Finasteride - the latest updates

At an international conference recently it was discussed in depth about Finasteride and the possible sexual side effects resulting. It was again concluded that Finasteride is a safe medication and side effects were mainly dose dependent and went away completely upon ceasing the medication. It's been noted that recent media reports on the severity and incidence of side-effects have been extremely overstated and that Finasteride remains the best option for treating male pattern balding.

In my care, side effects are very uncommon and a minimal, intermittent dose of the medication is all that is required to give long term stability of hair loss in most thinning men.

The Latest Treatment for Pattern Baldness

The most interesting topic discussed at our recent annual meeting of the ISHRS (International Society of Hair Restoration Surgery http://www.ishrs.org ) was the new research to come out about prostaglandins. Medications currently being created to treat illnesses including Asthma, by preventing specific prostaglandins (inflammation chemicals) may have other benefits e.g. stimulating growth of thinning hair in men. While the new medications are a few years off yet, these medications may turn out to be the next chapter of medicines that successfully affect thinning hair. Also discussed where the interesting versions of prostaglandins, some of which actually hindered new hair growth, whereas others stimulated hair growth.

The latest information about hair loss treatment

I have just recently returned from the Asian Association of Hair Restoration Surgery Annual Meeting in Seoul, Korea. It was very well attended with over 250 surgeons attending to find out the latest information about hair loss treatments.

Of particular interest to me were the presentations regarding the influence of the recipient site on the growth rate of transplanted hair. The original research was performed in Korea over 10 years ago and showed the surprising result that, contrary to our earlier belief, the body site where the transplanted hairs are placed influences and changes the growth rate of the hairs.

The relevance of this is that hairs in different regions of the body grow at different rates. Therefore when using scalp hair to reconstruct eyebrows the transplanted hairs initially grow at the scalp hair rate which is three times faster than the eyebrow rate. This means that the transplanted eyebrow hairs have to be trimmed regularly as they grow much longer and faster.

Over time however, the surrounding eyebrow skin somehow influences the transplanted hairs and they slow down considerably to more resemble the growth of normal eyebrow hairs. Even more interestingly, if the transplanted hairs are then removed from the eyebrow and re-transplanted back into the scalp, they then begin to speed up their growth rate again! Amazing stuff.

The other benefit from this research is that it shows that certain body hairs can successfully be used to replace lost hairs in the scalp. Over time these body hairs will more closely resemble natural scalp hairs in appearance and growth rates. Despite this, body hairs should only be used as a last resort when there are no more usable scalp hairs available as donor hairs.

Follicular Unit Extraction (FUE) VS. Strip Harvesting

Many of my patients have been reading about the supposed superiority of Follicular Unit Extraction (FUE) versus Strip Harvesting during hair transplant surgery. Be aware that it is very important to separate the marketing from the actual science. Both techniques involve cutting the skin. There is no such thing as a scarless technique for hair transplants.

Both techniques produce the same sized graft. Both techniques leave scar/s which may, or may not, be visible to the naked eye. The difference being that FUE produces small, circular, dot type scars that may also have a white coloured appearance. Strips produce linear scars that may have hair growing back through them and be very difficult to see with the naked eye. Short haircuts are usually possible with either of the techniques but shaving the entire head will probably show scars with either of the techniques.

Combating Hair Loss for Men & Women with Low Powered Lasers

There has recently been a lot of interest in low powered laser devices and their effectiveness on treating hair loss. Research suggests that it has a mild stimulatory effect on hair follicles. Laser could be an effective secondary (i.e additional) treatment for hair loss in patients who have mild balding or thinning. It also may be effective in seasonal increased hair shedding (i.e a moult).

However, the way the laser is delivered and the amount of laser exposure is critical to the chance of success. A new device called the Lasercap (http://www.lasercap.us) applies 224 laser lights continuously to the scalp area in the comfort of your own home. It uses rechargeable batteries, can be worn under a hat or cap and can be used at your convenience. Suggested dosage schedules are 15-30 minutes every second day.

The major advantage of the Lasercap device, compared to other hand held devices, is that the correct energy level is continuously applied to the scalp area. Other hand held laser devices only apply energy for a very short period of time if they are used to the manufacturer’s instructions. If you would like to know more about this additional treatment for mild hair loss, please contact our Sydney Hair Loss Clinic Ph:1800 685 399.  The Lasercap can also be ordered directly from The Knudsen Clinics.

