We’re taking some more time off for the New Year holiday, but we’ll be back on Monday, January 4.
Thanks to everyone for making 2009 such a great year for BaldingBlog! Here’s to a fantastic 2010!


Happy New Year

Note: I’ve received quite a bit of negative feedback about my views on the various hair lotions and potions that are for sale and while I take it in stride, I received this great post from a longtime reader. He’s contributed some fine posts about hair lasers and the FDA in the past, and really, his post below sums up my thoughts on the issue:

Post by Guest Writer

    Worthless hair productsI am a physician, scientist, patient, and someone who has brought several therapies for life-threatening diseases to market via my work in the biotechnology industry. I enjoy your blog. In response to posts oddly critical of your views of “Propecia, Merck, and the FDA”, I wish to add some unsolicited comments.

    Occasional readers take you to task for their perception that you discredit alternate therapies. You do nothing of the sort. You simply ask, “What is the evidence for Product X’s safety and effectiveness?” To some, hearing someone say something wonderful about Product A is adequate. Unfortunately, the history of medicine is full of examples of useless products (and invasive, unsafe therapies), which fortunately have fallen out of favor after being subjected to rigorous, lengthy, and costly scientific scrutiny where adequate comparison groups (placebo) and other controls are used.

    In general, alternate hair therapies are worthless and little evidence exists showing any effectiveness. Because many of these therapies are made of natural substances, they do not qualify as drugs and fall outside of the realm of the FDA (where unsupported claims of drugs can not be made without penalty). Unlike these bogus products, where there is no evidence to support their value, drug manufacturers make the summary data on the thousands of patients that underwent clinical trials supporting approval of a drug publicly available (See Drugs@FDA).

    Your readers who fret about some undeclared and irreversible side effect occurring years from now for a drug can make their own decision after reading the studies that go into their approval (and supplemental postmarketing safety info). No such data exists to make informed decisions about these “alternative” therapies. And, before hearing “conspiracy theories” about how the FDA is financially beholden to drug companies, the reality is that scientists who develop therapies over many years are salaried and make no additional money based on the success of development (although obviously the drug company does). Do you think the health care proponents of alternative therapies are similarly financially removed?

Tags: hairloss, hair loss, alternative, fda, pharmaceutical, natural

the hair in my crown area is short, not bald but shorter than the rest of my hair. everything else is fine. im only 13 and i dont want to be bald, especially at this age.

is there something wrong with me? and if there is how can i fix it?

I have yet to see a healthy 13 year old bald young man, but I can’t say if there’s something wrong with you. We haven’t established whether what you’re seeing is actually even hair loss. Perhaps you had a bad hair cut? Sometimes if you look at yourself in the mirror or woke up from sleep with bed-hair, your crown area can look thin. This does not mean you are balding. I’d give it some time and let the hair on your crown grow longer.

You should see a doctor for a mapping of your scalp and hopefully the examination will not show miniaturization in the crown. Get your parents involved and let them know what you’re going through. It could just be that you’re looking for something that isn’t there.

Tags: teen, hairloss, hair loss, crown hair loss

Hi Dr.
I have a question for you. Why does Rogaine sell a Women’s version, and a Men’s version, Why couldn’t I use the womens version if they have both have minoxodil in them?????

Thank you

Women's RogaineYes, you could use the “for women” version if you wanted to.

  • Rogaine for Men contains 5% minoxidil, less alcohol and more propylene glycol than the Women’s Rogaine.
  • Rogaine for Women contains 2% minoxidil, more alcohol and less propylene glycol than the Rogaine for Men.

Propylene glycol is found in many products, and you can learn more about that here.

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

Doctor Rassam,

I have recently started taking anti-anxiety drug escitalopram clonazepam after consultation with a doctor.

Please let me know can I also take finasteride along with it.

This is a question for your prescribing doctor who knows your medical history. Generally speaking, finasteride does not seem to produce problems with most other medications.

Tags: medication, drug, anti-anxiety, finasteride, propecia, hairloss, hair loss

Thank you Dr. Rassman for maintaining a wonderful blog and for being a generally nice guy. My history is a bit checkered:

Seven Years ago I was told by Dr. Bernstein (another really nice guy by the way) that based on family history I might have diffuse pattern alopecia although only the vertex was thinning. He put me on Propecia and refused to operate till some time passed. The Propecia worked well but I had elevated liver enzymes from fatty liver deposits and stopped it after a year. After six years I have lost a lot of hair on the crown but the rest of my hairline did not vanish as I expected. In fact the crown is noticeable precisely because the rest of my hair is present. So basically from a thinning vertex I now have a bald vertex but the rest is intact. I don’t know about miniaturization though.

