Dear Dr. Rassman,

you stated in a previous post that the pictures of the Dr. Gho patient is “confusing”. Could you be more elaborate on this topic? Why do you say so? In your previous post concerning Dr. Gho you stated that a follow up video would be nice. Aren’t these photographs followup documentation. It clearly shows regrowth. I used photoshop to lay the before and after images over each other. It is definately the same hair region displaying how the follicles are regrowing from the extraction sites. Why do you still consider this deceptive?


For those that missed it, the original post is here.

Has anyone ever stopped and considered that maybe the regeneration you are seeing is just regular hairs (missed FUEs) growing back? I mean, what about the photos of the recipient site? Did anyone count the number or percentage of transplanted hairs that actually GREW?

If 1000 hairs were harvested, 700 of the transplanted hairs grew in the new location and 300 hairs regrew in the harvested donor area, would you consider this regrowth or hair multiplication or hair stem cell transplantation? Of course not! But you can take pictures of the donor area and show regrowth, and take pictures of the transplanted area and also show growth. The observer could think, “Wow! This is regeneration!” — but the observer would be mistaken. To show regeneration, duplication, cloning, stem cell transplant regeneration, or an outcome that showed splitting of the hairs, you must account for ALL the hairs that were taken out and ALL the hairs that grew back (not just a sample section). Otherwise, it is just hairs that grew back after being plucked.

Basic high school science teaches us about conservation of energy or mass in the universe. Many have tried to invent the perpetual engine or create gold from lead with no success. If Dr. Gho really figured out a way to clone hair, then he will be famous. If you would like to believe in it, that is your prerogative… but simply looking at someone’s diary or posts on the Internet is not a way to validate or document science.

The method and presentation of Dr. Gho’s study has serious issues and it does and (will) confuse many readers. A credible review by a third party should be something that Dr. Gho should want to do, if he is legitimate.

P.S. I understand that you’re very excited for my answer to your question, but sending a dozen emails and blog comments demanding that I answer right away is unnecessary.

Tags: hair multiplication, gho, stem cell, claims

Dear Dr. Rassman,

Please read the link: RepliCel Announces Retraction of Public Disclosure

Do you hear the fat lady singing for Replicel (and us balding lucky ones)?


I had the link to the original press release and intended to write about it early this week, but saw it was removed. This explains it.

For those that aren’t aware, RepliCel issued a press release touting their hair loss “cure” and promoting the price of their stock. Then they issued a retraction of the statement, which is causing some on various forums to believe they aren’t hitting their targets. It sounds to be more like lawyers making sure they aren’t going to dig too deep a hole, but I really don’t know one way or the other. The link you sent about the retraction doesn’t mention anything about results of their treatment.

Tags: replicel, hairloss, hair loss, press release

dr Rassman, does consuming foods rich in phytosterols such as black sesame seeds cause hairloss? I know phytostreols are plant hormones, can they increase testosterone and therefore more DHT?

If it means anything, I’ve seen phytosterols listed as a key ingredient in various herbal hair loss treatments…but I couldn’t say one way or the other if they work (I’m leaning towards them not working).

As to whether phytosterols can cause hair loss — I am not an expert on dietary issues and phytosterols, so I don’t know the answer to that.

Tags: phytosterol, phytosterols, hairloss, hair loss

Hi, I have a couple of questions about finasteride, if you have any answers they’d be very appreciated:

– Does finasteride shrink the prostate even in men with a normal prostate (no BPH)? Are there any studies available for this?

– I have read that although finasteride is said to increase testosterone, it actually decreases free/bio-available testosterone which is more important than total testosterone for muscle strength/libido etc (see here). This worries me because as much as I want to save my hair, I am also an athlete and want to be at my peak. Could you comment on this?

– Along the same lines, do you have many patients that are sportsmen using propecia without side effects or reduction in their performance (particularly those in more ‘physical’ sports)? Apart from the ‘free testosterone’ theory, I have heard that DHT plays a role in strength/aggression etc.

Many Thanks for taking the time to read. I find it so frustrating that there isn’t more information on the subject and when I do find something I can’t be sure to trust whether it is a study which should be considered valid or not.

I don’t know if finasteride shrinks a normal prostate, though since it is used to treat enlarged prostate it can be inferred that there is the possibility of some effect. I don’t have any studies to refer to off the top of my head, but there have been many studies done relating to finasteride and BPH… so if someone has links to studies that this reader is requesting, please feel free to share.

From a practical point of view, I do not know if taking finasteride will negatively impact your overall physical strength. I would doubt that you would see an impact from reducing your DHT, but everyone is different and this opinion is not universal across the board. I don’t recall any of my more athletic patients mention their athletic performance being limited after taking the medication.

