Hi, thanks for this service. While I am somewhat suspicious of your constant hawking of propecia to the exclusion of topical solutions (pun intended) such as minoxidil in your earlier entries, I would still love any insights you have on that topic. I am a 25 year old man. At age 18 or 19 my internist noted some frontal hair thinning/loss, evident to me retrospectively when I examined pictures (esp. if flash was used). I was immediately placed on minoxidil, which seems to have not only arrested the loss but perhaps, over the last 6 or 7 years, even allowed some regrowth toward the front. Finally, now, at age 25, I am noticing some thinning and folicle miniaturization in the center and back of my head for the first time, though I am still at the point that only other balding men notice—my female friends and loved ones think I’m neurotic and that even my minoxidil use is unnecessary. What I wonder is whether I should expect acceleration of the loss or merely loss at the same rate; if the loss rate itself is constant then I think I’ll try to hold on by using topical minoxidil.

Second, if I were to switch to a dht blocker, would you recommend avodart or propecia, and would you recommend cessation of minoxidil? I worry that after 6+ years my hair could do unpredictable things without the minoxidil. Lastly, I don’t think I yet qualify on any of those charts as balding, though I myself notice some thinning and, of course, many hairs in my hands when using hair products.

A DHT blocker impacts the cause of male patterned hair loss, so it is the best approach to use a drug that is known to be effective and safe. Avodart is not proven to be effective or safe (no scientific study for hair loss victims) for treating hair loss, but I believe that it is effective. Notice I did not say I believed it to be safe, because long term use of this drug has been on older men with prostate problems, not young men with hair loss problems. Is there a long term Vioxx type problem hiding in the closet? I don’t know, nor does anyone really know.

Norwood 3vI tell everyone who is on minoxidil that when it is working to stay on the topical medication, for stopping it often causes ‘catch up hair loss’. Frontal hair loss and early crown hair loss indicate you may be a Norwood Class 3V pattern. You need to have your hair and scalp mapped out for miniaturization to make the diagnosis, otherwise you are flying blind.

I have no connection to Merck (producers of Propecia) and I am not ever paid by them for my opinions on this drug. I do not now, nor have I ever owned stock of this company (as I’ve stated before), so I am clean in expressing my opinions on this drug, because it has had wonderful results that I have seen in many of my patients.

Tags: propecia, proscar, finasteride, merck, hairloss, hair loss, avodart, dutasteride, minoxidil

I recently had a hair transplant and I can tell that the grafted skin is clearly visible in only one particular area (I keep the hair extremely short). All other grafted areas are perfect. The difference is night and day. Can the surgeon tell if there will be a mark in one spot by inspecting the grafted areas during surgery? What causes one grafted area of skin to be visible and not all others? Could it be that the incision wasn’t deep enough…making the grafts not go in far enough and stand out a bit resulting in bumpy grafts? I hope you can answer because I am concerned about returning. I need to know if I can really trust the surgeon. Maybe I made him angry?

It is difficult to understand why you would have surgery without being able to trust him/her. Afterall, they are cutting you open. You really do need that trust. Furthermore, I cannot stress the importance that the relationship between a doctor and yourself should be a partnership and one of mutual respect. Your surgeon should be able to address any and all of your concerns before and after surgery without any reservations. I understand that it may not be a perfect world, but I would recommend that you speak with your surgeon first.

With respect to your particular situation, it is virtually impossible to know what was done and what the plan in your surgery was without examining you or asking your surgeon/and yourself the pre-operative plans and expectations. The ability to see the transplanted skin in the graft could be caused by many factors, including the deployment of minigrafts rather than follicular units, placing the grafts too deep or too superficial, angular placement that is inconsistent, inadequate trimming of the grafts when they were harvested, etc…

Tags: surgery, surgeon, trust, hairloss, hair loss, hairtransplant, hair transplant

I am curious to know whether water would be an issue in hair loss. I am currently in Spain. I have been here since September and am not coming back to the states till August. I recently started taking generic finasteride at the beggining of this month should I be concerned about water and its pertinence towards hair loss, as well would the 5mg generic finasteride have exactly the same ingredients as the propecia?

Unless there is something I do not know about the water in Spain, it should not be a cause of hair loss.

Generic finasteride in 5mg strength is FIVE times more potent than Propecia, which contain 1mg of finasteride. Thus, if you are using finasteride in 5mg strength you should cut it (ideally in 5 pieces, but realistically in 4 pieces) to make 1mg of finasteride. Taking 5mg finasteride at once is NOT more effective than taking 1mg of finasteride for treating hair loss. In fact, you may have an increase in the incidence of side effects.

