Hair Loss for men: A Brief Overview
Experiencing hair loss is very difficult to cope with; and there is very little we can do to prevent hair loss. I should make you aware I am not a doctor. I am a consumer advocate and a customer of hair loss products and services. Sometimes, physicians do not have your best interest in mind because they want to sell experimental, unproven hair loss services or products in order to make a buck.
Hence, many hair loss sufferers trust consumer advocates’ opinions more than doctors’. After ten years, I have come to the conclusion that Propecia is the most effective medicine to combat hair loss in men. I have spent tens of thousands of dollars combating hair loss with little or no success, including Rogaine, PRP/Acell injections, vitamins D, and hair transplants. Aside from Propecia, the $5 you have paid for this essay is one of the smartest investments you made so far. However, you should come to your own conclusion.
I will be short, honest, and straight to the point in every paragraph. I will only address findings that have been proven to be somewhat effective, significant, or relevant to the study of hair loss.
If you are a man suffering from hair loss, you should be on Propecia (Finasteride) immediately. Propecia is the trade name for Finasteride, which is an inhibitor of the enzyme that converts testosterone to DiHydroTestosterone (DHT). Finasteride reduces DHT in the scalp, preventing hair loss. Researchers have found out DHT in a man’s scalp plays a significant role in Male Pattern Baldness. Propecia is 1mg of Finasteride. Propecia has been approved by the U.S. Food and Drug Administration (FDA) to treat Male Pattern Baldness. You are to take 1mg per day to reduce the DHT levels in your scalp.
A 90-day supply of Propecia used to cost roughly $250.00. Merck used to be the only pharmaceutical company authorized to sell 1mg of Finasteride (Propecia) in the United States (U.S.). However, Merck’s patent expired back in January 2013. Many pharmaceutical companies are now selling 1mg of Finasteride, which has reduced the price of the medicine significantly. A 90-day supply of 1mg of Finasteride now costs about $130.50 at Walmart Pharmacy. Currently, Merck is being sued due to the sexual-side effects of Propecia. After having read more about the lawsuit, I think it is a lawyer-driven lawsuit since the side effects are suffered by a very small percentage of men (about 2%).
Moreover, any hair-loss sufferer can tell you that he would rather have hair, even if he is to suffer some of the sexual side effects from the drug. Side-effects may include reduce in semen, diminished sexual desires, and male breast enlargement. Finasteride also comes in a 5mg dose/pill called Proscar. Proscar, Propecia, and Finasteride are the same drug. Propecia is 1mg of Finasteride. Proscar is 5mg of Finasteride.
Your doctor can prescribe you Proscar to combat hair loss to save you money, but you should split every pill of Proscar in four before taking it. A 90-day of Proscar is only $40.00 at Walmart. A foot note, Finasteride reduces the amount of DHT in your scalp, it does not eliminate DHT; hence, chances are, you will continue loosing hair. However, there have been few cases in which Finasteride has stopped hair loss completely. Women should not take Finasteride or be near the medicine due potential birth defects of the fetus in a pregnant woman. Children should not take this medication.
Rogaine (Minoxidil) is for patients (including women) who are experiencing gradually thinning hair. Rogaine works better on vertex or crown. Even though Rogaine is somewhat effective, clinical trials showed that only 13 percent of women had significant hair growth when using this product. If you decide to try this medication, it may take at least four months to notice any improvement. It is also important to mention that women should use only the Rogaine 2% concentration and not the 5% concentration.
There is no scientific finding as to how Rogaine is able to prevent hair loss; however, it has been proven somewhat effective in 13 of the subjects tested. Hence, Rogaine is approved by the FDA to combat hair loss. I do not use Rogaine. For some reason, Rogaine has not worked on me (front or sides). I am not experiencing hair loss on the crown. Please keep in mind, Rogaine is most effective on the on vertex or crown.
Many doctors would recommend to do both, Rogaine (Minoxidil) and to take Propecia (Finasteride) at the same time. However, it can be quite expensive to do both. I have used Rogaine on the frontal and temporal regions (front and sides) with no success.
Avodart or Dutasteride is another inhibitor of the enzyme that converts testosterone to dihydrotestosterone (DHT), same as Finasteride. However, Avodart significantly reduces DHT, more than Finasteride. There are some serious side effects to Avodart, including sterilization in men, tenderness in the chest, and significantly diminishing sexual desire (more than Propecia). I do not think you will find an ethical doctor willing to prescribe you Avodart to treat hair loss in younger man. Avodart has been approved by the FDA to treat enlargement of the prostate gland, but not for hair loss. Please, do not take Avodart for hair loss, you will become sterile. I have never taken Avodart.