  1. Question 1. My liver readings are the same. What are my options?
  2. Unrelated question 1. I have always wondered whether i have mild trichitillomania. I ask because I never pull my hair hard but I used to (and still sometimes do) very very gently test my vertex hairs and they always slip out readily. The test is so mild that on my permanent zone I can barely feel the tug and yet on the vertex two out of three hairs slip out. Have I harmed myself with this “strength test or were these weaklings doomed anyway?” Incidentally the hairs would not come out when I took Propecia.
  3. Unrelated question 2. My biggest discomfort from my bald spot is the dampness from sweating on the bald crown. In New York my scalp sweats profusely from the heating indoors and once outdoors it feels colder than the rest of my head even with a hat. In fact the hat in contact with the bald spot feels awful.


  1. People with liver disease just need to take a smaller dose of Propecia and they can be on that medication. Without seeing you I can not make judgments. I’d see Dr. Bernstein again.
  2. I don’t know if you have a mild case of trichotillomania, but if you’re just gently pulling on the hair to see if it comes out, it may just produce traction alopecia. Trichotillomania is an obsessive compulsive disorder, and it doesn’t seem like that’s what you’ve got going on… but I really couldn’t diagnose trichotillomania over the internet like this.
  3. Bald heads do sweat in hot weather and lose body heat in cold weather. Hair allows air to move through it in hot weather acting like a radiator effect. In the winter it acts like a blanket as it insulates the scalp where the blood supply is quite high (in the winter) so the body does not lose heat. When Napoleon’s French troops invaded Russia in the early part of the 19th century, the first soldiers to die from the harsh cold temperatures were those who had balding.
Tags: liver, propecia, finasteride, weather, trichotillomania, traction alopecia, hairloss, hair loss

Hello Dr. Rassman,

This is without a doubt the best hair loss site on the web. I have learnt a lot over the last year or so. I really hope you can find the time to answer my questions.

I am 28 and have noticed that my hairline has receded on either side of the widows peak and even the widows peak looks thinner and see through now than it did 3-4 years ago (when I believe the changes started). I can feel my hair has thinned in a norwood 3a pattern although this is not noticable to others yet.

My question is regarding propecia. I have tried to take it but no matter how little a dose I tried I had the same side effects (low libido and erectile dysfunction). I tried 1mg daily, 0.5mg daily, 0.5mg every other day and 0.25mg daily but just could not adjust to it. What would be your suggestion for me and others in my situation as I would really like to try and combat the hair loss? I have been using minoxidil but is there anything else I can do as I really can’t handle propecia?

Also with regard to balding patterns you have said that the final balding patterns become evident for young men that start losing their hair early but as mine started at 24-25 when would you expect my final pattern to be evident as it is not obvious yet but I can only guess at a Norwood 3a as the hair still feels very thick past this point?

I would really appreciate if you could take the time to answer my questions. Thanks

Compliments will get you a long way with me, but not long enough to solve your Propecia (finasteride) problem. While I don’t know how long you were on the medication before each of your dosing changes, you could just be one of the men who just can’t tolerate even a small dose. Minoxidil is likely your only other option, aside from perhaps a hair transplant. You indicated that you’re in the UK, so I’d get yourself followed by a good doctor like Dr. Bessam Farjo, who is located in your area.

It’s really difficult to say when your final pattern would be evident without any real history to look back on. Unfortunately, I can’t give you any kind of realistic estimate on when your hair loss will stop.

Tags: propecia, finasteride, hairloss, hair loss

Dear Dr. Rassman,

Thank you for this informative website. I visit everyday, and my wife just gave me your book for the holidays. Unfortunately, I am one of the few who have experienced side effects with Propecia. I was orginally on 1mg per day, and then I tried 1mg every other day, and .5 every day. But everytime I had to stop. Luckily, all three times the side effects disappeared after I stopped taking it (the last time I was on propecia, was about a year ago). I would like to try to get back on the medication again, but I was wondering if you had any advice on how I should approach this. I am only 25 years ago, and plan on getting a transplant in the near future, but would like to stabilize my hair as much as possible before hand. Thank you for your help.

I hope you enjoy the book, and I’m glad you find this site useful… but I am afraid that I have no good news for you. Those few patients who have sexual side effects or breast pain and/or enlargement that persist after numerous attempts to restart their drug program, will continue with the same outcome.

Be sure that your hair transplant surgeon maps out your worse case hair loss with miniaturization studies before you start the transplant process. A good Master Plan is critical to looking good for the long term.

Tags: propecia, finasteride, hairloss, hair loss, side effects

i recently was diagnosed with something called acromegaly which partly means the pituitary gland produces too much hgh. one of the symptoms of this disease is course or thick hair, which i have. i’m wondering once i correct this issue & my hgh levels return to normal. will this cause hair loss of any kind whether its the legs, eyelashes, etc…

Many of the body’s changes from acromegaly do not reverse after the pituitary problem is fixed. Unfortunately, I have no real experience dealing with this disease or the hair changes that go along with it. Perhaps you can find more info here or here.

Tags: acromegaly, hairloss, hair loss, hair growth, pituitary gland

What’s the risk of dying from hair transplant procedure?

CNN – What really killed the beauty queen?