Tags: finasteride, hairloss, hair loss, propecia, proscar, water, h2o, spain

First of all I’m a 29 yr old male with extreme anxiety. I’ve read a couple of posts on this site about Xanax & hair loss. In every question asking about whether Xanax can cause hair loss, you mention that it definitely can.

As I stated earlier, I have an anxiety disorder & have just recently started taking the generic version(1mg 3 times a day) of Xanax again. Can you explain to me how & why the Xanax would cause hair loss? I’m just REALLY concerned now after reading about that. I was thinking that extreme anxiety would be more likely to cause hair loss than Xanax?

If you could just give me any kind of explanation, I’d be extremely grateful.

Occurrence of hair loss can be due to several factors. Although most the common cause of hair loss at your age is male pattern baldness, anxiety could be considered an aggravating factor for your hair loss. Hair loss is not one of the commonly known side effects of Xanax. We hear from our patients who just got started on Xanax that they lose hair, but it is hard to prove that their hair loss is really associated with Xanax or if it has to do with anxiety itself.

Tags: xanax, anxiety, hairloss, hair loss

I am a 19 year old male and since August of 06 I have lost a significant amount of hair due to shedding and maybe miniaturization (some hairs that fall out look much thinner than others). From about february 06 till august 06 i was on a very reduced calorie diet and lost about 80 pounds. I can’t help but think there is some connection between the weight loss and hair loss.

My first question is: could that restrictive diet have caused my early and rapid onset of hairloss? Also, I have currently been taking propecia for the last 2 months.

My second question is: will taking vitamins (which ever ones they say promote hair growth. ex.Vitamins B6 and biotin) along with propecia help promote new growth? or are vitamins ultimately uneffective against hairloss (assuming its MPB)?

Thanks for your time, and your site is by far the most informative i’ve found so far.

Nutritional deficiencies (or as you put it, restrictive diet) can cause hair loss. In addition, this may trigger a stress response and turn on a gene that may kick start your male pattern hair loss. Unfortunately, after the process has started it is difficult to stop the progression of hair loss.

In either case, you should have a balanced healthy diet. And if you are concerned about male pattern (genetic) hair loss, you should see a doctor to get the correct diagnosis. Propecia can only be prescribed by a doctor and even if it is readily available over the internet you should see a doctor for a correct diagnosis and appropriate follow up.

Tags: propecia, finasteride, hairloss, hair loss, diet, nutrition

Baldingblog - Post #3000

You’re reading the 3000th post here on BaldingBlog, which is quite remarkable for a site less than 2 years old. Thanks to the readers out there for the continued support!


Hi, I am 22, male and have been using hair straighteners for roughly a full year now. i have seen a decline in hair and hair thinning occur over the past 3 months. I am very concerned as i am soo young and not married and have already experienced hair loss, most likely due to traction alopecia. I am so styling my hair in this way and i hate to change and stop using my straighteners, but if my hair will grow back to its natural healthy and thick form it was in before i began using the straightening irons i will. So, if experienced significant hair lost by using straightening irons for one year, will my hair stop falling out and grow? And, will the hair that has fallen out be replaced? i know you have had similar questions, but most have been from females and i know alot of males that use such products and are having the same hair loss & thinning problem. we need to know if our hair will grow! PLEASE

Traction alopecia could be reversible if diagnosed early. If you are predisposed to male pattern baldness due to your genetic background, traction or any other type of trauma to your hair may have accelerated your approaching male pattern baldness. Occurrence of hair loss can be hastened by trauma. A visit to a hair specialist can help to determine whether your hair loss is an accelerated male pattern or purely traction alopecia. You should have your scalp mapped out for miniaturization to determine if you actually have genetic patterned hair loss. In either case, you need to stop what you are doing with your hair and let the hair follicles that are still alive grow new hair.

Tags: hairloss, hair loss, straightener, traction alopecia, alopecia

Dr. Rassman,

I understand that hair loss is understood to be a dominant trait. I also understand that men can be homogeneous dominant or heterogeneous. Would it be fair to say that main with homogenous genes are the ones to lose their hair early? say in their 20s and 30s, while men who are only heterogeneous dominant lose their hair later in age? say their 40s and 50s, I was just curious because I figured that maybe men who have a double gene are the ones more likely to have severe hair loss. Or does it not matter either way?


Hair loss is not a dominant trait. If so, a bald man’s sons will all be bald — which is not the case. What you are describing is a classic Mendelian type of genetic inheritance. The expression of the genetic factors also often skip generations. The hair loss gene(s) is not so simple to categorize and no one really knows how many genes are involved with hair loss.

