Hair Loss Prevention

Overview: You Don't Have to go Bald!

In 1994, Dr. Elliott, then 24, had his first hair transplant to the corners of his receding hairline. He liked the result so much that he decided to specialize in hair transplant surgery. The next year he got a sunburn on his crown and realized that the loss was progressing. He had learned about the use of Finasteride in hair loss research and started taking it. Two years later, sunburns didn’t happen anymore. There was more hair as a result of Finasteride. He started using Minoxidil as extra “insurance” against future loss. He remains convinced of the importance of early medical treatment in hair restoration.

In 1994, considering your options meant the re-growth treatment Rogaine®, hairpieces, or hair transplants. Rogaine® didn’t re-grow hair like it said it would and hairpieces looked like hairpieces. Plugs were gone. Doctors were doing transplants that were natural, but your hair loss continued. Today, we can stop your loss with Finasteride and we understand that Rogaine® has a new role. Hair transplantations possibilities have expanded far beyond what could have been predicted 10 years ago. It was always important to consider all your options, but today they include effective prevention.

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What Can You Do To Prevent Hair Loss?

If I already have these genes and can’t get rid of them, what’s the point in worrying about fate?

If there were nothing that could be done, there would be no point. But, now we have treatment to stop the loss. You can do something to take control.

I don’t want to go bald! What can I do?

The most important message is to act to stop the hair loss early. With every day that goes by, you lose more hair. Thankfully, there are better options to treat AGA than ever before. You can stop or slow the loss with medical therapy, maintaining your hair as many years as possible. Hair restoration surgery may be the right option to reverse the appearance change that you have already suffered. Non-medical options, like hairpieces, also can compensate for the appearance of hair loss.

When should I start preventive treatment?

Start the day you know you have hair loss. The reason is simple: it is easier to save hair than grow it back. Early treatment will maintain hair so it is not lost in the first place. The more hair you save, the more you have. No one ever complains to Dr. Elliott about having too much hair.

When should I see a hair loss specialist doctor?

You know your hair best. If you think you are losing, you are probably right. Get it checked. You may not need any treatment yet, but remember; early treatment saves hair.

What really works?

There have always been a lot of unproven treatments available. Some might even work, but there are only two scientifically proven options to regrow hair: Medical therapy and Hair Transplantation. The approved medications are Minoxidil ( Rogaine® and generics) and Finasteride ( Propecia® ). Minoxidil is topical (you put it on your scalp) and Finasteride is a pill you take by mouth.

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About Minoxidil (Rogaine®)

How does Minoxidil work?

After all these years, we still don’t know the exact mechanism, just that it works to help slow and prevent loss.

I tried it years ago and nothing grew.

When Minoxidil first came on the market it was as a hair re-growth treatment for men. It didn’t work well, and mostly grew “peach-fuzz”. It was also expensive. Expensive and ineffective is a bad combination.

What’s different with Minoxidil now?

Several things. We now know that its best use in men is to prevent future loss. This means that to get any benefit, you have to use it before the hair is lost. When used in the newer 5% concentration, results are even better. We also know that it is the best medication treatment for women, producing better results than in men. The other difference is that it is now much cheaper.

How fast does it work?

Several months may be needed to see the effect of Minoxidil. Serial examinations and photographs are needed to track progress.

How do you use Minoxidil?

The solution must be applied on the scalp twice per day. Using it only once is usually a waste of time. With simple techniques, this can be done in less than a minute and won’t affect hairstyling. Dr. Elliott will show you how to apply it easily.

If it’s topical, then there are no side effects, right?

Not quite. Side effects are not common, but can be a red rash in the areas treated. This is usually not an allergy, but sensitivity to the solution that the medication is dissolved in. This often improves, or a pharmacy can prepare Minoxidil in a different solution which doesn’t cause the rash.

Can it make my hair loss worse?

No, it won’t. However, in some patients there may be increased hair shedding between 4 and 6 weeks after starting. This actually represents new hairs (follicles starting new anagen cycles). The new hairs push old resting telogen hairs out of the follicles. This means the treatment works. The new hairs take some time to grow out to styling length. This may mean things get a little worse before they get better. When treatment is being supervised, your doctor will reassure you that nothing is wrong.

