Dr. Rassman,
First, let me thank you for the valuable resource your blog provides. I understand that it is in men’s nature to become concerned about hair loss as we age. I also understand that you have answered this question, or at least very similar questions many times. I’ll ask anyway, because you seem like a good guy.

I am a 27 year old white man. I have severe depression and OCD. I recently (past couple of months) started obsessing about my hair. I’ve always been overly concerned about the way I look, and I’ve always been severely lacking in self confidence. When I tilt my head back and look up at the front of my hair line in under direct light from a couple inches away, I can see scalp going back about two inches. When I tilt my head forward, I see no scalp and my hair looks the same as it always has. There are a few long hairs growing below my hairline. I dont notice a change in my hairline when compared with photos taken when I was in my early 20’s. If I pull hard on my hair around my hairline, nothing comes out. Same with the crown. My mom’s dad died with a full head of hair in his 90’s. My dad thinned over the course of his life, but didn’t really go “bald” until he was in his early 50’s. He’s now maybe a norwood 3v or 4. His dad had the same pattern, except it didn’t kick in until later in life. My mom’s brother went bald young. My maternal great grandfather had Homer Simpson’s hair by the time he was 30 or so. My dad’s brother still has a good head of hair in his 50’s. What do you think (and I know you can’t really tell without a miniaturization study)… which leads me to my next question.

Is a miniaturization mapping something that is common among dermatologists? Do most of them (in your experience) properly perform and understand the procedure? Is this something that has been written about in peer-reviewed publications? Will a dermatologist that does not specialize in hair loss be able to correctly diagnose what is going on with my hair (if anything)? Thank you very much for your time.

If you know you have OCD and are starting to obsess about your hair, I think you answered your own question about what my thoughts are. You’re seeing possible thinning when your head is tilted and you’re under direct light. The hair will generally appear thinner under harsh lighting.

I wrote about this when I applied for a US patent in 1992. I published it in various articles, not suggesting mapping the head, but showing the connection between balding patterns and miniaturization. The rest is not rocket science. It is not exciting to map out the scalp for miniaturization and actually if the doctor is knowledgeable, then a good sweep of the scalp will give the needed information for a well trained physician.

Many doctors now have video imaging systems in their office, like slightly more expensive versions of the USB video microscope mentioned in the Mapping Your Own Scalp series. For around $100, you can buy this microscope for yourself and get the mapping started. One of the biggest reasons that I created BaldingForum.com was because of comments like yours — that forum gives site visitors the chance to empower themselves by mapping their own hair and making their own diagnosis, following the process over time with aging, drugs, etc. You can share your results with others and get feedback from other site members, not just from me (time is always a problem for me, because I can’t just get to everyone). I believe that the real power will be in the hands of people like you — those who just want to know what is happening to them.

Tags: miniaturization, hairloss, hair loss, mapping

I’m a black female and two years ago I wrote to you guys about dreadlocs and hair loss. I cut them off and kept my hair almost to the bone most of 2007. Last year, after growing my hair back for a few months I cut them off after experiencing very localized alopecia at the back of my head along my ears (about an inch inside my hairline). I thought that maybe it was reaction to the hair dyes I used so I cut it all off and started over and was all growing in nicely. Well now a year later I’m having the alopecia problem again.

I’d been growing my hair since I trimmed it in June. But when it started getting cold here it started to get the itchies behind my ears, something I remembered from the previous time I lost my hair and whenever I’d wash it, it would have lots of hair coming out. I thought maybe it was because I did my hair in styles that I kept for a week (and therefore losing on in day a weeks work of shed hair)but deep down I knew it was much more then that.

So I looked in the mirror yesterday and saw the bald patch, much larger then what I had last year. I just don’t understand what’s going on. If you drew a line from ear to ear, my hair is much denser from the front to that line, I get thick braids when I style that part of my head. At the back it’s much finer. I’m really at a loss as to what could be going on.

I don’t use relaxers, artificial hair dyes (only pure henna), I don’t use heat to straighten my hair and I’m as gentle as possible when combing my hair. Can you shed (no pun) some light?

