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Hair Restoration Answers

Is Pulsing or Cycling Hair Loss Medication Dosage Effective?

Q: First off thank you for providing this Blog, it is extremely informative and gives people the opportunity to ask questions of one of the most knowledgeable hair transplant surgeons in the world. You are considered the consummate researcher in the field of hair loss, so I ask this question of you. It appears that all the current hair loss drugs, at one point or another, begin to lose their effectiveness. Have you ever entertained the idea of cycling these drugs, or reducing the dosage for a period of time, to prevent the body from becoming acclimated to these drugs and subsequently making adjustments to receptors causing this? This method is commonly used by bodybuilders and others in the sports profession to elicit the maximum effect from the drugs they employ. Though I have not found any studies along these lines, I believe there are valid reasons why this may work. I hope you may be able to share any information on this subject. — Z.Z., Chicago, I.L.

A: Excellent question. I can answer it only indirectly.

It has been our experience that when you discontinue finasteride (Propecia), or decrease the dose to a degree that it no longer works, the patient will begin to shed hair. When the drug is re-started or the dose increased again, the medications will begin working, but the patient now maintains his hair at a lower baseline. He doesn’t seem to regain the amount of hair he has before the medication was stopped. For this reason, we don’t stop and start finasteride. The same argument applies to dutasteride, although we have less experience with this medication. This experience would speak against using pulse therapy for hair loss.

On the other hand, the hair loss medications finasteride and dutasteride do not necessarily need to be used once a day. Although the serum half-life of finasteride is around 6 hours, the tissue half-life is felt to be around two days. Therefore, alternate day dosing with 2 mg of finasteride (or approx. 1/2 of a 5mg tablet) should work just as well as 1mg a day. An average daily dose of less than 1mg, however, does not seem to be as effective. Dutasteride has a half-life of 5 weeks and is found to bind to scalp tissue for many months, so with dutasteride, a dosing of even once a week will most likely be just as effective as once a day.

Note that this regular alternate day dosing is different than pulse dosing. In pulse therapy, the body is given a chance to recover. The principle here is to take advantage of the persistence of the drug in the scalp even after blood levels drop and not to let the scalp recover (which we have found to result in a net loss of hair (as discussed above).

When patients do become acclimated to these drugs (which seem to be common after 3 to 5 years) we increase the daily dose of finasteride gradually up to 5mg and then consider switching to dutasteride 0.5mg a day.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Instead of Hair Transplant, Can You Treat Early Hair Loss with Once a Day Minoxidil?

Q: I have some early thinning in my crown and the doctor said I am too early for a hair transplant. I don’t want to take Propecia, but using Rogaine twice a day is a big nuisance. Can I use Rogaine once a day? — L.B., Cleveland, Ohio

A: The tissue half-life of minoxidil is 22 hours.

This means that 22 hours after it is applied, about 1/2 of the compound is still bound to the skin and exerting some effect. Because of this, once a day dosing is probably OK.

Please note that this is hypothetical and that there have been no controlled studies to confirm this.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Transplant Thicken Thinning Hair in Person with Early Hair Loss?

Q: I am 22 and losing my hair all across the top of my head. How can I thicken my hair to its level a few years previously? — I.L., Kentfield, CA

A: If medication, such as finasteride, is successful it can thicken hair by increasing the diameter of the existing hair shafts. Although the cosmetic benefits can be dramatic in a person with significant hair loss, a hair transplant can not restore hair to its original density, since it only moves the existing hair around and does create new hair.

When hair cloning technology is available, this will change as a person’s donor supply will be increased.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Hair Transplant Treat Diffuse Hair Loss in Women?

Q: My hair loss resembles the grade I female hair loss scale, but none of the male hair loss patterns. It has been relatively stable for the past five years and only recently has it begun to progress further. I began both Propecia and Rogaine two months ago, but the hair loss still continues at the same pace. I’m really worried. Does a hair transplant work in such a diffuse hair loss? — D.D., Park Slope, Brooklyn

A: If your hair loss is diffuse only on top, then a hair transplant will be effective. This condition is called Diffuse Patterned Alopecia or DPA.

If the diffuse pattern of hair loss affects the back and sides as well, then surgical hair restoration should be avoided. In this case (called Diffuse Unpatterned Alopecia or DUPA) the donor area is not permanent and the transplanted hair will continue to thin over time.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Restoration Series in NY Japion Features Dr. Bernstein

NY Japion - Dr. Robert M. Bernstein

NY Japion — a weekly newspaper in the Japanese language, published in the New York tri-state area, and distributed for free in the Japanese community — has featured Robert M. Bernstein, MD, in their series on hair loss in men and women. In the series, TV producer, Hideo Nakamura, who is bald himself, goes on a mission on behalf of fellow bald men. His column hopes to help others with hair loss to have a more fulfilled, fun life and to raise their self-esteem.

Nakamura interviewed Dr. Bernstein for this weekly series that began in October 2006. In issues No. 1 and 2, Dr. Bernstein explained the basic mechanism of balding for both men and women which are quite different in its causes, balding types, and progression of hair loss. The NY Japion’s readers were all very surprised by the fact that balding for men is actually related to genes on both the mother’s side as well as the father’s side of the family. Dr. Bernstein also shared his unique theory of why Japan’s Samurai had the uniformed bald look.

The column discussed post-op care after hair restoration surgery and explained the drug Propecia, a men’s oral hair growth treatment, minoxidil and some cosmetic hair products.

Reporter Nakamura was also examined by Dr. Bernstein and with the patient’s permission was allowed to observe a hair transplant surgery. Issues No. 3, 4, 5 are about the surgical hair restoration procedure known as Follicular Unit Hair Transplantation (FUT), a method that Dr. Bernstein helped to pioneer. By using the patient’s own hair, FUT can give totally natural looking results. The patient’s own hair starts growing where there was no hair before.

You can download a PDF version of the original series (in Japanese) at the link below:


Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Do You Treat Diffuse Hair Loss in Donor Area?

Q: I underwent hair transplant surgery several years ago and was pleased with the results. However, over the last 2-3 years I’ve lost hair in the donor area with subsequent loss of hair in the transplanted area. Is this type of hair loss especially difficult to treat? What accounts for hair loss from the back of the head that is typically considered “permanent”? — F.D., Laude, Missouri

A: Less than 5% of patients have unstable donor areas, i.e. where the back and sides thin along with the front and top. We call this condition Diffuse Unpatterned Alopecia or DUPA. It is best to identify this condition before hair transplant surgery is contemplated as people with DUPA are not good candidates for hair transplantation. The diagnosis is made using densitometry by noting high degrees of miniaturized hair in the donor area.

