ASK THE DOCTOR: Hair-growth products aren’t cure-all|
By DR. JIM MITTERANDO
For The Patriot LedgerQ I am a 30-year-old single man losing my hair. What can you recommend for treating baldness? Does Rogaine or Propecia work? Can I use both to get better results? Anything else helpful?
A Hair plays a role in defining one’s self-image. From the ‘‘snake oils’’ of the past to high-tech microsurgical hair plugs, men have been willing to try almost anything and to spend large amounts of money in search of a cure for male pattern baldness.
Male pattern baldness - characterized by a receding hairline at the front and temples and baldness on the top of the head - affects 2/3 of men. A testosterone derivative called dihydrotestosterone (DHT) causes thinning of the hair follicles and eventual loss in these areas.
Unfortunately, Rogaine (generic: minoxidil) and Propecia (generic: finasteride) are only mildly effective and their benefit is limited more to the top of the head (crown) and not helpful with the front and temples, which is what most men see in the mirror and what bothers them most. Neither drug restores all the hair and the response differs among men. These drugs are not helpful in men who have advanced balding. Most studies evaluating these medicines have been sponsored by drug companies.
You will need to use these treatments for at least three months before you see results and any benefits will be lost three to 12 months after stopping use. Men often ask me if they will lose more hair if they stop the medicine. You will not. You will simply return to your prior pattern of hair loss. Finasteride was originally developed to help shrink enlarged prostates. This prescription medicine prevents testosterone from being converted to its more potent form DHT.
One in four men will notice some improvement in the appearance of their hair after one year of treatment with finasteride; one out of six will be satisfied with the appearance of their hair. Finasteride is not helpful for men 60 and older since hormones play less of a role in hair loss at that age.
Avoid taking this medication if your partner is pregnant or planning pregnancy since it can cause birth defects. Rare side effects of finasteride include diminished sex drive and impotence which are resolved when the medication is stopped. The long-term effects of this medication are not yet known.
Finasteride is not covered by insurance companies. Propecia (finasteride 1 mg tablet) costs around $52 per month. You can save money if your doctor prescribes Proscar (finasteride 5 mg) - the original prostate drug - and cut the pill in quarters. This would cost you $22 per month.
Avodart (dutasteride) is a new drug similar to finasteride that reduces DHT and is licensed for the treatment of prostate enlargement. It is not FDA approved for treatment of hair loss despite being heavily marketed on some hair loss web sites. It costs $100 per month.
Minoxidil (Rogaine) was originally developed as a blood pressure medication and was noted to modestly reduce hair loss and sometimes increase hair on the crown of the scalp. New hair resulting from minoxidil use is often thinner and lighter in color than previous hair.
Minoxidil is available over the counter as a liquid that is applied to the scalp. It is safe and does not affect blood pressure. Men often mistakenly apply this medication to the front and temple areas hoping this may help. In fact, studies have shown this medicine does not benefit these areas. Minoxidil costs $25 for a one-month supply and costs $45 for a three-month supply.
No studies have been evaluated combining finasteride and minoxidil.
All other over-the-counter hair growth products are generally considered ‘‘snake oil’’ and probably do not work. If there truly was a very successful product, many men already would be using it.
Hair-plug transplants show some promise but are costly and can cause scarring of the scalp. Hair is transplanted from the back and sides of the head where the hair is not sensitive to testosterone. Unfortunately, hair loss may continue around the transplanted hairs which could result in patches of hair that appear unnatural. You may need to repeat procedures as you lose more hair. It is the only effective treatment for male balding at this time. Exercise caution in choosing a qualified surgeon.
Other options are to wear a wig or shave off the remaining hair.
Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright 2003 The Patriot Ledger
Transmitted Tuesday, August 26, 2003