Hey doc, I have just found your website and have enjoyed it tremendously. I am 23 and have noticed my hair thinning since I entered college at 18. I tried Propecia but grew impatient. I wish I would have stuck with it but I chose to stop. I have lost enough hair now that I am fairly thin on top and towards the front. I was curious if you would recommend a transplant for someone so young. I am on the bubble about this, but I think that for my mental well being and career that really it is my only option. I am constantly unhappy with my looks and miss dating a lot. Truly the only real thing holding my back is the price, I would do it tomorrow but I just truly do not have enough saved. I think I would need extensive graphs to restore what I have lost. I have only looked into Bosley because it is the most popular and respected name. Would you recommend them or should I look elsewhere? I am very afraid of a poor surgery where I come out looking like a fool for the rest of my life because of some doctors weak job on my head. Thank you so much for your time.

You must be careful that you are not body dysmorphic. Dating and hair loss relate with regard to self-confidence certainly, but losing your hair should not be an excuse to stop living. Your points about career, mental well being, dating, happiness, (I can go on and on) are good reasons many people try to either hold on to their hair, or if they can not or have lost it, they can get it back with good medications or hair restoration surgery. Now with that said, you need to first get a diagnosis established, your scalp mapped out for miniaturization and the pattern of hair loss that you may develop. Many good medical hair restoration practices, such as Bosley or NHI, can supply a good working diagnosis for you. It is important that you find a hair restoration clinic that you feel comfortable with, and that you feel will give you the results you are looking for. I would not go somewhere based solely on marketing. Do your research.

There is much in this blog about how to shop for hair transplants (my lengthy post from earlier today, The Truth About Cheap Hair Transplants, is a good start), because budget minded people need to understand the entire shopping experience. With a diagnosis in hand, you may find out that you can reverse it (if you have it) with something as simple as Propecia (one pill a day), which works well for many young men. Be careful of the sale pressures to make you buy a hair transplant before you do your comparative shopping and before you know what is wrong with your hair. Knowledge is power, and you as a buyer are very powerful in determining your fate and the status of your hair for much of your life.

There is a post out of the UK that says there is a cure for Baldness called the Fleming-Mayer Flap. Please see the link and give me back your comments. See “An end to baldness – for those who can stomach it

The original procedure was actually ‘invented’ by Dr. Jose Juri in South America. It was widely performed around the world with, at times, terrible consequences. Dr. Juri has been quoted by doctors I know as believing that this invention was a terrible mistake and I believe he apologized for the damage his procedure did to the many victims that the radical surgery produced.

As there is no cure for baldness, certainly a radical scalp moving procedure has many opportunities for problems. Worse, it can not cover all of the balding area, for that would take God’s hands, and not this technique.

  • A banana-shaped piece of hair-bearing skin is marked out on the side of the head
  • Incisions are made and the flap is loosened, always remaining attached to the head in order to maintain the blood supply
  • The bald area is cut out of the patient’s scalp and removed
  • The flap is twisted, flipped over the top of the head and sewn into place where the bald patch was. Surrounding skin is stretched lower down to compensate

I would not recommend this procedure for many people with ordinary male pattern balding. Even if their balding pattern does not look too bad at the time they have the procedure, as they get older, the flap will make them look freakish and I have treated many patients for deformities resulting from this type of surgery as they continued with an advancing balding pattern. The article you sent is very misleading; the flap is not a cure for baldness.

For more information about the flap procedure, please visit:

I just visited a doctor who took me into a surgery and showed me nails in the head of a patient. He said that these kept the wounds open and makes the graft placement easier and produced less damage to the skin and hair. He also told me that he used a multibladed knife to harvest the grafts. I thought I read somewhere that these instruments cause damage. Can you explain what I am being told?