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About Finasteride (Propecia®)

Do we know how Finasteride works?

We know exactly how: by lowering levels of DHT, the culprit. It blocks an enzyme that converts testosterone to dihydrotestosterone (DHT). Once you are out of puberty, the only thing DHT does is fuel AGA and cause the prostate gland to enlarge. This is why lowering DHT doesn’t cause the body to work any differently, or men to take on any female physical traits.

Why do I have to take it everyday?

If you stop, the blockage of the enzyme is lost, DHT levels rise and hair loss resumes. Remember that the genes haven’t gone away.

I tried it once but it didn’t work.

Many patients who initially tried Propecia® when it came on the market in 1998 were disappointed. The problem was starting the pills expecting immediate re-growth. You took it for 3 or 4 months and nothing happened. Then the prescription ran out, and you were busy so you didn’t get it refilled. The average length of time that men take Propecia® in North America is only 6-8 months. Yet, it takes longer than this to see all the benefits. See a specialist who can explain to you at the start what to expect from the medication.

What should I expect from medical treatment?

You should expect to stop losing hair. This will happen in 90% or more of men. Give treatment a one-year chance to prove itself. More than half of men will also experience re-growth with Finasteride, but look at this as a bonus from the second year on treatment. In Dr. Elliott’s experience, there are very few men who don’t see benefit after the first year.

How fast does it work?

Stopping the loss is like slowing down a train; it takes time. Finasteride acts to slow down and stop the loss over the first 3-6 months. Full benefit, including any re-growth will be seen between 12 and 24 months. Serial examinations and photographs are helpful to track progress.

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Which Medication Works Best?

Which works best, Finasteride or Minoxidil?

It is useful to think of minoxidil as a fairly effective hair maintainer, but a weak re-grower, and finasteride as an excellent maintainer and a fairly effective re-grower. Dr. Elliott believes that the most effective medical therapy is the combination of finasteride and 5% minoxidil. (It’s what he uses himself!). Think of Finasteride as the engine and Minoxidil as adding a few more horsepower.

Do the medications work for everyone?

Finasteride will stop hair loss in about 90% of men who use it, minoxidil in less. Without medical treatment, about 90% will continue losing. Discuss this with your hair loss specialist physician and decide what is best for you.

Do the medications work everywhere?

Minoxidil is proven effective only in the crown (top back) and finasteride in the mid-scalp and crown. Imagine a line drawn from ear canal over the top scalp to the other ear canal. Medical therapy is proven effective behind that line. It may help in the front half as well, but this has not yet been proven.

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Does Medication Re-Grow Hair?

Will they actually regrow hair?

Minoxidil does not commonly re-grow full diameter, comb-able hair, but may grow some finer, shorter hairs. Finasteride will grow normal quality hair in about 60% of patients, but only in the back half of the top scalp.

What if I have been bald for a long time?

Can those follicles still be revived? Finasteride is most worthwhile when used early before the hair is lost. Physicians initially thought that Finasteride would never be effective in long-term stable AGA. However, Dr. Elliott has had many patients re-grow hair that had been lost 15 years before. He believes it is always worth considering. If you could regain some hair just by taking a pill, would you think it was worth it?

Are there no guarantees?

What is guaranteed in nearly everyone is more hair loss. That is, unless you do something about it. You will never see any benefit if you don’t try.

If its not going to regrow my hair, is it worth it?

Dr. Elliott believes that saving hair is always worth it. At minimum, treatment will allow you to slow down the thinning. Most patients in his practice achieve more than this and feel medical treatment has been very worthwhile. You should discuss treatment expectations with your physician.

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Over the Counter Medication For Hair Loss

How about using over the counter stuff?

Not a problem, but it doesn’t work as well (most don’t work at all). The only effective medical treatment available over the counter is Minoxidil 2% (also 5% in USA). It is better than doing nothing, but your doctor can help you do better still.

I have heard about Saw Palmetto and other stuff on late night TV. Does any of it work?

The truth is, no one knows. There have never been any scientific studies done on these products to show that they work. There is no harm in trying, as long as you are not missing out on the proven treatments. Unfortunately, most of these products cost more than Minoxidil and Finasteride combined.

