Hi, i’ve been using rogaine foam for about 7 1/2 months, and started using nioxin system 1 shampoo and coditioner. i’m starting to get a lot of head aches i think from the foam (since i think i’m using too much) and i’m not sure i’m getting much results, so i was thinking of starting using propecia, except it’s costly and i’m afraid of the side effects, seeing as i’m only 22, male. i heard the younger you are though, the less likely you are to have side effects from propecia, is that true?

i’ve been reading around and would like to only use .5mg, by cutting themin half. is it safe to just take a knife and cut them in half though? and i’ve heard using nizoral shampoo along with the foam is considered the “big 3” and has shown a good amount of results for people, do you recommend using all three products?

HeadacheHeadaches may be from the hypotensive impact of minoxidil (Rogaine), which does drop blood pressure in some people. You may be using too much of it, or may just be too sensitive to it.

If costs on Propecia is too much, you can get a prescription for the genetic finasteride 5mg tablet and cut it into quarters. At our local Costco, the cost runs about $5/month for the 5mg generic. With regard to halving the dose, the financial solution to your problem is discussed already with the generic finasteride… and why take half when a full 1mg dose is better? Side effects are rare in men of all ages, but I don’t recall seeing statistics about side effects relating to age.

You can use Nizoral, but aside from being a good shampoo, I’m not sure it’s going to regrow your hair. If you’ve got the financial means to do so, you can continue to use all three products.

Tags: nizoral, finasteride, propecia, proscar, minoxidil, rogaine foam, rogaine, hairloss, hair loss

I have been gradually losing hair for the past 4 years. I don’t think I lose more than the “normal” 100 hairs per day, but the consistent shedding has definitely led to a receding hairline and a significant difference in density on top versus the sides and back. As I continue to shed on a daily basis, I worry and stress about getting to a point where my hair loss becomes very noticeable. It’s like dying a slow and painful death.

Is there any way to tell whether my hair loss will stop/plateau, or is it a foregone conclusion that I will eventually lose it all?

Hair deathYou aren’t the first person to use the analogy comparing hair loss to death. For many men, their hair is part of their identity.

As for being able to tell whether your hair loss will stop, well, this is what I’ve been referring to as miniaturization mapping. You use a microscope to examine your scalp… then do it again in 6-12 months to see how the loss is progressing. A physician should be able to tell from there where your hair loss will end. Taking medication like Propecia could likely help halt your loss at this point (if you are male), but this needs to be prescribed by a physician and with all of this information you should be able to develop a Master Plan with your doctor for your future hair loss possibilities.

Tags: hairloss, hair loss, death

I have a small, linear non-transplant scar above my ear. It has healed pretty well, and is looking more and more like normal skin each day. I’ve been thinking about transplanting hair into the scar by an east-coast doctor, about 100 grafts is my guess. If this were to be done with FUE, is there a huge risk that the scars produced from such a small FUE procedure will be worse than my linear scar? I want to be able to wear a buzz cut (somewhere around #2) as I believer my hair is thinning and short hair is a better look. Should I be very worried about moving just 100 grafts from the back of my head into this scar to minimize it?

Follicular unit extraction (FUE) is a good way to fill in a scar, but not all FUE is the same. Different doctors use different techniques and instruments. As long as the FUE instrument is less than 1mm (ideally 0.8 of 0.9mm diameter), you should be OK.

I am flattered you would ask me, but I would ask this question to your doctor since you need to trust the surgeon that will be performing the procedure on you!

Tags: scar, repair, fue, hairloss, hair loss, hair transplant

Hello, I was missing the middle of my eyebrows ever since I was a child. My oldest child pictures have virtually no eyebrow hair in the middle but it wasn’t noticeable until I became a teenager and they darkened. I have no idea how I lost them or perhaps I was born that way. When I was a teenager the remaining hair started seemingly shedding. So I got 2 hair transplants with a doctor.

