Dr. Rassman, you won’t believe this. Maybe you will. I have had I guess 7 scalp reductions. Brandy did a lateral with that Y incision, but not a scalp lift, per se. Marzola, Stough, all did a couple of procedures. I saw my scalp under bright lights (the last thing one wants as that is very unforgiving) on a big screen last night and was shocked by the 1 inch by three inch or so bald thin area in the midline. Dr. Hitzig performed two large midline graft sessions around 1999 or 2000, fixing the scar but the density leaves something to be desired. I see you mentioned Dr. Frechet of Frechet extender fame I imagine in a response to a patient. Some sort of triple flap procedure. I have some donor left but can’t get over my lack of crown density despite a large number of grafts. I know Dr. Hitzig always grafted the midline before reducing a scalp. Do grafts just not grow after reductions, especially that many reductions? I could emply better styling but I wish I had followed the late C.P. Chamber’s advice and avoided reductions altogether. He knew what he was talking about. It sounds like there is no practical fix at any price.

Scalp reductionYour case is complex. I have no idea what densities you have or the extent of your scar and wound defect. Most people who’ve had 7 scalp reductions are left with a slot deformity. I would like to see some good pictures of your scalp from the front, top, sides, and back. I am sure that you know that scalp reduction is no longer the standard of care today, because they do not work. I have seen men who had up to 16 scalp reduction surgeries and the last ones never really accomplished anything. I wonder about your 7th procedure and what you were trying to accomplish that the prior 6 have not.

It is best to be examined carefully by an expert and then see what your needs are. Patients should make a list of priorities and then try to work down the list. Patients who have had so many procedures never really get too far down that list, so be realistic.

For more information on scalp reductions, see:

Tags: scalp reduction, scarring, slot deformity, hairloss, hair loss, scalp

You used to be a dairy farmer, correct? Is there a difference between dairy cattle and beef cattle? I always assumed they got milk from the females and meat from both males and females.

Can you clarify this? I’m asking b/c if they only use steroid hormones in beef cattle, then drinking milk would presumably be clear from any steroid hormones.

MilkIf you are worried about hormones in your milk, you can start with organic food stores and inquire about where they get their milk. I believe you are the same reader that sent me the earlier posted email about how steroids in milk (when used) get broken down by the acid in the stomach so it does not get absorbed into the body (see Growth Hormones in Milk).

From the Wikipedia entry for “cattle” —
Cattle raised for human consumption are called “beef cattle”. Within the beef cattle industry in parts of the United States, the term “beef” (plural “beeves”) is still used in its archaic sense to refer to an animal of either gender. Cows of certain breeds that are kept for the milk they give are called “dairy cows” or “milking cows” (formerly “milch cows” – “milch” was pronounced as “milk”) and their genetics are such that they produce high milk outputs whereas beef cattle are genetically created for their muscle mass.

Male bovine are called bulls (or steers if they are castrated) — and they do not have udders, nor do they produce dairy milk.

Tags: dairy, steroid, milk, hairloss, hair loss, bull, cattle, cow

I’m a 31 year old male who has been losing his hair for approximately 9 years. My hair has suffered diffused thinning throughout the entire top – in a Norwood 6 to Norwood 7 pattern, however my hairline remains intact, albeit with very fine hair.

I’ve been consistently on finasteride and minoxidil through a majority of the past 9 years. However, year by year, month by month, my hair continues to thin.

My question is as follows: For the time being my hair remains very thin, but with an extremely close cropped haircut, I don’t look THAT bald because of the fact that I still have coverage (as thin as it may be). In your opinion, will continued treatment with rogaine and propecia help me maintain this thin hair or is my continual thinning a sign that these drugs are not helping me?

A response is appreciated. Please don’t tell me to have my hair mapped. Been there, done that. I’m losing it.

You will continue to lose your hair if you have been thinning for all these years despite your daily doses of Propecia (finasteride) and Rogaine (minoxidil), but it is safe to assume that these medications will continue to support the hair you have left. I suspect it is helping slow the balding/thinning process down. If you still have a hairline and are just thinning behind it (with fine hair in general) it does not sound like you have a problem now and are more worried about later on. If you can delay any surgical decision, it may be in your best interest to do so, but without a direct examination of you, I can not ascertain what you need.

