Hair Restoration Blog

Q:

I had a hair transplant surgery a month ago.  As it turns out, I have a huge amount of shock loss right now.  As i’ve never taken propecia before, do you think it’s too late to combat this shock loss with propecia?  Any suggestions on how i could eliminate this shock loss from further damage?  I hope my hair will return.

A:

To prevent shock loss, it is never too late for Propecia (finasteride) if you really need it. You may not get the maximum benefit as if you started on the medications before your hair transplant, but your shock loss may not have been completed yet.

We generally start our patients on Propecia a few days prior to their hair transplant so the medication is in the system at its therapeutic level on the day of surgery.

Many people choose to continue the medication after hair restoration surgery and we encourage that. We continue the medication for 6 to 8 months after the hair transplant, depending on the degree of miniaturization for patients who do not want to be on finasteride for the rest of their lives or the ones who have minimal miniaturization. After the first few months, the chance of shock loss due to the hair restoration surgery is very minimal but it still may occur.

Q:

I started the Propecia at the beginning of March (8 months ago), prior to the procedure last March. Should I still be on it?

A:

It is great to hear from you and I am glad you are happy with the result of your hair transplant. The final result of your hair may still get better up until one full year after your surgery if you allow your hair on the transplanted area to grow longer.

Finasteride was mostly prescribed for prevention of shock loss after hair transplant or losing native hair on the balding areas after a hair transplant. You have significant miniaturization on the front, top and crown area (90%-100%), which makes your preexisting hair on balding areas prone to further hair loss. Now that you had your transplanted hair grown, you can decide to stop Propecia. By doing that, you may risk losing your own hair on the balding area further (transplanted hair does not need Propecia for its growth) or you can continue taking the medication to increase the longevity of your preexisting hair on those areas.

Q:

I am using another prescription drug for my prostate problem, which is RAPAFLO 8 mg. Please advise whetehr or not I can take it with finasteride that was prescribed for my hair loss problem.

Thanks,

A:

Rapaflo (Generic Name: silodosin) is in a group of drugs called alpha-adrenergic blockers. Silodosin helps relax the muscles in the prostate and bladder neck, and by doing that makes urination easier.  It does not help shrink prostate as finasteride (Propecia) does.  You can take finasteride (Propecia) in combination with Rapaflo and there should be no interaction between the two.

Q:

Hello,

I did a search for hair re-growth, hair loss, etc. and I found your email address.  These internet searches are definitely far from perfect, in fact sometimes they are way off!  So if this is not the type of business or practice you’re in, I apologize and please disregard this email.

I’m a 43 year-old male.  I started losing my hair, very slightly, at age 27.  I really haven’t lost a whole lot since then, however, my hairline has receded a little and I have been using Rogaine pretty faithfully.
I’m trying to find the best way or multiple ways of re-growing my hair.  First, I am curious to know if it is okay to use Rogaine (5%) and take Propecia?  Do you know if Nioxin or any other shampoos or hair thickeners are helpful?  Would you recommend any?  Are there any other factors that make a difference in re-growing hair such as: vitamins, hormones, foods or physical exercise?

Do you think these types of remedies are all stop-gap solutions and I will need to look for something more permanent? Do you have any insight or additional thoughts or sell any products or services that I can purchase that will help?

Thank you,

A:

Thanks for your email.  You have asked many questions which most have been answered in our Hair Restoration Blog.  There are many hair loss products in the market, but most of them do not have any active ingredients that can help your hair loss condition.  There are only two FDA approved medications that have been approved and proven to be effective and safe for hair loss treatment and prevention.  Those two medications are Rogaine and Propecia.  If you are suffering from male pattern baldness, hair transplant surgery may be the only option that can improve or eliminate the appearance of baldness by bringing good quality hair from the permanent zone to the front and balding areas.

I do not have any particular hair loss product nor recommend many different lotions and potions that are out there in the market for hair loss.  You can find other valuable information on our postings in our blog and can answer your questions on:

• Nioxin - hair loss product
• other shampoos for hair loss
• vitamins for hair loss
• balding and hormones
• foods for hair restoration
• physical exercise and hair loss

I recommend that you find a good hair restoration doctor who can evaluate you and come up with a master plan for your condition.  This may include medications, surgery or even cosmetic changes that you need to bring your hair and beauty back to your life.  We do offer an online consultation for hair restoration through pictures and if decided that you are a candidate and you choose to have a hair transplant with us, it could be easily done.  Our California offices of hair restoration can arrange your trip to our Los Angeles office for your hair restoration surgery.

