It appears that most of the hair transplant examples I’ve seen have tended to be transplants around the hairline (and hair combed back in most cases too) versus crown transplants. If one suffering from MPB were to undergo a hairline transplant and be on Propecia (for the crown) indefinitely, there will inevitably come a time (5+ years) when even the finasteride will wear out in terms of its effectiveness in keeping the crown hair. Does that mean that a series of hair transplants are required to “keep up” with the rate of hair loss overtime?

To give this question the respect it deserves, one needs to understand the natural progression of genetic male patterned balding. This is a progressive process that will eventually lead to a final pattern consistent with your genetically predetermined pattern. Look at the Norwood classification chart for hair loss and you will see a series of patterns. These can be the ‘end stage’ of the hair loss or they may be intermediate stages leading to a more advanced stage along the progression indicated in the Norwood scale. The problem is that you really do not know (for sure) where you will end up, but there are many ways to estimate where you might be by looking at:

  1. Your miniaturization map of your scalp. The final pattern may very well show some degree of miniaturization, even if you are not frankly balding yet.
  2. Your family pattern and see if you can identify (a) the worst case in the family or (b) the person whose pattern you believe you are following. Then you might be able to ascertain your final pattern (an educated guess).

If your final pattern is not the more advanced patterns (demand for hair) and if your hair density is adequate (supply), then you might be able to keep up with the progression of your balding as it is happening. If, however, the final pattern will be a Class 5, 6 or 7 pattern, you might not be able to keep up with the balding process with additional transplants because you may run out of donor hair (supply). The one clear point I wish to make is that you need to have a Master Plan to take in your worst case scenario and you must have a doctor who you can trust to work with you on that plan. The Master Plan has one objective and that is that no matter what happens, your hair restoration surgeries should always leave you with a natural appearance. Too many patients and doctors think in the short term, and think that the hair transplant will solve the problems of balding. That may not be realistic, so the relationship between the patient and the doctor is all important.

If you are having your first surgery when you are 24 years old and you are supposed to become a class 6 or 7 in the future, even though you are only a class 3 now, it is likely to assume that you need more than one surgery. On the other hand, if you are 35 and have almost reached the end of your hair loss process, you may be done with just one procedure and may never need another surgery. You have to understand that Propecia is not a permanent solution, but it does slow down the loss process in most men. Sooner or later, your hair loss will catch up until that final hair loss pattern is reached. Taking Propecia (Finasteride) may prolong the outcome, but the final pattern is probably inevitable.

Tags: finasteride, propecia, hairtransplant, hair transplant, hairloss, hair loss

the doctor that did my hair transplant told me that i “should not” use proscar because when the droplet of finasteride drips into the 5mg proscar pill, all the finasteride could be on one side. so when you cut the pill into 5th or 4th you might not get anything in a couple of 1/4 pills. is this true??

I highly doubt this is true. If this information is true, wouldn’t there be a chance that a “droplet” of the active medication (finasteride) can also miss the pill, making it a dud? This just goes to show you that have to be very careful about what to believe and what not the believe. Or hope that there is someone out there who is very careful about where they put the “droplet”.

The only concern I have heard about cutting Proscar in to 1/4 pieces is that the dosing may not be exactly accurate and that if you cut more than one in advance, the cut pills may be able to hydrate from the humidity in the air and then become less effective. I do not think this is of clinical importance. If you elect to cut the pill, but sure to store only one cut pill in a sealed small air tight container.

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

I’ve recently had a total hysterectomy at age 24. I’ve noticed that my hair has stopped growing. Is this something permanent or can something be done about it?

Stress and shock loss is something that we have discussed before in many posts in this blog. Almost any kind of stress can precipitate hair loss in some people. Women seem to be more impacted by stressful surgeries like hysterectomies, while men are more stressed by business, financial, or family problems rather than by surgeries. Any major surgery can cause shock loss and it is not limited to the scalp surgery. This is called telogen effluvium and is similar to what women experience after delivery of a baby.

Tags: hysterectomy, hairloss, hair loss, stress, female, women, woman

Hi Dr. Rassman,

In an earlier post you said that it is safe to take accutane and propecia concurrently because they do not interact. However, is it possible taking both at the same time will lead to some kind of liver damage? Another, related question is: how taxing on the liver is propecia?