What I am concerned about is the remaining original eyebrow hair seems to be shedding too much and it seems from the before and after shot I have less of the original hair than I had before. Today when I put tea tree oil on the original hair to get rid of the dry skin 15 hairs from my original brows came out. I just had a third hair transplant into my eyebrows so the trauma from the surgery might be why but still it’s just an example. The transplanted hair does not seem to be effected like the original hairs but if possible I still want to protect what I have left of the original hairs in case I am loosing them. I did pluck a lot of the dry skin plaques out so I might have lost some of the hairs to traction but that doesn’t explain why the hairs shed so easily and I’m wondering if this shedding suggests that the follicles are in danger.

My dermatologist doesn’t know whats wrong. Is their any tests I could take to determine what is causing the excess shedding and possible hair loss such as a hair biopsy or skin biopsy? Could the inflammation from the dermatitis be causing telogen effluvium or something? Is there anything I could do to stop it? I feel very discouraged about finding out what the problem is.

If you have seen a good dermatologist and had a good hair transplant doctor, I can not add much here as I would have less information than they have. You could be experiencing some shock loss in your eyebrows, but I’m just not sure, as I’ve not examined you and am not familiar with your history. If your dermatologist doesn’t know what the problem could be, I’d try another dermatologist.

Tags: eyebrow, hair transplant, eyebrow transplant, hairloss, hair loss

There is an herb called black cohosh in my DHT blocker blend. I researched it and it seems to increase blood flow in the pelvic region, but no one has pinpointed exactly the mechanism of action is or what the hell it really does, or if there are side effects. I saw a study that it might block DHT. My question is this, if we’re going the natural route for hair loss, would we be better served eating foods that are considered staples in our diets (fish, rice, potato, chickpeas, vegetables, fruits, soy, and so forth) or consuming supplementary herbs? Would these herbs REALLY make a difference?

The best natural treatment for hair loss is take what you want (dietary staples or herbs) and then, assuming you have genetic hair loss, watch as the hair loss continues. In other words, there are no natural cures for hair loss, but there are a lot of places that will try to sell them to you anyway. No amount of vitamins or herbs will bring your hair back.

Tags: hairloss, hair loss, diet, dietary, supplement, herbal, herbs

Is it possible and/or safe to use propecia and minoxdil at the same time or is it not recommended to take these together. Additionally, if I take propecia, is there a recommended method of taking it – ie with/without food, empty stomach, without other medicines or vitamins.


You can use Propecia (finasteride) and Rogaine (minoxidil) together. It doesn’t matter if you take it with or without food.

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

Hello Dr.

I have a problem regarding my brother starting to lose his hair.He is losing his hair at a very young age (he is 17.5) I want to get him on propecia since he is nearly 18 but i am worried that even 18 years old is a little young to use propecia,do you think this is true? The reason i think it may be too young is that boys don’t stop growing until they are around 20 to 22 sometimes, and i am worried that DHT is needed for boys to develop into men.Do you think 18 years old is to young to use propecia and could it stunt his growth? I am really worried for him,please respond.

You are your brother’s brother, not his doctor, so you can not be objective about the process of hair loss and its diagnosis and treatment. Assuming that he meets with a good doctor, gets examined for miniaturization, and gets a diagnosis of male pattern baldness (MPB), taking Propecia at 17.5 years old should not be a problem. The clinical trials and data are from men as young as 18 years old, and as you stated he’s nearly 18, he should be done growing anyway.

Maybe there is something else wrong? Perhaps he is not genetically balding, but just developing a mature hairline In any case, do what is right and in his best interests. Seeing a doctor should be step 1, as the medication is by doctor’s prescription.

Tags: propecia, finasteride, teen, teenager, hairloss, hair loss

I had SEVERE Vitamin D Deficiency (MY LEVELS WHERE 5) I’m a male and my doctor thought this could be contributing to my diffuse thinning. I started therapy in three months ago and got my levels up to 20. If the loss was caused by VitD than how long does it usually take to cycle the hair back to normal growth.

