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Propecia is a 1mg oral tablet taken daily and acts as a potent 5 alpha-reductase type-2 inhibitor. It blocks the conversion of testosterone to Dihydrotestosterone and decreases levels of DHT by about 65 percent. It is the most effective of all the medications and has shown impressive effects in both stopping or slowing further hair loss, as well as producing re-growth. The effects are greatest on the crown however it also has beneficial effects in the frontal area as well. Five-year results showed over 85% of men stabilized or improved.






Propecia not officially FDA approved for use in women and is actually contraindicated in women of the child-bearing age because of possible birth abnormalities that could occur to the fetus. However there have been studies that suggest Finasteride may have some beneficial in both pre and postmenopausal women. Due to these reports Propecia has been used off label for hair loss in women. When used in women of childbearing age the physician is taking a medical/legal risk, and at a minimum needs to make sure the patient is on birth control.


In general, after 25 years of being on the market, the side effects profile of finasteride are felt to be very low. In men the most common concerns are sexual side effects, gynecomastia and decreased semen volume. Numerous double blind studies have shown the overall incidence of sexual side effects to be very low at less than 4.5% and reversible when stopped.

However, recent concerns have been raised on the internet over anecdotal reports of more permanent sexual side effects as well as other symptoms collectively called “Post Finasteride Syndrome (PFS)”. Whether or not this is a true clinical entity is currently controversial. Studies have been inconclusive and have been interpreted in multiple ways. The difficulty in interpretation is that many of the symptoms (i.e. ED, Depression, etc.) occur quite frequently in the general population and would be more frequent in the population of men having angst over hair loss without the influence of medication. Most physicians do agree that IF it does exist it has to be extremely rare and probably occurs in a small subset of patients with some predisposing factors.

However, PFS has made big splash the last few years and both physicians and patients need to be aware of this issue and be able to discuss it. The main decision to be made after an open discussion is; whether the almost certain, very positive benefit of improved hair growth and density is worth the very small (but possible) risk of some of the symptoms of PFS.


In attempt to reduce potential side effects of Propecia even further two new approaches have been developed:

  1. Low dose Propecia is the use of 1 mg only 3 times a week instead of 7 days a week. It is found to be almost as effective as oral treatment (70%) with less complaints of side effects.
  2. Topical Propecia: A few pharmacies have developed a topical Propecia that stays in the skin. It has been reported, but unsubstantiated, to have fewer side effects but some side effects do still occur.


Avodart is another 5-alpha-reductase inhibitor that blocks both type 1 and 2 versions of the enzyme. The blockade of the type 1 enzyme (in addition to type 2) decreases levels of DHT greater than 90 percent and is felt to be more effective than finasteride. However, it has a very long half-life and the side effect profile is thought to be worse than that of finasteride. It is not released for the treatment of male pattern baldness yet some hair transplant clinics prescribe Avodart off label for patients that are not responsive to finasteride.



Rogaine is a topical medication approved for both men and women. It currently is available as a 2% liquid, 5% liquid, and 5% foam. It thought to act as a direct anagen-prolonging agent. It is effective in both men and women, although not to the same degree as finasteride. Although the packaging inserts state it is for the vertex, it works in both the front and crown.
Personal experience, and experience from colleagues suggests that approximately 50% of men have their hair loss slowed or stopped, 20% show some signs of regrowth, and 30% continue to lose hair (i.e. no effect). Rogaine is currently available over the counter (OTC).

A number of companies & pharmacies have created shampoos and topical lotions that contain Minoxidil plus other ingredients to combat hair loss. In many of the over the counter products that fight hair loss the main component is Minoxidil. One popular product that patients seem to feel works is Formula 82M. Formula 82M contains 5% Minoxidil, tretinoin, the topical steroid 0.01% fluocinolone, and a natural 5-alpha reductase blocking agent, oleanolic acid, in addition to several other ingredient in non-propylene glycol base. Many patient feel it works better with less irritation than over the counter Rogaine foam.


A big problem with the use of Minoxidil is compliance. In addition to irritation, the original product was oily and messy. The newer 5% foam as well as the Formula 82m mentioned above contains no propylene glycol so it is much easier to use and is better accepted by patients. It was recently FDA approved for women as a once a day therapy.
Another potential side effect in some women in an increase in facial hair but it is uncommon and mild if it occurs. Minoxidil was originally used orally as a blood pressure medication. Therefore, and also very rarely, it has been reported to cause a slight drop in blood pressure and palpitations. Usually one would have to be very sensitive or use a lot more than recommended.


Oral Minoxidil is an option for patients who find the topical form too messy or would prefer the convenience of a pill. It has been used in low dose ( 5mg) by Dr Pathamovich in Thailand for 22 years with reports of success and minimal side effects.


Laser Light Therapy (or Low Level Light Therapy) has become very popular over the last 10 years. Originally it was controversial and reserved for inconvenient office treatments using a larger bulky appliance sized devices. Over the last few years a number of less expensive & in home treatment laser light devices have been developed.

A number of studies have now confirmed that consistent use will thicken miniaturized hairs and slow hair loss. In some cases new hair growth is observed. The results are variable with some patients getting great results while other get less impressive results but it is a good adjunct for patients to consider.

Typically, a patient needs to use the laser device 3 times a week for only 20-40 minutes. Most devices are in the form of a helmet that is designed to be worn at home but there are options that present as a hat or ball cap which are battery powered and designed to be worn outdoors and while running short errands.