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Doc,

It appears that most of the hair transplant examples I’ve seen have tended to be transplants around the hairline (and hair combed back in most cases too) versus crown transplants. If one suffering from MPB were to undergo a hairline transplant and be on Propecia (for the crown) indefinitely, there will inevitably come a time (5+ years) when even the finasteride will wear out in terms of its effectiveness in keeping the crown hair. Does that mean that a series of hair transplants are required to “keep up” with the rate of hair loss overtime?

To give this question the respect it deserves, one needs to understand the natural progression of genetic male patterned balding. This is a progressive process that will eventually lead to a final pattern consistent with your genetically predetermined pattern. Look at the Norwood classification chart for hair loss and you will see a series of patterns. These can be the ‘end stage’ of the hair loss or they may be intermediate stages leading to a more advanced stage along the progression indicated in the Norwood scale. The problem is that you really do not know (for sure) where you will end up, but there are many ways to estimate where you might be by looking at:

1. Your miniaturization map of your scalp. The final pattern may very well show some degree of miniaturization, even if you are not frankly balding yet.
2. Your family pattern and see if you can identify (a) the worst case in the family or (b) the person whose pattern you believe you are following. Then you might be able to ascertain your final pattern (an educated guess).

If your final pattern is not the more advanced patterns (demand for hair) and if your hair density is adequate (supply), then you might be able to keep up with the progression of your balding as it is happening. If, however, the final pattern will be a Class 5, 6 or 7 pattern, you might not be able to keep up with the balding process with additional transplants because you may run out of donor hair (supply). The one clear point I wish to make is that you need to have a Master Plan to take in your worst case scenario and you must have a doctor who you can trust to work with you on that plan. The Master Plan has one objective and that is that no matter what happens, your hair restoration surgeries should always leave you with a natural appearance. Too many patients and doctors think in the short term, and think that the hair transplant will solve the problems of balding. That may not be realistic, so the relationship between the patient and the doctor is all important.

If you are having your first surgery when you are 24 years old and you are supposed to become a class 6 or 7 in the future, even though you are only a class 3 now, it is likely to assume that you need more than one surgery. On the other hand, if you are 35 and have almost reached the end of your hair loss process, you may be done with just one procedure and may never need another surgery. You have to understand that Propecia is not a permanent solution, but it does slow down the loss process in most men. Sooner or later, your hair loss will catch up until that final hair loss pattern is reached. Taking Propecia (Finasteride) may prolong the outcome, but the final pattern is probably inevitable.

the doctor that did my hair transplant told me that i “should not” use proscar because when the droplet of finasteride drips into the 5mg proscar pill, all the finasteride could be on one side. so when you cut the pill into 5th or 4th you might not get anything in a couple of 1/4 pills. is this true??

I highly doubt this is true. If this information is true, wouldn’t there be a chance that a “droplet” of the active medication (finasteride) can also miss the pill, making it a dud? This just goes to show you that have to be very careful about what to believe and what not the believe. Or hope that there is someone out there who is very careful about where they put the “droplet”.

The only concern I have heard about cutting Proscar in to 1/4 pieces is that the dosing may not be exactly accurate and that if you cut more than one in advance, the cut pills may be able to hydrate from the humidity in the air and then become less effective. I do not think this is of clinical importance. If you elect to cut the pill, but sure to store only one cut pill in a sealed small air tight container.

I’ve recently had a total hysterectomy at age 24. I’ve noticed that my hair has stopped growing. Is this something permanent or can something be done about it?

Stress and shock loss is something that we have discussed before in many posts in this blog. Almost any kind of stress can precipitate hair loss in some people. Women seem to be more impacted by stressful surgeries like hysterectomies, while men are more stressed by business, financial, or family problems rather than by surgeries. Any major surgery can cause shock loss and it is not limited to the scalp surgery. This is called telogen effluvium and is similar to what women experience after delivery of a baby.

Hi Dr. Rassman,

In an earlier post you said that it is safe to take accutane and propecia concurrently because they do not interact. However, is it possible taking both at the same time will lead to some kind of liver damage? Another, related question is: how taxing on the liver is propecia?

Thanks in advance for your reply!

The combination of these two medications is not reported to be causing any liver problems. Propecia (finasteride), like many other medications, is metabolized in the liver. Metabolism of this medication in the liver does not affect the function of the liver in normal individuals. If you have severe liver insufficiency, doctors may need to adjust the dose of Propecia, as well as any drug that gets metabolized in the liver.

Dear Dr.,
I have a scar on my cheek that I have from when I was a little boy. I’ve had 2 scar revisions but the scar always spreads and I’m left with a pretty noticable scar where no hair grows.
Would it be possible to somehow fill in that area with hair from maybe my lower neck?

