I’m very seriously considering starting a course of propecia/proscar. But before I began I wanted to ask two questions.

1. It has been said that if you start propecia early the better chance you have of slowing down/halting hair loss, but that doesn’t tally with the propecia chart from studies which show that it generally peters out after 3 years. so surely you’d only save your hair for 3 years and then it would quickly regress, not making much difference how early you start because you only have 3 years of good hair.

2. I was wondering if you could recommend a good dermatologist/hair doctor in London, who I could have a consulation with before I begin taking proscar, do you know any who do miniturisation tests or some kind of form of monitoring on hair loss? There are a lot of snake oil merchants in London that are willfully telling you that you must get on medication and I just want to talk to who is honest and experienced.

I have many patients that have reversed their crown loss and held the reversal over 10 years. Everyone is different, but the official studies show that the expected maintenance should be about 5 years on average. That means that some men get better than 5 years and some worse results while on the drug. It depends upon how aggressive your genes are.

As to your second question about London-based doctors, Dr. Bessam Farjo is a contributor to this site. He and his wife are terrific doctors and worthy of a trip to their offices (in London and Manchester). They may be able to give you a referral if you call their office.

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

Hi dear Dr Rassman

I am a 43 years old man which have taken Propecia (1 mg) for 7 months. I know taking the said pill for women is forbidden and they should not even touch it. So, if a man who is taking Propecia and want to bring a baby, he should stop using the pill before intercourse with his wife? I mean the finasteride dose not transfer through the sperm.

If the answer is yes, how long before intercourse the man should stop using the Propecia?

Your soonest reply will be appreciated. Thank you

After extensive studies in this very issue, we know that the drug is not transmitted to the woman through sexual intercourse. We have not seen the problems of fetus sexual differentiation in women who were fertilized by men taking this drug at the 1mg dose for hair loss. It is generally considered safe to have a successful pregnancy while a man is taking finasteride (Propecia).

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

Hello Drs.,

I am a 35 year old male (of Korean descent) and I currently have a Norwood 2 hairline (by checking the top of my hair with a mirror).

My question is in regards to hair transplantation for those who are at the early stages on the Norwood scale. I know that most responsible hair transplant doctors will not treat Norwood 2 patients. Thus, my question is what is the minimum stage a person must be at on the Norwood scale for a serious consideration of hair transplant surgery? Thank you.

I’ve been asked this before, but I’d have to advise a one-on-one consultation. Each case is different. It is possible that a non-balding person does not like the shape or the height of the hairline and wants it altered. Such cosmetic surgery is not hair transplant surgery for balding.

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

My question is about coping with hair transplants. It seems like one of the biggest challenges/inconvenience of transplants is for patients to go out in public and resume their daily responsibilities after surgery because of the physical appearance of the scalp and how it initially is red, scabby, and punctured after surgery. I find this a very unappealing aspect about transplants and Im wondering how do patients cope considering the gruesome appearance of the scalp after surgery- do they take time off work and just lock themselves in their house until their scalp starts healing?

The scabbing can be easily addressed with good techniques and small wounds by the surgeon. Add good daily washes and most patients will have no significant crusting after the surgery. Everyone is different, but in regards to redness, only a few patients develop this. You can usually find out if you are one of them by performing a scratch test on the skin of your forehead. If it turns red 2-5 minutes after the scratch is performed, then you run a high risk of redness after surgery. The scratch incites histamine release at the skin level.

Remember, no matter how you want to look at it, a hair transplant is a cosmetic surgery. Just like any nose job, face lift, etc, there will be healing time needed. Some patients might get permission to wear a hat to work, others might adopt a new styling method to cover any initial redness from the surgery. Many of our patients go back to work fairly quickly after surgery (usually 2-5 days).

Tags: hair transplant, healing, surgery

Dear Dr Rassman,

Have you had any patients who have taken very low doses of finasteride (i.e. less than 0.25mg)?

I am not keen to take propecia because I’m concerned of the effects to my internal body chemistry but would also love to keep my hair for longer. I have had issues with my sex drive previously and do not want to mess with my hormone balance too much as a man still in my 20’s. Another reason being that I’m an athlete and want to be at my peak physically. I’ve read a lot about how finasteride affects the hormones, particularly the obvious reduction in DHT but also the decrease in free (not total) testosterone and the rise in estrogen.

Then I read this forum post: Hairlosstalk.com

It seems that taking a dose as low as 0.05mg is enough to lower scalp DHT considerably while keeping 20% more DHT in the blood. Like the original poster in the forum thread who is considering crushing a pill and measuring smaller doses – this prospect is more appealing to me. If I could just lower my blood DHT by 40-50% instead of 70% then surely my hair would still get some benefit and I would be able to keep my hormones at a more normal level. I have ruled out taking 1mg but am really curious about taking 0.05mg if only I could just measure it accurately each time (I wouldn’t want to take fluctuating dosages each day).