On the flip side of the coin, finasteride/Propecia was once banned in professional sports by the World Anti-Doping Agency due to a similar idea that it may enhance performance or mask steroid use. It does not and it is not banned in professional sports anymore.

Tags: propecia, finasteride, hairloss, hair loss

I came across your writing on SMP. I am a Norwood 5 – 6. Caucasian, fair skin blue eyes 63 years old. I decided against a hair transplant but would consider SMP. Can you tell me what the costs would be?

Are you planning of shaving your entire head? If so, the Scalp Micropigmentation (SMP) procedure will cost $7,000 and will include up to 2 touch-ups in the first year. The process often takes one or two touch-ups, as early as 5 days after the first, and then a month or two for a second. The pigment can fade and become patchy, so touch-ups are important. For less than the entire head, costs can be about half that. For very small areas, even less.

The first procedure often takes 6 hours and the second procedure can take 3-4 hours, depending upon the fading. Anesthesia to minimize or obliterate the pain is recommended and included in the professional fee.

Tags: hairloss, hair loss, smp, pigment

I’ve started balding a year ago (when I was 19), since then my crown has become very thin, but now i’m also slowly losing hair in front and top, what kind of Norwood class did I start with because I can’t find any that starts with the vertex while having full hair in front, but slowly thinning on top and front too.

Also, would you advice propecia to a 20 year old?

If you were taking Propecia (finasteride), the hair loss you are experiencing will be slowed, stopped, or reversed (particularly in the crown). The Norwood scale is to define the final stage of balding, not the interim steps you are experiencing. It’s not unusual to have the loss start in the crown.

Get a good doctor who will work with you to build a Master Plan for your short and long term hair loss problem.

Tags: hairloss, hair loss, propecia, finasteride

Dr Rassman

Many shampoos claim that they are “suitable for every day use” . Does that mean that shampoos that are not for every day use could be dangerous for hair ?

This is a statement that promotes the sale of more shampoos. It has nothing to do with health of hair issues.

Tags: hair, shampoo


I am a 41 year old female and have been thinning for several years. My hair loss was triggered by the removal of an ovary and a tubal ligation of the other. I have visited many doctors over the years with no success. Two have indicated that I have androgenic alopecia, the rest indicate I have telogen effluvium because my hair loss has a diffuse pattern and I show no miniaturization. I had the HairDx test done and the results were high androgen sensitivity and low risk of AGA. Both my physicians (an endocrinologist and dermatologist) are considered experts in their field and have a different set of opinions based on the results. One indicating no treatment needed and the other indicating I should go on finasteride. What is your take on this result?

I can not possibly form an opinion one way or the other based on what you wrote. I would need to examine you and make a determination based upon my observations and measurements.

Female hair loss is not as clear cut as male hair loss, so differing opinions are not unusual. Finasteride is not FDA approved for treating female hair loss, but your high androgen sensitivity (as revealed by the HairDX test) means there could be some benefit from the medication. It would have to be prescribed off-label, and is something you and your doctor should discuss in depth.

Ultimately, you may have to go with your gut feeling on this one.

Tags: hairloss, hair loss, female hair loss, finasteride

This may sound like a weird question and it might not really happen. If an individual is 29 years old and is on propecia losing hair at a slow rate initially, and then all of a sudden starts to lose it a rapid rate, and then goes back to losing it a slow rate what is the cut off age for you to perform surgery? I ask this questions because I am in a similar situation and I feel that my hair loss at a slower rate is preventing me from getting a surgery right now. I have minor thinning in the front which is noticeable in certain lighting, but still enough to cover it up for the time being.

I am afraid if I get surgery done right now, the shock loss will for sure kill those hairs I have in the front. And if I am losing hair at a slower rate it will be hard to determine when I will reach my final hair loss pattern, so by me getting a surgery will be pointless because I will always be losing hair, albeit it a slower rate. Please help!

If you want to have a hair transplant, taking Propecia (finasteride) in advance and through the process beyond 8 months, should reasonably be expected to prevent shock loss from the transplant. This has been my experience. Hair loss is progressive, and taking this medication should halt or slow your continued loss so that you’re not just chasing your loss with transplants.

As for your surgical candidacy, that is up to your doctor to determine. You’re not disqualified from surgery at 29 years old, though.

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

Is polysorbate an ingredient (in a cosmetic creme or lotion) which could temporarily increase the diameter of thin & regular size hairs? If so, how long would the effect persist after a single application? And assuming no commercial product is available could it be compounded by any pharmacist?

I am asking these questions because years back a commercial lotion, supposedly from Norway which (falsely) claimed to be the solution to baldness incorporated polysorbate (I can’t remember if it was polysorbate 20). An employee of a pharmacy who told me he was using the product stated that he had noticed an apparent increase in hair density over a short period of time which could not be from new hair growth. I did not try this product after reading critical comments. But I wonder if one could safely use polysorbate or for that matter other products to improve the apparent hair density.