At this point, I would use medications such as finasteride. I would not do further hair restoration surgery.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Why is Propecia Not Stopping My Hair Loss?

Q: I have been on Propecia for a year and my hair loss has not stopped or slowed down. How much longer should I give the drug? Can Propecia speed up hair loss in some patients? — N.V., East Hills, N.Y.

A: If you have not responded to Propecia in one year, it is unlikely that you will.

Finasteride may cause shedding in the first 6 months of treatment, but should not accelerate hair loss long-term. It is most likely that you have progression of your hair loss.

In addition, be sure that you have a correct diagnosis i.e. that you actually have androgenetic alopecia.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Avodart Hair Loss Medication Safe for Male with Early Hair Loss?

Q: My query is prompted by your answer to another query “Is Avodart Safe?” My son, who is in his mid-20s, has been taking Dutasteride for hair loss for about two years now. He had tried Finasteride earlier but without much benefit. Medical supervision regarding Dutasteride is not available in Australia as the drug has not been released here yet. — N.V., Melbourne, Australia

I am concerned by your remarks that there is no biologic model to show the long-term safety of Dutasteride (as opposed to Finasteride). Would you suggest that he goes back to taking Finasteride? We would be grateful for your advice.

A: It is a tough call as I have never met or examined your son, so I can only offer an opinion based on limited information. If you feel your son will be emotionally or socially debilitated by the hair loss, then I think that it may be worth the risk (if there is any) of taking the medication; otherwise, I would use Finasteride.

Please keep in mind that you don’t need to make the final decision now. You may want to defer the decision until he is 28 or so, at time when he is more mature. It is a tough call. Please let me know what you decide.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Finpecia a Viable Hair Loss Medication?

Q: A friend of mine is taking Finpecia, is this the same as Propecia?

A: Both Propecia and Finpecia contain the active ingredient Finasteride 1mg. Finpecia is manufactured in India by the company Cipla. It comes in packets of 10. Finpecia contains the same chemical ingredient as Propecia, i.e. 1mg of Finasteride, but it is manufactured differently and it is less expensive. — A.B., St. Louis, Missouri

Indian patent law allows companies in India to make medications that are patented by drug companies in other countries, since Indian law protects only the processes by which drugs are made and not medication itself. Therefore, if an Indian company finds another way to make a drug, it can legally do so.

Cipla has not published any studies showing that their generic Finasteride is identical or as effective as Merck’s original product in treating hair loss. These alternative processes and drugs are not regulated by the FDA, so there is no assurance that the medication manufactured in India has the same biologic activity or potency as the FDA approved counterpart made in the United States.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Hair Loss Treatment with Avodart Safe?

Q: My friend is taking Avodart, he bought it over the internet. Is it safe to take? — T.G., Denver, Colorado

A: Avodart (dutasteride 0.5mg) was approved by the FDA for the treatment of prostate enlargement in men in 2002. Avodart has not been approved for the treatment of androgenetic hair loss, although physicians can use an approved medication in ways other than for which it was specifically approved. That said, the use of dutasteride certainly requires a doctor’s supervision.

Like finasteride (the active ingredient in Proscar and Propecia), dutasteride blocks the enzyme 5-alpha reductase that converts testosterone to DHT (DHT is a key hormone that causes hair loss). However, unlike finasteride, which only inhibits the Type I form of the enzyme, dutasteride inhibits both the Type I and Type II forms. This combined effect lowers circulating DHT more with dutasteride than with finasteride, but also increases the incidence of its side effects.

The Type II form of the enzyme (blocked by finasteride) is found predominantly in the hair follicle. The Type I form of the enzyme has been found in the scalp and sebaceous glands, and many other parts of the body, but its exact role in hair growth has not been determined. It is felt that dutasteride’s ability to dramatically lower serum levels of DHT is what makes it a more potent medication in hair loss.

When considering the safety of dutasteride, one should consider the following:

  • It acts on other parts of the body besides the hair follicle.
  • Unlike finasteride, where families that had a deficiency of the Type II 5-alpha reductase enzyme were followed for years without any adverse effects, there is no natural biologic model to show the safety of dutasteride.
  • Dutasteride has been approved for prostate enlargement in an older male population. It is not approved for hair loss and, in fact, the clinical trials for hair loss were discontinued, so there is no safety data for its use in younger patients. There is a greater incidence of sexual side effects with dutasteride compared to finasteride.
  • The 1/2 life of dutasteride is 5 weeks compared to 6-8 hours for finasteride. Serum concentrations of dutasteride are detectable up to 4-6 months after discontinuation of treatment.
Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Was Propecia Originally for Treatment of Prostate Enlargement?

Q: I heard that Propecia was being used originally for shrinking the prostate, is this true? — M.D., New Hyde Park, N.Y.

A: Propecia (finasteride 1mg) is not a prostate medication that was serendipitously noted to have a side effect of re-growing hair, it is a medication that was known all along that it might be able to slow hair loss and/or to grow hair.

Although finasteride was first approved for the treatment of prostate enlargement, the researchers at Merck knew, at the outset, that there were families whose members were deficient in the 5-alpha reductase Type II enzyme and that the men in these families neither developed prostate disease nor went bald. In addition they had no long-term problems from the lack of this enzyme.

Merck used this natural model to develop a medication that could block the 5-alpha reductase Type II enzyme – the result was finasteride. Because the only approved treatment for symptoms related to prostate enlargement at the time was surgery, Merck developed finasteride as a medical treatment for this condition prior to developing finasteride as a potential treatment for men with male pattern hair loss.

This also meant that Merck would understand the safety profile of finasteride, and have it approved for a medical disease (symptomatic prostate enlargement), before developing it for a cosmetic condition.

The drug was first submitted to the FDA for the treatment of prostate enlargement as Proscar (finasteride 5mg) in 1991 and it was approved for this use in 1992. The drug was submitted for the treatment of men with male pattern hair loss as Propecia (finasteride 1mg) in 1996 and was approved for this use in 1997.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Treat Hair Loss Using Rogaine and Propecia Together?

Q Do Rogaine and Propecia work synergistically? — N.W., Chappaqua, N.Y.

