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

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.

Many of my patients are not enthusiastic about long term drug therapy, and that is OK. I only recommend FDA approved options to stop ongoing hair loss. And the male patients have three options to choose from. Commonly the patients will ask me, “Which of these options is best for me?” I suggest that they answer that question by putting their options on a “scale of justice”. By this I mean that they can choose either long term drug therapy, (i.e. either Minoxidil or Propecia), or non-drug therapy, (i.e. low level laser therapy). If the patient is strongly opposed to long term drug therapy, then they have answered their question for themselves and should utilize long term low level laser therapy, 15 to 20 minute sessions, three times per week, on non-successive day’s, (i.e. Monday, Wednesday, Friday for example). They should consider low level laser combs that are “cordless” to increase patient convenience, and therefore compliance. If the patient finds this regimen too demanding, then they should consider long term drug therapy.

Again, I ask the patients to place the two options, (Minoxidil and Propecia) on the “scales of justice” and consider them from a “cost vs convenience” standpoint. The main advantage of Minoxidil is that it low cost, (about $8. per month). The main disadvantage of Minoxidil are that it is not convenient to use, (twice daily topically to the scalp).

On the other hand, Propecia is safe, has no known drug interactions, and is very convenient to use, (one pill by mouth daily). However, Propecia is expensive, ($70. to $75. per month in my geographic area). In my opinion, concerns regarding “sexual side effects” with Propecia use is truly rare, and not of any significant concern for the healthy male patient. It is my understanding that Propecia is scheduled to be available as a generic medicine, (and therefore less expensive) by mid 2013 when the patent expires. Recently we have found that patients can purchase Propecia for less money if they have a Sam’s Club or Costco membership. If they go to the Propecia web site, www.propecia.com , and print off a coupon, this saves them an additional $25. for each three month supply of Propecia that they purchase. This effectively takes the monthly cost of Propecia down to the low to mid $50. per month range.

Since the patients weigh out the “cost vs convenience” issues for themselves, (I am comfortable with this because the options are all approved by the FDA), they can make the correct option that is most likely to lead to long term compliance with one of these products and significantly increases the likelihood that they will stop ongoing hair loss, (allowing the recipient zone to not expand further over time).

If none of these options is considered “acceptable” then the patient can still get a wonderful result with modern hair restoration surgery. Especially since there is no “guarantee” that they will continue to lose additional hair over time. However, statistically speaking, they are more likely to continue to lose hair over time without the use of one of the previously mentioned FDA approved products, and the likelihood that they will seek out a second hair transplant procedure in the future rises for most with time.

Most of my patient only have one hair transplant procedure. All of these patients get a natural, “finished” look with a single hair transplant. But all of the patients also want more “density”, and some will elect to have a second procedure even in the face of a recipient zone that is not expanding. So the “safest” strategy is to use one of the three medical options discussed above as an “insurance policy” against expanding the recipient zone over time, and therefore obtaining the most “density” possible with a single procedure.

So, is it a “waste” to proceed with surgical hair restoration as a Norwood 3? Absolutely not! If your procedure is performed by a qualified, full-time, professional hair transplant surgeon, it will be one of the very best investments that you ever make!

I hope that this discussion has been helpful for you!

Best Regards,
Robert J. Reese, DO
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

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