RK19 vs Propecia vs Minoxidil

/by William Rassman, M.D./4 /,

At age 59 what results can I expect from RK19? Can RK19 be used with Finasteride(propecia) and Minoxidil? Which is a Better program? Is a Dr.’s prescription required?

RK19 is a product that sells over the counter and can therefore be purchased from their website. Minoxidil can also be purchased without a prescription. Propecia, on the other hand, does require a doctor’s prescription. I have no personal experience with RK19, but after reviewing the photographs, I am more than concerned. The blonde picture was foggy, and the other two pictures seemed to have a scalp coloring agent in them. That makes me suspicious. Let the buyer beware, so use this as your guide in trying to figure out what to do. Please review what I have said in the past on this blog about RK19, as well as what I have said about safe and effective hair loss remedies.

After Stopping Propecia, How Long Until My Hair Loss Plays Catch Up?

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

Dear Dr. Rassman–

I understand that after one stops taking Propecia for some amount of time, X, one will lose all the hair they have gained and kept as a result of using Propecia in what you term “catch up hairloss.” I also understand that this may result in what appears to be a large amount of hairloss. However, what is that amount of time, X, referenced above? That is, how long must one be off Propecia to lose all benefits of having taken the drug? For instance, I have been using the drug for 14 months–if I stop today, when will I lose all the hair I have gained and when will catch up hairloss begin–next week, next month, within 9 months? Sometimes, I forget to take the medication and skip a day or two–is this lethal to my regimen of measures taken to maintain my hair count?

The time it takes to play catch-up is about 3-6 months. Forgetting to take the pill a day or two might have a marginal effect on you.

Transplanting African American Women

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


I am a 38 year old african american female. Like many other women of color, I began thinning in the top of my head as well as around my hairline. To make matters worse, my occupation requires me interact with many people in public places. Needless to say to go from beautiful hair to wearing a hair weave (to stop chemical processing) has damaged my self esteem(my hair is braided underneath a hair net). I am hiding my problem from family and friends and do not like being seen in public. I have acquired a biopsy and have been told that it’s probably due to genetics or stress. I have been to clinics that offer to match a hairpiece that is bonded with “medical glue” but the maintenance cost along with having to go back every six weeks for life did not appeal to me. I have not seen many photos of women of color with hair transplants; is this realistic? Please let me know if you perform this process; It is hard watching my self esteem deteriorate. Please help…

I am so glad you decided to write, because there is definitely hope for someone such as yourself and there is so little material available to TELL you that! You are correct – it is not generally advertised, but women of color do very well with hair transplant as a general rule. Because African-American hair is curly/kinky and because it matches the darker skin tones, you generally get good coverage and very nice results. You need to be careful if you do not have good donor areas, or if you have a history of keloids (abnormal scar healing), but for most cases you have a lot of options.

Clinics that offer glued attachments of hair to your head are not medical doctors and the products that they attached with the glues will accelerate hair loss and produce traction alopecia over time. Unless you plan on keeping this up, getting hair systems is not a wise choice.

The first thing you need to do is to meet with a respected hair doctor for a consultation. They may recommend a set of blood tests to rule out the many other causes of hair loss in women that can masquerade as genetic alopecia. You have had a scalp biopsy already, so you won’t have to do another (I’d bring those results to your doctor when you arrive for your appointment). Depending on your test results, there might be some drugs you can try before jumping straight into surgery.

In any case, please do not let this hurt your self-esteem. Studies show that women are especially impacted emotionally by hair loss, much more so than men and in more dramatic ways, even though men suffer it more commonly. Remember above all that there IS hope and treatments available. Go see your doctor! The fact that you have taken the time to write is an excellent first step.

Does DHT Cause All Genetic Hair Loss?

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

Is DHT the cause of all genetic hair loss? I ask because I have DUPA similar to my mothers type of hairloss which is hairloss all over with not balding pattern. Whats the best way to attack this, thanks.

The answer is different for each sex.

Male: DHT is the cause for almost 100% of genetic male pattern hair loss. There are other genetic diseases and other weaker male hormones made in the adrenal glands that can cause hair loss. Other diseases include the various alopecias (e.g. areata and totalis) and unique diseases that are generally not found in the United States. We know that if your testicles are cut off (this was done in mental institutions in the U.S. many years ago when we did not understand mental diseases) hair loss can be prevented. When these men were given testosterone, they lost all of their hair in months, as was typical for the family pattern.

