Hair Restoration Blog

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, Propecia 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.

I have performed a hair transplant surgery on this 42 year old man who had another hair transplant last year with micor- and minigraft with another office last year. I would like to assume that the era of mini and micro-grafts are over, but still every now and then I see patients who are recently operated with micrograft or minigraft techniques. This 42 year old patient had small number of grafts for a large area with less than adequate coverage.

The patient’s old hair line is lower than where it should be on the corners for his age and race. He had some pluggy hair growth on the corners and on his hairline. We restored his hairline with 400 single hair FUT grafts, removed some of the pluggy hairs on the hairline using a 1mm punch biopsy device. We increased the density of hair on the front are with total of 2293 follicular unit grafts.

The frontal area was densely packed and the some of the frontal grafts with pluggy appearance were removed. I expect great result in a few months for this patient at our 10 month follow up.

Patient immediately after hair transplant surgery with 2293 FUT grafts including 400 single hair grafts on hairline.

Can shampooing affect our hair loss? Can I hurt my hair by doing too much washing and shampooing? Is there a shampoo that can help the growth of my hair? These are some questions that patients ask me in my office on a daily basis.

The answer is simple. The external factor such as shampoos and conditioners cannot really affect the growth or fall of your hair much. You can wash your hair on a regular basis with shampoos if you have oily scalp and greasy hair. You can choose special shampoos for that matter as well; shampoos that have a stronger cleansing effect for oily scalps. You cannot possibly hurt your hair by washing your hair if you are not having obsessive compulsive disorder. Not washing hair may cause you to lose your partners or friends, but it does not affect your hair strength much.

You can find many different shampoos in the market with the claim of helping your hair growth and preventing further hair loss. Unfortunately most those statements are not quite accurate. Even using the shampoos with some effective ingredients such as minoxidil or DHT blockers chemicals cannot be that effective on preventing your hair loss. The active ingredients of the shampoos cannot freely enter the skin and even if they can be absorbed to some degrees, they cannot reach the generative layers of the skin. The contact time of the shampoo and conditioner with the skin is also limited that does not allow for the ingredients to penetrate the skin.

My suggestion to those patients is to stick with whatever shampoo that they are comfortable with and not to change the shampoo because of the miracle shampoo advertisement they saw on the news paper.

Q:

Hi Dr. Mohebi,

I had asked you some question about Finasteride 1 mg. I am still hesitating to re-take it. I came across a product named Procerin. Do you suggest it? Does it work in a different way compared to Finasteride 1 mg. What are the side effects and efficiency with respect to Finasteride?

Regards,
Patient’s name

A:

Procerin is a mix of several elements such as some herbal, vitamin and minerals. To be more precise the ingredient formula of Procerin tablets includes:

• Saw Palmetto Berries (which is an herbal DHT blocker)
• Gotu Kola
• Nettles
• Magnesium
• Zinc Sulfate
• Eleuthero Root
• Vitamin B-6
• Pumpkin Seed Meal
• Muira Puma Root

Procerin XT Topical Serum ingredients include:

• Gamma Linolenic Acid
• Grape Seed Extract
• Azelaic Acid
• Saw Palmetto Extract
• Avocado Oil
• Nettle Extract

We know that pattern hair loss is not due to lack of vitamins or minerals so you really should not take those components on a regular basis. Out of the herbal components of Procerin the only ingredient that is known to help the stop hair loss is the Saw Palmetto extract that has DHT blocking activities. The effect of Saw Palmetto (topical or systemic) in comparison with finasteride is not studied extensively. I should say the same thing about its side effects that are not evaluated as in depth as finasteride so I do not recommend it regularly for my patients. However if you cannot take finasteride for any reason Saw Palmetto might be an alternative.

Q:

I am a 45 year old woman. My dermatologist told me that I have male patterned baldness. I am also diagnosed with Iron deficiency anemia. Can Iron deficiency in women cause hair loss in male patterned baldness and if so, can treatment of iron deficiency help reversing balding process?

A:

Iron deficiency with or without overt anemia can intensify the rate of hair loss in women with either male or female patterned hair loss. If Iron deficiency is the only cause of your hair loss and you are not genetically prone to anemia, hair loss can be reversible. However in many situations, patients are genetically predisposed to patterned hair loss and Iron deficiency has only accelerated the hair loss process. Accelerated hair loss in women who are genetically predisposed to patterned hair loss may not be reversible by just correcting the Iron deficiency. You need to see a good hair specialist to confirm the type of your hair loss and plan the proper treatment method including hair transplant surgery.

