Hair Restoration Blog

DHT or dihydroxytestosterone is a byproduct of testosterone that causes hair loss in men who are prone to baldness. Another negative effect of DHT is increasing the incidence of prostate enlargement and prostate cancer. Other than above effects, no other major physiologic function is known for the hormone DHT in adult males.

During infancy and childhood, DHT accelerates the development of male genital organs. This effect of DHT stops when a male external genitalia matures completely.
By using 5 alpha reductase inhibitor medications such as finasteride in medical hair restoration, we can block the enzyme to slow down the process of baldness in men and prevent prostate enlargement in elder men.

There is a congenital disorder in which the enzyme 5 alpha reductase is lacking that leads to the lack of DHT production. Congenital 5 alpha-reductase deficiency is also known as familial incomplete male pseudohermaphroditism type 2, seudovaginal perineoscrotal hypospadias, 5-ARD, 5-alpha-reductase type 2 deficiency, ambiguous genitalia or male pseudohermaphroditism.

Deficiency of the type 2 isozyme 5-alpha-reductase, which transforms testosterone to DHT is the cause of this disorder. DHT major role is in development of male fetus external genital organs and without that effect male newborn can develop immature or ambiguous external genitalia.

Diagnosis of congenital 5 alpha-reductase deficiency is through testing the testosterone to Dihydrotestosterone level. Elevated ratio is an indication of 5 alpha-reductase deficiency. The Level of testosterone is also elevated. There is also alteration in HCG stimulation test. In congenital alpha reductase deficiency male fetus develops a female phenotype without presence of uterus.

Congenital 5-alpha reductase deficiency could be treated to some degrees and the symptoms could be controlled with high doses of testosterone to make the deficient enzyme make normal or close to amount of DHT in this patients.

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.

I am in the Detroit airport on my way back to Los Angeles from the 16^th annual meeting of international society of hair restoration surgery (ISHRS) that was held in the beautiful city of Montreal in Canada last week. This five day meeting was filled with a variety of presentation on the clinical and basic science aspects of hair transplant surgery and medical hair restoration.

I gave a lecture on psycho-social impacts of hair restoration on men on the first day of the meeting. The lecture has been prepared based on my other article on Psychology of Hair Transplant that was previously presented and published on the Hair Transplant Forum International on April, 2008. In the current presentation on psycho social impacts of hair transplantation, I explored some other social and psychological aspect that hair transplant patients experience after their hair restoration procedures based on experience we had with our Los Angeles hair transplant patients and what we found in our research last year with New Hair Institute (NHI).

Several other interesting studies were presented on the aesthetic planning and designing of the hair line and frame of the face with hair transplantation. There were many articles on the hair transplant surgery techniques that could be used for optimization of the final appearance of a hair transplant.

Few articles were presented on hair stem cell research and hair multiplication. However based on the presented evidences, there were no signs of an upcoming solution for hair multiplication or hair cloning any time soon.

One article discussed an innovative method of hair graft harvesting that can produce more hair from an existing follicular unit. The result of this study, although interesting was very controversial among the experts and the author could not release the study details on the methodology to elucidate this matter.

I will publish the highlights of this meeting on the website of US Hair Restoration soon.

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 am a 35 year old woman with history of scalp dermatitis. My doctor gave me steroid solutions for my dermatitis that helped the condition, but I have been suffering from hair loss now. Could steroid solution be the cause of my hair loss or could the scalp dermatitis be the cause of my hair loss?

Although hair loss is reported as a rate side effect of many medications, losing hair is not a common condition that could be seen after topical steroid use. Dermatitis or inflammation of skin could be seen as part of many other skin conditions. I think you have to see a good dermatologist and get an accurate diagnosis for your hair loss condition. Microscopic evaluation of the scalp or miniaturization study is a great tool to diagnose the condition of your hair loss and to see whether your hair loss is still active or not. I perform a miniaturization study on almost all my patients to determine the activity of their hair loss condition and also to predict their future hair loss. The type of your hair loss and its association with other medical conditions could be assessed by a hair specialist after taking a history and examination of your hair and scalp including performing a miniaturization study. We do perform

miniaturization study on all patients while evaluating them for hair transplant. If you are diagnosed with a treatable condition that has caused or accelerated your hair loss, proper treatment may cure your balding and give you your full head of hair back.

Many hair transplant patients are concerned with the scar of cosmetic surgeries including hair transplants. Several techniques have been suggested to minimize the scar such as corticosteroid injections, irradiation, ultrasound, silicone applications into and around the forming scar. However, the effects of most these methods were far from satisfactory. Botox is a new method that could be used to minimize the size of both facial and scalp scars. The use of Botox for reduction of facial scars from surgeries was first suggested by plastic surgeons who were trying to reduce postoperative effect of facial muscles on stretching and widening of scars.

In many patients with ugly scars of the face, botulinum toxin (Botox) was used successfully to induce temporary paralysis of the muscles during revision surgery. Botox with the same mechanism can help minimizing tension on the healing wound edges until collagen could mature and scar if completely adnd firmly formed.

The use of Botox has been suggested for the treatment of stretched scars on the face by many plastic surgeons now. Hair transplant surgeons also use Botox for treatment of the hair transplant widened scars of the donor area that do not show improvement with a simple scar revision procedure. There are reports of successful decrease in the final size of the scars with injection of Botox into the muscles surrounding the maturing scar. We at the Los Angeles hair transplant offices of US Hair Restoration don’t offer Botox to every patient who is having a hair transplant surgery through strip technique, but it certainly could be used for the patients who suffered from widened scars of prior surgeries and did not respond to the other methods of scar revision.

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.