These nails that you are describing are something that was invented by Dr. Manny Marritt in the mid-eighties to make the placement of smaller grafts easier. Within a year, he abandoned the use of these dilators as his staff built the skills to not need them anymore. He concluded that these dilators did not have great value to anyone other than the novice. I did try them early on in my practice, but I quickly abandoned their use within a month. For more information on dilators, including a photo of what they look like, please see this dilators page.

After I designed the 2 bladed knife with the offset of 30 degrees, I built a multi-bladed knife with variable settings to it. I eventually found that when I used the final design on the first 9 patients, the results were decent (I estimated the loss at about 15%). Then on the 10th patient, I had a follicular holocaust with a loss factor of 70%. Fortunately, on these first 10 patients, I only used it on a limited area, but the high transection rate on this 10th patient said to me that inconsistency was going to be the problem. If I could do it 9 times right and then 1 time wrong, the technique was flawed.

This clinical research was done by me in 1992-1993 when cutting was a manpower problem that I eventually solved with a larger and better trained staff. The multi-bladed knife was the wrong answer to this problem and that is my final opinion on the subject. With multi-bladed knives, the labor that the doctor saves does not offset the hair that is killed off. I believe anyone who uses such instruments today are subject to the same type of variables.

hey doc… thanks for your reply. A few weeks ago I posted a question to you: Maturing Hair Line at 18 Years Old

what I would like to add is I’m of east Indian origin and my hairline is in the form of an U curve and is thinning badly. I will try Procepia eventually but I would like to know your opinion on natural suppliments. I’m taking multivitamins + 2 capsules of saw palmeeto every day. The thing I don’t like about procepia is that its a drug and most drugs produces side-effects…and I think that there are natural remedies for every ailment.

I have answered this type of question many times. Natural remedies include every conceivable thing, some of which is safe (saw palmetto), some of which can kill (arsenic), some of which may be different by different suppliers (saw palmetto), some of which is effective (vitamins that are antioxidants), some of which are ineffective or have variable effectiveness (saw palmetto). I only picked saw palmetto, because it meets many of these opposing criteria, but it plain does not work.

There is all of this focus upon side effects. Remember, arsenic is a natural supplement and it kills; death is a side effect. Sexual side effects are known with saw palmetto, but the sexual side effects with Propecia only occur in 1 out of 100 people. Why assume that you will get the bad sexual side effect from Propecia, just because a drug company is honest and compelled by the FDA to tell you about it? The suppliers of saw palmetto do not have to disclose it; the drug company that makes Propecia does.

If you really care about your hair loss, why do you want to risk losing it or your health, when there are safe alternatives? I am afraid that I do not understand the logic here, but you are not alone with that type of thinking. Sorry if I am harsh, but I do not seem to get the message over to my readership and I really do not understand where I am failing to communicate.

I heard nick cage and travolta have hair transplants ,does anyone know what doctor they used? I want to find the best hair transplanter? I heard brazil?

I can not tell a good hair transplant patient from a normal person 95% of the time, even on a close up examination. The best hair transplant surgeons are those that use Follicular Units and adhere to the standards that have been set for Follicular Unit Transplantation. We have published those standards and they are available to read on the New Hair Institute website on the Medical Publications page.

As to your celebrity hair transplant questions, I can only speculate, as I have no first-hand experience with either actors. I would assume that Nicolas Cage was transplanted, because it appears that what he has on his head are the older type of smaller grafts, not the follicular units we use. Some times, people look transplanted even when they are not. If he was transplanted, then I did not do them (if I did, I could not comment on it because it would violate doctor/patient confidentiality). With regard to John Travolta, I have not done transplants on him either, so my best guess is that he found another great hair transplant surgeon, or never had them transplanted in the first place. I have only seen these two actors in films and some interviews that were public, so I might change my mind if I examined either of them in person and they then asked me to make that information public, a doubtful scenario at best.

