I went to a hair clinic for a consultation to get someone experienced to examine my hair and I have a couple questions, but I’ll give you the story first. I’m in my early twenties and a NW I or somewhere between a I & II at most, so I wasn’t considering surgery (felt guilty “wasting their time” but oh well). I hoped they’d focus on miniaturization/magnification, etc… But unfortunately it wasn’t until the end when I asked them did they actually use magnification. The guy didn’t really take the time to examine me thoroughly and after looking quickly at a few areas said there was possibly miniaturizing near the hairline but everywhere else was consistent and thick. He said my recession was minor and (adult hairlines are 7-8 cm from the brow?) that I had 1-2 cm before I was even at an adult hairline. My questions are:

1) The consultation advisor was very helpful and nice (unlike the M.D. who basically seemed annoyed that he wouldn’t make money from me, which I guess is understandable. The advisor implied that Propecia has little effect on any frontal areas. Is this true? I’m questioning this because he was sincerely advocating the laser comb, which seems ridiculous.

2) My brother gradually thinned and is noticeably thinner on top at in his mid-twenties. If my hairline is changing isn’t that still a form of hair loss? I’m just worried and trying to take preventive measures.

3) How certain/significant are the results of the HairDX gene test? Would you say it is worth the $250 it costs?

Thanks very much for your time taken to read this.

Not all clinics use magnification during a consultation, and it doesn’t make much sense to me that they try to rush you out the door if you’re not a candidate for surgery. It’s a good idea to call ahead and make sure that you will be able to have your scalp mapped during your initial consultation, so that you don’t leave disappointed.

  1. It is unfortunate that your doctor wasn’t caring or gave an annoyed impression. Not all doctors are like that, but I suppose it is better than having your doctor scam you into an unnecessary surgery. Your advisor was right though, Propecia has minimal effects on the frontal hairline other than slowing down the hair loss, but on occasions I have seen some reversal of the hairline in very young men (under 27 years old).
  2. Changing hair characteristics occurs with aging and it is not balding when it occur, but it does occur when a person is balding in its early stage. That is why bonding with a good doctor is a good idea. Think long term.
  3. I think I’ve answered this question before. The existence of miniaturization in the patterned hair loss areas is the best way to diagnosis balding, for if you have it, the test will be positive. If it is not clear and you are concerned about what is going to happen to you, then you need to ask yourself how much you’d pay for peace of mind. Remember, HairDX will tell you if you carry the gene, but not if you will lose hair, to what degree, or when it might occur.
Tags: doctor, hairloss, hair loss, propecia, consultant, advisor, finasteride, hairdx, genetic, gene

Ok, I’m a 20 year old male, and I was born with a widows peek. Is there anything that can be done, to like, normal that out. I have never had hair on that part of my head and it’s beyond embaressing.

Norwood Class 4AIt is generally not a great idea to transplant hair into a non-balding 20 year old, because you must take into account the possibility that you might bald as you get older. Imagine that you got the right side evened out and then began balding to a Class 4A pattern. You would have a wing of hair where the transplant was done and then be bald to the Class 4A pattern.

You need to accept the premise that if you bald and have the frontal line fixed to your liking and desires, that you will be committed to transplanting behind it if you should lose the hair behind it so you will not look freakish.

Tags: widows peak, hair loss, hair transplant, hairline

I sent you the fake Propecia press release a month ago. Here is another short article dating back to 2007 about people stopping finasteride thinking it didn’t work for them when they were taking a placebo after all.

Thousands Of Men Sold Fake Propecia

The article states, “Propecia is one of the world’s most copied drugs and it is an extremely easy drug to sell online as many men to feel embarrassed to go to a doctor to speak about their hair loss problem. The Propecia drug works for about 90 percent of men.

And it continues, “It is estimated that thousands of men around the world have stopped using Propecia believing that it doesn’t work for them when in fact if they had used a real version of Propecia made by the drug company Merck they would have experienced good results and possibly hair regrowth.

I’m not sure where those estimates came from, and seeing as how the article is a couple years old by now, the problem might even be worse, regardless of attempts to thwart it. Thanks for sending this in, along with the previous article you sent.

