Hair Transplant > Hair Transplant Surgeon Interviews > Hair Transplant Surgeon Dr. Paul McAndrews Interview Part 2

Hair Transplant Surgeon Dr. Paul McAndrews Interview

Part 2

Regrowth: Do you prescribe Proscar to your pateitns who want to get on Finasteride but want to save money by quartering Proscar pills?

McAndrews: Yes, we do have a few patients that cut the Proscar pill (5mg of finasteride) into quarters in order to save money. However, we have had some of these patients revert back to Propecia because of the inconvenience of splitting the tablets.

Regrowth: What percentage of your patients using Propecia would you say experience side effects:

McAndrews: Approximately 1-2% of our patients experience side effects that they report to us.

Regrowth: Do you recommend Rogaine Extra Strength / Minoxidil 5% to your patients?

McAndrews: Many of our patients use Rogaine Extra Strength / Minoxidil 5%. Once again, we believe it is our responsibility to educate our pateints on the PROS and CONS of all the legitimate medications for hairloss and then let our patients decide.

Regrowth: Do you find Minoxidil 5% provides additional results over Minoxidil 2%?

McAndrews: We are seeing better results in our patients that have switched from the 2% minoxidil to the 5% minoxidil. The result of the clinical studies of 5% minoxidil published in the Dermatological Literature is bearing this out.

Regrowth: How do you feel about the higher strength Minoxidil formulas of up to 15% that can be obtained via a prescription through custom compounding pharmacies? Do you think they will provide additional results?

McAndrews: Theoretically, we would expect the higher strength minoxidil formulas to show better results than the traditional strengths (2-5%).

However, we are a big believer of letting our patients know what we "do" and "do not" know. There is no "double blind human studies" comparing the effectiveness of the higher strengths of minoxidil (12-15%) versus the traditional strengths (2-5%). Therefore, we can only base our beliefs on case reports from several of our patients who do feel it is more effective.

Regrowth: Have you prescribed Minoxidil 5% to many women and if so how effective was it?

McAndrews: Yes, we have prescribed 5% minoxidil to women. There is only one study performed in women that looked at the effectiveness of 5% minoxidil in women and it showed "no significant improvement" over the 2% minoxidil. This has not been our experience with 5% minoxidil in women. We feel it is more effective than the 2% solution, however there is an increased side effect profile.

Regrowth: Have you seen any or many women using Minoxidil (2% or 5%) who had the side effect of unwanted facial or body hair growth?

McAndrews: Yes, we have seen the growth of unwanted facial hair with the use of minoxidil. This side effect seems to increase with increasing the strength of minoxidil to 5%.

Regrowth: What do you think of the claim of the woman who is suing Upjohn saying Minoxidil caused unwanted facial growth that didn't go away after treatment was discontinued?

McAndrews: We have seen the growth of unwanted facial hair in women using minoxidil. However, in every case I have seen, the unwanted hair resolves with the discontinuation of minoxidil.

Regrowth: Do you find patients using both Propecia and Minoxidil 5% have better results than patients using either alone?

McAndrews: Theoretically we would say YES. Propecia and Minoxidil work on different mechanisms of action. We constantly see that dermatological diseases respond better using a combination of medications with different mechanisms of action than either one when used alone.

There was a study loking at the stumptail macaque monkey, who appears to have a similar pathogenesis of balding as humans. There were three study groups of monkeys; one group of monkeys were treated with minoxidil alone, another group of monkeys were treated with Propecia alone, and the last group of monkeys were treated with both Propecia and minoxidil. The monkeys who had both Propecia and minoxidil grew significantly more hair than the monkeys that had a single form of treatment. Unfortunately, there have been no studies presently performed on humans to prove this point.

Regrowth: What is the largest improvement you have seen in someone taking Propecia alone (on the Norwood scale)?

McAndrews: Norwood III+ to Norwood II.

Regrowth: What is the largest improvement you have seen in someone using Minoxidil 5% alone (on the Norwood scale)?

McAndrews: Norwood II(Vertex) to Norwood II.

Regrowth: What is the largest improvement you have seen in soemone using both Minoxidil 5% and Propecia (on the Norwood scale)?

McAndrews: Norwood III+ to Norwood II.

Regrowth: What do you tell people for whom Minoxidil 5% and Proscar is ineffective and who don't wish to have transplants or use a hair system?

McAndrews: Unfortunately, there is no perfect treatment for every patient's hairloss. There are other medications that could be considered, such as retinoic acid, azelaic acid, or spironolactone. However, these also may not be effective. Therefore, part of our responsibility to the patient is to make them realistic about the limitations of the medical, surgical, and cosmetic treatment options and help them steer clear of the "snake oil" companies. At times, the best treatment option for some patients is NO TREATMENT at all.

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