Snippet from the non-hair-loss-related-but-still-impotant article:

Prostate cancer screening has become increasingly polarized, with experts weighing in on both sides of the equation. The draft recommendation issued by the US Preventive Services Task Force (USPSTF) in October 2011 ignited the controversy — like pouring gasoline into the fire.

Now 2 experts with opposing views on the USPTF recommendation offer evidence for and against routine screening with the prostate-specific antigen (PSA) test. The point–counterpoint appears in the March issue of Cancer Epidemiology, Biomarkers and Prevention.

The USPTF draft recommendation advised against routine screening with the PSA test, as reported at the time by Medscape Medical News. The USPTF had previously recommended against routine PSA screening in men older than 75 years, but the draft extends that to all men. It gives routine screening in men younger than 75 years a “D” rating, which means “there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits.”

Read the rest — PSA Testing Continues to Polarize Medical Community

I know this isn’t a hair loss related entry, but it is an important issue I wanted to discuss. So what is this all about? In patients with prostate cancer, a protein (PSA – prostate specific antigen) is found in the blood. It is a cancer marker and like many cancer markers that are detected early (like in a pap test for cervical cancer) their presence means that the person who has tested positive, has cancer of that particular organ.

It has always been a goal to try to detect cancer early enough to produce a cure; however, it is thought that some breast cancers and now even the prostate cancers may never grow enough to be life threatening. If a woman has an in-situ breast cancer that will never grow (can be detected in about 10% of women who were autopsied) or potentially threaten her life, should the breast come off if it is present? That is the question.

For the prostate, even if the cancer grows as the PSA blood test indicates that it does (and biopsies often confirm its presence), is the treatment worse than the disease? Few patients with known prostate cancer ever die from the disease, as they usually die from other diseases like stroke and heart disease. If a man undergoes a prostate surgery, or radiation therapy, or other radical treatments to treat the prostate, their quality of life is often impacted by urinary and fecal incontinence (having to wear diapers for the rest of their lives), have chronic pain from surgery, lose their sexual capability, have their testicles taken off, etc.
Read more

I’ve only just noticed I have bald spot after someone mentioned it, it is in an awkward place to see in the mirror. The bald spot is only at the crown area and I haven’t noticed any other hair loss anywhere else. However I do think my hair has thinned recently (last year or so). Do you have any suggestions as to what I should do next -see a GP, observe for a few months etc.?

I’m only 21 years old and I’m quite self conscious now that I’ve had comments about it.

Thanks in advance for any help.

You can consider a visit to our office in Los Angeles if you’re local or planning a trip out this way (the consultation is free). Otherwise see a good doctor, perhaps your family doctor, who will be able to determine what you have and what you can do about it.

If you think it is the beginning of male pattern baldness, you certainly want to see about starting treatment early… but I don’t know what is causing your bald spot at this point. I often mention the Master Plan when considering future hair loss. Educate yourself.

Tags: hairloss, hair loss, bald spot


I am 25 and have been using rogaine since i was 20…the foam worked great having used it twice a day however it seemed to be ” lacking” recently and with instructions from Dr.Bernstein in NYC switched to the liquid only at night time. Few questions:

1. Can i use foam in the AM and liquid at night?

2. Does PG help with hair growth? I just went through a new shedding stage and am assuming that was weak hair falling out.

3. Any vitamins to help with hair loss? I take the standard multi but wonder if there is anything more or shampoos to block DHT? Ketoconazole?

Thank you

Yes, you can use the foam and liquid on the same day.

As for “PG”, I assume you mean propylene glycol. It is included in minoxidil to help the medication penetrate the scalp (see here).

Some people use ketoconazole with hopes of treatment help in the battle against hair loss, but I’ve got mixed feelings about it (see here).

Tags: ketoconazole, propylene glycol, minoxidil, rogaine, hairloss, hair loss

Hey Dr.Rassman,

What do you think of the placebo effect in regards to side effects associated with taking Propecia? This snippet from Wikipedia on the placebo effect got me thinking about alot of individuals that have expectations/concerns on getting potential side effects from the medication.

Expectancy and conditioning

In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different. According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus. Both conditioning and expectations play a role in placebo effect, and make different kinds of contribution. Conditioning has a longer-lasting effect, and can affect earlier stages of information processing. The expectancy effect can be enhanced through factors such as the enthusiasm of the doctor, differences in size and color of placebo pills, or the use of other interventions such as injections. In one study, the response to a placebo increased from 44% to 62% when the doctor treated them with “warmth, attention, and confidence”. Expectancy effects have been found to occur with a range of substances. Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture.”

