Limmer Hair Transplant Clinic

Understanding that Androgenetic Alopecia is a genetically encoded and hormonally driven disorder is key to making decisions regarding treatment options.  Hair transplantation is a great tool to replace lost hair, but it does not prevent you from continued loss of the remaining genetically susceptible hairs on top of the head.  Only medical therapy can at times stop or slow this continued loss and in some cases actually regrow miniaturizing hair.

At minimum I tend to recommend the following over-the-counter products:

1.)    Rogaine (minoxidil) foam or liquid

2.)    A Zinc or Ketoconazole containing anti-dandruff shampoo

 5-alpha reductase inhibitor facts (finasteride and dutasteride)

 -the vast majority of men can benefit from these medications without adverse side effects and in over 15 years if prescribing these medications I have never seen an allergic reaction occur to the medication or an adverse side effect from the medication that did not go away upon discontinuation of the medication.

 -women who are pregnant or potentially could become pregnant should not take these medications, as it manipulates the developing baby’s hormones.

 -you should not donate blood while taking these medications, because a pregnant woman might be the one who receives your blood.

 -tell you doctor you are taking one of these medications as they can lower your PSA score.  Your PSA is used to monitor for possible prostate cancer development.

 -Decreased sex drive and difficulty in achieving an erection have been reported in ~2-4% of men using these medications.  In all major studies the side effects went away upon discontinuing the use of the medication.  However, there have been rare reports of men who claim to continue with problems even though they stop the medication.  The validity of these reports and a medical explanation are not known.  In most of these reports the men took the medication for several years in spite of having decreased sex drive.

 -breasts or testicular tenderness can be seen.  This is rare (<1%) and in both the literature and my experience goes away upon stopping the medication.

 -allergic reactions are possible but in over 15 years of prescribing these medications I have not seen a person allergic to any of these medications.

 -depression.  While not reported as a side effect in any of the major studies there have been rare reports in the literature and on the internet.  The validity of these reports remains unclear.

 -decreased sperm counts.  While not a reported problem during FDA trials, there have been rare cases reported in the literature and a positive link between use and decrease sperm count found.  Upon discontinuation sperm counts increased.

 -breast cancer is very rare in men and in no major study has an association between using these medications and breast cancer been shown.  However, if you experience any lumps, bumps, pain or nipple discharge you should report it to your physician.

 -prostate cancer is very common in men.  In fact it is the 2^nd most common form of cancer in US men and ~1/6^th of US men will be diagnosed with it during their lifetime.  Prostate cancers are graded on a Gleason Score scale from 1 to 10.  The vast majority of prostate cancers are low to mid grade types with Gleason Scores of 6 or less.  In two large clinical trials studying these medications there was seen a 15-25% reduction in the overall incidence of prostate cancer.  However, if you developed prostate cancer there was a small increased risk that your cancer would be a higher grade Gleason Score 8-10 sub-type.  For those taking 5mg of finasteride the risk was 1.8% vs. 1.1% on placebo and for those taking dutasteride the risk was 1.5% vs. 1.0% on placebo.  The data regarding the link between these medications and possible increased/decreased risk of prostate cancer remains controversial are under intense review.  For now the FDA will not allow the manufactures to make any claim that these medications lower your risk of prostate cancer while the new package warnings include the information that there might be link between these medications and slightly higher risk of developing a high grade prostate cancer.