Hair Loss Information at Balding Blog

Your hair loss questions, answered daily.


After 5 years, this patient came to see me to show me the transition of his new look. Considering the degree of balding he had when he came in, his results were spectacular. He did comment that no one ever noticed the change from a bald look to this hairy look. That is what surprised him most. The two pictures tell the story without words.



Doctor Rassman I want to know something about grey hair. Is grey hair caused by stress or simply genetics?

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Probably a little of both. Some people almost never go grey. Some people, even in their childhood years have grey hair. Some have total white hairs (Santa Clause). People with little or no stress get grey hairs. There is no clear cut rule.

Aging has a part to do with it as well. If you think about it from a scientific approach with genetics as a partial cause, we all have a certain programmed destiny of the cells in our body. Environmental factors may alter some of this destiny but the point is that if the hairs go through several life cycles (anagen catagen telogen) over a person’s life some of those hairs may be pre-programmed to fall out and never regrow after an “x” number of cycles. Some may be pre-programmed to turn white or grey after an “y” number of cycles. This may be a simplistic way to view biology but it may help understand the variation and why some may lose hair or have hairs that turn grey.


Hi, I went to see a ISHRS physician 7 months ago because I was concerned about family history. He told me he didn’t see anything but told me to come back in 6 months. I recently went back and he examined my crown and mid scalp and found miniaturization, however I am still a NW1. He confirmed I have MPB, and gave me Finasteride. My question is, provided finasteride works, can I expect to keep this hair for a while? My thinning is unnoticeable to the naked eye but is present on a microscope.

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I think you should ask this to your doctor since they examined you. If you have signs of male pattern balding (MPB), then finasteride 1mg (Propecia) is a medication to treat this condition. The thinning may not be detectable to the naked eye but it may be present under a microscope with signs of miniaturization. This is why we have always advocated the miniaturization (microscope) test. You can also consider a Bulk Measurement as well which is fairly accurate in detecting very early balding using the HAIR CHECK instrument. It is not necessary if you already have the diagnosis, but it can still document the progress of the hair gain or loss.

Tags: early balding, miniaturization, bulk analysis, miniaturization, Propecia, Finasteride


I have been taking Finasteride for over 6 years. (I am 32 now) Over the last year or two I have been getting an intense pain when I ejaculate. The pain feels like it radiates from the base of my penis, then it dies down. It feels a bit like a burning sensation.

The pain doesn’t occur every time I ejaculate, but quite often it does. I wonder if this may be caused by Finasteride in some way – such as the drug’s effect on the prostate. The only other side effect I have noticed is watery semen.

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Painful ejaculation may be a sign of serious medical issue such as sexually transmitted disease (especially the burning sensation), prostatitis, prostate cancer, etc. I doubt it is related to a drug side effect especially after 6 years but such reports of pain with ejaculation are appearing over forums on the internet. As their appears to be legal actions taken against Merck (manufacturer of Propecia), the motivation for such reporting may be questionable and I do realize it is a very sensitive topic for many readers. In any event, you need to see your primary care provider or a urologist to see if there are medical issues associated with this complaint.

I realize we answer many questions about side effects on Propecia here on Baldingblog. However, not all sexual or penis related symptoms are related to Propecia.

Tags: painful ejaculation, finasteride, propecia, prostatitis


I’ve checked out Dr x’s website, and he claims that he can perform an FUE surgery with a transection rate of under 3 percent. I’ve read your article on FUE which was written near the end of 2007. In that article you mentions that “the transection rate by our NHI surgeons are still well within the 10% range for FUE and we make no pretenses that it is better than that routinely.” With Dr x’s experience and latest tools, has he overcome a major flaw within the FUE procedure?

Also Dr x is marketing a new device which he created to improve the FUE procedure.

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Some doctors have big egos. Some claim to have a better mousetrap. I can not and will not comment on another doctor’s claims. There are now robots doing FUE with good success and low transection rates that are evaluated by independent third parties and trusted researchers. There are no independent judges or observer who can verify claims. You are stuck to doing your own research and then trusting that the doctor you selected was honest with you.

The transection rate with FUE depends upon the skills and experience of the doctor, the instruments used and in many cases, the tissue make-up of the patient’s collagen. where the doctor (or robot) has no control. In the later case, it is individual PATIENT dependent.

I would guess that normal transection rates still vary in the hands of good, experienced and honest surgeons, number less than 10 percent transection rates. The transection rate is not the critical element in an FUE procedure, rather it is the experience of the team in managing the grafts. Even with the Artas robot, other than the coring of the grafts, the rest of the process is manual, so manual quality control processes determines the success or failure of graft growth. I have recently seen a patient who had FUE with the Artas robot, and the procedure largely failed. Even if the transection rate was very low, the detail in the manual management of the grafts may have been an issue. Did you know, for example, that if a graft is left open to the hair for as little as 10 seconds, it will die. That death, will not be seen until 8 months after the transplant surgery is finished.

I’ve seen Dr. Pak’s FUE surgery and his transection rate is not infrequently less than 3%, however, on the rare patient who has ’tissue’ differences in their collagen, the transection rate may go up to as high as 10%. We could ignore this singular result and report transection rate of under 3%, but that would not be honest. Our efficiency with FUE using our own internally developed tool is higher than most doctors in the world. It is not unusual for us to extract FUE grafts at the rate of 1,000-1,500 grafts/hour. We run an ‘open shop’ (open door policy) here which means that we hold open house events every month where our patients, happy or unhappy, can come to meet with people like you. Few doctors are that open with their patient population.

I realize for marketing purposes and advertising to the public these numbers and stats would seem important, but I would rather that your ask to meet some of his patients and get the doctor’s results from the patient’s own mouth as well as see the results with your own eyes.