Thanks in advance for your reply!

The combination of these two medications is not reported to be causing any liver problems. Propecia (finasteride), like many other medications, is metabolized in the liver. Metabolism of this medication in the liver does not affect the function of the liver in normal individuals. If you have severe liver insufficiency, doctors may need to adjust the dose of Propecia, as well as any drug that gets metabolized in the liver.

Tags: liver, propecia, finasteride, accutane, hairloss, hair loss

Dear Dr.,
I have a scar on my cheek that I have from when I was a little boy. I’ve had 2 scar revisions but the scar always spreads and I’m left with a pretty noticable scar where no hair grows.
Would it be possible to somehow fill in that area with hair from maybe my lower neck?

Scalp hair transplanted to the beard area (cheek) is a relatively common procedure. Some men who can’t grow facial hair have these type of procedures to fill in a beard, and likewise it can also be used to cover a scar. Lower neck hair would not be the best place to harvest donor hair, since neck hair is not considered permanent hair.

Tags: cheek, beard, hairtransplant, hair transplant, hairloss, hair loss, scar

Is propecia less likely to work if one is required to start it as a younger age (such a I, who is 18) as their is a higher level of testosterone present? Also when propecia proves not affective in a person why is this?

Thank you

It is not a perfect world! Some people respond to a medicine differently than others. I believe that all men with genetic balding will have some benefit of Propecia, but will the degree of benefit meet the needs of the patient? That is the question…

Tags: finasteride, propecia, hairloss, hair loss

I’m a 32 year old Filipino male. I have thick black hair that’s shoulder length and both parents still have hair. My question for you is, does shaving your head affect the regrowth of your
hair in any way? I am cast in a film set to shoot this summer BUT I have to shave my head WITH A RAZOR. I’ve heard from friends (through their friends…of course) that shaving your head with a razor may make the hair to grow back very rough and course…and in some cases, it grows back like “pubic hair” by being kinked. I guess the worst case scenario is that some parts of my head don’t even grow back hair. Please let me know as I’m so nervous about the whole thing and losing some sleep over it. Thank you very very much in advance!

Simply shaving your head will not cause you to lose hair or change the character of the hair. Good luck with the movie!

Tags: shave, shaving, hairloss, hair loss, hair character

I am a 42-yr old African American woman. I had hair restoration surgery in March 2006 for androgenic alopecia in the crown. For the last year and a half, I’ve been taking Propecia in pill form 2.5mg/day as well as topically. I’ve noticed since taking the meds, I’m experiencing diffuse thinning all over my head now. Have you heard of Propecia causing accelerated hair loss? Is this a temporary side effect? If I stop now, will my density return?

Propecia (finasteride 1mg) is an oral medication for the treatment of androgenic hair loss approved only for use in men. It blocks a hormone known as dihydrotestosterone (DHT) which is responsible for hair loss in men. Propecia is not approved for women, because female hair loss is not necessarily caused by DHT and it may cause birth defects when women take the medication. Finally, only 1mg of finasteride is recommended for the treatment of androgenic hair loss. Taking 2 mg or 2.5 mg is not necessarily twice as better or effective. It will however increase the potential for more unwanted side effects. I would recommend that you see your doctor and address these concerns to him/her and or see another physician for a second opinion. This website is NOT a second opinion.

The question should be: Will taking Propecia harm me if I am not going to get pregnant? We really don’t know the answer to that, as the appropriate clinical studies were not done on women so safety and effectiveness are still up in the air. I couldn’t possible know the cause of your hair loss without an examination and a detailed medical history.

Also worth noting, Propecia is not available in a topical form or available in 2.5 mg strength.

Tags: finasteride, women, woman, female, propecia, hairloss, hair loss

I was unable to access your link that campares Rogaine to ScalpMed. The link is broken. Therefore, my question to you is this: Is the only ingredient in Scalp Med, (when mixed with “Vitadel” which is simply minoxidil) that actually effects hair growth Minoxidil? I suspect that all these similar products are merely inactive ad-ons since the only common ingredient ALL the products have is that they must be mixed with minox.