Love the site.

Vitamin DI do not have experience with treating a Vitamin D deficiency and the recovery from it. Assuming that you do not have male patterned baldness on top of it, I would imagine that the hair should recover (I used “should” because it is logical that it would) in the normal cycling phase, which may take 3 years as the existing hairs undergo their anagen (about 3 years), catagen (days to weeks) and telogen phases (3 months). To learn more about the hair growth cycles, see here.

I am curious how you became deficient in Vitamin D, but pleased to hear you’re undergoing appropriate treatment.

Tags: vitamin d, hairloss, hair loss, deficiency

Hi Dr Rassman,

I recently visited a very reputable hair transplant surgeon. I am a 33 year old with Norwood 2 recession. My hairline has receded at the sides of the hairline and slightly at the temples. The surgeon recommended that instead of straightening off the hairline and transplanting hair to the temple that due to chances of further recession it would be more beneficial to bulk out the line of the current hairline, totalling 800 grafts/20cm. He was adamant that this would produce the most natural looking results, whereas bringing the hairline further forward would leave open the danger of having a gap between transplanted hair and any hair that further receded (both in the hairline and temple regions; i thought that he was using the danger of further recession as an unnecessary reason. Am i best to follow his advice or go with the look i would like?

In essence he is recommending this type of procedure: link

when i would he more inclined to go with this: link

I am generally not inclined to perform preventive hair transplantation and given the borderline nature of your desires, I would have to evaluate you to determine if your goals are reasonable or not. You must remember that once you start the process, you are committed for life to following back the balding if and when it should progress.

I’d need to see photos of your head at the very least before getting any kind of idea of the best way to go about creating a hairline for you. Unfortunately, I can not answer your question from the photo examples you supplied.

Tags: hair transplant, hairline, hairloss, hair loss

Hi Dr.Rassman,
I read about the Hair Dx test for finasteride response on your blog. Have you done this test on any of your patients ?. What are the results ?. Is the Hair Dx test kit available for online purchase?

Hair DXI have just requested the HairDX tests get shipped to me last week and expect to have them in hand shortly. I have not had the opportunity to use any of the HairDX tests yet, so I don’t have my own results at this time.

To my knowledge, these are not available over the Internet for sale and must be obtained from a doctor registered with the company.

Tags: hairdx, hair dx, test, finasteride, hairloss, hair loss, genetic

How much does taking Propecia at exactly the same time each day matter? I try to take it within 10 minutes or so, but occasionally I am 2 to 3 hours late. I know you have said that the half life of the medication is only fours. By the time 24 hours passes, has essentially all the medication left the body so that if you don’t take it again at exactly the same time you are going that extra time without Propecia? Will taking it a few hours late cause a decrease in benefits?

Thank you for keeping up with this blog. It’s a great resource.

It is not critical to take Propecia at the same time each day, but it does make sense. I take my medications in the morning so I develop a routine and do not have to remember if I took them. Maybe it’s my age. As long as you take it daily, you shouldn’t see any decrease in benefits by taking it a few hours later than the day prior.

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

Question re Propecia and Sperm Count. I take Flomax and Finasteride. Side effects are reduced libido and ejaculation. I noticed if I discontinue taking the pills, I regain libido and ejaculation volume in 3 – 4 days, although I had only been on these pills for three weeks. My question is, can I periodically take a “prescription holiday” and then resume medication after, say a week without risk of return of BPH? I.E. will the long term benefits of this prescription program remain in effect if I take periodic holidays?

I am not a urologist, but I suspect that when the “flow problem” has resolved, you might be able to stop if for a week, but I would first check with your prescribing doctor for a more definitive answer.

