Most male pattern baldness is due to the accumulation of 5 DHT in the hair follicles preventing the hair from growing, explains Dr. Gary Hitzig, a hair transplant surgeon from Rockville Centre, N.Y. The cause is genetic, with genes from both mom and dad contributing to the way a man becomes sensitive to 5 DHT.
Popping a Pill
Propecia is a drug that blocks the formation of 5 DHT. At 1 milligram it is used for hair loss treatment; at 5 milligrams, doctors use it to treat prostate conditions.
Before a doctor would give a prescription for Propecia, he or she would take a medical history, says Hitzig. Certain drugs, for example, can cause hair loss, such as certain high blood pressure medications and diuretics. After ruling them and other diseases out as factors, Propecia might be recommended.
The problem with Propecia is that some men of the men who take it — less than 2 percent — experience some sexual dysfunction, such as impotence or reduced sperm volume. “That is too high a price to pay to treat baldness for some men,” Hitzig says.
Chris Fanelle, a spokeswoman for Merck & Co of West Point Pa., says any sexual side effects go away in men who stop taking the drug. They also disappeared in most men who continue taking Propecia.
Doctors suggest men also must take a prostate specific antigen test before they start taking Propecia to obtain a baseline level of this diagnostic marker for prostate cancer. The drug cuts the PSA levels in half.
Propecia is effective in growing good hair, doctors say. In Limmer’s practice, 66 percent get good coverage, compared to 5 percent for Rogaine. But Hitzig does not recommend that men who are trying to get their wife pregnant use the drug, even though there is no evidence that it does damage. The packaging on the drug says pregnant women should not touch the pills, he says. “It concerns me,” he says.
Going Under the Knife
Finally, if impotence scares the guy away, then he may be willing to go under the knife and needle for follicle transplants. “Don’t go to a surgeon or dermatologist that still uses plugs,” says Limmer. The state-of-the art is follicular transplants, in which groups of one-, two-, three- and four hairs from hairy areas on the head are implanted into tiny holes in the balding area. Single hairs are used to create a hairline.
The extent of the baldness determines how many grafts need to be performed. The “chrome-dome” may need about 4,000 to 10,000 grafts, while a receding hairline only 1,000 to 3,000. Each procedure requires a seven-day healing period, with hair not showing up for 90 days. Groomable hair usually sprouts in six months, with the full benefit accruing in nine months to 12 months.