MOB is caused by dihydrotestoterone (DHT) which has the effect of causing the pores and folicals of the head to narrow and finally close up, and the root does not or cannot regrow hair as it should. It should be eliminated by srs. As Portia said, theoretically after srs or orchiotomy continuation of propecia should not be needed. But preop, the chemical finesteride (which what propecia is) acts as an antiandrogen, but maybe not sufficiently strong to use as an antiandrogen in the propecai dose. Both of the treatments usually prescribed below are for lifelong use in order to work. Some younger post ops have reported thickening hair growth with normal estrogen hrt. However, some post op women have continued to lose hair in the male pattern after surgery, so the medical opinion may or may not be correct. MBP is apparently genetic, though may or may not be inheritable (inconclusive information), but one might speculate that enough of the DHT might be made in the body from the natural androgen secreted from the adrenal gland to continue MBP in post ops. One thing to recognize is that natal women also have baldness issues, and in some cases it can even be MBP.

The two common treatments:
Finasteride (brand name: Propecia): This is a lower-dose version of a drug that shrinks prostates in middle-aged men. Propecia is by prescription and is taken once a day. Propecia does grow and thicken hair to some extent, but its main use is to keep hair that's still there. It's therefore best for men who still have enough hair to retain. One side effect is impotence, but this is no more common than it is in the general population, and is reversible when the drug is stopped. Taking Propecia once a day is easier than applying minoxidil, but the prospect of taking a pill daily for years doesn't sit well with some men. There's also the cost, about $60/month, not reimbursed by most health insurers. It acts as an antiandrogen, and a stronger dose is good for preops for that purpose, but will likely not have an additional effect over the minimal dose.

Minoxidil (brand name: Rogaine): This topical application is over-the-counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but is better at holding onto what's still there. There are few side effects with Rogaine. The main problem with this treatment is the need to keep applying it twice a day, and most men get tired of it after a while. In addition, Minoxidil works less well on the front of the head, which is where baldness bothers most men. This drug also comes in a higher strength, 5%, which may be a bit more effective. There is a Rogaine for women.

Most sources say that propecia and minoxidol have widely varying effectiveness in post menopausal women who have tried it. The drug companies claim to have versions for women.

CaroL