Tags: finasteride, propecia, flomax, hairloss, hair loss, libido, ejaculation, medication

An earlier question brought up an article about a topical DHT inhibitor at HairLossTalk:

The doctor interviewed in the article made some pretty impressive claims. Paraphrasing:

  1. His topical DHT blocker is as effective as Propecia as long as you could apply it to the affected area
  2. Downside of topical: It’s more of a pain to apply. It would be really difficult to apply to entire scalp, whereas Propecia blocks DHT everywhere.
  3. Upside of topical: it only blocks DHT near the scalp, having less of an affect on serum DHT levels. This decreases the chances of side-effects.

The claims seem to make sense to me, but this kind of stuff can sometimes be counterintuitive.

  1. Do you agree with his general evaluation of topical vs. serum DHT blockers?
  2. Do you have an opinion on the specific topical solution he is talking about?

We have written about topical DHT blockers before here. The doctor in the article you referenced is a web-based provider of compounded, off-label medicaments for hair loss. The use of spironolactone has been a mainstay as a treatment for female hair loss when taken orally, but there is no real evidence that it works and many studies show the controversy, saying either it works or does not work. It is tied to the belief of the doctor, but you must keep in mind that doctors who recommend it profit from its use. When you take such medications and convert it to skin (topical) use, there is no guarantee that it works, if it is absorbed through the skin and just where the medication works (if it does work at all). It is easy to make such compounds and when a doctor puts his concoction into a cream or topical, there is an implication that it is safe and effective. Spironolactones are known antiandrogens and as such should work in men, but if taken orally, men will have significant secondary sexual side effects, such as loss of libido and problems with sustaining erections (when and if they get them). The question one should ask is whether this medication has sexual side effects. Without proper scientific studies, we really can not tell.

I never understood why men chase this stuff when the rare sexual side effects from Propecia (finasteride) have been measured. I would guess that if spironolactone was taken orally, they would dwarf the side effects of Propecia in men, yet men somehow want to experiment and may find themselves swamped with side effects or ineffective treatment losing valuable time on fixing hair loss with what is known to work. Topical spironolactone has a bad smell associated with it which is claimed to have been successfully addressed by this doctor, so I don’t know if this medication stinks from the aroma or its success and without good science behind it, it becomes a real gamble with the belief of one doctor who makes his living putting topical medications together.

Tags: spironolactone, dht, topical, hairloss, hair loss, doctor, physician

I currently use the EXT product line from hair club. Are there any other products comparable to EXT?

You should dissect each element of their EXT approach:

  • Cleansers on the scalp do not do much
  • Lasers, in my opinion do not work
  • Lotions that contain minoxidil work just like minoxidil without the packaging
  • Scalp massage feels good but doesn’t grow hair
  • Finasteride works well
  • Vitamins have limited value in a person who is not vitamin deficient
  • Miniaturization studies tell you where your hair is going and how fast
  • Hair transplants work very well with the right Master Plan

I do not offer many of these elements because they may not work, take too much time, and will raise the costs for most people.

Tags: hairclub, hair club, ext, extreme hair therapy, hairloss, hair loss, finasteride, minoxidil, lotion, cleanser, laser

Hi Dr Rassman
Big fan of your Blog. It has informed and guided my HT decisions in the past several years with excellent results. Now my question.

Tom Jones – he has stopped dyeing his hair and now is grey/white. His hair looks better than ever, I know white hair reflects light giving a fuller appearance to the hair but his hair looks so good now, he has definitely had further procedures. I assume FUT or FUE. He has already had quite a lot of work done, but this latest procedure has delivered fantastic results. Do you know what he has had done? Whatever is was it has delivered a very good result.

Kind Regards

Tom Jones

I guess this was big news in the UK, because I found quite a few articles about the singer’s decision to go natural —

At 68 years old, Tom Jones does look good (or perhaps I should say “grey’t”). I don’t know his hair transplant history, but if he had some work done, I was not his surgeon. You are correct in that white hair is often fuller looking, but I’m not sure what else I can add to this discussion. His hair looked pretty full even with the dye, but that could also be because of the wiry characteristics.

Photo source BBC

Tags: tom jones, singer, celebrity, white hair, grey hair, gray hair, hairloss, hair loss