A: They are synergistic, since the mechanisms of action are different.

Rogaine directly stimulates hair growth, while Propecia is permissive for hair growth by blocking DHT, the byproduct of testosterone that causes hair to miniaturize and eventually disappear.

The important thing to remember, however, is that for most people, Propecia is far more effective.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can Women Use Propecia to Treat Hair Loss and Does Their Age Matter?

Q: I have early thinning on the top of my scalp and I was told to use Propecia, but I heard that is was only for men. What do you think? — T.G., Staten Island, NY

A: Women can’t take Propecia during the child-bearing years because, if ingested, it can cause birth defects in male offspring.

In post-menopausal women, where we see the greatest frequency of hair loss, it doesn’t seem to be effective.

In pre-menopausal women who do not plan to become pregnant or who already have children, we are still cautious about using the medication, since there effectiveness has not been proven and its long-term safety in this population has not been tested.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does Hair Transplant Prevent Hair Loss?

Q: How does a hair transplant prevent hair loss? — M.M., White Plains, N.Y.

A: It doesn’t. Surgical hair restoration does just what it says. It restores hair to an area where the hair has been lost (by borrowing it from an area of greater density that is less important cosmetically, such as the back of the scalp).

To prevent, or slow down, further balding one would need to receive treatment with hair loss medication such as finasteride (Propecia).

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What Causes Common Hair Loss or Baldness?

Q: I know that I am going to be bald because my father is bald and I am losing my hair just like him. What actually causes this kind of hair loss? — J.P., Paradise Valley, Arizona

A: Although there are many different causes, the overwhelming number of people that have hair loss have what is referred to as “patterned hair loss” or “androgenetic alopecia.”

In men, it is due to a hormone called DHT, which is a by-product of testosterone produced by the action of the enzyme 5-alpha reductase. This enzyme is inhibited by the hair loss medication Propecia. See the causes of hair loss in men page on the Bernstein Medical – Center for Hair Restoration website for more information.

In women, the mechanism is a little bit more complex as another enzyme, aromatase, is involved in the metabolic pathway. See the causes of hair loss in women page on the Bernstein Medical – Center for Hair Restoration website for more information.

We know that the inheritance comes from both the mother’s and father’s side, although the actual genes causing hair loss in men and women have not yet been identified. Statistically, the inheritance from the maternal side appears to be a bit stronger, but the reason for this is unknown.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

When Will Propecia be Available in Generic Form?

Q: I heard that Proscar, the 5mg version of finasteride, is now generic. Is that correct and is Propecia going generic as well? — F.J., Red Hook, Brooklyn, NYC

A: Yes, Finasteride 5mg (Proscar) is now available in a generic formulation. It is my understanding that Finasteride 1mg (Propecia) will not be available generically until the year 2012.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Switch from Propecia to Generic Proscar?

Q: I am currently taking Propecia 1mg a day for hair loss and heard that Proscar 5mg now comes in a generic form. If I get that, how should I take it? — G.A., Fort Lauderdale, FL

A: If you are currently taking Propecia 1mg a day, and want to switch to Proscar (Finasteride 5mg), you can either take Proscar 5mg, 1/4 pill every day or 1/2 pill every other day.

If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets. You can purchase a pill cutter in any pharmacy.

You should be aware that this dosing is not recommended by Merck and that there are no studies showing that either breaking up the pills or taking alternate day dosing is as effective as taking Propecia (Finasteride 1mg) a day.

That said, finasteride lasts in tissues for several days, so these alternate day dosing schedules seem reasonable.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Success of Hair Transplant Affected by Age or Scalp Fibrosis?

Q: It is my understanding that as a person loses his or her hair, the skin of the scalp undergoes a number of changes, namely there is a loss of fat, an increase in cellular atrophy, and of course the dreaded perifollicular fibrosis (now that’s a mouthful). It seems to me that these changes, in particular the fibrotic scarring, are the main obstacles in the way of regrowth, and the reason Propecia does not work for extensively bald men. What can be done about this demon we call fibrosis? Can it be slowed, stopped, prevented, reversed? If we could somehow counteract collagen formation, wouldn’t our baldness problems be solved for good? If a bald scalp is atrophic, how does it have the capacity to hold a whole new head of transplanted hair? Is there a limitation to the number of hairs we can transplant (outside of donor limitations)? — R.L., Rivington, C.T.

A: The findings that you are describing are well documented; however, it is not clear if these changes are the cause of the hair loss or are the result of having lost one’s hair. Most likely, the DHT causes the hair follicles to miniaturize and eventually disappear. This, in turn, causes the scalp to thin and lose its abundant blood supply (whose purpose is to nourish the follicles). The changes in the scalp are also affected by normal aging, which causes alterations in connective tissue including the breakdown of collagen and other components of the skin. The changes seen with aging are greatly accelerated by chronic sun exposure.

Fortunately, even with long-standing baldness there is still enough blood supply to support a hair transplant, although there are some limitations. One should perform a hair transplant with a lower density of grafts when patients have thin, bald fibrotic scalps since the blood supply is diminished.

The most important factor, however, is photo change. The sun dramatically alters the connective tissue making the grafts less secure in their sites and alters the vasculature, (blood vessels) decreasing tissue perfusion (blood flow to the tissues). When there is bald atrophic, sun damaged scalp, I generally perform two hair transplant sessions of lower density (in place of one) spaced at least a year apart to give time for the scalp to heal and blood flow to increase in the area.

I often have the patient treated with topical 5-flurouracil before the surgery to improve the quality of the skin and to treat or prevent pre-cancerous growths from the sun.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Is Propecia Necessary for Hair Transplant?

Q: I am 35 years old and have been using Propecia for the last 3 years, waiting to save enough money for a hair transplant. I no longer feel comfortable using it due to side effects. Can hair transplantation still be effective even without continuing to take this drug afterwards? — Y.C., Matinecock, New York

A: Many people choose not to take Propecia or choose not to take it due to side effects and the surgical hair restoration is just as effective. The only difference is that medications can prevent further hair loss whereas surgery cannot.

Medications are not needed for the hair transplant to be successful or the transplanted hair to grow and be permanent.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Do Propecia and Rogaine Act Synergistically?

Q: I have read on numerous websites that Propecia and Minoxidil work synergistically, and that a hair loss sufferer will see better results using them together than either one alone. Do you believe this is the case, or do you think Propecia is enough treatment by itself for someone who just began to experience slight hair thinning and is too early for hair transplantation? — K.V., Hewlett Bay Park, New York

A: They may act synergistically since their mechanisms of action are different.