Female: Women have some male hormones just like men have some female hormones. When these ‘male’ hormones are produced in high amounts in some women (example would be tumors that secrete such hormones), we have observed the impact of these hormones as they contribute to hair loss in genetically prone women. With women, our understanding is not quite as good as with men, because in men we have recognized the role of a single hormone (DHT) as the major cause of most hair loss. You need to have a complete medical workup for hair loss before assuming that this is a genetic process. There are many conditions that cause hair loss in women and it is dangerous to assume that it is genetic unless you take the right tests to rule them out.

MesoHair / Mesotherapy

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

Can you give me your opinion about MesoHair (or mesotherapy)? Just from reading this article, it sounds like it is INJECTIONS in the scalp. Is this better than taking a pill?!?! It says “virtually painless” but I can’t see how injecting stuff into my head can be without pain. The article is at https://www.clickpress.com/releases/Detailed/6646005cp.shtml

Thanks

I can not answer this with any authority. I read the page referenced above and am not convinced that problems of vitamin deficiency are a cause of the hair loss in many normal healthy people who have a good diet. There is a suggestion on that website that this therapy “delivers long-acting neutralizing effects on the DHT hormone” and I have a hard time understanding how this is done. If there was proof, I would love to see it, but as it exists, these appear to be just claims. I suggest that you use Google, as I have, to search out the history and science behind this approach and read the above reference carefully. “Let the buyer beware” is an axiom that still applies.

Just to be clear, the above linked “article” is actually just a press release rather than an independent news story.

Bald Spots on 6 Year Old

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

My 6 year old son has developed bald patches in his head. It began with one bald spot this summer and then traveled to the opposite side of his head. So now there are two bald spots. Now it looks as another bald spot is forming on top of one of the other spots. We have taken them to him to the dermatologist and they stated that is was nothing to worry about. They tested the spots and informed us that no fungus was located and that the patches should fill in on there own. I don’t see any impovement and want to that him to another dermatologist.

Do you have any idea what this could be and could you provide some suggestions.

Thanks in advance

I have addressed this type of question a few times before (search for “child”). There are many causes of hair loss including fungal and bacterial infections. In children, fungal infections are not uncommon. The presence of conditions such as alopecia areata are amongst the many possibilities, but if it just goes away as your doctor said, then waiting sounds like the thing to do. Most of these conditions are not life threatening. I wish I had more advice to give, but without seeing the child, it would be very hard to try to come to a conclusion over the internet.

Will Avodart Lose Effectiveness After 5 Years, Like Propecia Does?

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

Hi Dr,
We know that the study on Propecia shows that after five years, users typically lose most of their regrown hair, and that propecia continues to deter hairloss but that hairloss does continue over time.

My question is…why? Is it that Propecia no longer effectively inhibits DHT after 5 years (body develops an immunity, DHT serum/scalp levels therefore increase.) Or, more likely, is it that there are still undetermined factors which contribute to hairloss, even though the type 2 DHT inhibition rate remains constant?

The question links to avodart. If avodart is just a *much* stronger DHT blocker, and if DHT-inhibition is not the cure-all to hairloss, can’t we expect that Avodart too is equally limited in its scope?

I don’t see how type 1 inhibition and long half life can help in the overall process if there’s more ground to cover than DHT inhibition.

Actually, Propecia users keep more hair than non-Propecia users even after 5 years (ie they do not lose most of their retained hair), and Propecia continues to stop or slow hair loss at the very least in the crown area for as long as you take it. I have patients who have been on it since it came out and their hair loss (if any) is undetectable.

As for those who only experience dramatically slowed loss (still a big improvement), no one knows why hair loss continues at low levels. You are correct to point out that we do not have all the answers with hair loss, the fact that Propecia works mainly in the crown for returning hair and not the front (and only in men) is proof of this. But Propecia will slow loss in the front if you catch it early enough in some people. Pattern baldness is progressive by its very nature.

