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Propecia After a Hair Transplant

Dr. Rassman here’s my question. I am 40 years old and started to bald when I was about 36. Around then I bagan taking propecia and have encountered good results. Most of my hair has regrown. Anyway, here’s my question. From time to time I think about a hair transplant and I think about this as a means to stop taking Propecia. Am I fooling myself. Will I still be on Propecia after the hair transplant? Thanks.

With the good results you’ve reported, you should not consider stopping the Propecia. Hair transplants should be looked at as a way to augment the results, if you feel that the results now do not meet your objectives. If you stop the Propecia, you will go back to square one and lose all of the benefit you recieved from it in a matter of a few months. You need to sit down with your doctor and work this into a Master Plan for your present and future hair loss.


2006-02-20 20:59:59Propecia After a Hair Transplant

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Did The Great Hairline / Thin Top Patient Take Propecia?

DR. R
did this patient you mentioned last week take propecia by any chance as well? I just want to know as to if he lost non transplant hair after the transplant through the years was it with or without propecia

So everyone is up to speed, the post from last month you’re referring to is here — Great Hairline, Thin Top and Crown, Low on Donor Hair

This patient did not take Propecia (finasteride) over the period of time we worked with him. Many people who are satisfied with their transplant results don’t “officially” recognize that they have a progressive process and in men like this, practicing denial as it goes on is common. In older men (like this man, over 40 years old), their decision to not take Propecia is common, as these men feel as if they beat the balding process and will not bald more over time. And in men over 40, this is not an unreasonable conclusion as the balding process often slows or stops on its own — but clearly this man lost his gamble as his balding pattern acted as if he was in his 20s, not 40s.

When I see a man under 35 years old losing hair, I stress the need for Propecia to guarantee, as much as possible, that the balding process has slowed or stopped. It is often a battle between us, as no one really wants to take the drug, especially with good transplant results. I can not stress the importance of staying on the drug to stop the type of changes that this man had and although there is no real guarantee, it is reasonable to take the drug for life.


2013-01-04 13:43:55Did The Great Hairline / Thin Top Patient Take Propecia?

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Propecia and Hepatitis C?

How is life treating you today?

I have a question but first I have to thank you for providing this excellent resource free of charge. The blog has been an invaluable tool in my continuing effort to learn more about hair loss and unicorns.

My question is this, is there a difference between the effectiveness of Proscar and Propecia? I recently switched to Proscar (I was prescribed it during my consult at NHI). I am a little nervous though because the blue Proscar pill looks to be the same size as the brownish Propecia pill, yet I am cutting Proscar into fourths. I thought a 5mg pill would be larger than a 1 mg pill. Am I missing something or is Proscar simply more potent?

Also, I have Hepatitis C. Prior to starting the medication, I found nothing to indicate that taking Propecia would be a problem for someone with my condition. Does this hold true for Proscar as well? I found nothing in Merck’s online product information to prove otherwise but the internet is so full of misinformation that I honestly don’t know what is what.

If you don’t feel comfortable answering the second question with certainty, do you know of any good Gastroenterologist’s in the LA/Orange County area?

I am sorry, that was 3 questions.

Thank you very much for your time and patience

Life is going well, thank you. I hope you’re doing fine and I’m glad you enjoy the site, but if you got your medication prescribed from us (NHI), you should call our office to discuss any issues/concerns at 310-553-9113. You’re our patient and we are here for you!

In general, I think some drug companies make it hard for patients to divide up and cut pills sometimes because it’s all about economics and making a buck. The reason the 1mg and 5mg pills might be the same size has more to do with the inactive fillers, which you can learn more about here.

With respect to Hepatitis C, as long as your liver enzymes are normal and your primary care doctor (or gastroenterologist) is aware that you’re taking the Propecia, I am fine with it. As for gastroenterologists in the Los Angeles area, you can try Dr. Norman Panitch.

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Differences Between Strip and FUE?

I’m told that there are two different processes for this procedure, one for a client with hair and another method for clients without hair. My understanding is the client must decide before the procedure which they want because the process for buzzed/shaved hair will not look right with the method used for longer hair and vice versa.

1. Is there two different methods, one for buzzed/shaved hair and one for hair with a longer length if so why and what is the difference between the two methods?
2. You indicated in an email that the same amount of dots are used for an individual with hair as one without. Why?
3. If the method for clients who want to leave some length to their hair is different from clients who have shaved/buzzed hair and the client must decide which method they want before the procedure, because the method for buzzed/shaved hair won’t look right with clients who leave some length to their hair what happens if the clients hair thins out in the future? Will it not look right?
4. I’m told the hair must be shaved/buzzed before the procedure. If that is the case, and the method for longer hair is used which they say doesn’t look right with shaved/buzzed hair is that going to look weird until the hair grows back?
5. How deep does the needle go?
6. For my situation being that I want to keep my hair longer than a buzzed/shaved length do you use dots or more of a blanket coverage. Can you explain? If you use dots what size would the follicle dot be?

