Your hair loss questions, answered daily.


Hi Dr. Rassman, I’ve been a “lurker” on your blog for yrs, 46 yrs old and if I were to guess, a Norwood 3. I’ve been taking finaesteride for about 1 1/2 years, shampoo with nizoral a couple times / week. I started using Rogaine foam for a few months, but at $62 CAD / mth, it was starting to add up. I’m single, confidence is severely lacking as a result of my receding hairline, so dating isn’t really an option and needless to say I’m always looking for options. l almost considered going for a consultation with Hair Club, but decided against it for now at least. I did come across this article and wondered if you had heard anything about it.

Thanks for having this blog, allowing for people like me a chance to see your advice, keep up with any new developments etc.

Block Quote

There was an article on SCIENTIFIC AMERICAN April 9, 2015 Hair Regrowth Discovery Suggests Skin Cells Communicate Like Bacteria
“When a researcher at the University of Southern California and his colleagues plucked 200 hairs from mice in a specific pattern in a confined area—ensuring that many neighboring hairs were pulled—more than 1,000 hairs grew back in their place, including some beyond the plucked region. “
This finding does not translate into finding a cure for male pattern balding or hair loss in humans. This finding does not mean that if you pluck your own hairs, more will grow. It does however give us a new perspective on cell signaling. More research would be needed to see how it can be applied for practical human applications.

To address your concern for hair loss that relates to a lack of confidence or dating: There are plenty of confident bald or receding men where hair loss is not a factor. Of course everyone is different and if hair loss or hair recession bothers you, see a doctor for possible treatment options. Norwood 3 hair loss pattern can be easily addressed with a good hair transplant surgery.


Creator of Cancer-Cure Diet Faked Her Cancer
Nick Mulcahy April 23, 2015

“The creator of a best-selling mobile phone app and cookbook,The Whole Pantry, has confessed that her story of healing terminal brain cancer through diet and other natural therapies is a fabrication.”…

Dr Saunders continued: “This story shows the difficulty scientists have in getting their stories heard over snake oil salespeople.”

“Hopefully this will make people think twice and do some basic checking of facts,” he added. “We need to be skeptical of the mythical lone genius selling magical cures that ignore basic science and hard evidence.”

Block Quote

I get hundreds of emails a week asking me about my opinion on new hair loss treatment or my thoughts on side effects of Propecia. While the Internet is a great source for information, it is not always accurate. My point has always been there is no substitute for seeing a doctor (in person) when it comes to your personal medical issues which include side effect from Propecia or your hair loss issues. Finally the old adage, if it sounds too good to be true, it probably is.


Your website is a great and informative, objective source of information. Well done.

I’m 48 and been on fin for nearly 15 years under the care of a doctor. I started on 1 mg per day, but reduced to 0.25 mg per day mid last year in response to what I perceived as libido issues. These are now resolved.

I have also noticed a return of morning wood at the lower dose. My question is: do you know of any science to support a negative correlation between finasteride dosage and morning erections, and if so what is the mechanism?

Thank you for your efforts.

Block Quote

I am not aware of any studies and I would be guessing at the mechanism of how morning erections is correlated with finateride dose. It could just be a perceived effect not related to the dose or it may be the dose change after all. It is not hard to imagine that less drug should cause less side effect. The other issue to consider is that would less drug produce less benefit for what the drug was treating. There is a delicate balance between these two statements.

The observation you pose is real (for yourself) but it is difficult to prove on an absolute basis unless you have hundreds (if not thousands) of patients who are willing to take the a pill that is randomized to different dose or just a placebo (“sugar pill”) and report their erection in the morning. Even the doctor overseeing the patient would not know if the pill was a placebo until the entire study was complete (double blind randomized control test).

My personal thought is that if you and your doctor are in agreement with what works for you, then so be it.


If I have been using Propecia religiously but also been experiencing anxiety to the point of palpitations and twitching, would Propecia blunt any possible stress-related hair loss? If stress is what has lately been causing thick hairs to fall out when I gently comb my hair with a wide-tooth comb, are those hairs gone forever?

Block Quote


Propecia is only for the treatment of androgenic alopecia. It has no effect on other types of hair loss. Hair loss from stress is not androgenic alopecia.


I’ve noticed recently in the shower that short hairs are falling out that are tapered at the end of my hair, not the root. I’ve noticed more of these recently. Some are thinner and some are thick. All my uncles are balding on my mothers side. Are these hairs a sign of future balding? Thanks.

Block Quote

Hair morphology is not a sign of male pattern balding. Hair loss is a special “Male Pattern” is considered Male Pattern Balding. How a hair looks don’t really mean much. Usually miniaturized hairs will look thinner even for people who are not balding. We all can lose up to 100 hairs a day.