Note: My answer to this question is very extensive and detailed, almost like a consumer guide for shoppers needing hair transplants. Please take your time in reading it and try to read between the lines, for there is much I did not say. The answer took me over a week to write, because the question was so pointed and so appropriate to what I am asked almost daily.

I am very confused about prices that are charged in your field and the associated estimates in what you guys want to do for me. I believe in capitalism so the wide range of prices does not bother me as much as the wide range of recommendations I get when I see a hair transplant doctor. This clearly impacts costs. My Norwood Classification is a Class 6. I have had recommendations as low as 1000 grafts in one or two sessions. That doctor told me that more than 1000 grafts in a single session could not be supported by the blood supply of the balding area. I have also been told by you earlier this year, that I could have as high as 4000 grafts in one or two separate sessions. No matter what the prices are, the difference between one session of 1000 grafts and two sessions of 4000 grafts is a huge cost differential. On one hand, I want to believe that 1000 grafts will work for me as it is easy to afford (the doctor charges $5/graft, or $5,000) but on the other hand, your estimate of between 4000-8000 grafts is so out of line with the lower estimate, I am a bit put off about having hair transplants at all. I have also seen other doctors and the wide range of estimates continue to amaze me. I want to be a good buyer so I want to compare apples and apples. Who should I believe?

Hair transplant costs are one thing and ethical practices by the physician are another. You must know what you are buying to value a hair transplant’s real cost to you. Add to that, the expectations you have and the probability of meeting them. Bottom line, a meeting of the mind between you and your doctor addressing your goals is what matters and only in the final results will you really know what you purchased.

In your particular case, the more of a perfectionist you are, the more hair you will want. If I projected 4000 to 8,000 grafts, I would have anticipated your desire for fullness is far greater than the average person. Then there is still another factor, your donor supply. If your donor density is high, then you can get more hair moved and more hair placed in the balding pattern you describe, but if it is not very high, then you will be hair limited and 4000 grafts might be out of the question for you. Some doctors will tell you exactly what they think you want to hear (rather than what is really best for you) – to make sure that you will proceed with the surgery.

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Dr. Rassman,

I am experiencing what I think may be a finasteride side effect that is really alarming and embarrassing.effect My pubic hair has been thinning for over a year. I am a 48 year old male and have been using finasteride (1/4 proscar) for a about 7 years with decent maintenance results, and also I have been using minoxidil 5% for the same time period.

I told my GP of my concern at my annual physical this past spring and he had no answer, but included testosterone in my blood work and it came back as in the normal range at 575. I have noticed some reduced body over the past 7 years on the finasteride and attributed it to the reduced DHT. I thought reduced DHT increased testerone which is responsible for axillary hair growth? Could the reduced DHT actually be thinning my pubic hair as well? I don’t want to quit finasteride, but should I do so?

Thanks for your advice

DHT does historically cause the appearance of pubic, underarm, beard, ear and nose hair. The pseudo-hermaphrodites that were studied in the original research who were devoid of DHT from very high doses of finasteride in their diet since birth and therefore largely absent of DHT, had very little facial or body hair. I would expect, therefore, that some people may see reversal of some of the things that DHT causes with DHT blocking drugs, but prior to your email, I have not seen or heard of any patient who complained about it. There is logical reasons to see this side effect, although clearly not common in my experience. If you stop the drug, then the benefits may be lost as the pubic hair returns (if it does do that at all).

If finasteride actually reversed nose, ear, beard, and ear hair, I am sure that most men who have too much hair in these places would rush to take finasteride, but alas, the stampede did not happen. That says a great deal about this type of a hair ‘removal’ phenomenon.

Several years ago from a stressful situation, my hair started receding. I then found out that I am hypothyroid. Over the years it stabilized, but recently due to severe dieting, it started receding some more. What can I do to stop the recession and what can I do to have some of the hair regrow? Thank you.

