What about propecia’s safety? The cancer study along with altering hormone levels just doesnt sound like a good idea. What do you think about starting propecia in your 20’s and altering hormone levels for say 15 years?

Finasteride (5 mg dose of the same drug as Propecia) was first used to treat prostate enlargement and cancer. There have been many studies through the years about this product which demonstrated its safety in the older male population (over 50). I have not seen any dangerous effect in my practice and the drug is carefully monitored by the drug company (Merck) under FDA guidelines. There is no doubt from recent articles published in the past few years that Finasteride in 5mg doses taken daily, reduces the risk of Prostate cancer. There is no suggestion that the slight rise in testosterone that occurs in many people will increase any particular cancer risk.

My girlfriend has the opposite problem as your patients seem to have. She has a low hairline which crouds her forhead and seems th throw the whole proportions of her face off. What can be done to create a more natural and astheticly pleasing hairline for her?

Yes, hairlines can be raised. Brow lifts do just that, but candidacy for this type of procedure in the young patient will be very restricted. In the older women (above 40 or possibly even above 50), a brow lift may have value.

I have just moved to Jordan from London to live and I notice that more hair than usual (enough for me to worry) comes out when I brush my hair and wash my hair (in particular). It has been quite stressful moving and adjusting, plus I have a 5 month old son. There is no history of hairloss in my family – should I worry?

Many thanks

Hair loss comes when a person has genetic tendencies for it (many people find that they may not have it in the short family history but that it exists in the ancestry somewhere). Add hormones and stress to that and you have a deadly hair combo. Well, not “deadly”, but you get the idea. Then add time and you cement the process. Moving from one country to another with your family will almost certainly cause a high degree of stress. Hair loss is caused by genes, hormones, time and stress. Do you have it all? Yes, you should worry and get your hair assessed for early balding. The drug Propecia (for men only) should slow it down or reverse it if the diagnosis is made.

Im Indian. Have half black and half grey hair. My eyebrows are thin. So if i want to transplant a few from my chest / scalp to the eyebrows. Can a surgeon make sure that only the black hair is transplanted? I mean i would not want my eyebrows to be grey in color.

This is the sort of question that requires a patient to prioritize. Which is more important? Having hair in your eyebrows or having it the right color? Bear in mind that coloring your hair, whether on one’s eyebrows or somewhere else, is a cheap and easy process. Transplanting hair is not. One last thought is that your eyebrows may one day change color (ie they may become gray) on their own! That would really be a pickle…

As a side note, I want to address the suggestion of chest hair for your eyebrows in the first place (I know you also mentioned scalp – I just want to address this for other readers of the blog). FYI, often the texture and character of chest hair make it less than suitable for transplantation, even if it does grow slightly shorter than the hair on one’s head. You would have to be examined by your surgeon to determine where the best donor area is, and that may be your chest, but I would simply suggest that you enter the appointment focused on getting the most natural and best results possible.

Dr. Rassman,
I’m 11 weeks pregnant and I’m suffering from alopecia. I was just wondering if is there any safe form of treatment that I can go through or any specific food that I can eat to prevent any further hair loss. The hair loss started off as about a quarter size in circumference now it has grown to about five inches in size!! Please I need some help, because I feel that pretty soon I will be completely bald. Thank you for your time.

I am assuming that the hair loss is relatively complete in the areas showing. If so, it sounds like you are suffering from Alopecia Areata induced by the pregnancy. You need to see a dermatologist for a biopsy and treatment. You will need to coordinate any treatments with your OB doctors to keep things safe for your baby if the doctor elects to treat the problem and my presumptive diagnosis is correct.

I’m a 20 years old male. I started to use Nutricap since I started to notice my hair getting thinner. Just used it for 20 days and I think that my hair loss has increased. I was wondering if Nutricap Anti-Hairloss pills have caused it. Usually, I lose a lot of hair 3 days after I wash my hair (like it was scheduled). I was thinking of stop taking those pills. Please advice me as soon as possible. Thank you.

