MouseLast week we attended a lecture at Cedars-Sinai Medical Center in Los Angeles on the topic of hair stem cells. Dr. Robert Hoffman (speaker) is a professor at the University of California, San Diego. He and his colleagues have done several studies on hair stem cells and its application in different fields of medicine.

Dr. Hoffman’s team extracted special cells from the bulge area of hair follicles (above the lower generative center of hair) that are known to be easily accessible and a good source of actively growing, pluripotent cells (cells that have capability of differentiating to different cell lines). They found the protein markers of the neural stem cells in this group of cells (Nestin). They performed several projects to evaluate the final cell lines that could be harvested from growth and differentiation of these stem cells. Among those were using these cells to produce nervous system and blood vessel cells. In one study, Dr. Hoffman’s team applied these stem cells on mouse severed sciatic nerve. The animals that were treated have recovered from nerve injury and could resume the function of affected limb faster in comparison to the control group that never received any treatments.

Dr. Hoffman and his colleagues also performed similar study on a mouse with spinal cord injury. The animal with spinal cord injury gained the function of its paralyzed limb following application of these cells to transected part of spinal cord. The findings can bring about hope for treatment of patients with ‘fresh’ spinal cord injuries. Currently, there is no effective treatment for spinal cord injury and those patients are doomed to lose the neural function of some part of their body, commonly their lower extremities for the rest of their lives.

Although Dr. Hoffman was optimistic about application of hair stem cells in regeneration of cells in nervous system, when asked about his opinion on hair multiplication, he did not believe that it would be that easy. Dr. Hoffman believes that the necessity of interaction of this dual stem cell system (cells from bulge area and cells from dermal papilla of hair follicles that produce hair formation) makes it more complicated for producing hair with a method similar to what is described (in producing nervous system or blood vessel cells).

It is most interesting that Dr. Hoffman and many others working in this arena, find that producing the hair organ (which contains skin, hair elements, blood vessels, fat, and other supportive tissues) is far more difficult than producing just one of these elements (nerves, blood vessels). For those of you who are anxiously waiting for hair multiplication results to be available in the clinical world, I would not postpone the more standard treatment for hair loss (e.g hair transplantation), as your balding will inevitably progress as you will wait, and wait, and wait for the breakthrough that may not occur in the time frame when you can enjoy having hair on your head.

Tags: stem cell, stemcell, hair multiplication, cloning, hair cloning, spinal cord, hoffman

Da Vinci RobotMy first cousin just had a diagnosis of prostate cancer. With my help, we explored his options. He is 67 years young and his father lived to 96, and many on both sides of his family lived into their 90s and 100s. This is important, because the decision on which treatment to take for the cancer depends upon your life expectancy. Many men over 70 are pointed to non-surgical treatments, because their life expectancy is in the 10 year range so the value of surgery over radiation (radioactive seeds) or “watchful waiting” is not clearly defined compared to the risks of surgery. You don’t want your surgeon to use actuarial tables alone in deciding whether surgery is right for you.

In my cousin’s case, we selected a radical prostatectomy with a new technique using the da Vinci robot directed surgery. The surgeon does surgery from another room, all through the use of telemetry and robotics. The surgeon most skilled in this technique is Mani Menon, MD, based at the Henry Ford Hospital in Detroit (my cousin flew from Washington DC for the surgery and will fly back out for the post surgery follow-up). Dr. Menon has personally done over 2,000 such surgeries and his complication rate is the lowest in the world. His extensive pioneering research and experience on nerve sparing techniques results in a lower incidence of complications, such as erectile dysfunction (ED), in particular, and incontinence. My cousin could have had the surgery done locally at much less cost with surgeons who had some experience (20 – 200 surgeries) with the robot. There is no substitute for experience. For more information on the da Vinci surgical robot, see

He just had the prostate surgery yesterday and said it was easy with no pain. He thought that the entire process was first class. Of interest, his older brother had the same surgery with a local doctor just a few weeks before and did not have as smooth a course with the surgery. I don’t know and can not say that this is an apples to apples comparison, but my cousin thinks it is. He is now 24 hours from his surgery and is already walking around and being discharged from the hospital as I write this blog. Had finasteride been around for 20 years and had he taken it, it may have reduced his risk for developing prostate cancer (better than a slick surgery, of course).

