Thank you for seeing me yestserday. You put my mind at great ease. As I reached you on this blog initially, please feel free to use my photographs to tell my story.

This is a 21 year old man who came to see me, because he felt that his hair was thinning in the forelock and his corners were rising. These pictures tell half of the story.

  1. The changes are consistent with the appearance of the male hairline.
  2. Mapping out the scalp shows no significant miniaturization present in any part of the scalp.

It is worthy to note the well illustrated picture of the left hairline where the fine hair (which is miniaturized as it is lost) is receding into a mature hairline. Behind this frontal immature hairline, is a mature hairline with no miniaturization. This clearly tells me that this young man is not balding at this time. As a 21 year old, the future is uncertain, so timing is everything. I always tell these young men to follow with me yearly, just to detect miniaturization at its first appearance and if the miniaturization appears, then with a drug like Propecia, the miniaturization may be arrested. The focus of a good Master Plan should be to keep the hairy person hairy, not transplant the balding one. Although this is not a profitable thing for me to do, it is what you would demand from a good doctor, doing what is in the best interest of his patient.

The good news is that he does not have to start Propecia at this time and may postpone it until miniaturization appears (if it ever does). Peace of mind is the reward for a good and proper examination (one way or the other).





Tags: hairline, miniaturization, propecia, hairloss, hair loss

I am a 22 year old female who has been losing hair since the age of 16. My hair loss has stopped or is constant but there has been no re growth. i have had all blood tests and everything is fine. i have been applying minoxidil for the past 3 years but yet there has not been any re growth. There are some areas on the crown of my scalp which show that i have had severe hair loss. I use nanogen fibres to cover this but this still doesnt cover it entirely. please could you offer me a solution. Can i undergo hair tranplantation , if not, why exactly ?

If you have been evaluated by a medical doctor and cannot find a medical reason for hair loss, your next step may be to make an appointment with a dermatologist or a doctor like me to establish a good working diagnosis. If you are a transplant candidate (a complex analysis for women), one has to make sure that your donor supply and your needs match up. If the donor supply is impacted with diffuse alopecia in significant amounts, then a hair transplant (moving sick hair around) does little to solve the problem you are trying to rectify. Women are generally poor candidates for hair transplantation, because the cause of women’s hair loss is very different than it is for men and the donor supply is often weak. You will not know until you can establish a diagnosis by mapping your scalp for miniaturization and hair loss pattern. Be careful of any doctor who is enthusiastic about transplanting you without answering the mapping diagnosis posed here.

Remember, a hair transplant with a poor donor supply may make you worse off for having it done in the first place.

Tags: female hair loss, hair loss in women, hairloss

Dear Doctor,
I just recently stumbled across your site while doing research. I’m glad that I can actually speak with a doctor, as opposed to self-proclaimed hair loss zealots on forums and other sites. Here is my current situation.

I’m 21 and about four months, and I do believe that my hairloss started when I was just turning 19, maybe even as early as 18. All my hairloss practically is from the crown area. It started with a quarter sized essential bald spot, and its spreading to either side of my crown. My hair was always thick, and it has thinned somewhat, but still remains pretty thick. I have little to no signs of a receeding hairline. I tried finasteride (finpecia, www.unitedpharmacies.com) for six months, and tried generic mixodil 5% for a little over a month. Currently I am taking nothing, and it seems to be getting somewhat worse. I am a college student, so once I get enough money I intend to take finasteride again.

I have the following questions…

  1. Is the generic finasteride I found on unitedpharmacies.com legitimate?
  2. Should I definitely use Minoxidil in conjuction with finasteride?
  3. Are there any shampoos/conditioners, that will help my situation?
  4. I’ve heard that in Canada hair transplants are much cheaper than in America
  5. Is Hair cloning going to be legal in any time in the near future?
  6. Maintaining hair is one thing, but I would really like to regrow. Is there anything besides the above mentioned treatments that may help my cause?