Nutricap is a dietary supplement. The only pill known to prevent hair loss is Propecia. Strictly speaking, if there is no rigorous scientific evidence for a hair loss treatment (Propecia, Rogaine, and hair transplant surgery are examples of those which have evidence of efficacy), then I do not recommend it. To my knowledge, vitamin supplements do not either cause hair loss (when taken in moderation) or prevent it (unless you are malnourished). Save your money, go see your doctor (or a dermatologist or a hair loss specialist), and take a photo to document your hair loss for your own assessment.

I am 23 and have experienced significant hairloss in the past 5 months. I did not start taking Propecia and now I am currently studying in China and the medication is unavailable here. To stop the anxiety of noticing my rapid hairloss I was considering shaving my head. Will this at all increase the rate of hairloss until I can begin treatment on Propecia, Minoxidil, etc?

Shaving your head will have no impact on your hair loss, one way or the other.

I have a 20 month old who I am suspecting may have alopecia. Can you recommend a physician in the Chicago area who sees children and specializes in alopecia? Thank you for your time.

Look to the ISHRS website for a hair specialist, or even the American Academy of Dermatology for a listing. Best for you to consult your pediatrician as there are many causes of balding in young children that he/she should be able to treat and if necessary, make an appropriate referral to a competent specialist in the field.

Hi, I am 35 years old and started losing my hair about a year ago. I had been taking Prozac for over 6 years and after some research discovered that this could be the reason for my hair thinning so much. I have managed to come off Prozac now (about 3 months ago) but haven’t seen much of an improvement in my hair. Then I started to think about the possible effects of coming off the contraceptive pill ‘Brevinor’ which I had been taking since I was 19. I came off the pill last May. Could this also be the cause of my hair loss? If so, is there anything I can do? perhaps some sort of oestrogen supplement? Do you think my hair could re-grow? Any information would be greatly appreciated since my GP does not seem to have a clue. Thank you

Both Prosac and Brevinor can contribute to hair loss. In some women with genetic hair loss tendencies (often evident in the female side of your family) these drugs may induce or precipitate the hair loss and it may not reverse. If the genetic tendency is not there, then it should return over a 6-18 month period with the drugs stopped. Of course, these drugs offer you value, so stopping them may cause you more problems; these are not easy decisions to make.

Dear Dr.Rassman, I recently had a hair transplant the beginning of December of 2005′. I only needed a small area above my bangs,(I’m a female with blond, baby fine hair),and was given a mega’ session to my surprise!) It will be three months the start of March. My question is that post-op, I was told to start using minoxidil for 3 to 6 months. I was told that this would help in blood flow to the follicles. Will the transplants grow without minoxidil? I haven’t been using it every day like I should. Shouldn’t a transplant grow without using minoxidil? I lost alot of my hair that I already had when they were putting it the grafts. I don’t see any of the original hair coming back very fast…something about the hairs being “shocked”? Were they destroyed when the new hairs were translanted, or will they come back? I have less hair now, than when I went in for the procedure! Not to mention the “ear to ear” donor site, that is slowly coming back! Thank You.

Minoxidil may help improve the rate of hair regrowth, however, transplanted hair does not need minoxidil for growth. It sounds to me like you may have some shock loss from the surgical procedure. More than likely, the shock hair loss will reverse (it usually does in women) and your hair would then grow back somewhere between 3-5 months following the surgery.

I am frankly surprised and dismayed by your comment that the megasession was a surprise. There should be no surprises in this process so I would think that your doctor failed you in this regard as good communication is the key to the entire hair restoration process. Your concerns are real, but I wonder if you lost faith in your doctor by my observation that you came to the internet for advice that should be part of the standard of care that one should expect from their doctor.

For the information of the readers reviewing this blog, hair transplantation in women is usually restricted to a sub-set of balding and thinning problems because female genetic hair loss does not occur in patterns like it does in men. In the fringe area around the sides and back of the head (donor area for the transplant), men usually have healthy hair (99%) while women often do not (20% have a good supply of healthy hair). That means that if a women does not have healthy hair and is transplanted, the unhealthy hair is moved along with the healthy hair (not a good use of a surgical procedure). Women with female genetic hair loss can have 4:1 unhealthy hairs:healthy hair ratios. What that means is that for every good hair transplanted, four unhealthy hairs get moved. This is the reason we do not transplant many women as the value may not be there. I have met some doctors who claim that women make up a sizeable part of their practice and generally I have the view that the value proposition here is totally favoring the unscrupulous doctors that do this and give this industry a bad name. What makes women easy victims for the unscrupulous doctor is the general hopelessness that they feel as they move from doctor to doctor looking for the magic cure for their balding so when a doctor brings the promise of a cure, they will easily spend thousands of dollars to go that route. I do transplants on women, but very few of them as women make up less than 5% of my transplant practice and of those women, half of them are treated for non-genetic balding problems such as complications of facial surgery. The old axiom remains, ‘Let the Buyer Beware’.

