Happy Halloween

Today being Halloween, I decided to dress in my beautiful new naughty nurse costume and hang up the doctor scrubs for the day. And now that you’re all thoroughly terrified, I also wanted to use this opportunity to remind you all that the brand new BaldingForum is live!!! We’re very excited about this new site and hope to develop a community of folks that want to discuss everything and anything hair loss related.

Tags: hair loss, hairloss, halloween, rassman, balding forum, baldingforum, forum

Dear Doctor,

I want to start using minoxidil to help with hairloss. I was reading as much as I could about it, including every entry on your site.

While reading about minoxidil on the web, I came across companies utilizing a different form of minoxidil in their formulas called “minoxidil sulfate” which is supposed to be much better than regular minoxidil.

A search for minoxidil sulfate pulled up the following study on PubMed apparently from research done by UpJohn:

“An important step in understanding minoxidil’s mechanism of action on hair follicles was to determine the drug’s active form. We used organ-cultured vibrissa follicles to test whether it is minoxidil or its sulfated metabolite, minoxidil sulfate, that stimulates hair growth. Follicles from neonatal mice were cultured with or without drugs and effects were assessed by measuring incorporation of radiolabeled cysteine in hair shafts of the treated follicles. Assays of minoxidil sulfotransferase activity indicated that vibrissae follicles metabolize minoxidil to minoxidil sulfate. Dose-response studies showed that minoxidil sulfate is 14 times more potent than minoxidil in stimulating cysteine incorporation in cultured follicles. Three drugs that block production of intrafollicular minoxidil sulfate were tested for their effects on drug-induced hair growth. Diethylcarbamazine proved to be a noncompetitive inhibitor of sulfotransferase and prevented hair growth stimulation by minoxidil but not by minoxidil sulfate. Inhibiting the formation of intracellular PAPS with chlorate also blocked the action of minoxidil but not of minoxidil sulfate. Acetaminophen, a potent sulfate scavenger blocked cysteine incorporation by minoxidil. It also blocked follicular stimulation by minoxidil sulfate apparently by directly removing the sulfate from the drug. Experiments with U-51,607, a potent minoxidil analog that also forms a sulfated metabolite, showed that its activity was inhibited by both chlorate and diethylcarbamazine. These studies show that sulfation is a critical step for hair-growth effects of minoxidil and that it is the sulfated metabolite that directly affects hair follicles.”

I found a few companies such as Sinere that use this form in their Nanominox and DS Labs which uses it in their Spectral DNC.

My question is….if this form of minoxidil is “14 times more effective” than regular, according to UpJohn’s own studies, do you have any idea why they don’t use it in their own Rogaine products? Also, do you think I would be better off using this form myself?

I cannot find anything impartial written about this compound, so anything from you, hopefully detailed, would be greatly appreciated.

I do not have a good answer to your question, but the study (which is nearly 2 decades old) that you are referring to was done on neonatal mice, not humans. I would think there are some differences between mice hair and human hair. Being that the studies are from the late 80s/early 90s, I’d make the leap and assume that if the minoxidil sulfate were to be that much better than regular minoxidil (and with no greater side effect potential), that there would be a new product out by now using it. The FDA has approved standard minoxidil in 2% and 5% concentration, and both are available for over the counter sales (no prescription required).

If you know of a product that uses minoxidil sulfate, I suppose you can give it a shot — I’m not by any means recommending it (I like to stick with the medications proven safe and effective), but if you don’t mind being a guinea pig, I’m sure visitors to this site would love to hear about the results.

Tags: minoxidil sulfate, minoxidil, rogaine, hairloss, hair loss, spectral dnc, nanominox, sinere

Hi Dr. Rassman,

Is there a minimum amount of time I need to be on Propecia before I can get hair transplant surgery?


There is no set rule. Obviously, the longer you take it the better off you’ll be, but it also depends on individual basis. For example, if you are completely bald, it does not really matter. Or if you are young in your mid twenties and you are rapidly losing hair, I would say you should take it as long as possible to slow the hair loss. Or if you are in your mid to late forties and your hair loss is stable, the risk of shock loss is less and the importance of being on Propecia for dealing with shock loss is not as great. Generally a few days or weeks is minimal. The drug works fairly fast on the hair follicle.

