Thank you for your question. You submitted a question without a photo showing
your current situation with your hair but as your question describes, you’re starting
Propecia but you’re starting at half a dose initially thinking of increasing it and you
think of increasing it to a full dose at 8 weeks. And your question is about when will
the Propecia take effect? Will it work immediately? And you are asking more information regarding
the relative benefit of Propecia.
Well, certainly I can address your question and I think I have some understanding as to
why you’re doing what you are doing. Just a little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve
been in practice in Manhattan and Long Island for over 20 years. Hair loss treatments specifically
hair transplant has been a significant part of my practice and in fact, I am the founder
of Hair Regeneration Centers called TrichoStem™ Hair Regeneration. This is a treatment that
we developed in our practice as both a non-surgical alternative to hair transplant as well as
what has become an alternative to taking oral finasteride for people who don’t want to
take it or cannot take it. And so the counseling of patients about finasteride has become a
big part of my daily routine in our practice.
So before I get into details about Hair Regeneration, let’s just understand a few things about
finasteride. First of all, when you take finasteride, the dosage was developed based on a certain
basis of relative efficacy in the ability to diminish the amount of DHT. So if you think
about it, taking half a dose can be compared to taking half a dose of an antibiotic when
you need a full dose. So I don’t think that in itself is a great plan. It might reduce
approximately 60-70% of your DHT so it’s not necessarily one to one in terms of effectiveness
but we also have to think about the relative likelihood of it being of benefit to you.
Although a lot of men do respond to the finasteride and the numbers vary depending on the studies
you read but I would say that it would help probably somewhere around 60% and this is
also from studies. Some would say up to 90% but the point is that not everyone responds
to finasteride and there is only one way to tell which is by taking it at the prescribed
dose on a daily basis.
Now, there has been a lot of concern about not only the effectiveness but also when it
comes to the compliance. That is actually a major issue when it comes to the management
of hair loss. It has been shown that a lot of men may take finasteride with consistency
in the first year but a lot stopped taking it in the second year and there is a whole
lot of reasons and that’s from clinically studies. From my own clinical practice, I
can tell you that I’ve started a lot of people on finasteride and they’ve been taking
it since the beginning since I started prescribing it sometime around 1997. They will take it
every day for their whole life and they will have no problems but I would say significant
percentage will take it for a while and not take it, maybe think about taking it and just
be very sporadic and essentially they will not enjoy the benefit if they are responsive.
And in fact, the original studies with finasteride had to be stopped early because the benefit
was clearly there and the people who were receiving the placebo were not benefiting.
Now when you started, those same people who are on the placebo, on finasteride again,
they did not catch up to those who were taking them from beginning. So the hair counts matter,
the hair inventory matters.
Now currently, the biggest concern about finasteride is the potential side effects related to short-term
and long-term sexual side effects. In our practice, we counsel people on the effectiveness
on the alternative we developed called Hair Regeneration. Hair Regeneration was developed
out of our working on patients with hair transplants using a material called extracellular matrix
combined with platelet-rich plasma (PRP) which is derived from your own blood that is essentially
is the growth factors and healing factors. The idea was to help our hair grafts heal
better and the donor area to heal better. Well, what evolved from was that thinning
hairs become thicker in different ways in different levels for different patients. So
I took it upon myself to develop a process and system so that in the absence of doing
a transplant, just do an injection. This injection has been so effective that both men and women
with androgenetic male and female pattern hair loss will have 99% success defined by
stopping of progression of hair loss, reactivation of hairs that are not growing and the shedding
of thinning hair and the re-growth of thicker hair.
Patients come to our practice from all over the world because of this and we actually
developed a company called TrichoStem™ Hair Regeneration and we are trying to scale this
so that people can get this treatment outside of our two offices.
The point is that when you think about the way we developed Hair Regeneration was based
on a very methodical process. I customized the dosage, the delivery system and developed
an algorithm based on gender, age, level of hair loss, onset and a whole bunch of parameters
and I dose it appropriately and in fact, in every single injection is dosed specifically
with that algorithm in mind. So going back to finasteride, I think you need to make a
decision on whether or not you want to stick with it and if you’re going to stick with
it, do the right dose and then see if it’s effective.
Discuss this with your doctor and as far as the onset of benefit, typically you have to
wait at least 3 to 6 months to see any benefit. And those who respond do pretty well within
that time frame. The responsiveness is also dependent on growth cycles and hair growth
cycles and the amount of hair shedding. Sometimes, the early signs of improvement are the diminishing
of hair shedding and then slowly the thickening of hair. So it’s really a journey whether
it’s hair transplant, finasteride or even Hair Regeneration, you are looking at about
a year’s timeline. It always takes a long view and you have to be consistent about taking
the medication every day.
So I hope that was helpful, I wish you the best of luck and thank you for your question.