Your hair loss questions, answered daily.


A drug has been recently discussed in the Yale University news letter: “In 2014, King showed that tofacitinib, marketed as Xeljanz, could be used to treat alopecia areata. The new study confirms the validity of that report and builds a case for pursuing treatment of the disease with this and similar drugs.”

Some of my patients think that this will be used for standard genetic alopecia, but it will not

Read it here: ““This study demonstrates the drug is effective for treating alopecia areata,” said Dr. Brett A. King of Yale School of Medicine, who designed the study with Dr. Brittany Craiglow. In 2014, King showed that tofacitinib, marketed as Xeljanz, could be used to treat alopecia areata. The new study confirms the validity of that report and builds a case for pursuing treatment of the disease with this and similar drugs.”


One of my patients asked if I could treat the FUE scars using FUE graft into the scar through another FUE. I smiled at him and ask what we would do with the new FUE scars created when treating the old ones, He got it! The only answer to FUE scars is Scalp Micropigmentation which we do all of the time for this purpose (see:


The study was released by the Britich Medical Journal which reported that the association of finasteride and Erectile Dysfunction when used for Benigh Proetatic Hypertrophy stated: “Our findings should be reassuring that the risk of erectile dysfunction is not higher for men who are prescribed finasteride or dutasteride for BPH or finasteride 1 mg for alopecia. Clinicians should be aware that the longer a man has BPH, the higher his risk for developing erectile dysfunction,” Katrina Wilcox Hagberg of the Boston Collaborative Drug Surveillance Program at Boston University School of Public Health, told Reuters Health by email.

The same was suggested in men who used the drug for hair loss, which they said “Similarly, in the cohort of men with alopecia (n=12,346), the risk of ED was not increased for users of finasteride compared with unexposed men with alopecia (IRR, 1.03; OR, 0.95).”.

What this says is that these drugs do not cause Erectile dysfunction. I am not sure that I believe this as some of the patients who I ahve treated have reported real one-on-one relationships between ED, libido and the drug finasteride, and when they stopped it, the symptoms always went away.

Here is the article which you can read for yourself.


I’ve been trying to find the best ARTAS doctor but I am still confused. Some doctors say NeoGraft is the best surgery. It’s hard to choose or believe which is better. Where can I find the best doctor for this?

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ferrari hair transplant

Follicular Unit Extraction (FUE) is a basically a harvesting technique in hair transplant surgery. FUE is a way for doctors to “take out” your donor hair. The other method is oftern called a “strip” method or Follicular Unit Transplant (FUT). The strip method harvests the hair follicles by taking a small linear cut of your scalp. You often see horrific hair transplant scars on the Internet related to strip scars. However this is not always the case.

The ARTAS robot is basically a tool or an instrument a doctor uses to harvest donor hair follicles using the FUE method. Instead of a doctor doing the surgery, an automated robot takes out the hair follicles. You still need the doctor to design and make the recipient sites to implant the hair. In other words, ARTAS does NOT perform the critical part of the surgery. The part that matters. The part that give you a new hair line. A great ARTAS robot that is used in surgery may still give you a horrible result if the doctor is not a skilled artist and surgeon. There have been cases where doctors (gynecologists or pediatricians) that are NOT hair transplant surgeons, doctors that have never performed a hair transplant surgery, buy the ARTAS robot believing they can be a great hair transplant doctor. Can you be a great cook if you buy the best cooking knives, pots, and pans? Can you be a great football player if you have expensive football gear?

The Neograft system is also an instrument a doctor use to harvest donor hair. The Neograft system has not been traditionally popular with hair transplant doctors. Instead, the Neograft system is sold to cosmetic surgeons and dermatologist who do not specialize in hair transplant surgery. In many cases there is a Neograft team of technicians that are contracted to come on the day of surgery to harvest the hair for the doctors. These people are called “ICs” Independent Contractors. Most ICs are not even nurses or hold any medical degree. This (ICs doing surgery) is illegal in certain states and a grey area in the field of hair transplant surgery. After the grafts are harvested, the contracted team usually place the grafts for the doctor. Some doctors who perform hair transplant surgery on a regular basis may have their own team but it is rare for a doctor to actually do the harvesting with the NeoGraft. You may want to ask about this when you are interviewing doctors. You may want to ask how many hair transplant surgery they perform a week. You may want to ask who does the actual FUE harvesting. There are cases where patients never see their doctor on the day of surgery because the entire surgery is performed by the IC or the technician.