Scalp hair transplanted to the beard area (cheek) is a relatively common procedure. Some men who can’t grow facial hair have these type of procedures to fill in a beard, and likewise it can also be used to cover a scar. Lower neck hair would not be the best place to harvest donor hair, since neck hair is not considered permanent hair.

Is propecia less likely to work if one is required to start it as a younger age (such a I, who is 18) as their is a higher level of testosterone present? Also when propecia proves not affective in a person why is this?

Thank you

It is not a perfect world! Some people respond to a medicine differently than others. I believe that all men with genetic balding will have some benefit of Propecia, but will the degree of benefit meet the needs of the patient? That is the question…

Hi,
I’m a 32 year old Filipino male. I have thick black hair that’s shoulder length and both parents still have hair. My question for you is, does shaving your head affect the regrowth of your
hair in any way? I am cast in a film set to shoot this summer BUT I have to shave my head WITH A RAZOR. I’ve heard from friends (through their friends…of course) that shaving your head with a razor may make the hair to grow back very rough and course…and in some cases, it grows back like “pubic hair” by being kinked. I guess the worst case scenario is that some parts of my head don’t even grow back hair. Please let me know as I’m so nervous about the whole thing and losing some sleep over it. Thank you very very much in advance!

Simply shaving your head will not cause you to lose hair or change the character of the hair. Good luck with the movie!

I am a 42-yr old African American woman. I had hair restoration surgery in March 2006 for androgenic alopecia in the crown. For the last year and a half, I’ve been taking Propecia in pill form 2.5mg/day as well as topically. I’ve noticed since taking the meds, I’m experiencing diffuse thinning all over my head now. Have you heard of Propecia causing accelerated hair loss? Is this a temporary side effect? If I stop now, will my density return?

Propecia (finasteride 1mg) is an oral medication for the treatment of androgenic hair loss approved only for use in men. It blocks a hormone known as dihydrotestosterone (DHT) which is responsible for hair loss in men. Propecia is not approved for women, because female hair loss is not necessarily caused by DHT and it may cause birth defects when women take the medication. Finally, only 1mg of finasteride is recommended for the treatment of androgenic hair loss. Taking 2 mg or 2.5 mg is not necessarily twice as better or effective. It will however increase the potential for more unwanted side effects. I would recommend that you see your doctor and address these concerns to him/her and or see another physician for a second opinion. This website is NOT a second opinion.

The question should be: Will taking Propecia harm me if I am not going to get pregnant? We really don’t know the answer to that, as the appropriate clinical studies were not done on women so safety and effectiveness are still up in the air. I couldn’t possible know the cause of your hair loss without an examination and a detailed medical history.

Also worth noting, Propecia is not available in a topical form or available in 2.5 mg strength.

I was unable to access your link that campares Rogaine to ScalpMed. The link is broken. Therefore, my question to you is this: Is the only ingredient in Scalp Med, (when mixed with “Vitadel” which is simply minoxidil) that actually effects hair growth Minoxidil? I suspect that all these similar products are merely inactive ad-ons since the only common ingredient ALL the products have is that they must be mixed with minox.

Is that so? In other words, if the product works for me-and it does so remarkably, would I see the same results by simply using the $20 a bottle minox and not spend the extra $100+ on the Scalp Med or Follicare, etc.?

I’d be very grateful if you could clear this up for me as I love the results but simply cannot afford their prices anymore. And stopping using will cause the new hair to fall out. Also, do
you think that a DHT blocker is important and/or effective in combo with minox? I look forward to your kind reply. Thanks much.

ScalpMed, as we stated before, does not have any scientifically proven ingredients besides minoxidil and I do not see any reason why minoxidil should not be as effective, possibly even better.

There has been some research done on topical DHT blockers (mostly by Japanese researchers), which shows effectiveness of these products. I guess I would like to see more research on larger groups of patients before recommending them to my patients on a regular basis.

Hi Doc,
I am very concerned about my hair loss, and so far my frontal area is balding apparently. I thought about having hair transplant, but one doctor told me that I need to take propecia to stop losing the existing hair after the surgery.

However, I have Hepatitis B so my personal doctor suggested me not to take propecia since propecia can increase the chance of me getting liver cancer.

This is truly a delimma to me, do you have any suggestion or solution to that? Thanks

I do not understand why your doctor suggested that you can not use finasteride (Propecia). Finasteride get metabolized in the liver like many other medications. If you are in liver failure, then that may be a different story. Its use needs to be controlled and it probably needs dose adjustments in the patients who have liver disease or cirrhosis (not just hepatitis). I am not aware of any evidence that indicates an increased risk of liver cancer with finasteride if you have hepatitis.