Tags: fake, counterfeit, propecia, merck, finasteride, hairloss, hair loss, drugs, medication, uk

I hear a lot about how Finasteride and Minoxidil do not work well in reversing frontal hair loss, how far back is the hair considered frontal hair. To rephrase the question, by what Norwood are you considered to have no frontal hair? Also, even if Finasteride wont reverse frontal hair loss, will it at least help me keep the hair in my hairline and at best help thicken it up?

Norwood 4AThe area that balds in the Norwood Class 4A is the frontal area (see art at right). Finasteride might slow the loss down in the front, but rarely reverses the hair loss in that pattern. Minoxidil might regrow hair in that area, but it would be extremely rare.

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

Snippet from the article:

Allergan believes it may have a cure for baldness in the form of Latisse/Lumigan, its glaucoma drug-cum-eyelash enhancer. EVP R&D Scott Whitcup told investors on Allergan’s Q2 2009 conference call:

“We’re in the midst of looking at a number of [selections] by Bimatoprost [the chemical name for Latisse and Lumigan] for hair growth on the scalp.

Unlike Lumigan for glaucoma, we don’t have the eight years plus of clinical trials data so we’re sort of starting from scratch.

It’s a little too early to give you the final timeline but we are working as quickly as we can to get a formulation, get the pre-clinical work done and into the clinic and we’ll update you as soon as we have more from timeline.”

Read the full article at Aesthetic Medicine News – Is Allergan’s Latisse Also a Cure for Baldness?

The enthusiasm is high for this approach to hair loss, but we really don’t know if it will work on the bald skin. We are all waiting to see what the research tells us, but the conclusions may be years away.

Tags: latisse, lumigan, bimatoprost, hairloss, hair loss, scalp, eyelashes, glaucoma

Great blog, very informative. I am 23 years old and just started taking propecia. After reading about the drug in various forums online, I’m pretty scared about the sexual side effects. Many propecia users claim to have an irreversible loss of libido and some even say that have had trouble conceiving. With so many people reporting devastating sexual side effects, why is this drug so freely prescribed by doctors? Am I right in feeling vain for taking this risk? After all, a healthy sex life and eventually the possibility of having children are much more important than a full head of hair. Aren’t they?

1-2% experience side effects of varying degrees from Propecia. As I’ve written many times before, the loudest folks are those with complaints. You’re not going to find a large number of men rushing to web forums to talk about how great their hair medication is working, but the ones that feel cheated will be the first ones to let you know… over and over, often times under multiple usernames. I see it quite a bit in the comments to posts on this very blog (the IP address is an obvious clue).

Also keep in mind that these are unsubstantiated claims you’re referring to, with some being written by people trying to steer you from a proven FDA treatment like Propecia to an unproven “natural” supplement that they just happen to be selling online (with a convenient link right in their Propecia complaint post). There’s a lot of scams out there, and message boards are full of people eager to believe anything from an anonymous person that offers them a glimmer of hope.

As for feeling vain, you want to look and feel your best, and I don’t see why anyone should feel bad about that. Here are some related posts you might want to check out:

  1. Official Word from Merck Regarding Propecia’s Effect on Sperm and Pregnancy
  2. Can You Dismiss Propecia Information on the Web?
  3. Propecia Causes Damage to the Penis — If It’s on the Internet, It Must Be True!
  4. Propecia Info on the Internet Has Me Worried!
Tags: propecia, finasteride, side effects, complaints, medication, hairloss, hair loss

i had an HT-surgery in the late 90ies with a 20 centimeter linear scar. a year ago i made a scar repair (FUE-technique) and i can cut my hair now from 1.8cm down to 0.9cm which is a great improvement.

now, i am considering to do a fraxel treatment on the scar and wanted to ask if the FUE-transplants (~250 follicles) would be damaged with the laser

FraxelFor those that aren’t familiar with the Fraxel laser treatment, it is an outpatient procedure that renews the look of your skin. The depth of these lasers do go into the dermis and therefore create a partial 3rd degree burn, but apparently the damage is limited to a narrow column which is claimed to heal quickly. If the laser took the burn into the depth claimed, any hair could be killed… and in theory, there could be an infection risk, as 3rd degree burns open that possibility, even if it is an a narrow column.

