I have been taking Pradaxa for over a year-I also take metoporol & digoxin. I always had plenty of hair & my eyebrows were almost perfect naturally.about 6 months ago my eyebrows have disappeared almost completely & my hairline is receeding–could these meds be causing this??? Thank you! I am a 68 year old female & would like my eyebrows & hair!

metoprololWomen lose hair just like men, but in different patterns and stages. Women don’t go bald like men, but they thin out later in life. This can also be genetic as well. For women, there may be other medical issues such as thyroid conditions. There’s a list of possible causes here.

In general, medications can be the cause of hair loss. Pradaxa (dabigatran) and Lanoxin (digoxin) aren’t known to cause hair loss as far as I can find, but metoprolol (marketed as Toprol or Lopressor) does have hair loss listed as a rare side effect. More importantly, these medications are taken for serious health issues, so they should not be stopped or changed without a serious discussion with the doctor.

Many women lose their eyebrows and this can be genetic as well (as do men). A hair transplant procedure is a good option for those who want eyebrow restoration.

Tags: pradaxa, digoxin, metoprolol, hairloss, hair loss, female hair loss, eyebrows

Snippet from the article:

It sounds more like an explanation that would be used by nursery children than respected scientists, but researchers have found that rather than losing their hair altogether, people who are going bald are suffering from “sleeping” hair follicles.

Trichologists have discovered that hair follicles on the scalp can become trapped in a resting state where they do not grow new hair, leading to thinning.

They now claim to have identified a way of waking the follicles up again to help restore a fuller head of hair to people who are going bald.

Read the rest — Balding men offered hope of waking their ‘sleeping’ hair

We have long believed that the stem cells that eventually grow into hair are probably still present in many people. Are they really dead in the balding man or can they be restarted by finding some defect in the pathway to the creation of an anagen hair? We really do not know this, so is it reasonable to call this sleeping hair?

L’Oreal in Paris carried out the research, and they’re reportedly working on a shampoo or cream to be a used as a new hair loss treatment. No time frame has been announced so far on this treatment, though.

Tags: loreal, shampoo, stem cells, hairloss, hair loss

A comment received from the recent post about Propecia and free testosterone levels

doctor…as an athlete, this is something about propecia which interests me greatly – but there just doesn’t seem to be enough information available about it.

Would there be anything to stop doctors like yourself taking bloodwork of patients before and during finasteride use so that you (as someone in a position who sees finasteride users daily) could report back to us – so we could make informed decisions taking into account not only our hair, but other matters also of interest to us like hormone levels?

Would really appreciate a response. Thanks.

This can be done, but insurance may not cover these tests. If someone wants to pay for the tests out of pocket, it would be in the hundreds or even thousands of dollars. And even if these tests were free, what would we do with the results? What significance or interpretations would come from the tests?

If you look in the literature, I am sure there have been similar studies done before Propecia or finasteride was approved by the FDA. You need to know what you’re looking for before searching for data points.

Tags: blood work, hairloss, hair loss, finasteride, propecia

First off thank you very much for such an informative and helpful website.

I am 25 year old male who is concerned with my hairline. I have always had a high or mature hairline since my teens along with really thick hair, but I am worried about miniaturization starting and progressing in my temple and frontal areas. My family does have a history of mild to moderate hair loss. However nobody in my immediate family is completely bald including both grandfathers.

I am interested in taking propecia. I understand that at my age and my stage of hair loss, I am a good candidate for the drug. I live in Denver and have scheduled an appointment with Dr. James Harris who appears to be one of Colorado’s top Doctors in hair restoration. However, the earliest I can see him is in a month and a half. Would waiting this 45 or so day period be detrimental to the goal of maintaining my current hairline? How quickly can miniaturization advance?

I don’t want to miss out on my window of opportunity but at the same time I want to talk to an expert who can examine me to see if I even need the drug, and if I do, discuss the side effects of Propecia before recommending an appropriate course of action.

Thank you so much for your time and advice.

Best wishes

I do not think 45 days would be a cause for alarm. At least you are getting in to see a reputable doctor in Dr Harris and he can give you a good assessment and recommendations. You need a diagnosis, then a plan. You cannot go about it backwards and blindly go on a medication.

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

There have obviously been lots of inquiries on the forum about ACell’s ability to multiply hair, but I’m curious about a different use. I had a consultation with a doctor that advocated using ACell in the donor region to aid wound healing (which you’ve discussed), but also injecting into the graft areas–not for hair multiplication, but to thicken miniaturizing hairs in the grafted areas and promote growth of the grafted follicles; sort of a nourishing property, if you will.

This is a completely different use from the “plucking” application yes? Any thoughts about this use?

ACell does not multiply hair. Some doctors, including myself, were involved in a year long study and the multiplication/plucking claims by the original doctors involved were false and unable to be replicated (see here and here). Otherwise, the entire hair transplant industry would have been changed by now (almost 2 years later).