Short Hair After Hair Transplant Surgery

A common trend for male patients is the desire to wear their hair short after surgery. We have received many inquiries at our Sydney hair loss treatment clinic about whether its possible.  The good news is that this can be achieved. The modern donor technique overlaps the donor area skin edges whilst stitching allows hair to grow back through the donor scar. This is called the trichophytic technique and almost always creates a great result that is almost undetectable, even with a very short number two haircut!

Some patients would like the ability to shave their head after the transplant.  This is slightly unrealistic however, as no matter which technique is used for the hair transplant, all surgery creates scarring to a certain degree. The modern techniques that we currently use minimize the visibility in both the recipient hair area (the thinning/balding area) and the donor hair area. Our website has further information about Hair Transplant Surgery. If you have any questions about this, please feel free to visit our Sydney Hair Loss Clinic or call us on 1800 685 399.

Finasteride and its Side Effects

Hair loss prevention treatment using finasteride: There has been some publicity about persistent sexual side effects from the use of finasteride (e.g. Propecia, Proscar, Finasta, Finnicar) tablets. The reports correctly state that a small number of patients can get sexual side effects. What is most controversial about the reports is a suggestion that the side effects persist for long periods of time after stopping taking the medication.

In my 14 year experience of prescribing the medication, finasteride, I have never had a case of persistent side effects after stopping taking the tablet. Nor have any of my colleagues around the world who prescribe it frequently. Side effects always resolve soon after stopping the tablet and the chance of side effects is dramatically reduced if the medication is prescribed 2-3 times per week instead of every day. This intermittent use of the finasteride is just as effective and removes almost all possibility of a patient having side effects.

Long term use of finasteride is the cornerstone of therapy designed to prevent or dramatically reduce more hair loss. It also greatly reduces the need for future hair transplant surgery/surgeries by stabilizing the loss. Most patients get great benefits from the finasteride medication and I have over 4000 patients in my clinics successfully taking the drug without any side-effects.

Hairloss Medication Treatment

A huge amount of internet and media interest has recently focused on claims of persistent sexual side-effects long after discontinuing the use of Propecia (finasteride) hairloss medication. A study published by Irwig in 2011 suggested the occurence of a high incidence of long-term sexual side effects in some Propecia users. It should however be noted that this study wasn't a study of Propecia users in the general population, but a sample of men who already claimed to have long-term side effects. 

Whilst not wishing to cast doubt on these patient claims, I do find them somewhat surprising. In over 14 years of prescribing Propecia/Proscar, to well over 4000 of my patients, I have no reported cases of permanent sexual side-effects. Those few patients who reported these sexual side-effects recovered fully after stopping taking the medication. In most cases recovery occurred within one month, in a couple of cases it was about 2-3 months until full recovery.
A few of recently published medical studies from Japan and Italy support the previously published lower incidence of side-effects and the long term effectiveness of Propecia. The Japanese study  followed 3177 men for 3 years and the Italian study followed 113 men for 10 years. In both studies, over 80% of patients showed long-term growth and stability on the medication without any significant side-effects.

Another factor, which is largely unknown, is that the frequency of sexual side-effects depends upon the dose used. In my care, I have consistently recommended a dosing of a 1mg tablet three times per week for the last fourteen years. This is because Propecia lasts a lot longer than 1 day in your system. In fact, the enzyme is blocked for up to one month! This means that you can maintain the effectiveness of Propecia without having to use it daily. The other great benefit is that, the frequency of sexual, or other side effects, drops dramatically if you only take the tablet every 2-3 days.

I believe that the frequency of patient sexual side effects in my care is approximately 1 per 200 patients on 3 tablets per week and even less frequent on 2 tablets per week. All my patients have fully recovered after stopping therapy. Some of my patients who could not tolerate 3 tablets per week were able to be re-introduced to 2 tablets per week without any side effects.

With regards to depression whilst on Propecia, I have seen this in only a handful of patients. It occurred quickly after starting the medication and resolved quickly upon stopping the Propecia tablets.
In summary, Propecia remains a very effective and safe treatment for male pattern hair loss. Propecia has demonstrated clear superiority compared to other treatments for hair loss and side effects can be significantly reduced with adjusted or lower doses.