Hello, I am turning 26 in a few months, I would like to know what transplant procedure would best suit my current hair loss pattern. I have researched the strip method, also the individual extraction method, I like the individual method better, it seems to be less evasive and less surgical, however, the cost appears to be higher, why is that? Would I qualify for the single extraction? What degree of a transplant do I require to restore my hairline to a even more full appearance? Any estimates in cost? Thank you for viewing my questions and looking over my pictures, you have my permission to use them on your site if they help in any way. If you require photos from any other angles please let me know. I am not on Propecia, I have been reading about Provilus, is that a good alternative? I am more interested in the natural ingredients if they have similar results.

Thank you again, I hope to hear back from you with some positive ideas!



Norwood 4AFirst, thank you for permission to post your photos! If I was able to map out your scalp for miniaturization, I’d be able to tell if the top and crown of your head, which appears normal now, has any early signs of balding there. The pattern you present with is between and Norwood 3A and 4A pattern and I suspect that there is miniaturization in the 4A pattern area where part of the forelock still persists. If you took Propecia (necessary to prevent further loss and the possibility of shock loss after transplantation), then transplanting the frontal area with about 2000 grafts would suffice in most men with your pattern. I would have to know more about your hair characteristics (straight vs curly, coarse vs fine) as this will tell me the value of your hair, part of the essential formula for estimating hair replacement.

Provillus will not give you the same protection against shock hair loss that Propecia (finasteride 1mg) would, so if you get a hair transplant, you need to be aware of this. For your information, the main ingredient in Provillus that does work is saw palmetto, which as I’ve stated many times before, is a weak DHT blocker at best.

The follicular unit extraction (FUE) technique is very labor intensive and the time it takes to do it is much more than a standard strip procedure. That is why the cost is higher. Also, the results from FUE are variable while the strip procedure is predictable nearly 100% of the time. For more info on FUE, please see:

Tags: fue, hairtransplant, hair transplant, photo, hairloss, hair loss, propecia, finasteride, provillus

i am a 24 yr old sikh male living in the uk. up until the age of 18 i had long uncut hair but then in 2003 i cut my hair. my hair has always been thin in texture from a young age. at first when i cut my hair it seemed to be quite thick on top and didnt seem to concern me too much. however after a few months of getting it cut i began to realise that a lot more of my scalp was visible, particularly in well lit areas.

so in following summer of 2004 i shaved my hair off completely in hope that it would grow back thicker which was really a waste of time. by summer 2005 i had realised that my scalp was a bit more visible than before so then i made the decision to start using rogaine. this seemed to work at good effect and by jan 2006 i had grown my hair a bit longer and had a new style cut. my hair appeared to be a lot better than before and a lot of people did notice. this however may have been due to the new style as well. but by summer 2007 i began to realise that my hair was appearing to be thinner again and i also noticed that at my crown the balding area had increased. the fact i have got a double crown does not help appearance either. so in late december 2007 i decided to switch rogaine for a private minoxidil 5% containing MPG. this too at first appeared to have made a slight improvement, and is a lot easier to apply than the rogaine. however by now in may 2008, i am still not to happy with the density of my hair. i went to a trichologist late last year, he advised me that i should not consider a hair transplant until i am least 25 and that i still have a bit too much hair for a HT. he advised me to take propecia, however i am scared of using the drug due to all the reported side effects. i would be willing to use the propecia, preferbly in a few years and after marriage! both my mother and fathers family have cases of hair loss, my father is bald apart from the hair on his back and sides. both my sisters have fine hair aswel, but they have a full head of hair.

i have seen pictures of hair transplants on patients who have diffused thinning and this would be my preferred method of sorting my hair out, however i am aware that i need to consider the long term instead of the short term. can you please give me some advice on what to do? thanks.

