NY Hair Transplant : Rogaine (Minoxidil) and Propecia (Finasteride)

Additional Topics:

-	Limited role of scalp reductions
-	Use of Propecia/Rogaine
-	Transition from a hairpiece to hair transplants
-	Temple area transplantation
-	Trans-gender Transplantation
-	About Donor Scars

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60 Railroad Place Suite 102 Saratoga Springs, NY 12866
Phone: 518-581-1872 Toll Free: 1-800-281-9198
e-mail: saratogahair@spa.net

The Role of Rogaine (Minoxidil) and Propecia (Finasteride)

Rogaine (Minoxidil) in pill form is one of the strongest blood pressure medications used by physicians and around 28 years ago was found to have the side-effect of promoting hair growth in patients taking the medicine. For the past fifteen years it has been available as a topical application, first in a 2% compound, and in recent years as a 5% formula. It is typically applied twice a day to the area of the scalp being treated. Topical minoxidil is available "over-the-counter" without a prescription as either Rogaine or generic minoxidil.

The exact way that Minoxidil works to promote hair growth is not fully understood. The medicine is known to be a potent "vasodilator", which means that it causes the walls of blood vessels to relax and widen, thus allowing more blood flow to pass through them; but it is generally agreed by most experts that there is some other additional way that the drug works in relation to hair growth, which remains somewhat mysterious. The best way to describe it is that it seems to be a “growth factor” for hair.

Topical Minoxidil helps a person with hair loss mainly by slowing down the rate of hair loss. It is not real helpful in growing new hair, and in those men and women who do have this happen, it is more of a “peach fuzz” type of hair growth. If a patient who has been topical Minoxidil for quite a while, stops the drug for several weeks, then whatever gains were realized while taking the drug may be suddenly lost, as hair sometimes sheds rapidly.

When someone has been on Rogaine for some time and is undergoing hair transplantation, it is our policy to have them continue using it until the second session has grown out, at which time they may simply stop using the drug. Using this strategy, the patient will retain whatever remaining hair he has on top, so that it can serve as a camouflage during the early months while the transplanted hair is growing.

Also, in patients that have had several hair surgeries in the past (multiple scalp reductions, old transplants, etc), Dr. Beehner often will encourage them to "pre-treat" the scalp area being transplanted with Rogaine for three weeks prior to and three weeks after surgery, in order to help "prime" the blood vessel circulation of the scalp and insure that all the grafts "take" and grow hair. This same strategy is used for all of our female patients, again, in order to help prevent any temporary "shocking" of the "weak" hair on top as a result of the transplant procedure.

Propecia (Finasteride) has been available since 1997 and is the first oral medication to ever be approved by the F.D.A. specifically for the prevention of hair loss. A physician’s prescription is required. The overwhelming majority of men using this drug experience some benefit from its use, sometimes dramatically. It takes a full year before the full benefits can be fully seen and appreciated. The recent 7-year research studies show that, for most patients, there is a substantial increase in the number and quality of hairs growing on the patient’s scalp for around 4-5 years, somewhat paralleling the length of time of a hair’s anagen growth cycle. After that, the patient’s overall hair mass on top very gradually starts dropping ever so slightly each year, so that at the end of around 10 years, the patient is back to where he started 10 years earlier. From our present knowledge of how the drug works, it makes sense to take it even after that point, because the rate of loss will still be dramatically less rapid than if one goes off the drug. There also are many clinicians and investigators who believe that finasteride works nearly as well when administered in dosage amounts substantially lower (and cheaper) than that recommended by Merck.

(to see enlarged view of transplant patients click the desired photo)
24 year old before going on Propecia	Result several months after taking Propecia

Finasteride works by blocking the conversion of the "male hormone," testosterone, into dihydrotestosterone ("D.H.T"), the hormone mainly responsible for hair loss. It should be noted that DHT is not the cause of hair loss. Heredity is. But, the expression of one’s heredity regarding hair loss can only occur in the presence of DHT, which is obviously present in all men. This does not mean that men who lose their hair have more DHT or testosterone than men who retain a full head of hair.

There is a 5.9% incidence of sexual side effects according to Merck, the manufacturer (2.9% if one subtracts the 3% incidence found present in the placebo group). In my experience of having prescribed it to several hundred men over the past 5-6 years, I have only had four of them call and tell me they had any sexual side effects, and one of them was able to return to taking the medication at a lower dose with no further problems. Since I have gone to routinely recommending lower daily doses, such side effects are extremely rare.

In our opinion, Propecia is a valuable weapon against the hereditary onslaught of hair loss and is a much better choice than using Rogaine (Minoxidil) as a single treatment. I should be mentioned here that combining Rogaine and Propecia has a synergistic effect, which means that the benefits can be greater than the combined “solo” effects of the drugs. Another strategy that we commonly use is to combine transplanting of the front part of the head in a younger patient with prescribing Propecia to help retain the hair in back.

There is a new and stronger drug, similar to Propecia, called Dutasteride (Avodart), which was recently put out by Glaxo Corporation with F.D.A. approval for use in the treatment of prostate problems. It is anticipated that many physicians will prescribe this “off label” to younger patients for hair loss. At this time I am not prescribing Dutasteride, due to concerns that I have about the elevation of testosterone that occurs and also because, if a man does have side effects from the drug, there is the possibility of these effects remaining for quite a few weeks (or months) due to the long half-life of the drug. And finally, we don’t know what the long-term effects of such strong drug are in terms of later medical effects on the patient's health. For all of these reasons, Propecia will be the only oral hair-loss drug we will be prescribing for some time to come.