Tags: fue, transection rate, follicular unit extraction, new tool, artas


I read your post on Aug 13, 2014 on how Asian men have low density of hair. How successful is hair transplant in Asian men who have low density of hair?

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Asian men usually have dark black hair on fair skin giving them a high contrast that makes thinning stand out. Their hair is also straight and not wavy which does not cover the thinning as well. These factors are not as favorable when compared to blond, wavy hair on fair skin or dark curly hair on dark skin. Med with fine hair require more hair than men with medium of coarse hair. Asian men don’t have the high hair density of Caucasian males.

However, we work with what we have and we have great results. It is more about managing expectations and individual goals. The following photos are of a Norwood 3a/ 4a patient who was in his early 20′s who looked like he was in his late 30′s with his hair loss pattern. While he may not have the full density, his styling and 1700 grafts provided a permanent front hair line and a new frame to his face. He looks his age.

Hair Transplant at NHI - Asian Hair

Hair Transplant at NHI – Asian Hair


Tags: hair transplant, asian men, high contrast, low density


I have been taking Propecia since my early 20′s and I am now 39. My crown was thinning back in the day and that’s what inspired me to start the drug. My brother is totally bald but my frontal hairline seems to be in near perfect shape all these years later. I am considering stopping taking it because I’m worried about the long term effects and I think as I age my hormones may change and I’ll develop issues from it. In your humble opinion at this point do you believe propecia is keeping my hairline intact? I’ve read that propecia rarely works on hairlines and I’ve heard you say it’s a tug of war between genetics and propecia. I just think I wouldn’t experienced some form of loss by now. The crown is ok but not what it was 6-7 years ago. You thoughts?

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Please speak with your doctor for these issues. In general if you stop Propecia you can ‘have catch up hair loss’ where the hairs you kept or regrew over the time you took Propecia, may fall out on stopping the medication. Long term use of Propecia from studies show no adverse effects. There was a study that show high dose (finasteride 5mg) can even lower the risk of prostate cancer and many doctors believe that this benefit extends to the 1mg dose, but this particular point was not studied and is just conjecture.

Tags: propecia, prostate cancer, hairline


Hi, I’m wondering if the change in skin colour after hair/eyebrow transplant is ever permanent, I had eyebrow restoration 7 weeks ago and the area is still very pink/red. Does it completely return to skin colour eventually? Whats the longest it can stay discoloured for?

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Skin or scalp can have some color changes after a hair transplant or eyebrow transplant surgery. The skin can look a little red but this usually goes away after several days, weeks or to the extreme to several months. Every person is different and every surgeon’s techniques may be different. Please follow up with your doctor.

Tags: eyebrow transplant, skin color


Hey doc. Love your work!!

1) Why so sceptical over PRP when there are so many pics, videos and documents online supporting it as part of the overall treatment for baldness. Heck there’s even an article on the website so I’m guessing there must be something in it.

2) Assuming all the research into PRP was true then would it make a good proscar replacement for people with ‘side effects’.

3) Depending on the baldness scale / category one fits under is it possible that you might never have to take drugs again? I guess what I mean is that if your body is always producing dht does that mean after a while all your hair will eventually get effected or is some hair safe?

4) I once spoke to a guy at a Clive Clinics who said if you don’t take proscar each day it’s a waste of time. The doc who prescribed it countered his opinion by saying although it might not be perfect less dht is being produced by your body so it must slow down your hair loss. I take it twice a week What do you think?

Thanks heaps!!!

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PRP (Platelet Rich Plasma) is hype without good science behind its value on hair growth. Doctors make money offering it. Photos or videos on line do not prove anything. There’s documents, photos, and videos of aliens here on Earth but that does not mean it’s true. I need to see good science before I recommend it and try to cash in on it. It’s not that I’m a skeptic, but maybe it an ethical decision. I am just maintaining a scientific approach in expressing my opinions on BaldingBlog. I have been known to use Google and read Wikipedia for information but I also know that what I read may not be accurate. I encourage our readership to do their own research. But if you’re asking for my opinion on hair loss topics, I attempt to give you a sound clinical, scientific based answers.

Stopping Propecia for something that does not work does not seem like a reasonable choice to me, but you are in the driver seat with the decisions you make. I do not believe that what you said as ‘gospel’.

Tags: baldingblog, prp, platelet rich plasma, making money


I’m a medical student from New York that has been taking propecia from 18-26 years old. Stopped for about 6 months and noticed growth of body hair, especially facial, in addition to additional muscle mass growth, increased libido, and decreased brain “fog”. The lack of facial hair wasn’t apparent to me as I attributed the smooth face to my own luck (even though my entire family has relatively pronounced facial hair) rather than the propecia. Learning more about hormones I got off the drug, lost some hair but lost body fat around my buttocks, face and thighs and gained muscle mass without change to any daily routines (not active in the gym or any exercise besides walking). I’m sure loss of body hair isn’t a side effect most men would consider negative, you shave far less and the embarrassing strands of chest hair are repelled, a major convenience that I can’t see many men reporting or taking issue with. Thank you for your time.

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In my 23 years in the hair restoration field having seen many men who were on finasteride Propecia, I have come across a handful of men (less than 10) who complained of less body hair growth, and brain fog. One to two percent of the patients speak of sexual side effect, consistent with reports by the drug company Merck. I have also seen many body builders who started, stopped, or restarted Propecia without any reported changes in muscle mass. So what you describe is not very common.

I do believe what you’re saying and I have treated thousands of men on this drug, Perhaps you can send us your pictures (on and off Propecia) and with your cooperation it may be publishable in a medical journal as a case study.

Tags: stopped propecia, muscle mass, brain fog


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