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Why See a Doctor?

Why go through the extra step of seeing a doctor?

Simple. To get better treatment, advice, and monitoring than you can do on your own. The 5% minoxidil concentration is more effective than 2% and, in Canada, is only available with a prescription. Finasteride, the most effective medication, is by prescription only.

Who should I see?

Your family doctor or dermatologist can prescribe 5% Minoxidil or Finasteride. However, early treatment saves hair, and most physicians are not trained or experienced in recognizing early hair loss and may place a lower priority on early treatment, or on treatment of any kind. Seeing a hair loss treatment specialist may be the best use of your time. They are also more experienced at avoiding or managing side effects. Dr. Elliott has treated more than 2000 patients with these medications since 1996. He uses both medications himself.

Do I lose anything by waiting?

You lose hair. Imagine two men with equal hair loss potential at 30 years of age. One starts Finasteride now and the other waits until three years later. Both stop their loss. What’s the difference? The one who started at 30 will have more hair at 35 because he saved more early on. He never got as bald as the other man did before he stopped losing. This situation has been studied, and is what actually happens.

How can the effects of treatment be tracked and monitored?

A hair loss treatment specialist will track the results of treatment with standardized clinical examination and photography. This is important in the decision making process for the long-term fight against hair loss. How else will you know if you are making progress?

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Side Effects of Medication

Doesn’t Propecia® (Finasteride) have bad side effects?

Side effects are RARE (less than 2% of patients) and REVERSIBLE (never permanent). Physicians who have a lot of experience with finasteride will tell you that side effects can be either reduction in your libido (sex drive) or problems getting an erection. In the real world, after treating thousands of patients, Dr. Elliott has been able to avoid side effects in 99% of his patients.

Is it safe if a couple is trying to get pregnant?

Yes, it’s safe. There is no risk to a woman if her partner is taking Finasteride. This was a common misunderstanding after Propecia® became available.

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Medication is Your Choice

I don’t like taking pills. Can’t I just use the Finasteride on the scalp like Minoxidil?

No, because it works in a different way than Minoxidil. Using the medication on the scalp surface only blocks the enzyme in the scalp. Most of the DHT that chokes the follicles comes from the blood circulation. You have to block the DHT in the whole body to achieve a lower level at the follicles.

I don’t want to take medication for the rest of my life!

Of course not. No one does. It’s just a choice that you make. The alternative is losing more hair. Think of it like brushing your teeth. You don’t have to brush your teeth, but if you don’t, they will fall out. So, you choose to brush them. You may only decide to treat the loss with medication until you are older, or until better treatment comes along. There will be improved treatment in future, but in the meantime, you are not getting balder.

If I stop my Finasteride or Minoxidil, will I lose more hair?

You will lose whatever hair the medication has been maintaining. Remember that there is no cure, just the ability to block or slow the effects. Think of a condition like Asthma. There is no cure, but with treatment, the symptoms go away. If you stop the medication, the breathing problems return.

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Women and Hair Loss Prevention

Is the treatment different for women than it is for men?

The progressive nature of hair loss is no different, so the importance of early medical therapy remains the same. However, Finasteride is for use only by men. The good news is that Minoxidil is a far better re-grower in women than it ever was in men. It is the best medication to start with, though there are others. Dr. Elliott believes better results are achieved when the treatment is designed and supervised by a hair loss treatment specialist.

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Surgery Vs. Medication

Should I do surgery or just use the medication?

The answer to this question depends on your hair loss situation and what you want to accomplish. A physician who specializes in the medical and surgical treatment of hair loss can listen to your goals and concerns and advise you on what plan is best to get you where you want to go. Started early enough, medical treatment may be all you need, but it will not re-grow your hairline. For others, restoration with transplants and medical therapy to prevent future loss is the most powerful solution.

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How to Choose a Physician

How do I choose a hair loss treatment physician?

Simple. The same way you would choose any other professional. Experience, skill, integrity, honesty. Someone who understands your problem and takes it seriously. Find a doctor who will work as hard to save your hair as you would if you were a doctor. Someone you can trust with your hair. You’ll know when you’ve found the right one.

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Dr. Vance Elliot