Thank you for your question.
You submitted several photos of the top of your scalp. And you stated in your question
that you were using minoxidil for a period of a time about a little almost close to two
years and that apparently, the minoxidil stopped working after about six months. You also state
that you were taking finasteride and unfortunately, you felt that the finasteride was causing
testicular pain. And so now you’re asking whether or not you should be taking PRP or
a transplant.
Well, I can give you some guidance as to how I answer these questions in my practice. A
little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. Hair transplant has been an important part of my practice for many
years. I am the founder of TrichoStem™ Hair Regeneration Centers and this is a technology
that we developed that evolved out of hair transplant and it uses PRP or platelet-rich
plasma and Acellular matrix which we developed into a system to help men and women from all
over the world who suffer from androgenetic alopecia.
So to begin with, it is certainly important to understand that you have to choose when
to do a transplant very strategically if you’re going to do it at all. And basically, there
is a challenge depending on the age of onset, the rate of progression and the degree of
hair loss. Now when I look at the photos of the top of your scalp, it looks like you have
very diffuse thinning. Well, when you have diffuse thinning, a hair transplant is usually
not that practical. The reason being that when you have an area, for example, which
is very smooth and has no hair, well that’s an ideal place to do a hair transplant because
you can actually place the grafts in that area and not worry about existing hair. When
you have a lot of existing hair even though it’s thinning, what you’re going to end
up with is something called collateral loss where when you do transplants into those areas,
you’re making multiple stabs. Let’s say you’re getting a transplant of 1500 grafts,
well that’s 1500 incisions being made into your scalp and that will result in collateral
loss. So I think that most transplant doctors would not be excited about doing a transplant
in your situation.
Now where does the role of PRP as well as our treatment Hair Regeneration fall? Well,
we learned over many years of doing this procedure. And specifically to differentiate PRP from
Hair Regeneration, PRP is platelet-rich plasma and platelet-rich plasma is a concentration
of the wound healing and growth factors that are necessary when you get a cut. We use PPR
a lot in our practice. We use it for wrinkles, we use it for under eye dark circles, we use
it for acne scars, we use it a lot for skin improvement. But what we have observed and
certainly the feedback I get from patients who come to use who have gotten PRP done elsewhere
is that the effects of PRP are relatively short-lived when it comes to hair stimulation.
What is effectively happening is the PRP is stimulating hair growth in a way that can
prolong the lifecycle of that hair. Unfortunately, with PRP injections, you have to do it relatively
frequently. I have heard patients going into places where they went once a month which
you can imagine is difficult to sustain no matter how motivated you are.
Hair Regeneration which is for our practice which we developed and started the company
TrichoStem™ Hair Regeneration evolved out of 7 years ago when we were doing hair transplants
which initially we were using this Acellular matrix which is a wound healing material that
leverages your body’s ability to generate stem cells for wound healing combined with
platelet-rich plasma. And we were doing this to help improve the graft yield of the transplanted
hairs as well as improve the donor area. A side-effect, a benefit was that thinning hair
became thicker. And we’ve been treating men and women of all ages in large volume
for the past 7 years and the overall majority of patients have had a benefit that is sustained
for 5 years. We customize the treatment in terms of concentrations and methods of delivery
and a lot of things are based on protocols derived from experience. But what I can caution
you about is and I cannot tell what age you are by the photos is that if you fall into
the younger age group and this is where I would say under 30 where you have a young
age of onset and whether it’s a rapid or moderate rate of progression, intrinsically,
your hair loss issue is more aggressive than would be the male who comes in, in their 40s
or 50s who have a similar type of clinical picture and this is very important.
So when you think about management, you do have to understand that your pattern is more
aggressive and PRP as well as Hair Regeneration is essentially pushing the growth cycles for
as long as is possible for that hair follicle. What we have learned from doing platelet-rich
plasma and Acellular matrix combination, we have been able to see stopping of the progression
of hair loss. We have been able to see a reactivation of hair that is not growing, we have been
able to see thickening of thinning hair, effectively prolonging the time as well as the quality
of the hair. However, I would say that the best candidates have been people who have
moderate degrees of hair loss with a relatively moderate level of aggressiveness. So these
are people who can be as young as in their 20s but their progression is a slower progression
as opposed to a younger person who has a more aggressive progression. Again, we have been
able to establish a significant benefit in terms of 5 years with a single injection and
we have adjusted protocols for other patients who have more advanced hair loss but certainly,
we have been challenged with younger people who have more aggressive patterns and we may
not be able to get to that 5 year mark even though we can still prolong the growth cycles
as much as possible.
Now that being said, I think that it’s important for you also speak to your doctor about the
side-effects of finasteride that you experienced. You may or may not be making a correlation
causation error in terms of the effect of the drug and the testicular pain that you’re
experiencing. Again, finasteride like any medication can have side-effects but generally
speaking in my experience, finasteride has been well tolerated in prescribing for patients
for about 20 years and our colleagues from around the world also feel comparatively the
same. Yes, the original studies showed about 2% of men had sexual side-effects but this
was both in the active drug group and the placebo group. And so there are certainly
multiple causes of these types of symptoms whether they’re sexual side-effects or testicular
pain. So it might be worth considering or maybe trying an alternative drug such as dutasteride
but again, this is a discussion for you and your doctor.
So think about stabilization, think about maximizing the lifespan of your hair and trying
to buy as much time as possible before you move forward with a hair transplant or require
a hair transplant.
So I hope that was helpful, I wish you the best of luck and thank you for your question.