Is Propecia Mandatory After Hair Transplant?

I have looked into hair transplants time and again but have been scared off by the horror stories of bad HTs. FUEs sound good to me. Where do I go to get evaluated? I am losing hair in my temple areas and am 36 years old. Also, do I have to be on Propecia? I was on it for a year, didn’t see any results in hair but did notice problems with sexual activity (i.e. hard to keep an erection) I like it a lot better without it. So, if I had a HT, would I have to be on propecia?

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You do not have to use Propecia after a hair transplant. However, by not using this drug you will not have any protection against the progressive nature of hair loss, assuming you are still losing hair and not totally bald. With regard to your sexual problems, almost 40% of men of your age have some difficulty maintaining an erection. One of the erectile dysfunction (ED) drugs can solve that. Taking Propecia for your hair and ED pills for your erection may give you both a better sex life and hair at the same time.

You indicated that you are based in Colorado. I would be happy to evaluate you for FUE, but my offices are in California. To find a FUE surgeon in your area, please visit, but please note that there are not many of them out there that have the reputation and experience you may want.

Propecia Side Effects

I am 28 years old, and I have had the unfortunate expierence of losing my hair for the past 2 years.
I had a consult with a Bosley representative, and reccomended that I go on Propecia for about 9 months in order to retain my hair to be a good risk for hair transplantation. I would like to know, if this is a good reccomendation, and is the risk of side affects worth the effort? I have been on propecia now for almost 3 weeks, and I have had some side effects. In fact, I feel like I’m losing more hair due to propecia…Is that possible? With all this drama and money involved with going bald, I am about to resort to just shaving my head. It seems all the effort is in vain. It’s hard to beat genetics with a natuaral look.

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It is almost always a good idea to try Propecia if you have genetic hair loss, especially at your age, BEFORE you go through a surgical hair transplant. You may decide that after 9 to 12 months, you are happy with the results and do not need surgery.

I suspect that in the past three weeks, you have spent more time looking at your hair, watching for growth or hair loss, than you have in the past two years. It may take up to 12 months to see results from Propecia, and by watching your hair very closely and very often, you may miss some of the subtle growth that will hopefully be taking place. As far as side effects, erectile dysfunction, decreased libido and ejaculation disorders were reported about by .5% more men taking Propecia, than those taking the placebo- according to Merck. If the side effects are greatly impacting your life you will have to make the decision if you want to continue Propecia.

You sound like you are conflicted about your hair loss and solutions that are open to you. My suggestion is to take your time and research all of your options before you make the committment to surgery.

Avodart’s FDA Status?

You have mentioned that Avodart is not yet approved by FDA. Do you know what the status is on them approving it? Is it in its beginning trial stages or are the trials mostly complete and the FDA is just evaluating all of the research before making a decision. Or have they rejected it all together?

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Avodart was approved by the FDA for treatment of benign prostatic hyperplasia (BPH), in 2001. While I do not know which stage the trials are currently in, I am sure that the manufacturer of Avodart is doing all they can to speed up the FDA approval process for use in hair loss, if it is even at trials to begin with.

Alopecia Areata Universalis

Im suffering with alopecia areata universalis. due to it i lost my hair totally on my scalp, eyebrows & eyelashes. Is hair transplantation possible for me? please give me a reply. thank you.

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A hair transplant requires a sufficient amount of donor hair taken from the back of the scalp, to be moved to the balding area. Unfortunately if you do not have the donor hair to accomplish your goal, then hair transplantation is not an option. You can discuss your choices with a good dermatologist, and the National Alopecia Areata Foundation has a very extensive and informative website for those suffering with your condition.

Common, Yet Sad Story

i am 32 years old/ my hair has been receeding slowly for 10 years. my entire life has taken a different course then what i would ever would have imagined. my life is one of boring structure and panic, this disease has ruined my youth and the saddest part/ nobody knows but me.

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Many balding men suffer in silence. I remember a psychologist that I transplanted in two sessions with about 4500 grafts in total. He told me that he had been in analysis for his balding problem for over 15 years. It made no sense to him that he was so devastated over his hair loss, but it nevertheless made him suffer. He had taken some medications as well to deal with his depression.