Some doctors use ACell in the donor area to promote faster wound healing. It does not grow new hair there nor does it make the scar smaller. It just promotes healing faster. We have been using ACell at NHI for a couple years for this purpose and based upon our experience, I can say that there is no evidence presented anywhere that miniaturized hairs can be reversed with ACell.

Tags: acell, hairloss, hair loss, hair transplant, scarring

Okay, so let’s face it, hair loss sucks, hair loss does make a man less attractive by a noticiable amount. There’s no avoiding it. Propecia is an effective medication at stopping hair loss and regrowing hair. Is it really safe though? I have my doubts. One could say that anti propecia blogs are full of men who had problems in the first place and that most normal men wouldn’t be on these blogs in the first place. But the other day, I stumbled upon this article written by none other then Men’s Health magazine. Here is the link.

The full article is not available online but the first page does a good job of describing what the article will talk about. Now Men’s Health is no subtle underground publication it is read by millions of men. I’m no doctor but when you block DHT by using Finasteride which also happens to alter how your endocrine system functions, things probably won’t go well, hormones are emotional regulators and DHT is a powerful male androgen. Obviously hair loss is slighty devestating at worse and dissapointing at best but is it worth sucking out the life of an increasing number of men just for hair? Men want hair to appear as if they are full of life and virility so isn’t it ironic that propecia kills that motivation for many men?

The basis for the article in Men’s Health seems to be the tale of a guy with side effects from Propecia. Then it references a study that says sexual side effects occurred in men 45 to 78 years old when taking 5mg of finasteride (to treat their prostate problems). That is 5 times the dose for treating hair loss, and the prostate problems themselves can lead to libido issues without any medication involved. The article fails to mention that.

The rest of the article is a story about a man named “Charles K”. There isn’t much science here, but rather, a story about an unknown man.

Tags: propecia, finasteride, mens health

I am scheduled to go in for a consultation in two weeks for getting a procedure done. What I wanted to know, I have wavy hair but when it is short its not wavy. However, the wavy hair starts to come out on the top and front of my head first then the donor area follows a few week after. Wouldn’t that be a problem if I get a transplant b/c I will have straight hair in certain areas and then wavy hair?

Are most clinics required to develop a long term plan for future hair loss for a patient, and are they required to use devices to measure miniturization on the scalp for a patient?

You should always start off with a Master Plan, created by you and your doctor based upon his findings during your examination. If you have wavy hair in the donor area it will grow out as wavy hair in the transplanted area.

There are no requirements to measure miniaturization. It is something I stress in my practice and on this site, but many doctors do not do this, nor do they measure bulk of the hair in the various parts of the scalp in the initial examination.

Tags: hairloss, hair loss, miniaturization, hair bulk

Hello Doc,
I have recently been diagnosed with low testosterone levels and my doctor recommended that I start testosterone replacement therapy. Is it possible that once my testosterone levels reach “normal” or average levels that I will experience hair loss?

This is something you need to discuss with your doctor and express your concern to him/her. If you carry the genes for genetic androgenic alopecia (AGA) then testosterone replacement therapy can potentially cause hair loss.

Tags: testosterone therapy, hairloss, hair loss

I am 40 years old. I have bald areas corresponding to Norwood 3 Vertex but thin (but stable) hair corresponding to NW6 according to two doctors. I am not taking Propecia for 18 months.

1. Can I still progress to a NW6?
2. If you (Dr. Rassman) were to transplant me, would you fix the NW3 regions or the NW6 regions or both?

Norwood 6Generally, when doctors assess patients with a Norwood scale, it is meant to categorize your eventual balding pattern. You may not look like a Norwood class 6 right now, but it seems two doctors that have examined you think you are going to eventually be a Norwood 6. This likely means you are not a Norwood 3V, but you have a pattern leading to a class 6.

Many men on finasteride may never lose all of the hair in the end pattern, but no one really knows. Best to get good baselines with bulk measurements along with some good pictures, and then repeat them serially year after year to know where you are actually going.

So a good doctor should recognize this and transplant the hair with both a short term focus to address your immediate needs and a long term focus leaving enough donor hair available to address the evolving situation as it unfolds. In short, this is what I always stress about on this blog and in my private practice. This must be a Master Plan for each patient before going forward with the first hair transplant in what may become a course you will follow over your lifetime.

Tags: hairloss, hair loss, norwood patterns

since we know DHT is a cause of hairloss, why do some people start showing sings of male pattern baldness later in life? I know a few family friends pople who have had extremely thick beautiful hair norwood 1, with no signs of balding in their 40’s and late 40’s. then in their 50’s they started get thin and crown balding. if dht is the cause then i’m sure these guys had dht in their body in there 20’s, 30’s, and 40’s. why all of a sudden in there 50’s the dht decided to choke the follicles?

Dihydrotestosterone (DHT) is the cause of hair loss when it is associated with the genetic disposition of male pattern baldness. The genes that cause hair loss are preprogrammed and often express themselves at different ages.

For example, some men and women get grey hair in their 20’s, whereas some never do. Most men with the balding gene will go bald in their 20’s and 30’s, but there are always exceptions to the rule as you pointed out.