You can contact our office at 888-302-8747.

Good luck,
Parsa Mohebi, MD

Q:

Hello,

Do you map hair for miniaturization, and are you able to tell which, if any, hairs are currently being attacked by dht, testosterone, or something else entirely such as a disease? Or should I be looking into a dermatologist?

Thinking about getting on Propecia, but I am not sure if my receding hairline is caused by dht (androgenic alopecia), or just naturally receding from testosterone. If it’s the latter then Propecia might affect my hairline negatively due to an increase in testosterone. Or perhaps something else entirely, deficiancy, or disease. Just a bit precautious and want to stay ahead of whatever is causing it.

Please advise,
thanks!

A:

Yes, as part of our hair loss evaluation, we do perform a miniaturization study on all of our hair loss patients before planning any medical or surgical hair restoration.  This helps to determine the candidacy of each individual before starting them on medical treatment.  A miniaturization study needs to be done before starting hair loss medical treatment so you have the mapping of the scalp before the treatment that could be used in the future to assess the effectiveness of the medication.  Miniaturization study also can predict your destination when hair loss is concerned.

You can call our main office at 1 (888) 302-8747 and arrange a hair restoration consultation at one of the California offices of US Hair Restoration - Beverly Hills, Encino or Orange County.  We look forward to assist you to come up with a master plan for the prevention or treatment of your hair loss condition.

Q:

Firstly, thanks for responding me
Secondly, my only concerns regarding finasteride is:

a) What about family planning issue after marriage
b) I haven’t had sex so i cant figure out any pre and post Libido changes
c) Does one have to take Propecia even after HT,what about those who face some side  effects from Propecia ?

A:

I am answering your questions in the order they were asked:

a) What about family planning issue after marriage

Propecia does not affect sperm count and fertility.

b) I haven’t had sex so i cant figure out any pre and post Libido changes

If you have side effect as decrease in libido with finasteride, you need to stop Propecia and the side effects will go away.  Some patients decide to continue the medication despite of the side effect and over time they may experience that they regained their libido.  Study shows that the rate of side effects is similar in patients who took Propecia and the ones who were on placebo after a year.

c) Does one have to take Propecia even after HT, what about those who face some side  effects from Propecia ?

If you stop the medication you continue the regular hair loss as before and it should not have catch up hair loss as described with Rogaine.

Q:

HI sir, I met you today, and you suggested me to take Finasteride, but Finasteride is marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX. Which one do you suggest me to buy. You said to buy it from a particular pharmacy, so could you please specify the tablet.

thankyou,

A:

Propecia is the trade name for the hair loss medication finasteride, which is the only FDA approved oral medication for male hair loss prevention or balding treatment in the United States.  Proscar is the other trade name from the company Merck for 5mg finasteride which is prepared for prostate enlargement treatment.

Some people cut Proscar into quarters to save money in the long run.  If you buy finasteride under any brand from an American Pharmacy, it should be fine as long as you take the proper dose for hair loss treatment that is 1mg or if you have to buy 5 miligram and cut it, the closest does would be 1.25mg per day.

Q:

I am a 30 now and I have been losing my hair since I was 18. I started taking finasteride last year and seen great result only after taking it for only a few months. I think I may have been experiencing some side effects.  The thing is I noticed that it might have affected my erection and it takes me longer to get an erection. I know when you know you are taking a medication that has to do with your male hormone it may automatically affect your sex function negatively. So I do not know whether it is mental or real. I don’t want to stop Propecia if it is safe to continue it.

A:
You have been experiencing erectile dysfunction recently while taking Propecia (finasteride) for a year. Erectile dysfunction has been evaluated in patients who have been taking Propecia.  The incidence of erectile dysfunction is reported to be 1.3% of men who were on Propecia for one year.

The rate of erectile dysfunction was reported 0.7% among the patients who only took placebo. You can test this side effect of Propecia by stopping it for at least two weeks and see if you still have erectile dysfunction. If the erectile dysfunction goes away by discontinuing Propecia after two weeks, your problem might be a real side effect of finasteride. If you still want to continue taking Propecia despite experiencing erectile dysfunction, you may try a lower dose that can still help your hair growth without giving you any negative effects to your sexual function.