Women should not be near Dutasteride due to the potential birth defects of the fetus in a pregnant woman. As side note, Avodart has not been scientifically proven to be much more effective than Propecia in combatting hair loss, but it would be unethical for a doctor to prescribe it.
There are several other (expensive) treatments, which I find ineffective. For example, the PRP/Acell injections by Dr. Gary Hitzig in New York are ineffective. I paid around $3,000 for the PRP/Acell injections, including airfare to New York. Dr. Hitzig is currently is being sued for medical malpractice (not by me).
Dr. Hitzig is currently practicing medicine under Prasad Hair Restoration, not under his name because of the lawsuits. Also, in San Francisco, Dr. Peter Panagotacos offers a topical solution to his patients, which I have tried, I find it ineffective. The solution costs about $35.00 for a 30-day supply. In 2008, I had a hair transplant at the Berman Skin Institute in Palo Alto, California. The hair restoration procedure was ill-advised.
The procedure was a failure because I was too young; I continued losing hair around the transplanted area after the surgery. I paid around $3,000 for the hair transplant (800 graphs). Please, do not have a hair transplant unless you are completely bald, or close to it, or you are in your 40s (by then you may have a better idea of the hair loss pattern). Please, understand a hair transplant at such a young age is ill-advised because you might continue to loose hair around the transplanted area.
Other hair loss treatments that have been proven ineffective include:
(1) beard hairs transplanted onto the bald scalp (treated with Acell). There are several doctors offering beard transplanted hair (treated with Acell) as a treatment, including Dr. Jerry Cooley in Charlotte and Dr. Gary S. Hitzig in New York.
(2) Taking vitamin D by mouth and
(3) the laser treatment. Dr. William R. Rassman (from Los Angeles) insists that the laser treatment is ineffective. I respect Dr. Rassman’s opinion very much. A side note, if you have your hair transplant at Dr. Rassman’s office, he can refill your Propecia or Finasteride free over the phone (for life since you’re one of his patients). In short, you should not buy any other product in the market other than Propecia or Rogaine. In my opinion, Rogaine is less effective than Propecia; I have tried them both.
There are some new treatments for hair loss in the horizon, including (1) hair multiplication and (2) blocking a protein called Prostaglandin D2, which is found in the bald scalp of men with male pattern baldness, and (3) activating the vitamin D receptors in hair follicles.
- RepliCel is a bioscience company (from Canada) conducting FDA-compliant clinical trials for hair multiplication. Last update some time ago, in April 2012, which included the six-month post injection follow-ups in all 19 subjects with no major development to report. It was said these medical trials may have taken up to three years to complete. However, no updates have been publically communicated as of 07 November, 2016. Hence, the Replicel experiment may not be going well. However, on October 21, 2013, an article in the New York Times talked about hair multiplication, in which researches successfully managed to grow hair (that was on human skin) grafted onto a mouse. Hence, hair multiplication is a possibility in the near future. In its website, RepliCel continues to state regenerative hair loss treatment could be possible in 2018 in Japan since a Japanese company bought RepliCel’s patent to hair multiplication growth.
- In March 2012, researchers from the Perelman School of Medicine at the University of Pennsylvania found an abnormal amount of Prostaglandin D2 in the bald scalp of men with Male Pattern Baldness. Pharmaceutical companies are currently researching and determining a way to block Prostaglandin D2 from reaching the scalp. Prostaglandin D2 seems to prevent hair growth. If a drug can block the effects of prostaglandin D2, this could be the cure for balding that we are all looking for. I think the finding of the Prostaglandin D2 is significant. I have not heard anything else about this discovery as of June 6, 2016.
- According to some researches, targeting vitamin D receptors in hair follicles may also provide some answers. Take it for what is worth, but I was diagnosed with low vitamin D levels a few years ago. When I first had my vitamin D levels tested, I was at 16.1ng/ml. Normal levels range from 30ng/ml and up. So my primary provider (not my hair doctor) has me taking vitamin D supplements. Nonetheless, I have not seen any difference in my hair loss progression.
- In June 2014, doctors at Yale University tried an unusual treatment to hair loss using an FDA-approved drug, tofacitinib citrate, which is designed to treat the autoimmune disease called Rheumatoid Arthritis. The patient, who had Alopecia Universalis (that is not Androgenetic Alopecia or Male Pattern Baldness), was able to regrow a full head of hair, eyebrows and eyelashes, facial, groin, and other hairs. Researchers suggested that the drug works by stopping the immune system from attacking hair follicles. However, doctors believe such treatment could only work on patients with Alopecia Universalis. 
Read as much as you can about hair loss to keep yourself educated. Save your money to be able to afford effective and proven treatments in the future. I am including some reputable websites and consumer advocate information about hair loss.
By Luis E. Blandon