What does this have to do with hair transplantation? Unfortunately, hair transplant surgery is fast becoming a commodity as more and more doctors enter the business and drop prices to lure patients into their practices. If you were my cousin, would you accept a discount from a local, less experienced surgeon rather than pay higher fees and endure travel expenses and associated inconveniences? Does it pay to travel to get the surgeons who are the leaders in the field? My cousin thought that some years ago when he traveled cross country to California to have his hair transplant surgeries done at NHI.

Here are some questions you should ask yourself when choosing your hair transplant surgeon:

  1. What are the complications that one can experience from doctors who do not have experienced teams performing this type of surgery?
  2. Do you really know what you are getting and what you are paying for?
  3. Are the graft counts accurate?
  4. Do the doctors maintain a high standard on quality control while performing these surgeries?
  5. How many surgeons have you met with that show the results of the ‘local’ doctor’s surgery? It is better than seeing some of their “failures” walking around the city.
  6. Do you have the discipline that my cousin had to ensure that the surgeon that you select will do the best job the first time around? Unlike prostate surgery you never see the patient’s incontinence or impotence, but on a poorly done hair transplant, you have to face it in the mirror every day and if it is bad enough, so will everyone else (and few will tell you what they see).

Case in point, I just met with a patient who had a terrible hair transplant. I asked him about the doctor who did it and he told me that the plastic surgeon who did the procedure was a relative of his and was willing to do the transplant at no cost to him. He thought he got the deal of a lifetime. This is a family connection that is now in trouble. Some plastic surgeons who do not have substantial training in hair transplantation and do not have an experienced team working with them, will fail at getting the results that are possible. There are no real bargains out there, and often, the old saying ‘that you get what you pay for’ is hard to learn.

Tags: prostate, davinci, da vinci, robot, prostatectomy, menon, nhi, hairtransplant, hair transplant, surgery, surgeon, hairloss, hair loss

Hi Dr. Rassman
Great site…thanks for helping out so many concerned men and women. I am a 42 year old male, with Norwood class III hair loss. I had 2 hair transplants about 10 years ago at the temples, and was happy with the results(they have taken me back to a norwood class I or II look). Now my hair is thinning more in the centre. I use a scalp covering paste (couvre) applied with a sponge, that does a great job of helping to cover the thinning area…but I am wondering if using this will cause my hair to fall out even more? Also, I read that most men slow down or stop their hair loss in their mid 40’ hair loss is starting to pick up again over the last year. Can I use products like minoxidil with products that colour the scalp?
Thanks for your help.

CouvreI highly doubt Couvre causes hair loss. You can use minoxidil with scalp coloring agents. For more on Couvre, see their site here.

I suspect you are losing hair due to general male pattern hair loss as it is a progressive process (something we do not like to admit). Hair loss should slow down as we age, but it still happens in men at all ages. There is no rule or exception if it is happening to you. You may consider seeing a doctor for a good diagnosis and you may be a good candidate for finasteride (Propecia/Proscar).

Tags: finasteride, proscar, propecia, couvre, coloring, masking, hairloss, hair loss

Dr. Rassman,
I am a 23 year old male. I recently began using Rogaine and Nioxin because of hair loss, but stopped after about 3 weeks because of severe itching/irritation. One of the products (not sure which since I stopped/started them at the same time) has given me dandruff. I have never had this problem before in my life. I would like to know if this is a common problem with either of these products, and if so how long will it persist? Indefinitely? Also can dandruff cause hair loss? Thanks so much for your help.

Your scalp irritation or dandruff may be from either Rogaine or Nioxin as both of these may irritate or dry the scalp. Since you started them at the same time, it is impossible to tell. I have heard on occasion that Rogaine (as with any topical medication / shampoos / lotions / etc) can cause significant scalp irritation.

Dandruff does not cause hair loss. If you have dandruff you may consider using an anti-dandruff shampoo or seeing a dermatologist.

Tags: minoxidil, rogaine, nioxin, dandruff, iritation, hairloss, hair loss

Dear Dr. Rassman,

I actually have a few questions, my first one is, can going tanning (whether in the sun or a tanning bed) cause hair loss and/or permanent damage to hair follicles?

My other question is, can seborrhoeic dermatitis cause permanent damage to hair follicles? Also, how long does seborrhoeic dermatitis usually last? I’ve been diagnosed with SD and I’ve
lost alot of eyebrow hairs and I’m curious as to how long I can expect this to go on for. Any help would be much appreciated.

Thank you.

The sun nor a tan should impact hair loss directly in the short term, but long term exposure to the sun can damage the skin to the depth of the bottom of the hair follicle. You need to be evaluated by a good doctor.