Can that numbing agent that the dental assistant repeatedly injected into my gums before she cleaned my teeth cause hair loss?

Block Quote

How does hair loss and teeth cleaning or gum numbing agent even related?


I am a 25 year old male with dark and curly hair. Some family background: My father has no hair loss, but has a high hairline. Possibly NW2/NW2A. My paternal and maternal grandfathers both experienced Male Pattern Hairloss around the age of 60. My maternal uncle is an NW2 but has no other hairloss. My younger brother (age 23) however while having a higher hairline than mine has definitely experienced noticeable frontal hairline recession in the last year. Around October of this year I became concerned with my hairline after getting a shorter than normal haircut. I usually wear my hair medium length and longer in the front which completely covers any visibility of my hairline. I expressed concern to my parents and a few close friends at the time and all of them said I had no noticeable hair loss, and if anything maybe had receded a tiny bit at the hairline. I did make an appointment with my PCP to check it out but ended up being scheduled to see another doctor at the last minute. I had never seen this physician before and she said that she could not give me an answer about hair loss because she had never met me before nor had she seen my hair. She ordered blood tests which all came bak normal. I went on with my life. During the months of December and January I experienced extreme emotional stress and more sleep deprivation than normal as a result of the new job I started around Christmas time. Around February I got another haircut, and shortly afterward felt extreme itching and burning at the back of my head right where the occipital bone meets the top of the neck. My rommate had a look and said that it looked very red and inflammed. I made an appointment with my PCP and met with him a few days later. I described my symptoms and my thoughts about possible hair loss. He had a look all over my head and asked if I had a history of thin hair or anything while also noting redness on below my occipital bone where I had experienced the itching. I said no because people have always told me I have had thick looking hair. His diagnosis was that I had “Age related hair loss” on my hairline and “possible” thinning on my vertex crown. He said he could not be sure. I asked if this meant I had a mature hairline or was undergoing male pattern baldness. According to him there was no way to tell either way until it gets worse/if it gets worse. He spoke to me about minoxidil and finasteride which I was already familiar with after extensive research online. However he said in my case it was much to early to start on either of these treatments. I left the office not feeling entirely convinced of his diagnosis. Later after going online and seeing examples on forums of men who were thinning at the crown and hairline I became very stressed and thought that if I possibly had thinning this may be a sign of mpb and should begin treatment immediately. I emailed my physician and asked him if it were possible to get a referral to a dermatologist for a second opinion. He said of course but that either way the treatment for hairloss would be finasteride/minoxidil and didn’t see the benefit of seeing a dermatologist. In fact he prescribed me Proscar and said I could begin using Minoxidil if I wanted to. This was a bit over a month ago and since that time I have been using both medications. However, since that time I have continued to have itching, bumps, and pain all over my scalp (even down my neck) and ears along with what seems to be a rash on my ears. Also, in speaking with my mother and others it came to my attention that I had apparently always had a cowlick near my crown and that it looked exactly the same as always which may have been what the doctor was talking about when he discussed my “possibly” thinning crown. That said I apparently do have a more noticeable line of thinning hair behind my head in between the vertex crown and my neck which the physician apparently didn’t notice. However after looking up pictures online I don’t really see any examples that look similar to the thinning pattern I have behind my head. I am going to continue using the medications advised my my pcp until my dermatologist appointment which is scheduled a little bit less than a month from now however I can’t help but feel a little wary in regards to the medical treatment/advice I’ve received up to this point.

My questions are:
Would Finasteride/Minoxidil have an effect on my hair if I didn’t in fact have MPB? I now find 1 or 2 hair strands when running my hands through my hair for a time. Sometimes more. However, I know that Minoxidil is said to cause an increase of shedding 1-3 months after initial usage.

2. How often do you find cases where patients where misdiagnosed in regards to their hairloss?

3. Is a line of thinning below the rim of the crown along with itching/pain in the scalp, ears, and eyebrows something you see in patients with genetic hairloss?

4. Do dermatologists often do miniaturization studies or hair bulk measurements? I know from reading many of your answers to questions that this is the most crucial part of measuring possible hairloss, and am worried my dermatologist will either not have the equipment to do those measurements or not know how to do them period. I live in Seattle and there are not a great deal of hair loss specialists nearby, and none of the HT surgeons I’ve looked up seem to be highly recommended.

Block Quote

The simple fact is I cannot diagnose your condition and if you think you were wrongly diagnosed, see another doctor.
Genetic Male Pattern Balding is not a difficult diagnosis. Having a small microscope to look at your scalp helps for a miniaturization study but not always necessary.
Propecia does not work for non balding patients and Norwood 2 is generally not considered balding.