DefribrillatorShort answer — the risk is extremely minimal, at nearly zero. Hair transplants are a surgical procedure and if your doctor did not know what he is doing, you could die. There is one case report of a death during a hair transplant from a couple years back, which I wrote about before.

Not only could you die from the local anesthetic that is normally safe in proper doses, but you can have an allergic reaction, an arrhythmia of the heart, a stroke or heart attack at the time of the surgery (possibly the same risk as if you were home doing regular house work), or you could die of infections, amongst other things. Then again, you can also die at the dentist for similar reasons.

In the 19 years that I have been doing this surgery, I have never had a complication that could have produced death. The risk factor is incredibly low (statistically zero), so your chances of death are essentially none. You should also read these more in-depth posts if that doesn’t set your mind at ease:

  1. Hair Transplant Surgery Risks
  2. With the Death of Kanye West’s Mom After Plastic Surgery, I Wonder How Dangerous a Hair Transplant Is?
Tags: death, hair transplant, surgery, physician, surgical, hair loss, hairloss

hey dr i was just wondering if you feel hair transplants have peeked or will they improve some way in the future i just analyze them in terms of reaching their full potential but your opinion is greatly appreciated as always and also do you see them getting any cheaper in the near future also

I think that the technology has been pushed as far as it can go as we mimic just what nature does. The problems in the community are mainly related to the surgical team, and a few issues with physician education. Too many doctors are doing this with inexperienced teams of assistants, so the practical problem is to get the standards up. When the transplants do not grow as expected and the surgical team is less skilled, the failures are often caused by an inexperienced team.

With regard to pricing, this is not a commodity and as such if the prices go down much from where they are, the quality of the teams just won’t be there. We pay our staff competitive wages so that they can support a family, have health insurance, etc. If you ask our patients you will find the theme they speak of is our quality patient care and great results.

Tags: hair transplant, hairloss, hair loss, technique

Dear Doctor,

I just wanted to know if there is any point of taking 5mg proscar for hairloss? From my research I think the answer is no but I have taken 5mg for last 6 weeks. I have noticed a lack of motivation and being a bit down but I am not exactly sure if they are related to taking the 5mg or due to other things in my life. Could there be any side effects for taking for the 5mg for the past 6 weeks? If I just cut down to the quarter Proscar tablet (1.25mg) will my body take long to readjust after having taking 5mg dosage?

Thanks you for your time,

Kind regards

There is no point in taking finasteride 5mg (Proscar) for treating hair loss. Aside from the increased side effect possibility, it will not work any better for hair loss. I really cannot comment on your lack of motivation and its relation to the medication. Maybe you have the holiday blues? Side effects from medications should generally reverse in about a week or two.

Tags: finasteride, proscar, hairloss, hair loss

Hi Dr. Rassman, I recently had a hair transplant at your facility, everythings going well, my question to you is, can i apply rogaine on my newly transplanted hair, I read that when you apply rogaine, the hairs fall out at first, and then it grows back, is that true? I’m afraid if I apply rogaine to the transplanted area, the hair’s will fall out and not grow back. Your response will be greatly appreciated.

I’d say to wait at least 7-10 days before using the Rogaine near the transplanted hairs. Using Rogaine Foam would likely be the best way to go about it, as it is easier to apply (requiring less rubbing on the area).

Tags: minoxidil, rogaine, foam, hairloss, hair loss, hair transplant
Happy Holidays

Our offices are closed until Monday, so we won’t be updating the blog until then. Happy holidays!


I’d like to bring to your attention another product making wild claims – Zenagen Natural Hair Loss Shampoo

Presumably you have a similar attitude towards it to other similar products?

ZenagenOh boy. I’d say anything that bills itself as a “natural hair loss shampoo” already falls under my “buyer beware” list. But, let’s review the product’s site anyway…

The first thing my eyes were drawn to on the site is the big “1,000,000,000 hairs protected” graphic. I wonder how long it took them to count all billion. Then as I scrolled down the page, I noticed the lovely “As seen on Los Angeles Times and Chicago Tribune” graphic at the bottom. Often the only mention for products like these in major publications is in the form of a paid advertisement or reprinting of a press release. I’d love to see what the LA Times actually said about the product, if anything. I assume that if there was a real mention in those newspapers, there would be links to the articles (of which there are none). The photo results are equally laughable. Look at the “Results” page to see an example of a guy with a mostly-shaved head as the “before” and with his hair grown out as the “after”. You can clearly see he’s got a prominent and strong hairline in the both photos.

The makers offer zero proof and zero science to back up their statements, yet their site insists, “Based on science and research, the unique formula makes Zenagen shampoo the number one rated hair loss product“. It’s always the #1 rated products that nobody has ever heard of and offer no basis for their claims, right? Ha! Of course, you’re welcome to try the product for yourself, but until I can see a bit of proof of this shampoo’s efficacy, I’d say it’s not going to do much of what the maker claims it will. I am not impressed.

Tags: zenagen, natural, shampoo, hairloss, hair loss