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

Ok this is really upsetting me. I’m 27, male, in great physical shape. There was a period during march of 2007 where i was under alot of emotional stress. (girlfriend cheated on me, work was really stressful (Sales job), and I noticed my hair wasn’t the same. Then November 2007, I decided to take rogaine foam. Shedding ocured initally and it looked like something was growing back. Fast forward to October 2008. My hair is falling out alot. not at the temples or front part, nor the crown area. Its literraly on top of my head. Rub my hair and like 25 strands of about 2.5 inches come out. I called Pfizer about the situation and they never heard anything like it. So my question is? Any idea what’s happening? and also if it is the rogaine that tirggered this, is it permanent? Any suggestions?

You have a progressive process of hair loss as 50% of men do. It sounds like you are heavily stressed and we know that stress accelerates the genetic hair loss problem. Assuming that you are genetically balding, the better drug would have been Propecia (finasteride), but with aggressive hair loss even that may not have worked. Do the right thing by getting a diagnosis from a competent doctor and use the appropriate medication to try to hold what you have left.

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

Just wondering if you could comment on the effectiveness of Propecia. The official website for the drug states that 99% of men who took it did not lose any hair after 2 years. If this is true, then why have I read in other places that propecia doesn’t work for 10-15% of men?

I verified the 99% on the Propecia site — 5 out of 535 lost hair, which is 1% of the study. I would tend to believe Merck, who is under scrutiny from shareholders and the FDA, before I’d believe the various sensationalist writers on various forums that state “facts” as they see it, not like it is. I don’t know where you got the 10-15% figure from.

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

I had a strip procedure done almost 3 months ago. My scalp is still a bit pink. I was wondering two things. How long can it take for the pinkness to go away? And is it alright for me to go to a tanning salon or sun bathing?

TanningPinkness in the recipient area is often gone by 3 months. You and your doctor may want to treat this area with some limited steroids topically, but it should be done under the control of your doctor. Tanning with the pinkness present is probably not a good idea at this time.

Tags: hair transplant, hairtransplant, tanning, sun, aftercare

If you have a cap on to do highlights, do you need a skin test first? Also is there any chance the bleach can get on the skin? People keep reasuring me it wont but I’m not convinced. Please help I have a condition where I dont like anything, like chemicals going on my skin.


The side effects from dyes can be quite severe and in case it does drip onto the scalp, having the skin test will be reassuring when you do have your hair dyed. Accidents can happen, and it’s better to be safe than sorry.

Tags: bleach, dye, color, skin, allergy, dermatology

Hi Doc, two things.

1) I don’t know what the whole fuss about decreased libido with propecia is. I’ve been on it for a while and instead I’ve experienced increased libido,which,according to me,is a good thing (less mishaps in the bedroom!).

I have only one thing to say to all readers, don’t believe the horrors of internet stories of propecia users. I was really scared before I took the drug because of those very stories,but gave into better reason and took it instead. I’m experiencing no side effects, and my hair does seem to be filling up, although I’m yet to go for my second miniaturization test. Remember, the FDA *APPROVED* the drug, and there have been studies done on it. FDA approval means a lot.

And those lasercombs..They don’t have approval, they’re just allowed to be sold. That’s because there are few, if any, dangerous effects that could be associated with them. Just fancy toys.

2) How long do you think it would take for doctors across the country to use your FUE2 procedure? I would like to know how you went about training doctors when you first came up with FUE, and also how many you trained (it would be great if you could actually name some of the doctors across the country you trained personally).

Thanks for your time.