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

Hi Dr. Rassman

I’m a 46 year old male and had an operation about 2 years ago with apprx. 2000 grafts. I had pretty good results after 1 year my hair had grow in fairly thick in the front where most of the grafts were placed. I have Rheumatoid arthritis so I’ve been on Methotrexate, Embrel, prednisone and a lot of vitamins for about 4 years. I’ve also been taking Finesteride for about 6-7yrs. On 5/14 to 5/17 I had tried a new drug (hydroxychloroquine) it is suppose to help the methotrexate for the RA. I had to stop it due to the many unpleasant side effects, which I think has something to do with my recent dramatic hair loss. Just in the last month my hair has been shedding dramatically and has thinned everywhere and very thin on the top crown area now. We are not sure if it is the hydroxychloroquine that caused the hair loss, but it’s very suspect. I’m still shedding 1 month after I stopped the (hydroxy- ) maybe a little less, but maybe because there is less hair now. Have you heard of hydroxychloroquine and hair loss?

1. My concern is does it hurt the chances of the hair that fell out from the medicine, if the case, from growing back when we put new grafts in or on top off the potential dormant hair?
2. Should I wait a little longer to see if some of the hair grows back before I do another procedure?
3. My other concern is would I have two scars or do you take just below the 1st donor area and somehow minimize the size of the 2 scars into one.

Thank you for your time…I’ve found some great info on this blog!

Yes, hydroxychloroquine (marketed as Plaquenil) can cause hair loss as a side effect (see About.com). In your situation, waiting a little bit on a hair transplant makes sense. It does not pay to have a hair transplant when you’re experiencing active hair loss, possibly from a drug. I can not comment on your scarring without seeing you. Usually, we can minimize the scars into one, but it depends upon what kind of scarring you currently have.

As you indicated that you are in Los Angeles, I would be pleased to see you and give you an opinion in my LA office.

Tags: plaquenil, hydroxychloroquine, hairloss, hair loss, hairtransplant, hair transplant, rheumatoid arthritis, arthritis

Two questions here,

  1. Can Propecia be taken before bed at night instead of, say, in the morning, or during the day?
  2. I saw some post about someone mentioning grogginess as a side effect of taking Propecia. I consider myself a pretty silver-tongued guy, sort of along the lines of Dane Cook. I speak relatively fast and somewhat witty, I’d hope. When I take Propecia I feel like I trip over my words more, thereby causing me to lose some of that quick wit. Does this make any sense or not?

Dane Cook

  1. Once a day, anytime, will work for Propecia (finasteride 1mg). I generally suggest to take in in the morning when testosterone is highest in men, but I really do not have any figures on that, just my logical mind.
  2. There have been some reports on depression with Propecia, but I don’t know if your quick wit can be dulled by the medication. I haven’t had any reports from my patients about feelings of disorientation or foggy-headedness, but I had one person that I can recall wrote in a while ago saying they felt a little foggy when on Propecia (though it is unsubstantiated).
Tags: depressed, depression, propecia, finasteride, hairloss, hair loss, wit, foggy

Hey Dr. Rassman, I was just wondering if I took saw palmetto and saw some results and then stopped using it, would that have the same effect as taking propecia and then stopping its use. I know after one stops taking propecia all that hair is lost, would that be the same outcome of stopping saw palmetto?


If the claimed DHT blocking occurs with saw palmetto, then I suspect that if/when you stop it, the maintained hair would be lost under the exact same mechanism as Propecia (finasteride).

Tags: dht, saw palmetto, propecia, finasteride, hairloss, hair loss

Interestingly, Provillus’s website states that, “Minoxidil, the only ingredient clinically tested, and approved by the FDA for restoring your hair, inhibits DHT.”

I thought finasteride was the only FDA approved DHT blocker and minoxidil was something else. I’m confused.

