Procerin and Curetage

/by William Rassman, M.D./8 /

I just turned 20 years old and for a year now my hairline has receeded and started to thin dramaticly. Which I am very self-conscious of. I have been taking a natural suppliment called Procerin and using a daily treatment called Curetage for a little over a month and a half, but have noticed no difference. Do external treatments work, and pills work? Or are they just a waste of time? I also heard that hair transplants can’t be done on young men, is this true? Is there anything else i can do to make my hair grow back?

I have written about Procerin before (see past blog entries: Procerin and Procerin Info). The only topical treatment that seems to work is Minoxidil. Many add compounds to Minoxidil to try to make it more effective (e.g. Retin-A, which adds irritation to the skin and some burn to it as well) or combine it with other ‘magical’ formulations to sell it at a high price to take advantage of the value of its marketing label. The best and only real treatment for you is Propecia. There are many things done for hair loss and many people making money from the panic of hair loss victims. ‘Curetage’ sounds like one of them.

Stick with what works and do not risk permanent hair loss to go outside the known effective treatments that are available. Get a good doctor to work with you.

Why Is Avodart Not Approved Yet?

/by William Rassman, M.D./0 /

I keep reading and seeing all these photos of people using Avodart and the results are amazing.Why is this drug not FDA approved.I really want to start a new game plan with my hairloss.I can not afford anymore hairloss.

This drug is approved by the FDA for the treatment of prostate enlargement. So while Avodart has been deemed safe for treating the prostate, it is not approved for hair loss. The drug is currently targeted towards older men, but any drug for hair loss would probably be targeted at a younger market. I am not an expert on the toxicology of drugs, so I can not comment on the effects of Avodart use by the young man, however, I do believe that there may be indications for use in young men, such as those who are failing to get their hair loss under control with Propecia, for example. I am not the manufacturer or the FDA, and without clinical trials and proven scientific results about the use of Avodart in hair loss, I can’t have complete confidence of its efficacy. A doctor can elect to prescribe this drug ‘off label’ if the doctor is comfortable with the medication use.

I’ve answered quite a lot of Avodart questions on this blog. Here’s a quick roundup of some of the past Avodart posts:

Donor Area Repair

/by William Rassman, M.D./0 /

I would like to know if it is possible to repair the donor area. I had transplants done over 20 years ago, but they never formed well. I was able to survive on a comb over, but about ten years ago got a good hairpiece. I am satisfied with the piece and have no desire whatsoever to do a HT again (it is still painful in the back today).

The problem I have is that they took way too much hair on the back/left of my donor area. It has always been a problem and I had even resorted to using “Top Coverage” to fill it in so it wouldn’t be noticeable. If my hair gets wet or if I am laying on a pillow watching TV, when I get up, it is noticeable – VERY noticeable.

Ideally, I would love to remove the transplants form the top of my head and put them back on the side. Or, at least, reduces the thinning area in back.

Any ideas? Thank you

Today, we can relocate transplanted hair by removing them from within the old plugs thereby thinning them. When they are taken out, we can then move these follicles into areas of need. The areas of need could be the scars from the old transplants or to fix some abnormalities that make your ‘look’ less than what you may wnat to look like. Look at the links below and see some of the wonderful ‘fixes’ we have done. Send photos of yourself (confidential of course) and then give me a call and I would be happy to evaluate you and your problem.

For more information on repairs, please check out:

More Questions for Clarification

/by William Rassman, M.D./0 /

I read your blog from beginning to end and found it very resourceful- thank you. There are a few questions on which I would like clarification.

