Thanks for the forum Dr. Rassmun, it has been very informative. I do a lot of research on the internet and it seems that people are all for hair translplants or they are all against them with many failure and nightmare stories. I saw something you wrote saying hair grows for 99% of translpants, but gaging from other sites it seems like 50,50. I was wondering if you could give me a ballpark number in your experience of people who are happy with their transplant to people who are not.

Anyways I am 24 and have pretty accelerated hair loss, but the back and sides of my hair is pretty strong and thick. Does the regrowth of transplanted hair in the mid 20s have a better look than transplanted hair later in life? Its seems the pictures Ive seen have led me to believe this, thank you for your time and keep up the good work.

Generally, delaying hair transplants just increases the suffering time for those individuals who are bothered by the balding process. Why delay a hair transplant when the young man needs and wants the youthful impact of a full head of hair? If you wait until you are 60 years old, then you will look older until the day you decide to be transplanted. A 25 year old may look 40, a 40 year old may look 50 or 60, and a balding 60 year old may look 80. A hairy 25 year old will look 25 and that is what most 25 year old people want. I have transplanted many 40, 50, and 60 year old men who look 10-20 years younger with hair.

Satisfaction rates in my practice are very high, not just because we are good surgeons and know what we are doing, but because we set expectations correctly, do not employ salesmen who get a commission for selling you what you may not really want or afford, and we give all of our patients access to previously transplant patients at our monthly open house events. Patient education is at the foundation of satisfied patients.

Tags: hair transplant, hair loss, hairloss, satisfaction

Hi Dr Rassman,

Will Propecia show up on my Insurance or my company’s medical report, namely the urine sample test? I’ve been on Propecia 1 mg for 2 months now, and I’m 24 years old. I am taking Propecia without a prescription, my local pharmacist sold it to me

Should I tell the insurance people about the Propecia, or is it nothing to worry about?…Personally, I’d like to keep it to myself..

Thanks a bunch doc :)

PeeingI am not sure what you are worrying about. Is it illegal to take Propecia in your country? Propecia is not a controlled or illegal substance. In any case it is ALWAYS a good idea to tell your health care professional what medical issues you have and what medication you are taking. Always tell the truth! I doubt that any insurance company or government agency will react to your taking finasteride, unless you’re competing in sports where finasteride is still banned (though most bans should’ve been lifted).

There’s info about Propecia’s detectability in urine tests at Google Answers. The author of that post concludes that it is around 90 hours, and provides links and the math to back up his calculation.

Tags: propecia, finasteride, insurance, hairloss, hair loss, urine, pee

I recently went through about 4-5 months of hair loss. I stopped taking Lexapro and it stopped falling out completely within 6 weeks or so. Do you believe this hair loss is permanent? Do you have any advice on what to use to promote hair growth? I hope this medication did not actually damage the follicles and I will have spots forever. I am worried. Thank you for responding.

45 year old women very nervous.

LexaproIn medicine, as in life, things are not so clear cut. I cannot say for sure if your hair loss was due to a medication such as Lexapro (escitalopram oxalate), but there are reports of hair loss with this medication. In fact, I’ve written about it in the past. So if it is the Lexapro, I would expect that this loss is temporary and you’ll need to wait with great patience for regrowth to occur. There may be other factors involved, though. This is something you need to explore with your physician and have a medical work up and a good history of events.

Tags: lexapro, female hair loss, hairloss, hair loss, escitalopram oxalate, antidepressant, anti-depressant, anxiety

I have a few very unusual hair characteristics. The first is that all over my body (including head), i have a few random hairs that are literally a few times the thickness of a normal hair, like an eyelash, jet black, and they don’t stop growing at a certain length. Is this normal?

The second is that I have always had a norwood two-ish hairline on one side of my head, I guess that isn’t too unusual but the hair i have at the concave part of my hairline towards the middle don’t point down, it points straight to the side. Is this normal? I also have semi-curly hair, which I think may have developed during puberty? and I can’t find anyone in my family tree tree with any of these characteristics, which sucks because I have no idea what-so-ever who I may take after balding-wise. are any of these things normal or indicative of anything?

I am not sure what you are asking and I would have to see you, or at the very least I’d need some good photos to understand what you are referring to. We are different and at times one part of the scalp will be different from another. Sometimes unusual hair can grow from a nevus (birthmark/mole). Is that what you see? If what you are describing is more radical, then maybe your hair demonstrates a chimeric process. See a good doctor who can research your problem for you.

With regard to the hair direction, the frontal hairline often has hair that points to one side. When I transplant such individuals, I usually discuss hair direction choices with them.

Tags: hair character, hair growth, chimera, nevus, hair direction

Hi doctor, you mentioned [editor’s note: this post] that “Another more important reason is that the half life (the time it takes for half of the drug to be eliminated by the body) is only 5 to 6 hours”.

So does that mean it will be more effective to take 1mg at 12 hours interval since 1 mg will be eliminated by the body in about 10-12 hours time.

