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Hi Dr Rassman

I was just wondering if you could explain why grafts enter a dormant phase immediately after being transplanted, and only start recovering after 8-10 months?

I’d also be interested to know why they initially grow back much finer, and then thicken up later. Essentially the follicle itself hasn’t changed, so why does the hair diameter it produces fluctuate in this way?

Many thanks

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I do not know why there is a dormant phase after a hair transplant. To put it simply, when you have hair transplant surgery, your follicle was removed from your body, handled, cut, manipulated, put in solutions, manipulated some more, and put back into another new location on your body. If I was that follicle and I survived all of that, I’d be traumatized and go dormant for awhile. In all seriousness though, I do not have a professorial explanation.

The simple fact is that most follicles go dormant (telogen) and start to regrow in a period of 3 to 12 months. Most patients see results starting on the 6th month to 12th month. Some lucky minority of patients (< 5%) see results within a month! This is what we have observed over the last 20 years in thousands of patients. [tags]dormant phase, hair transplant, hairloss, hair loss, telogen, hair cycle[/tags]


Hello Dr. Rassman,

Is it possible to start balding in the vertex area and scalp area while still maintaining a juvenile hairline? I noticed that I still have hair under my furrowed brow, but the overall thickness of my scalp hair has dramatically decreased. I am 22 years of age.
Thank you.

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Yes! You can start balding from the vertex (crown) area while maintaining a juvenile hairline. Those patients are a subset of the normal Norwood hair loss patterns with a persistent frontal hairline.

In rare instances, someone with this type of hair loss may even continue to have his juvenile hairline for the rest of his life, even though his crown has become bald.

Tags: hairline, hairloss, hair loss, vertex, crown


Is it possible to permanently damage the Sebaceous gland to where it is not secreting any sebum? Two yrs ago i used a re moist intensive hair treatment and left it in my hair for several hours and every since then my hair has been brittle and dry.

I know that sounds crazy but my hair just hasn’t been the same. While i might be wrong about the product that i left in my hair causing my brittle, dry hair, one thing i do know is that (all of)the hair on my head is very unhealthy. Im debating to see a doctor about it but im afraid to waste my money to just be told to use a deep conditioner, which i have been.

Is there any thing that a doctor could do about very brittle, dry hair? Or is there any way to get the body to produce more sebum?

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Maybe it is probable, but I do not really know. Some people just have dry and brittle hair, and it can change during one’s life. I do not know of any way to increase sebum production aside from perhaps washing it regularly.

Tags: sebum, dry hair


Just wanted to send you a link to this silly article. One of the claims is that petroleum-based waxes can block hair follicles.

Link: Worried you’re going bald? Eat nuts and have a fried breakfast

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Thanks for the find. Yes, it is a silly article. Journalism isn’t what it used to be. Even the title of that article suggests eating a fried breakfast will somehow stop your hair loss. That’s ridiculous.

Tags: hair wax, hairloss, hair loss


Hello dr Rassman,

I think you are 68-69 years old.Does that mean that you are going to retire soon?If yes what will become of baldingblog?I hope you are going to be with us for another 5-10 years.

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Dr RassmanMy grandparents lived well past their 90’s and longevity runs in the family… and since I love what I do, I suspect I will be doing this for a very long time. In fact, I am very involved with Dr. Pak in the engineering process of new hair transplant instruments and we will be testing a new FUE extractor and implanter in the next month!

Besides, even if I do eventually retire, I only need a computer and Internet for BaldingBlog, right? With respect to what you read on this site, Dr. Pak and I equally share contributing to the posts without the reader knowing who answered what. So even if I am gone for a long vacation, BaldingBlog will continue on. But in general, before any content is posted, both Dr Pak and I cross check and edit each other’s answers.

But just to make it clear, I am not planning on retiring yet.

Tags: rassman, retire


Hello Doctor

How bad does a scalp wound has to be in order to mean permanent hair loss in the area ? I bleeding or crusting afterwards na indication for bye bye hair ?

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Any cut on the skin will produce a scar, and on the scalp no hair will grow on that scar. Even with follicular unit extraction / FUE (advertised as “scarless” surgery by some) will produce a round punctuate scar.

