I love the site and am a big fan but I’ve recently seen something troubling regarding a famous patient of yours. I admit to watching that Jon and Kate Plus 8 show (my wife liked it) and I saw the episode of Jon getting the hair transplant. I’ve been losing hair for years and I was intrigued, so I researched it and I came across your work and found this site.

After seeing your posts about Jon Gosselin’s great looking hair transplant I was almost considering a flight to LA but now I see this new photo of Jon and I’m quite nervous about it. So my question is, why does Jon Gosselin’s hair look like crap now after his hair transplant? Was it a problem with the transplant or just nature taking its course?

Here’s the photo

Jon GosselinWe actually addressed Jon Gosselin’s hair loss back in December, but I’ll give it another try. If you follow this site, you should be well aware that my overriding point is that hair loss is progressive with no cure, and although medication might slow the loss down, it won’t stop it forever. A hair transplant procedure is an option, but it does not bring back the hairs you lost. Hair transplants work by rearranging your small area of permanent hair (from the back of your scalp) to a big area where you are balding. With any sense of logic it is clear that you can never have full original hair density.

We rearranged Jon’s hair to the front to give him a non-balding frame to his face. He was well aware that he would continue to lose his original (non-transplanted) hair and that he may need further hair transplant surgery. He was advised at that time to take Propecia to slow this process down. Keep in mind that the hairs we transplanted are still there (even in harsh direct sun light), but the natural progression did occur. Here’s a side-by-side of the pre-surgical hairline (the area that was transplanted is circled) with the “faux-hawk” style in the photo you sent:

Gosselin hair

I have no clue if Jon took Propecia, used minoxidil, or just let nature take its course… but it appears that he’s not done much to treat his hair loss beyond the televised hair transplant. I agree that his hair doesn’t look as good as it did even last year, but in the end, Jon will continue to lose his hair in the areas where we didn’t transplant any grafts. It is not my place to critique his choice in hairstyles or force him to come in for a follow-up with me. If he elects to have another session of transplants to extend the work further back in the areas where he is clearly losing more hair, that is his choice to make.

Tags: jon gosselin, jon and kate, gosselin, celebrity, reality show, hairloss, hair loss, hair transplant

I am just curious to know how many grafts would it take for a Norwood 6 to return back to a Norwood 1? I know this is not possible, but suppose hair multiplication became possible in the next decade, can you give us an estimate of how many grafts it would take for a Norwood 6 to return back to Norwood 1 ?

HypotheticalIn general, you need about 15% of your original hair density to achieve the appearance of non-balding if you have an average hair density. Please note that this will give you a non-balding look (somewhere between a Class 2 and 3 pattern), but not the complete original density. Moreover it is NOT all about the numbers. Factors such as hair color, skin color, texture, etc are of great importance. For more, check out the Assessing Hair Loss page at the NHI site (scroll down to “How Much Hair Do I Need?”).

But if you want to know how many grafts you need to replace (hair for hair) of hairs lost, it could be in the 30 to 50 thousand hairs range. This is based on a general assumption that you are born with about 100,000 hairs. Remember, grafts are made up of 1-4 hairs.

Tags: hairloss, hair loss, hair transplant, hypothetical

i’m 39 yrs old. have had 4 or 5 (honestly cant remember) procedures (transplants) since age of 22. as is the loss has progressed. was on propecia and got off it about a year ago. felt tired and down. was told propecia may contribute to these feelings.

in any event, i think my donor area is very limited (i assume) but i would love to fill in my widows peek and get some fullness back in my very thinning crown. i was never satisfied with my hairline from previous looks very natural..but is still high in my mind. i’m wondering, in general what types of strategies you use when dealing with someone who has limited donor area like myself?

I would have to examine you to give you any information beyond generalities. There are many men who have depleted their donor areas. The FUE technique can take some hair from depleted donor areas and may be used to move beard hair or even body hair. Regular readers of this site may note that I’m not a fan of body hair transplantation (BHT), but I am willing to consider exceptions when it comes to a depleted scalp donor area.

An examination is appropriate and as you indicated that you are possibly local, we may be an easy connection for you. My office is in Los Angeles if you’d like to setup a free consultation.

Tags: hair transplant, donor area, hairloss, hair loss, widows peak

Hi There,
I have had 2 procedures with a clinic and have been pretty happy with the results, however I seemed to lose a number of hairs due to (what I now know to be ) shock loss. The clinic manager advised that if I was taking finasteride then I was to stop doing so 2 weeks prior to the procedure. Is this normal advice as I thought you usually advised patients to take finaseride up until surgery to help prevent against shock loss.

