I am considering having a hair transplant. I am have a bold spot of the right top side of my head and a similar one is gradually developing on the left. My biggest problem is that I have ITP. I had been scheduled to do a transplant a few days ago and had gone for ITP treatment- I was given IVIG but it had no impact; infact it seems the platelets dropped. So I had to put off my surgery. The problem is it is difficult to schedule an appointment for surgery without knowing for sure that I’ll have the right platelet count on the day of surgery. Do you know of any hair transplant centre whether they can handle both the haematological and transplant aspects?

For those unfamiliar with idiopathic thrombocytopenic purpura (ITP), I’ll turn to Google Health for a good description — “a bleeding disorder in which the immune system destroys platelets, which are necessary for normal blood clotting. Persons with the disease have too few platelets in the blood.” Idiopathic is just a fancy way for doctors say we really don’t know what is going on. There are some treatments as you know, but sometimes it can be difficult to treat.

Having surgery when your platelets are low can be dangerous, because your blood will not clot and any bleeding may not stop. I understand you want to have a surgery, but any surgeon in their right mind would not knowingly perform surgery on a patient with ongoing ITP with low platelets. The key point is that you need to have your ITP treated and wait until your platelets return to normal levels. Until then, I would worry more of your health than your hair.

My final thought is that you mention a bald spot on a part of your head. While I really cannot diagnose you with a description, are you sure you have male pattern baldness? Something about the way you described your hair loss makes me think you have alopecia areata (which is also a condition where your immune system attacks your hair follicle, the way it destroys your platelets in ITP). Just a hunch. Please follow up with your physician and I wish you well.

Tags: hair transplant, itp, platelet, blood clot, hairloss, hair loss

Hi doctors,

Any word on Histogen? I haven’t seen any news from them in a long time now. There hasn’t been any news posted to their website since last August. I know you said you don’t have inisder info but i didn’t know if maybe your doctor mailing list or industry letters talk about it.


HistogenI did hear one thing about Histogen, and that related to a patent violation. I found this article via Google from a couple months ago that has some interesting news…

Histogen was hit with a patent lawsuit last year by SkinMedica, though the article doesn’t say which patents are in possible violation. Following that, their investors pulled out and they laid off all their employees. They still say 85% of their 2 dozen test patients saw results, though I have no idea what is considered a positive result in their book or if their testing will be expanded beyond that small number of people. One thing is certain — if the patent litigation doesn’t come out in their favor, they’ll need to strike an agreement with SkinMedica or go the way of the dodo. The CEO sounds very positive, but I suppose when you’re looking for new investors you should always have a positive outlook in interviews.

Tags: histogen, patent, skinmedica, hairloss, hair loss, hair cloning, histogen hsc

The following is a comment I received on the post from last week, How Many FUE Grafts Actually Grew?

Please let us know who this Dr. is. I know you do not want a reputation of badmouthing Drs. — but for the benfit of those of us who do not want this type of result, please mention it — it is not badmouthing, it is warning. At least the State where this Dr. practices. What good is a warning, if it isn’t linked to a culprit?

We maintain a policy to not slam specific doctors. I don’t want to open myself up to any legal action and honestly, I’d prefer to focus on revealing the scams some doctors pull and encouraging users to do their own research on any doctors they are considering.

We hold open house events each month where any patient can come in and say whatever he/she pleases in front of a very interested audience. I would challenge other doctors to have this same policy, which would obviate the problems that this patient had.

Tags: hair transplant, hairloss, hair loss, doctor, surgeon

(male) Several years ago I lost all leg hair.. Now I am losing arm hair – getting really thin, and I am a little concerned/upset about this. My head hair is pretty decent thus far. I am a 69 year old male in reasonably good heath, with high normal blood pressure which is treated with drugs. Can you recommend what I can do to stop the hair loss. Thanks

Reasonable leg and arm hair growth is a male trait, so I would think of things that are opposite, such as a dropping testosterone level (testosterone supports leg and arm hair), or the presence of some female hormone production (certain tumors can do this). Hair growth on the extremities may be genetically modulated as well. Go see your doctor and check out your hormones.

Tags: hairloss, hair loss, body hair, arm hair, leg hair

I am a man of 29 years old but i noticed when i was 27 years old at the lower part of my jaw on the left part of my face, the hair on a part there started going bald. It started gradually with a tiny spot of hair loss then it started expanding and now it as expanded to its limit and it stopped expanding but my hair won’t grow back and i can’t have my proper shave. please doctor i need an advise to know if or how i can grow my hair back.

I couldn’t say precisely what it is, but alopecia areata starts like how you described. You need to see a dermatologist and your condition will probably require a biopsy for confirmation. Learn more about this disease at the National Alopecia Areata Foundation.

Tags: alopecia areata, alopecia, facial hair, spots, hairloss, hair loss

Dr. Rassman,I have been on finasteride for a little over a year, and it has pretty much stopped my hair loss. Needless to say, I am a pretty big fan.

