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
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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

Do you recommend having a hair transplant if the patient can not tolerate Propecia?

I have been on Propecia in an effort to stop my hair loss for the past 7 months but have been experiencing some sexual side effects. I would like to have a hair transplant, but I am concerned that undergoing the procedure without being on Propecia might not be a good idea. Do you recommend having a hair transplant if the patient can not tolerate Propecia?
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Propecia is a medical treatment designed to slow down male pattern hair loss and promote growth of new hair. It does not work for everyone and some can experience sexual side effects. In addition, there are some patients who do not want to take a medication for their hair loss and propecia is expensive. Read more

Is It a Waste To Have a Hair Transplant Without Using Propecia?

I just turned 30 years old and really would like to do something about my hair loss this year. I feel that my receding hairline is making me look older beyond my years. This is my problem, I am not a big fan of taking medication, and I am also very concerned about the long term side effects of Propecia. I think I would be a Norwood Class 3 with thinning sides, but the hair on the back of my head is extremely thick. Would it be a waste for me to have a hair transplant, but not take Propecia? Thanks in advance, Carl
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Carl:

Thank you for your e-mail.

I will attempt to answer your question, “Would it be a waste for me to have a hair transplant, but not take Propecia?” in the following manner.

In my opinion, modern hair restoration surgery deals with an imbalance in “supply vs demand”. What I mean by this is to say that most patients that I perform consultations on have a larger “demand” area, (i.e. the area of the scalp that we transplant into), and smaller “supply” areas, (i.e. the available donor follicles). Stated another way, most patients have a “mismatch” in the larger recipient zone compared to the smaller donor zone. Therefore, it is important for me to council my patients about the importance of “getting serious about stopping hair loss” such that the recipient zone does not continue to expand over time. Read more

Propecia Has Slowed My Hair Loss - I Am 41 And Interested in a Crown Hair Transplant

I’m 41 years old and have been losing my hair since around the age of 24. I’ve been on propecia since it came on the market which has really slowed my hair loss down. I’m around a Norwood class 4 but I have a lot of hair in the hair line. Do you think it’s ok to have a hair transplant performed to fill in my crown now that I am above the age of 40 and have maintained a lot of hair for all of these years?
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Without seeing your scalp, I will have to speak in generalities. I am very pleased you have been on Propecia. As I am sure you are probably aware, Propecia is able to stabilize male pattern balding in up to 90% of men as long as they continue to use it. Before talking about transplanting your crown, I would like to focus on the last part of that statement. Propecia controls hair loss, but it does not cure it. If you were to stop taking Propecia, your balding would resume. However, worse than that, it is possible that your balding could actually catch back up to where it would have been at age 40 had you not been using Propecia at all. If you have been using Propecia since age 24, that suggests that you could lose a tremendous amount of hair over a year or two period if you stopped taking Propecia. So before considering whether you want to have your crown transplanted, you need to be certain that you are willing to continue taking Propecia indefinitely. Even if you are committed to long-term use of Propecia, please keep in mind that it is possible that you could develop side effects down the road that would necessitate its discontinuance. That would be quite unusual after having used it for such a long period, but we very rarely see men who develop enlarging breasts (gynecomastia) after many years of taking Propecia. Read more

Is Propecia Use Required If You Have a Hair Transplant?

I have been progressively losing my hair for about the past five years, but I am concerned about using propecia because of sexual side effects. I’ve been researching hair transplants but have read that if you have a hair transplant then you have to take propecia to maintain the new hair. This does not make sense to me. I was under the impression that the hair from a hair transplant will last a lifetime. Can you shed some light on this for me?

Your questions and are commonly expressed concerns. Unfortunately you have read incorrect information. Transplanted hair is not dependent on Propecia. The donor hair follicles are genetically different from the follicles that are effected by male pattern baldness. Donor follicles are not sensitive to normal levels of dehydroxytestosterone (DHT). Once transplanted to areas of balding scalp these follicles will continue to produce living hair. Propecia or finasteride lowers DHT levels reducing the effect on native (non-transplanted) follicles and by doing so helps to control progression of male pattern baldness.
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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

14 Years old and Losing My Hair - Can I Use Propecia?

I’m a 14 year old high school freshman and I think I’m losing my hair. Is it possible to go bald at such a young age? Can I take Propecia or do I have to wait until I am 18?

While it is unusual to lose your hair at such a young age, I have seen a number of such cases. And usually, I have found there is a very strong family history of extensive hair loss in such situations, although this iscertainly not predictable. I am not comfortable prescribing Propecia or any other DHT blocker to a young man Read more