I don’t know what I can say that hasn’t already been said on this site —

I’m not sure I quite follow the logic about waiting until after marriage to start Propecia (finasteride 1mg). The side effects from Propecia occur in less than 2% of men and most claims you read about on the Internet are unsubstantiated. Without seeing your hair, I couldn’t tell you if you’re a transplant candidate, but if you’ve already seen a doctor and were told that surgery was not recommended, I’d listen to him. You could’ve very easily gone to someone that would’ve taken your money and performed a surgery on you just to appease you. I don’t know which doctor you went to, but by not doing surgery on you, he likely did you a favor. You are, of course, entitled to go to another doctor and I’m sure eventually you will find a surgeon that is more than willing to take your money.

See the following for more:

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

Hi there – I am a 22 year old who is just now noticing a receding hairline. Just a year ago this wasn’t a problem for me so I think it has progressed since January of this year. My dad and one of my brothers went bald, with only hair on the sides of their heads. My other brother just has a receding hairline with a large forehead. Obviously I have some concerns since it runs in my family.

I know you recommend Propecia but I am scared to take it because of the side effects. I suffered from a small case of gynecomastia growing up and got surgery to fix it. I am scared that taking Propecia would bring this condition back, or bring other unwanted side effects. I currently use a topical solution that claims to be the “topical version of Propecia” and is a DHT blocker. It is hard to tell if it’s working or not. What are the risks of taking Propecia?

There may be no connection between the youthful gynecomastia you had as a child and the side effects of this drug. You are worrying about something that has not happened to you yet. If you take Propecia and have any problems with it, stop it and the drug will be out of your system in days, along with any side effects like gynecomastia (risk is less than 1 in 500 patients).

There is no topical Propecia (finasteride). Also, the ability to absorb this drug through the skin is not reported anywhere I have read.

Tags: propecia, finasteride, dht, hairloss, hair loss, topical

Hi Dr Rassman

Im a 18-year old boy having male patterned hairloss. I started balding when i was 16 and am a full norwood 3. Since the last year a have felt some tingling feeling when i run my hand trough my head,all of it except on the sides. I dont feel pain nor do i have some disease of what i know but just the tingling feeling. Its like i know what my hairloss pattern will be a (norwood 6) wich i can tell from the feeling.I have looked trough the internet to see if anyone has experienced the same thing and interestingly alot of people have. I was wondering if you heard about this? And if you have please tell

Tingling on the scalp does not mean you will lose hair. While people who are balding may experience these symptoms, people who are NOT balding also experience these symptoms (they just don’t write about on the Internet hair groups). You may consider dandruff, head lice, scabies, or other conditions (not related to hair loss). Or you may having nothing at all! I really can’t say what you are experiencing, but you may want to see a doctor if the problem persists.

Tags: hairloss, hair loss, tingle, feeling

Hello! I would like to ask a question about rogaine. I have understood that sideeffects like change in texture and color may occur. This is rare but it does happen according to the information i have got by reading about rogaine. Now I haven´t had any signs of hairloss but I tried it for a while anyway. Stupid I know but that I already know. What I don´t know if this is the same as what you describe as DUPA. You see since I quit rogaine after using it for a month the texture and color changed slowly the following six months. Now more than half of the hair is lighter not as dark in color as before and it grows in a different direction and I have a mix of thin and thicker hair. Could that be that all my hair is changing to a different density? It´s ok I can accept my stupid mistake but do you think it´s DUPA where it´s an ongoing process created by rogaine where the density is decreasing more and more like DUPA. Or do you think I just got a new density and that´s it case closed? I would really want to know if I will keep my hair since there is no male pattern baldness in my family or if rogaine started a DUPA process. ´Please if you could make time to answer this question that is so important for me I would be very greatful.

I have heard no similar history, so I couldn’t begin to guess at what you are experiencing, especially over the Internet without an exam.

You need to be examined by a professional. If you have diffuse unpatterned alopecia (DUPA), it will show on the mapping of your scalp hair for miniaturization.

