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Hair Restoration Medications

US Hair Restoration has reviewed and continues to review different products that claim to restore hair. Hair restoration and hair transplant surgery has advanced greatly and so have the medications approved by both the FDA and hair transplant surgeons as two viable options to prevent and restore hair in hair loss patients.

Finasteride (Propecia)

Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is a medication with antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts the male hormone (testosterone to dihydrotestostrone (DHT).  This medication is used as a treatment in male patterned hair loss and also in benign prostatic hyperplasia (BPH).

Finasteride was approved initially in 1992 as Proscar, a treatment for prostate enlargement, but the sponsor had studied 1 mg of finasteride and demonstrated hair growth in male pattern hair loss. On December 22, 1997, the FDA approved finasteride to treat male pattern hair loss.

Recognized side effects, experienced by around >1% of users, include decreased sex drive and volume of semen. As expected from its short 6-8 hour half-life, in trial studies, side effects ceased after dosage was discontinued.  Finasteride is not indicated for use by women.

There are several studies on using finasteride for treatment and prevention of hair loss.  In a 5-year study of men with mild to moderate hair loss, 48% of those treated with Propecia (finasteride 1mg) experienced some regrowth of hair, and 42% had no further loss. Average hair count in the treatment group remained above baseline, and showed an increasing difference from hair count in the placebo group, for all five years of the study.  Propecia is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy.  In clinical studies, Propecia, like minoxidil, was shown to work on both the crown area and the hairline, but is most successful in the crown area.

Some hair loss patients who use finasteride, in an effort to save money, buy Proscar instead of Propecia, and split the Proscar pills to approximate the Propecia dosage. Doing so is generally considered unadvisable if women of pregnancy age are in the household; this is because finasteride, even in small concentrations, can cause birth defects in a developing male fetus. The birth defects involve the development of male genitalia. Propecia has been shown to be ineffective for treating hair loss in women.

Androgenetic alopecia or male pattern baldness is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles that are present mainly in the front, top, and crown of the scalp (rather than the back and sides). DHT causes hair loss by shortening the growth, or anagen, phase of the hair cycle, causing miniaturization (decreased size) of the follicles. The effected hair becomes progressively shorter and finer until it eventually disappears.

DHT is formed by the action of the enzyme 5-alpha reductase on testosterone. Finasteride is a drug that works by blocking the enzyme 5-alpha reductase Type II that converts testosterone to dihydrotestosterone (DHT) in the hair follicle. Propecia, the brand name for finasteride, is the only FDA approved oral medication for hair loss. Finasteride causes a significant drop in both scalp and blood levels of DHT and its effect is felt to be related to both of these factors. Finasteride 1-mg/day decreases serum DHT levels by almost 70%. Serum testosterone levels actually increased by 9%, but this are within the range of normal.

Minoxidil (Rogaine)

Minoxidil (Rogaine) is a medication known for its ability to slow down or prevent hair loss and promote hair regrowth. Rogaine was the first FDA approved medication that was used for hair loss prevention.  It is available without prescription (over the counter) for treatment of hair loss in men and women, among some other baldness treatments such as finasteride or hair transplant, but measurable changes disappear within one to two years after discontinuation of treatment.

Minoxidil was first used exclusively as an oral drug for treatment of high blood pressure. It was, however, discovered to have the interesting side-effect of hair growth and reversing baldness, and in the 1980s a topical solution of it was produced contained 2% minoxidil to be used to treat baldness and hair loss, under the brand name Rogaine in the United States. Treatments usually include a 5% concentration solution that is designed for men, whereas the 2% concentration solutions are designed for women.

In 2007 a new foam-based formulation of 5% minoxidil was shown to be an effective treatment of male pattern baldness without the usual side-effects of the topical solution such as itching and skin irritation.

The mechanism by which minodixil promotes hair growth is not fully understood. Minoxidil is a potassium channel agonist.  It contains the chemical structure of nitric oxide, a blood vessel dilator, and may be a nitric oxide. Studies show that minoxidil is less effective than finasteride but the combination of the two drugs can be more potent.

Side Effects of Minoxidil

As a drug to prevent hair loss, the most common side effect is itchy scalp. In some cases minoxidil may initially cause an increase in hair loss within the first few weeks. This is called shedding and is seen as a long-term positive effect during hair loss treatment since the shedded hair strands will regrow within a few months with renewed strength.

There have been cases of allergic reactions to minoxidil or some of its non-active ingredients, which is found in some forms of topical Rogaine. Large amounts of minoxidil can lower the blood pressure.  If a person uses minoxidil to stop hair loss for a length of time and then stops taking the drug, hair loss will occur again.  This phenomenon is called catch up hair loss.

Other rare side-effects include acne on the area where it is being used, headaches and lightheadedness, drop of blood pressure, blurry vision and chest pain.  All the side-effects in the above list except for acne or allergic reaction may be an indicator that too much of the drug is being used. It has also been found that the drug can be passed from a mother to a child via breast milk.  

Women and Minoxidil

Minoxidil unlike finasteride could be used in women with hair loss to increase the bulk of hair and prevent further hair loss.  Only the 2% concentration of minoxidil is approved for use in women. Women are generally more sensitive to the side effects of minoxidil in decreasing blood pressure (hypotension). The allergic reaction to this medication is also more common.  Facial hair could occasionally be seen in women who use minoxidil for the treatment of their hair loss. Limiting the application of medication carefully to the scalp can prevent this side effect.

At Parsa Mohebi Hair Restoration, we perform microscopic miniaturization study before starting patient on any anti hair loss medications.  This way, we can have a complete mapping of scalp hair miniaturization that could be used to follow the effectiveness of our treatments.

Please contact us today for a free personal hair transplant consultation with Dr. Mohebi, a Orange County hair transplant and Newport Beach hair transplant specialist and take the first step toward a natural looking head of hair. We can be reached online, by email or by calling: Please fill the form below for personal consultation Or call numbers listed below:
After great research into hair restoration, I selected you as the doctor to restore the youthful look that I once had. As a teenager and as a young adult in my 20's, I always had a full head of hair, but was born with a high hairline. This genetic trait I got from my mom's side of the family and therefore, my mother always tried to make me feel better by saying, "...a high forehead is a sign of intelligence". However, as I reached my 30's I noticed my hair thinning at the top of my head. My existing high hairline looked more pronounced.
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