First, I want to let you know that I agree with your comments about not believing all of the horror stories some people post about Propecia (they’re unproven, for starters), and I also agree with your analysis of the laser products. Now onto the meat of this post…

When I originally pioneered the follicular unit extraction (FUE) technique, it took me 7 years to figure out how to do it. Then my group (under my leadership) published it in a scientific journal and presented the technique to the International Society of Hair Restoration Surgery (ISHRS) in video form. I even gave out a free video showing how to do the procedure at the time of my presentation. I personally trained my team and the breakthrough became evident. Dr. Jae Pak worked along side me and was one of the members in California who I relied on for creating the tools and refining the technique. FUE had been under development for just under two years, and although many techniques were tested, the one breakthrough that ended up being the ultimate be-all-end-all became known as the FUE². The idea actually came to me while I was on a flight, and as I woke up from a nap on the plane the idea was staring me in the face. Building the technology took about 18 months and the first prototype was delivered to us a few months ago. It worked with great success.

Initially with FUE, I trained some doctors at conference workshops sponsored by the ISHRS and some doctors came through the office for a day to see how it was done. Fully 98% of the doctors offering the standard FUE with their own twist to it, have learned on their own by practicing on their patients. For those doctors, some performed incremental FUE (a few per patient) while others announced that they were experts on the subject in just days, weeks, or months. I am certain that the amount of follicular holocaust has been substantial in those that offered the technique with no basis of expertise. Since the process was pioneered in 2002. I wish I could name names for good and bad doctors, but I’m not going to do that. I have not seen the results of many of the doctors who claim expertise in the field. With regard to when I will release the FUE² technology, the answer is: when I am ready and fully understand the technique. Each and every week I am learning more and more about the value of this technology and I want to command it enough to teach it prior to releasing it.

Tags: fue2, fue, hairtransplant, hair transplant, hairloss, hair loss


I am a 22 year old caucasian male. I have had thick dark-brown hair my entire life until recently. Only in this past year I have been noticing thinning and receding in my temples and shedding, thinning of all the hair on my head. I still have a full head of hair, but people have noticed that my hair has changed from thick, wavy and dark to thin, straight and brown. 5 months ago I visited a doctor because of Hairloss/constipation/and not feeling that great. i got a physical and blood test. Nothing was wrong.

shedding continued so.. I recently visited a dermatologist who walked in the room, prescribed me PROPECIA and ROGAINE and walked out. Didn’t look at my head or ask questions. I also have obtained a habit of gently combing my fingers through my hair and seeing how many hairs that fall out and then collect them. I have a ziplock full of hair. They fall out from all over and ive noticed that they have gotten thinner and lighter.

I am only 22 and I am not sure what is causing the shedding/thinning, whether its Male Pattern Baldness or not.


1. I am kinda scared and not sure whether I should take the Propecia or not. And if i take it then stop will it make things worse.?
2. I started the rogaine for 2 weeks, I think it gave me a flaky scalp, and maybe lightened my hair strands? And Is it bad to stop and start rogaine.

random question
3. I get really thick and strong red or light pigmented hairs in my dark beard and dark hair. They are much harder to pluck/pull out. WHAT ARE THESE HAIRS?

With regard to the dermatologist who did not examine you, to me that says he did not care. Go see another doctor who will look at your hair, examine it, and perform a mapping of your hair and scalp for miniaturization so that you can not only have a diagnosis, but get a baseline study to see value (or lack thereof) after a year of taking Propecia.

Some people get drying and flaking of the scalp with minoxidil. I would suggest that you use the oil based minoxidil and see if this addresses the flaking.

I don’t quite understand what you are asking about with regard to the red hair mixed in with the dark hair other than you may have some red genetic factors that induces it. Were you are red-head when you were a child?

Tags: hairloss, hair loss, dermatologist, propecia, fiansteride, minoxidil

Hello Doctors,
I’m a 21 year old male who has developed what appears to be a receding hairline over the past four years or so. It looks like I have some small, finer hairs around the temples, as well as the frontal hairline. It even seems that I can see back through my hair about a quarter of an inch or so. Is this miniaturization the normal development of the mature hairline? Should I be able to see a change in density through that much of my front hairline? Or am I beginning to loose my hair? I know this is a tough question to speculate on, but any advice would be great.

Fine hairs at the edge of the hairline are normal, as it is somewhat of a transition from the forehead to the mane of hair on your head. I’d need to see what you’re talking about to make a determination. Your hairline recession could simply be a maturing of the hairline, but as you know, I couldn’t speculate on that without seeing you. If your hair appears to be more see-through, it could just be harsher lighting, different shampoo / styling, or it could be early loss. Tough call to make.