  1. I have read briefly about itchy scalp which requires use of Nizoral. Is this a very common side effect which I should expect if I decide to take Propecia, or does this only happen to a small number of patients you have seen? I had to stop using generic Minoxidil after three days because it gave my hair a greasey feel. Will Nizoral cause a similar problem or other side effects?
  2. I have read somewhere that you might expect to see accelerated loss for the first four months as the follicle’s “cycle” adjusts. What percentage, if any, of your patients would you estimate see this accelerated loss?
  3. I take various supplements for body building purposes, such as creatine, glucosamine, and whey protein. Since hair loss is related to testosterone/DHT, are there certain substances which I should be avoiding in order to prevent extra testosterone generation in the body?
  4. What is your real world experience with the Laser Comb? With all the various internet sites which sell this type of gadgetry, is there a reputable company or site which you would trust?

  1. Itchy scalp does not require any particular treatment, but some people feel strongly about their medications and post their opinions on the internet. This is particularly true for those who sell the medications. In my experience, not one patient complained about itchy scalp after being placed on Propecia, but they do complain of this from the use of minoxidil. Many people find that styling hair is made difficult with minoxidil. If you want the non-greasy minoxidil, try the minoxidil for women, as it is alcohol based and is not greasy.
  2. I have personally not seen any patients complain about a period of hair loss when they start Propecia, but I have heard reports by some of my colleagues. I must therefore assume that it is a rare occurance.
  3. Anything that builds up testosterone production will raise DHT levels and accelerate the course of male pattern balding. Check with the claims on the bottles and check out each component of the nutritional substance you are taking.
  4. I have no personal experience with the Laser Comb. The story is still out on all laser hair treatments, but I remain very hopeful. See Low Laser Light Therapy for Hair Loss for more details.

Transplanting Pubic Hair to Head

/by William Rassman, M.D./1 /

So since there are already tests that determine the pubic hair a possibility for transplantation to the scalp, are there any doctors currently performing this procedure now? If so, how much would it roughly cost?

I remember a picture and article in the parody tabloid Weekly World News from many years ago, of a person with a pubic hair to head transplant. The pictures looked exactly as described — like curly pubic hair transplanted onto a head. Obviously, being parody, we can’t take this at face value, but it serves as an example. If your head hair is like your pubic hair, then this may work fine for you, but I would want to know why you want to use your pubic hair for the donor supply rather than using your other head hair? Personally, I would not want my transplants to look like pubic hair if the other hair was different in character. It would be like transplanting hair from a french poodle to a bulldog. To answer your question, I can’t recommend anyone that may be doing this procedure.

Hair Loss at Age 16

/by William Rassman, M.D./2 /,

Hello Doctor. I’m a 16 year old boy with a family history of MPB. My father (who is almost completely bald now) told me how he started balding in High School and was almost completely bald when he got out of college. I recently noticed my hair line receding. My hair is somewhat long so it’s easy to cover up, but I was wondering if any treatments can help stop, or delay my fate. I’ve been to my doctor to ask about Propecia, but she recommended against it, saying I’m too young, and opted for Rogaine or it’s generic counter-parts instead. Is there anything I can do?

In young men your age, it is unclear if an aggressive hair loss pattern will respond to Propecia as well as if the hair loss started later in your life. The data is not in. With that said, I do not believe that you are too young for Propecia. I feel strongly that Propecia is the only drug that can help you slow or stop the hair loss. If your doctor does not have a better solution, get another opinion. Minoxidil just will not stop the hair loss that you will have, assuming of course that you follow your father’s pattern (a likely scenario based on what you’ve told me here).

How Long Until Transplants Grow?

/by William Rassman, M.D./0 /

How long does it take for the transplants to grow?

I generally tell my patients to wait a full 8 months to have 80-90% of the impact of growth on stylable hair. Hair grows about 1/2 inch per month and as transplants often do not start until 3-5 months after the surgery, growth can be calculated from that point. For those hairs that start to grow at 5 months, they will be 1 1/2 inches at 8 months, while those that started at 3 months will be 2 1/2 inches long. Usually a person has a combination of the two. On less frequent occasions, about one in twenty people have instant growth of all of their transplants.

In good hands, however, growth will always occur. I hope that answers your questions.