Rogaine (Minoxidil) stimulates the hair follicle directly, but Propecia (Finasteride 1 mg) permits hair growth by blocking the negative effects of DHT. Of the two, Propecia is far more effective. It is reasonable to use the two together as long as the medications are used regularly.

For patients contemplating surgical hair restoration, we generally have them continue Propecia only, since applying Minoxidil is too fussy and offers only incremental benefit.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Should I Increase Dose of Propecia if Hair Loss Continues During Treatment?

Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon

A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.

I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.

For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).

If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Before Hair Transplant, How Long Should I Use Propecia?

Q: I am 28 years old and was told that I have early Norwood Class 3 hair loss. I want to have a hair transplant but my doctor told me to use Propecia for 6 months and then come back to discuss surgery. I don’t want to wait that long, what should I do? — L.B., Oyster Bay Cove, NY

A: Actually, you should wait a full year. If you are an Early Norwood Class 3, the Propecia can work so well (in actually growing hair back) that you may not even need a hair transplant. The important point is that Propecia only starts working at 3-6 months and during this time there may actually be some shedding as the new growing hair literally pushes out the old.

A hair transplant performed at 6 months may not only be unnecessary, but growth from the medication may be attributed to the hair restoration surgery. I suggest to wait and see what the medication can do before going for hair restoration surgery.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Authors ‘Hair Transplant Blog’

Hair Transplant Blog - Bernstein Medical - Center for Hair RestorationDr. Bernstein’s Hair Transplant Blog is a new medical web log (aka “blog”) that is helping the online community handle the challenges of going bald.

Selected as one of New York Magazine’s “Best Doctors” for the ninth year in a row, Dr. Bernstein answers questions at the following website URL:

bernstm.devgmi.com/hairtransplantblog/

His replies cover over 30 categories ranging from commonly asked questions on “male pattern hair loss” and “when to have a hair transplant” to more scientific issues on specific surgical techniques.

The Hair Transplant Blog serves as a clearinghouse for important concerns of both men and women suffering from hair loss. “I consult with many patients each week in our New York and New Jersey facilities who are so distraught about the state of their hair loss that some can barely function. There is so much information available about baldness and its treatment on the internet that it is difficult to tell exactly what is true. I spend a lot of time just clarifying false, or partially correct, ideas. This misinformation just serves to exacerbate the problem.” Dr. Bernstein says “This Blog is an outgrowth of these consultations. In the Blog, I post answers to the questions that patients bring to my office or submit via our web site.”

Question are answered by Dr. Bernstein in a concise, but easy to understand way. He covers a wide variety of subjects; including new hair replacement techniques, hair transplant repair, medical therapies and interesting diagnostic problems.

The expert medical perspective in the Blog has received the attention of editors for many popular blog directories such as GetBlogs, and Answers.com. Being a featured blog has allowed people from around the world to have a better understanding of hair loss and the process of surgical hair restoration.

Dr. Bernstein has been recognized worldwide for his pioneering work in surgical hair transplantation. His landmark publications on Follicular Unit Hair Transplants, which give results that mimic nature, and Follicular Unit Extraction, a non-invasive hair replacement technique, have earned him international recognition and make him one of the foremost authorities on hair restoration in the world. Known to audiences from his appearances on NBC’s Today Show with Matt Lauer, CBS’s The Early Show, ABC’s Good Morning America, NPR’s The People’s Pharmacy, The Discovery Channel and other nationally syndicated programs, Dr. Bernstein has been providing answers and solutions for hair loss from his Manhattan facility for over 20 years.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Buy Propecia at a Discount?

Q: I am considering taking Propecia, but it I went to my local pharmacy in New York City and it is so expensive. Is there a way I can get it cheaper? — A.S.A., Midtown, Manhattan, NYC

A: The website sells Propecia online at a reasonable price. A doctor’s prescription is required.

Read about

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Can I Vary Dosage of Propecia in Treatment of Hair Loss?

Q: I am not yet ready for a hair transplant but am considering Propecia. What is your opinion on the “optimal dose”? I know Merck recommends 1 mg, but could I get away with taking less? Or would I get a better result by taking more (2-3 mgs)? — V.B, Darien, CT

A: You may get away with 0.5 mg a day. However, there are published data by Roberts et. Al. in the JAAD in 1999 showing a dose-response between 0.2 and 1 mg/day, with the lower dose showing reduced efficacy, from controlled clinical trials.

There is little evidence that a higher dose helps, but I often double the dose if a patient has been on 1mg a day for 3-5 years and then stops responding. The hope is that this can postpone the need for surgical hair restoration, but there is no scientific data to support that it will.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Should I Take Propecia After a Hair Transplant?

Q: I have heard that you should take Propecia for 6 to 12 months following a hair transplant. Is this correct? — P.E., Dallas, TX

A: I would only use Propecia if you plan to continue the medication long-term. That said, Propecia — the brand name of the hair loss drug finasteride — is very helpful in preventing further hair loss. I do recommend that patients who have hair loss stay on the medicine for an extended period, regardless of whether or not they decide to have a hair transplant procedure.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

What is "Shock Fall Out" After a Hair Transplant?

Q: What is “shock fall out”? – D.B., Chappaqua, N.Y.

A: Shedding after a hair transplant is also referred to by the very ominous sounding term “shock fall out.” The correct medical term is “effluvium” which literally means shedding. It is usually the miniaturized hair (i.e. the hair that is at the end of its lifespan due to genetic balding) that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow.

Interestingly, if transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern.

Typically, when shedding occurs, a patient looks a little thinner during the several month period following the transplant, before the transplanted hair has started to grow. The thinning is often more noticeable to the patient than to others. Shedding is generally noted as a thinning, rather than of “masses of hair falling out,” as the term “shock fall out” erroneously suggests.

In general, the more miniaturization one has and the more rapid the hair loss, the more likely shedding will be from the hair restoration surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk. In either situation, since miniaturized hair is eventually going to be lost, the effluvium has no long-term effect on the outcome of the procedure.