You’re right to be skeptical, as this is not normal advice. I would be suspicious / curious to know why they would say that. Propecia is your best weapon against shock hair loss, the enemy of the transplant patient. There is no downside to taking the drug through the day of surgery. In fact, I encourage those that are taking Propecia to maintain their normal dosing before, during, and after the hair transplant surgery. I’d ask the doctor that prescribed you the medication, not the clinic manager, what he/she suggests.

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


I’ve been using Rogaine consistently for over a year now. I haven’t had any obvious side effects or reactions from it and am completely healthy. However, I’ve noticed that over time, my cheeks don’t seem to match the rest of my body. In other words, I have a very low body fat content (I’m lean and in shape) but have big “chipmunk cheeks.” I’ve looked around and found people reporting similar experiences while on Rogaine. Could this be a side effect of the Rogaine? Have you heard anything about this before? If so, would there be a way of counteracting it? The ideas I’ve read thus far have suggested that it might cause water retention in the face or redistribution of fat. I’d appreciate any insights! Thanks!

Facial swelling is a known rare side effect possibly due to an allergic reaction of Rogaine (minoxidil), and we’ve reported on this before. Changing the dose or the formulation (like the use of foam rather than the liquid) may be helpful.

Tags: rogaine, minoxidil, allergy, side effect, hairloss, hair loss, swelling

Stem cellsThe most recent issue of Scientific American has a wonderful review of the stem cell opportunities and updates on what is going on in an article titled “Your Inner Healers”. I will try to summarize this article for those of you who do not have access to this publication…

Throughout history, researchers have wanted to escape from aging and disease. They have looked for way to to crease embryonic cells from adult cells in the body. In experiments in mice, some researchers have been successful in creating stem cells from mouse skin cells. These cells have contributed to better understanding of diseases like Type 1 Diabetes, Parkinson’s Disease and Alzheimer’s Disease. There are 220 cell types in the human body that are created by embryonic stem cells and the stem cells can be extracted before they differentiate into their adult state. These cells can generate into any tissue type (pluripotent).

The goal for today’s scientists is to reprogram the adult cells into going backward to their embryonic state. Cloning is but one example of the reprogramming process where genetic material from one cell is transferred to another (Dolly the sheep). Although we have successfully cloned a variety of animals, no one has cloned a human being. A group of Japanese researchers have attempted to create pluripotent cells from adult cells without the use of eggs or embryos, but with the use of a retrovirus. Eventually they identified 4 genes that were critical to the process (Oct-3/4, SOX2, c-Myc, and Klf4 — read more about those here). Researchers have found that some of the creation of these pluripotent cells became cancers and the ability to control that process was clearly a risk that was not understood well. Controlling these cells’ ability to produce cancer is critical to what will be the eventual human work that will follow, in time. The goal is to create chemical activators that will do what the gene transfers do without the risks. Growing pluripotent cells in a petri dish could eventually produce an endless supply of stem cells for whatever purpose we need. Control of the reprogramming process will eventually lead us to create organ and tissue types. It may even give us the hair that genetic balding has taken away.

The Scientific American website has a fantastic interactive presentation about this for those interested in learning more — Your Inner Healers: Progress in Induced Pluripotent Stem Cells, Made Interactive.

Tags: stem cells, pluripotent cells, cancer, cloning, organ

Snippet from the non-hair loss related article:

New results from the United Kingdom show that a single examination with flexible sigmoidoscopy in healthy individuals between the ages of 55 and 64 years, and removal of any polyps that are found, reduced the incidence of colorectal cancer by one third and deaths from the disease by 43% over a median follow-up of 11 years.

Read the full text at Medscape — Single Sigmoidoscopy Could Prevent One Third of Colorectal Cancers

ColonAnd if that link requires you to login, try this article at ABC News.

I am passing this on to our readers because colon cancer is a killer disease and is so simple to catch it early. This new research suggests “that flexible sigmoidoscopy will save 1 life for every 400 people who undergo this test”. Considering that this site gets literally millions of visits per year, if just one person is helped in any way by reading this, I will consider this message a great life saver!