Check with the doctor offering this treatment, as he/she has practical experience. You might also wish to research a little about safety issues on your own. For more info on how the Fraxel laser works, see here.

Tags: fraxel, laser, hair transplant, hairloss, hair loss, damage

I am 30 years old and a professional singer. I am beginning to show major thinning of my hair. I have been considering propecia for a while now. My question is could there be any side effects on my voice? Obviously, it is my livelihood and i don’t want to take a risk but then again having a decent head of hair is also important for my profession as well. Any info would be most helpful. Thank you!

MicrophoneI’ve not heard anything from my patients nor have I read anything in the medical literature about finasteride (Propecia) effecting the voice. There’s one young reader that sends me questions through this site from time to time suspecting his speech was altered by Propecia, but I have no way to verify that it was the medication or that it actually occurred.

I would just say that if you tried it and found any such side effects, the impact of the drug is gone in days so just stopping it should do. And just so we’re clear — I believe your voice would not be impacted by this drug.

Tags: voice, vocal, hairloss, hair loss, propecia, finasteride

Dear doctor, I started using Lipodrene Ephedra-free formula since 3 days and I’m getting scared because of the hair-loss thing. I would like to know if this problem is caused only by ephedra or there is the possibility to loose hair even with the s-r formula? Thanks for your attention, I look forward to hera from you soon.

Lipodrene SRThe pill doesn’t seem to contain anything that would cause hair loss (ingredients here), but as it is a weight loss supplement, in general it has the potential to lead to an unhealthy diet… and that could cause hair loss.

In your case though, you’ve only been taking Lipodrene SR for 3 days, and I wouldn’t expect any major reaction that quickly and I’d look into other possible causes. I’d discuss your concerns with your doctor, which you should do before starting any new diet regimen anyway.

Tags: lipodrene, ephedra, hairloss, hair loss

I had taken Propecia for about half a year. Recently, I was found that I had a hepatic adenoma. I had consulted to my doctors and they said it is unrelated to taking Propecia. I want to know whether it is caused by the Propecia effect. Is there such effect by Propecia for this?

A hepatic adenoma (benign tumor of the liver) can occur in people who’ve never taken or even heard of Propecia, and I’ve not heard of any cases where the medication was even suspected as a cause for something like that. I agree with your doctor.

Tags: hepatic adenoma, tumor, liver, hairloss, hair loss, finasteride, propecia


I’ve written before and have another question. Do you think within the next ten years there will be a new hair loss drug that supplants Propecia as the go-to non-surgical option, or is FDA approved Dutasteride (for hair loss) the only new, clinically proven product you see on the horizon?


DutasterideDutasteride (marketed as Avodart) is being used by many men, prescribed by some doctors to treat hair loss despite the absence of FDA clearance. In the phase 3 dutasteride study done in Korea, there was no mention of sperm or sterility. This is a concern to me, and I do not believe that this drug will be approved for treating hair loss until issues like that are studied further. That’s my opinion, and I’m sure I’ll get plenty of emails from people telling me how I’m wrong or I’m narrow minded about this medication. Ultimately, going to market is in the hands of the drug company that manufactures it. I am reluctant to prescribe dutasteride, because without clinical clearance from the FDA, I do not know the risk of sterility for those taking the drug for their MPB treatment.

As for other new hair loss drugs… I am not familiar with anything in the short term pipeline of 5 years, so it seems 10 years may be enough for us to hope and short enough for us to wait. Propecia should be off patent in the 1mg finasteride dosage in the US in a few years, so once generics are available in local pharmacies I’d imagine it would cut into their profits. I’m sure the drug companies will want to have a newer product out before then to keep their shareholders happy.

Tags: dutasteride, avodart, hairloss, hair loss, fda, sterility, sterile, korea, propecia, finasteride

I’m considering purchasing the Scalproller but i’m concerned as to the safety of the increased absorption of minoxidil. In your opinion do you think it is safe if the increased absorption is so much greater? And would using the Scalproller lead to a shed similiar to the shed when switching from 2% to 5% minoxidil?