Q:

Hey doc!

How’s it going? I hope all is well. I have two things on my mind. One is a question: the Murad shampoo directs users to use the shampoo daily.. do you think i is okay to use that shampoo daily? The reason why I am asking is because of the chemical content in shampoo, it is usually recommended to shampoo every other day or so.

A:

I answered another question about Murad shampoo “Murad Shampoo for hair loss” before. I don’t believe that DHT blockers especially in the form of shampoo can be absorbed from the skin to affect the hair growth compared with systemic DHT blockers i.e. finasteride pill. I don’t think that daily use of the shampoo can hurt your hair either, unless it is specifically prohibited by the manufacturer.

Q:

Next week will be the second month I have used proscar, and to be honest, the shedding has only lessened a little. I would say it is better than before. Do you think I will see more observable results by the end of summer perhaps?

By the way, after looking at numerous propecia experiments, I think that some of the results could be misleading. Now, I mean this in a good way. It is possible that the success rate could be higher if the experimentation would be more controlled. The reason why I am saying this is because there are not many parameters that are being analyzed within the experiments. It is also important to see people’s “daily actions” to see the possible reasons why proscar/propecia might not work for them. Even though the mechanism mostly occurs internally, there are external factors that could play a pivotal role.

Thank you! Hope you have a good week.

A:

Hair shedding is not always a sign of hair loss. In fact the real bad hair loss that leads to balding in male pattern hair loss is losing miniaturized hair that you really cannot see. People who take finasteride may have increased levels of hair shedding due to the increased hair cycling within the first few weeks to months. The initial hair shedding should get resolved within a month or two from the time it starts. The final effect of finasteride should be assessed and judged at least after 6 months from the time you start the medication, but it may be also seen as late of 12 months from when you start the medication.

Remember that with Propecia, we are not only after re-growing hair and stopping or slowing down the process of baldness is the goal of treatment for most people.

I understand your points on the research done on Propecia (finasteride). Most Propecia studies are done on a large number of patients like many other double blinded prospective clinical trials; so the individual differences are diluted and negligible.

Q:

You have mentioned shock loss in some of your articles that may happen after hair transplant surgeries in young men. Does it happen to everyone and if happened, is it reversible.

A:

Shock loss used to be a big problem for many hair transplant patients. Shock loss generally happens in the first 1 to 3 months following the hair transplant procedure and can be reversible in some patients and to some degrees. Remember that shock loss happens mostly to the hair follicles that have some degree of miniaturization are already in the process of falling out and the stress of surgery just accelerates the rate of hair loss. Strong terminal hairs are usually resistant to the shock loss.

There are several ways to minimize shock loss after hair transplant surgeries. Topical medications like minoxidil could prevent shock loss to some degrees. Finasteride (Propecia) would perhaps be the most helpful medication for reducing the shock loss after hair restoration surgeries, if patient starts taking Propecia right before his hair transplant surgery.

My recommendation to most patients is to start finasteride even a few days before the surgery so it is locked in the system by the time of surgery and can protect hair from shock loss phenomenon. The rate of shock loss has significantly dropped in our hair transplant patients in the last few years, and it has to do with us strongly recommending finasteride use before hair transplant surgery to all our male patients.

Q:

I am 34, male with recession of hairline slightly. There are many bald men in both side of my family. I have been trying Rogaine for about 10 years until I thought it is not working anymore and my hair loss strated to speed up. I recently started taking Propecia. I am originally Mexican. Is Propecia as effective for Mexican as white Caucasians?

Thank you

A:

Propecia (finasteride) has been studied extensively within the last few decades in terms of its effectiveness on different age groups, balding classes and even ethnic groups. Below you can see that the effectiveness of Propecia in comparison with the Placebo on the vertex baldness has been compared in different ethnic groups:

Combined analysis of the two studies on vertex baldness, mean hair count changes from baseline among Caucasians, Blacks, Asians, Hispanics and other ethnic groups. Patient self-assessment showed improvement across racial groups with PROPECIA treatment, except for satisfaction of the frontal hairline and vertex in Black men, who were satisfied overall.