You are also correct to point out that Avodart is far from being a panacea. We do not even have studies proving it’s efficacy in hair retention (although I myself believe it possible), so it cannot be the final answer or the magic pill we all hope for. Before starting more medications, you should get a metric (measurement) by having your scalp mapped out for miniaturization to determine if you have premature genetic balding.

There are still many unknown factors in hair loss, the future will bring many advances and surprises, I am sure. Until then, Propecia, Rogaine, and hair transplantation are the only means of hair loss help that have scientific evidence to prove and quantify their effectiveness.

Benefits from Minoxidil and Propecia

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

I am 21 years old and noticed a receding hairline and thinning of hair about 2 years ago. My hair loss is mainly the receding hairline. I am in my 9th month of the EXT program at [name removed]. By the way anyone considering it dont do it! it cost me $2,600 for a year and all they do is give you shampoos, conditioners, vitamins, and minoxidle. You can buy all that on your own for much cheaper. Anyways i have noticed that my hair is thicker on the vertex and my front hairline has gotten a little better. It is growing little baby hair. I have 2 questions. I just started taking propecia 2 months ago along with the program. I dont like minoxodil because it makes my hair greasy and its hard to style my hair in a nice way when minoxodile is in it. My question is if i stop taking the minoxidil but keep taking propecia will the benefits of the minoxidil remain, or will they just disappear?

If you stop the minoxidil, you might lose hair if some dependence built up. Alternatively, once you start, switch to minoxidil for women, as it has an alchohol base and is easier on the styling with the same hair benefit.

I would have hoped that you would have started with Propecia first, and nothing else. Then if after 8 months there is no benefit, possibly go to minoxidil. I do not sell any products to gain a profit so I am never in a position to make a distinction between what is in your interest and mine. Only your interest is what counts. The Propecia value will show in 8 months after taking the drug. Please wait it out and possibly stop all of the other things you are taking except minoxidil, which you may be hooked on by now.

15 Year Old Losing Hair

/by William Rassman, M.D./17 /,

I’m only 15 years old and I’m starting toI started to lose my hair about month ago.I had mentined it to my mom when I first noticed it.She had told me that it might be from stress.I don’t know what I should do.Can you please help me.Thank you so much.

Where are you losing your hair? Any bald spots? How many hairs are you losing per day? Is it receding? It is normal to lose up to 100 hairs per day. Sometime, you may go through a shedding phase where you lose a significant amounts of hair and then stop. There are many causes to hair loss like Male Pattern Baldness (adrogenous alopecia), alopecia areata, hypothyroidism, eczema, telogen effluvium and stress. Send me your photos or come by for a free consult so that I can better evaluate your scalp.

Sometimes, assuming you are male, the genetic balding process can start early, even younger boys than you can develop it. You will need your scalp mapped out for miniaturization and a diagnosis for genetic hair loss must be made by an expert. The use of Propecia is not an unreasonable approach, as long as your parents are involved with making the decision.

Hair Assessment in Early Balding

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

Hi Doctor,

I am a 26 yr old male started thinning about 11 months ago sometime in december last year. My hair was really thick before so obviously I didnt realise I was thinning when it kicked in during the early stages.

Observations :
1. I notice about 18 -25 hair every morning on my pillow. Most of these hair are very fine and shorter than usual. Some of them have a white bulb at the end.
2. Even at work I notice about 4-5 hair falling on my desk/ keyboard everyday even when I gently rub my fingers on my scalp.
3. During a shower when I apply shampoo on my hair I get about 10 – 12 hair sticking on my hands/fingers even though I shampoo very gently. I wash my hair with shampoo and conditioner ( Clairol Herbal Essences/ Nizoral; was using Garnier Fructis earlier) about 5 times a week usually after a workout.
4. My Hair is thinning all over my scalp. Even on the back although since there is a higher density of hair so No scalp is visible.
5. Some of the common symptoms I have experienced in the past 8-9 months are itching, flaking/daindruff, A kind of burning sensation as if there is some heat generated from my body which is burning the hair roots on my scalp, and obvoiusly my hair is a lot thinner than a year back.
6. I do not see any receding of my hairline( thank god for that)but the area right behind my hairline/top has some noticeable bald spots where it seems like the hair thinned a lot and i have lost some hair.
7. Been on propecia for almost a month and do experience some pain in my balls of late (after ejaculation) however I dont think its reduced my sex drive or erections but I am determined to ride it out.
8. Overall When I examine my scalp minutely,I notice my hair still grows fast however the quality of hair is much more thinner than a year ago annd as a result a lot of scalp is noticeable. I probably have some hairloss too.
8. The worst part is I am not able to comb my hair like before and if I make it puff from the top/front My scalp is very visible from the front. I really woe the fact that I should have taken corrective measures early (when visible hair loss/thinning started about 10 months back but like most people I was in a denial mode and just would not digest the fact that I was loosing/thinning for good.

