Physician Answered Q & As

Hair Loss Treatment Dilemma, Considering a Hair Transplant

I’m a 23 year old male who seems to be thinning towards a norwood 5ish pattern. I have taken propecia in both 1mg and .5 mg, but have experienced side effects both times. I use Rogaine 5% foam 2x daily. I’m wondering what my next plan of action should be. Should I keep trying propecia? Is it possible to have hair transplant work done if you are not on propecia? Thanks.

First of all, studies on Propecia showed that approximately 2% of patients who take the medication will experience a decrease in libido, or sex drive. Interestingly, in half of the patients who experienced this side effect, it resolved despite continuing to take the medication; the other half had to discontinue treatment for this side effect to subside. The question in your particular situation is, then, how long you have taken the drug. If it is only for a short time frame, for example, a couple of months, then I would advise you to continue it to see if your body adapts to the medication and the side effects subside. Other options are to change the time of day in which you take the drug. That is if you usually take it in the morning, try taking it at bedtime , or vice versa, and see if that makes a difference . You might also try taking it every other day. Obviously if you have taken it for longer term and attempted to make these changes in dosing schedule and, the side effects persist, you will have to make the decision to discontinue the medication.

Hair transplantation in the young patient is complex decision. Certainly, the decision to go forward with the procedure can be made more comfortably in an individual who is on Propecia for at least a couple of years and has shown stabilization of their hair loss pattern. This decision also depends on multiple factors among which are, family history of baldness, present baldness pattern, psychologic maturity of the individual, understanding of the progressive nature of male pattern baldness with subsequent need for future transplants and acceptance by the patient that, if extensive baldness does occur, there probably will not be sufficient donor hair for total coverage, so that a bald crown area may have to be accepted. For this reason, transplants in the young patient are generally limited to very conservative frontal coverage. Also, with the trend towards shaved hair styles, it is important to understand that, despite modern techniques which result in a fine line scar, someone who undergoes hair transplantation will not have the option of shaving their head without some detectability of the donor hair removal.

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