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.
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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.
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.
Q: I am taking a baby aspirin to prevent heart disease and I heard that I should stop this medication before my hair transplant. How long should I stop for? — G.A., Fort Lauderdale, FL
A: You should discontinue the aspirin 10 days prior to your hair restoration procedure.
Other NSAIDs (non-steroidal anti-inflammatory drugs) need only be stopped 3 days before the hair transplant.
Both aspirin and other NSAIDs can be resumed three days after surgery. ((Otley CC: Preoperative evaluation and management in dermatologic surgery. J Am Acad Dermatol 2006; 54:119-2))
Here are some resources for before your hair transplant:
Before FUT Hair Transplant
Before FUE Hair Transplant
Here are some resources for after your hair transplant:
After FUT Hair Transplant
After FUE Hair Transplant
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
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)
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