It is important to differentiate the phenomena described above from shedding of the hair in the graft. This shedding is an almost universal characteristic of a hair transplant and occurs because during a hair transplant a graft is temporarily stripped of its blood supply. As a response to this insult, the graft sheds its hair. This shedding is generally noted beginning a week following the procedure and can continue for up to six weeks. A very small percentage of patients do not shed and the transplanted hair continues to grow. In others, the transplanted hair remains on the scalp for months until a new hair pushes it out. Whether a patient sheds or not has no bearing on the outcome of the hair restoration.

There are a number of ways to minimize the effects of post-operative shedding: the first is using medication, the second is timing the transplant properly, and the third is performing a procedure using a sufficient number of grafts.

• Medication

Finasteride 1mg reverses or halts the miniaturization process in many individuals and is thus the logical way to decrease the risk of shedding following a transplant. Although many physicians have had the clinical impression that this assumption is correct, there has been no controlled studies to date that prove this.

• Timing and the size of the transplant

It is important to wait until a patient is ready to have a transplant, and then to perform one of sufficient size so that if there is some shedding, the procedure will more than compensate for it – and thus be worthwhile. A problem that patients often run into is that they present to their doctor with early hair loss but with a significant amount of miniaturization. The doctor performs a small procedure and it does not even compensate either for potential shedding or for progression of the hair loss. The result is that the patient is thinner (or more bald) than he was before the procedure. The doctor rarely blames the problem on the fact that the procedure was too small or that the miniaturization was not taken into account, but only that the patient continued to bald. The better solution is to treat early hair loss with medication, but once you make a decision to begin surgery, have a procedure large enough to make a significant cosmetic improvement.

• Performing the procedure using a sufficient number of grafts

As a final point, it is a fallacy that some doctors’ techniques are so impeccable that they can avoid effluvium or those “small” procedures will avoid shedding. Of course, bad techniques and rough handling will maximize effluvium, but effluvium is what hair naturally does when the scalp is stressed and it is stressed during a transplant from the anesthetic mixture and the recipient site creation. It is important to note that it cannot be totally prevented. Despite claims to the contrary, Follicular Unit Extraction has no bearing on this process as it is a harvesting rather than a placing technique.

In sum, the best way to deal with effluvium is:

  • Treat with Finasteride — the active chemical in the hair loss drug Propecia — when hair loss is early
  • Perform a hair transplant only when indicated
  • Perform a hair transplant with skill and using a sufficient number of grafts
Posted by Robert M. Bernstein M.D.
Hair Restoration Research

The Effect of Propecia (Finasteride 1mg) on Hair Transplants

Leavitt M, Perez-Meza D, Rao N, Barusco M, Kaufman K, Ziering C. Effects of Finasteride (1mg) on Hair Transplant. Dermatol Surg 2005; 31: 1268-1276.

SUMMARY

The progressive decrease in hair shaft diameter that causes thinning (also called miniaturization) characteristic of male pattern baldness, can be decreased by the use of the DHT blocker Propecia (chemical name finasteride). Most men undergoing hair restoration surgery have some existing hair in the area that is to be transplanted that will thin over time and, in fact, may thin a bit more quickly as a result of the surgery. For men undergoing surgical hair restoration, the thinning of the surrounding hair can diminish the overall impact of the hair transplant. Even though Propecia has no effect on the transplanted hair, it can help to maintain the patient’s surrounding hair and is, therefore, useful as an adjunct to hair transplant surgery, to enable the patient to obtain a better overall result.

The present study looks to see if Propecia given from one month before surgical hair restoration until eleven months after, can increase hair growth in the area surrounding the hair transplant. In the study, consisting of almost eighty men divided into two groups in a double-blind fashion were either given Propecia or a placebo. Growth was recorded by hair counts and by photos.

The study showed that Propecia was substantially better than the control group in increasing hair counts and in increasing visible fullness when patients started Propecia a month before their hair transplant and were on the medication for one year.

Comments by Dr. Bernstein: The present study confirms scientifically what has already been widely observed, that treatment with finasteride is an important adjunct to hair restoration surgery, for those with androgenetic hair loss. The authors appropriately state their conclusion based upon the parameters studied. As a result, the paper does not stress enough the importance of continuing Propecia for an extended period of time after the hair transplant. At the conclusion of the paper, the authors state that Propecia, taken for a year (i.e. one month before and eleven months after surgery) will increase the density of the surrounding hair. Some may interpret this as indicating that one only needs to take Propecia for a year in order for it to be a useful complement to hair transplant surgery. Of course, this is not the case, as one must continue to use Propecia for it to be beneficial.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Does Hair Grow More Slowly After a Second or After a First Hair Transplant?

Q: This is my second hair transplant and is seems like it is growing more slowly than my first. Is this normal? – J.D., Port Washington, N.Y.

A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss.

Propecia may be helpful in this regard. It is important to wait at least a year for the transplant to grow in fully and to give a chance for any hair that was shed to regrow.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Hair Transplant for Thinning Hair on a Crown?

Q: Should you perform a hair transplant on a crown that is just starting to thin? — R.R. Philadelphia, Pennsylvania

A: A “thin” crown should first be treated with Propecia, as it may thicken the hair to a cosmetically acceptable degree without the need for surgery. If Propecia is ineffective in restoring enough hair, then surgical hair restoration can be considered.

The surgeon must also factor whether or not the patient has enough donor reserves to transplant the front and top part of the scalp if the patient becomes very bald. This is hard to predict in patients who are still in their twenties.

See the paper Follicular Transplantation: Patient Evaluation and Surgical Planning for a more complete discussion.

Posted by Robert M. Bernstein M.D.
Hair Restoration Research

5 alpha-Reductase Inhibition in Hair Growth

Edwin S. Epstein, M.D.
Stuart Medical Group, Richmond, VA, USA.

SUMMARY of Dr. Epstein’s Abstract from his presentation at the International Society of Hair Restoration Surgery, 2005 – Sydney, Australia

Dihydrotestosterone (DHT) is known to be the more potent androgen in both Benign Prostatic Hyperplasia (BPH) and in Androgenetic Alopecia (AGA). Testosterone is converted to DHT by the enzyme 5-α reductase in several organs including the prostate, hair follicles, skin, liver and sebaceous glands. 5-α reductase exists in two isoforms: type 1 and type 2. Type 2 is the predominant enzyme in prostate and hair follicles. Finasteride, approved in 1992, inhibits the type 2 isoenzyme and is available in two doses: 1mg dose for AGA, and 5mg for BPH. Dutasteride, approved in January 2003 to treat BPH, is a dual inhibitor of both isoenzymes.