Thanks in advance

I have no experience with this approach for using polysorbate (80 or 20 or any number) as a hair regeneration treatment. If it really worked, I would suspect I would know about it. I will, nevertheless, keep an open mind and probe it with some of my colleagues.

Tags: polysorbate, hairloss, hair loss, hair growth

Is Viibryd more likely to accelerate MPB than other SSRIs? Thanks Drs

Vilazodone (also known as Viibryd) is an antidepressant medication and I have seen in my research that there has been hair loss reported with its use. I have no way to compare one medication to the other concerning hair loss.

Tags: vilazodone, viibryd, hairloss, hair loss, ssri

This isn’t hair loss related, but it’s something I wanted to write about…

Bullying is one of the evils found in schools, and the spotlight has been placed on this topic as of late. When a young man develops adolescent gynecomastia, he often become the target for bullying and peer ridicule. This is common and often not a subject of focus between parent and child. I have just become aware of a suicide in a 16 year old boy who was the target of bullying when his peers found out that he had breast swelling. His parents did not recognize the social impact on his psyche.

Here’s a post on a gynecomastia forum that serves as a heart-wrenching example of the feelings of a man with breast enlargement, which may be a silent epidemic.

The good news for parents and men with gynecomastia who might read this post is that there is a simple surgical cure for this cosmetic defect. If you are so impacted, look to your communities for doctors who offer treatments.

Tags: gynecomastia, breast enlargement

I took finasteride for two months and then stopped because of decreased libido. However, I am not sure they were because of the drug. I had low libido even before I started to take it. It just got worse, but it might have been just in my head anyway.

Now, my libido is back to normal so I am considering starting propecia again. My question is, if I already have taken propecia without permanent side effects (because everything is fine now, those side effects were clearly temporary) does that mean that I will surely not have adverse side effects if I get back on it again? That even if I do have the side effects they will be temporary?

I think the key is that you had low libido even before starting Propecia (finasteride 1mg). You should speak about this with your doctor and consider further testing of your hormone levels. If you took Propecia and you believe it caused side effects, you can try a lower dose (such as 0.5mg). A lower dose may give you no or lower side effect profile, and is about 70 to 80 percent as effective for treating your hiar loss. In all my years in practice I have never seen irreversible side effects or even heard of them from short term use (2 months or so).

Tags: hairloss, hair loss, finasteride, side effects

Dr. Rassman,

I’ve had intense burning scalp pain for the past 10 months. It all started during a particularly stressful point in my life so I initially attributed it to that. Unfortunately it persisted so after a month I went to see my general doctor then 3 dermatologists, all whom said my scalp and hair looks fine (albeit slightly pink at times). One of the dermatologists did a biopsy in the spot that hurt the most and came up with nothing indicating why I would be in such excruciating pain. I was prescribed topical steroids which I used and did nothing.

Over the course of the 10 months the areas that are burning have begun to shed hair and not regrow them, where once I had an incredibly thick head of hair it’s started to noticeably thin (top, back). There is a point towards the back of my head to the left of my whorl that I have been told is hot to the touch, and that is the spot that hurts me the most. The best way to describe the pain there is as if someone is jabbing a hot poker into my skull. The rest of the pain in the top and back is like someone poured gasoline on my scalp and lit a match. The pain is so bad that sometimes it wakes me up and I end up throwing up due to the agony. It’s at its worst when I wash my hair, regardless of the shampoo.

Is this some sort of insanely aggressive MPB? Neither my father nor my mother’s father has any history of MPB. I am a 37 year old male and up till 10 months ago had no hair issues. Thanks for any advice/guidance you can give.

I’ve never heard this complaint before, about the scalp being hot to the touch (hypersensitive skin) as some sign of MPB. I always call on my experience with taking detailed histories from my patients. Sorry!

It could be something like trichodynia that you’re experiencing, which hasn’t really been studied all that much.

Tags: trichodynia, sensitive scalp, hairloss, hair loss

I’m currently 19 and my hairline has matured within the normal boundaries of the measurements that you have given and as far as I can tell my hair is not thinning as I am not losing an excessive amount of hair a day. However, I have noticed some shedding of shorter hairs from all over my scalp and I was wondering whether it is normal to shed some shorter hairs along with hairs of my normal length (about 2 inches long). Any advice as to what this maybe or what is causing it would be much appreciated.

I suspect that we all lose different lengths of hair in our daily hair loss experience. You should be examined by a good doctor if you are losing hair so you can determine what is happening to you and hopefully stop counting your daily hairs in the drain.

Tags: hairloss, hair loss, hair length