Hair Transplant > Hair Transplant Surgeon Interviews > Hair Transplant Surgeon Dr. Peter Panagotacos Chat Transcript

Hair Transplant Surgeon Dr. Peter Panagotacos Chat Transcript

Peter Panagotacos MD: Good evening, I'm a slow typist . As long as I'm on let's get started.
Mike: ok! what is your opinion on minoxidil and finasteride?
Peter Panagotacos MD: I prescribe both
Peter Panagotacos MD: I prefer Propecia
Mike: you prescribe them to be cut into quarters correct?
Peter Panagotacos MD: It prevents the aging process  of hairs in 85% of men whereas minoxidil simply is an artificial life support for old or dying hairs
Peter Panagotacos MD: Proscar is 5mg Propecia is 1mg
Mike: so do you think that propecia would do almost as good on its own or do you think that minox. is really neccessary?
Peter Panagotacos MD: Proscar can be cut into fourths.
MAN: I am wondering if it is safe and logical to order Propecia from overseas, like New Zealand?  They say no prescription required.
Mike: Man, I believe that as long as it is distributed through Merck to that particular company, it is perfectly ok
Peter Panagotacos MD: It would be safe to order it but it may be stopped by customs
Mike: I have the problem that I am in Canada so its hard for me to obtain products for a decent price
MAN: Customs may stop it, really?
Regrowth: The problem with overseas orders even if they get to you is they are typically more expensive than here... no reason not to go to dr. lee or cyberdocs and pay $20 to get a prescription then get it from the US
Regrowth: well $50 in the case of cyberdocs
Regrowth: or to a dr. like dr. panagotacos :)
Mike: you say $20 does that mean that even I in canada can get these products for a good price?
Regrowth: Dr. P, how much do you charge for consultations for minox/propecia prescriptions?
Peter Panagotacos MD: It is against the law to import meds not approved AND IT IS AGAINST THE LAW FOR A DOCTOR TO PRESCRIBE FOR A PATIENT HE HAS NOT SEEN.
Regrowth: $20 is the price for a consultation/prescription through dr. lee's online service... then you have to get it still from a pharmacy
Peter Panagotacos MD: More than 1 doctor has lost his license for doing that.
Mike: and how much does it cost from the pharmacy (I have no medical plan at the present time)
Regrowth: I got mine for $46
Regrowth: from Walmart
MAN: If it is against the law, how is Dr. LEE able to give an online prescription?
Mike: what did you get for 46?
Regrowth: 30 pills
Mike: why not order from new zealand and pay 100 new zealand dollars for about 3 times that?
Peter Panagotacos MD: In my office I sell Propecia (90) for $125 and the patient gets a $10 rebate from MERK
Regrowth: where from mike?
Regrowth: hi Toronto
TorontoResident: hi all
TorontoResident: sorry im late
Regrowth: Is anybody here interested in transplants or primarily minoxidil/finasteride/etc?
Regrowth: hi man
MAN: hi
TorontoResident: not really interested in transplants
TorontoResident: more for minox finasteride
Regrowth: Hi Alec
Mike: some place called international anti aging systems sells proscar   60 tabs for 150
Regrowth: ahh
MAN: I sit from overseas?
Mike: i think new zealand
Mike: ??
Alec: Hi is Dr. P ready for interogation?
Regrowth: Yes he's answering questions
Mike: I will be right back!
TorontoResident: Im really interested in his various pharmaceutical treatments he can offer
Peter Panagotacos MD: Dont be surprised when youget a call from the FDA about your overseas drugs.
Mike: but I live in canada
Mike: so I dont think that we get hassled like you guys in the states
Alec: Dr. P- What is your take on the gene discovery?
Peter Panagotacos MD: In my office ,for patients I have personally seen I prescribe 1mg finasteride PROPECIA   for nearly everyone.-I'm still trying to answert the last Q.
Peter Panagotacos MD: 5%minoxidil with RetinA and Anti-androgens is also a major part of my treatments
Peter Panagotacos MD: Gene therapy is 10 yers away.
MAN: Would you not recommend and online consultation for a prescption of Propecia from Dr. LEE, Dr. Panagotacos?
TorontoResident: what type of antiandrogens do you use other than propecia
Peter Panagotacos MD: Please excuse the typos
Alec: When the gene lady says 5 years for a topical, wishful thinking?
Peter Panagotacos MD: Spironolactone-flutamide-ketoconisole-finasteride
Regrowth: I believe she said MAYBE as soon as 5 years.. she didn't say definitely 5 years
Regrowth: How effective do you think Spironolactone is, Dr. P?
Peter Panagotacos MD: 5 years for RATS 6FOR LAWYERS  10 FOR HUMANS
Alec: Maybe 5 years is still a strong statement.
Alec: good one Dr. P
Regrowth: As with anything, Alec, it's still a supposition based on the assumption this gene is the key
TorontoResident: how effective is flutamide and ketoconisole?  is it in topical form
Peter Panagotacos MD: 2%SPIRONOLACTONE  TOPICALLY IS  a good way to augment oral PROPECIA
Regrowth: plus I wouldn't put it past the press to have misquoted her... we'll be having an interview with her soon and see what she has to say
Mike: DR. I have a question that I believe alot of people are wondering. What is this shedding phase all about when on finasteride and why are some people so devestated with the results?