In current the study, men ages 21-45 received dutasteride (0.01mg, 0.1mg, 0.5mg, 2.5mg), finasteride 5mg, or placebo.

Results showed the following:

• Dutasteride seemed to have an earlier onset of effect than Finasteride
• Dutasteride 2.5mg appeared to be significantly more effective than Dutasteride 0.5mg.
• The effects of Dutasteride 0.5mg were comparable to Finasteride 5mg.

The side effect profile was difficult to interpret. All of the data is presented in such limited terms that make any interpretation difficult.

Dutasteride appears to work faster than finasteride in the treatment of androgenetic alopecia and clearly is more effective in lowering DHT levels. Because there is no human model for combined type I and II 5-α reductase inhibition (as there is with type II) long-term usage should be viewed cautiously.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

How Do You Recommend Treating Early Hair Loss?

Q: I am 27 years old and have a Class 3 degree of hair loss. Should I do a hair transplant or consider non-surgical methods of hair restoration? — Y.B., Lake Forest Illinois

A: At age 27 with early hair loss, you should consider non-surgical options first.

Propecia is the most important medication, but you need to be on it for one year at the full dose of 1mg a day to assess its benefits.

If you have done this and other parameters are OK for a hair transplant, such as adequate donor hair density and scalp laxity and you have little evidence that you will become extensively bald (i.e. no donor miniaturization and no family history of extensive baldness), then hair transplantation can be considered.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Should I Consider Hair Transplant if I Have Early Hair Loss in Crown and Donor Area?

Q: I’m currently 24 years old. Ever since turning 20, my hair on top began to thin little by little. I have noticeable thinning on the top part of my scalp and on my crown, but have no recession at the temples. My hairline looks amazingly young and hair on the donor areas seems quite thick. Am I in the early stages of male patterned baldness? I cannot place myself in the Norwood scale since my thinning doesn’t seem to follow the classic pattern. I just started on Propecia. Should I be considering a hair transplant? — B.R., Landover, MD

A: From the description, it sounds like you have typical Diffuse Patterned Hair Loss or Diffuse Patterned Alopecia (DPA). In this condition, the top of the scalp thins evenly, the donor area remains stable, and the hairline is preserved for a considerable period of time. Please see: Classification of Hair Loss in Men for more information.

Propecia would be the best treatment at the outset. When the hair loss becomes more significant, patients with DPA are generally good candidates for surgical hair restoration. It is important, however, that your donor area is checked for miniaturization to be sure that it is stable before a hair transplant is considered.

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

Will Increased Propecia Dosage Improve Hair Growth?

Q: I have been taking Propecia for three months. Would it help to up my dose? — F.J., Red Hook, Brooklyn, NYC

A: For most people (of average body weight of approximately 150 pounds) 1 mg is the ideal dose of finasteride (Propecia).

This is a statistical statement, however. There are some people who fall outside the bell curve. As we don’t know who these people are, we occasionally increase the dose on non-responders after 1-2 years, particularly for those who weigh significantly more than 150 pounds.

Remember, an increased dose also results in an increased risk of side effects and most people experience no additional benefit. There have been no scientific studies to support this regimen.

Read more answers to questions on Propecia Dosage

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

When Can I Judge the Effectiveness of Treatment with Propecia?

Q: I was wondering why you chose two years as the amount of time one should wait to judge the effectiveness of Propecia. Have you had patients who only saw results after that long? Why does Merck say 3-6 months and Dr. Rassman at New Hair say 6-8 months? I know these numbers aren’t arbitrary, but I’m just wondering what the logic is behind this and how does this relate to planning a hair transplant? — I.P., Hempstead, Long Island, NY

A: The Merck data showed that over 90% of patients had peak response at 1 year and this has been my experience as well.

Most patients show the most dramatic response between 6 to 12 months with some getting additional benefit up to two years. Prior to 6 months, the results are quite variable and there may even be a net loss due to shedding during this period, as the Propecia (finasteride) stimulates a new anagen cycle.

If one is planning to go on Propecia before a hair transplant to minimize any shedding from the surgery and to prevent future hair loss, one should start the medication at least one month prior to the procedure.

If one wants to use Propecia for the purpose of possibly avoiding hair restoration surgery, then one needs to wait at least a year to see if there will be enough regrowth.

Finally, if one is younger (i.e. in the 23-25 age range) one should be on Propecia for at least two years to give it every possible chance of working and see its maximum benefit before considering a hair transplant.

Read more about taking Propecia before a hair transplant
Read more about Propecia (finasteride)

Posted by Robert M. Bernstein M.D.
Hair Restoration Answers

In Early Hair Loss, Can Scalp Tingling and Hair Thinning be Related?

Q: I am twenty and think that I am starting to thin. I am also experiencing a slight tingling in my scalp. Are these related? — T.N., Philadelphia, PA

A: Most likely. Early androgenetic alopecia can be associated with a slight tingling or slight tenderness of the scalp.

You should see a dermatologist for evaluation and, if you have early male pattern baldness, consider starting finasteride (Propecia).

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Hair Loss in Women the Topic in Dr. Bernstein ‘Early Show’ Interview

The highly-rated CBS television program “The Early Show” interviewed Dr. Bernstein as part of a three-part series on hair loss in women. View a clip of the video here:

Watch the video at YouTube or go to the Bernstein Medical YouTube Channel to see more videos on hair loss in women and other hair restoration topics.

Read the full transcript here:

Julie Chen: There are many treatments available for serious hair loss including surgical options like hair transplants. That may sound scary, but for one woman, it was the answer she’d been waiting for.

Narrator: Marian Malloy is used to being in control. As the duty manager for an international terminal at Newark Airport, it’s her job. But Marian wasn’t always so self-confident. Due to a condition called alopecia areata, Marian began losing her hair back in college.

Marian Malloy: I was on my own for the very first time and I was learning about life and learning about my hair loss. And it just devastated me. So I started out picking out methods to improve my hairline. Initially, I went to a dermatologists who put me on a prescription of injections, actually. I would go over weekly and he injected my head, and I got results, but I also started growing facial hair, which wasn’t something that I wanted. After that, I decided to start with the Rogaine and once again I saw results, but Rogaine was something that I had to do every day for the rest of my life, and I just didn’t want to be that dependent on a medication.

Narrator: Marian continued to search for an acceptable treatment to her condition, even trying hair plugs, until she heard about Dr. Robert Bernstein’s new method of Follicular Unit Transplantation, or in layman’s terms, a hair transplant.