There are two ways to harvest the donor hair for transplantation:

1. Take out the hairs one-by-one using a small (1mm diameter) punch. This is called the Follicular Unit Extraction (FUE) method. To do this, you need to shave the back of your scalp so that that hairs will fit into the small punch. Without shaving the area, you can individually thread each long hair into the small 1mm diameter punch, but that would be a very, very long and inefficient process. FUE will allow you to have a buzz cut or keep your hair very short later on (when everything has healed) without seeing scarring… but if you shave your head completely, you will see thousands of white dot scars. So there will be scarring there, just not a linear scar.

The needle goes in the depth of a follicle, which is about 5mm, and the dots of the FUE scar can range from 0.8mm to 2mm in diameter. It all depends on how each person heals and the size of the instruments used by the doctor. To read more about the pros and cons for FUE, see here.

2. Another method (strip surgery) is to cut out a small section of your scalp and stitch it back together, like if you had a cut to any part of your body. This section of removed scalp is taken and dissected under a microscope into individual follicles. Your body will heal with a line scar, which won’t be visible if you keep your hair relatively long. The shortest haircut should be with maybe a #2 guard on the clippers, though a #3 guard should hide the scar without any issue. If you shave your head, you will see a linear scar. This type of procedure can be done without any hair cut or shaved in the donor area, so that when you leave the office you will not be able to see any evidence of surgery, as your hair will immediately cover the incision.

You will, however, have redness in the area where the grafts were transplanted. The severity of the redness depends on your body and where the grafts are transplanted to (if it was to a completely bald area, it will be evident — if it was to an area that had some hair, you might be able to cover it with styling).

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Propecia and Shock Loss After Surgery

Dear Dr. Rassman,

Does a young man (mid twenties) who has been on Propecia for a few years run a high risk of permanent shock loss in the recipient area after an HT surgery? Also, will the HT speed up the normal balding process?

Thanks

Usually, Propecia will protect a man against shock hair loss and acceleration of your hair loss, but alas that is a general rule and not everyone follows that rule. It is about 90+% predictable. Those at greatest risk for acceleration of hair loss are the young men who have very active miniaturization going on and are showing fast-track balding in process.


2006-09-07 13:47:57Propecia and Shock Loss After Surgery

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Propecia – Brand vs. Generic

I currently take Propecia, 1 mg., and am paying $86 at Costco for a one month’s supply. I have been told by a pharmacist that the generic has the same ingredients as the brand name. The generic sells for $22 for the same amount. My question is – are the results the same? If the brand name works better, I’ll gladly pay the extra money. Am I paying too much? I could really use a professional’s opinion. Thank you.

Genetic drugs are same as brand name drugs in its efficacy. The difference is the price and the shape or color of the pill and its packaging. Even the 5mg version which you cut in 1/4s will give you the same results. The 5mg version costs about $6 a month and I believe that Costco will sell you a 3 month supply for $28 which is quite a cost saving.

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Propecia Is Working Well in My Hairline, But Not So Much in the Crown

I’m 20 years old, have naturally fine hair, and my hair started miniaturizing/thinning when I was 17. I have recently started Propecia and have been taking it for approx. 4 months. The shedding stage of Propecia has pretty much stabilized and I have noticed a significant improvement in my hairline as well as improvement in thickness of hair. My crown, however, seems to not be improving other than stopping hair loss (I could be wrong it’s hard for me to see that area on my head). Am I likely to grow new thicker hair in hair in the crown, given that I already have in the temporal area? I know you’ve said that Propecia is generally more effective in the crown, so if I’m already growing new hair at the hairline it would seem logical to conclude that I should expect improvement in the crown. Is this assumption valid? Is improvement likely in another 6 months?

Thank you

I generally tell men to take the drug for at least a year to see the benefits. At 4 months, you have not been waiting long enough. As the impact of Propecia on the crown is reported to be more frequent than the impact on the frontal hairline, I would expect that if you had a good response in the frontal area, that you will have a good response in the crown if you wait long enough.


2008-07-15 08:54:05Propecia Is Working Well in My Hairline, But Not So Much in the Crown

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Do Hair Doctors Still Use Plugs?

Are doctors still using the plugs that I see on the street, in the malls and at airports all of the time?

Not as a rule. The old plugs that gave this industry a bad name in the 1970-80s have largely been replaced with small grafts that are called follicular units. But there are some doctors that use ‘combination grafting’ which is a mixture of larger small grafts and naturally occurring follicular units. Only the follicular units are undetectable in bright light or close inspection.