Taking more than 1mg per day of finasteride to treat hair loss just increases the risk of side effects. One does not need to sustain a constant blood level, as it is the tissue fixation that really is doing the work to prevent your hair loss, not the blood level.

Tags: finasteride, propecia, proscar, hairloss, hair loss, halflife, half life

Hi Dr.,

I have a question concerning Nizoral shampoo. I take Propecia once a day, and have been using Nizoral every few days for the past month since there seems to be a great deal of praise for it as a supplemental item when using a treatment like finasteride (no decent clinical studies to back that up, I know). My question is, have you come across any recent evidence that suggests it has negative consequences/interactions as part of being on a regimen like Propecia.


NizoralThe use of both Nizoral (ketoconazole) and Propecia (finasteride) together seems to have great popularity to many of this site’s visitors. I have not seen negative reports from using both of these products together, so that’s good. There was a small study published in Journal of Dermatology in August, 2002 about using a ketoconazole and finasteride combination. From the study:

    “One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups.

    Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year.

    At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. "

There are possibly more recent studies on using ketoconazole as a hair loss treatment (there’s one from 2007 with no abstract available), but this one from 2002 includes combining the medications and was the first such study I could find. If anyone using both treatments together has a story to share, feel free to send it or leave it in the comments section.

Tags: ketoconazole, nizoral, shampoo, kcz, hairloss, hair loss, finasteride, propecia

I went to a local doctor for a consult and he mentioned that he uses a 2-3 bladed knife with the Haber spreader to insure that no transection occurs. He said that there is less transection with that than with the single bladed knife, when used properly. According to him, with the single blade, you must go down 2-3 times as deep to cut past the follicles, and if you are not right on target there will be some transection. Does this sound correct – does using a Haber spreader with a 2-3 bladed knife sound right?


BladeMore than 2 blades with depth may cause hair transection. The use of spreading instruments such as the Haber spreader or a Kelly clamp will also work to minimize transection. If a two-bladed knife is used, it should have a built-in angle to minimize transection. A three (or greater)-bladed knife causes more transection and loss of hair from the donor area.

One vs two blades (with built-in knife angles for the 2-bladed instrument) are about equal to minimize hair loss from the harvest. I use a specially designed (by me) two-bladed knife that has a 30 degree angle built into the holder to minimize transection. Two-bladed knives like the one I use precisely control the width of the strip, so I prefer that to a single-bladed knife.

Tags: surgery, blades, blade, knife, knives, scalpel, hair transplant, hair restoration, hairloss, hair loss

I have celieac disease and I (unknowingly) used a hair color product that contained wheat. It blistered my scalp and my hair fell out. it has been about two months and very fine peach fuzz hair is growing in the spots but its very thin. will my hair ever grow back in the right texture and density? Female, 45

I know, as I’m sure you do, that those with celiac disease shouldn’t have foods, beverages, or medications that contain wheat, barley, rye, and oats. What I do not know, however, is how the disease impacts hair loss after using hair dye with wheat in it. I would assume your hair should grow back, but it would take many months, possibly up to a year to find out. This doesn’t seem like it would be a permanent loss, but you should be followed by a good doctor that can provide you with an examination (perhaps even the doctor you’re already seeing for your celiac disease).

Tags: celiac disease, coeliac disease, hairloss, hair loss, wheat, hair dye

Dear Dr. Rassman

you mentioned before “Some of my patients do not take Propecia (finasteride 1mg) by their personal choice. It is your choice as well. The risk is that you may have increased shock hair loss without taking Propecia before surgery. Shock hair loss is common in men under 30 years old or those who are losing their hair actively when they have a hair transplant. Propecia will prevent this complication in most men” …

Well i used propecia before for 9 months and had great results. but by the 8th and 9th months it killed my libido and impotence although i was 26 years old only.. but as you said shock hair loss is really scary. so if i wanted to use finasteride just to avoid the hair shock loss post surgery, how many months you advice me to take it temporary, definitely im not willing to go on with it…

thanks doc…

Stopping the finasteride after a hair transplant has been done with a few of my patients with success. The risk of shock loss is mostly in the first 4-6 months, and those that stopped it after the transplanted hair grew out did not have a problem with shock loss. Of course, they had the benefit of hair transplants to cover any new loss of the original hair, so they may have lost some hair without knowing. This may be a better route than not taking the drug at all, but you will still face the natural evolution of your hair loss over time without the drug on board.

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

Snippet from the article:

The government is liable for a military staff member’s hair loss due to extreme stress related to his duties, a local court ruled Sunday.

The Seoul Administrative Court ordered the Ministry of Patriot and Veteran Affairs to acknowledge 27-year-old Lee as a “man of national merit” and compensate him monthly for the loss of all his hair.

Read the rest at the Korean Times

And here I thought that the US had favorable courts rulings, but this one takes the cake…

Tags: south korean, korea, military, hairloss, hair loss, lawsuit, legal

i was just wondering if you heard of a company called “Boost”? They are a vitamin company and a hair care product company. Supposedly there stuff works they say?! Have you heard of them? Their website is

Can you check out their site and tell me what you think? I basically dont want to start buying there product and realize it’s bogus!!

