Hi Dr.Rassman,I am currently a 16 year old male who has hair loss for the past 5 months now. At first, we thought it was dermatitis, but nothing worked. A few days ago, my doctor said that if he was in my position, he would start using propecia, which I have started yesterday.

However, i’m truly not concerned about the side effect ( like you said, all medications have side effects and the ones in propecia are rare). What I am concerned about is the fact im taking it at 16. I know that it says Propecia hasn’t been tested in people under 18, but should I seriously use the treatment? What side effects can a person under 18 see that a person over 18 can’t? Thanks!

You are right — Propecia has not been studied on young men under 18 years old. Puberty is the difference between those over 18 taking the medication and younger men like yourself. Here’s something I wrote a couple years ago about this very issue: Can Propecia Stunt Growth?

First and foremost, you need to have a good diagnosis of male pattern baldness (MPB). Is this what you were diagnosed with? The decision to take a medication rests solely with your and your doctor… though as you are under 18, you’ll also need parental approval.

The other day, I met with a man in his early 20s who felt that he was following the genetic hair loss history in his family. I performed a bulk analysis and a complete miniaturization study and concluded that he is not undergoing any hair loss at this time. I strongly suggested based upon the metrics I established that he NOT take Propecia, and have me follow up with him every year to be sure that he does not pick up the family trait.

Tags: propecia, finasteride, teen, teenager, hairloss, hair loss

I am a female, caucasion woman in her early 50’s. My hair color is blonde (treated now to hide the grey) and my scalp is fair. I had hair transplant surgery with NHI about 15 years ago (about 1800 grafts–I think in Palo Alto.) Anyway, 15 years later the transplanted hair is about all that is left at the top of my scalp. The doctor did tell me that since I have male pattern baldness (yes, he told me male pattern) that eventually the rest of my hair at the top would fall out, and I would be left with the transplanted hair. Which is where I am now. I am also noticing that my hair is more brittle (probably due to my age). I am so thankful that I had the surgery 15 years ago, because if I hadn’t I would be pretty much bald.

I have been using the Ovation Therapy system for about a month without much success. I’m contemplating another transplant, but don’t think I have enough donor hair to get the density of hair that I desire. I’m sure the cost is much more now too. I’m considering laser hair treatments. I know this isn’t your area (laser), but what are your thoughts? How do you suggest I proceed … next steps?

You should come in to see me (Dr. Rassman) or Dr. Pak for an examination and an opinion. If you lost only the native hair and had only one session with us, you probably can have another. We’d have to see the donor hair to make any determination, though. We’re no longer in Palo Alto, but we do have an office in San Jose, so we’re still nearby.

As for laser hair treatments, I’ve been very outspoken about them in the past on this site. I’ve yet to see any great results in treating genetic hair loss by using this low level laser light technology (LLLT), but ultimately it is up to you.

With regard to the diagnosis of male pattern baldness, I’d have to assume the doctor must’ve slipped and actually meant female genetic balding… but we can straighten that out when we see you.

Tags: hair transplant, female hair loss, hairloss, hair loss

Thank you very much for your useful blog. I have been taking propecia for a year and a half with great success. I have tried to get a prescription for finasteride 5mg from two different doctor but they both refused to prescribe it to me. So my question is do you know anyone that can do this in the London?

Some doctors aren’t open to prescribing the 5mg, but I couldn’t say for sure which ones would. You made sure to tell those doctors that you know you’re supposed to cut each pill when treating hair loss and you just want it to save money, right?

Dr Bessam Farjo is an occasional contributor to BaldingBlog, and he has an office in London. I can’t say for sure if he’d prescribe the 5mg dose, but it’s worth a try. Good luck!

Tags: finasteride, propecia, proscar, hairloss, hair loss

If i part my hair from right to left, would it be a good idea to transplant more grafts on the right side compared to transplanting the same amount on each side?

If the balding need exceeds the supply of donor hair, then weighting the hair during a transplant from the parted side makes great sense… something that I do often to get better coverage.