After the transplants were finished, he said that he could not understand why he had not done it sooner. He thought, in hindsight, that had he transplanted his hair 20 years ago, he would not have had to suffer with the problem for all of those years. But the reality was really something different, because only the newer technologies would have given him a normal head of hair. Had he chosen surgery 20 years earlier, the results would not have been a walk in the park.

Aside from that anecdote, it is still important to find out why you feel that your hair loss has ruined your life. It might be worth talking to a good therapist and explore how hair loss has affected your life. You are in control of your life, so take charge and do something about getting it together and stop suffering in silence. Look for help.

Herbal Treatments

Hi from Virginia Dr Rassman! I am 27 and am concerned about a receeding hairline I (and my friends) have noticed occuring right above my temples. The hair in this location has always been thin, but has become more pronounced in recent years. What can I do to retard and even reverse this thinning? I have read about Propecia, and they do not recommend it for receeding hairline. Currently I am taking Saw Palmetto (supposedly an herbal Propecia), a sustained-release B Vitamin and MSM (both which supposedly feed and thicken hair). What other treatments are available for receeding hairline, herbal, pharmaceutical, or other?

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If you have been losing hair in the temples and only the temples, then you may have a condition called Triangular Alopecia. IF this is the case, then you need a diagnosis. As I have repeated many times, the hair throughout your head must be observed with high magnification. If the hair loss is only in the triangular temple area, then this diagnosis is probable.

Make an appointment with a good hair doctor and show them this answer. They will know what to do. Don’t rush to herbal or other over the counter remedies without knowing what is going on. Once you get a good diagnosis then you should address the cause or use a treatment that works with scientific proof or at least a reasonable certainty.

Nizoral Shampoo

Is Nizoral better than other shampoos and can it promote hair growth?

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Nizoral 1% (Ketoconazole 1%) is sold as an over the counter anti-dandruff shampoo. Nizoral 2% (Ketoconazole 2%) shampoo has twice the strength of the over the counter shampoo. The active ingredient, Ketoconazole is said to act as a DHT blocker. While some people who use Nizoral may believe that it does control hair loss, there is no objective evidence that it is anything more than a good shampoo.

Shiny Forehead

Dear Dr Rassman,
I hope you are well! Thank you for your dedication to providing men with a source of advice and information. I for one greatly appreciate it, and I am sure hundreds (thousands) of others do also!

I have a question that does not relate directly to hair loss, but one that is associated with appearance.

I have a high forehead, my hair has moved back an inch and a half directly in front and two inches roughly on the sides, with thinning on top. I tend to cut my hair short, usually a one or two shaven look. I am comfortable with the way I look, although I wish (as the majority of bald men do) had more hair, I am hoping that I will see more of a fuller appearance in time, since I started using Propecia two months ago.

My question is regarding the shininess I get on my forehead. It is greasy, oily moisture that accumulates during the day, which I usually wipe away with a tissue. I feel that if I could reduce the amount of greasiness I get on my brow I would feel better about my appearance. As the hair is thinning at the front, it makes my head look very shiny, when the back and sides of my head are thick with hair. Is there any product, or dietary plan that you could kindly recommend that may reduce this shiny appearance? I have found it is not good for the skin, to keep wiping the grease away with a tissue, it causes spots, which is the last thing I need at 23, along with the baldness!

Thankyou kindly for your help with this question. I hope you don’t mind me asking questions that are not directly related to hair loss.

Kindest regards

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I gave this question to hair restoration surgeon, dermatologist, and my collegue Dr. Robert Bernstein to answer. Here’s his response:

The easiest way to remove oil from the forehead is with alcohol swabs. If you are acne prone then Erycette and Cleocin Pledgettes are topical antibiotics for acne that come on an alcohol based pad. These can be carried in your pocket but require a doctor’s prescription!

Switching From Propecia to Proscar

I have taken Propecia for 4 plus years with some success. I’d like to take proscar but don’t know how to go about it. Could you help? thanks

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Proscar is the same drug as Propecia, just in a higher dosage per tablet. Propecia contains 1 mg of finasteride per tablet, and Proscar contains 5 mg of finasteride per tablet. When Merck did their studies on hair loss, it was determined that 1mg of finasteride was just as effective as 5 mg or even 10 mg of finasteride, but that taking only 1/2 mg of finasteride was 20% less effective.

