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I am a 20 year old boy, I have been noticing hair fall eveyday.  I have read on the website progesterone cream for hair fall. Is this safe? What about PRP?

While progesterone is generally considered a natural female hormone, biochemically it is a precursor to testosterone much like testosterone is a a precursor to DHT. (Men produce progesterone naturally  just like women produce testosterone in their body)

Without going into detailed biochemical / medical logic, there may be an academic reasoning behind the use of progesterone but it is not a standard treatment for male pattern balding.

Keep in mind, male pattern balding is a genetic condition for which there is no definite cure.  Drugs such as Propecia and Rogaine can help but over the long run the genetic predisposition will manifest.  The only FDA approved medication for the treatment of male pattern balding is Propecia and Rogaine.

Many doctors and Internet sites will promote treatments such as progesterone, PRP, low level laser light therapy but it is my opinion that the consumer take a “buyer beware” approach for every treatment as you are the only one to protect yourself.  For every success story behind these treatments, there are many disappointed consumers who have spent thousands of dollars with no benefit. Try to make sure you are not one of them.


I have always assumed that a male will not recede from genetic balding without some hair loss somewhere on the scalp. This patient has challenged me as I hold this concept. I believe that both the frontal forelock (in some people) and the juvenile hairline in all men, have a different genetic makeup with regard holding on to their hair. I have seen men who have kept a fully intact juvenile hairline and become a full Class 7 pattern of balding, and to me that proves this concept. The concept that a persistent frontal forelock remains as the corners recede is common  and all of us have seen this.  This 22 year old male is different because I have been following him before the juvenile hairline disappeared. I believe the corners of this line are now receding. Here is the letter I sent to him as well as a series of experts in the field of hair restoration for opinions on my question.

Good to see you today. We repeated your HAIRCHECK measurements today which we have performed on numerous times over the past couple of years. This instrument continue to report no balding evident which means that there is no detectable hair loss behind the frontal hairline. Despite this, you have now what appears to be some mild recession, but considering that you have a persistent frontal forelock, this may be an illusion and you could be developing a maturing hairline in the corners as there is no hair loss in the mid-line where the persistent frontal forelock is present. Notice the faint line I drew at the leading edge of your hairline, which takes into account the persistent frontal forelock and a location where I think a mature hairline belongs. This is where your hairline actually belongs. It does appear that you have some early erosion of this leading edge of the hairline.

The question we discussed is: What is the timing of finasteride?  If you take it now, you will be locked into it for the rest of your life. IF you do have balding, then at some point decide to stop the drug which may have been holding the hair on your head, then you will develop catch-up hair loss. If you hold off starting the drug and come back in a year, it may become more apparent what you diagnosis is.  We both decided to wait another year, repeat the HAIRCHECK test at that time, reassess your frontal hairline when compared to the photos we took today, and then take another assessment if finasteride is appropriate for you. 

Question: Can frontal recession occur without any evidence of miniaturization or hair loss elsewhere on the head of a male.
maturing haiirline question


This 22 year old, very obsessed with a very early thinning of his right and left corner hairline, went to a doctor before seeing me. The doctor recommended 1500 grafts for him. In my opinion, there was not way that such a recommendation was warranted because (2) he was too young to have a hair transplant, and (2) if he was over 26, it will would not require 1500 grafts other than for the doctor to pay his car expenses.  There seems to be a license by doctors to victimize patient at will, and as a patient comes in holding the doctor in great esteem, this is a full abuse of his license and his profession. I condemn this practice, all too common by doctors in this field of hair transplantation. In the photos you can see marginal thinning and with his hair shaved, some thinning is clearly present. This will be best treated with finasteride which will probably reverse the process but unfortunately, the doctor won’t make any money for prescribing this medication

corner hairline shaved corner thinning


Doctors, I’m confused as to what Haircheck is and how it’s different from the miniaturization mapping. Can I get some more info please?