Here in the US, colonoscopy is the “popular” choice for checking colon health, but flexible sigmoidoscopy is safer and easier. But as the article points out, more research needs to be done. I realize the younger segment of our readers might not find this information all that beneficial to them yet, but just you wait…

Tags: colonoscopy, sigmoidoscopy, colon cancer, cancer, colorectal cancer, health, breakthrough

Any comments on Charlie Sheen? These shaved down pics would indicate he probably wears a hairpiece. I am more interested, however, in if that frontal patch seems to be a thick transplant to enhance a natural look from the hair system?

Photos: without and with


Charlie Sheen

The shaved photos of his head show that he has a strong frontal forelock (just like talk show host David Letterman) and shows a classic Norwood 3 balding pattern. When the forelock is strong, it may last into his old age. I would also have to assume that he wears a hairpiece, which is what we are looking at in the second picture.

Tags: actor, hollywood, two and a half men, sitcom, charlie sheen, celebrity, hairloss, hair loss

Could the obesity be contributing to the baldness? Has anyone noticed that some obese people tend to have lots of wiry body hair in places other than the chest such as the back, shoulders, and arms. And overweight women tend to grow lots of facial hair.. perhaps the same hormones increasing body hair increases the risk of baldness??? Just a thought..

It is a good thought, but it is not completely correct. Genetic factors cause hair loss. Hair loss is not related to obesity or vice versa. However, I believe there are genetic factors that contribute to obesity (unrelated to hair loss).

Overweight women who have facial hair reflect a term called hirsutism, which you can learn more about here. It is related to hormonal imbalance and an increased amount of androgens in the blood stream.

Tags: obesity, fat, obese, hairloss, hair loss, hirsutism

Does 1mg of Finasteride per day have any adverse effects on muscle growth in a natural bodybuilder mid 40s :~)

Nope, there aren’t adverse effects on muscle growth with finasteride (Propecia). Some people assume blocking DHT (which is what finasteride does) will cause you to develop feminine qualities, and others believe that finasteride will increase muscle mass; both of these are also false.

Tags: propecia, finasteride, muscle, bodybuilding

I honestly think you have been somewhat indifferent towards Histogen’s potential. As researchers have recently discovered, the baldness gene affects WTN7 pathway. Histogen stimulates this pathway to produce new folicles and thicken exisiting ones. Obviously, there is a connection. The only affirmative emails you respond to involve propecia. I have been taking propecia for 2 years and I have not had any improvements with my hair. In fact, I have significantly lost more hair. Now you’ll probably say, it’s keeping what you have, but that’s BS. It isn’t effective because it isn’t addressing the real issue of hair miniturization which has been recently connected to WNT7 pathways (Dr. Christiano, Columbia)

Now I can understand why you would want to downplay this company because if it does go to market within 3-5 yrs in Asia, hair transplant surgeons will not benefit financially as much as they have in the past. In fact, nurse practitioners would be able to treat patients. At this point, I will no longer be a reader of your blog because I find your replies to be completely boring and repetative. Maybe you should invest some of the kickbacks you’ve received from Merck into a Histogen if you really wanted to see a viable hair growth treatment come to market

Good Bye and Good Luck

For those who freely read on, my position on hair loss has remained constant. There is no cure for hair loss and Propecia is certainly not a cure (though it helps treat hair loss in most men). I recently wrote about the discovery of the hair loss gene pathway you are referring to, but if you read on, it is not about male pattern baldness. As quoted by Dr. Christiano herself, “It is important to note that while these two conditions share the same physiologic process, the gene we discovered for hereditary hypotrichosis does not explain the complex process of male pattern baldness.

In the end, I am happy that there is research being carried out to find a cure. I care about patients and if I was actively trying to steer people to my surgical practice why would I bother telling them to take a pill? Why would I spend time answering questions on this site every day that have nothing to do with directing patients to surgery? Your logic is full of flaws and you come across as an angry, desperate person. You are misdirecting your anger at me, possibly because of your impatience at these cloning companies and their moving timelines. Should I be sad that I do not receive any kickbacks by Merck or Histogen or Dr Christiano or any other companies or individuals? I’ve already stated my connections (or lack thereof) to Merck. They make a medication that works to treat hair loss. It is proven safe and effective. The rest is all conjecture.

Lastly, I am sorry that you find my comments to be repetitive, but at least they are consistent! So thanks for your insightful comments and we will miss you here!