Triangular Alopecia

/by William Rassman, M.D./1 /,

Dear Doctor Rassman,
I am 20 years old. I want to know something more about triangular alopecia. My temples are receded about 1.5 inch. I have also genetic hair loss in bitemporal area and also in vertex (or at least it is what the doctors said). My father has lost also all of his temple hair including the hairline and the top, but nobody else in my family lost his temples hair, even though everybody has genetic hair loss. In addition I want to say that my temple hair is changed. Above the ear it is thicker than before but with less hair count, curly (it was not) and with a slower growth. Can it be part of genetic hair loss or it is genetic and something else in the same time? I have tried many doctors in Vienna, but I was not satisfied. When I ask about Propecia thay said: “It is not for you, it is for old men”. There is a clinic, Moser Medical, with some doctor of ISHRS but from the emails that I sent to them, they seemed more commercial than helpful. Can you tell me something about my condition? Thank you for your time and for this website.

Triangular alopecia is a condition of hair loss which impacts the anterior temple area on either or on both sides. It may not be a complete loss of the temple hair, at times showing an atypica or asymetrical pattern, even to the point where a little residual tuft may be present on one side and no problem on the other side. It can affect either men or women and it is not necessarily part of the genetic balding process we commonly see, which produces balding in other parts of the scalp. It is probably another inherited process and hair transplantation is the best approach to treating it.

Taking Propecia While Trying to Have a Baby

/by William Rassman, M.D./0 /

I have been taking Propecia for about 8 years. My wife and I are anxious to have another child. I completely stopped taking Propecia for about 5 months when my wife and I started trying to have our first child two years ago as I was afraid of side affects. He is perfectly healthy. Was that necessary or advisable? Should I stop taking it while we try to conceive again? Thank you.

There are many answers to this question depending upon the doctor and his interest in practicing and giving advice on what could be sensitive medical legal issues which are at time at odds with what is in your best interests. Very little, if any, Propecia comes from the sperm into the woman’s womb. Merck (the manufacturer of Propecia) does not warn men wishing to have children to stop taking the medications for your situation. That, in itself, tells much of the answer to your question. Some doctors, however, tell their patients if they are worried to do the following:

  1. stop taking the Propecia during the one week that fertility is present or stop it through the entire period from conception to the delivery of the baby
  2. use a condom when your wife is pregnant
  3. stop the drug completely during the entire pregnancy

I feel that the first part of #1 may be wise if you do not trust the drug company disclosures and to adopt #2 if you are really worried. These two steps are extreme, while #3 is almost crazy because you will abandon all of the benefits of the drug and get progressive hair loss during the 9 month pregnancy period, based upon no evidence that this is a problem. See my previous answer to this question here: Taking Propecia While Starting A Family.

Where Are the Celebrity Transplant Photos?

/by William Rassman, M.D./0 /

I want to see a one time result, best if you can show it in a celebrity who had a hair transplants. Come on Dr. Rassman, if you really have celebrity patients, why won’t you share them with us?

Privacy is critical to my business and to the entire issue of medical ethics. All patients are entitled to their privacy. Also, California law states that a doctor can lose his license if he breaches the confidentiality of his patient’s identify or shows his/her pictures without consent. Now with that said, CBS sports reporter and XTRA Sports Radio host Steve Hartman does come to mind. Steve had one surgery of 1,895 grafts with us almost 12 months ago. As he has allowed the use of his identity and his pictures, here are the before and after photos. The photo on the left was taken just minutes after his procedure was completed, and the photo on the right was taken 11 months after. Click each image below to see the full size photo.



The entire growth cycle from start to finish are shown in the Steve Hartman Feature.

Face, Beard Hair, and Sideburn Transplants

/by William Rassman, M.D./3 /

Hi, I am 50 years old. I am unable to grow sideburns. I am sure it is inherited because I can grow a great mustache and facial hair on my chin, and from there, down my neck, but no sideburns which I have always wished I could. So, I see you folks may be able to help me. I have the usual questions, cost, and will the results look natural? Thanks!