Tags: dupa, hairloss, hair loss, diffuse unpatterned alopecia, rogaine, minoxidil

Hi Dr. Rassman,
Assuming that Rogaine does work the same throughout your scalp, do you think Rogaine will be able to bring forward a maturing hairline? In other words, does a maturing hairline work in the same way MPB does through DHT? Or is a maturing hairline just programmed follicular apoptosis that wouldn’t respond to minoxidil in the same way that miniaturizing hairs would? Thanks.

Rogaine (minoxidil) is not a DHT blocker and only works as a side effect to grow hair. I am virtually 100% positive that Rogaine will not restore your juvenile hairline.

Tags: rogaine, minoxidil, dht, hairline, hairloss, hair loss

Is it possible to suffer from a phobia of balding. I am losing my hair and am suffering to the point where i cannot face to look in the mirror or touch my head. I no longer go out or interact in any shape or form. Bluntly put.. my life is hell and im seriously thinking of killing myself. I shake when i think of the state of my scalp. Could i have a phobia?

I have seen this type of reaction in the past. You need to get professional help to manage your problem. This is something that I can not help you with and a doctor/patient relationship is critical to solving the problem.

Tags: hairloss, hair loss, phobia, fear

Hi Doctor

I have been using this these herbals – Profinast, a substitute to propecia, to get rid of my hairloss. But I’m not sure if they are helping. I have fine hair in the frontal, but they are reasonably long. I think I have slight bald spot at the back, which I think either:
A. It is very slowly thinning out.
B. It has stopped.

I have been loosing between 10 – 20 hairs a day on average, and have used these pills for about 3 months since. And have noticed no reduce in hairs falling out. Should I still be shredding phase or not? My hairs that fall out are a variety of fine to thick strands. I have thought about to stop using this product and to use propecia instead, but propecia seems expensive, and two doctors have advised against it. I’m a little reluctant stop using the product because it has some very good nutritional hair ingredients as follows.

Vitamin B6
Saw palmetto
Propriety blend
Pumpkin seed
Eluethero root
Muria puama

Also how does hair loss usually stop, does it stop all over the head at once? Or is it frontal then back? I am 26 now and have been going bald, surely but slowly for the past five years. I am also Male. I would be entirely grateful if any advice is offered.

Kind Regards

ProfinastThere have been many posts on this site that discuss how when companies claim DHT blocking capabilities, they are usually not on target and actually violate FDA and FCC rules. Not only does this product’s marketing state that it will guarantee your hair loss stops in 7 days, but it also claims that within 365 days of taking the first pill, you will experience a “complete reversal of the [hair loss] process”. In other words, the product is claimed to completely regrow all lost hair in a year. Oh, come on! The most ridiculous part of it all (as if it could be any more) is that they offer cartoons on their site rather than actual before/after photos. So if you want to see how an art drawing can regrow hair, look no further than with Profinast! Also, performing a “whois” lookup on the owner of the official product’s website domain shows that rather than seeing the actual name/address/phone of the owner or manufacturer, it displays a “private registration” — meaning they are hiding their real contact information from the public. Does none of this seem fishy to anyone but me?

I think that you need to see a doctor and get a real diagnosis. This can have no real value for managing your hair loss and you are wasting significant amounts of time as your hair, which will get worse by the month, will continue to do so as you play with these products. I can not believe that Profinast does anything other than profit from your naivete.

Tags: profinast, hairloss, hair loss

Dear Dr. Rassman.

I wrote you before about my hair condition. I am male, 22, caucasian. I went to the trichologist last week and was prescribed to apply topical Minoxidil 5% +mpg 0.0125% together with some vitamin-enriched solution called “Biostim” (ingredients include: Aqua, Sabal Serrulata extract (biogen), mono propylene glycol, ceramide, panthenol, calcium pantothenate (vitamin b3), vitamin E, vitamin A, Vitamin H (biotin), vitamin H (P.A.B.A.), Inositol (vitamin B8).