However, I just came across an article that seems to think that finasteride has some questionable long-term safety concerns that deal with its ability to block allopregnanolone. The article seems to hint that the lack of allopregnanolone in the body could lead to neuro-degenerative diseases like Alzheimer’s in the future. I am not a doctor, so I was hoping that you could give me your thoughts and possibly speculate on the article’s validity.


Here’s the article: Allopregnenolone (synthesized from 5AR) may prevent neurodegeneration

MouseMy thoughts are that if you do enough scouring and research on the Internet for any hint of negative effects associated with any medication you will be amply rewarded… and thus spiraling you down the path of confusion, fear, indecision, mistrust of the medical field, and eventually diverting you from your original path of enlightenment and trying to take control of your health.

I am not trying to brush off the article, but I really do not know what the clinical value is with the research (on mice) you found or what it means at hinting of a correlation. But ALL medications have risks and benefits. I personally believe finasteride 1mg is a very safe medication and I prescribe it to my patients. On a positive note, there are actual human studies on 5mg finasteride that was shown to reduce the risk of certain prostate cancer.

A lot of the questions we receive through this site have to do with finasteride (Propecia/Proscar) and its side effects or other various concerns. In the real world grand scheme of things, out of thousands of drugs that people take daily, finasteride is a very safe medication. Furthermore, I highly doubt I am answering all these question from men who ONLY take finasteride (no other drugs) and does not have any medical or psychological issues… plus doesn’t smoke, drink alcohol, or take recreational drugs (such as marijuana). All medications and herbs and even certain foods can have negative effects. My point is that anything is a possibility, but we need to look at the probability of such side effects and think of the risks and benefits of what we do. This mouse study just doesn’t cut it. I do appreciate you sending the article though.

Stepping down from my soap box now…

Tags: hairloss, hair loss, alzheimer’s, propecia, finasteride, proscar, mouse, mice

Hi Doc, Great Blog

If a patient was norwood six on the scale with normal density how many grafts do you think it would take to create a hairstyle similar to that of Tom Ford With strong density. I believe a conservative hairline with more overall density produces a better appearance that that of a lower hairline. Here is a sample of the hairstyle: Photo

I know this is difficult to estimate so even an approximate figure would be interesting. Thanks in advance doc.

You should visit our hair transplant photo galleries, which showcases hundreds of different patients — before and after photos, their starting Norwood class, and the number of grafts it took to achieve their new look. So instead of me just giving you a number, you can see the many examples of hairlines yourself. It is not just about numbers of hairs that we transplant, as factors like hair color, style, texture, and distribution are very important in the overall cosmetic result.

With respect to lower vs higher hairline, that is more of a personal preference for each patient. Some patients choose a higher hairline. We (Drs. Rassman and Pak) do not dictate where a hairline should be. We give each patient a baseline to guide them, so we take a team approach to where the hairline should go.

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


I am a 25 year old male, and I’ve been experiencing very slow hair loss over the last four years or so. Last August 2009, I decided to finally ask my doctor for a Finasteride prescription for hair loss (5mg cut into 1mg taken once a day).

Over the course of three months, I could tell a noticeable improvement in the way my hair looked and felt as well as a significant decrease in the amount of hair I would see on my hands when showering. Unfortunately, this came at a cost of side effects in the form of decreased sexual drive and weaker erections. I stopped taking Finasteride 1mg in late December 2009 and have since recovered from all side effects.

Given that I was going through high stress at the time (relationship, employment, relocation), I want to be fair to the drug and it’s potential effect on me. Would you recommend restarting daily Finasteride at half the dosage? I realize this would make the drug roughly 80% effective; however, would there also be a chance I see reduced side effects? I’m curious if you’ve seen patients re-start daily use at lower dosages (or remaining at 1mg) with a lack of side effects the second time.

Alas, it could be wishful thinking. It would be a shame as the drug was working great for it’s intended use (my hair).

Thank you!

Thank you for a fair self-assessment of finasteride (Propecia) for the readers out there.

You are right, it may just be a coincidence that you experienced those side effects, as you were going though a lot of stress, but I agree it may have also been the drug’s side effect. Stress itself can cause issues with libido and erectile dysfunction. So to be fair, I would try the full Propecia again and see what happens since the drug was working so well for you in your hair loss battle. If you experience the side effect again, then you can try 1/2 dose. Either way discuss this with your prescribing doctor and good luck!

Tags: propecia, finasteride, hairloss, hair loss, dosage, dosing

Dr Rassman, I have been using minoxidil 2% for 12 months and have found it quite effective on my crown. But in the last 3 months its having a strange effect on my eyes making them red and my facial skin is looking more grainy with larger pores. I have read other reports of this but of course they may be incorrect so a professional opinion would be appreciated. Thanks

Assuming that you do not apply the minoxidil to your face or get it in your eyes, I do not know what is the cause of your problem. It may not be related at all, or perhaps you are having a systemic reaction to the drug. I would follow up with your physician.

I have not heard of minoxdil making pores larger and eyes red, though I did get an email that I posted about a year ago from a reader that claimed the medication was giving him black rings under his eyes.