  1. Please be aware that finasteride is covered by a series of U.S. Patents held by Merck (drug company), one of which I believe is about to expire shortly. I am not in the drug manufacturing business so I can not state with any certainty that someone will be able to manufacture and sell a ‘generic’ Propecia in the United States anytime soon. Any generic finasteride you purchase, may or may not actually be finasteride — there is no way for you to easily be sure.
  2. You do not need to use Minoxidil while being on Finasteride, especially considering that you are college student without much money, but crown hair loss (your pattern) is most impacted to finasteride, so that would be my drug of choice here. If you want to be sure and knock down the price, then some people will purchase Merck’s Proscar (5 mgs of finasteride) and cut it into quarters — though it is available by doctor’s prescription only. I can not advise that you do this, but I know that it is done. I believe in Propecia/Proscar/finasteride use in all genetically balding young men.
  3. I don’t believe one brand of shampoo/conditioner is better than the other in saving your hair.
  4. See my blog entry titled The Truth About Cheap Hair Transplants and draw your own conclusions. Buyer beware.
  5. See the Hair Cloning category, but don’t hold your breath.
  6. Not that I can endorse.
Tags: hair loss, hairloss, propecia, finasteride, minoxidil, hair cloning, hair transplant

Hi, Im a 14 male and losing hair.

I have been checked by a doctor (just a GP) and have been told that i have a very healthy scalp and that its not a scalp issue. I do not have hereditary hair loss in the family, my father is in his mid 50’s and still has all his hair. I have always had very ‘big’ sort of hair so its becoming increasingly noticeable. Im not losing terrible amounts of hair, only about 30-40 per day , but it is very stressfull. Especially when i have to wash my hair, and also when i wake up in the morning and have 15 + hairs on my pillow.

Is this ‘normal’ so to speak? Could it be stress related? Am i just shedding? Please help me out. Thanx.

The average person loses 100-150 hairs per day. What fall out you are noticing in the shower is probably less than what you lose during the day when you are not washing your hair. It is normal.

Tags: hair loss, hairloss, teen

Hello Dr.Rassman!
Thank you for the previous answers! I have another question:

If guy A starts losing his hair when he is 20 and guy B at 27, is it 100% sure that guy A will have less hair than guy B at his 40s? Once again thanks for your time!

TrafficIf guy A starts out traveling at 55mph from Los Angeles on the 405 freeway going south at 4pm on a Memorial Day weekend in an SUV and guy B starts out traveling at 70mph on the 10 freeway east bound at 5pm on the Friday of Thanksgiving weekend in a Porsche, who will have traveled the farthest by 7pm?

If you can answer that question, then I will attempt to answer yours.

For those of you who can not calculate the math challenge (hey, I can’t either) — I would say that no two people lose hair at the same rate, so time varies with the patient.

Tags: hair loss, hairloss

I’m curious (and nervous) about what it means when I comb out two scalp hairs that both stem from a single, hard substance that looks like a follicle. My hair is too short for this to be a split end. Is it a follicle these hairs are attached to? If so, why are there two hairs growing out of it?

Hair grows from a follicular unit in one, two, three, or four hair groups. It seems you pulled a follicular unit that had two hairs.

Tags: hair loss, hairloss, follicular unit

A recent article, titled “An update on chemoprevention strategies in prostate cancer for 2006”, published in the May 2006, Volume 16, Issue 3 issue of the Current Opinion in Urology medical journal discusses the ability to reduce prostate cancer with a variety of herbs, vitamins and drugs including the roles of: finasteride, selenium, lycopene, soy, green tea, anti-inflammatories and statins. It warns of the increased risks associated with excessive vitamin E and cyclooxygenase-2 inhibitor. We are learning much about prevention of Prostate cancer. Below is a review of the article:

PURPOSE OF REVIEW: An increasing volume of research has been directed at the prevention of prostate cancer. This review proposes to summarize the large trials, novel approaches and molecular mechanisms of effect published in 2004 and 2005.

RECENT FINDINGS: The impact of the Prostate Cancer Prevention Trial continues and subsequent articles have addressed the increase of high-grade prostate cancers detected in the finasteride arm of the trial, as well as the potential costs and benefits of extrapolating the findings to a public health campaign. Studies of risk have been published warning of excessive vitamin E and cyclooxygenase-2 inhibitor use in chemoprevention. Growing evidence supports the concept of chemopreventative agent combinations and further data on the roles of selenium, lycopene, soy, green tea, anti-inflammatories and statins in prostate-cancer prevention are presented.

SUMMARY: Level one evidence exists for the preventative effects of finasteride in prostate cancer. The evidence for other agents is less conclusive but a number of large-scale, appropriately designed trials will hopefully address some of the relevant issues in prostate-cancer prevention over the next decade.

Source: Curr Opin Urol. 2006 May;16(3):132-7, An update on chemoprevention strategies in prostate cancer for 2006, Neill MG, Fleshner NE. Division of UroOncology, University Health Network, Toronto, Canada.

Tags: finasteride, propecia, prostate, cancer

I am in the process of a losing my juvenile hairline. It is turning into the mature hairline. Does the hair that is receding to that of a mature hairline just fall out are does it have minuturization.

I am 26 years old and my straight across hair started changing to a mature hairline 2 years ago and have noticed minuturization for some time around the temple region,basically what i’m saying is this a normal event or the start of the balding process.I would be extremley grateful for your comments on the matter

As World War General Douglas MacArthur said in his retirement speech, “Old soldiers never die, they just fade away“. That is like hair and most people miniaturize some of the hair in conjunction with receding. The miniaturization process is an early indication of what the future holds, but there is no timeline on that prediction. We do not usually note miniaturization, because it sneaks up on us. Even your juvenile hairline will behave like the ‘old soldiers’ that General MacArthur talked about. The key for someone like you is to get the entire scalp mapped out to be sure that it stays in the juvenile hairline, otherwise drugs like Propecia may have great value in preserving the other hair you have before it sneaks up on you as well.

Tags: hair loss, hairloss, hairline, propecia

What is the difference between a hair system and a wig or a toupee?

ToupeeIt is the same as the difference between a garbage collector and a sanitation engineer! Everything is in the packaging!

Shakespeare wrote, “What’s in a name? That which we call a rose by any other name would smell as sweet.” I would change this for the sanitation engineer: “That which we call garbage smells the same under any name you choose to give it. Unfortunately, for many wig wearers, there is a smell that comes with chronic use of wigs unless you have replacement wigs that you wash with some regularity.” It’s not quite as romantic, but it fits.

So to answer your question straightforward — no difference, except for the name. Hair system was coined to market fake hair so that it sound better than wig or toupee.

The picture shows a ‘hair system’ from the bottom (you almost can’t see the hair). What you are looking at in the photo above is the part that attaches to the scalp. To get the best fit, the scalp should be shaved and then the device is glued to the skin with some ‘attachment’ compound. Once glued, it stays in place on the scalp until it is removed and reattached. Many wearers do not do this for themselves, but rather pay someone to do it for them. If the device stays on for a week or more, the sweaty scalp produces an odor which then transfers to the ‘device’. Some people remove it at night and this allows them to shower and wash their scalp. They may also wash their device, but washing it makes it wear out earlier. Alternatives to glue include weaves, which use the existing hair around the head to be weaved through the mesh of the device like thread or clips which can attach the ‘device’ to the existing hair around the edges of the ‘unit’. The clips are better, because they can be easily removed while the weaves can not be moved and must be reworked as the hair grows longer. The average weave becomes more and more loose the longer it stays in place and to make matters worse, it moves as the hair gets longer.

The constant movement of the ‘device’ as the hair gets longer, or the pull from the clips or the glue, creates traction alopecia (hair loss from pulling) which is permanent in almost every person. The sad thing in all of this is that these devices will cause permanent hair loss and dependence upon them. This dependence creates business for the life of the customer.

The reason I think that hair transplants are a better solution is that rather than create dependence, it creates independence. Most of my hair transplant patients say goodbye to me after one or two sessions. From a financial point of view there is no comparison, as the wigs run an average of $3000/year for purchases, replacements, adjustments, repairs and services (and more and more services). Just think of the money a person will spend at $3000/year in 10 years ($30,000) — a far more expensive process than two hair transplants that run between $10,000-$20,000 (hopefully with a stopping point at just two sessions). The existence of a good Master Plan with an honest and reputable hair transplant doctor is critical for the hair transplant candidate who wants to ask “when will it end?”

Tags: wig, hair system, toupee

I’m 16 years old, I first noticed my hair loss, probably early this year. I was worried, but not to worried as it wasnt that bad, and I figured it was natural for your hairline to shift. But I went the get my haircut and the guy cutting my hair told me I had “better brace myself for early baldness” that striked me as odd, because, while I knew something was happening with my hair, I didint realize that it was that noticable. I told my parents that I was concerned, but they pretty much brushed it off as me being paranoid. So I thought that maybe that was it for a while… then I noticed how much hair was on my hands everytime I shampoo in the shower, and no matter how long I do it there is always hair on my hands, and then on the towel I use to dry my hair. SO I begain to research on the internet, but I didint find anything that great, except for this site, and maybe a few others, the rest where just sites trying to sell miricle potions. I read up as much as I can on this. mainly the hair on the top and front of my head seems to be the hair that is falling out, and it almost looks like back of my head too, wear I part my hair, but I am un sure. I’ve become so self concious, and scared. I’ve spent many a night, laying awake in bed, almost in tears, trying as hard as I can to fiure out a solution. At first I was just gonna live with it and when I had to, just cut what hair I had left really short, or just shave my head all together, but when I really looked at it, looked at myself, that just wouldnt look good. There are men who can pull off being bald, and look great, but I just cant. I hate going to school and just looking around and seeing all these full heads off hair, and I’m sitting there trying as best I can to cover up my thinning hair. I look at it, and I dont care if I (in a perfect world) lost my hair in my 40’s or 30’s. My father is bald, his father is not, but his grandfather was, and my other grandfather on my mothers side is. I’m just very stressed out, and didnt know where to turn… some days I feel like “eh, just gotta live with it” while others I cant stand to look at myself, and mope around pretty much in tears. right now, I’d love to just get a hair transplant, I know I cant, but I wish I could, because from the things I’ve seen at other transplant websites, the hair is pretty much a natural head of hair, and it looks great. I appologize for this long, drawn out, and horribly put together thing, but while I write this, I’m extremeley stressed out about my hair. Well thanks for this blog, and helping us guys out.

First you need to know that balding can start in the teen years. As I have said many times on this site, you need to get a diagnosis and have your hair mapped out for miniaturization and then you will know if you have just developed a fine hair (natural) or are thinning in the balding sense (many miniaturized hairs will be seen). If you have miniaturization, then you probably will follow the bald side of the family. There is good news here, because a daily pill of Propecia will likely slow it down or prevent it. At that point you could be doing something about it, but there is no point to worry about something that may not be. Your parents are like many of the doctors out there who do not really understand balding and its management. Show this blog to them, select particular sections on it and then get to see a good doctor who will map out your scalp as I have suggested here.

Tags: teen, hair loss, hairloss, balding, propecia

hi dr. rassman, are you saying you will be able to get propecia generic the 1 mg this summer??? please let me know… thanks

Please read my previous response carefully. There are patents that go well beyond this summer, but the business folks will show us how it will all fall out. I have no insight to what may happen.

Tags: propecia, finasteride, hair loss, hairloss, patent

Do FUE procedures form scars?

Yes, there are scars anytime the body is invaded by the surgeon, or any time you cut yourself. The scars come about when the edges attempt to close the gap. The FUE scars are circular, so the size of the scar somewhat reflects the size of the wound. To answer the question appropriately, let’s talk basic math and then convert the math to logic.

The chart here shows the size of the cutting punch and compares the size of the wound that is created. The scar reflects the size of the wound.

 

Diameter Area % change from smallest wound size
0.75mm 0.44mm square (baseline)
0.9mm 0.64mm square 44 % larger than 0.75
1.0mm 0.79mm square 78% larger than 0.75
1.5mm 1.77mm square 300% larger than 0.75

 

The reality of these number are that the 0.75mm leaves almost no scar, because the edges co-apt and there is minimal secondary healing as the scar fills from below as the side skin grows over it. With all of the wounds from strip harvesting, the scars are long and the wound is much larger. Such ‘line’ wounds can be seen when the scalp is shaved.

The 0.75mm wounds are impractical, but the 0.9mm wounds are the standard used in my practice. So in answer to your question; scars are related to the size of each wound. The smaller the wound for FUE (for example), the smaller the instrument used by the surgeon, the smaller and less noticeable will be the wounds in their final healing phase. Please see this previous post, Size of FUE Procedure, for discussion on actual yield rates. If only a needle is used (like the one you get with a flu shot) I sincerly doubt that you will ever find the scar with the naked eye.

Tags: FUE, hair loss, hair transplant, hair restoration, hairloss

If you are a female taking Spironolactone 100 mg can you take propecia too?

If you are taking spironolactones, you must be managed by a doctor. As I do not have experience with it, I can not answer this from direct knowledge, but I would suspect that it would be reasonable to take Propecia, provided that you are past child bearing years. There is no long term studies on safety in women for Propecia, but there are certain conditions that cause a woman to make a great deal of male hormones and as such, may actually develop a male patterned hair loss. Having these diseases and being past child bearing years, a trial of Propecia may be indicated, but be aware of the possible appearance of conditions that ‘theoretically’ may develop which could impact the breast, uterine and ovarian organs. For example, cancer risks have never been studied when a women is placed on Propecia and those women who are genetically prone to breast, uterine, or ovarian cancer may find themselves at greater risk.

Tags: propecia, female hair loss, hair loss in women, spironolactones, hairloss

Dear Dr. Rassman,
A few months ago I visited you and you mentioned you were right on the edge of creating an improved tool for Follicular Unit Extraction procedures.

Are we there yet?

There have been recent improvements in technology related to the tool used in the FUE process and I personally believe there is room for even more improvements. There are still some patients who do not make good candidates for FUE and if it is possible to get around whatever the limitations are that we are experiencing with hopefully better instruments. As the instruments improve, then the FUE technique may become more common place. Unfortunately, it is now a limited offering by a very select few physicians who have invested the time and put their skills to the test to become good at it. It is the curse of a perfectionist to always try to improve from the status quo, but clearly as some people are still not candidates for FUE, the present has another surgical option that is already good, reliable and replicable (the Follicular Unit Transplant with strip harvesting). What is needed for FUE is an instrument that works in other than God’s hands, like the mortal surgeon I am, trying 100% of the time to be better.

Tags: fue, hair loss, hairloss, hair transplant

I am an almost 19 year old female and I have a high forehead. I was coloring my hair the other day and noticed that I have a receding hairline. I also noticed that there is ‘new growth’ but it is very blonde and there is not enough of it to cover the areas. I have also smoked for three years and have been under quite a bit of stress lately. Will it continue to fall out? Is there anything I can do to stop it from doing so? Thank you so much for your time and consideration.

High hairlines in some women are normal genetic patterns, like the size of your nose and other facial proportions. If you really have a high hairline since you were much younger, then there are things you could do for it surgically.

Some women with the genetic hair loss genes can lose their hair in response to stress and when the stress is over, most regrow their hair. What you are describing, however, is not clear for me to make a diagnosis. I always tell women with hair loss to get checked out by a doctor and be sure that there are not medical causes of hair loss. The most common include hypothyroidism, genetics, hormonal imbalance, pregnancy, anemia, crash diet and oral contraception pill. In your case, smoking does not help your situation, but it is not the main reason for your hair loss. Otherwise, every smoker would be bald. Cigarettes have many chemicals which are toxic to your body and may assist other factors to induce your hair loss. Smoking may lead to less blo0d supply to your scalp which may lead to weakened growth of hair. I recommended that you visit a dermatologist and your primary care doctor to evaluate your hair loss and run blood tests to find out the cause of your hair loss.

Tags: female hair loss, hair loss in women, stress, genetics, smoking, hairloss