Tags: hairloss, hair loss, genes, genetics, genetic, mendel, mendelian, inheritance

Hi Dr Rassman,

Ive been reading your blog daily for a short while now, and im curious, if you were to look at someone how would you know if they had dupa, what are the symptoms that you would be able to diagnose that with?

Thank you.

Diffuse unpatterned alopecia (DUPA) is a condition where miniaturization is present all over the head, even in the areas that hair transplant surgeons think is sacred (the back and sides of the head). Thinning in the donor area where there was no thinning before, would make me suspicious of DUPA. You should get your hair mapped out for miniaturization and that would clearly give you the diagnosis.

Tags: alopecia, dupa, hairloss, hair loss

Hi Doc,

I found this article about caffeine and hair loss. It seems a little silly to me. Care to comment? Once again thanks for all of your work.

Coffee could help cure baldness

CoffeeThis article is referring to the research that was done in Germany and recently published in International Journal of Dermatology. In this study, researchers removed some hair follicles from balding patients. They have cultured the hair follicles and then exposed them to testosterone and/or caffeine. The growth of the hair follicles has shown to be increased after being exposed to caffeine, so the investigators suggested that caffeine may have a protective mechanism against testosterone effects on hair growth.

Does it mean that you should double the amount of coffee you take every day to prevent your hair loss?

The answer is “absolutely not“.

Although interesting, this basic study was done in the lab and not in the human body. There are several factors involved in the process of hair loss that can not necessarily be contemplated in cell culture. In order to reach the conclusion to use caffeine as a medication for hair loss, several other studies should be done. Efficient levels of caffeine should be determined in animal studies in an appropriate hair loss model (topical, as well as systemic). Safety of caffeine at those concentrations should be determined with toxicology examinations. After these phases, and if it is proven to be both efficient and safe in animals, the product should pass different phases in human trials, like any other medication. The human part of the study usually takes years before it could be approved for human use.

Tags: caffeine, hairloss, hair loss, testosterone, trials

Hello. I had an FUT procedure done at [name removed] about 8 months ago. I see visible, what look like holes on my recipient area from overhead lighting, almost like scarring. Obviously, I wasn’t expecting this as I had heard that new techniques show no visible recipient scarring or mini holes. Will this EVER heal in time, because now i am freaking out about it. If so, how long does this take to go away?

In addition, my hair is darker on the sides than the top so the recipient hair does not match in color. Will this change in time? My doctor tells me the sun will change it and it will eventually grow in lighter at the roots but I don’t know if I trust anything they say anymore.

I wish I had never done this and don’t know where to go from here. Any answers and direction would be very helpful because I am freaked out now.

Generally by 8 to 12 months most of your hair transplants should have grown and you should not have the visible holes or scarring that you are describing. As you do, then this is probably permanent. Sometimes certain patients are more prone to scarring than others, but that is not what you seem to be describing and it is very, very, very rare in the recipient area. With respect to hair color, your hair color should generally match the hair on the back and sides of your head.

Obviously it is very difficult and practically impossible to give personalized advice this way. If I viewed the recipient site ‘holes’ you are talking about, what you call ‘holes’, I may call something else. If you like to have a formal consult, I would be happy to review your case. Please call my office at 800-NEW-HAIR to arrange this or send photos to the address on the contact page (reference this posting, please). You pictures and your correspondence with us will be maintained confidential (it is also the law that protects privacy).

Tags: hairtransplant, hair transplant, hairloss, hair loss, scar, scarring

(female) Hi my question relates to the previous question you received regarding hair loss and the use of head and shoulders shampoo. I have used this product for about 10 years now and have over the last month or so noticed my hair thinning. I have switched to the Loreal Elvive Anti Dandruff shampoo now but the volume i once had to my hair does not seem to be returning. My hair used to be very thick and wavy now it is limp and lacks volume. I also am currently taking the medication beta blockers, would these be contributing to what is happening, rather than the shampoo?

I clearly can not tell you what, if anything, will help you. Too many changes at the same time confuses the issues. Go back to do what you were originally doing and then after some months, make one change at a time to see if there is an effect and note what that effect is.

Be sure that you have a medical work-up for the diseases that impact women (first choice) before jumping to conclusions that this is a simple matter just involving shampoos. Hair loss in women can sometimes be caused by underlying medical conditions, so it is important for you to be evaluated by your own physician. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. It is also important to review the use of medications that can cause hair loss, such as oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin and prednisone. The following laboratory tests are often useful if underlying problems are suspected: Estradiol, FSH, LH, SHBG, Prolactin, T4, TSH, ANA, Iron, TIBC, Ferritin, Free and Total Testosterone. It might help to print this page out and show this to your family physician.