Marian Malloy: I wasn’t scared at all. I was desperate, so that overrode everything.

Julie Chen: Marian Malloy is here along with her hair transplant surgeon, Dr. Robert Bernstein, to help us look at some of the medical options that are available to women suffering from this affliction.

Good morning to both of you.

Dr. Bernstein: Good morning.

Marian Malloy: Good morning.

Julie Chen: Marian, thank you for speaking out about this very private problem. How has your life changed since getting the hair transplant?

Marian Malloy: Well, I just feel better about my appearance, and appearance is very important to me in my line of work. I just feel a lot better and I think I look better. My hairline looks better.

Julie Chen: Boost in the self-confidence department?

Marian Malloy: Actually, yes.

Julie Chen: And your friends and family see a difference in it?

Marian Malloy: You know, my friends and family really didn’t notice a difference before, and they thought I was crazy for harping on it the way that I did.

Julie Chen: But if you see it, that’s all that —

Marian Malloy: And it was all about me. It’s not about my family and friends. It’s about how I feel.

Julie Chen: Right.

Marian Malloy: Yes.

Julie Chen: Dr. Bernstein, I want to go through all the options that are available for women, but what is the difference between female and male hair loss option-wise. What can we do to treat it?

Dr. Bernstein: The main difference medically is that women have hair loss often from hormonal changes and it’s due to an imbalance between progesterones and estrogens. That equilibrium can be reestablished with medication. Often birth control pills can do that.

Julie Chen: So that’s one option.

Dr. Bernstein: One option. For the most common cause of hair loss, genetic hair loss, Minoxidil can be used for both men and women, but the most effective medication for men, Propecia, can’t be used in women. And the reason –

Julie Chen: Why not?

Dr. Bernstein: The reason is that it causes birth defects if taken during pregnancy and postmenopausally it doesn’t seem to work.

Julie Chen: Oh, okay. So talk to me about Minoxidil, also known as Rogaine .Just as successful for women as in men?

Dr. Bernstein: It seems to be similarly successful, but the success rate is not very good, and one of the problems with its use in women is that you can get hair at the hairline on the forehead. So the usefulness is a little bit limited.

Julie Chen: So is it promoting hair growth if it does work, the Rogaine, or is it just making your existing hair grow in thicker? I’ve heard both.

Dr. Bernstein: It actually stimulates the growth of existing hair.

Julie Chen: Okay so you got to be really careful topically what you touch after you’re rubbing it into your scalp.

Dr. Bernstein: Yes.

Julie Chen: Another option is topical Cortisone and Cortisone injection.

Dr. Bernstein: Yes many people think that Cortisone can be used for genetic hair loss or common hair loss and it really can’t. It’s a good treatment for specific types of diseases, the most common one is alopecia areata. In that condition, the body actually fights off its own hair follicles. And then the Cortisone is used to suppress the immune system and actually allows the body to permit the hair to grow back.

Julie Chen: Now, Marian tried these options that we’re talking about. You weren’t satisfied, so you had a hair transplant.

Marian Malloy: Yes.

Julie Chen: Describe exactly what you did for Marian.

Dr. Bernstein: In the past, hair transplantation was not a good option for women because hair was transplanted in little clumps. With Follicular Unit Transplantation, we can now transplant hair exactly the way it grows, which is in little tiny bundles of one to four hairs. With Marian we took a strip from the back of her head, in other words, right from the back of the scalp where you can’t see it.

Julie Chen: Where there’s more hair?

Dr. Bernstein: Yes, we remove that strip and place it under a microscope and dissect out the individual follicular units – the hair is transplanted exactly the way it grows in nature. And that hair is then put in needle-poke incisions all along the hairline, and because the grafts are so small, you can actually mimic the swirls and the change in hair direction exactly the way the hair grows naturally.

Julie Chen: And it stays?

Dr. Bernstein: Yes, it stays. We make a very snug fit between the graft and the needle-poke incision. And so it really holds on to the grafts well. In fact, the patients can shower the next morning.

Julie Chen: The next morning? Marian, what was your experience like having this hair transplant? No problems since?

Marian Malloy: No problems, absolutely no problems.

Julie Chen: Did insurance cover any of this?

Marian Malloy: No, absolutely not.

Julie Chen: How costly is this?

Dr. Bernstein: The average procedure is about $7,000.

Julie Chen: And it’s one procedure and you’re done?

Dr. Bernstein: Usually one to two procedures.

Julie Chen: $7,000 a pop. Well, you found it was worth your money, is that right, Marian?

Marian Malloy: Absolutely, yes.

Julie Chen: Dr. Bernstein, Marian Malloy, thank you both for coming on the show talking about this.

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Dr. Bernstein Discusses Hair Transplant Repair In Discovery Channel Interview

The Discovery Channel interviews Dr. Bernstein for a piece on hair transplant repair. View the segment, which includes footage of Dr. Bernstein speaking about hair transplant surgery and performing a procedure, below:

Read the full transcript of the segment:

These days, more and more men who want to compete in the marketplace are seeking cosmetic surgery because they see it as giving them a competitive advantage.

With over 35 million American men affected by hair loss, it’s not surprising that hair restoration ranks high on the list of most popular procedures, generating two billion dollars in revenue each year.

Forty two year-old New York composer Ken Gold started losing his hair 20 years ago.

Ken Gold: In your 20s, you know, everyone is more image-conscious and you don’t want to lose your hair in your 20s.

Ken is not alone. 20% of men in their 20s experience hair loss. In their 30s, the odds jump to 30%, and by the time a man is in his 50s, there is a 50% chance he will be losing some hair.

Ken Gold: Once you’ve lost your hair, you look older. And you don’t want to be 22 and look 35, you know?

Determined to stay youthful, Ken investigated his options and decided to undergo a series of hair transplant procedures beginning in 1981.

Ken Gold: One of the guys I was doing business with, he had a very thick full head of hair. And he said, “Well, I’ve got a hair transplant,” and I was just astonished.

But after five years and four painful, expensive procedures, Ken still didn’t have the full head of hair he wanted.

Ken Gold: My head was a mess. You only had to lift up the hair in the back and you could see what they call the Swiss cheese scalp, just this huge massive scar tissue with little round holes, you know.