So the only ‘benefit’ to taking more than the recommended 1 mg of finasteride in each Propecia pill, is a higher chance of side effects. If you want to take Proscar because it is more cost effective, you can split the pill into fourths. Splitting into fifths is more difficult and you tend to lose some of the pill in the cutting process. The doctor who prescribed Propecia for you, can prescribe Proscar for you.

Journal Articles on Propecia (Finasteride)

Two articles are summarized below which address the drug Finasteride (Proscar 5mg and Propecia 1mg).

These article are very technical and may not be good reading, but I have put them here as part of my effort to educate the readership. Both of these articles discuss what we have learned on preventing prostate cancer with finasteride (very important as most men who live long enough will develop prostate cancer) and the cost/benefits of taking finasteride over time. In medical circles, these are controversial articles in many ways. I have included the comments of one doctor in the hair restoration field. Dr. Bill Reed, states: “An oversight on the author’s part that would probably negate the need to reduce the price of finasteride is the enhanced quality of having more hair! With regard to the authors’ basic approach, it’s an awkward premise to attempt to attribute a monetary value to quality. For example, is the real quality and value of treating BPH (enlarged prostate) with finasteride [to produce a] better sleep and absence of urgency or the money saved from a TURP? I’ve always loved how a healthier prostate and more hair probably go together with this drug [How does one quantify this value?]”


European Journal of Cancer. 2005 Jul 29; The article addresses the finasteride prostate cancer prevention trial (PCPT) and asks: What have we learned?

Author: Mellon JK., Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.

In 2003, the first of two large NCI-sponsored prostate cancer chemoprevention trials was reported. The prostate cancer prevention trial (PCPT) demonstrated a 24.8% reduction in the prevalence of prostate cancer in men taking finasteride 5mg/d for 7years. However, despite the overall reduced risk of prostate cancer, men in the finasteride-treated arm of the study were more likely to develop high-grade disease. This article examines some of the controversies aroused by the PCPT and evaluates some of the arguments that have been advanced in an attempt to explain some of the unexpected outcomes of the study. In addition, some of the recent studies assessing the potential impact of an effective chemopreventive strategy on population mortality are reviewed. To conclude, there is some discussion of factors, which need to be openly discussed with male patients who might be considered for finasteride therapy.


The American Journal of Medicine. 2005 Aug;118(8):850-7. The article addresses the lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer.

Author: Zeliadt SB, Etzioni RD, Penson DF, Thompson IM, Ramsey SD., Fred Hutchinson Cancer Research Center, Seattle, Wash.; Health Services Department, University of Washington School of Public Health and Community Medicine, Seattle, Wash.

PURPOSE: We estimate the lifetime implications of daily treatment with finasteride following the results of the Prostate Cancer Prevention Trial (PCPT). In this trial, prostate cancer prevalence was reduced by 25%; however, an increase in the number of high-grade tumors among the treatment group necessitates the long-term projection of the likely benefits and costs. METHODS: We use a Markov decision analysis model with data from the trial, the SEER program, and published literature. The model measures the cost per life-year and cost per quality-adjusted life-year (QALY) gained for a cohort of men age 55 years who initiate preventive treatment with finasteride. RESULTS: Finasteride is associated with a gain of 6 life-years per 1000 men treated at an incremental cost of $1,660,000 per life-year gained. The quality-adjusted analysis results in 46 QALYs gained per 1000 men treated at an incremental cost of $200,000 per QALY gained, due primarily to the favorable effects of finasteride on benign prostatic hyperplasia. Under the assumption that the increase in high-grade tumors observed among finasteride treated men is a pathologic artifact, the incremental costs are $290,000 per life-year gained and $130,000 per QALY gained. CONCLUSIONS: The cost burden associated with finasteride is substantial, while its survival benefit is small and only realized many years after initiating treatment. To achieve an incremental cost below $100,000 per QALY gained, the price of finasteride must be reduced by 50% from its current average wholesale price and finasteride must be shown to prevent high-grade as well as low-grade disease.