Sometimes I feel like alot of us convince ourselves we have these side effects when in reality they are non existent.

I have no doubt that many of the problems with sexual side effects reported while taking finasteride, are impacted by the power of suggestion. Also, some men have erectile dysfunction prior to ever starting the drug finasteride, so it is easy to blame the drug for that problem if they exercised denial. Thanks for sharing this with us.

Tags: placebo effect, finasteride, propecia, power of suggestion, side effects

In the article recently published in Science Translational Medicine, it was shown that the enzyme prostaglandin D2 (PGD2) was elevated in bald scalps at the mRNA and protein levels.

In a group of 17 men, bald scalp was compared with haired scalp and showed elevated PGD2 levels. The authors also found that PGD2 and a related metabolite 15-dPGJ2 inhibited hair growth in both mice and men, providing insights into the prostaglandin pathway in genetic balding. They found a receptor in the bald scalp which is responsible for mediating the negative effects of PGD2, suggesting that therapeutic drug targets could be developed for a possible topical treatment. They have determined that this receptor may impact the hair characteristics (i.e. straight or curly).

Dr. Walter Unger wrote his take as follows:

Unfortunately, baldness is not caused by a single factor but rather multiple ones. The most important and well-known one is the correlation of balding with a male hormone called dihydrotestosterone (which is a byproduct of the more well-known testosterone). Specifically, we have known for many years that you cannot develop MPB unless you have an excess production of that hormone in the affected areas. Yet, many years later, we still do not have a “cure” for everybody’s baldness either in terms of stopping the progression in everybody or regrowing hair in everybody though anti-dihydrotestosterone drugs such as finasteride (Propecia) and Dutasteride certainly help many people with male pattern baldness (MPB) and female pattern hair loss (FPHL)—to varying degrees.

Dr. Garza’s and Dr. Cotsarelis’s announcement of the role of another factor, Prostaglandin D2 synthase, appears to represent another building block towards the ultimate goal of medical treatment of MPB and perhaps FPHL. However, we have no idea as yet, if it is, for example, more or less important than dihydrotestosterone or any other of the substances already implicated in MPB and FPHL. Unfortunately, despite the media frenzy, “the end of baldness” likely remains well down the road.

Tags: hair loss, cure, hairloss, prostaglandin, pgd2

hello dr

lets say if the new drug came to the market and it can regrow the hair completely, then what what happened for who had hair transplant over 8000 grafts like me, they will have too much hair, i mean their hair back and the transplanted. will that make the hair to not look natural ?? or is that dangerous? thanks

Fun with hypotheticals!

I have never heard a person tell me that they have too much hair. Actually, the typical hair transplant rarely exceeds 35% of the original density, so getting all of your old natural hair will only add to your density. And, it should look absolutely natural if it was done correctly in the first place.

Tags: hair transplant, hairloss, hair loss

Hi Dr Rassman.

You have posted before that hair bleaching can damage the scalp. Is there any risk to hair through bleaching outside of the scalp issue?

My hair looks much better highlighted, and to do this the hair is pulled through a cap then highlighted by a hair stylist. Can bleaching accelerate the balding process? Is this something I have to give up?

Thanks for your time

If you bleach the hair and do not get the chemicals on the scalp, there will be no problem to the scalp; however, bleaching can damage the hair if not managed well. If you’re thinning already, risking damage to already weakened hair probably isn’t in your best interest. I don’t know anything about your hair loss situation though.

Tags: bleach, hair damage, hairloss, hair loss

Propecia(Finasteride) cause hypothyroidism? I am on propecia for more than 2years now. My TSH is elevated in the last one year. I would like to know if Propecia has any impact on the thyroid glands. I do not have any symptoms of hypothyrodism. I am planning to go off propecia now. Appreciate your reply.

There is no connection between thyroid function and Propecia.

Tags: thyroid, propecia, hairloss, hair loss

First of all, let me thank you and your technicians and please convey my appreciation to the GREAT job they did in placing my grafts and for the fabulous technical job on my hair. I believe my regrowth was close to 100%. Grafts are very firmly rooted with no weak hairs that lie flat that I know of. I saw substantial new growth between the third and fourth months…I’d say from then up to six months when it was pretty much done. The grafts are very natural looking in the sense that texture and thickness is indistinguishable from other hair.

