Hair Transplant Adviser

Finasteride, which is the generic name for Propecia, has been approved for the treatment of Male Pattern Hair Loss since 1998. Finasteride works by inhibiting the enzyme ,5 alpha reductase type II, that forms DHT. There has been a lot of interest by both patients and physicians in dutasteride, which is a drug that inhibits both type I and type II 5 alpha reductase enzyme.Dutasteride is three times more potent than finasteride inhibiting the type II enzyme and 100 times more potent than finasteride inhibiting the type I form of the DHT producing enzyme. Dutasteride is not approved by the FDA for the treatment of Male Pattern Hair Loss and is approved at a dose of 0.5 mg a day for the treatment of prostate enlargement. While both the type I and type II enzymes are found in the hair follicle, there is a recent study which shows that type I is present in the human brain.The function of this enzyme in the brain is still unclear. Read the rest

New Hair Transplant Adviser Contributor: Bernard P. Nusbaum, MD
- Accepted member of The International Alliance of Hair Restoration Surgeons

- One of less than 50 hair transplant surgeons throughout North America recommended by The American Hair Loss Association

Website: http://www.miamihair.com
Email: drnusbaum@miamihair.com

Dermatologist/ Board Certified by the American Board of Dermatology

Dr. Nusbaum has been widely published in the fields of dermatology and hair transplantation and has been extremely active in research and professional societies. He is in demand as a lecturer and has presented dozens of programs, research findings, and clinical reports at medical conferences.

He graduated from the University of Colorado in 1974, then received his doctor of medicine degree from he University of Miami School of Medicine in 1979.

Dr. Nusbaum interned in Internal Medicine at Mount Sinai Medical Center in Miami Beach from 1979 to 1980. He did his residency in dermatology at Mount Sinai from 1980 to 1983, serving as chief resident in dermatology from 1981 to 1983. Read the rest

In February of 2007 Lexington International LLC, the makers of the HairMax Laser Comb, announced that they received FDA clearance of their hand held laser hair growth device and described this event as a “landmark achievement”.

510k FDA clearance allows the company to legally state that the HairMax Laser Comb is now clinically proven to promote hair growth in males with androgenetic alopecia.

However, the $64,000 question that still plagues many well known hair loss experts is, can the HairMax Laser Comb grow visible, appreciable hair or is this FDA “clearance” based solely on slight changes in hair characteristics and microscopic photographic evidence?

Does the HairMax Laser Comb truly help hair loss sufferers, or is Lexington International just helping themselves to an even bigger piece of the $3.5 billion a year hair loss industry pie?

On Sunday October 7th, 2007 The Bald Truth Radio Show invited Lexington International’s CEO and inventor of the HairMax Laser Comb, David Michaels along with Randy Veliky, Lexington’s COO to answer some difficult questions about their product as well as to speak with callers who purchased The HairMax Laser Comb.

Issues discussed on the program include:

• The difference between FDA approval and FDA clearance

• Specifics of clinical study results.

• Why the FDA only granted the HairMax Laser Comb clearance for males?

• Does the HairMax Laser Comb really stop hair loss and regrow hair?

• Is their a difference between the HairMX laser comb and other LLLT hair growth devices?

• The validly of Lexington’s before and after photos.

• Inventor of the Hairmax Laser comb David Michaels’ credentials and much, much more.

Listen To The Show:

The Bald Truth Segment One

The Bald Truth Segment Two

Question:

I’ve had a thinning spot on the top of my head for almost 10 years.

I’ve been using Minoxidil and Finasteride since 2004, and the combination seems to be working. I may have a little regrowth, but the important thing is that the spot seems not to be growing.

My question is this: Is there anything else I should be doing? The whole “Laser combs” thing sounds like a fly-by-night industry to me - do they really work?

Thanks in advance.

– Keith in NYC

Answer:

Hi Keith. You have a good question which has a highly debatable answer. The main idea behind the “laser comb” is basically that it increases the circulation in the area where the low level laser light therapy is used. This increase in blood flow to the follicles, according to the laser comb promoters, has a positive effect on the follicles which causes an overall decrease in hair loss.

I have a problem with the supposed mechanism by which the laser comb works to prevent hair loss. While I don’t dispute the comb’s ability to cause a transient increase in blood flow, I do feel that this does not treat the underlying cause of the hair loss. In my opinion, hair loss is not the result of a lack of blood supply to the scalp but rather, it is a result of the negative effects of DHT binding to the follicle receptors. This concept is widely accepted as the root of male pattern baldness and is the reason why finasteride helps prevent hair loss (by lowering the DHT level). Since the laser comb therapy does nothing to change the level of DHT at the receptor site, I do not feel that it has much more than a placebo-type effect on hair loss.

In practice, I have not heard many good things about laser comb therapy. I have had a few patients state their belief that the comb has helped stop their hair loss, but these are usually patients who are also taking finasteride. The problem in this lies in the fact that if a patient is taking two treatments at the same time, it is difficult to gauge the overall effects of each individual treatment. Basically, it is hard to show that the comb had any beneficial effects, as the hair loss prevention may have been attributable only to the finasteride.

I am going to point out one more issue regarding the comb. The laser comb does have FDA approval, though this may be misleading. The technology behind the laser comb has been around for decades. The FDA approval for this device is not based on any amazing new studies. Rather, it has been approved because the technology pre-dates when the FDA began its supervisory role. Therefore, this device did not have to pass through today’s stringent FDA approval process.

Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

Question:

Hello,

I hope you answer my question. My 12 yrs. old daughter has been diagnosed with Androgenetic Alopecia. Her hair has been thinning in the front and at the temples. We have been using the 2% Rogaine for 3 weeks, as recommended by her dermatologist. The hair in the back of her head seems normal. This is starting to affect her emotionally.

Is it too soon to think about hair transplant? Should we wait until she is 18? Please let me know.

We live in the Bay Area, Any recommended hair transplant MD’s??

Thank you for your time,
Mariam

Answer:

Androgenic alopecia is quite uncommon in a 12 year old male or female. I am curious how the diagnosis was made. There are multiple reasons for hair loss in the front and temple areas besides androgenic alopecia. If it is androgenic alopecia, one would consider a full medical workup to determine why it is occurring at such a young age. Androgenic alopecia has some characteristic findings. These include miniaturization of the hair and lightening of the hair color in the affected areas. In addition, there are also some characteristic histological findings under a microscope. I would have her seen as quickly as possible. In the bay area, I recommend Sheldon Kabaker, who practices in Oakland or Peter Panagotacos, who practices in San Francisco. They can assist you with a diagnostic work up, as well as a treatment plan. Read the rest

Question:

I am 57 and have had multiple hair transplants with great results. I suffer from male pattern baldness. Two years ago I began taking testosterone and HGH replacement therapy under the direction on an anti-aging physician. My concern is by increasing testosterone/DHT, am I at risk of loosing the grafted hair. What has been your experience with patients using hormone replacement therapy and hair loss. Could propecia mitigate the potential side effects of hormone replacement and hair loss?

Answer:

First of all, if you were going to experience any loss of hair, transplanted or otherwise, you would have noticed by now, having taken testosterone (T) and HGH for two years. The loss would be the greatest in non-transplanted hair.

Theoretically the transplanted hair originated from a zone of follicles free of DHT receptors so they should not be affected by DHT or T. In reality the transplants behave like the donor hair and there have been reports of thinning of transplants if the donor hair thins. Most often this thinning is seen with age (senile alopecia) but can also be associated with medications or systemic illness. Fortunately the incidence of this is low. By taking T, DHT will most likely increase. As a precaution finasteride could be taken to lower the concentration of DHT. Finasteride reduces the amount of DHT by 70%. If you are increasing T and therefore DHT, even with blockage of 70% of the production of DHT there will still be more DHT.

So the answer to your question is yes finasteride could potentially decrease hair loss from DHT produced by an increase in exogenous T. One has to be aware of the side effects of finasteride which are well documented.

Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon

Question:

I have been on 1.25mg of finasteride daily for the last 10 years, over the last year my MPB went from a norwood 2 to a 4 aggressively. I am now contemplating .5mg of dutasteride every other day, I understand that dutasteride isn’t FDA approved for MPB, some studies in 2002-03 revealed more hair counts as opposed to finasteride, but the drug just fizzled away.

Do you believe that by taking dutasteride, it may decrease shed and increased hair counts better then finasteride. Secondly what is the status quo in reference to taking dutasteride for MBP.
Answer:

It is not uncommon for 5 alpha-reductase inhibition to ultimately fail. My belief is that they prolong the anagen duration and therefore delay the inevitable, which is hair loss. All hairs cycle through a growing (anagen phase), to a resting (telogen phase), and to involution (catagen phase). This ultimately leads to exogen or temporary loss of the hair. I believe that hairs have a limited number of cycles. Once they reach the critical number of cycles, they begin to miniaturize and this in a single cycle. Miniaturized hairs become finer with less pigment. They grow slower and the anagen duration is less, which means they will not grow as long as they did prior to the onset of miniaturization. It is not possible to eliminate the resting phase altogether, but you can delay its onset.

A number of products seem to help with the prolongation of anagen. These include minoxidil, Finasteride, Avodart, and Nizoral shampoo. One can also consider saw palmetto, the laser comb, and other products that can prolong anagen such as Hair Cycle shampoo and conditioner. I generally recommend that individuals consider maximal medical management to help maintain their hair. It certainly is a better alternative than surgery for many individuals.

Combination therapy with a 5 alpha-reductase inhibitor and minoxidil is probably better than either alone.

If you are considering Avodart, you should probably take 0.5 mg every day for 2 weeks and then three times a week on Monday, Wednesday, and Friday is probably adequate. If you plan to take it every other day, you should probably still take it every day for the first 2 weeks.

It is true that Avodart did increase hair counts above finasteride in phase two clinical trials, but phase three trials were never undertaken. I suspect that the company assumed that there was more risk than reward and suspected that physicians would still prescribe it off label for hair loss.

Anecdotally, many individuals seem to respond better to Avodart than they did to finasteride. However, I have also heard of some patients who said finasteride worked better for them. You should read the warnings on the product information prior to taking Avodart. You are blocking both 5 alpha-reductase type one and two with Avodart. Finasteride primarily blocks type 2. This could lead to more long term side affects though none have been identified to date. One would expect more sexual dysfunction on Avodart than on Finasteride, but I have heard some say they had less sexual dysfunction on Avodart than they had on Finasteride.

There are also other factors that cause hair loss besides 5 alpha-reductase activity, as well. It could also be that you were on a plateau of stable hair loss for a prolonged period of time unrelated to the intake of Finasteride and that you have suddenly experienced a progression in hair loss. This scenario seems less likely given your long period of stability. Certainly, if you hair loss is bothering you, you should consider your alternatives provided that finasteride is no longer maintaining your hair.

No one has studied the status quo with regard to Avodart, but it does seem to work better based on phase two clinical trials.

John P. Cole, MD
http://www.forhair.com
IAHRS Recommended Hair Transplant Surgeon