What I tell black women is that anything they do to their hair can cause hair loss if it is done often enough. It’s a general statement, but I see it almost every day. Hair straightening with relaxers does it, pigtails do it, dreads do it. Perhaps you are best served with a good afro, but if you’ve already lost a considerable amount of hair, that might not be an answer. Wigs work, but the attachment mechanisms can cause hair loss. It’s a huge catch 22. I really can’t give you any kind of solution without at least seeing what the problem is for myself.

If you’d like to visit my office for a consultation, I may be able to come up with something. I might suggest hair transplants (I’d need to see you first), but then again, that is an expensive solution and it still may not help 100%. Just don’t let any doctor recommend a hair transplant unless he/she is honest and straightforward with you. Good luck.

Tags: hairloss, hair loss, african american, african, dreadlocks, dreads, traction


I am a 23 year old Sikh Male. I have always had long hair my whole life. And I have been suffering from either traction alopecia or eczema on my head but I am not sure what it is. I am seeing my doctor soon to diagnose it. My doctor has given me 2 different types of shampoo and a liquid clear acid application that burns the skin after I shower. And nothing works, I’ve had this for nearly 10 years now. Any suggestions? I have tried everything BUT wear my hair out in the open and or cut it. Cutting the hair wouldn’t be a great loss for me considering that I am not religious. But do you think that would help? I also work out at the gym and do physical activities through out the day so I am always sweating. So my head really never gets air. Please get back to me, I really need to make a decision. Thanks

The common cause of hair loss in Sikh men is traction alopecia from the use of the turban, which pulls on the side and frontal hair. The turban is tightly applied to the head and the traction of it against the skin causes traction alopecia. If you have hair loss on the front and the sides above your ear, then that should be the diagnosis.

Treatment is often best with hair transplants. If you are losing hair elsewhere, your doctor should be able to map out your scalp for miniaturization to determine if you have genetic hair loss.

Tags: hairloss, hair loss, sikh, turban, traction alopecia

How do you determine benefit from a treatment if there has never been regrowth and further loss? I’ve used 2% minoxidil once a day for many years with out regrowth and continued loss. I continued on the assumption the loss might have been worse without treatment. But that’s just a guess. How do I know if I’m just wasting time and money? Do you assume that after many years the hair is going to become minox dependent regardless what the seen results are and quiting is a bad idea?

This is the problem that many people have. If you stop the medication and nothing happens, then the medication was having no impact… but if you stop the medication and the existing miniaturized hairs were dependent upon the medication, then reactive hair loss from withdrawal will be the problem. Most of the time restarting the medication does not return you to same status as before you stopped the medication. It’s kind of a guess that you have to make.

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

I have a question concerning today’s blog post. you mentioned that “exclamation point” hair is a sign of a disease but isn’t that what happens when miniaturization occurs in general? doesn’t the shaft get smaller, generally at the root first? that’s what’s happened to me. does this mean i have a disease? i doubt it. i got my thyroid checked when i first noticed hair loss and everything seems fine. i guess what i’m asking is, what’s the difference? thank you!

The term “exclamation point hair” is a term of medical art (see more info and a diagram at American Academy of Family Physicians). You are correct that as the miniaturization progresses (it would have to be rapid progression) one could theoretically see the reduction of shaft size, which is normally a very, very gradual process. It rarely can be picked up visually as you report.

Tags: exclamation point hair, hairloss, hair loss, miniaturization

Snippet from the article:

Scientists in the United States have pointed the finger at seven genes that appear to play a role in psoriasis, a study published on Sunday says.

The work could unlock new drug targets and tailored treatments for this painful, disfiguring skin disease, they said.

Read the full text at Yahoo! Health

We are unlocking more and more of our genetic codes. The balding four most probable genes have been identified. Now we have identified one of the main culprits of psoriasis. Once we know the gene and command it, we will develop appropriate drugs for its cure.

Tags: skin, psoriasis, disease, gene, genetic

Snippet from the article:

Men who are very sexually active in their twenties and thirties are more likely to develop prostate cancer, especially if they masturbate frequently, according to a study of more than 800 men.