I’m 32 and have been taking Propecia for 1.5 years. I’ve also been having problems with erections and possibly libido. They’ve gotten worse and are causing real problems in my life.

I’m not 100% sure it’s because of the Propecia because for a few yearsbefore I started taking Propecia, I was having some issues with maintaining an erection, though much less severe.

My prescribing doctor, who specializes in hair loss, says it’s very unlikely it’s the Propecia, citing the trials that show ~1% difference from placebo. To try and help the erection issues, he prescribed that I take a half a Viagra before bed every other night for three nights (without following it with sex) to see if that extra physical help might help me overcome a psychological issue. Though the Viagra helped when I took it, it didn’t change anything longer-term.

A little frustrated with this doctor and his dismissiveness towards my concerns, I went to get a second opinion. The second doctor immediately said that I should stop Propecia. He seemed convinced that Propecia was causing it, especially since I’m relatively young. He said the most prudent course of action right now is to immediately discontinue use and he suggested using Rogaine to try and retain

I’m not sure what to do with the two extreme opinions. I know that sometimes these symptoms can by rooted in psychological causes, especially since I was very nervous about this particular side-effect for years before finally starting Propecia. And I guess I should mention that Propecia seems to be working well with my hair loss.

I’m stuck between two seemingly extreme opinions and was hoping you guys might have some additional information that these two doctors haven’t given me. For example, I’ve read anecdotes about people reducing to 0.5mg and the symptoms improving. Any ideas on what I should look in to?

Thank you guys so much.

Block Quote

I am not the one to break the tie between the two doctors who have different opinions on Propecia and its side effects and how it relates to your issues.

I do know that Propecia can cause sexual side effects in 1 to 2% of the men.
I also know men in their 30’s can also have libido and erection problems.
It may even be a combination of both. I do not know!

You should see a doctor and have some basic testing such as your testosterone level and consider all your options, make an informed decision on a plan of action, and follow up with that doctor to see how the plan is working.


“Alcohol-dependent patients in general hospitals live significantly shorter than patients without alcohol dependency. According to a German-British study published in “European Psychiatry”, they die 7.6 years earlier on average. In addition, they suffer from several concomitant diseases.

Block Quote


We often get question on if alcohol can cause hair loss. Well, while alcoholism likely do not cause balding, it seems it causes an earlier death.
This was the result of analyzing 23,371 patients over 1.5 years with know alcohol dependency along with 233,710 patients without alcohol dependency. This, they said, can be reversed with appropriate treatment and cessation of the problem.


“I’m seeing a few hundred hairs in the shower drain every day. I really don’t think I am balding, but I came to ses you because I wanted to be sure that if I was balding, you could transplant my hair and keep it looking good.”

Block Quote

This comment reflected the comments, one way or the other, of many men who visit me, but this particular day, this 26 year old actor who just finished his first role in a major movie came to me with the above comment. He looked like a typical hairy 26 year old male and I thought that after I measured his hair bulk, that I would reassure him that he was not balding. Much to my surprise, the numbers from the tests surprised me but shock him. The tests indicated that he already lost 50% of his hair bulk in the front of his head just behind his hairline, and 40% in the top (between his ears) and crown (back) of his head. He came apart emotionally. “This can’t happen to me”, he said. “I am going to hit it big time in Hollywood, I have an interview coming up for my second film, now a leading man, and I just can’t go bald”.

I tried to calm him down. At 26, he could go on the drug finasteride and probably stop most of his hair loss, so that was the ‘good news’ I told him. But despite my reassurance, he had difficulty letting go of the idea that his career was going to be ruined. “They won’t take me on if they knew”, he said. Again, I tried to reassure him that the drug might very well buy him years on keeping his hair, but he would not, could not focus on what I said. Over and over again he said “It over, my life is over”.

Hair loss is devastating for many young men and they don’t have to be heading to the top of the Hollywood scene to feel the way this man did. Although the drug often turns out to be effective in 26 year old men, the reality is that some day he will have to face balding. Although preventive hair transplants are a terrible and improper decision for him now, if and when he starts losing his hair, this may become an option. He left very unhappy and even unwilling to consider taking the drug finasteride. I asked him to return to see me, but he was from out-of-town and not easily accessible, but I called him a week later anyway and he promised to see me in 4 months on his return to Los Angeles. I wonder if he will deny what I told him or if he will think this matter through and make the logical decision to try to slow down the balding process and fill the prescription I gave him.


Page 1 of 1,25112345Last »

Valid CSS!

HTML 5 Validated