Transcription
Today, we want to discuss with you two oral medications that are essential to address hair loss: finasteride and dutasteride. We believe these medications are very important if you're experiencing mild to moderate hair loss. So, what we're going to do is compare and contrast these drugs and then decide who is the ideal candidate to take these medications. We will also discuss the possible potential side effects for these drugs, and then you'll make up your mind whether or not you want to take these medications yourself. Okay, so let's dive in.
So, to kick it off, the first thing we want to emphasize is it's never too early to start medical therapy for hair loss. Now, Dad, I know that in your 30s you didn't start medical therapy. I started late, too late, and once my hair follicles are gone, there's no way to revive those hair follicles. So, it's very important to start an early program of taking medication that way you can help to retain, as much of your hair follicles as possible, and possibly, uh, reinvigorate the ones that are starting to become weak. But once it's too—once they're too far gone, there's no way to re-uh—invigorate these these hair follicles; they're gone, and they're gone for good. And then you need to have either a hair transplant or some other method to give you hair in the front of your head.
So, knowing what you know now about hair restoration and about finasteride and dutasteride specifically, you would have started these medications at a much younger age, correct?
I would have started probably in my mid-20s to early 30s. If I started to see recession of my hair in these areas, I would start using oral medication first, and then I would also potentially use other, uh, drugs topically to stimulate my hair follicles. So, the point is that it's never too early. If you start to experience some level of hair loss, that is the time when you should start considering being on medical therapy, and it's possible that finasteride or dutasteride might be a good option for you.
Let's start with: why do we lose hair, and why are some people prone to losing hair?
Yeah, so before we explain how finasteride and dutasteride work, it is essential to understand that hair loss, for the most part, is genetic. Okay, and so you might have a higher propensity for having hair loss than someone else. Now, genetics is not the only thing, but it's a big part.
Well, my grandfather had lost most of his hair, both my grandfathers and my father lost hair later in life, so I assume I inherited some of their genes.
Yeah, and in my case, I got lucky because hair loss is actually polygenic; it's not just one side of the family. And my grandfather on my mother's side had a full head of hair, uh, his entire life, and so I'm blessed; thankfully, I got the good genes on that side of the family. So, genetics does play a big role, but genetics is not the entire story. There can be a buildup of the hormone testosterone, and testosterone gets converted by an enzyme called 5-alpha reductase into another hormone called DHT. And if you're someone who has a genetic propensity for hair loss, your follicles on your scalp will be more sensitive to DHT, and DHT is a major, major contributor for miniaturization of hair follicles as well as hair loss. And the DHT actually are more sensitive in certain areas of the scalp, so really, you know, in the mid-scalp, in the frontal area, in your crown, not necessarily in the back of your head. So, that's something to keep in mind.
So now we can talk about the medications; we can talk about finasteride, we can talk about dutasteride, because now you understand the basics of why we're having hair loss to start.
So, finasteride and dutasteride work in a very similar way; they block an enzyme called 5-alpha reductase. And when you block that enzyme, you decrease the amount of DHT that's floating in your bloodstream that could cause hair loss. Now, finasteride originally was a medication that was prescribed for benign prostatic hyperplasia, and what they discovered was when men took this medication, they would grow hair. Fast forward, it was discovered that finasteride blocked the enzyme 5-alpha reductase type 2, and that had an impact in decreasing floating DHT, and it did this by decreasing it by the activity of the enzyme by 60%. So, it didn't 100% block the enzyme; it blocked it by 60%. Fast forward, we now have another medication, dutasteride, and it's been discovered that dutasteride can block the same exact enzyme by 90%. And also blocks another 5-alpha reductase; it's called type 1. So, it's a much more powerful drug; so it blocks one and two, one and two. So, in fact, they did a study looking at dutasteride in comparison to finasteride to stimulate new hair growth, and they found that dutasteride was clinically significant in terms of stimulating new hair growth. And so, in our practice, we like to put patients on dutasteride over finasteride. The only time that we would not put a patient on dutasteride is if they're experiencing side effects. We can always change them over to using finasteride, but we would prefer to use dutasteride.