Unless you have a disease like alopecia areata, you should be able to get hair transplants to place into the face and chin to create a beard, mustache, or sideburns. We do these kind of procedures all of the time and they look completely natural. The use of a fine needle to create the sites in the facial beard area is important to minimize any puckering of the skin. Most doctors charge by the graft, but some charge a flat fee. Your costs can be estimated by sending me photos to the email address on my Contact page. To help get an understanding of where you want the transplants, I would suggest marking up your face, beard area, and chin with a China Marker, which will easily wash off. You can get a China Marker from a local stationary store.

Here are some examples of sideburn transplants we have done at NHI:

Facial Hair After Pregnancy

/by William Rassman, M.D./0 /

i am 36 and have been losing my hair over a span of about 12 years. it started after my pregnancy, but over the last 2-3 years it has gotten VERY, VERY worse. I’m getting a lot facial hair, and acne. I NEVER had an acne problem until having a baby. I’m afraid i’m going to wake up bald . any answers will be appreciated. Thank You, Michelle

There are a series of masculinizing disorders that should be checked out by your gynecologist. Rather than play doctor here or set you into an alarming process, just pay your doctor a visit and have him/her perform an examination and do the appropriate testing for these disorders.

Lisinopril and Hair Loss

/by William Rassman, M.D./5 /

I have been using Lisinopril for high blood pressure for more than a year now and I have noticed that my hair is falling out. I don’t know if the Lisinopril is the cause because I am also under a lot of stress, but is hair loss a side effect of this medication? If it is, will my hair grow back if I stop using this medication? Is there another high blood pressure medication I can use? Please let me know. I don’t need this added stress.

Yes, Lisinopril can cause hair loss. There are many antihypertensive medications, but I would not want to recommend which one you should try, as that is your doctor’s job. Ask your doctor to recommend another medication if you feel that the hair loss and Lisinopril are more than a coincidence.

Sudden Hair Loss in 21 Year Old

/by William Rassman, M.D./0 /,

Hi Dr. Rassman,
I was hoping you could help me with some suggestions or information on what is going on. I recently began losing a lot of hair suddenly. However, the really weird thing is that a lot of my hair (maybe 50 to 70%) of it has a white hard mucus type of substance that can be scraped off from the end of the hair(maybe its the actual skin from the scalp or the hair follicle or something?) Is this normal because i really feel like its not?!?!?! I’m freaking out here because im so young (21 years old) and it came on so sudden and i dont know if every hair that falls out with that stuff means that it will never grow back again, and maybe there is something i can do to stop it???? I’m really scared here, if you guys could help with any suggestion or what you think it is, i would forever be in debt to you. Thank you so much.

You are panicking and that is not a good way to evaluate something as serious as your hair loss seems to be. Clearly, a good doctor knowing hair and scalp problems will be able to diagnose your problem. I can only guess without having you in front of me and that would not be doing your any service. My suggestion is to see a good dermatologist in your area.

Southwest Florida Doctor Recommendation?

/by William Rassman, M.D./1 /,

I’m 36, female, and have been losing hair for 8 years. My hair has always been fine and thin, and I inherited my father’s “receding” hairline. Now to be losing hair on top of this is awful. I’m new to the are and seriously considering transplants. I just saw a dermatologist who took a biopsy and said it’s female pattern hairloss, use Rogaine, there’s no other hope. I want to see a real professional who is caring, sympathetic, and willing to work with me to discover the best option of treatment. Can you recommend someone in southwest Florida please? Thanks

Ask your dermatologist to recommend a doctor in your area. A direct referral is always the best way to go. Dr. Bernard Nesbaum is a hair transplant doctor in Florida who has considerable experience with women and he is a dermatologist. You might want to check with him. You can get the doctors in Florida by looking at ISHRS.org.