Doctors who specialize in hair transplant surgery may have their own FUE instrument or automation device. Some examples are Dr. Harris who use his own SAFE system, Dr. Umar who use his own UGraft system, Dr. Shaio who use his own 4DFUE system. The ARTAS, 4DFUE, and Safe system are used at NHI by Dr. Pak and Dr. Rassman since they hold key U.S. Patents or technology used in the ARTAS. Dr. Pak also uses his own unique FUE device as well.

In the end, the best FUE surgery outcome should be judged by the final artistic result. The final result is NOT about the technical method of taking out the grafts (hairs). The ARTAS or Neograft are just machines or instruments. You cannot make a great football player with fancy uniform and a state of the art stadium. You don’t become a great race car driver because you own a Ferrari. It just means you can boast (advertise) about the Ferrari (ARTAS, Neograft) to draw patients in.


I have been on Finasteride for 4 years and my hair didn’t really change much. I did, however stop the drug for the past two months, but am back on now. 1) could my hair have changed in those two months? 2) what pattern do I appear to be? 3) a reputable IAHRS surgeon consulted me and recommended 1200 graft FUE , what are your opinions on that?

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FUE 1200 grafts recommended by one doctor

If you trust your doctor then go with it!
The Internet is not a place to receive a second opinion.
If you would like a second opinion it is best to consult with another doctor in person.

Photo(s) are not a good way to determine if you are balding or if you “need” surgery for the following reasons:

1) There is no way to know your history in detail. This involves a dialogue between a doctor and patient. A consultation usually involves 30 minutes or more.
2) There is no way to examine your hair under a microscope to understand how much miniaturization you may have (to plan for a possible surgery). What will you do if you have further recession or balding after the surgery? Are you prepared to have another surgery to fill in the gaps? You need a Master Plan.
3) Photos do not convey your understanding or expectation of a hair transplant surgery. Someone with your hair loss may be happy with 1200 grafts. Another person with the exact same hair loss may not be happy with 1200 grafts.
4) Photos do not convey your goals. Someone with your hair loss may want a drastically low hair line where 1200 may not be enough. Another person with the exact same hair loss may want a very conservative hair line where 1200 may be too much.
5) FUE or Follicular Unit Extraction is just a harvesting technique. It has nothing to do with the end result. In fact FUE may give you a suboptimal result over a FUT (Strip) surgery. Did your doctor tell you this?
6) etc


I visited your office last year in august and I was told that I most likely did not have “balding” just that my I had low hair density. This is contrary to a what another office told me. Quite frankly I trusted your doctor more, and he advised that since I was already been taking propecia to continue it if I wanted to be safe. Well I did continue it but have only been taking .25mg 3 times a week for over a year now and my hair has remained the same. In your opinion do you believe that .25mg 3 times a week would actually do enough to maintain my hair as it has if I was truly suffering from balding? I want to come off completely because I do suffer from some side effects but am afraid that if I do I will lose hair density.

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If one doctor says you are not likely balding and another doctor says you are (and may need surgery) it is definitely a confusing situation. You may consider visiting a third doctor for another opinion. You may also consider the motivation behind any recommendation. If we told you that you were not balding, we must have used the HAIRCECK instrument to measure your hair bulk which is a very accurate way to determine if you are balding. If we did not use it, come back and let us do so.

With respect to Propecia, the recommended dose is one pill (finasteride 1mg) a day. Taking 0.25mg three times a week is not a typical way to take Propecia. Some people do take 0.5mg or 0.2mg daily. The key is taking the medication on a daily basis. It is important to note that you should contact your doctor if you want specific guidance.