I have spent many sleepless nights on this issue in the past month and literally think bout it every 30 minutes.
I am a vegetarian and take about 100 grams of whey protein (courtesy GNC) per day for supplementation. I would say My professional life isnt that stressfull at all. The pics in the album were taken with a Kodak 4.0 MP digital camera under bright light.

1. I am applying Minoxidil twice a day but I am thinking bout changing it to once a day at night. I apply it mostly at the top and some on the vertex. Also its too flakey and makes it look like I have daindruff on my hair. Do you think this is a good move and is once a day 5% effective ?
2. From my pictures can you tell me whats my norwood scale ? I am thinning considerably from the top. The hair on the top of my scalp are very thin compared to last year. As a result They tend to clump together when I make them wet or when I apply hair gel. Sometimes in the morning when I gently rub a wet hand on to my scalp I get about 6-8 hair sticking into my hand. Will Propecia or Minoxidil make them thicker again ?
4. From the pictures how bad is my vertex ?
5. Realistically what are the chances I will retain my “Hair Glory” I had in Sept 2004 ? Or is it all downhill from now ?
6. Is there any way i can get the thickness measures with a densitometer in the North California area ?

Photo Album at [link removed for privacy]

Most of the pics in the first album were taken immediately out of the shower. these days I just stand under the shower and let the water wash the shampoo itself with out rinsing it off after applying. No towel dryng too. Notice how the thin hair clumps together from the force of the shower and my scalp is exposed. Or Am I balding on those areas ? looking at my current situation do you think I should continue using minoxidil 5% I started it 2 weeks back in panic I use it twice a day for now. Should I cut it back to once a day or totally eliminate it ?

I would appreciate your assessment of my situatiocn.
Best regards

Your photographs are consistent with genetic hair loss, but there is no substitute for a good examination as I have said many times in this blog. You should not be your own doctor. The miniaturization mapped on your head will allow the doctor to determine the pattern of the hair loss. The Propecia you are taking will probably stop much of what you are seeing, but you do need to have the examination for miniaturization, or you will not ever truly know if you are actually benefiting from the drug, or if the problem was just temporary and drugs were not necessary. You discussed your hair glory, wanting to go back. I can not (nor can anyone else) predict your response to Propecia, although I have seen some men return to their ‘hair glory’. Responses depend upon the time you have been losing hair, the genetics of each patient and the timing with regard to starting the Propecia with regard to when you actually started losing your hair. The quicker a young man starts Propecia, the greater the overall effect I generally see. As to your question about using Minoxidil while also using Propecia, I’ve talked about this a few times before: here, here, and here. I am in Southern and Northern California, and would be happy to perform such an examination on your free of charge. I can not make a doctor recommendation in the North Carolina area, but you could take a look at the physician search on ISHRS.org. Be sure to do your research before chosing a doctor.

Proscar Prescription

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

Hi Dr. Rassman,

I was wondering if it would be possible for you to write me a prescription for Proscar which I can cut into 4 pieces. If not, do you know a physician who will? Also, is there a good method for cutting it evenly? Thank you.

Yes, I can write a Proscar precription for you, but you will have to come into the office for a check-up and diagnosis. Since you indicated you are in the Orange County area, you’re not too far from my Los Angeles office. You can use a pill cutter to cut the pill into 4 or 5 parts. These are sold in every pharmacy for a dollar or two.