The following response is by UK-based physician Dr. Bessam Farjo:

Response by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

5% minoxidil is the safe limit. More may cause systemic side effects such as dangerously low blood pressure. It is speculated that the absorption of minoxidil in a lot of people is not as efficient as it could be. This is most likely due to method of application which can be influenced by the amount of hair present. I have prescribed 6% in the past without side effects and I know of a clinic in the UK that gives a 12.5% preparation! I don’t have any data with regards to their side effects. One possible side effect of too much minoxidil is a lowering of blood pressure and resultant light-headedness.

I don’t know if the scalproller will cause any shedding, but it will be one of the observations I will make when I start a clinical trial. I emphasise that at this point I see the scientific basis of such a device but cannot actually endorse the scalproller itself or support any claims that it will help with hair loss.

Learn more about the author of this article, Dr. Bessam Farjo, on his BaldingBlog profile or at his website.

Tags: scalproller, minoxidil, rogaine, regaine, scalp roller, hairloss, hair loss, farjo

Hello, Dr. Rassman, I have a couple questions for you about hairlines. You see, I’m a little confused…

I am a 24-year-old Caucasian male with no outward signs of pattern baldness, even though it does run on both sides of my family. I was looking at pictures of myself the other day from when I was about 12, and noticed in one picture of me with a crew cut, that I at one time had a very rounded hairline, like that of a female. This got me thinking (and a little worried), since my hairline today looks like that of the guy in the first picture on the Norwood scale. It’s not the hairline I had when I was 12, but it’s not a “mature hairline” either. I did the brow measurements and my hairline is still very much in the juvenile position, albeit more square in shape and rising slightly at the corners, just like the guy in the picture.

So I’m curious, is it possible for the first Norwood illustration to be the mature hairline in some cases? My hairline has been like this since I was about 18 or 19-years-old and hasn’t moved an inch since then.

Thank you for your help on the matter.

Norwood 1I’d say that yes, a Norwood Class 1 (see art at right) and a mature hairline are basically the same. The hairline you saw at 12 years old is your childhood hairline and it is completely normal for your hairline to mature to some degree a dozen years later. You can not tell at your age for sure, but with a good mapping of your scalp and measurements looking for miniaturization in the corners, you might just see where your hair loss is going, if anywhere.

Tags: hairloss, hair loss, hairline, mature hairline, norwood

My 16 month old daughter has had a rather large bald spot since birth. It is about half of the back of her head. If you were to draw a line from the left ear to the right ear, the entire area below it only seems to grow very short, fine hair. Also, there are numerous tiny red spider veins in this area. I have no idea what this could be. Her hair is growing on the top and the sides of her head, although the hair on top is really short. I’ve had lots of people ask if they are bangs that I have cut. She prefers to sleep on her belly and I very rarely see her sleeping on her back. She is otherwise a very healthy vivacious little girl. She has another well visit in 2 months where I will address it with the pediatrician. She never mentioned any concern before, but it’s starting to worry me. Any help would be appreciated. Thanks.

Although you have an appointment with her pediatrician in a couple months, I would suggest that you bring her to a dermatologist with an interest in children’s hair loss. There is no urgency here, so take your time and find the best doctor. The American Academy of Dermatology site has a dermatologist search, and I’d start with those physicians that list “pediatric dermatology” as a specialty.

Tags: dermatology, dermatologist, hairloss, hair loss, child, pediatrician

Dr. Rassman,

I understand your skepticism and reluctance to accept or recommend PRP on the scalp. I was wondering though, what would it take to establish a definitive verdict in regard to effectiveness (or lack thereof) of PRP? There have been some very promising sounding testimonials and pictures that some doctors have produced. But nothing that I guess would qualify as a comprehensive medical study.

I would need a well-controlled scientific study and if it proved to have value, I would likely become a convert. I generally keep an open mind about new techniques and love to see things progress as long as they’re safe and effective. The last thing I want to do is give false hope and waste anyone’s time or money.

Tags: prp, study, protein rich plasma, platelet rich plasma, surgery