Dear Dr Parsa Mohebi,

I have been experiencing male pattern baldness for some years now. Initially used Rogaine, it worked at first but now no longer respond to it. Next used Propecia, but had to stop due to side effects. Lasercomb failed too. I am currently saving up and considering getting a hair transplant maybe in 4 years time. I’ll have enough money by then.

There’s one thing I’m really curious about. Would you happen to know anything about Revivogen from www.revivogen.com. It’s a topical lotion combined with shampoo/conditioner that was invented by Doctor Alex Khadavi, MD, a US Board-certified dermatologist. I have a question below which I hope you can answer and shed light on.

All I just want to know before trying the product and applying the lotion to my scalp is for my “safety” concerns. If this product was developed by a dermatologist is it okay to allow myself to test it out even if it may not grow/and or stop hair loss but at least I can be rest assured it won’t cause allergic reactions on the localized surface of my scalp. Although I don’t have sensitive scalp skin, some of the things I’m scared of are like more hair loss(worse than pre-treatment) or cause unknown severe harm like scalp dermatitis/acne/burn/swolleness, stain my scalp permanently orange etc.(I’ve probably just exaggerated every side effect.May or may not true!). This is what I mean by safety. What’s the worse a topical solution like Revivogen could do to my scalp anyway? Any potential risks? Are the ingredients mentioned on the website even safe on humans?
Finally, do you believe it is safe enough and whether its worth a try for me to test out what appears to be a very safe and sound consumer product and hopefully not a scam? There’s nothing else on the market and I’m really desperate too to give it a go.

Please do feel free to take your time and answer me whenever you can. Your comments and recommendations would be very appreciated. Thanks.

Kind regards,
-

A:

It seems like you tried everything for your hair loss, but stopped them all due to either side effects or inefficiency. You are now exploring other options before you can get a hair transplant surgery. You are not alone and there are many other young men who are going through the same path.

First of all, I really like to know what kinds of side effects you experienced with finasteride (Propecia), because finasteride is an effective hair loss medication, although it has been blamed unfairly for many side effects. I put most my patients at our Los Angeles and Orange County Hair Restoration Clinics who have significant miniaturization on finasteride. Finasteride can help prevent further hair loss. Some of your hair loss might be irreversible by medication and you may need hair restoration surgery, but at least you can stop further hair loss by the time that you can restore your hair surgically. Revivogen® is a hair loss product with some natural compounds that mainly inhibit 5-Alpha-Reductase. 5-Alpha-Reductase is the enzyme that converts testosterone to dihydroxytestostrone (DHT). Prevention of DHT production can slow down hair loss in male pattern baldness.

One of the components of Revivogen is Saw Palmetto Extract, which is a DHT blocker and is used systemically for prevention of both hair loss and prostate enlargement. The efficacy of its topical product is not studied as extensively in large human experiments. Other components include a variety of fatty acids like: Gamma Linolenic acid (GLA), Alpha Linolenic acid (ALA), Linoleic Acid and Oleic Acid without strong human research on their absorption from skin level as well as their efficacy on human hair growth. Other components such as Azaleic acid, Vitamin B, Zinc, Beta-Sitosterol and Procyanidin Oligomers have shown some effects on the DHT production in labs, but the extensive studies to compare their effect with more researched medical treatments for hair loss is lacking.

The absorption level of the ingredients of Revivogen® from human scalp skin is not studied as extensively as well. I personally have not heard anything about any serious side effects of Revivogen, but I would rather have more information about long term studies, which are published in peer reviewed medical journals, before I can recommend the product to my patients. There are many hair loss products out there, which are safe, but you do not have a life time to go around and try them all to find out whether they have any effect on your hair or not.

You need to establish a good relationship with a good hair specialist that you can trust. He or she should be able to document the level of your current hair loss and miniaturization of hair and can come up with a master plan, which includes medication treatment, surgery and even cosmetic alterations that can make your hair look better. Side effects of the medications that you tried before need to be re-evaluated closely by your doctor.

You don’t want to deprive yourself from effective, FDA approved hair loss medications that their safety and efficacy are confirmed in scientific studies and instead start looking around to see what else is in the market. If you have no alternatives, your doctor may have some suggestions for your individual condition to preserve whatever hair you have with a product with minimal side effects.

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.