BoostVitamins are great, and products that can strengthen hair or make it healthier are good… but they have one product in their Boost line that claims to be good for thinning hair, and even says “guaranteed to stop hair fall”. Most over the counter hair products people ask me about the outlandish hair loss treatment claims (like guaranteeing something that can’t be guaranteed), and unfortunately this one is no different. It appears to just be a vitamin infused shampoo. Which vitamins is it infused with? No idea. However, I’d be skeptical of any product that brags about hair growth abilities and tries to sell the idea by saying it contains, “herbs, proteins, aminos and more“. I want to know if “more” includes leprechaun magic…

Does it work? Again, I have no idea. But when a company uses smooth sounding marketing lingo and doesn’t provide any real substance, it doesn’t fill me with any trust in the products. Don’t expect it to regrow hair, but if you do try it I’d be curious to read your review. The FDA takes a strong position when a company promotes a benefit and can not prove it. They can be told to stop selling the product.

Tags: hair vitamin, boost, vitamin

Hi Im sorry if you’ve answered this before but what in your opinion would be the best way to tackle hairloss? Would you reccomend using Propecia, Regaine and Nizoral all at the same time or just Propecia or Regaine and Nizoral? I did try using Regaine and was fine with it for a year or so but then for some reason the itching got unbearable! Any tips for that? Thanks

RegaineItching while using minoxidil may reflect an allergy to the drug, though it is interesting that it developed after using it for a year. Which strength were you using? Perhaps you could try a lesser strength.

As for the best way to tackle hair loss — well, I’ve already written a book on it (Hair Loss and Replacement for Dummies), so I’m not going to rewrite that here. I can tell you that Propecia (finasteride) and minoxidil (commonly sold as Rogaine or Regaine) are the only FDA approved hair loss treatments currently available, and as I’m a US-based physician, I look to the FDA. Another way to tackle hair loss would be hair transplant surgery, but I would not suggest rushing into that. Your question doesn’t really have a cut and dry answer that works perfectly for everyone. You can learn more by searching this blog (search box in the top right) or reading up on hair loss at

Tags: hairloss, hair loss, propecia, minoxidil, rogaine, regaine, finasteride, fda

Hi Dr. Rassman,

Thank you for your willingness and dedication to share your expertise and insights around this very important field of medicine. My question pertains to the relationship b/w serum testosterone levels & DHT. I am 38 and have been on both Proscar 5mg & Avodart.5mg as well as a slew of natural antiandrogens (eg, saw palmetto, etc.). I recenty increased my dose of Avodart to 1mg but have met w/ marketly increased shedding 2-3 months following the dose increase.

My question is if I could have elevated my free testosterone to a level that is allowing for more conversion of DHT in the small amount, say 10%, of DHT receptors that are not blocked. Is there a balance or fine line between the level of serum testosterone and DHT conversion that takes place? I’ve noticed that my hair shafts have thinned in diameter and lost pigmentation at the bottom and it seems to correspond to about 3 months of growth (I.e., aboth the time I increased my dose of Avodart). Could I have raised DHT levels by raising free testosterone or could I have induced a form of telogen effluvium shocking all my hair into a resting state? If so, can I expect subsequent regrowth? Your professional opinon is greatly appreciated.

On a side note, although this is a progressive,unorthodox, and off-label treatment regime, I am tolerating the treatments very well-very little side effects. Just want to try to understand the science better. Thanks-a-million!

You can not match one piece of a science to another and then create new science. You are doing many things to your hair and your body, all at the same time. You have no measurements taken (mapping out the hair for miniaturization and followed over time area by area). You may be shedding and this may be temporary, but only time will tell you that. I can not heal you with any insight other than what I have written before on this site.

Tags: testosterone, dht, hairloss, hair loss, serum


I have been on minoxidil for about 7 months and i just went through a terrible shed about 2-3 months ago that has seem to have ended because I don’t see too many hair falling out anymore. I still use minoxidil but I have not seen an improvement with the hairs growing back yet. Is it because these shed hairs have to grow through several hair cycles before they can become terminal healthy hairs and is it likely that these lost hairs will grow back if i stay on minoxidil?

To see the value from minoxidil, you must stay on it at least a year. If you stop it at any time, you may lose the hairs that developed minoxidil dependence. Hairs lost from minoxidil induced shedding should return as the hair cycle completes its process.

Tags: minoxidil, rogaine, hairloss, hair loss, shedding

Dear Dr Rassman, I am 55 years old with a reasonably good head of hair. I started propecia and rogaine 10 years ago and am happy with the results.

The hair at my crown/vertex area is a little bit thinner but nothing too bad. Here is my question as I have gotten older my hair has gone from brown to gray and is now turning white in some places. It seems as if the white hair is slightly thinner then the darker hair. does this happen?

If it is translucent white it can appear thinner, but I have not personally measured the white and black hairs with a caliper to compare. I can’t really tell you why it might happen, though it is probably just genetics.

Tags: hair color, hair character, white hair