However the UK research team also found that frequent sexual activity in a man’s forties appears to have little effect and even small levels of activity in a man’s fifties could offer protection from the disease. Most of the differences were attributed to masturbation rather than sexual intercourse.

Read the full article at ScienceDaily.

Well, all I can say to that is… man, I’m in trouble! Now, cue the hundred “this somehow proves hair loss and masturbation are linked” emails….

Tags: masturbation, sex, prostate cancer, prostate, cancer, study


I am 25 years old and have a gradually receding hairline around the temples and thinning hair for about the past two years, but I’ve been wary of getting propecia because of the health risks, and I thought about Rogaine Foam, but I heard that it it smelled and led to shedding, among other things. Since I’m trying to hang on to everything I have left, I didn’t want to take the risk of incurring significant shedding with Rogaine, as well as no promise I’d grow any hair back around my temples or forehead, so I did nothing but occasionally browse message boards until I came across information on Revita. It seemed like just what I was looking for; a shampoo that would at least reduce hair loss/thining. Well, I started using Revita about 5 weeks ago, and the first time I used it, leaving it on my hair for 2.5 minutes, then approx. 4 minutes, and my hair seemed a little thinner, but shinier. The next day I got a haircut so my hair was a little shorter and I continued using Revita 5-6 days a week, for the prescribed times, and I’ve noticed I’ve shed a couple 1-4 hairs just about every time I use it. This has been exceedingly disturbing, but I’m not sure if it’s just something that has to happen before it starts working better . . . I don’t know.

My theory – the reason I’m still using it – is that the hairs that are shedding are the ones closet to my forehead and temples and these are the real light hairs that already seemed on the verge of falling off. So I’m thinking that maybe just keeping the shampoo in the hair for so long and then rinsing it out is causing the weaker hairs to come off b/c of the contact. I’m hoping it’s just the weak hairs that will shed and the healthier hairs will become even healthier. But so far, I’ve seen none of the benefits promised by the company.

Thank you very much

RevitaI need to make this very, very clear to everyone — there is no shampoo currently available on the market that can regrow your hair. None!

This Revita product contains ketoconazole, which is a volumizer and can increase the hair shaft diameter by about 7%. This increase in shaft diameter may look like you have more hair and in fact, considering that fullness is a result of numbers and thickness of hair, you will have more hair that produces more fullness. Any shampoo that uses ketoconazole will have the same effect. By keeping it on for a few minutes before washing it off, the ketoconazole probably does a better job with thickening the hair shaft.

For those keeping score, ketoconazole is the active ingredient in Nizoral, and is a commonly used antifungal medication and dandruff treatment.

Tags: ketoconazole, nizoral, revita, shampoo, hairloss, hair loss

Dr, I have been taking Propecia for 10 years. If the drug would indeed stop working, what exactly would happen? Would I have some form of telogen shed? Or would the loss be gradual? The reason that I ask is because I am going through a severe shedding phase that began in September of 2008 and it continues until now. I have indeed ordered the “generic” drug from overseas the past couple of years. Could the overseas drugs be bogus and this is the reason I began shedding again?

There’s two possible problems — the generic you bought overseas could be fake, or your finasteride dosage could just be starting to finally lose the fight to your genes. I often talk about a tug of war of sorts, where Propecia works on one side of the rope and your genes work against it. The genetic side appears to be slowly winning. Talk to your doctor about increasing your dosage to 2mg daily and see if that helps.

Whatever you do, do not stop the drug! You’ve taken the medication successfully for 10 years now, and it hasn’t stopped working for you… but if it’s not due to fake overseas medication, then it’s not slowing the hair loss as well as it was before. Stopping it completely will likely result in a massive catch-up hair loss situation occurring.

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

Hi Dr. Rassman & Staff. Great blog.

Anyway, here’s my question. On my morning drive into downtown Chicago, I invariably hear radio commercials for laser treatment to REMOVE “unwanted” hair. Yet, I also see promo’s for laser treatments to GROW hair. Well which is it … do lasers GROW or REMOVE hair?


