How Propecia Works on Hair and Why Miniaturization Mapping is Important

• Changes in hair weight in men with androgenetic alopecia after treatment with finasteride

Authors: Price VH , Menefee E, Sanchez M, Kaufman KD. Department of Dermatology, University of California, San Francisco published an article in the J Am Acad Dermatol. 2006 Jul;55(1):71-4. Epub 2006 May 3.

This is an important article which shows the impact of finasteride (Propecia) on the miniaturization process. It is clear from this study that Propecia produces much of its value by reversing the miniaturization process, making the hair shafts thicker, more so than growing new hair follicles. That is why it works well in people who still have hair that is being impacted by the genetic balding process, while being minimally effective in those men who lost most of their hair. The article concluded:

“CONCLUSION: Long-term finasteride treatment led to sustained improvement in hair weight compared with placebo. Hair weight increased to a larger extent than hair count, implying that factors other than the number of hairs, such as increased growth rate (length) and thickness of hairs, contribute to the beneficial effects of finasteride in treated men.”

I know that many of my readers may be tired of the constant references to mapping out the scalp for miniaturization. This scientific study, by a prestigious university, shows that the degree of miniaturization in the drug treatment for hair loss is where the benefits lie. Mapping the scalp absolutely shows from ‘whence your hair came to where your hair is going’. The measurements of miniaturization is the diagnostic backbone for the diagnosis of genetic balding, particularly when it occurs in patterns (male pattern balding or MPB). Even female genetic hair loss has distinctive patterns of miniaturization and the skilled diagnostician who commands that knowledge, is more effective in giving advice and building the Master Plan that I keep talking about. The doctor should:

1. make the diagnosis by mapping the scalp and analyzing miniaturization
2. document the pattern of hair loss and miniaturization
3. use his/her knowledge to predict what should happen when a person is treated with drugs on miniaturized hairs
4. observe what happens when the drug is used on the miniaturized hairs by repeating the mapping process periodically over time
5. build a Master Plan based upon the degree of miniaturization and its response to drugs and/or time
6. get to know the patient and his/her goals
7. evaluate the transplant option when appropriate
8. learn how the treatments (transplants or drugs) impacts the patient’s goals and the balding process based upon successive scalp mappings, and
9. re-evaluate the Master Plan based upon the knowledge of what has happened in 1-8 above.

This 9 step process is the standard of care today and anything less than this is less than what every hair loss victim should accept.

Too many times, readers of this blog tell me that they have gone to their doctors and asked to have their hair mapped out for miniaturization and the doctors they speak with essentially call mapping ‘hogwash’ or BS. As you can see from what I wrote here and the published article I referenced above, mapping out the scalp for miniaturization is possibly the most important part of the doctor’s evaluation of hair loss. Too many doctors look at the scalp hair, run their hands through it and make a diagnosis and a recommendation based upon a naked eye evaluation (as if to suggest that there is a microcope on the ends of their fingers), but this approach brings no sophistication, little added value, and no clinical science to the ‘hocus pocus’ that has been associated with hair loss and its diagnosis. The standard of care dictates that the 9 step process outlined above is the basic minimum a patient should expect when he/she visits an expert in hair loss. The metrics of miniaturization is the foundation for the clinical diagnosis of hair loss.