I’m going to try to clarify the usefulness of this tool as best I can. I saw a patient (we’ll call him John) that came to see me after I started him on Propecia a year ago. At the time I prescribed Propecia, I noticed he had miniaturization to 50% in the top of his head. I measured this when I used the video microscope, but there was no see-through appearance as his hair had a good weight to it so with the naked eye and I did not see miniaturization, nevertheless, the hair looked normal but with the microscope. It was clear that he had early balding when measured by the HAIRCHECK instrument. The HAIRCHECK instrument measures hair bulk and puts an actual number to it. From a visual appearance, there was no sign of balding on John (just like a year ago). The main reason for taking the test at the office on this visit (as with the last one) was that John saw hair on the pillow case indicating that he was losing hair. The HAIRCHECK device confirmed his concern that he was losing hair.

The measurement of hair in the mid-head (between the ears) at, 17 cm just above the glabella (just above the nose), was measured for hair bulk and compared with hair from the donor area, just above the occipital notch, in the back of the head. The measurements of the hair on the back of his head should reflect his normal hair bulk. If the area between the ears had the same bulk as the back of his head, I would tell him he did not need Propecia and was not balding. But last year we saw a reduction in hair bulk determined with the HAIRCHECK instrument in the top of his head indicating that he was balding. One year ago, John has a measurement showing that he had lost 45% of the hair on the top of his head. On today’s visit John had a bulk measurement of the hair at the exact same location (in the middle of his head) and a bulk measurement indicated that on this visit, John had a hair loss now of 55% of the hair on the top of his hea (between the ears), a clear sign of more hair loss and a progressive process.

When he comes back in a year, if his number may drop further because hair loss is progressive. Fortunately, many men stop their hair loss with the drug finasteride (Propecia). Let’s assume that in 1 year it drops to 35% of the bulk, and in three years it drops to 25% of his hair bulk when compared with the back of his head. If this becomes his case, then the idea of the Master Plan that I have been pushing for many years is just what should he needs, as this plan will define a path for him to take. At some point, his hair loss will become obvious to him.  My job is to follow the progression of his hair loss and build a plan for him on what to do. There are many options, but I will not write a book on it for this blog post.

I hope that this blog post gets the message across that everyone needs a Master Plan for his hair loss and it must be with a good doctor, one that can be trusted to always act in the best interests of the patients.


Interesting article :

Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells. This is exciting because this means that the critical elements for creating the mature hair follicle is in the scalp and once the progenitor cell defect is solved, we should produce gobs of good hair bringing back what was lost.



The arrows point in the center picture shows for our readership what a miniaturized hair look like. From these photo below, it does not look like you are balding. You have good vellus hairs in the leading edge of the hairline on your hairline picture. That does not mean that you won’t bald in the future but you should consider getting a HAIRCHECK which will tell you for sure if you are balding beyond what your eye can see now.

miniturized hairs

normal vellus hairs



Dr.Rassman, I’m thinking of trying Propecia. In your medical opinion can taking it long term also decrease total testosterone and bioavialble testosterone? I’m worried about it causing problems to my endocrine system.

Propecia is used by millions of men everyday and there does not appear to be any issues with their endocrine system. Testosterone levels often rise when a person is on Propecia.



Over 20 years, this patient lost a lot of hair and as it was filled in, he ended up with a total of 7635 grafts, 2000 to achieve the goals shown below. His last procedures is show here, which reflect before and after pictures on moving his hairline down and filling in the crown. Clearly, he did not dye his hair in these after pictures.

tj crown before tj front before

tj fromt and crown



You absolutely should not get a hair transplant. Drugs like finasteride and/or minoxidil might work. Wait until you see what you look like at the age of 26 when your balding pattern will become more evident. Then work with a good doctor who understands the concept of a MASTER PLAN for hair loss and if transplants are warranted then, you can consider it.

Very early crown balding


Why does it seem that way, way more than 2% of Finasteride users experience negative side effects? I wish we lived in a world where there were clear, concise answers to whether or not our bodies would be negatively affected by this drug. I’ve been taking Fin for 3 months now – no side effects. But the more I keep reading about real & permanent side effects hitting guys, the more I don’t. know. what. to do anymore. Its a horrible feeling. It’s a decision where I now feel damned either direction I take. Thoughts?

If you are not having side effects, stop worrying as you will be like the majority of finasteride users able to take the drug without experiencing many of the problems you are reading about; however, if you keep focusing on the side effects that you don’t have, one day you will not be able to hold an erection and start blaming the drug. A cycle may be started psychologically, where you may induce side effects just from worrying about it. I have seen it happen.


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