You provided the answer to your own question. The recent weight loss may have precipitated the hair loss you reported and you will certainly need a proper diet with a positive protein balance before the hair loss can be reversed (assuming that the weight loss is responsible). Radical diet alterations to get a jump on weight loss is something that is common in our overweight society and weight loss of just a few pounds can cause of hair loss. You can imagine where the genetic process exists, extreme dieting can accelerate what may take years to unfold on its own. Some authorities believe that short term loss, by as little as 4-8 pound, can precipitate hair loss in men or women.

You will also need to be sure that your thyroid and other endocrine organs are functioning normally, including hormonal balance in the various female hormones. Although you didn’t specifically say if you were a man or a woman, judging by the name you gave, I’m going to assume you’re female.

Dr Rassman
Do you have a list of doctors in the US that use and are skillful with the Densitometer?
Thank you

Go to the ISHRS website to look up doctors who specialize in hair diagnosis, treatment or hair restoration. Good dermatologists should also fall into this category. When you call their offices, before you make the actual appointment, ask them if they map out the degree of miniaturization on the scalp for quantifying the extent of balding or thinning. That is a better probing question than asking about an instrument I invented, since other doctors may not know it by the actual name I gave it. (FYI, the U.S. Patent I obtained for this was U.S. Patent #5,331,472 ‘Method and apparatus for measuring hair density’, issued July 1994).

Hello Doctor,
How effective would a combination of propecia and Minoxidil be to fighting hair loss in the initial stages ? My hair started thinning in the past 11 months and now the scalp is noticeable. I recently started propecia and the Dermatologist advised taking Minoxidil 5% with it. I cant do it twice a day so he advised to apply it at least once a day at night. My question is I cant commit to the cumbersome process of applying it for more than 3 months. Will it benefit me if i take the combo for 3 months and then stop minoxidil 5% but continue on propecia indefinitely ? Will I gain/thicken my hair with minoxidil 5% once a day and will it sustain after 3 months once I stop taking it ? Please Reply
Thanks so much

I get this question quite a bit. Using minoxidil once a day has limited value. Using it for 3 months and then stopping has no long term value — once you stop it, you will lose any hair you may have gained. For men, Propecia is the right thing to do for hair loss caused by genetics. I generally tell people to start Propecia first, then to consider minoxidil after a year, only if the result from Propecia does not get them what they want. There is no guarantee that one or both will work for you.

Using the higher 5% dose of minoxidil may be more effective than the 2% solution, but unless you are really willing to commit to the process required for either of the drugs, do not embark on that path.

Hello, I am 19 years of age. Over the past year I have found that I have lost alot of hair. All my life I have had thick hair. my whole family has relatively high hairlines, even my 13 year old brother. I have always had one although there was always alot of hair around the hairline. In recent months my hairline has been receeding noticably and I have found that hairs have come out when showering, sometimes just randomly in the day, and I find them in my mouth. There are no patchy bald spots. However the hairline is extremly thin and around the crown it has also thinned out. Even the hair at the sides do not feel half as weighty as they used to. I used to badly need a haircut every two weeks, now although I still do at times, it is more in the vain hope it will make my hair look better. It is whispy looking on top also. I also find my scalp feels odd although this could be in the mind. It has all happened suddenly.

You need to have your scalp mapped out for miniaturization to determine if you have genetic balding. If you do, it will follow a pattern much like those shown on the Norwood chart, as your hair starts to thin in these patterns before it becomes bald. Over 50 years ago, General MacArthur said, “Old Soldiers never die, they just fade away”. I will rework his quote by saying, “Hair never dies, it just fades away”. Some day, when hair cloning starts up or we figure out the missing link in the pathway that stops the hair from cycling in the normal manner, we might be able to revive those hairs that are present even in the baldest of men, but at age 19, lets start to crawl before we walk. Don’t live in fear of what may not be. Get a good doctor to diagnose you and then treat you appropriately, if treatment is needed.