Tags: hairloss, hair loss, histogen, hair cloning, hair transplant, propecia

(female) Hello.
I’ve been diagnosed with AA. Have tried several “remedies”. Most recently began using the Unda drops, 9, 40 and 243. I actually, for the first time in 3 years so a marked decrease in shedding and my hair felt better over all. Recently though, (2-3 weeks ago) I began using Rogain 5% as recommended by my dermatologist. nearly three weeks into it I’m seeing a huge amount of shedding. more than I’ve ever experienced. My fear is that the rogaine will not work and the shedding will continue at this rate.

question. Can Rogaine make matters worse? If my stress factor allows, how long should I remain on the rogaine to see results and how long can I expect this increased shedding to continue? I’m so tempted to just throw in the towel and just continue the unda drops and biotin hair/skin/nail formula.

Thank you

UndaUnda drops are homeopathic remedies and I am not a homeopathic doctor. I do not know the utility of what you are using, but if something worked for you why would you want to do something different? Many men and women report initial loss or shedding of hair after starting Rogaine (minoxidil) in the first month of its use, but the shedding should stop unless there are other underlying issues not related to the medication. Generally you need to use Rogaine for a minimum of 8 to 12 months before seeing the effects.

Rogaine may work for alopecia areata or androgenic alopecia (I’m not sure which you meant by your diagnosis of “AA”). It does grow hair, but I doubt it will grow back the hair you once had and if the problem is underlying alopecia areata, then you should be under the treatment by a good dermatologist who can often help with the process.

Tags: unda drops, unda, rogaine, minoxidil, hairloss, hair loss


My brother is in his early 20’s and has begun losing his hair. He has had inherited hair from my mum’s side of the family, lighter and thinner since he was born. My mum’s side, it is common for the males to bald early. I on the other hand have always had thick and really dark hair from my fathers side of the family. My fathers side does not begin to thin until in their 40’s.

I’m curious as to if I will bald early as well, or is it less likely to happen until later because I have always had my fathers hair.

DiceI do not know for sure when you’ll go bald. It is commonly thought that genetic balding tends to be inherited from the mother’s side, but this is not a definite rule. You cannot predict hair loss on mother/father/family history alone. You can expect nearly a 50/50 chance of inheriting from one side or the other, like a roll of the dice. It might actually be 52/48 in favor of the mother’s side, but it is close enough to not rule the father’s side out completely.

Tags: hairloss, hair loss, genetics, family history


Your blog is very helpful has recently ive been concerned about my hair. I’m 18, and ive always had a Norwood #2 hairline, its never been a straight hairline. I have thick hair, but its very light, hairdressers etc always say its so thick. I realise this doesnt mean your not going bald. But when I look under light in my bathroom, pretty strong light, or just look at my hair under any reasonably strong light, i can see my scalp in a line that zig zags slightly from my crown to my hairline, but when it reaches my hairline its thin in a patch. You cant see it when its not exposed to strong light really, maybe the odd weak spot. I dont really notice that many hairs, but now that I’m paranoid about going bald i notice just about every hair i lose. My father has black hair unlike mine, and his hairline is pretty similar to mine, my grandfather on my mothers side, and my uncle are the only ones that displayed signs of male pattern baldness, but they didn’t get it till they were well into their 40s/50s.

So my question is, is it common for people with fair hair to see their scalp when under strong light, or sun light. Or can MPB be the reason for this?

LightMale pattern balding could be a cause for what you’re seeing, but what you’re describing is something commonly seen under harsh, direct, or bright lights. Lighting can make any hair appear to be thinner than it is, and if your hair is fine, the problem would even be more prominent.

I wouldn’t be too concerned about this, but if you see a doctor for it be sure to have your scalp mapped for miniaturization so you can actually have a metric to go back and look at in a follow-up visit.

Tags: hairloss, hair loss, fine hair, lighting

Dear Dr.,

Thanks always for devoting your time to the public with this forum. I notice you’ve been getting swamped with questions about a cloning cure (i.e. a class 7 bald person having a teen-age head of hair again), and people don’t seem to want to accept such a thing is so many years away. I was wondering if it’s more realistic to speculate: for those of us in our early 30’s who’ve preserved most of our hair and reversed some thinning with Propecia, is it reasonable to think a better pharmaceutical for holding on to what we’ve got will come out at some point this decade?

Thank you

There are drugs in the pipeline for hair loss, but the real question is which, if any, will make it through the investigative and FDA process. It must be proven to be safe and effective at doing what the manufacturer will claim. So I suppose it is reasonable to assume (or at least hope) something will come out eventually, but I couldn’t begin to guess at how much better it will be than what is available now. Keep your fingers crossed.

Tags: hairloss, hair loss, propecia, medication, drugs