Tags: hair transplant, hairloss, hair loss, hairstyle

This is a great blog. Very insightful and well written.

My question is how many years/ no. of surgeries or grafts would it take for surgeons to be competent at FUE?

If someone has only been providing the FUE service for a year or so (even though he has been tinkering for a few years previous to this with smaller sessions ie less than 600 grafts), should I feel comfortable enough to go ahead with a 2000 graft FUE offered by him for my frontal hairline?

Thank you very much for your help.

It isn’t just about how competent a surgeon is at extracting grafts with a punch or a follicular unit extraction (FUE) tool, it is about a combination of factors, of which extraction may be the most difficult for the beginner. Most surgeons take a few years to learn the extraction process and once they got it, it is relatively easy. The next skill is placing the grafts into the scalp without drying them or damaging them. When the grafts come out in the extraction process, the surgical team must trim the excess tissue from the FUE graft (which some doctors do not do), make sure the direction of transplanted hair is correct (which some doctors never get), make sure the medical staff are handling the grafts properly (quality control issue), and commanding the artistic process for each particular patient by controlling the distribution and direction of the grafts so that the fullest look will be obtained.

Hair transplantation is an art and technical skill that takes years to master for the doctor and the staff. Some people don’t realize that the doctor is not the one who inserts the grafts into the scalp (placing), but the doctor is the one that determines the direction and distribution of the grafts, and trains the staff to do it correctly. These are the most critical aspect in how well a hair transplant surgery turns out. With respect to inserting the grafts, it usually takes over a year for the medical staff to learn to insert the grafts efficiently. Some doctors will hire per-diem workers to do this work, so the quality will vary day by day, worker by worker.

I have said this before: cosmetic surgery is not like buying a car. It is not a commodity. No matter what the technique is advertised, each and every surgeon and their work is different. This is where due diligence comes into play. Before you put your head in the hands of any surgeon you should be well informed. There is no reason not to ask the surgeon if you can see his/her previous FUE patients and to speak with them about their experience. Find out if they were happy with the results and if their expectations were met. You should always voice any concerns you have so that any and all issues are addressed to your satisfaction prior to giving your consent to surgery.

Bottom line — some surgeons are more talented than others and there are a variety of factors that influence the outcome of any given procedure, therefore it is difficult to judge a surgeon based solely on the length of time they have been doing a particular procedure.

Tags: fue, follicular unit extraction, hairloss, hair loss, hair transplant, skills

Hello Doctors
I am a 39 year old man and had a problem with my eyebrows since I was probably in my 20s. My eyebrows aren’t very thick. I never plucked them and do not know why they appear thin around the edges or when it exactly happened ,but I wanted to talk to you about what a transplant looks like in that area for men. My hair is otherwise great on the scalp and I have a strong hairline. Have you done any man eyebrow transplants? Thanks

Here’s a male patient we haven’t shown before, with some beautiful eyebrow transplant results. I placed 189 grafts into his eyebrows with almost all single hair grafts taken from the scalp using follicular unit extraction (FUE).

In general, eyebrows are difficult to get control of the direction of the hair as it exits the skin, but these results turned out great! The after photo was taken about 7 months following his hair transplant.

Before photo on left // After photo on right. Click to enlarge.


Tags: eyebrow transplant, hair transplant, fue, eyebrows, thinning eyebrows

I am a 25 year old female experiencing hair loss. I can tell that my ponytail is about half the thickness it was about 2 months ago. I haven’t noticed any bald spots really, but at the front of my head and can definitely see my scalp and it is a lot thinner. I have had blood work done for thyroid and anemia. Everything came back normal. I attributed it to moving away and starting a new job and just being stressed out, but losing my hair is just making me stress even more.

There is even less hair on my arms, legs, and body. My skin is starting to become itchy, but no rash or dryness. And my hair is less oily. I have gained about 5-10 pounds, but I figure that’s because with my new office job I am less active. I have no history of hair loss in my family, but my dad does have thyriod problems, but that test came back normal. Any ideas on what could be going on?