Prenatal exposure to pot is associated with differences in the thickness of the brain, particularly in the frontal brain, in preadolescent children. This was a study done with MRIS. This was written by Hanan El Marroun, Department of Child and Adolescent Psychiatry, Erasmus University, Rotterdam, the Netherlands and published online June 15 in Biological Psychiatry.

Children aged 6 to 8 years were invited into the MRI component of the program and the mothers use of cannabis exposure during pregnancy was measured with maternal self-report asking questions for each each trimester of the pregnancy. 113 nonexposed children; 96 children whose mothers smoked only tobacco during pregnancy; and 54 children whose mothers were studied during the pregnancy.

When comparing exposed to non-exposed children, those exposed to cannabis had “thicker frontal cortices, specifically, a thicker superior frontal area of the left hemisphere… and a thicker frontal pole of the right hemisphere” This part of the brain, the prefrontal cortex, supports functions such as the ability to suppress responses and thoughts, attention, higher-order motor control, and working memory.


The New York Times “reported a study published in BJU International found that the sperm of male smokers was “damaged in ways that could reduce the chance of fertilization and might also lead to health problems in the baby.” The researchers found that the “DNA in smokers’ sperm was fragmented, probably because of oxidative stress from the cadmium and nicotine in cigarette smoke,” which has been associated with increased risk of genetic problems and childhood cancer. They also found nonintact acrosomes and changes in seminal plasma, both of which “might impair fertilization.”


It is clear that if you want to avoid a stroke or heart attack in your life time, there are some simple steps you can take which have proven statistically significant. These are simply: (1) treat high blood pressure if you have it, (2) stop smoking if you smoke, (3) treat your cholesterol if it is high with statins and diet also keep your red meat down in your diet, (4) regular exercises on a daily basis to keep fit, (5) keep your weight in normal ranges for your age, (6) take one baby aspirin each day which has value not only for prevention of cardiac and stroke events, but also prevention of many forms of cancer.

The formula is easy and you don’t have to be a rocket scientist to understand these 6 simple things to keep you healthy.


This is an excerpt from the FDA website from 2010 on finasteride ( Dr. Ed Epstein, from the Bosley Medical Group is a urologist by training and has kept up on the latest information on the impact or lack of impact of the drug finasteride on risks for an unborn fetus.   “I am not aware of new studies on amounts of finasteride in semen or vaginal absorption data” that reflect increased risks for fetal abnormalities induced by finasteride other than what is written in the FDA white paper referenced above.

Some doctors are concerned that patients who go on finasteride should get semen analysis to keep track of semen levels in case these level dropped while a patient was on the drug finasteride.  Dr. Epstein said: “Concerning getting semen analysis on child bearing age men starting finasteride, I totally disagree.  Typically a male infertility workup is suggested after one year of unprotected intercourse. The subgroup of men who have low sperm counts on finasteride are those with preexisting conditions and appear to respond to discontinuation of finasteride.”

In other words, he feels that a young man should not worry about either low semen counts caused by finasteride, but that they could always stop the drug and if there was a causal relationship, it would reverse. He also suggested than men with low sperm counts while on finasteride, probably had it before they started the drug and should get any low sperm count evaluated by an expert.
The FDA while paper referenced above showed that studies on semen in sperm were either not present or when present were so low as it not cause a risk to a pregnant woman or a woman who is expecting to become pregnant. “Semen levels have been measured in 35 men taking finasteride 1 mg/day for 6 weeks. In 60% (21 of 35) of the samples, finasteride levels were undetectable (<0.2 ng/mL). The mean finasteride level was 0.26 ng/mL and the highest level measured was 1.52 ng/mL. Using the highest semen level measured and assuming 100% absorption from a 5-mL ejaculate per day, human exposure through vaginal absorption would be up to 7.6 ng per day, which is 750 times lower than the exposure from the no-effect dose for developmental abnormalities in Rhesus monkeys and 650-fold less than the dose of finasteride (5 ?g) that had no effect on circulating DHT levels in men”
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Another opinion can be found here:


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