Good luck to you.

Hi, Dr., I’m 19 years old and I live in france, so excuse my english which isn’t wonderful. I’ve experienced hair loss for 3 months and I’m taking finasteride + minoxidil 5%. At the moment I’m not loosing hair but I’ve noticed that my hair are getting thinner? Is it possible that one of the two drugs I use is making my hair thinner? It’s bothering me a lot. Thank you for your understanding

Propecia and Minoxidil can possibly put you into a shedding phase, which will be short lived. Don’t be alarmed. Keep on the track you are on.

Is hair transplantation only for men in their 20-40’s? I am in my 60’s and while I would like to not be bald anymore, I am worried that the surgery is too risky for someone my age.

Hair transplants, like all forms of cosmetic surgery, cover all ages. More and more men in their 60-80s are now coming in for hair transplants. They just don’t want to look old. I’ve posted these photos before, but they are worth pointing out again. Take a look at this 68 year old man:



He had a new lease on life. His wife, looking like she now had a younger man, had a face lift just to keep up the youthful appearance started by him.

I recently read that prednisone is usually not related with hair loss in women, but I am a 35 year old female who has ulcerative colitis. I spent 2 weeks in the hospital where they gave me prednisone intraveniously as well. I have been on oral doses starting at 55mg and over a course of about 5 months, have gone down to 5mg and will soon be off. I am also taking Asacol which may also be contributing to my hair loss. I have also been losing A LOT of my hair and it is really starting to affect my confidence. I have been hospitalized 3 other times for this condition where I also lost hair due to the meds and it did return. I just don’t remember it being as extreme. Is there a product I can take to help me grow it back and is it the Prednisone that has caused this hair loss? Thank you for your time.

Your hair loss can be attributed to multiple causes, such as malnutrition from Ulcerative Colitis, the medication in Asacol, and stress from your recent hospitalization. Steroids have androgenic properties and can also be the cause of your hair loss. I do not know if the hair loss is reversible, certainly as long as you are on many of these medications. If the medications have precipitated genetic hair loss, you may not get benefits even if you are off of the medications.

I live in Philadelphia, PA. and have researched many hair restoration companies including Bosley, Newhart and others. Most of the companies I’ve spoken with I have insisted on meeting with some of their clients that have had the procedure. I find that people are surprised when I ask. I am amazed at their surprise. I mean would you commission an artist to do a mural and not check out his/her work? The few clients I have met with I have not been impressed with their so-called natural looking hairline. There are a lot of hair companies out there. I would really like some advice on who will give me the most natural looking hairline. I am willing to travel to go to the best.

I love your question. You are absolutely correct — do not buy without seeing the type of results you will get first hand. This is precisely why we started holding free open house events around 13-14 years ago.

Dr. Robert Bernstein in New York has open house events, just as we do in Los Angeles and San Jose. For our upcoming open house events, please see the NHI Event Schedule. Our next open house will be held in our Los Angeles office next week on Thursday, March 9th from 4pm-7pm.

I am 24 year old currently on propecia for the last 8 months. While the results have been satisfactory, I am not thrilled. I have had zero side effects from the medication. I am looking into taking avodart .5 mg. I know you are not legally permitted to condone the use of it for MPB, but is it more effective than propecia? I am looking to get a little regrowth that i have not seen with propecia. Is it safe to use for MPB and is there substantial non FDA controlled testing credibility regarding regrowth? Please Advise

There are no FDA studies on Avodart related to hair regrowth, but Avodart has been studied for prostate problems and it is safe in the older population. To my knowledge, there are no good studies on Avodart with a hair loss focus either. If any readers out there are aware of such studies, please feel free to send me links to the address on the Contact page. Please follow past blog entries related to Avodart by using the search.