In general, if the injury or wound is significant there will be permanent hair loss. Even a scratch could cause bleeding, but that doesn’t necessarily mean permanent hair loss will result. Only time will tell if your hair will grow back. This time frame is around one year. If you see no hair growth after one year, then it would be safe to bet it is permanent hair loss.

Tags: hairloss, hair loss, scalp wound, scar


Hi Doc. i’ve been on finasteride 1mg for 3yrs without major sides just an increased in body hair. i quit for 2yrs and now my hair has thinned so much that i’ve started fin again. now will i get sides this time? or should i expect the same.

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Increased body hair from finasteride is not a common side effect I have seen, but I have been asked about it before. I have seen decreased body hair in a couple patients over the years.

If you restart the medication I cannot say if you will get the same side effect. You should follow up with your doctor.

Tags: finasteride, propecia, body hair


Dear Dr. Rassman,

I found this blog a very interesting read, and I appreciate you taking the time to answer questions online like this. It has been a wonderful resource in coming to terms with the somewhat shocking discovery of my hair loss.

I am about to start treatment with propecia for my thinning top, but there’s something that has been nagging me:

I want to heed this blog’s earlier recommendation and wait until after a year on propecia before trying Rogaine. But isn’t it “the earlier, the better” even with propecia working in the background? Wouldn’t this delay risk my potential for improvement? Wouldn’t it risk killing miniaturized or dormant hair?

It is my hope to completely eliminate the visible thinning with medical treatment. I realise my odds aren’t super great, but I also feel it wouldn’t take much improvement to achieve this. My hairline has receded to mature levels but seems stable. I will be 25 this year and I only noticed my thinning a month ago.

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Generally, when I recommend a medical treatment for androgenic alopecia (AGA), I only have two proven medications I can recommend: (1) Rogaine (topical minoxidil), and (2) Propecia (oral finasteride 1mg). While you can start taking both treatments at once, it would be difficult to assess which medication had more or no benefit. So I usually give the patient a choice on one medication and they use it for 6 to 12 months to assess how it is helping their hair loss issue before we add on the second medication.

Also, in practical (real world) terms, it is a hassle for men who are not used to taking any medication to stick with the regimen of taking a pill every day (Propecia) and putting on a topical medication twice a day (Rogaine). Before they know it, most patients get lazy, forget to take the medication, or forget to resupply the medication when they run out. I find that in a good percentage of time, the failure of a medication is related to the poor compliance issue. This not only applies to Propecia, but many other medications.

So yes, while starting both at the same time allows you to potentially see your maximum benefits begin sooner, it’s a lot for most men to keep up with every day. And who knows — since you just noticed your thinning, only one of the meds might be all you need.

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


I take 5mg Finesteride daily and also used to take 0.4mg Tasulosin. My doctor ‘s PA took me off Tamsulosin with no reason given.

Is there a reason?


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The reason can be found by asking your doctor or your doctor’s assistant. Finasteride 5mg (Proscar) is used to treat the symptoms of an enlarged prostate. Tamsulosin (Flomax) is also used to treat the symptoms of an enlarged prostate. This is a site focused on hair loss issues, not prostate issues… and I have no insight into why your doctor did or didn’t prescribe certain medications to you.

The recommended dose of finasteride is 1mg a day for treating hair loss, and taking more will not make things better with respect to hair. Tamsulosin is not (and has never been) used for to treat male pattern baldness.

Tags: tamsulosin, flomax, finasteride, proscar, prostate


Hey Doc,
You have a great site going. Thanks for all you do. I am a 20 year old male and my hairline is receding at the corners. The only family history of balding that I have is my maternal grandfather who was completely bald by the time he was thirty. I am currently on finasteride, but I was wondering about a transplant.

Would it be a bad thing to have smaller transplants over the next fifteen years instead of just waiting until you’ve reached your final pattern? For example, could I have one to fill in the corners, and then another in ten years to fill in whatever else is thinning or gone? As of right now, I am about a NW 2.5 with no evidence of thinning in the crown.

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Not everyone has the exact same goal, and some patients have transplants to keep ahead of their thinning. This issue is up to both you and the doctor to plan out the Master Plan. Generally, most patients do not wait until they are completely bald… but in your case at 20 years old with early loss, you would likely not be a candidate just yet.

Tags: hair transplants, hairloss, hair loss


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