Tags: shampoo, beta-blockers, betablockers, hairloss, hair loss, female, women, woman

Dear Doctor Rassman,

I am a 25 year old male. I have a Norwood 1, so no thinning at the crown or at the temples. My hairline is about the same as when i was 17. My hairdresser always tells me I have very thick hair (she even thins it out sometimes) I lose about ten hairs a day when brushing and in the shower. My father and grandfather mothers side are not bald and neither are my other male family members.

You might wonder, why is he writing?

I’m really curious. When my long (well medium length) brown hair gets wet, I can see some skin. No bald spots, but dependent on the way the hair falls, I can see my scalp. Well, not eveywhere, but small lines.

How is this posible? (couldn’t find the answer anywhere on the internet)

(I have light skin btw)

Thanks in advance for your answer.

P.S.Great site, interesting and helpfull :)

This type of question has been addressed here before. Thinning differs in people. Those with coarse hair can lose more hair than those with fine hair and not show thinning. Those who have miniaturized hairs will show thinner and thinner as the miniaturization increases. The loss of 10 hairs per day only reflects about 10% of what a typical person loses throughout the day. Most people see more hair loss in the shower, because they can not see what blows away on a windy day — but just because they do not see it, does not mean that it does not happen. We lose some of the 100 or so hairs on a 24 hour basis. Everyone can see their scalp, unless the skin is dark and the hair is dark as well, has a high density, or it mats together with a good, tight afro.

Tags: hairloss, hair loss, scalp, thinning, balding

Most of my hair on the top is gone except for some baby fuzz, and very thin on the sides and back. Will I see benefit from the use of minoxidil or propecia?

PS: my body is very hairy (face, chest, back, etc) will taking any of these medications increase body hair?

Since I hardly have any donor hair on my head, is body hair transplant a possibility? Where can I get good information on this subject?

Thanks for your assistance.

Best regards

MonkeyThe medications of topical minoxidil or systemic Propecia (finasteride 1mg) should not cause more hair to appear on your already hairy body. If you have a full Norwood Class 6 or 7 balding pattern, then chances are that these medications may not help. The marginal edges are where such patterns may see benefit, but you need to get a good doctor to help. Body hair transplants are not the solution (see Body Hair Transplantation for more). To see a Class 7 patient who had enough donor hair to cover his balding head, see Is Hair Transplantation too Risky for Older Men? Each person has different hair characteristics and densities, so you need to be evaluated to find out where you stand.

Tags: hairloss, hair loss, body hair, body, minoxidil, finasteride, propecia

hi there
just an update i had a consultation in London, i was told that due to my age i was likley to lose more hair, we have already established that. I was given the option of just having my hairline restored, and think about having the crown area’s filled in, at another 2 -3 years time when i will be at least 25 and my pattern hairloss will be evident as to what way it is declining towards. My gp will not precribe propecia to me, as i told you i am located to Dubai do you think i could purchase it over there. My plan is to try propecia for 6 months or so and see what happens. although hairline is more important to me, i know propecia can restore that, then what can propecia do for me on a realistic level. Is it guarnteed to work for everyone or it is a chance of luck and variency? Is the drug relatively safe i mean the drug will be stored away, but as a user i can still handle and pick up kids cant i? please tell me the best option , and if propecia works where am i likely to see results on the scalp?

You are 23 years old and it is not good medical practice for you to transplant early hair loss. You should take finasteride 1mg for one full year, then reaccess your situation. It works in young men to reverse hair loss, slow down the hair loss, or(3) stop the hair loss. Why rush doing hair transplants? You have your whole life to live and a wrong decision now will impact your whole life.

Propecia is safe and it will not impact anyone else by simple touch. Generally, you can buy Proscar or generic finasteride 5mg and cut the tablet into 4 pieces, taking one piece of a pill each day. Generic finasteride is available in practically every country that has men with prostate problems, UAE included. I am not sure why your physician will not prescribe it — you should ask him/her why.

Tags: finasteride, propecia, hairloss, hair loss

I was wondering since alota aussies smoke cigerettes, drink and love to party, if it cuases any premature hairloss from excessive binge drinking and chain smoking.

I am not familiar with a proven connection between smoking, drinking alcohol, and hair loss. Your definition of “party” may include drugs, in which case hair loss could be a problem, though I hope this is not the case. Please note a previous post, Does Drinking Alcohol Contribute to Hair Loss?

Tags: smoking, cigarette, tobacco, alcohol, drinking, drinks, hairloss, hair loss, party