Dr. Bernstein: When hair transplants were first started, they thought in order to get enough fullness, you had to move the hair in large clumps, and that’s traditionally known as plugs. And much of our practice is still devoted to hair transplant repair.

Ken despaired of ever finding the solution to his problem until he found the New Hair Institute in Fort Lee, New Jersey.

Dr. Bernstein: When I first saw Ken in 1995. He still had the traditional plugs, and I would say on a scale of one to ten, he was maybe a seven, with ten being the worst. We performed a procedure called follicular unit transplantation where hair is transplanted in exactly the way it grows in nature, which are little tiny groups of one to four hairs.

Ken Gold: After the first surgery I was just ecstatic because I was actually able to look at myself in the mirror.

Almost 20 years and $40,000 later, Ken has finally achieved the natural-looking hair he wanted. But there are alternatives to hair transplant surgery.

Dr. Bernstein: Probably the best thing to do if you’re noticing hair loss is to have a diagnosis of male pattern hair loss to make sure there is not some other treatable condition, and then to use a medication, such as Propecia, which actually can prevent hair loss if it is taken early enough.

But Ken Gold is convinced he’s found the right solution for him.

Ken Gold: I’m very happy now. I wasn’t happy five years ago. When I look in the mirror now, I see someone with hair and I’m able to comb it back and say, yeah, this looks okay.

Watch more videos on hair transplantation and hair transplant repair in our Hair Transplant Videos section

Posted by Robert M. Bernstein M.D.
Bernstein Medical In The News

Newsday Discusses Hair Loss and Hair Restoration Treatment with Dr. Bernstein

Dr. Bernstein was interviewed by New York Newsday in their article, “It’s a Hairy Decision Picking a Treatment for Baldness.” The complete article is below:

HEALTH MATTERS COLUMN

Even IF they don’t talk much about it, just about all the guys he knows are taking medication for their thinning hair, said Steve, a retail manager in his early 30s from Suffolk County, NY. He would be too, but he had side effects right away. He’s had consultations for hair transplants, but that won’t work either because of the pattern of his balding.

So he’s using a protein product that makes his hair look fuller, changed his diet to include leafy green vegetables, gone to two psychics for help. And, he said, he’s biding his time, waiting for new hair restoration medications or for hair cloning to hit the marketplace.

“In the ’90s, everything’s about looks,” said Steve, who asked that his last name be kept confidential. “No one wants to give up their youth.” All the effort to find a hair restoration solution is worth it, he said, “because losing my hair bothers me a lot.”

Sure, hair loss isn’t crippling or life-threatening. But to hear people’s tales, it’s traumatic, depressing and embarrassing.

Yet, you’re more likely to get a snicker than a hug for your pains, said Spencer Kobren, 34, a Manhattan consumer activist and author of “The Bald Truth,” (Pocket Books, 1998, $6.99.) There may be few open arms to comfort you, he said, but there are plenty of extended hands to take your trust and your money.

Kobren should know. He has spent several years testing out hair loss products and talking to the experts about his own hair loss, which began at 22. Now he serves as a sounding board and clearinghouse for the good news and the bad about hair loss and its treatments on a syndicated radio show, aired locally on WEVD /1050 AM on Sunday nights.

“You feel like you’re losing a part of yourself. You see your appearance deteriorate, often rapidly and drastically,” he said. You become vulnerable to promises and pitches, but don’t be swayed by them, said Kobren, who now has a full head of hair. Instead, do a lot of research. The wrong hair restoration products or treatments may not only fail to grow hair, they can make matters a lot worse. For example, he said he gets thousands of letters and e-mails about botched hair transplants that leave men scarred, poorer and balder.

According to Kobren, about $7 billion is spent by consumers annually on finding solutions to hair loss. There are about 50 million men who are balding, with at least 20 percent starting in their 20s. Most have male-pattern baldness, genetically linked and triggered by the action of a hormone called dihydrotestosterone (DHT).

Hair loss is not just a guy thing, though. Plenty of women — about 20 million — have varying degrees of it too. Hair loss is finally getting recognition as a women’s health problem, said Maggie Greenwood- Robinson, whose book, “Hair Savers for Women” (Three Rivers), is due next spring. Kobren’s “The Truth About Women’s Hair Loss,” (Contemporary) will be out in January. “There are more options than ever before for women with hair loss,” said Greenwood-Robinson, and they shouldn’t give up.

But they do have to be cautious. The diagnosis and treatment for men and women is very different, said Dr. Robert M. Bernstein, assistant professor of dermatology at Columbia College of Physicians arid Surgeons and medical director of the New Hair Institute in Manhattan and Fort Lee, N.J.

“Women usually have a diffuse type of hair loss with thinning all over,” he said, “while men generally lose hair on the front and top and keep a permanent zone on the back and sides.” Female baldness can also be due to DHT, but many women lose hair because of anemia, gynecological issues, thyroid disorders or stress, among other reasons. You don’t want to waste your efforts on hair restoration products when what you need is more iron or different birth control pills. “A medical evaluation is extremely important to rule out underlying medical conditions,” said Bernstein.

The treatment of hair loss is an increasingly complicated decision for both men arid women, but at least there is more information than ever to help you ask the right questions. Web sites include www. thebaldtruth.org and www.regrowth.com. Bernstein’s practice has a Web site at www. newhair.com and a detailed book called “The Patient’s Guide to Hair Restoration.”

Your hair restoration options include:

Medication: Finasteride (brand name Propecia), taken orally by prescription. Available for under two years, Propecia is for men only and causes side effects in about 2 percent of them. It has been shown to stop hair loss in about 87 percent of users and new growth in about half. It’s not for women, because it can cause birth defects if a woman is pregnant, and if she’s past child-bearing age, it doesn’t seem to work.

Minoxidil: (brand name Rogaine), used topically. It can be used by both men and women and appears to slow down the rate of hair loss, but not to prevent balding in the long haul. Any effect from either of these hair restoration medications stops when you no longer use them.

Hair transplant surgery: for men and women. Bernstein has pioneered a state-of-the-art technique called follicular unit transplantation, a precise method using hair-follicle groupings that result in a more natural growth of hair and doesn’t leave scars.

Removing grafts of skin from your head and placing them in balding spots is clearly an art as well as a science. Besides being a good candidate for surgical hair restoration, you need to find a dermatologist with a lot of experience performing hair transplant surgery. Expect to ask many questions, learn the risks, see pictures of other patients and meet them in person.

Posted by Robert M. Bernstein M.D.



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