The doctor I went to also told me the weirdest thing about the long-term treatment plan. he suggested that I follow the usual minoxidil regime for 12 to 14 months, then switch to less concentrated solution with less frequency of application until I’m in my late 30s. What he added to that,that it is possible to take me out the medication at that age, because (quote) my “hormone levels will settle up”… I don’t know what to think of it? It sounds like some sci-fi scenario for me…

another thing I want to ask you is that I’m currently quite happy with my hair – I have slight recessions at the temple area and that is my only problem. I always had quite high hairline, so recessions are quite visible (if I for some reason will go for shorter haircut). I have no history of baldness in my family (my father is 60 and he is on NW3, so are/were most of my family). So as far as I understand the idea of the treatment is not to let my hair loss progress…

I’m very confused abouth this whole situation. Should I trust my trichologist, or does he sound ridiculous? Should I consider undergoing Minoxidil treatment at this stage or not?

I look forward to your reply.

kindest regards

Hair loss is a progressive process and if you think about it, you can logically figure out if the Master Plan made by your trichologist makes common sense. Certainly, I approach the problem with a solution (Propecia and/or minoxidil) and continue treatments that are successful. The idea of starting minoxidil and withdrawing it if it is working, guarantees hair loss from that withdrawal. Propecia always works at least by slowing down the hair loss (to what degree though, is different per person), possibly stopping it altogether, or maybe reversing it.

As for the Biostim product, the only place I can find that references this is one trichologist in London, leading me to believe he is the exclusive marketer of this product. Perhaps it is a private label item and he is just looking to make some money? I don’t know. The ingredients you listed do not look like they’ll do much for your hair. It is your call, of course.

Tags: minoxidil, rogaine, biostim, hairloss, hair loss, london

I am a 37 year old breastfeeding mom. My hair started thinning in my early thirties a little, but not noticeably. I had to have two rounds of in-vitro fertilization to have my baby (17 mos old now). After the first round of IVF (not pregnant) my hair started really falling out, thinning all over but more at the crown and top. My doc said he didn’t think there was a connection. The second IVF was successful and my hair got thicker throughout my pregnancy until my baby was three months old. Predictably, my hair started falling out again, but just to the thickness it was before. However, after my baby turned one, I started losing more hair and now my scalp is visible in the crown/back . I’ve been to an endocrinologist (i have atypical PCOS symptoms. he recommended propecia when i am finished procreating) and a dermatologist who specializes in hair loss. The derm said she would put me on Rogaine and Yaz birth control pills once I stop breastfeeding. I do not want to wean my baby for this. However, I am panicking a little because my hairloss is so rapid! I am otherwise healthy, and am normal weight, no thyroid issues. My questions: is there any research into ART and hair loss; and is there anything I can do to treat my hair loss while I am breastfeeding? Thank you so much for your time.

Generally, when you breastfeed, you do not want to take any medication because it will enter your baby through the breast milk. I rarely deal with women who have polycystic ovary syndrome (PCOS) or endocrine issues that could relate to hair loss. Propecia (finasteride) may help, but absolutely not when you are ever going to have a child. You need to discuss the risks with your doctor. While I’m not sure of any research relating hair loss and in-vitro fertilization, I am aware that fertility drugs like Clomid (clomiphene) can cause hair loss in rare cases (see RxList.com).

Tags: reproduction, in-vitro, ivf, hairloss, hair loss, clomid, pcos, breastfeeding

im am experiencing increasing amount of pain and discomfort causing lack of sleep and loss of concentration and its been 5 years since i had a hair transplant and 4 years since scar revision which has caused this pain (pulling, burning). I ve seen many doctors, neurologists and have been to pain clinics with no success. any thoughts as to why this is happening? thanks

Did you follow up with the doctor who performed your surgery? I do not even know if your pain is related to the surgery. It is possible (speculative) that you have a nerve entrapment which can sometimes be determined in your examination. I have seen patients present to me with a long-term nerve problem from this cause. I am sorry, but there really is no way for me to tell especially after what you tell me of seeing all the specialists. If those doctors (who actually examined you) cannot help you, I highly doubt I can tell you what is going on, certainly not without a direct examination.