In a recent article in the Journal of Urology, an article was published which addressed the relationship between prostate cancer and the drug finasteride. The authors came out of various universities (Dr. G. Andriole was the lead author, Ref: J Urol. 2005 Dec;174(6):2098-2104)

Simply stated, what I read suggested to me that they reviewed the 7 year Prostate Cancer Prevention Trial that was finished a few years ago and published in the New England Journal of Medicine. The conclusions of the original study showed that this drug (finasteride 5mgs) reduced the appearance of prostate cancer by a statistically significant degree. There were some questions about the ‘control’ group when compared to those that actually received the drug. These authors suggested that the difference in the severity of the malignancies that were identified between the two groups may not have been real, but rather they were the results of patient selection criteria based upon blood testing, amongst other things. This group still did feel that prostate cancer chemoprevention with finasteride needs further research, although I personally believe that they are ignoring good statistical evidence to the contrary. Keeping an open mind is always good.

Please note that I just wanted to share what I read with the readers of this blog. I do not own Merck stock and can not benefit from any opinions expressed here.

hi, i’ve had two hair transplant procedures in the past. over the last couple of years i have just been shaving my head. i feel very uncomfortable going anywhere without a hat because of my scars. i would just like to be able to shave my head without the scars being so obvious. they are mostly right at my front hairline. can i go to a physician to have the transplants removed? and if they are removed will my scalp where the transpants are taken out heal so those little puncture holes are not as noticible? or could a procedure such a dermabrasion or laser help to smooth out the area? thank you

Without seeing you it would be difficult to make an assessment. Please send photos to the email address on the Contact page.

Generally, it is difficult to put you back in time to the days before you had your hair transplanted. With that said, we can reverse it in many ways, and sometimes it might be brought back to the “before” status. I like to tell my patients that I have good news and bad news about hair transplants: they are permanent, so get it done right the first time. If you are amongst the unfortunate that did not time your procedure correctly with current technology, then the good news is that there is a great deal of experience now in removing or hiding the ugly plugs of the older types of hair transplants.

What are your opinions on the techniques and procedures of Dr. John Cole, such as his FIT procedures which he acknowledges was developed from your FUE. However, the FIT is allegedly an improvement. Also, what do think about his claims regarding Body Hair Transplants. I know you have made previous comments regarding BHT’s. However, I am asking specifically about Dr. Coles procedures regarding BHT.

FUE and FIT is exactly the same procedure, with some technique variations. There are a number of technical ways to do it and FIT is a proprietary brand name developed by Dr. Cole to show some unique identification for him. Body hair transplants are new with not much validation from other doctors. There are only a few patients with any history to the process and we do not know much about success rates in, let’s say, 100 patients overall. I am not surprised that they may work, but body hair is limited in numbers, usually growing as a single hair unit although there are some two-hair groups. The hair has a different character than scalp hair, but Dr. Cole’s claims have no real science with them, although I am not saying that it is not true, just not proven scientifically. I would not jump into it just yet. It is, in my opinion, still an experimental procedure.

Dear Dr.
I am a recovered burn patient from childhood with forehead scars that extend to my left temple area. I was able to grow my hair to cover it as a young man until my late 30’s. My hair started to thin and I now wear a hair system to cover and blend the non hair scarred area. Are hair transplants now being able to be transplanted into scarred areas that are cosemetically acceptable. I have been told that bloodflow below my scarred areas is still good. Thank you for your response.

If your skin is what we call a full thickness, hair may be able to grow from it. If it is covered with a split thickness of skin and scar, it may not support hair growth. There are things that can be done today to bring your hair-baring skin here and may include a variety of surgeries like flaps, and balloon-stretching the normal scalp and rearranging it to cover the bare area. Some of the results are remarkable. I would be happy to give you an opinion and as you’ve indicated that you are in Southern California, I would suggest that you make an appointment with me and maybe together, we can address your problem. Please call my office at 800-NEW-HAIR to set up a free consultation.