HairyThe lasers which claim hair growth are a low level laser energy dosage that do not penetrate the skin… nor do they grow hair, in my opinion.

The lasers for hair removal are high energy lasers which focus the power to a very small area (the hairy area that you’d like de-haired) in bursts to be safe. They will penetrate the skin to get to the root of the hair follicle.

Both lasers work at different light frequencies.

Tags: hair growth, hair removal, laser, hairloss, hair loss

Why isn’t minoxidil taken orally? I’ve always been under the impression that drugs taken orally (like Propecia) get to the root of the problem as opposed to ones topically. For instance, if caffeine theoretically helped hair loss, I would think consuming caffeine would work better than putting caffeine on one’s head.

Minoxidil was originally used as an oral anti-hypertensive medication for the treatment of high blood pressure. It was unpredictable in its use so it was abandoned, but people taking it (women) would notice face and body hair appearing from the oral pills. That is why it is not used orally today, as it has a tendency to drop blood pressure. That even occurs when you apply it topically, as some of the medication is absorbed into the body after a skin application.

Tags: minoxidil, rogaine, hairloss, hair loss, oral, tablet, pill, blood pressure

Snippet from article:

Hair loss affects more than 50 million Americans, 20 million of them women. With numbers like that, it’s not surprising that the people behind the bestselling Dummies Books series have taken note. Their comprehensive new book, Hair Loss & Replacement for Dummies, authored by four medical experts on hair loss, has just been published by Wiley. TIME senior reporter Andrea Sachs spoke with one of the authors, hair-transplant surgeon Dr. William Rassman in Los Angeles.

TimeHey, that’s me!

Read my new interview with Time Magazine at their website — Time.com. I’m glad I got the chance to get some publicity for my new book, Hair Loss & Replacement for Dummies (which you can buy online or in stores now *cough cough*). The interview was just posted on Time’s site, so feel free to post your thoughts about it here (after you read it, of course).

Read: Time.com Interview


Tags: hairloss, hair loss, dummies, time, rassman, wiley

You often talk of shedding and how in theory if miniaturized hairs are shedding after starting medication like Propecia it might be making way for new thicker hair. Is this the only way that reversing miniaturization can occur or can it happen within the same cycle? A reverse “exclamation point hair” I guess. Thin at the end and thick at the root.

Considering that most people have a hair cycle of 3 years and we see changes in miniaturization with medications in months, the answer is that changes do occur within cycles. I have the means to measure hair shaft thickness and maybe on a patient with an 8 month reversal of miniaturized hairs, I will measure the two ends of a single hair shaft.

Tags: miniaturization, hairloss, hair loss, hair cycle

I read that sodium hydroxide is one of the chemicals used for hair straightening, and it can burn the scalp if it comes in contact with it too long. I also noticed that sodium hydroxide is an ingredient in both my shampoo. Is this bad for my hair?

At the low concentrations, the sodium hydroxide should not hurt you or your hair (such as in shampoos)… but when you are using higher concentrations for straightening it, you must be careful.

Tags: sodium hydroxide, hairloss, hair loss, shampoo, straightening

Okay, let’s say theoretically that saw palmetto does in fact help to block DHT. My question is, how the hell did they figure out that saw palmetto berries reduce DHT and not other berries out there such as cranberries and/or bilberries?

Saw palmettoSaw palmetto has been around for hundreds of years and has been used successfully for treating prostate enlargement. Native Americans used saw palmetto to relieve urinary symptoms in older men who had difficulty in urinating. It has been shown to reduce prostate size and it is used quite frequently in Europe.

There are many potential side effects of saw palmetto, including abdominal pain, diarrhea, nausea and vomiting, erectile dysfunction, breast tenderness and loss of libido. That is the connection that made people think that there is a DHT blockade in process, as so much seems to parallel finasteride’s side effects. Some think that since finasteride works for the prostate and hair, then if saw palmetto works for prostate issues it must also work for treating hair loss. Unfortunately, saw palmetto has never been studied in any well planned clinical endeavor for treating hair loss.

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