Stress from your new job and the move could contribute to hair loss, and I realize losing hair in itself can also be stressful — so it seems like a never-ending cycle. That being said, there are many possible reasons for hair loss in women, so it would be difficult to solely place the cause on stress. You can find a partial list of causes here.

Did you just start notice your hair starting to thin during or following the move, or was there some loss going on prior to that when you were under less stressful situations?

Tags: female hair loss, hairloss, hair loss, stress

Hi there,

I wanted to know what are the long-term risks and effects of user a mild chemical relaxer. Could it harm the follicles and cause balding? I am a white Jewish male in his mid-30s with very curly and frizzy hair. I have all my hair. My father lost all his hair in his twenties, but the men on my mother’s side seems to have all their hair.

Thanks for your help!

Relaxers require an experienced application. The risks for poor use can be a disaster. With a good professional applying these chemicals, you can get away with it for years.

Tags: chemical relaxer, hairloss, hair loss

When hairs become miniaturized, are those hairs necessarily doomed to fall out and not be replaced? Or, can some men maintain miniaturized hair indefinitely?

I honestly don’t know. There are no set rules and I’m not aware if anyone has ever scientifically studied this in detail. We see finasteride hold on to miniaturized hairs for years and likewise some patients will be able to hold on to them with minoxidil.

In general, we know that for non-balding men and women, miniaturized hairs do exist. Those miniaturized hairs fall out eventually and a new hair grows in its place that most likely will be miniaturized as well. The percentage of miniaturized hair in non-balding men and women are low (under 20% or so) and if one looks at the length of these hairs, they are often short. The shortness tells us that these hairs are the vellus hairs that are found in the follicular units.

When you are balding or thinning, this percentage of miniaturized hair is much greater and many of those miniaturized hairs fall out, never to return after a few cycles.

Tags: miniaturization, hairloss, hair loss

You called it, doc! John Travolta was on vacation without his piece!

Link: E! News

John Travolta was in Hawaii celebrating his birthday and the paparazzi caught him in what appears to be his natural balding state. One of Hollywood’s worst kept secrets, I’m not sure that I can or want to take credit for calling it. In fact, there was a photo taken years ago of what was likely his real hairline, so I don’t know why the entertainment reporters are making a big deal out of this. And we did point out the hairpiece years before that. At any rate, I got a few emails about this “late-breaking” news already, some of which sent a variety of photos. Here’s one:

John Travolta balding
Tags: actor, celebrity, hollywood, john travolta, balding, hairloss, hair loss

I recently was diagnosed (by three unaffiliated dermatologists having all examined my scalp under a light with the naked eye) with traction alopecia, which I was more or less already aware that I likely had. I received cortisone injections from one of the three in the crown of my head and all along the line of my scalp/forehead. I had already had thinning, naturally, but now it’s looking as if the areas having received the shots are actually going bald in patches (as opposed to the former more diffuse thinning).

I’ve noticed that more and more frequently when I go to those areas to apply oils (emu, rosemary, etc) I will inadvertently pull out a few hairs from the root. My part is ever-widening, it seems. I’m very worried… Is it possible that the shots actually worsened my hair loss? And if so, is it permanent? And if not, with regard to the latter question, how long will it be before my scalp recovers…?

Thank you.

Steroid injections into the scalp for treating traction alopecia makes zero sense to me. As you found out, the cortisone shots could even cause more hair loss. This loss could be permanent, but only time will tell. It could take up to a year or so for regrowth to be seen. If no growth is seen by then, it’s likely permanent.