It makes me wonder why propecia isn’t available at a much smaller dose (0.05mg or 0.1mg)

Could you comment please? I’d very much appreciate it. Thanks for such an informative blog.

Propecia (finasteride) at 1mg was determined to be the ideal dose for treating hair loss. Lower doses do work, but how low? I’ve said that 0.5mg produces 80% of the benefit, and 0.25mg probably give 50% of the benefit. I don’t have a clue about lower dosages.

But by dosing the 1mg level, it is the most effective treatment level to use… so why dose lower unless there are significant side effects?

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

Hypothetically can Finasteride for shock loss be discontinued after a period of time has elapsed after the Hair Transplant operation and the risk of shock loss has receded?

Yes, you can take finasteride temporarily to just protect against shock hair loss. I generally tell patients to take it for 8 or so months to bridge the gap between the transplant procedure and growth from the new grafts.

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

Hi Dr. Rassman,

My understanding from reading your blog is that FUE is over-hyped because it does not produce a linear scar, but is still inferior to the strip method in producing the most number of grafts with the least amount of transection. If hair cloning technology was to ever become a mainstream option that hair transplant surgeons offered, would that then make FUE the gold standard/go-to choice since the number of grafts needed could be created from a smaller amount of donor follicles?


The point of the post you’re referencing from a couple weeks ago (FUE Back into the Linear Scar vs Scar Revision) was that once a strip surgery has been done and a linear scar is already present, a FUE procedure should not be the harvesting method of choice.

To answer your question on cloning, if the clone somehow came from the scalp, then FUE would be used, but if the cloned hair came from a petri dish, then no harvesting mechanism will be needed and the cloned hair would be put directly into the recipient site.

Tags: hair cloning, fue, hairloss, hair loss

Since Acell has failed and seemed a year ago to be “A Cure for Baldness in Five Years” its seems to me that the only 2 research institutes that are really getting substancial funding are Aderans Research and Replicel. Aderans uses a small piece of tissue that is removed from the neckline…”Cells are cultivated in controlled conditions where they are encouraged to multiply by the addition of proprietary growth media. When enough new cells are formed, they are returned to the scalp, where they are injected and elicit new hair growth and thickness, ultimately producing more hair than the client had before.” Replicel has a way to isolate dermal sheath cup cells and cultivate them. They are hopeful that injecting them into the scalp will cause regrowth on the scalp.

Since both Aderans Research and Replicel are in phase 2 of their clinical trials one would think that unless the subjects of the trial were locked in a room for 6 months someone would obviously have come out and said that these injections are working. If so…investors and inside traders wouldn’t flinch to buy Replicel stock (Aderans Research is a private company.) But Replicels stock…regardless of its clinical studies that have been going on for all this time…has a low volume of trade and is at 2.35 a share. With all of this put together…it seems blatantly obvious that besides the procedure being safe…both Replicel and Aderans Research Institute’s attempts at regenerating hair follicles is failing. What is your take on this?

I guess that is one way to look at it. I am unaware of any leaked information, and I’m not even familiar with the ins and outs of these particular trials. I’d have to assume there are non-disclosure or confidentiality agreements which prevent participants from discussing their results (if any). If they are successful, the results will be announced when they’re ready. Rushing things isn’t going to help.

As for looking to insider trading as a sure-fire way to know if a product is coming to market… good luck with that.

Tags: hair cloning, replicel, aderans, hairloss, hair loss

I am very confused by one of your answers. You said Testosterone levels peak in the morning, but everything else I read says they peak at night. Is this just a mistake on your part?

Take Propecia With or Without Food?

It’s no mistake on my part. Testosterone levels peak in the morning, drop through the day, and then rise in the evening. Further reading here (PDF).

Tags: testosterone, hormones

We’re taking the day off and we’re going to be on a limited posting schedule this week. Be back tomorrow!

This well known Los Angeles radio host has an advanced Class 6 balding pattern. The bald area is huge (as well as his hat size), and the 2700 medium weight hair grafts were distributed so that it would take advantage of weighting to cover the large balding area. In other words, more hair was placed in the front and on the left side than elsewhere. Utilizing weighting so that a left to right combing style could be used to maximize the value of the 2700 graft he received in his first session, he remained see-through in the central and right areas of his scalp where the amount of hair was not great.

Had we been able to remove 4000-5000 grafts safely, we could have filled up the central area and addressed what was to be thin coverage. As you can see in the pictures, the coverage was good for that number of grafts, but he needs another session to complete the process, bringing up the number of required grafts to the 5000+ range.

If you look at our photo albums, you will see many patients who had 3500-5500 grafts to cover the Class 6 pattern adequately. We are limited to what can be safely transplanted in each session. Still, when you look at the photos below, the change with strict styling and the use of a comb-over produced a remarkable change in his appearance and he is very happy with stage one of what will certainly be a two stage process.

Click the photos to enlarge.

After (1 procedure of 2700 grafts):




Bonus – head shot:


Tags: hair transplant, hair restoration, surgery, hairloss, hair loss

Hi Doc,

I’m a 26 year old male with a fairly aggresive NW4 developing, and need to do something to stabilize this before going for a HT next year.

I’ve grown pretty scared of finasteride side effects through the experience of a good friend who unfortunately suffered some of the psychological sides we’ve all been reading about online.

Question is, would a 1/4 dose (0.25mg) finasteride still be more effective for someone in my position than the full (320mg) recommended dose of saw palmetto? I’ve tried the latter before with no side effects, but didn’t stay on it long enough to evaluate the results.

Thanks doc and keep up the excellent work!

Propecia is finasteride in 1mg strength that you take daily for genetic male pattern (androgenic) hair loss. It’s been indicated that 0.5 mg finasteride daily is about 70 to 80% as effective as the full 1mg dose. I suppose you can infer how a 0.25mg dose may help. But in general if you are going to take a drug, you should take it as directed and speak with your doctor about all these issues. With saw palmetto, you really do not know the dose of the effective ingredients as they vary per manufacturer. Add to that the knowledge that saw palmetto has never been proven to work on hair reliably with a good scientific study.

My final point is that if you are going to read the issues of Propecia on the Internet and scare yourself with unsubstantiated reports without even seeing a doctor, the chances are you will likely have a side effect from the sheer psychological impact.

Tags: saw palmetto, finasteride, propecia, hairloss, hair loss

Dear Dr. Rassman,
I am 28 yrs old have been suffering from hair loss since I was about 22 years of age. I am about a norwood 3 right now. I had chemically relaxed my hair once when I was 18 and a second time when I was about 21, while suffering a minor burn from my second treatment. I have taken the hair DX test and I have been told that I have a moderate predisposition to male pattern baldness. Can my hair loss be due to a combination of both factors?

If it were solely due to the chemical relaxers, would I have lost my hair when the injury occurred and wouldn’t my hair loss be more diffuse? If it is due to the insult by chemical straightening, would the hair/hair follicles show the same progression of hair loss as if it were male pattern baldness? I can’t change the past, but I would just like to know if my chemical relaxer treatments have led to this.

Thank You

You have a complex story and it would likely require a complex examination. Without seeing you and examining you, I can not tell you the cause of your hair loss or what you can do about it. The HairDX test can tell you if you’ve got the genetic markers, but it won’t tell you if or when you’ll see those genes expressed.

See a good hair transplant doctor who cares about your welfare and then you will know more than you know now.

Tags: hairloss, hair loss, chemical burn

Yes, another Propecia question for you. Sorry :) I am 37 and have a bi-lateral varocele, grade 2 on the left and grade 1 on the right. If I started on propecia, could its side effects be more potent or affect my condition? From what I remember, the Merck studies did not get into the issue of results or drawbacks of people with Varocle.

This is a question you must ask the doctor who is following your problem. There is no obvious answer, other than you cannot just correlate any medical issue with a side effect. I am not a urologist nor do I treat varicoceles, so I am probably not the one to answer the question.

Tags: propecia, varicocele, finasteride, urology

The following post is by UK-based physician Dr. Bessam Farjo:

Written by:
Dr Bessam Farjo, United Kingdom
Dr Bessam Farjo
United Kingdom

While I have discussed my reservations in previous blogs with regards to younger men undergoing hair transplant surgery, I felt that the most effective way to raise my concerns is by offering examples of cases I’ve dealt with in the past.

I’ve been liaising with a patient for several years who first came to me at the age of 19. After a couple of consultations at our practice, we advised him that he should try a course of Finasteride or Propecia before surgery. The patient went away and, after a couple of years, returned to the practice having undergone extensive scalp reduction surgery in Europe.

Scalp reduction surgery is a surgical hair restoration procedure that surgically removes bald scalp and stretches hair-bearing scalp upward and across to replace bald scalp that has been removed. While this is considered an effective treatment for sufferers of hair loss especially in the past, it was not the appropriate surgery option for this patient at the time.

He was 21 when he came back to our practice and had since suffered further hair loss. Once again, we advised he was still too young to undergo more surgery as the full extent of his hair loss was still unknown at such a young age. Against our advice, the patient had a further two hair transplant procedures at another clinic which he was unhappy about. He is now 24 and we’re still in regular contact as his hair loss has severely affected his confidence and self-esteem.

While we’re working with him to try and rectify his situation, it’s imperative that potential patients are educated correctly on the future consequences that may result from premature surgery as well as the, potentially irreversible, damage that can be done.

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