Seborrhoeic dermatitis does not cause hair loss. I’ve discussed eyebrow hair loss with seborrhoeic dermatitis before — Seborrheic Dermatitis on Eyebrows.

Tags: tanning, hairloss, hair loss, sun, seborrhoeic dermatitis, dermatitis, eyebrow

I am only 25 but I am starting to see signs of Male pattern baldness and I wanted to be proactive. I asked my doctor about Proscar, because I read that it could be cut into fourths, and he told me that it would look fishy if he prescribed this medication to someone so young. He told me he could only prescribe Propecia for me. However, I’m not sure that the cost of Propecia fits into my budget. Any advice on what I could do would be great.


Really, the only thing I can suggest is to find another doctor who will prescribe what you want. If you came to see me, I would first insist on an examination to determine if you are really balding (miniaturization study).

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

Is there any truth that copper peptide spray can encourage hair that is dormant. Ive heard it reduces the time the hair spends resting. Thanks

In our experience and from what I know, copper peptide promotes wound healing, not hair growth.

Tags: copper peptide, hair loss, hairloss

Hi Dr. Rassman,

I started taking 1.25mg of finasteride last week and I have to say up to now there do not seem to be any sexual side effects. The only thing which concerns me a little bit is this slight burning sensation in my groin area, I think its in the prostate area. Is this a common side effect showing that the drug is working? Should this go away after a while?

Your advice would be quite helpful cause there are a lot of bad publicity out there for Propecia and I wanted a more balanced opinion. Thanks!

ProstatePlease keep in mind that not all sexual dysfunction should be linked with finasteride use. You may have a preexisting medical condition that you are only noticing now that you are more focused on the issue. I have read some rare reports on testicular pain with taking Propecia, but the association is tenuous.

Interesting facts:

  1. Finasteride causes sexual side effects in only 1% of men, while some form of erectile dysfunction has a much higher incidence in men (not taking finasteride)
  2. You cannot feel your prostate unless you are probing deep inside your rectum with your finger. So I doubt that what you are feeling in your groin is your prostate.

My advice would be for you to discuss these issues with the doctor that prescribed you the medication and have a good physical exam.

Tags: finasteride, hairloss, hair loss, groin, burn, prostate, propecia, proscar

I was wondering if you have your hair dyed (darker shade), would minoxidil affect the hair coloring. I know some people say dandruff shampoos affect hair that has been dyed. I already use Propecia, but I was told that maybe a combination of Propecia and Rogaine (minoxidil) might help more. The problem was that the minoxidil generic liquid (i’ve seen you say the Rogaine foam may be less irritating), it seems to cause itching (have been losing some hair from it “shedding”, i guess, but hasn’t been a full two months, as you stated sometimes may last, ie. “shedding” from minox). I’ve already been on Propecia for over a year, but thought would try minoxidil again, but the itching makes wish to use anti-itch dandruff shampoos (but I swear they alter the dyed hair color, and tend to make it more orange, lol, like Brad Pitt’s),to be one of the largest databases and referrence sites, you’re a geni I thought maybe if I tried the minox again without the dandruff shampoo (since scalp already dry) and maybe a more oil-based conditioner might help dryness itching. Also besides whether the minox alters dyed hair color, I was wondering if the itching itself was bad (it is not severe itching and tolerable), would just having mild itching be enough irritation in itself to cause hair loss? Both me and Brad Pitt would like an answer to these questions if possible, lol, couldn’t find anywhere on internet mention of hair dye color affected by minoxidil.

Well thanks for any info or help, this site is great, you’re a saint, I’m sure eventually this is going us!

Your question is a bit confusing, so I’ll break my answer down into a few key points —

  1. If minoxidil is causing your scalp to itch, then using dandruff shampoo will not solve the problem. Minoxidil can cause skin irritation in some people. Dandruff can be made worse if you have an allergy to minoxidil.
  2. If you have irritation and itching of your scalp, perhaps you have a scalp/skin problem (such as psoriasis, head lice, ringworm, etc) or sensitive to chemicals (such as hair dye or minoxidil or any other products you put in your hair). You should see a dermatologist for this.
  3. Minoxidil in combination with Propecia may have a slight advantage over using one product alone.
  4. Dying your hair has nothing to do with the impact of either of these drugs (or vice versa).
  5. Minoxidil should not affect the color of your hair or hair dye.
Tags: minoxidil, hair dye, dye, coloring, propecia, rogaine, allergy, dandruff, hairloss, hair loss

I am a 46 yr old female wanting a hair transplant. I am concerned the transplant won’t “take”. I have no conclusive diagnosis. One Doctor thinks genetic, another thinks hormonal. Also, the texture changed to bumpy/kinky, like pubic hair. I wouldn’t want to transplant it. Any suggestions?