15 Year Old Female with Hair Loss

/by William Rassman, M.D./25 /,

Your information on female hair loss was helpful, but the information on teenage female hair loss was not as informative. I’m fifteen, and I feel I need more information. When I was a child, I had thick hair. When I was around seven, I cut it short. It was still thick then. Around seventh grade I decided to grow it back out, but still, it was thick then. When I started my freshman year in high school, though, mid-year, it began to thin. It has shown no sign of stopping, and it does worry me. My ponytail has significantly gone down in size. I can’t wear my hair down without having loose strands cover my back – which is not popular at school. Plus, I lose an extreme amount of hair each time I shower – at least fifty strands. My hair is also lackluster in shine, and crooked and crinkled when it falls out. My mother took me to a doctor, who told me it was not my thyroid level. A week or two ago, my father told me to start taking vitamins and trying to eat better – the latter of which is hard, when you go to high school. Personally, though, I’m not sure that I believe this is a diet issue. If it was, why wouldn’t it affect more teenage girls at my school? I wish to know if there are medical conditions that I might have that give a symptom of hair loss, and possibly also slight depression – I have noticed that my mood seems to be getting worse and worse. I am also on birth control, which I noticed you said might cause problems… but it shouldn’t, because I have been having hair loss much longer than I’ve been on birth control. I just want to know what I could have, and how I can get this to stop.

You need to have a good doctor do a thorough work-up on you. There is no way I can help you without getting a full opportunity to get a good history (including detailed dietary history) and a full examination of your scalp and hair for miniaturization. This will determine the health of your hair and your overall health. There are no shortcuts and no internet site that can get you what you want, because what you need is a good doctor (one who is interested in this field) first. Also, look through the Female Hair Loss category, as there are many posts that discuss the various conditions and tests that are part of what a good doctor will be able to perform on you.

Female Hairline Restoration After Brow Lift (with Photos)

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

I have had a higher hairline since I was a teenager. I always hated it. When I had a face and brow lift at the age of 49, the high hairline became even higher. Is there a simple way of lowering it? Is transplanting the only solution?

The photos below are of a 45 year old woman who, like you, had a high hairline compounded by a brow lift as well.

These first 3 photos are surgical pictures because they show what was missing, the deformities that were there and the problem that was tackled before (the middle and right photos were from immediately after surgery):




This next set of photos were taken after this lady’s 2nd procedure had grown in. The black hair and light skin are the most challenging contrast for hair transplant surgeons, explaining why it took two procedures to get the results you see here. She had a total of 3,508 grafts (in two procedures). Note that the side hair and temples were brought forward. In normal female hairlines the temple prominences often extend closer to the eyes than in men, narrowing the amount of forehead shown. Women’s hairlines, because they are rounded, not recessed, and the temples are important for accentuating femininity, make the work more difficult from an artistic vantage point.




The high hairline bothered her greatly after the brow lift and became unacceptable. The brow lift produced a wide scar behind the hairline (compounding the problem). In this situation, a hair transplant is the correct decision because lowering the hairline and filling in the scar behind the hairline can be accomplished with a single procedure in a person with blonde or white hair, and two procedures with someone with dark hair and light skin. The hairline was lowered by 3/4 inch and filling in the brow lift scar was also accomplished in the same procedure. A brow lift usually takes away the possibility of a hairline lowering procedure.

Plug Repair Cost

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

Hi Doc,

I’m a one time hair transplant patient of Dr XXX in Rhode Island and very displeased with the results. I had it done back in 1993 at 24 years old. At first it seemed okay, but now my hairline has receded more and the graft are way too pluggy and I’m forced to pluck them, but the pitted scars still show! I shaved my head once and the donor scar is way too obvious. It looks like I’ve been in a car wreck or something. Anyway, it appears my only logical options are to:

1) remove the plugs
2) wear a piece to hide the plugs
3) repair the hairline with a competent doctor

My current hairline has been the same for about 7 years now. It’s about the same as the actor’s Matthew McConaughey at TheSmokingGun.com.

Any idea on the cost to help thicken the hairline again. I know I’ll never get back my old hairline I had in my early 20’s. Just want it to look normal.

We have written articles for scientific journals on the repair options. Those options have become better than since the articles were written and now we can often be more aggressive when needed with far less risks. In addition, we can take follicular unit grafts from the old plugs, softening them in a more distributed way.

The costs vary per patient. At the least, I would need to see pictures to make that estimate. You can send photos to the email address on the Contact page.

For examples of plug repair, please see: