Dear Dr:

First, I would like to say thanks for this web site of yours. you’re one of the few sources of hair loss info that i trust. keep up the good work.

my question: what, if anything, do you know about Procapil (www.procapil.com/index/html)? there is a brand of hair care products on the market called MiN New York (www.min.com) and they all contain several DHT-blocking ingredients — copper peptides, saw palmeto, etc. — and Procapil. any thoughts on this company and their products? also, i have read some info re: Nizoral and how it may help regrow hair as well as Rogaine. is this true?

Nizoral contains a drug used to treat a variety of fungal infections of the scalp. So many people think that it is the magic shampoo for hair loss. If it is, there is far more fungal infections than I ever thought amongst the population. Many ingredients like copper peptides and saw palmetto claim DHT blocking capability, but they are poorly documented at doing just that. If saw palmetto is a DHT blocker, it is a weak one. Copper peptides are not DHT blockers.

Procapil reports that it is a patented plant complex that repairs, nourishes and prolongs the hair cycles of the telogen phase of hair growth. There are claims as well that it is a DHT blocker. In my opinion, none of this is scientific or can be substantiated to meet my standards. Again, I warn every reader that this is a ‘Buyer Beware’ business and many people make good money on promotions that may not have good scientific data presented.

Tags: hairloss, hair loss, procapil, dht, copper peptide, sawpalmetto, saw palmetto, min, nizoral

My daughter is 17 yrs. old. She has a 2nd degree burn to her scalp from a chemical. She had highlights done at a local beauty salon and she was burned. She now has a hypertrophic scar. Will cortisone shots to the scalp help? Her hair follicles are completely burned.

If it is a 2nd degree chemical burn, I doubt the hair will grow back normally (if at all) and the cortisone shots will probably not help the hypertrophic scar at this stage. It is very difficult to give an opinion without seeing her. Fortunately, there are many options to treat her, including scar reduction surgery or even hair transplants, which work quite well in many cases. Consider sending us photographs — in the photos include a ruler so that the size of the defect is clear.

In the last two weeks, I have seen three patients with similar problems. We have offices in San Jose, Los Angeles, and Newport Beach, California. You can always schedule a free consultation for an evaluation by calling 800-NEW-HAIR.

Tags: burn, chemical, hairloss, hair loss, salon, cortisone

I am 33 years of age and my hair line has become considerably thinner over the last year or so. Apart from having a transplant what else can I do to prevent further hairline loss seeing as Propecia and Rogaine only work on the crown?

Also is it possible that hair loss occurs in stages that last a year or so and then slow down?

Hair loss can occur in stages, spurts of hair loss and then a quieter period. Frontal hair loss is difficult to reverse, but Propecia (assuming you have genetic hair loss) does slow the process down. I have seen many men who were losing hair rapidly in the front, then go on Propecia and see the hair loss stop. If they should stop the Propecia (some do for reasons that I do not understand) the hair loss picks up again and makes up for the time the drug was effectively holding the hair there. Get your hair mapped out for miniaturization and then consider the Propecia option, if indicated. You may be concerned about frontal loss today, but taking action with the drug Propecia will help you in the frontal area today. Crown loss can be thwarted as well.

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

We moved in to a 25 year old house 11 years ago and over this time we have all (7 kids and parents) experienced thinning hair. We are all at the same level of hair loss, typically thinning on top. It is getting noticeable (this has been a very slow process) I have been to doctor many times but no answers. I have had a blood test that shows higher than normal levels of copper? Any help would be very much appreciated.

Ages and sex are as follows:
girl-6
girl-9
boy-12
boy-15
girl-16
girl-22
girl-23
Mom-43
Dad-45

Thank you

Hair loss can be a sign or a clue that something is going on with your health. If your entire family is truly experiencing hair loss and it has started around the same time, one would think that there is an environmental influence.

A genetic cause of higher than normal levels of copper in your blood is a condition known as Wilson’s Disease, which causes copper to accumulate in the tissues and cause extensive damage. You can also get higher than normal copper in your body from environmental factors such as drinking sources. Your brief history seems to fit with an environmental cause, since the hair loss cases all occured around the same time frame. There may be other causes beside copper, such as lead, or other elements in your environment and you may want to get some public health professional involved if it is impacting the entire family as you say. An evaluation of the hair shafts themselves can be made by a good toxicology lab under the proper direction of a qualified doctor in the field.

Tags: hairloss, hair loss, environment, copper, lead, poison, family

did second transplant 6 months ago.i seem to have alot of pimples and they are getting worse.is there any cure.tried with pills already but doesn’t work.thanks.age 27-sex male

Six months after a hair transplant should be enough time to end any cycle of pimples. I’m not sure what pills you might’ve taken to eliminate the scalp pimples, but I suggest you go back to your hair transplant surgeon and get yourself evaluated. You have a doctor, take him/her to task. Patient aftercare is important, and your doctor should be willing to answer your concerns.

Tags: hairtransplant, hair transplant, aftercare, scalp, pimple

I appreciate all the information you provide. I am a 30 year old male. It is my understanding from the blog that you believe Propecia to be the most effective pharmaceutical treatment option for hair loss. What advice would you give to a patient who has islet-cell antibodies present in their system? In other words, how would you characterize the risk that taking Propecia would prompt an auto-immune response by the body, thus causing an attack on the pancreas leading to Type I diabetes?

Finasteride (Propecia/Proscar) is a DHT type 2 receptor blocker which does not have any association with the pancreas, therefore I would expect that it should not lead to Type I diabetes. The drug company (Merck) would have recognized any such association if it would have been detected and considering the number of diabetics in the general population, I would expect that such an association (if it existed) would have been reported. Finasteride was originally developed for benign prostatic hypertrophy (which affects the prostate). If you are experiencing genetic androgenic hair loss (male pattern hair loss) Propecia may be a consideration. Propecia, as you probably know, is a prescription medication, so discuss these concerns with your prescribing doctor before taking it.

Tags: hairloss, hair loss, finasteride, proscar, propecia, diabetes, isletcell, islet-cell

I’ve read your blog with interest, especially having just returned from the ISHRS at San Diego. Could you comment more about the types of punch biopsy that you use, and where one can purchase them. Also, can arrangement be made where I can get some hands-on/observation training on the FUE technique?

Any help would be appreciated.

I am generally not in a position to train doctors. It takes many months to learn and master the FUE technique. Generally, I believe that a year fellowship is the right solution for the doctor who wants to learn this process. Structured learning is the right way to learn. The instruments are not available for sale yet.

Tags: fue, doctor, physician, training, hairtransplant, hair transplant, hairloss, hair loss

i like to know if avodart is better treatment then propecia? i’m taking avodart for 8 months and i cant say that i see so much different….

Avodart (dutasteride) should be reserved for those who do not respond to Propecia (finasteride). It is an off-label use, which means that the FDA does not authorize Avodart’s use for hair loss. In most people, the difference should be non-existent, but for the few who are unable to get Propecia to work, Avodart may have an advantage as it is a more powerful DHT blocker.

Tags: avodart, dutasteride, propecia, finasteride, hairloss, hair loss

Dear Dr. Rassman,

I’ve asked you this question before but had not received an answer. I recently read about a so-called new “trigrowthic” suturing technique that promises to leave no visible scarring post strip op. Have you looked into this procedure before and is it to be believed? Thanks.

“What’s in a name? That which we call a rose
By any other word would smell as sweet.”

–From Romeo and Juliet (II, ii, 1-2)

The use of trichophytic closures have been around for years — in fact, that closure has been used in plastic surgery for more than two decades. The hair industry adopted it recently as a standard of wound closure. You could change its name and correctly say that you invented that name, but it would be improper to say that you invented the procedure. The doctors you have referenced here are recycling techniques under a new, original name and as such, if they are claiming inventiveness, then they might be deemed dishonest.

There is NO such technique that can provide results with no visible scarring. ALL cuts on the skin will leave a scar and the scarring is unique to individual patients. Some patients have minimal scarring, while others have more scarring — it is dependent on their genetic makeup, which no one can tell with just a physical examination. Some of our patients heal well and have very minimal scarring that is hard to detect with a regular hair style, but even these patients will have a visible scar if they shave their head bald.

We routinely use a trichophytic closure which I assume is similar to what you have read. For more information about the trichophytic closure, please see:

Tags: trigrowthic, trichophytic, hairloss, hair loss, hairtransplant, hair transplant, closure, wound, scarring

Hello Dr. Rassman,

Intercytex has completed phase I human trials of their hair multiplication product ICX-TRC. The founder of the company, Dr. Paul Kemp, was one of the phase I trials volunteers. Phase II trials have recently begun in the U.K. and may be expanded to the U.S. sometime during 2007. Although there are always roadblocks that can slow progress, they are working towards phase III trials in late 2007/2008 in both the U.K. and U.S. and then the final FDA review for the 12-18 months following. This timeline would bring us to around 2010.

If they have already completed phase I and have started phase II, why do many in the hair transplant community still think it’s many, many years away until hair multiplication is a reality?

I was at the ISHRS conference in San Diego a week ago and more importantly to your question, I was in attendance for the Intercytex presentation at this event. It was stated that the phase II trials will end in 2008. Intercytex’s presentation, while enthusiastic, did not include any human volunteer examples or mention a specific (near future) time line. Anyone can assume and put a guess to a when and if hair multiplication would be a reality. But, considering that the completion of phase II trials is still two years away, it is virtually impossible to state when/if it would become a reality. There are still many obstacles ahead.

Tags: hairloss, hair loss, cloning, multiplication, intercytex, ishrs

For time and financial reasons, how effective is it to start and stop minoxidil within propecia treatment? In other words, can I retain whatever I gain from Minoxidil as long as I’m still taking propecia.

I’m on propecia right now and would like to try the Rogaine foam, but don’t necessarily want to be committed to taking it for life without it being a waste.

Thanks for your help.

Stay on the Propecia and add minoxidil foam, but use the minoxidil foam for at least 8 months prior to concluding if it works. If there is benefit beyond what you got from Propecia, then you should stay on both, probably for life. The two drugs work differently and they can have added value to each other.

Tags: propecia, finasteride, rogaine, minoxidil, foam, hairloss, hair loss

Ok, I just have to ask. I have been searching around for information regarding pros/cons of starting propecia. I came to a web forum in which several people were discussing the fact that propecia made their penis crooked. I have not read this anywhere in the side effects category listed with Merck. Is this a real possibility?

I highly doubt your penis will grow crooked after taking Propecia (finasteride 1mg). Many men are born with a penis that leans to one side or the other (example, Wikipedia – Chordee). What you read on that web forum just goes to show how the internet can be misleading and you must take all the information available with a grain of salt.

Tags: finasteride, propecia, penis, chordee

hi there,
i’ve been reading some of these articles about high hairlines, and most of them talk about the hairline at the forehead. however, with me, my hairline at my forehead is fine, its the hairline at the side of my head (near my ears) thats high. its been a real issue with me ever since i was a kid and i’d always need long hair to cover it up so that it wouldn’t seem as if i’m balding (which i’m not). my doctor says that i am not vulnerable to balding when i get older. i am an 18 yr old filipino male. and i was wondering if there are any treatments to this surgically/nonsurgically. i’d prefer nonsurgical more than surgical. but if there is anything at all, pls tell me. thx

Some people have a genetic high temple hairline (above ears) which can be treated with hair transplants very effectively. There are no other treatments for this that I know of.

Tags: hairtransplant, hair transplant, hairline, side

Dr. Rassman,

For the past 3 to 4 years, i am suffering from severe dandruff. I have also been diagnosed with PCOS last year which is now under control. Mine is long hair and this dandruff is also cyclic. Some times it is perfectly clean and sometimes at its worse. I have used topical products like diprovate with minimal improvement and the shampoos are also not giving the desired result. The dandruff is primarily flaky which is very embarrassing to me. Please suggest me if there is any solution to it. My hair is thinning day by day.

Dandruff may be the sign of a skin disorder like seborrhea, psoriasis, etc. You need to see a good dermatologist and find out if you have some scalp disorder causing what you are seeing and calling dandruff.

Tags: dandruff, dermatologist, psoriasis

Hello I’ve been told that going to bed with wet hair, after coming out of the shower without drying it first, can cause hair loss because of the humidity it builds up or something like that? Is this an old wives tale or is there some truth to it?

If you go to bed with wet hair, I do not believe that it will cause you to lose hair — but it will get your pillow all wet. Be sure that the wet hair does not get pulled when you move around. Generally, it’s probably best to dry it first.

Tags: wethair, wet hair, hairloss, hair loss, myth