Dear Doctor,

Great blog. Why is it not possible to do many hair transplant surgery till your hair is completly restored.

You can’t completely restore a head of hair in one surgery unless you are not very bald. Technically, you can’t completely restore a head of hair at all, but you can create the illusion of fullness. You’ve got a limited number of hairs on your head to start with. For a person who lost 8,000 hairs only in the front, it is possible to restore it back to about 50% of the original density, which may work with reasonable hair thickness. If you lost 60% of your original hair (60,000 hairs) then the amount of hair that you can move will be limited to possibly 7,000-10,000 hairs per session as long as the supply of donor hair lasts.

I tell people that they need a Master Plan because the future of your hair loss may not be clear and your worst case needs to be planned for. Once you start losing your hair, transplantation enables us to move some of the remaining hairs to other areas of the scalp.

Tags: hair transplant, hairloss, hair loss

No question this time, but I wanted to share a quick story…

A 58 year old patient of ours was transplanted in the corners of his frontal hairline. He had used minoxidil for years with what he thought was no effect. After his corners were transplanted, he stopped the minoxidil and in time, lost hair behind the transplanted corner on his right side. In hindsight, this complication could have been avoided had he gone back on the minoxidil, but neither he nor I realized the dependence of the minoxidil over the previous years.

As a rule, men in his age range do not suffer from shock hair loss (very, very rare), but in this case, minoxidil was far more effective than we thought. He is now only 2 months post surgery and was immediately restarted on the minoxidil. I am hopeful that the drug will regrow the hair he lost behind the transplants on his right side, but only time will tell us. The lesson here is that when you are a long term user of minoxidil, you really do need to stay on the drug for life.

Tags: minoxidil, rogaine, hairloss, hair loss, hair transplant, hairtransplant

I’m a male who has just turned 18. In the last 4 months, I have had growth in my facial hair, but am losing hair on my head as fast as I am gaining it on my face. As soon as my facial hair started thickening, my pattern baldness got aggrivated. The hairs on the edge of my hairline are thin, small and weak (like a baby’s hair). Why is this happening now?

What you are describing is the unfortunate results of DHT (dihydrotestosterone) doing its job on growing your beard and taking advantage of your genetic defect in causing hair loss. Your facial hair isn’t the reason for your hair loss or vice versa. If genetic hair loss is the case and you confirm it, then the drug Propecia (finasteride 1mg) will be the best approach to this problem. Don’t wait, as time appears to be working against you. You should see a doctor to find out if you have genetic hair loss, as Propecia is only available by doctor’s prescription.

Tags: propecia, facial hair, beard, hairloss, hair loss, finasteride

Snippet from the article:

For the first time, leading medical groups are advising millions of healthy men who are regularly screened for prostate cancer to consider taking a drug to prevent the disease.

The advice stops short of saying men should take the drug finasteride, sold in generic form and as Proscar. It is already widely used for urinary problems from enlarged prostates as men age. Merck and Co sells it as the baldness remedy Propecia. However, it has not been widely prescribed as a cancer preventive, and it may carry some risks. The new guidance tells men to talk to their doctors and decide for themselves if the good outweighs the bad. This advice is bound to be confusing, doctors admit. For one thing, it doesn’t apply to men who choose not to have screening with PSA blood tests, which no major medical groups recommend.

In men who are regularly screened, finasteride can cut the odds of being diagnosed with prostate cancer by about 25 percent.

See the full article: – Medical Groups Advise Men to Take Baldness Drug to Prevent Prostate Cancer

For those that already take finasteride, it’s likely not news to you that the medication has prostate cancer prevention benefits (I’ve mentioned it as far back as 2005). Finasteride was at first used as a prostate treatment called Proscar (in 5mg dosage), with Propecia becoming available as a hair loss treament a few years later (in 1mg dosage). Still, it is important to point out the health benefits of this drug.

Here’s the National Cancer Institute’s page about their Prostate Cancer Prevention Trials, since there’s bound to be questions — Prostate Cancer Prevention Trial (PCPT).

Tags: propecia, proscar, finasteride, cancer, prostate, hairloss, hair loss


Just read a recent post regarding someone who notices his hair thickens and thins and thickens again. I’ve noticed that for years and just assumed it was from Rogaine. That it was either synch shedding which happened after first using the drug and just continued through the years or that at times realized I’ve been missing areas and after reapplying those areas came back. But again that was Rogaine not Propecia which the previous post was on. Wonder if other minox users noticed this.

After reading your reply made me wonder if TE tends to reoccur in people. It would make sense if it is in response to a stress. People who have physical ailments in response to stress tend to have the same physical responses repeat throughout their life. I wouldn’t be surprised if some people are predisposed to TE under stress. Just as some develop IBS that comes and goes.. acid reflux.. back pain.. IF TE happened once it will probably happen again under stress.

Thanks for your comments. I’m posting this to hopefully get other readers to share their experience with back and forth shedding from minoxidil, as you describe.

