What Is Your Opinion of Replacing Propecia With Avodart?

I was wondering what your opinion is on the idea of replacing Propecia (finasteride) with the newer drug Avodart (dutasteride). Both Finasteride and Dutasteride have originated as Prostate medications. Dutasteride reduces the two enzymes responsible for the conversion of testosterone to DHT. Finasteride only blocks one enzyme. By blocking both with Dutasteride, could the results be better?

Thanks for your input,
Stephen
- - - - - - - - - - - -

Avodart the brand name for dutasteride does lower the DHT by 90% whereas Propecia only lowers it by 65% so it would seem there is no argument as to which one is better for protecting the hair from DHT. I routinely prescribe Avodart for men who are in the 15% who do not respond well to Propecia as well as to young men such as the 20 year old who is showing signs of extensive baldness with a father with only a one inch fringe of hair. That young man wants to do everything possible now to prevent the balding genes from being expressed. Even with Avodart a young man of 20 and with an inherited Norwood type VII pattern can expect to get thin just as his sister might with the same inherited balding genes but with less Testosterone and therefore less DHT.

DHT is the bad guy. Dutasteride works better to lower the DHT and gives better results for protecting the hair and increasing density.

Peter Panagotacos, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Is It Possible To Have My Hair Transplant Grafts Removed? Will My Head Look Normal?

I am 28 years old and had a hair transplant procedure of 1800 grafts two years ago. The transplant isn’t really horrible or anything, but it just Isn’t as natural as I hoped it would be. What I really want to do is just have the grafts removed, shave my head and move on with my life. Can this be done? And if so, will my head look relatively normal after?
- - - - - - - - - - -

If you are convinced that you really just want to shave your head, my guess is that there is a pretty good chance you could make your head look relatively normal. Let’s start with the recipient area. The first thing you should probably do is to closely shave a small area of transplanted grafts to make sure that you don’t have any scars there that would bother you if there were no hair to hide it. If your hair is dark and coarse, you might even choose to pluck a small area of grafts or to use a small amount of chemical hair remover designed for beard hair to really get an idea of what your scalp would look like bald. Assuming you are comfortable with the look and you want to proceed with graft removal, I would suggest laser hair removal. This may require 3 or 4 sessions and occasionally touchup sessions every couple of years, but the advantage is that it is relatively quick and it does not scar. You should understand, however, that it may not work well for blond hair. Read more

Currently Taking Propecia, Should I Also Take Avodart?

I am 18 years old and notice male pattern baldness taking place. I am currently take propecia, but still notice that my hair is receding at the temples. This is really bothering me, it is all I think about and my self- esteem has gone down. Should I take Avodart along with propecia? I really don’t want to go bald. Please if there’s anything else I can do please let me know.

Hello. I certainly understand your concern but I suggest you take a step back and take a deep breath before considering any aggressive and potentially harmful options to treat your hair loss.  First, from your description, it’s likely that you are the only one who notices your hair loss at this point.  So I suggest you get an objective opinion from a reputable hair restoration specialist before doing anything else.  Second, if you are thinking about your hair loss all the time then I strongly suggest you speak with a professional therapist who can help you put this issue into perspective and keep it from becoming an obsession.  I would certainly continue the Propecia and consider adding minoxidil 5%, even applied along the hairline.  It does sometimes help there.  At your age, I would strongly advise against Avodart.  This medication, which has not been proven to be any more effective than Propecia, does have disconcerting side effects in some men such as a significant reduction in your sperm count.  Your hair restoration specialist will be able to follow your progress objectively with photographs and modify your treatment when needed.

Gregory Pistone, MD
Member, International Alliance of Hair Restoration Surgeons

Update on Dutasteride

Finasteride, which is the generic name for Propecia, has been approved for the treatment of Male Pattern Hair Loss since 1998. Finasteride works by inhibiting the enzyme ,5 alpha reductase type II, that forms DHT. There has been a lot of interest by both patients and physicians in dutasteride, which is a drug that inhibits both type I and type II 5 alpha reductase enzyme. Read more