I’m extremely pleased with the appearance of the hairline and how the temples have filled in…it works very well with my features and the shape of my face…really well done on your part. I pull probably twenty-five white hairs from the first inch of the hairline because they look a little unnatural amongst the black hairs…I think it’s just the low density overall that makes it so. I just wish I had a spare three or four thousand hairs to throw at it!

The downsides? I now have more gray hairs around the scar line. The sutures took a long time to dissolve and were quite irritating. The scar line itself healed well but it’s still a scar line.

OK, I’ll stop by at some point so you can take a look in person…until then Best Wishes!

Sometimes we get great results with less hair than we would have liked to use, because of donor supply limitations. His surgical history is that he had 1600 grafts from us in 1996, then 1900 grafts from another well known clinic, and finally another procedure of 1005 grafts with us 2 years ago. The before photos presented below are from just prior to that surgery in 2010, and you can guess to how his hair loss progressed over the years to that point.

The after photos were sent to us by the patient, so the quality, size, and lighting are all different from the before photos. Click to enlarge.

After (1005 grafts):




Tags: hair transplant, hairloss, hair loss, photos

Hi Doctor,

I was wondering if hair grows back if a person were to lose a significant amount of weight? Many sources on the Internet (I know not very reliable source of information) shows that losing weight may help regrow hair.

Currently, I am a male (29) at 300lbs and was wondering if I were to hit about 230lbs… would any hair come back?

Do levels of hormones balance out or is the body under less stress without all the weight?

Please Help

Good nutrition and medically supervised weight loss is the best way for you to control your risk of losing hair. Crash dieting can cause hair loss.

I do not believe that your hair will regrow when you lose weight and the stress that goes with it. Most male hair loss isn’t caused by stress, but by genetics, though stress could cause your genetics to kickstart the hair loss earlier than you would’ve otherwise had it begin.

Tags: nutrition, weight loss, hairloss, hair loss

Does those who haven’t balding issue will then never experimented BPH issue (Enlarged Prostate Symptom) ?

since both have the same cause ?


The connection between prostate hypertrophy and balding does not appear connected. There is, however, an association between early genetic balding and prostate cancer (see here.

Tags: prostate cancer, hairloss, hair loss, balding

Snippet from the article:

Health Canada is informing health professionals and the public that certain prescription drugs may be associated with an increased risk of developing a serious form of prostate cancer known as high-grade prostate cancer.

High-grade prostate cancer is an aggressive type of prostate cancer that grows and spreads more quickly than low-grade prostate cancer. This type of cancer is rare, and the increased risk seen with prescription drugs finasteride and dutasteride is still considered very small.

New warnings on this risk have been added to the Canadian drug labels for finasteride and dutasteride products.

Read the rest — Prostate cancer risk could increase with use of hair loss drug: Health Canada

There it goes again. Like the pendulum of a clock, the claims on cancer swing in bother directions (positive and negative). The focus here was on 5mg dose of finasteride (for treating enlarged prostate), not 1mg that is used to treat hair loss. And the focus of the study was on the rarer high grade malignancies classified by microscopic assessment of a pathologist. These conclusions may not apply to the lower dose, nor may they not apply to the young men under 50 years old.

We’ve written about the possible finasteride/cancer connection before, most recently here:

  1. Propecia, the FDA, and High Grade Prostate Cancer
  2. In the News – Finasteride and Dutasteride Raise Prostate Cancer Risk
  3. More Opinions About Finasteride and Prostate Cancer Risk
Tags: prostate cancer, finasteride, hairloss, hair loss, proscar, propecia


I recently did research and wanted to know how i can go about finding out whether I am suffering from DPA or DUPA? I am devastated at prospect of potentially not being suitable for a HT due to potentially suffering from DUPA and wanted to know how i can go about finding more out, having density measured and who would be suitable person to see for consultation.

Generally a physician specializing in hair transplant surgery or a dermatologist can diagnose these things. DPA is diffuse patterned alopecia. DUPA is diffuse unpatterned alopecia. One has a pattern and other does not. Under clinical microscopy of the fringe area around the sides and back of your head, the DUPA patient will have significant miniaturization present, while the DPA patient will have a healthy donor area. I do not mean to make light of it, but a good physician should be able to diagnose these things.