Is that so? In other words, if the product works for me-and it does so remarkably, would I see the same results by simply using the $20 a bottle minox and not spend the extra $100+ on the Scalp Med or Follicare, etc.?

I’d be very grateful if you could clear this up for me as I love the results but simply cannot afford their prices anymore. And stopping using will cause the new hair to fall out. Also, do
you think that a DHT blocker is important and/or effective in combo with minox? I look forward to your kind reply. Thanks much.

ScalpMed, as we stated before, does not have any scientifically proven ingredients besides minoxidil and I do not see any reason why minoxidil should not be as effective, possibly even better.

There has been some research done on topical DHT blockers (mostly by Japanese researchers), which shows effectiveness of these products. I guess I would like to see more research on larger groups of patients before recommending them to my patients on a regular basis.

Tags: scalpmed, scalp med, minoxidil, generic, hairloss, hair loss, dht

Hi Doc,
I am very concerned about my hair loss, and so far my frontal area is balding apparently. I thought about having hair transplant, but one doctor told me that I need to take propecia to stop losing the existing hair after the surgery.

However, I have Hepatitis B so my personal doctor suggested me not to take propecia since propecia can increase the chance of me getting liver cancer.

This is truly a delimma to me, do you have any suggestion or solution to that? Thanks

I do not understand why your doctor suggested that you can not use finasteride (Propecia). Finasteride get metabolized in the liver like many other medications. If you are in liver failure, then that may be a different story. Its use needs to be controlled and it probably needs dose adjustments in the patients who have liver disease or cirrhosis (not just hepatitis). I am not aware of any evidence that indicates an increased risk of liver cancer with finasteride if you have hepatitis.

Tags: hepatitis, propecia, finasteride, cancer, liver, hairloss, hair loss

My husband sunburned the top of his head he is bald there could you tell me how to relieve sunburn pain there he says Aloe makes it hurt more is there something else he can do?

You can try over-the-counter pain relief medications for sunburns. There are also topical pain relief medications available at your local pharmacy. In the future, he should protect his bald skin with a good sun blocker. I suppose being bald can also be painful — literally! Many men who have had a hair transplantation procedure find that the transplants give them the cover they need to prevent sunburns.

Tags: sunburn, sun burn, bald, medication, hairloss, hair loss

Hi, I had a question about the effectiveness of generic rogaine. My hair has recently been thinning (I assume as a result of genetics since my doctors can’t find any other reason). I noticed that the Wallgreen’s brand of rogaine is a lot cheaper so I’ve been using that. So far after 3 months I haven’t seen any difference. Do you think generic rogaine is as effective as the name brand (they appear to have the same ingredients)? Thank you very much doctor! I really appreciate it.

The generic minoxidil and Rogaine do have the exact same ingredients. I do not see any difference between the two and their effectiveness should be the same provided that the concentration is the same, and they are using the same inert ingredients. The foam form seems to be better, because of distribution and penetration of the skin.

Tags: minoxidil, rogaine, foam, hairloss, hair loss, generic

I am a 37 year old female. In February/March I suffered from an acute sinusitis and was on 3 treatments of antibiotics and 2 treatments of steroids. About 3 months later my hair started shedding (diffused) at a rapid pace (100-150 hairs a day) and has been continuing for almost 6 weeks. I have started taking Evening Primrose Oil and other supplements that help hair growth. It dose appear as if new hairs are growing, but I can tell my volume is not what it used to be. I have had 2 blood tests – TSH (2.13) and Ferritin (18.7). My doc said both were normal. Any other test I should request? I am assuming that my acute illness has caused my hair loss, if so how much longer will my hair be falling out? Anything else I should do?

It is normal to lose around 100 hairs a day. You may notice more hair loss at one time or another in your lifetime and this is normal. As long as you are healthy with a normal physical exam, you can take some comfort in knowing that your hair will likely grow back. It is more about being patient and letting time take it course.

With respect to evening primrose oil, I have never heard of it for use in hair loss. If you seem to think it has been helping, then I see no harm in continuing it.

