Male pattern hair loss is the predominant type of hair loss in men. Male pattern hair loss (male pattern baldness) is extremely common, affecting up to 70% of men eventually.
With this type of hair loss, hair thins and then stops growing altogether along the hairline, temples, and crown of the head. Even in men with severe male pattern hair loss, a “wreath” of hair typically remains around the lower part of the back of the head.
Treatments for male pattern baldness range from accepting it and embracing the smooth look to topical treatments (like Minoxidil) to drugs to surgery. Propecia (finasteride) is the “gold standard” for treatment of male pattern hair loss with oral medication. Hair transplantation is a popular surgical approach to treating male pattern baldness.
Hair transplantation has been used in the US since the 1950s, and was used earlier than that in other countries. Propecia was approved as a treatment for male pattern baldness in 1997 and has been used by millions of men since that time. Here’s what you should know about Propecia versus hair transplantation.
Best Candidates for Propecia and Hair Transplantation
Best Candidates for Propecia
Propecia doesn’t work identically in everyone. Typically it works best in men whose hair loss has not advanced that much. Propecia may slow hair loss in some men, but fail to stop it altogether. In other men, it may arrest hair loss, but not cause new hair to grow. In still others, hair loss may reverse, and over time new hair will grow in. The majority of men who take Propecia will notice some positive result. Results tend to be better in men who start taking it within a few years of noticing male pattern hair loss.
Best Candidates for Hair Transplantation
Hair transplant surgeons look at density of remaining hair, that is, the number of hair follicles per square centimeter of scalp. They also consider a scalp quality called “laxity.” Laxity refers to the flexibility and looseness of the scalp. When hair density and scalp laxity are both high, the results of hair transplantation are usually better.
Coarse hair can be transplanted with fewer hairs per graft because the coarse hairs individually provide better coverage. Fine hair gives less coverage. Wavy or curly hair tends to do better in transplantation because it gives better scalp coverage than straight hair. Also with transplantation, the closer hair color and skin color are, the better the appearance after transplantation. If you have straight, dark hair and a light complexion, your case will be more challenging to the transplant surgeon.
How Propecia and Hair Transplantation Work
How Propecia Works and How to Take It
Propecia’s active ingredient is called finasteride, which works by inhibiting an enzyme called 5-alpha reductase. This enzyme converts regular testosterone to a form called dihydrotestosterone (DHT), which directly affects hair follicles, causing hair to thin and eventually stop growing altogether. The less testosterone that’s converted to DHT, the less the follicles are affected, and the better the chances of hair growth. Propecia is taken once a day as a 1 mg pill. It has to be taken every day to work. If you stop taking it, your hair will start falling out again. Because hair growth takes time, it can take anywhere from three months to a year to determine how well Propecia is going to work for you.
How Hair Transplantation Works
Hair is transplanted not between donor and recipient like a kidney transplant, but between one part of your scalp and another. Scientists haven’t figured out how to transplant hair from one person to another. Most hair transplants are done in a doctor’s office using local anesthesia. The donated hair, follicles, skin, and surrounding tissues are called grafts. Each graft contains one or more hair follicles.
The two main types of grafts are strip grafts and follicular unit grafts. Strip harvesting is the most common technique, where the surgeon harvests a strip of tissue from an area of good hair growth. Strips are around 1 cm by 15 to 30 cm in size. The strips are dissected into smaller units of naturally formed groupings of hair follicles. The surgeon uses microblades or fine needles to puncture the sites that will receive the grafts, placing them carefully in terms of density, pattern, and angle to mimic a realistic hair pattern.
Follicular unit extraction, or FUE, involves harvesting individual “follicular units” containing one to four hairs. These tiny harvested units are then placed into the receiving sites similarly to how strip harvested grafts are placed. FUE is more time-consuming, and some candidates are better than others for FUE. The advantage of FUE is that there is no single large incision or scar, and therefore no suture removal is required.
Risks With Propecia
Time is the biggest risk with Propecia. It can take several months to know how well it will work. You could invest several months and realize it didn’t help much. However, a majority of men taking Propecia do notice positive results, though just how positive the results are varies. The most common side effects noted with Propecia include chills, dizziness, and light-headedness when standing up. Propecia should not be ingested by women, nor should it be handled by them due to the risk of severe birth defects should the woman become pregnant.
Risks With Hair Transplantation
Though hair transplantation is not considered to be invasive surgery, it is a surgical procedure and therefore carries risks. The primary risks are bleeding and infection. Other risks of hair transplantation include scarring and new hair growth that looks unnatural. Hair transplantation is an art as well as a science, so it’s critical to choose a surgeon with the right combination of technical skills and artistic sensibility for best results. Once new hair growth starts after transplantation, some men experience folliculitis, which is inflammation of the hair follicles. This is generally relieved with compresses and sometimes with antibiotics if infection is suspected.
Cost of Propecia
If you buy the name brand Propecia made by Merck, you’ll pay around $4.65 per day, roughly what a cup of Starbucks costs. If you choose generic finasteride, you’ll pay just under $4.00 per day.
Be patient with Propecia. It can take a while to produce noticeable results.
Cost of Hair Transplantation
Hair transplantation costs vary significantly. Some men need multiple procedures to cope with extensive hair loss. You should count on one to two transplant procedures at the least. Each session lasts five to ten hours. Expect to spend from $4,000 to $15,000 for hair transplantation. The procedure is rarely covered by insurance, and hair transplantation is not something you want to cut corners on, so it’s important to choose a skilled surgeon who comes highly recommended.
Propecia (or generic finasteride) is going to suit most men’s needs better than hair transplantation. It’s a once-a-day pill, serious side effects are rare, and it’s more affordable than hair transplantation. However, Propecia works better for some men than others. For many men, however, it’s worth a six month trial to gauge effectiveness before making a decision on hair transplantation.
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