Tags: dpa, dupa, diffuse unpatterned alopecia, hairloss, hair loss

Dear doctor, this site has been helping me and guiding me a lot about hair loss. I suggested my brother to start Propecia 3 years ago and with doctor’s prescription he started it and has really been doing very well. Propecia controlled his hair loss and he even got some reversal. He was very happy about it till 2 months ago, where he was prescribed COQ10 by one of his endocrinologist. He started reading all kinds of information regarding COQ10 interactions with finasteride and found this article.

He became so nervous about parathyroid tumor they mentioned in that web site. He is blaming me for suggesting such drug to him now. He has been taking Co-enzyme 10 since 2 months and is worried a lot whether the parathyroid tumour has already started. Please please help him with his anxiety. Do they really interact with each other? What is the solution for such problem.? Your reply will help him get rid of his anxiety.

The COQ10 interaction is news to me. Although I doubt a parathyroid tumor connection, if that is one of his worries, he should seek medical attention to calm his fears. Parathyroid tumors can be diagnosed if he has one.

Tags: coq10, parathyroid tumor, finasteride, propecia

Hello Doc,

I had my first hair transplant 6 months ago in Texas and I received 1613 hair follicles in the frontal region (That’s what my Doctor claims 1500 + courtesy grafts). I lost all the transplanted follicles within first 2 months and I see few hair follicles growing in the sides.

From the day one I had doubt that I didn’t receive the number of follicles I paid for (1500). I felt I received only 1000-1100 grafts, My buddy did count the number of incisions made 2 days after the surgery. I also went to a hair transplant surgeon to get a second opinion but the surgeon refused to do the counting as he felt it was unethical thing to do. However he convinced me that I would have received the number of Grafts I paid for. He also told me the incisions are microscopic and I cannot count it accurately. As the days went by scabs started to form and I did my research by comparing the photos of people who received same number of grafts as me in the frontal region.

After all the research I’m still convinced that I didn’t receive what I paid for and I feel cheated. It took me great pain and sacrifice to get that surgery and I feel its not even worth it. I have decided to wait for few more months to see, how may hair follicles will grow and how far it covers my bald spot.

My question to you is

1) Is it normal to feel what i’m going through
2) Can someone count the number of incision/grafts accurately after the hair transplant ?
3) Lets say if I get a HT from you, How Am I insured that I receive what I paid for ?
4) Do HT surgeons really cheat ? or Am I just being paranoid ?
5) Lastly In case im really cheated , What Can I do ??

I don’t mean disrespect you or the HT surgeons community But I’m very disappointed with my situation. Please answer all my questions and relieve me from this confusion.

Thanks in advance.

I don’t know if it’s “normal” to necessarily worry about getting cheated, but I suppose that depends on your level of trust with the doctor.

On occasion, I have been requested to count the grafts for someone that wasn’t my surgical patient. I had one of my patients feel that he was cheated and took a professional photograph of his head the very next day. He had a large photo printed and placed pins in the wounds that he could see (in the photo, of course) and found that only 50% of the wounds were pinned after the analysis was done. So I managed it by showing him: (a) the count sheets of the 5 individual technicians who did the cutting of the grafts from the strip and we added them up together, (b) I had him come in to watch a surgery on his second day to see if he could identify the wounds in all lighting conditions with good photographs (he could not), and yet he watched us place the grafts to know that the counting process is intricate. He saw that there were two counts that were done simultaneously — one by me audited by an assistant working next to me as the sites were made, and one by the staff cutting up the hairs and grafts from the strip. I invested a great deal of time to address his concerns. I am not sure, to this day, if all of my efforts were successful.

In three people that came to see me to count their hairs and grafts on the 3rd-6th day after surgery, in two of them I found that the counts did not match up. One was off by over half of the amount claimed, one had 90% of what was paid for… and the third was on target.

On another patient, I counted the grafts and the hairs that grew 8+ months after the surgery (the man was relatively bald in the front and top where the grafts were placed) and found that many of the grafts did not grow to the numbers transplanted (about 2000 grafts out of 7600 graft he paid for), and the hairs in each graft had low hair counts. This was done under the assumption that everything on his head in the transplanted area were grafts. I had inside information on this last patient from one of the doctor’s technicians who claimed that this was far more common in that particular doctor’s practice than he could stomach, so he quit working for there.

There is little recourse for the patient if he feels that something improper has occurred, as an investigation would be difficult. I think that most doctors are honest and try to do their best when they deliver a service like a hair transplant or, for that matter, any cosmetic procedure. This, of course as I have said many times before, is a buyer beware issue, and each and every prospective patient should do their research before making a final doctor selection.

Tags: hairloss, hair loss, hair transplant, surgery