Short answer — no. I am unaware of any inhibition that minoxidil has for DHT. Minoxidil works differently and not on the formation of the DHT hormone; finasteride does block DHT.

Tags: dht, minoxidil, finasteride, propecia, provillus

This patient has had three procedures with a total number of 4761 grafts. The last procedure he had was a little over a year and a half ago, and the after photo was taken this week. He’s grown his hair long for the “rock and roll” look, and the results speak for themselves.

I realize that the quality of the before photos isn’t all that great, but they should still be clear enough to see what the transplants did for his hairline and the hair behind the hairline. The transplants were placed almost to mid-head and when he combs it in almost any direction, he has a full head of hair. The photos were taken previous to his first surgery 8 years ago and our digital camera back then was hit and miss, so I do apologize if the quality of those photos is lackluster. Click the photos to enlarge.





Tags: hairtransplant, hair transplant, hairline, photos, hairloss, hair loss

I want to reference: Can’t Take Finasteride, But Is a Hair Transplant Still an Option?

Dr Rassman,

Thank you for answering my original enquiry. Whilst i understand that one your goals is to protect patients from over enthusiasm for a HT. But is a HT something you would do on a 22yr old male who can’t take finestaride. I ask this before one fly’s across the globe to see you for a consultaion.

Thank You

I can not tell you for certain that I would do a hair transplant on you without knowing your donor density and doing a miniaturization study to determine (if possible) what your projected hair loss is.  Knowing your supply and demand potential and your density and laxity, I would then make a decision on a hair transplant on you. So if you can’t or won’t take Propecia (finasteride 1mg), it does not 100% rule you out, but I first need to make that assessment.

We can arrange a call after I receive good photos of you and base some of this evaluation at the time of a telephone consultation.  To setup the telephone consultation with my office, you can fill out our handy web form and you’ll be contacted via email to complete the setup.

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

Hi Dr. Rassman,

First, thank you for making this blog available. It’s great and tremendously helpful. Here’s my situation: I am 25 years old. My 65 year dad has major baldness and my mom’s brother have had issues with balding too, so my future is not good. My hair was normal until a year ago, when I graduated from university and got a job that’s stressful. Since then, my hair has been disappearing. The crowns are rising and my thick hair has become thin… losing about 40% in volume already.

Does balding happen this fast? And is it all this stress that I’m dealing with? I thought I’d have normal hair until my 30s, but I have to deal with this now unfortunately.


If you have genetic hair loss, you should map out the scalp and hair for miniaturization and then (assuming you are genetically balding) go on finasteride (Propecia), which will slow down and possibly even reverse the hair loss you are experiencing.

There’s no one true answer to each of your questions. Everyone loses hair at different rates and stress can certainly accelerate it. Seek out medical attention, as the earlier you start treating it, the better will be your future with the hair you still have left.

Tags: hairloss, hair loss, rate, genetic, stress, propecia, finasteride

I am 51 years old, i do not have anyone on my parents side that have male pattern baldness. I have always had a lot of hair, about 2 or 3 years ago i started to have this redness, inflame irritation at my vertex on top of my scalp. it has thinned out so much that you can see my scalp and my hair has thinned all over. I have been to several derm doctors but all of them are bald their self and they don’t take the time to help me. one doctor did a patch test on my back but everything was normal. i have oily and hair that has to be washed everyday because it is so fine. I have used head and shoulder shampoo which seems to work, but when i use it i feel a kind of a tingling burning feeling at the vertex, where the inflame, redness is at, but it will go away and feels better. does head and shoulder shampoo suppose to do this? It will return unless i keep using it. Should i continue to use this shampoo? I dont know what to use, Please help.

I have given up on derm doctors because it takes so long for a appointment, and they seem that they don’t care. I even dread to wash my hair everyday, but i have to because it is so fine an sweaty and oily. I have tried rogaine, but it irritated my vertex area so bad that i can’t use it. i am losing a lot of hair in the shower, I don’t know what to use. Right now my vertex is irritated and red. Please help. Thanks

I would like to help, but there is no way to diagnose your problems or even guess at what you may be experiencing without an exam. Daily hair washes with shampoo for oily hair is important for you to use. If your hair is fine, get a gentle shampoo.