You should have your hair mapped out for miniaturization by a good doctor who will tell you.

Tags: hairline, hair loss, hairloss, fine hair

I am trying to understand why I am losing my hair. Where can I send my hair to have it checked?

Analyzing your hair is offered by many trichologists, but I have yet to understand what they are analyzing. If you want to know if your are actually losing your hair (and not just experiencing normal everyday hair loss as new hairs grow in), get your hair mapped out for miniaturization by a good doctor. That will tell you what you need to know. As you are in Los Angeles, call my office to setup an in-office consultation where I will do this mapping.

Tags: hairloss, hair loss, analyzing, mapping, miniaturization

THL-1Just a couple weeks ago, the FDA published a warning letter sent to the makers of the LaserComb (see here). Now, a reader sent in a new find on the FDA website — a warning letter to another laser company that shows they are selling a product or service that is in violation of the law. The letter starts off…

Dear Mr. Gaunitz :

The Food and Drug Administration (FDA) has learned that your firm is marketing the THL-1™ Handheld Laser in the United States (U.S.) without marketing clearance or approval, in violation of the Federal Food, Drug, and Cosmetic Act (the Act).

Another laser, another violation. Read the entire document at the FDA site — here.

Tags: laser, fda, gaunitz, thl-1, thl1, erchonia, handheld laser, hairloss, hair loss, warning


I have been taking propecia for about 7 years. Am now 36 years old and I have a full head of hair. But now, I have stopped due to high SGOT reading of my liver. During the course of the 7 years, I have tolerated the drug very well but now, I just want to know whether I am genetically predisposed to balding or not before I take up the drug again.

I had a check with a dermatologist, she had checked my hair and told me to stop taking the drug as my hair was ok. Are there tell tale signs for me to watch out for me to decide to take up propecia again or not?

You can take the genetic test to find out if you have the gene for hair loss, which if negative will tell you that you do not have the hair loss potential problem. If you are positive for the gene, it means that you might get hair loss. Then you and your doctor can decide. I am not familiar with an association between Propecia and liver disease as a cause and effect (see Did Propecia Effect My Liver?).

Tags: hairloss, hair loss, hairdx, genetic, propecia, finasteride, liver


I am suffering from a second degree chemical burn. About 2 months ago, I had highlights done by a professional. First it started scabbing and all of the hair fell out..after a while my doctor informed me that my scalp is not healing right and it is making unhealthy tissues! He has been carving the tissues off my scalp..However after many testings he now knows that the area is infected by a bacteria…I am now on antibiotics(CIPRO)..I really would like to know where I am standing? Is my scalp going to heal? Is my hair going to grow back? and in how long?

These are questions to ask your doctor. It sounds like you have been through hell. If you think that the doctor is doing a good job, bond with him/her more through this difficult period. Infection following burns are no picnic.

Tags: chemical burn, burn, hairloss, hair loss, bacteria

Only thing I wonder is what’s the point of meeting prior patients? I’m sure the doctor will only select patients that had great experiences and outcomes to allow you to meet anyway. Just like on a job application, when they ask for personal references…..doesn’t everyone only list those that’ll give the most glowing reviews?

Open HouseAside from getting personal experiences from past patients and being able to ask them questions patient-to-patient, you can also have the opportunity to see the results in person. True, a doctor can just show off the best of the best, but you can at least determine if the best is even possible with that doctor. The results don’t lie, and if the doctor just has a pool of patients with poor results, their best won’t even make the grade.

We hold monthly open house events at both of our offices, where anyone can attend. If a patient was dissatisfied for whatever reason (results, aftercare instructions, etc), they have the opportunity to reveal that to others. I haven’t found that to happen in the 17 years that we’ve been holding these free events, so that’s a good thing and I believe that means we’re doing something right. Many times patients just drop in to say hello and we did not even know that they were stopping by. There’s no way we could control these open house events to only show off our best patients, as they are… open. That is why few doctors offer similar events year after year.

Tags: hair transplant, hairtransplant, patients, event, hairloss, hair loss