Tags: oenothera, evening primrose oil, hairloss, hair loss, female, women, woman

If a medication is the cause of your hair loss, how long does it usually take before it happens, days, weeks, months? Thank you

It can be days, weeks, or months. People react differently.

Keep in mind that the cause of hair loss due to a certain medication use is usually the very last on the list of many other more common causes for hair loss.

Tags: hairloss, hair loss, medication

Is DHT essential for proper genital tissue structure/function?

(more detailed: could lack of DHT lead to decreased AR expression in penile tissues & nitric oxide production… leading to tissue changes, ie fibrosis/collagen deposition which cause such shortening/lack of bloodflow?)

I know there is relevant posts to this issue where you dismissed finasteride in relation to a change in penis + testicle size but i thought it was important to bring forward my case to show that there is definately some relation with finasteride and penis size *in a flacid state*, aswell as testicle size. I am a 20 and a half yr old male who has been on propecia since about 19.

id like to point out im not saying that my penis has actually reduced in physical size due to finasteride, but in its flacid state it now resides alot different to how it use to – doesnt hang as much, looks like ive come out of a cold shower – which in turn gives the apperance of a smaller penis.

what ive experienced:
– testicle/scrotum shrinkage. they are no longer hanging as low as they use to, they are now tight and pulled very close to the body. scrotum could almost be described as empty and wrinkly
– reduction of how penis resides in flacid state. In the flacid state my penis is ALOT smaller then usual. penis doesnt “hang” nice and soft and move around loosely as it once did when to flacid. penis is now retreated /retracted as if in cold water, its almost withdrawn and seems it is lacking circulation/blood flow. penis once hung lower than the bottom of my testicles but is now actually pushed up and forward by how tight the testicles now are, and how reduced the size of flacid state is.

i found another person who experienced similar side effects to me. he stated he experienced:
– penile/scrotum shrinkage, loss of length/girth
– loss of morning/spontaneous/nocturnal erections
– empty/wrinkly scrotum
– penis constantly retreating as if in a cold pool
– loss of sensation/numbness to both penis shaft and scrotum, both feel lifeless/not pleasureable
– penile tissue changes: narrowing, curvature, darkening, emergence of numerous varicose veins along shaft

now i have not experienced the severity of his symptons, or his loss of size during erections, but it is quite alarming there are others out there who have experienced this issue and there isnt any warnings out there regarding this alarming side effect

after reading through several links below, one must question – is it possible that lack of DHT leads to decreased AR expression in penile tissues & nitric oxide production… leading to tissue changes, ie fibrosis/collagen deposition which cause such shortening/lack of bloodflow???

the links:

thanks for any input you can share on this topic!

DHT is very important in the first trimester of pregnancy when the testicles and penis form. If DHT is not present (mother on finasteride or born with a defect where the fetus does not make DHT), then a hermaphrodite will probably develop. For more on hermaphrodites, see:

It is true that being exposed to DHT blockers before puberty can negatively affect the development of the male external genital system and other secondary male sex characteristics (beard and body hair even after puberty). DHT is essential for development and growth of the male genital system before they are completely mature and reach their final size. Our current understanding is that the use of finasteride after puberty when the amount of testosterone is very high with corresponding high DHT levels, should not impact these secondary sex characteristics and will still allow the penis and testicles to reach their maximum size. There is not much information on the use of this drug in young teenagers and I suspect that prior to the age of 16 when balding may start in a select number of boys, the decision to use finasteride is easier the further into the teens the person is.

You have referred to a study done on 3 groups of young rats. This study has shown that a lack of either testosterone or DHT can affect the growth and development of the external genital system negatively.

In the studies done on humans, there was no report of similar or any other negative changes on the external genitalia in adult men or boys in their late teens. I have been recommending and prescribing Propecia to a good portion of my patients, and as of yet have not heard any such complaints with regard to impact on penis size once the penis has grown to its final adult size. You have to remember that this medication has passed all clinical phases and was proven effective and safe for treatment of male pattern baldness (in adult males). If you are still concerned with the changes in your genitalia, you can see a urologist to make sure you don’t have any other medical problems that have been causing this issue.

Tags: propecia, finasteride, hairloss, hair loss, genital, development, dht, testosterone, penis, testes