Peter Panagotacos MD: DISCOVERING THE LOCUS OF A BALDNESS GENE IS FAR FROM FINDING A GENE REPLACEMENT
Alec: Transplants- Some docs say start early to conceal the process, others say wait, whats the dillio?
Regrowth: BTW, anybody interested in transplants should check out the new design and info on our transplant site, http://www.regrowth.com/hairtransplant... the design is cool :)
Alec: Yes, the gene replacement is the big unanswered question in all the reports..
Peter Panagotacos MD: First I am not sure there is much of a shedding problem. I've read about it here on the net but in over a 600 patients I have not seen it.
Regrowth: From now on please ask me all questions in private and I will ask Dr. Panagotacos.  you can ask me by highlighting my name in the list and double clicking it or typing /tell Regrowth: message
Peter Panagotacos MD: RE; Transplants, It is easier to begin when the patient has some hair to cover the surgical areas.
Regrowth: Dr. P, is Minoxidil truly necessary in combination with finasteride and if so should one start with 2% or shoot for the 5%?
Peter Panagotacos MD: I have seen young men talked into transplants they did not need -being told to do it BEFORE you go bald
Peter Panagotacos MD: That is the equivalent of painting your car when it is new so you wont have to in 10 years.
Regrowth: Is Minoxidil truly necessary in combination with finasteride and if so should one start with 2% or shoot for the 5%?
Peter Panagotacos MD: It is not necessary to use both. They workin different ways so you will get maximum cosmetic results from using both
Peter Panagotacos MD: I would rec.5%
Regrowth: How much of a problem is trauma shedding after transplants in surrounding hairs?
Peter Panagotacos MD: Significant-I recommend all patients use Minoxidil to help prevent it. I know of some very good doctors who say they dont see it BUT IT HAPPENS
Regrowth: Should someone with mpb look into using flutamide and ketoconazole.  Is using nizoral once a week a sufficient dosage of ketoconazole?
Mike: tell Regrowth: what makes someone a better responder to propecia and or minoxidil than another person with the same problem?
Peter Panagotacos MD: Unfortunatly there are no good studies regarding this. What we know is that both drugs block the androgen receptor site, and canbe absorbed   into the skin, therefore it seems to be a logical choiceto add them to a solution of 5% Minoxidil
Regrowth: Dr. P, what is your opinion on the efficacy and worthwhileness of Graftcyte's posttransplant dressings?
Peter Panagotacos MD: The best response is with someone who has recentlylost hair
Spam: hi
Peter Panagotacos MD: I do not use the dressings-I use a topical antibiotic ointment. There are many studies showing plain vaseline works well.
Peter Panagotacos MD: Keeping the new grafts moist[hydrated] is the key to good results
Regrowth: Why the controversy about Graftcyte among transplant docs?
Spam: hello?
Peter Panagotacos MD: Some dont want to put anything on to make thei lives easier, others are resistant to change, in my case I'm happy with the results I have withno crusts in 3 to 4 days.
Regrowth: How often should nizoral be used?
Peter Panagotacos MD: I have my patients rub a little in every other day , and shampoo it out.
Regrowth: What do you prescribe betamethazone valerate for and how well does it work?
Peter Panagotacos MD: It is a cortisone - it works to decrease irritation caused by any of the other products in the solution-It also may inhibit androgen metabolism in the hair follicle as well as disperse the lymphocytes whic come up to escort the dying hair out of the skin
Regrowth: What about long term side effects?
Peter Panagotacos MD: No problem used on the scalp for many years. Other physicians have actually injected it into the scalp to prevent hair_loss_over many years without adverse effects
Regrowth: How bad are donor scars after several procedures?
Peter Panagotacos MD: Today -the scars are long thin lines which in most cases are very hard to see. IF a scar widens it can be removed.
Regrowth: What is your success rate with proscar & minoxidil and how long for results?
Peter Panagotacos MD: As stated by MERCK Propecia stops loss in 85% and grows hair in 50% By adding 5%minoxidil topically the result increase by another 25% and 8%
Regrowth: What sort of effectiveness have you seen with propecia in frontal hairlines?
Peter Panagotacos MD: 30% get new growth in front
Regrowth: So you're saying that the combination is 100% effective in stopping loss??
Peter Panagotacos MD: NO--THE COMBINATION IMPROVES THE RESULTS TO 1/2 CLOSER TO 100% INSTEAD OF 50% GETTIN Regrowth: WITH JUST propecia IT IS CLOSER TO 75%
Bardox: Howdy doc, all
Regrowth: Do these treatments work better on generalized FPB type thinning in men and how soon should someone with FPB type thinning wait to have transplants?
Peter Panagotacos MD: For stopping loss instead of 85% it is closer to 92%
Peter Panagotacos MD: Diffuse thin hair probably responds best- Try the ;medical treatments for 6 to 12 months first.
