Dr. Harris explains the facts and fiction of non-surgical, medical hair restoration options.
What are the various medical treatments for hair loss in men?
What are the various medical treatments for hair loss in women?
Note that Propecia (Finasteride) is unsuitable for women.
Is it true that PropeciaTM (“finasteride” is the generic name) works only on the back of the head?
No, it may work all over, as long as the balding process is not complete. Propecia has the potential to work wherever there are miniaturized (fine) hairs. The initial study on Propecia only evaluated its effectiveness on the back half of the scalp; therefore, we could only give statistics on that area.
Once I start Propecia won't I have to use it for life?
Not necessarily. You use it only as long as you want to hold onto your hair. And there will be even better treatments in the future. However, regardless of future medical advances, it will always be much easier to hold onto your existing hair and prevent loss, than to somehow grow new follicles.
Is Propecia safe?
Actually, Propecia is quite safe. There actually exists a human model in which DHT is blocked from birth through generations. As this is the mode of action with Propecia , Merck has been able to study this family to determine the long term effects of low or absent DHT.
We have over 27 million man years of experience with this medication.
Can Propecia be used by women?
Unfortunately, all of the studies done by Merck show that Propecia is not effective in women. There have been smaller studies which hint that Propecia may be effective in approximately 50% of women. It should not be used in women in their child-bearing years as can cause birth defects in unborn males.
I've heard Propecia can affect one's sexual activity. What can you tell me about that?
The occurrence of sexual dysfunction is less than 2%, and it always goes away when you stop using the medication. Over half the time it goes away if you continue using Propecia.
Even if you have sexual side effects that don’t resolve on their own we have the option of decreasing the dose. Usually the side effects will resolve 80-90% of the time and it will continue to preserve your hair.
Could smoking nicotine or marijuana change the effect of this medicine?
No studies have concluded that any medication changes the effect of Propecia.
What about the new Glaxo medication, DutasterideTM?
This medication blocks the formation of type 1 and 2 DHT to knock out over 90 percent of circulating DHT and may, as a result, have increased side effects. It is not currently approved for hair loss.
Does the herbal remedy Saw Palmetto work?
Saw Palmetto is reported by many to show beneficial effects, but there are no scientifically controlled studies to prove this. It has not been studied to determine if it works better in conjunction with other products.
Ask the doctor a question, he will personally answer it.
Does MinoxidilTM work as well as Propecia
Minoxidil works in a different way and studies suggest it may not be as effective. However, results vary by individual. Minoxidil seems to work better in women.
Would I benefit from taking both Minoxidil and Propecia?
Since Minoxidil and Propecia have different modes of action, it would be prudent to try them together. With recent studies showing that the use of these medications in combination results in increased hair growth, we recommend doing so.
What is Nizoral® Shampoo? How effective is it?
Nizoral is a medicated shampoo for dandruff. The 2%-solution shampoo (available by prescription only) was shown in a study to be about as effective as RogaineTM in producing hair growth. The active ingredient, ketoconazole, blocks the action of hormones, like testosterone, to prevent hair loss. There are no studies to show the long term results of this medication.
There are so many non-prescription hair loss products on the market. The ads sound so promising…surely some must work?
Think in terms of financial incentives. A prescribing physician generally has no financial interest in the drug he or she prescribes as the doctor's income comes from consultations or surgeries. When non-physicians sell products for hair loss, they always have a financial interest. There is no other reason for them to manufacture, market and sell their product. More importantly, claims of effectiveness are not based on scientifically conducted studies. Non-prescription medications are not as strictly regulated by the FDA; therefore, claims of hair growth are usually greatly exaggerated.
What is ACell?
ACell MatriStem™ is one type of extracellular matrix, available in both a powder and sheet form. It is made of porcine urinary bladder and contains the following:
• Types: I, II, III, IV, V, VI, VII
• Bioactive Components
• GAGs • Proteoglycans
• Growth Factors • VEGF, BMP4, PDGF-BB, KGF, TGFbeta1, IGF, bFGF, EGF, TGFalpha
• Laminin, Elastin, Fibronectin
• Anti-Infective Peptides
• 18 AMP’s have been identified in porcine tissue
• Porcine defensi n pBD-1
Benefits of ACell
• Stimulates angiogenesis (the physiological process through which new blood vessels form from pre-existing vessels) • Inhibits fibrosis (the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process)
• Recruits progenitor-stem cells
Benefits of combined prp/acell
• Growth factors known to stimulate hair growth
• Platelet derived growth factor
• Fibroblast growth factor
• Keratinocyte growth factor
• Vascular endothelial growth factor
• Insulin like growth factor
What are the side effects of Finasteride?
Finasteride will help maintain your hair, but over a long period of time, further hair loss may still occur. In 1992, Finasteride was approved by the FDA to treat prostate gland enlargement, and approved by the FDA to treat male hair loss in 1997. Finasteride is in the class of drugs called 5 alpha reductase inhibitors, which prevent the conversion of testosterone to dihydrotesterone (DHT). In men DHT promotes genetic hair loss and benign enlargement of the prostate, which generally begins after the age of 50.
Finasteride and blood tests
Finasteride can affect a PSA blood test, a screening test for prostate cancer. Because it shrinks a man’s prostate gland, it will lower the PSA level by about 50%. Whenever you have a PSA test performed, always advise your doctor you are taking Finasteride.
Data was gathered from a 7-year study involving >18,000 men which showed a slightly higher incidence of prostate cancer in the Finasteride group compared to the placebo group - 1.8% (Finasteride) vs. 1.1% (Placebo). This data is very difficult to analyze because on one hand it showed an overall reduction in the rate prostate cancers, and on the other hand it showed a slight increase in the risk of more aggressive types of prostate cancers.
Many urologists feel this was the result of an increased sensitivity of the prostate biopsy test to finding the more aggressive tumors, because the Finasteride prostates being tested were smaller in size. Regardless if you are on Finasteride, all men over 50 should have a yearly rectal exam for prostate cancer screening.
Very rare cases of male breast cancer have been reported in men using Finasteride. The relationship between long term use of Finasteride and male breast cancer is currently unsubstantiated. Because of the rarity of male breast cancer, we recommend routine self-breast exams in men to check for lumps, bumps, pain or nipple discharge.
Sexual adverse events
There is much clinical data derived from various studies that consistently demonstrates Finasteride tablets 1mg will have about a 2% incidence of sexual adverse events, such as decreased libido, difficulty in achieving an erection, and a decrease in the amount of semen produced. In these studies the side effects stopped not only in men who discontinued Finasteride, but also in most who continued taking the drug. Since the initial studies began, there have been reports of erectile dysfunction that continued after stopping the drug. The validity of these reports and the medical explanation s for this are not known.
Rare side effects
Breast tenderness and enlargement
Patients on Finasteride should not donate blood because the blood can then be potentially given to females in pregnancy. No females of child-bearing age should ever handle Finasteride tablets.