I realize a good doctor may be hard to come by, but start with your primary care doctor and ask for a recommendation. I wouldn’t think that any doctor would want to be seen as a non-caring physician so you should try hard to appeal to their caring side.  Speak frankly if you feel that they are not paying you the attention you want and need. Being direct is critically important to the doctor/patient relationship.

Tags: doctor, physician, inflammation, vertex, hairloss, hair loss

Hi, I’m thinking of taking propecia (my trichologist has advised that I would benefit from taking this medication) but, from reading your site I’ve just noticed the issue about risk of male breast cancer. My mum has had breast cancer and I’m concerned that this could cause problems for me now if I start taking propecia. Could you give me some advice on what to do as up until this point I was happy with taking the drug!

There have been two cases in the medical literature of male breast cancer reported with a patient on Propecia. The incidence of breast cancer in men as about 1% of female incidence. This alone may account for the finding in those two patients. It is not a high risk issue, even for those with a history of female breast cancer in the family.

Tags: breast cancer, cancer, breast, propecia, finasteride

Hi Dr. Rassman,

I appreciate your responding to a few of my questions in the past about LLLT. It gave me a bit of an education at the very least.

I do have a question regarding Telogen Effluvium. I have been dealing with TE for approx. 1 1/2 yrs. now (Chronic TE) due to high levels of stress during that time period. I feel comfortable in saying that the shedding seems to be slowing down or may have actually resumed to it’s normal daily shed (approx. 100 hairs/day) due to the decrease in the level of stress in my life over these past few months.

I understand that a healthy diet for someone with TE is important (lots of protein and iron), but are there certain foods that I would want to refrain from? I’ve heard breads, pasta and potatoes quickly convert to sugar which could have a negative effect on a persons hormones while trying to grow hair. Is there any truth to this?

Also, what would you recommend as a daily diet to help with hair growth?

Thank you in advance.

There are no proven connections between different good healthy diets with regard to chronic TE. The one on one connections you discussed are subjective assessments of various people and I would have no way to verify these observations.

Tags: diet, health, telogen effluvium, hairloss, hair loss

Would a body hair transplant work for just facial hair, like sideburns or even eyebrows

I would imagine that body hair transplantation (BHT) would work, but why not use scalp hair? I would match the hair and see what is best.

Tags: hairtransplant, hair transplant, bht, scalp, facial hair, sideburn, eyebrow

Hello. I recently came across a website claiming to sell Minoxidil 12.5% solution. Do you know if this is legit? I haven’t heard of the FDA approving such a solution, and if it is available on this one particular site, why isn’t it available at major drug/retail stores? Also, same question for 5% minoxidil solution w/out propylene glycol (which irritates my scalp)also “allegedly” available at this site. I just don’t want to get scammed if I do decide to purchase either of the above products. Thanks a lot for your time and information.

Note: I can’t really answer your question, as I have not researched the FDA issues and am just pulling from my general knowledge on the laws by which I practice under. That being said, I’m willing to take a stab at it…

Doctors have the ‘power’ to mix up medications for their patients under many state laws. These do not have to be FDA approved because they are not bottled and sold to the public. The FDA does not get into protecting one patient from one doctor, just lots of people from medications. The doctor should generally use medications that are safe and effective and if one doctor is producing 12.5% minoxidil, I would suggest that this doctor has special knowledge on the safety and effectiveness of this drug. Higher and higher doses of minoxidil can drop blood pressure, so it is not without risk when and if it is used. The same applies to the use of propylene glycol in the mix.

A couple years ago, I had a reader write in with a question about 15% minoxidil he could buy from his doctor, so apparently that is also available in some places. I don’t concoct my own minoxidil mixtures, so I’m not unfortunately not the most knowledgeable about this.

Tags: minoxidil, rogaine, blood pressure, hairloss, hair loss, doctor, physician, fda