many patients who used them in the past for a while and they gave me a mixed report. If they are affordable and you are happy using them as cleansers or conditioners I have no problem with that. However, by looking at what is out there on the ingredients on Nioxin products and the reports from my patients, I cannot recommend them as a treatment for hair loss.

Many people ask me on the use of hair products such as shampoos or conditioner after a hair transplant procedure in our Los Angeles hair transplant clinic. My answer as you probably have seen in this blog is that you can go back to your routine hair wash and maintenance after the first five day after your hair transplant surgery. They practically cannot damage the transplanted hair at that time by washing or shampooing it.

Q:

I am a 40 year old man with class IV hair loss. I started taking Propecia recently with great result on the crown area only after a few months. However, it seems like I need more time to get an erection. The other problem is that I cannot maintain an erection as before. I know there is a lot of psychogenic side effect associated with this drug so I am not sure I am really experiencing a side effect or it is just in my head?

Thank you,

A:

You have been taking Propecia (finasteride) recently and have had great result from it, but you are recently experiencing erectile dysfunction. Erectile dysfunction has been reported in men who used Propecia. The comparison of its occurrence between the Propecia and placebo group showed a slight difference (1.3% in Propecia group vs. 0.7% in placebo group).

You can stop Propecia for 2 weeks to test it. If you don’t feel any improvements in 2 weeks, Propecia cannot be the cause of your problem. If your erectile dysfunction improves by stopping Propecia, then you can reduce the dose of Propecia to half and you may not experience the problem with the new dose. This method is effective in most patients who experience erectile dysfunction with Propecia.

You have to understand that erectile dysfunction may be the sign of some other medical problems and you need to discuss it with your primary physician to rule out more serious causes.

Q:

Do you recommend Finepecia for treatment of hair loss?

A:

Finepecia is another name for finasteride or Proscar. Finepecia or finasteride is a medication that blocks the production of Dihydroxytestosterone (DHT) and can stop or slow down the process of baldness. The medication is also prescribed for treatment of enlargement of prostate by physicians. You need to be evaluated by your hair doctor preferably with a miniaturization study before starting on Finepecia. For more on Finepecia or generally medical treatment of hair loss you can visit the website of US Hair Restoration.