So, we get a lot of questions about who is the ideal candidate, and there's a lot of patients who come in and don't even know that they can be on oral medications. So, what should we tell them?
So, ideally, I believe any male over the age of 18 who has mild to moderate hair loss is a candidate to be on either finasteride or dutasteride. I would not advise any woman who is, uh, premenopausal to be on the medication because it can have, create birth defects in a male. So, that's a no-go. However, a postmenopausal woman who is, experiencing hair loss is a good candidate to be on either dutasteride or finasteride, uh, it will help those patients who have what's called androgenetic alopecia.
Now, how about if you're a male and you want to conceive with your partner, should they stop these medications?
No, I would say that anybody planning on having, having a family, they should not, uh, be on either either drug for at least a year prior to that, uh, decision because these drugs can impact, uh, the sperm count and, potentially, even the morphology of, of the sperm itself. So, we don't want any secondary effects to impact, uh, your fertility in terms of having children. So, we would like you to be off the medication for a minimum of a year prior to starting your family. And that's a very good thing to know. You have to take a lot of precautions when you take these medications, even as a male, especially as a, as a woman, but even as a male, to think about when you're going to have kids and you're thinking about building a family; it's something that doesn't get emphasized enough by hair surgeons, by dermatologists, or some of these websites that promote hair loss medications.
Correct. So, Ross, tell me what would happen if the guy who is thinking of conceiving and having a family, what happens to his hair if he stops the medication?
So, this is a very common question that we get all the time. When you are on any hair loss medication, number one, it's a lifelong commitment. So, when you take the medication, it's all about stimulating your hair, but you can stop the medication at any point, and if you stop the medication, it doesn't mean you're going to nosedive; you're not going to go from having hair to no hair overnight. It's a gradual decrease. Now, if you're conceiving, that's, it's a great reason to stop the medication well in advance, well in advance. Um, if you have a medical issue, you have to stop the medication; another warranted reason, but you can always restart it. But the big takeaway is that you want to continue to take these medications, and I hear stories all the time; patients say, I took finasteride, I took dutasteride, my hair was growing, I didn't see any reason to continue taking the medication. It's an illusion; they think, I took the pill, it's solved. Doesn't work like that, right? It's because they were taking the pill consistently, or they were using foam, or they were using a topical version of hair loss, of the hair loss medication that allowed them to maintain hair growth. So, don't get, yeah, confused, confused; this is not a one-and-done; this is an ongoing program to try to re-help you retain your hair, uh, starting at, at a relatively young age.
100%. And that's the big takeaway. You can stop these medications; there's nothing wrong with that, and you can restart them, but have a mentality that once you start, you really don't want to stop unless there's certain moments in your life that make sense to stop the medications.
Exactly, exactly. And that includes, by the way, even after you've had a hair transplant; you need to maintain these medications ongoing to keep those hair follicles, uh, from, uh, being subject to DHT, the insult of DHT on your hair follicles. So, you really need to maintain this, uh, medication as an ongoing commitment. And you brought up a great point when we're talking about hair transplants; it's not just about the hair transplant that gets you the great results; it's the hair transplant paired with medical therapy is where you get the optimal results.
Exact. So, especially in our practice where we do hair transplants, we also do medical management, and that is critically important for success in terms of hair, right? It's an ongoing program; it's not a one-and-done, uh, thing. And so, that's why people who go to foreign countries for instance and get hair transplants, they're really missing part of the puzzle, because part of the piece of the puzzle is, is not just getting the transplant; it's also the ongoing medical therapy that is associated with retaining your hair and, and having robust hair regrowth, uh, on your scalp. So, that's something to consider.
So, there are three ways to receive this medication: either orally, topically, which can be massaged into the scalp, or injected into the scalp, and that's called mesotherapy.