Tags: hairloss, hair loss, dht, age

Dear Doctor,

I am 28 yr old male. I have been losing a few strands of hair here and there for the past couple of years. However, it aggrevated in the past six months or so, with visible thinning of hair on the crown and receding of temples. I consulted a physician and a dermatologist. My reports about anaemia, thyroid function and blood sugar levels are normal. I was informed that I am suffering from genetic male pattern baldness.

I have been prescribed Minoxidil 5%, twice daily, Propecia once daily with Nizoral 1% twice a week. I have been on the above regime for a month. However, I have observed dramatic hair loss in the past month. I am loosing about 300 hair everyday. The most worrying part is that there are times when I loose a bunch of two to three hairs with a single white bulb at the bottom.

I am told that the use of Minoxidil can cause such increased hair loss. From your vast experience, can you confirm if such increased hair loss is common in the first month of treatment?

Also, assuming that this increased hair loss is pursuant to initial reaction to Minoxidil – will the hair lost in the past month grow back to their original length and thickness or is the best case scenario that only small thin miniature hair will replace them?


I’ve had some emails over the years of reporting on this site from people asking about minoxidil shedding. I’ve written about it here.

I can’t say for sure how long it’ll persist or if those shed hairs will regrow, but it seems to be a temporary thing that lasts about a month in those that see this initial shedding and the hairs usually do return.

Tags: minoxidil, rogaine, shedding, hairloss, hair loss

I have had several large hair transplant procedures. Subsequent to my last 2 hair transplant procedures I experienced a good deal of shockloss from existing hair which took months to grow back. I am interested in having SMP and was wondering, if because of my previous shockloss experiences from the last 2 hair transplants, would I be suseptible to shockloss from the SMP procedure?

Thank you

If you are considering Scalp Micropigmentation (SMP), you would need to arrange a consultation with us. Shock loss after SMP is rare, but is a risk you should consider.

Tags: smp, pigment, shock loss, hairloss, hair loss

Dear Dr. Rassman,

I am a 31 year old male who has been on Propecia for 5 years. After getting bloodwork done, it was discovered that while my Total Testosterone was high, the percentage of Free Testosterone was proportionately low.

Then, I discovered an article from an Egyptian medical journal entitled “Effect of Oral Finasteride on Serum Androgen Levels and Androgenic Alopecia in Adult men”, which found that all men in the experimental group experienced a decline in free testosterone after taking Propecia relative to no change for those taking a placebo. Were you aware of this? Does this not add to the growing body of literature showing how dangerous Propecia really is?

The main point of why Propecia (finasteride 1mg) works is because it changes DHT hormone levels. DHT is the result of testosterone catabolism (it is a byproduct of testosterone metabolism). So to say Propecia affects testosterone in some way is valid, but I cannot say what this really means. The study you refer to included only 30 men and it does not go on to state what the implication is or what the significance is of the findings.

For those interested, the study can be found here (PDF file).

These are the type of articles that can cause confusion and add fuel to the never-ending debate on Propecia depending on how you parse the information presented. Anyone can quote articles and infer what they want, but the real meaning or significance is unclear. At least this is interesting reading. Let the debates begin… or rather, continue!

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

Took Dr. Lees 5% non PG formula for years. After FDA shutdown switched to Minoxidilmax non PG form. After ran out of that tried Rogaine Foam and had a terrible shed in within 10 days. I know you don’t see much shedding in your practice, but why would I have such a dramatic shed switching from one 5% formula to another? Could it be the other formulas weren’t the real formulas? People swore by Dr. Lee so its possible Minoxidilmax wasn’t the proper formula. i just can’t handle PG. Even the women’s 2% form have PG.

I’ve read doctors who say stay the course during a shed, but if minoxidil is causing dramatic frontal shedding and the general wisdom is it doesn’t regrow hair in front, Seems like a losing prop to keep going. Would it shed hair that it doesn’t regrow?

Have to try something soon before I’m off minox too long.. Already on Propecia..


I would not know what is going on with your hair loss. It could be a problem with the formula, or maybe there’s another ingredient in there that you’re having an allergic reaction to, or it could be that the Dr. Lee product you used was stronger than 5%. Without an examination and follow up it is just a guessing game.

Typically it is my understanding Rogaine Foam is better absorbed than other formulations and does not contain the propylene glycol, so to have an opposite reaction is strange.

Tags: propylene glycol, rogaine foam, rogaine, minoxidil

I’ve read back 30 pages, but could not find a former instance of my question. Apologies if it is a chronic repeat.

I’ve been taking Propecia for one year, and recently accepted a lower-paying job. As such, I am interested in switching to the quartered 5mg generic Proscar method. I would like to know that the doctor is willing to prescribe the 5mg prior to scheduling an appointment – is there a way to politely obtain this information?

Thank you in advance for your response.

I can’t tell if your question is about another clinic or doctor at NHI. If it’s elsewhere, just call the doctor and ask. Most patients we treat with finasteride at NHI are prescribed the 5mg dose to save costs, and they are instructed to take 1/4 pill a day.

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