To put this all together, a good relationship with a doctor is a good idea. Yes, telogen effluvium can reoccur in some people. See eMedicine for more info.

Tags: telogen effluvium, stress, hair loss, hairloss, minoxidil

Can dying hair with Just for Men cause baldness?

You first need to have genetic balding. The Just for Men dye product will not cause you to lose your hair unless you perhaps have an allergy to a chemical used in it.

Tags: just for men, hair dye, hairloss, hair loss, dye

Hi Dr Rassman, like many others, I’d like to thank you for taking the time to maintain this blog. I’m 40, have considerable recession at the temples, but recently I started noticing more in the middle front and overall thinning. Obviously that’s not sitting well with me, probably causing a chicken and the egg situation, as its stressing me out, which can be a major contributor.

Do you think Propecia would still do anything for me? In addition, Retane is another product I’ve read about. Have you heard of it and if so, whether its worth looking into further. I hope you will be able to respond to my question. Thanks very much in advance.

RetaneRetane doesn’t appear to have anything of value in it to regrow your hair or cease your hair loss. This list the ingredients on their site as inositol, biotin, protodioscin, folic acid, vitamin B5, vitamin E, aloe vera, and ginseng panax extract. These ingredients simply don’t have value in treating hair loss. The product’s website references an 86% success rate over and over — and a closer look at the clinical study they reference shows that it was conducted 7 years ago, included only 22 people (15 men, 7 women), and was only 4 weeks long. Their website informs us that you might see regrowth at the 6 week mark, so why their “study” went to only 4 weeks is beyond me. That is such a half-cooked study for a hair growth treatment that I don’t think I need to go further with my comments.

As for the other part to your question — I haven’t seen your photos and don’t really have a full history of your hair loss, but if your doctor prescribes Propecia to you, I don’t see why it couldn’t work. At the very least, it could halt the hair loss from progressing for some time. As long as you know that you for sure have genetic balding (think miniaturization mapping), you should spend your money on a hair loss treatment that is proven to work, like Propecia and minoxidil.

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

Hello, I have alopecia and i lose my hair and eyebrows. Also I am losing my body hair. My dermatologist told me to try protopic once a day. Some scattered white hair in my head is growing. Also told me to take rogaine pills. I didn’t start this yet. What do you suggest for me. I really need your advice.

Protopic is a prescription medication which you can read about at This medication can be dangerous and must be prescribed by doctors who are experienced in its use. Some cancers can be induced at the skin level by this drug. For our readers, you should know that this is not a medication to get for treating hair loss.

I believe you’re describing alopecia totalis (see NAAF), but it is not really clear where you are in the disease progression. Also, your doctor likely mentioned Rogaine (minoxidil) topical — not pills. Do not take minoxidil pills to treat hair loss.

Tags: alopecia, totalis, hairloss, hair loss, minoxidil, rogaine, protopic

Hello Dr. Rassman,

I’m a pre-medical student, applying to medical school next year, and ever since discovering sites like ‘hair transplant network’ and doing independent research, I’ve decided I have a great interest in entering the hair transplant field. However, I recently read an abstract you published in 2003 regarding the status of the transplant market for both the consumer and the physician, and it lead me to believe that by the time I get out of medical school and residency, hair transplants may be an over saturated commodity? I may have interpreted the results of your work a tad harshly, but I was wondering if you had any advice for someone in my situation? Do you think there will still be potential for a successful, innovative private practice, or would it be akin to opening a laser clinic on Rodeo in 2009 -aka you’ve missed the cusp of the wave and it’s too late to break in now? I realize that you can’t predict the future, but I’d appreciate any advice or insight you can give me. Thank you very much.

I think that the issue is classic capitalism (supply and demand). With today’s economics, hair transplantation is not a necessity so there are clearly more providers than patients, but who knows 10 years down the road. The miracles I see daily in my practice will be better understood by the balding population and will, almost certainly, cause an upswing in patients seeking this service, but who know if the physicians skilled in the art will multiply faster than the demand for services. Ask our economists, who seem to know the answers to everything in our present economic climate.

Tags: hair transplant, doctor, hairloss, hair loss, economy, economist

I’m 23 years old with early frontal thinning but am currently a NW2. So I been on Propecia for 7 months now and everything is the same! By now I assume I should have seen if my hair was getting thicker or regrowing so I guess I should be happy if I just get to maintain. Now my question is if I won’t get any regrowth or my miniaturized hairs won’t get thicker are my chances to maintain my hair the way it is right now lower for 5 years which is the number of years for most men!? Because I read something that your hair count increases the most the first year and then gets less and less each year. So if I get nothing this year, I mean in like 5 years I will definitely look thinner although probably better then without Propecia but still thinner and I don’t want that.

The peak result from Propecia seems to occur by about 18 months, then some loss is common in the hair counts done by the drug company, Merck, in their FDA studies (over a 5 year study period). Some people have held their hair for years, while others slide in the hair counts. I can’t say for sure how you’ll respond to the medication, so I wouldn’t know how you’ll be 5 years on. I don’t know of any data that shows regrowth (or lack thereof) from Propecia correlating to the length of time the medication can halt your hair loss.