Tags: hair transplant, hairtransplant, pain, burning, nerve

Howdy Dr. R!

As a faithful reader of your excellent blog, I wanted to pass along some (hopefully) useful information to your readers. I have been taking Propecia for 6 months now and have been VERY pleased with the results. It has strengthened and increased the hairs on my crown and even some in the front hairline! About a month ago I noticed that my hair was becoming thinner, and I was seeing more hair come out in the shower, and seeing more scalp than normal. After looking into what might be causing this change, I realized that I had been taking Lorazepam on an almost nightly basis during this period. After realizing this, I stopped taking Lorazepam completely and saw an almost immediate return to healthier, thicker hair. I understand that many factors vary from one individual to the next, but I think people should be aware of the negative effects that I experienced with Lorazepam.

Thanks for your comments. Perhaps other people will have had similar results to report. Lorazepam (also known as Ativan) does list hair loss as a possible side effect. I’m not suggesting that readers discontinue any medication without consulting their prescribing doctor first.

Tags: lorazepam, ativan, hairloss, hair loss

Five days ago the hair on my legs, underarms, etc. just stopped growing. I am 45 yrs. of age. No other symptoms except that for the past two years I have had very irregular periods approximately every two weeks. It has been 4 weeks since the last one this time and still no period. I have been to my gyno a year ago and everything seemed ok. I am scared that I will now loose the hair on my head but so far so good even though it is not growing any longer.

I am not your doctor and I can not offer an opinion based upon what you gave me above. However, at 45 years old with a change in your menstrual cycle, the first thing I would think about is menopause, so your gynecologist may be the first place to look for answers.

Tags: hairloss, hair loss, gyno, gynecologist

Dear Dr. Rassman

What do you think of the new (hypothetical) concept about hair loss called “Alopecia contentionalis”, i.e. high scalp tension causing less blood circulation?

Wouldn’t the risk of getting this condition increase by the number of FUT’s (strip extraction)?

If you are suggesting that a tight scalp that undergoes strip excision will get tighter, I believe you are correct. I do not believe, however, that a tight scalp causes hair loss.

Tags: hairloss, hair loss, alopecia contentionalis, alopecia, scalp

I am 28 years old and have noticed that my hairline has changed over the last year (at the temples). This has caused a great deal of alarm that I might go bald. I went to Dr. Bernstein for a free evaluation & he said that he saw some minaturization in the front but as to future predictions, it’s hard to say as i’m adopted.

I have wrestled with whether or not I should take propecia as I don’t like medications/side effects. It is possible that my hairline might “mature” & then stop… but i don’t want to wait until it’s too late.

IF i start propecia & then decide to stop – will my hair be worse than if I had never started in the first place? If in-fact fate/genetics have it that I am not meant to go bald – will taking propecia interfer with the “nature of things?” and leave me dependent upon a medication whereas I wouldn’t have needed it before?

Thank you.

Think of a timeline that you are progressing on (your timeline), then look a couple years down that line — assuming you took Propecia (finasteride 1mg) for the first year and then stopped it, you will be in exactly in the same place as if you never took it. I always tell patients that when you stop taking Propecia, you undergo what appears to be rapid hair loss, but it is just ‘catch-up’ hair loss to bring you back to the degree of hair loss you would’ve had anyway. Propecia will not reverse the mature hairline back to your juvenile hairline.

My process for following patients is simple: the full value of Propecia takes a full year or so. We use general rules about balding and although most men slow down their balding process in their 30s (28 is almost 30), some don’t follow the doctor’s rules. Hair loss is a progressive process in most men, but fortunately it slows down to a “crawl” by the time most men reach their 40s. You should be followed by a good doctor with yearly miniaturization studies and Dr. Bernstein in NY is a good doctor to do this for you. At the least, it will give you a good metric as to how you are doing. Good photography will also help define what is happening to you. You need to have a good dialog with a doctor who can work you through the process.

Tags: propecia, finasteride, hairloss, hair loss