Tags: cortisone, steroid, hairloss, hair loss, female hair loss, traction alopecia

Hello Dr Rassman,
I believe that I have body dismorphic disorder. The object of my obsession is my eyebrows. I am 28 years old and ever since I can remember I have been overly obsessed with them and constantly plucking them and checking them in the mirror. It has now gotten to the point where I think about them EVERY waking moment and check them in the mirror anywhere from a few minutes up to an hour at a time about 20 times a day… literally. The problem is that one of my brows (my left one) keeps growing hair and then it falls out without any reason. I have seen a derm and primary doc and they don’t see any underlying pathology.

So, my question to you is: can it be possible that I am psychologically inducing this hair loss? I have heard of telogen effluvium (which I don’t think this is as it is localised to my one brow) but have you ever heard of or do you think its possible to be so focused on one part of your hair that it is causing hair fall? I really need your help as I have exhausted all efforts and would love to know your thoughts as a hair loss expert. By the way this has been going on (hair growing and falling out) for about ten years now. God bless.

I’ve never heard of the ability to cause hair loss in a particular area (left eyebrow, in your case) just by focusing attention on it without some kind of physical contact to the hair.

It sounds like you have trichotillomania. It is an obsessive compulsive disorder that needs professional help.

Tags: eyebrow, hairloss, hair loss

New Hair Institute is pleased to introduce a new service we’re offering —

Scalp Micro-Pigmentation (SMP)

Like any tattoo process, the technique involves placing a special pigment into the skin of the scalp to mimic ‘hair follicles’ almost to the size of a closely cropped head of hair. Think 5 o’clock shadow or stubble. We have been using Scalp Micro-Pigmentation (SMP) for two purposes:

  1. As an alternative style for making a balding person look full headed with the placement of pigment into the scalp (example below)
  2. To camouflage the scars from a strip procedure or anywhere on the scalp. Almost any size scar can be treated with SMP (example will be posted in the coming weeks).

So what does it look like?

NW7This patient came in for a hair transplant consultation. He likes his hair cut close, so follicular unit extraction (FUE) would have been a reasonable way to get there without a detectable linear scar that traditional strip surgery would inevitably produce. The problem for him is that he needed somewhere between 4000-6000 grafts to cover the balding area. We routinely offer up to 1500 FUE grafts per session and recommend the strip technique for larger sessions. That means that he could have been looking at 2-5 FUE surgeries to obtain the final look he wanted and as he continued to bald, he might run out of donor hair before completing the final look he wanted. This patient was heading towards a Norwood class 7 pattern, and eventually he might need 6000-8000 grafts to follow the hair loss he would experience over time when/if his Propecia would stop producing the benefits he is now getting from the drug. As hair transplantation is a supply/demand process, would he have enough hair to complete the entire transplant process to a fully evolved Class 7 pattern? I doubt that he would.

The pictures below tell the rest of the story. He came in with his balding pattern and left the same day with a completely different look, certainly not a balding look.





I want to emphasize that this patient will have to maintain this short-clipped look unless he elects to have a hair transplant. The upside of this technique beyond what you see is the low maintenance he will have, just trimming his head about every other day. If he is against medication use (like Propecia) this style allows that choice, but as balding progresses as it inevitably will, touch-ups of the SMP technique will be needed. The downside of this is that the pigment is considered permanent, so the style must be acceptable for him and it is a lifetime decision.

This patient elected to do the process under local anesthesia to subdue whatever pain might be there during the procedure, but like any cosmetic tattoo procedure, it can be done without anesthesia. He may require one or two touch-ups to the look that he now has, as the pigment tends to fade a bit after the first session, but he does not have to look at repetitive surgeries into his future.

He’s been thrilled with the initial results. His overall comments to me reflected upon the freedom that his new look gives him and how much he loved rubbing his bald head. No more styling gels and repetitive worries about going bald have made him a happy man. He also knows that when hair cloning or hair multiplication become available (fingers crossed), he can just add the value these breakthroughs will give him, and maybe get him the hair that he wanted at some appropriate time in the future.

Over the next few months, we’ll show more of the work we have been doing with Scalp Micro-Pigmentation (SMP). Contact my office at 800-NEW-HAIR (or 310-553-9113) for pricing and availability.

Update: I answered a bunch of questions posed by our readers in the comments below.

Tags: scalp micro-pigmentation, smp, hairloss, hair loss, new hair institute

Hi Doc,

I’ve been reading your blog on a fairly regular basis and have found it very informative. I’m almost 19 and my hairline has been creeping back since around my seventeenth birthday. At the moment I’m probably an nw2. My brother who is 21 would be considered nw4 if it wasn’t for a very fine scruff of hair in front.

Concerned that I was following suit with him, I decided to fill a prescription of propecia. The possible side effect were pretty unnerving but I figured it was my only real chance at keeping my hair.

I’ve read on your blog that the 1 mg dose does not affect the prostate but it definitely did in my case. The day I took the first pill, my prostate had sudden pains throughout the day. My semen also became water-like. I know this isn’t supposed to be a big issue, but it concerns me that it started happening right away and seems to me like another sign that it was affecting my prostate.

My question is where do I go from here? Have any of your patients had a similar experience? I recently started using a minox product but am unsure what to do as far as meds. Should I try a lower dosage of propecia? Would saw palmetto be worth trying?

Also, have any of your patients experienced results in the hairline from minoxidil alone?

Thanks for your work

First, how do you know what prostate pain feels like? I don’t imagine most men would be able to pinpoint which internal organ is hurting so quickly… particularly the prostate. Prostate pain generally ranges anywhere from lower back problems to urinary issues. Is that what you felt? Second, you had sudden pains after one dose? That strikes me as extremely odd. It’s worth noting that there are some rare reports of testicle issues after taking finasteride, but I haven’t heard of any case where this occurred on the same day that you took your first dose ever. I’d think it’s more likely that you psyched yourself up for side effects, as you said you were pretty unnerved about the medication before you even took it. You were expecting some negative reaction and you got it — this would also be known as the power of suggestion.

You need to get a good, solid diagnosis with the tests I have suggested (miniaturization mapping, hair bulk measurement) before you make the decision on taking finasteride for life. I hope your prescribing doctor gave your scalp a thorough examination before suggesting you take this medication. Now that you’re noting problems though, you should talk to your doctor about this. I’d get off the medication to see if the pain goes away. Remember, a good Master Plan is needed for every young man facing an uncertain future for hair loss.

As for minoxidil, that is an over the counter treatment and so long as you don’t become worried over potential side effects from that drug, it might be worth a try. It would be rare to see regrowth in the hairline from minoxidil or finasteride.

Tags: prostate, pain, testicle, semen, hairloss, hair loss, propecia

Hello Doc,

I have been a frequent reader and an occasional poster on your blog for a while now. I have been on finasteride (1 mg) for the past year and a half with mixed results. The drug has definitely slowed down my hair loss to an extent and could have also initiated some regrowth in the crown area. Of late (for about a month now) , I have been experiencing some sexual side effects that I had never experienced during the past year and 5 months. Although I do not want to discontinue the medication (since it seems to be working) I am apprehensive about the long term ramification of these new developments. Under the circumstances, would you recommend reducing the dosage from 1 mg a day to 0.5? I might have come across a post on this blog, where you had mentioned about virtually no difference in the potency of the medication at dosages of 0.5 and 1 mg (I might be wrong). It would be great if you could respond to this query.

Thanks for your time and keep up the good work.

I am not your doctor and Propecia is a prescription medication that a doctor needs to prescribe to you. You need to ask this question to the doctor you get your prescription from. You should ask your doctor about changing doses in your medication. As for the reduced dosage, I’ve read a study that cites about 80% effectiveness with 0.5mg.

There may be other issues (not only the possible side effect from Propecia). Some men (even in their 20’s) experience impotence, decreased libido, etc, WITHOUT any medications. These issues are not discussed openly in public, because of their sensitive nature… but it does happen. Find out if your issue is due to Propecia or other medical or psychological issues.

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