I don’t quite understand what you are asking. All surgeries have risks, just as driving your car has risks. You need good examination and a diagnosis before considering surgery. You also need to trust the doctor and establish a good communication line where your risks and benefits and expectations are addressed. Hairs that initially grow out from a hair transplant surgery may grow more coarse and wavy (rarely as you describe like “pubic hair”), but that is a risk and over time and it generally returns to its normal texture… unless the hair was harvested from your pubic area, of course.

Tags: hairtransplant, hair transplant, hairloss, hair loss, hair character

My 18 year old son is showing an over-all thinning of his hair. When his hair is wet, I clearly see his scalp. He takes fish oil capsules every day and he uses Strattera, 90 mg daily. Other than this, I can think of nothing that could be contributing to the thinning. Do you have any reports of Strattera causing hair loss? Thanks.

The most common cause of hair loss in males is androgenic hair loss or male pattern hair loss. It may start as early as their teenage years. Now add to this the medication Strattera (said to produce hair loss — see ADHD Message Board) and you complicate the hair loss presentation. Your son should discuss this with his prescribing doctor. You need a good doctor working on a Master Plan for hair loss (worst and best case) for him.

Tags: adhd, strattera, hairloss, hair loss

I BELIEVE AUGUST IS “Hair Loss Awareness” month. I also seem to remember that there is an international hair loss conference (In Sydney?). Could you please share any new info on AGA or laser therapy with us? Thanks

Those experiencing hair loss are usually aware of it every month. It is the end of the month, and I don’t think anything has changed on the awareness level. Nonetheless, I am pleased hair loss fits into the one of the 12 months of the year. :)

The 15th Annual Scientific Meeting for International Society of Hair Restoration Surgery (ISHRS) will be held September 26 to 30, 2007 in Las Vegas, Nevada, USA (last year was in Australia). I will be attending this conference and I will keep you informed on the all the new technology including gene therapy, cloning, lasers, etc.

Tags: august, hair loss, hairloss, awareness, ishrs, meeting

Is it normal for teenage boys to have a few gray or white hairs on their testicles? Is it normal for a pubic hair bump to be a little larger than usual around the thighs and the testicles?

Yes, yes.

Just to repeat my answer from a year ago

With respect to your gray pubic hair, it is often normal for a brown hair person to have a few random white hairs. Sometimes they can start in teenage years. I have seen men and women who are gray by the time they are 25, and if you have never seen these people walking around, that is because they ‘hit the bottle’ (the dye bottle).

Tags: pubic, white, grey, gray, hair, teen, teenage

Is it possible to have a misdiagnosis from a scalp biopsy?

It depends upon what the biopsy is for. If it is for classic male pattern balding, then the answer is yes. If it is for cancer or other real pathology, there are always human variables that relate to skills and specialization.

Tags: biopsy, misdiagnosis, hairloss, hair loss, cancer

hi. i took propecia for about 1-2 months. I suffered from a loss of libido and stopped taking it during the end of May. Its now mid August and my libido has not returned. Do I need to wait longer?

Propecia (finasteride 1mg) has a very short half life (about 4 hours), which means it would be almost completely out of your blood stream in one day. There are reported tissue binding that occurs, but that should be gone in a week or so.

Sexual side effects (decreased sex drive) associated with Propecia are relatively exaggerated and it occurs only in about 1% of men. If you continue to experience negative sexual effects after of month of discontinuing Propecia you should consider other underlying medical problems. Keep in mind that erectile dysfunction is a largely underappreciated and unreported medical condition.

Erectile dysfunction statistics:

  • One in 10 men in the world have erectile dysfunction (10%) and it rises with age (30% of men in their 30s, 40% of men in their 40s and 50+% of men over 50).
  • 30 million men in the United States have erectile dysfunction.
  • 50% of men with diabetes have erectile dysfunction, frequently within 10 years of diagnosis.
  • Smokers have a higher likelihood of erectile dysfunction as well as men with high blood pressure (with or without treatment), diabetes, etc… Men who smoke more than 1 pack per day have a 50% higher chance of impotency than nonsmokers the same age.

Stats source: MMHC – Facts About Erectile Dysfunction

Tags: propecia, finasteride, libido, side effect, erectile dysfunction, hairloss, hair loss