So, Dad, I know that you use the oral pill of dutasteride, right? And it's very simple, uh, very convenient; once a day, take a pill when, on brushing after brushing my teeth, and I forget about it for the rest of the day. Now, I like to put patients on oral, uh, medication for finasteride or dutasteride, but some patients are a little hesitant to be on oral medication; they're concerned about the systemic side effects and, and thinking it's having a widespread effect on their body. So, so luckily, there, there's the option of using a topical form of the medication; either comes in a liquid or a foam form. There's a little bit more involved because I actually have to apply it to the area that has thinning, and they have to scrub it in, you know, one or two times a day, right? And then, then we also have the option of patients coming back to the office for injections with microneedles into the scalp, which delivers the drug directly to, to the hair bulb, uh, in the scal—in the scalp, and we think that's a very effective way to treat hair loss.
Yeah, so this is called mesotherapy. So, whether you're a female or a male, you can get this treatment. You can't get this treatment if you are premenopausal or if you're obviously conceiving, but it works the following ways: we have you come in the first three months, one time each month to get these injections, and if you're a male, you come back every 3 months following that, and if you're female, every six months, and it's very effective in conjunction, actually, with using oral or topical forms of medication. So, that's another way to boost the, uh, medication in the area concerned.
Certainly, I do want to emphasize, however, when you use these medications, they don't work overnight. It takes weeks to months before you actually manifest the benefits of these drugs. It's not something that's, you know, like snap and you, and you got hair growing. So, you got to be committed to a long-term treatment protocol. You can't think that this is going to be like magic dust and make your hair grow overnight. You have to realize it's going to take weeks to months, and it takes a lot of patience before you see results. You will see results, but it takes a long time. You know what, it's very much like fertilizer, and it's pushing your hair from the resting phase really into the growth phase; that takes time, and that's why patients need to be patient. You have to be patient when you go on these oral medications; they're not going to work overnight, but they will start working within a couple of months.
Ross, I'd like to review for our listeners what the potential side effects are for these medications. Granted that these side effects are relatively rare, rare; they're not common, and millions of people, you know, who are taking these drugs for, uh, prostate enlargement are out there, and hair loss, but my point is, it's the, these side effects are rare statistically. Tell us, though, what the potential side effects are because I want the listeners to all know everything before they make the decision on whether or not they're going to, uh, take these medications, of course.
So, look, number one, we feel that these medications are very safe to prescribe to patients because they've been tested, and they've been tested, as you mentioned, by millions of patients. There is a very low level of risk in terms of side effects. So, as we mentioned, you can get decreased sperm count, you can get libido, erectile dysfunction. In fact, some men who take the medication within the first two or three weeks feel like they have libido or erectile dysfunction; it might just be psychological. So, for those patients, I would encourage you, don't stop the medication yet; give it a little more time. Sometimes it takes two or three months, and those side effects will dissipate. Now, if they do continue, you can stop the medication, right, and you'll resolve your, your sexual drive. So, I'm not too concerned about that. Okay. Now, there's another rare side effect; it's called gynecomastia, enlargement of male breast; very rare again, a side effect I have to warn you about, but something I don't expect. The other thing that I think is important to point out is that if you're a male and you're using topical finasteride and you're with someone that you're trying to conceive with or they're pregnant, and you're using finasteride, be careful. In some cases, I would even encourage you to stop using topical finasteride because I'm not concerned about you as the male partner; I'm concerned about the female partner because if she gets exposed to finasteride, even from a pillow sheet, right, that could be dangerous to a fetus, right? So, we want, we want women to stay away from any of the medications in terms of even touching the medication on their skin; there's a remote possibility that it could have an effect on their pregnancy. So, again, we want to be super cautious. Of course, if you're thinking of conceiving and having a child, the male, uh, partner also has to be off, off the medication technically because we don't want, uh, any changes in the, uh, morphology of the sperm or the, or the amount of semen that they're producing.
So, I think we've covered basically the side effects side that they might expect, right, but unlikely to experience.
Exactly. So, we hope that this, uh, session between us, uh, has been informative, uh, you're, you're going to be able to make a more informed, uh, decision on whether or not you want to undergo oral, topical, or injectable therapy, and, uh, I guess that's it. Is there anything else you want to add?
Well, if you have any questions that we did not address, we'd love for you to leave them in the comments below. We do our best to really answer everyone's questions, and we're so happy to have you come along on this journey with us because we want to make sure that you're super informed about medical therapy and hair transplants, um, and that's basically it. So, okay, see you later.
See you later.