Tags: rogaine, minoxidil, side effects, hairloss, hair loss

Hi Dr I hope u are well

I have very thin hair on the top and front of my scalp, Ive been taking only Propecia since Feb 2008. Over the past 4-5 weeks I noticed an increase of the thinning but I havent stopped Propecia or done anything wrong. The only change was that I have been on a fast from Jan to Feb I havent been eating anything for most days just a small meal in the afternoons. Could that have affected my hair in any way? it is the only thing that has changed in my lifestyle. What can I do to get it back?


You are asking a very general question. It is possible that your hair loss has to do with your diet and fasting. Malnutrition can cause hair loss. I would see your doctor and consider eating a healthier diet.

Tags: fasting, hairloss, hair loss, diet, malnutrition

This isn’t hair loss related, but it is still important medical news —

Red flagIn a recent publication, erectile dysfunction (ED) was found to be a robust predictor of all-cause mortality and cardiovascular events in men with cardiovascular disease or those with risk factors for cardiac disease. The connection between the blood vessels of the heart and the penis show that the blood vessels of the penis mimic those of the heart when there is significant cardiovascular disease present. These findings were recently published online March 15 in the medical journal called Circulation.

Treatment of cardiac disease, once recognized, can reduce the risks of cardiac death. The findings suggest that ED is a manifestation of cardiovascular risk. They conclude: “ED is a powerful predictor of cardiovascular death and of major cardiovascular events in high-risk patients and represents a symptom of more advanced atherosclerosis and endothelial dysfunction.

What does this mean? If you have erectile dysfunction, get your heart checked for the presence of advanced heart disease. Taking Viagra may work to solve the ED, but your risk of sudden death is higher amongst men with ED and heart disease. Sudden death is often the first sign of heart disease in 70% of men.

Tags: erectile dysfunction, ed, heart disease, cardiovascular

Hi Dr. Rassman.

I was wondering if you knew why hair seems to grow longer/faster in the Summer time. I don’t know if this has ever been scientifically proven, but I have always noticed this with myself and my hair dresser says she notices it all the time with her clients. I assume it has something to do with the warm whether.

If this is true, do you think heat/body temperature would have any affect on the way finasteride behaves?

TemperatureHair growing faster/longer in the summer isn’t a proven fact, but if it is something you notice I can’t dispute it. I’ve read all kinds of theories about why hair might grow faster in the summer (if so, likely due to hormones), but some people believe that hair actually sheds at a higher rate in the summer compared to the winter. Unfortunately, there is no good science on this subject. Maybe it is from a subjective perspective.

There is also no correlation that I am aware of with respect to body heat and finasteride. For that matter, humans are warm blooded and our body heat stays right around 98.6 degrees Fahrenheit (37 degrees Celcius for those outside the US), perhaps fluctuating only around a degree F.

Tags: hairloss, hair loss, hair growth, seasons, summer, winter, heat, temperature

Dear Dr. Rassman –

This blog is really a terrific resource. I’m 27 caucasian guy with thinning hair. Frankly, my thinning not super noticeable when my hair is dry; however it looks pretty bad when the hair is wet.

I’ve tried Propecia, but sadly, I’m one of the rare guys who got side effects (FYI they completely went away when I stopped taking the drug). My question is whether or not you think stand alone Rogaine foam is a decent alternative for us guys who can’t tolerate Propecia. I’m fine with applying it twice a day. The issue is that I just don’t want to commit to lifetime use of a medication that you think is, on balance a waste of time.

Thanks very much for your reply.

Rogaine FoamI’d say Rogaine (minoxidil) is a good alternative, though it doesn’t inhibit the DHT that causes hair loss. I wouldn’t say it is a waste of time, but it just works differently from the Propecia (which does block DHT). Minoxidil is FDA approved to treat hair loss, and you might see some decent regrowth. I won’t make any guarantees to how much growth you might see, but is worth a shot.

You might also consider taking a half dose (0.5mg) of Propecia, as some patients with side effects have seen some benefits and no side effects from going this route, though you should discuss this with your prescribing physician. Also, a quarter of the dose will produce half of the benefit of a full dose.

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

Kanye WestWhat is Kanye West on the norwood scale?

Here is a pic of him: photo. He wrinkled his brow there. His wrinkle doesn’t touch his whole hairline, but he doesn’t look NW2. What is he?

Kanye West’s hairline is slightly ‘V’ shaped and that reflects (in the photo) a mature hairline. I don’t see any loss, so classifying him on a hair loss scale doesn’t make sense. I don’t believe that Dr. Norwood classified the mature hairline. When looking at the shape of his particular hairline, I wonder if he is clipping the leading edge in some of the photos. I found more photos to review here and here.

Tags: kanye west, kanye, rapper, celebrity, hairline


This might sound like a very stupid query. Is it common for a man who is not thinning to see hairs on his pillow everyday in the morning.

PillowYou know, after years of answering thousands of questions here on BaldingBlog, nothing is a stupid question.

It can be normal to see hairs on your pillow everyday. The average person loses 100 or so hairs per day without balding present at all. Though if you’re seeing 100 hairs on your pillow, then that isn’t going to be normal unless you’re bedridden.

Tags: hairloss, hair loss, pillow, sleep