Tags: propecia, finasteride, hairloss, hair loss

I just recently went to the dr with a head fungus. He called it a “barber fungus” from contaminated equiptment from my hairdresser. Well, I jsut switched over to this person from the recommendation of a friend when I called her about this, she said there is just no way that can be possible. This hair dresser is so clean and I know you got it from something else. My question is coudl this be possible – getting it from somewhere else. None of my family members have it and they use a different barber/hair dresser. This is supposed to be a high dollar salon too. Can this be possible? I loved the way this hairdresser cut and colored my hair very much and want to go back. Could this just be an isolated incidence or what?

First, try to find out how the equipment is cleaned between clients. It should be soaked in a solution that is sold to the salons for this purpose. Don’t relate it to how much you pay your hair dresser, as anyone that does not properly clean their equipment can spread a fungus.

Tags: fungus, barber, haircut, cleaning

I’m currently on Synthroid 50mcg and I take this medication in the morning on an empty stomach. I read that Propecia should be taken in the morning (ideally) because testosterone levels are highest during this time. Is it OK to take Synthroid at the same time as Propecia or should I start taking my Synthroid at night?

Yes, taking both Synthroid (levothyroxine) and Propecia (finasteride) in the morning is not a problem.

Tags: propecia, synthroid, hairloss, hair loss, medication, finasteride

We sent this out to our mailing list of patients and consultations today, but the offer is available to everyone so I wanted to post it here. We’ve drastically reduced our fees for strip hair transplants during for procedures completed by the end of May and we’ve made financing even better! Also, I really want to point out our great travel incentives since I get so many emails from BaldingBlog readers all over the world that inquire about surgery. See our Travel Program section for details!

Here’s the email that went out today…

Balding Bailout


The economy seems to be hitting everyone hard these days, but you don’t have to be a bank or an automaker to get bailed out (of being bald)! This is why I’m announcing the three part “Hair Stimulus Plan” for New Hair Institute clientele.

Part 1: Starting immediately, NHI will offer a 20% reduction of our base fee structure for any traditional strip surgery performed prior to May 31, 2009. That means our Standby Program fees drop down to as low as $4 per graft! Our complete updated fee structure is on our website (or call for details).

Part 2: NHI has suspended the $100 initial consultation fee until May 31, 2009. Yes, free first consults are back!

Part 3: You can now finance up to 50% of your procedure fee, on approved credit, for a term of up to 24 months. The interest rate for the initial 6 month period is 0% and for the remaining months the interest rate has dropped to only 5%! These terms are for procedures completed before May 31, 2009.

Call our office at 800-639-4247 or 310-553-9113 to schedule an appointment to meet with an NHI physician in Los Angeles or San Jose, California, or just to learn more about our Balding Bailout special! Offer expires May 31, so don’t wait!

William Rassman
William Rassman MD
Founder, New Hair Institute

Offer applies only to procedures performed in our Los Angeles, California office.

Tags: balding bailout, nhi, special, hair transplant, hairloss, hair loss, new hair, rassman, hair stimulus

First off, thanks for everything you guys do! Doc I am 26 yrs old and I had several questions. I apologize in advance if any of them are stupid questions! I am closest to Norwood III Vertex, but not completely there yet. I actually have a fair amount of hair on the top, problem is it’s really thin. The back and sides of my hair are complete opposite, they are very thick. I want to do a hair transplant, but is there any point to doing so if I do NOT want to take Propecia? I am open to taking Rogaine. Everybody keeps telling me to wait till my 30’s to get a transplant, since if I do 1 so early now, I will still lose other hair. If this does happen, I just get a 2nd transplant, correct?

The problem with a 26 year old experiencing hair loss is that your balding pattern is in transition. Will you become more advanced in your hair loss? You can try to predict it by performing a miniaturization analysis and see how far back this process goes (see Mapping Your Own Scalp).

Having a hair transplant at age 26 without Propecia on board will just accelerate the hair loss you are likely going to see in the years ahead. Not taking the medication will allow what nature has planned for you to happen. The choice is yours. Rogaine will not offer the same degree of protection. Why keep putting yourself through more hair transplant surgeries as your hair loss progresses if a daily pill could be the solution?

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


I brought up my questions about the value of miniaturization studies which you responded to. Though I’m still not convinced, you posted a response from another doctor who also questioned it’s value giving his reasons. Your willingness to post those suggests you’re a true scientist. People often portray science as consensus when it’s just the opposite. Those who claim any debate is over are restricting knowledge not expanding it.

Thanks for you’re continued effort to expand all of our knowledge.

Sometimes the opposite opinions are from people who completely made up their minds and there’s nothing I could possibly say that would make a difference. This is my blog and the readers are generally a bright group who come here for answers and insights, and that is why I love doing this. Teaching is my responsibility to give back what I have learned over the years to those balding people. Thanks for your comments.

Tags: rassman, opinion, hairloss, hair loss