Bardox: regrowth-do we ask questions through you?
Regrowth: yes, Bardox
Regrowth: Do you recommend that patients use Minoxidil more than twice a day to improve effectiveness?
Peter Panagotacos MD: If using 2% -yes . use it 4 times a day If using the 5% twice a day is enough
Regrowth: How effective are your different minoxidil combinations on the frontal hairline?  5%, 5% w/ retin-a, 5% & betamethazone valerate, etc.
Peter Panagotacos MD: Difficult to answer,because none of my patients wants to use the med on only one side of the head. But my impression is that the additives make the lotion at least 50% more effective and I have seen new growth in many of my patients' front hairlines
Regrowth: How painful and annoying are transplants?
Peter Panagotacos MD: Most patients say the pain is minimal and well worth the results. "Less painful than going to the dentist" is a common response to the question.
Regrowth: Is your minox/finasteride combo made by a pharmacist or does someone just crush the proscar and mix it themselves?  what combination of finasteride is used?
Regrowth: john lithgow looks weird with a toupee
MAN: ha
Peter Panagotacos MD: I work with a biochemist-pharmacist and the mix is something of a trade secret
Regrowth: what concentration is it?
Peter Panagotacos MD: Currently the mix is not just minoxidil+finasteride but rather + other anti-androgens such as spronolactone and flutamide.
Regrowth: Have you ever seen people do worse on finasteride?
Peter Panagotacos MD: I am attempting to make a formula which will work at the follicular level without getting high enough to worry about absorption
Peter Panagotacos MD: I have never seen anyone do worse on finasteride
Regrowth: how effective is your custom formula and how does it compare to just normal 5% minox and propecia.
Peter Panagotacos MD: Propecia taken daily is the best treatment available. Adding 5%Min makes the hair look fuller -Adding other anti-androgens to the lotion does help the Propecia to work-HOW MUCH? is hard to quantitate. I would guess anothe 10 to 25% benefit
Regrowth: What do you think of dr. proctor's products and would you recommend them to your patients?
Peter Panagotacos MD: I have difficulty recommending them when Propecia is available and 5% Rogaine is readily availble--I'd like to see a study comparing those products to Propecia.
Regrowth: Dr. P, what is your take on adding an antiestrogne to finasteride and the amazing results claimed by some?
Peter Panagotacos MD: I assume they are going after the aromatase in the hormone metabolism pathway.--I need more facts to be convinced.
Regrowth: Do you recommend any oral supplements in the forms of vitamins or herbs?
Peter Panagotacos MD: Have you seen the starving peoples in Biafra-the Sudan- Bangladesh-Dachau- SKIN andBONES with a full hair. The answer is that there are rare reports of vitamin deficiency causing hairloss when a nurse fails to add biotin or zinc to an IV in someone dependent on IVs for months to years.
Regrowth: Do you recommend any particular shampoo?
pez: Hello?
Regrowth: hello
Peter Panagotacos MD: Regular Head and Shoulders. There have been reports that topical zinc inhibits 5-a-reductase- I do not know it the zinc in H&S works but it couldn't hoit.
Regrowth: Have you heard of the mite theory and what do you think?
Peter Panagotacos MD: No. Enlighten me
Regrowth: Oh some researchers a week or two ago announced that they found demodex follicularum (sp) in balding hair follicles and are theorizing that these mites may be at least a partial cause if not more of baldness... same ones that can cause hairloss in other animals
Peter Panagotacos MD: I doubt mites play any role at all. We have them in our eyelashes without a problem
Regrowth: This is true... plus their existence doesn't necessarily prove causality...
Alec: Mites have been blamed in the etiology  of many unexplained dermatological conditions like rosacea, etc..
Regrowth: Anyway I think we should wrap it up for the night... don't you Dr. P?
TorontoResident: thanks alot Dr P
Bateso1: Thanks Dr.
TorontoResident: if only you did out of country orders you would have my business
MAN: stay cool, Dr.P
Alec: Thanks Dr. P
TorontoResident: thanks john
Peter Panagotacos MD: Yes  I've got to pik up my basket ball plying son.
Regrowth: Thanks for coming dr. P!
TorontoResident: come again
Peter Panagotacos MD: I should also practice my typing
Alec: You da man
Regrowth: Hehe
TorontoResident: im sure your welcome to come anytime
Regrowth: Yes we'll definitely schedule him again in the future.
Peter Panagotacos MD: It was a pleasure and I'd be happy to do it again.
TorontoResident: ill be here
MAN: maybe I will have hair by then!
Peter Panagotacos MD: Goodnight
TorontoResident: keep up the great work
Regrowth: Don't forget tomorrow night Dr. Cooley will be here.. the doctor who did the follicle cloning article in the last newsletter
TorontoResident: keep up with being a pioneer
Bateso1: all right!!
Regrowth: Night!
Alec: Thanks John
TorontoResident: john are you going to stay a while or you leaving too
Regrowth: I have to go unfortunatley as well...
TorontoResident: oh well
Regrowth: Everybody check out the neato design at www.hair-transplants.net
Peter Panagotacos MD: {leaves}