I am confused by some of your answers in the forum relating to graft anchorage.

Specifically, in your study with Dr. Bernstein, you conclude that from the 6th day, it is not possible to dislodge a graft by pulling the hair. Similarly, this is not possible by the 9th day by pulling a scab attached to the scalp/hair.

However, on some of your answers to questions related to graft integrity, you mention that as long as the scab is present, there is risk to the graft coming out (e.g. you advocate not wearing a hat until scabs come out, etc.).

So, are you saying that from the 9th day onward, the graft will not come out even if the scabs are scrubbed off, wearing a hat, etc. and the only time to worry about losing grafts due to scabs is in the first 9 days? Or is it possible to still dislodge a graft after the 9th day?

The reason I ask, is that I have a lot of scabs and started trying to remove them on the 11th day, and am wondering if the grafts would have set permanently by then, scab or no scab.


The graft pull study (PDF file) was done to determine when the removal of the graft, really meant that the entire growth center of the graft was removed.

We found that in the first six days, although the physical graft could be pulled out, the graft growth center probably remained (reflected the sleeve of the graft itself). We generally felt better when the graft pull was done at 9 days, but that did not mean that the graft growth center could be removed at the 9th day.

We are big on post-operative correct washing to minimize the scabs present. Some doctors do not give the patient the instructions on proper washing and scabbing may remain for very long periods (as long as 3 weeks). Although pulling out the grafts (at say 20 days) would still have what appears to be graft material in the pulled samples, there is little doubt that the graft growth center did not come out with these pulled grafts at 14 or 20 days.

Tags: hair transplant, graft anchoring, hairloss, hair loss

Hi Doctor,

I am considering a hair transplant and I just wanted to ask you a question. I’m 30 and a Norwood 3. I am thinning in and around that part of the hairline but maybe alittle on top. It’s thinner than my crown and sides let just say that. My back and crown is thick and untouched by the mpb gene. I’ve got very thick hair where it is not thinning and more than able donor supply. 2.0 cm hair count.

I’m just thinking in general should I do one now to get my hairline and thicken the front. Then 1-2 for the top over the next 10 years then done. Or wait 2-3 years and get a larger one done then another 2 years after? Just thinking in regards to scar and the lifetime master plan? Thanks

Only YOU can answer this question. A hair transplant is an elective cosmetic surgery to enhance your appearance. It is not a necessity. If you want to look better now with a fuller, hairier look, then it is your choice. If you want to wait until you have more hair loss before going ahead, that is also your choice.

Planning out how you may bald in the future and coming out with a life long strategy is also known as a Master Plan (something that I strongly advocate in my practice). The Master Plan is something you and your doctor need to discuss one-on-one.

Tags: hair transplant, hairloss, hair lsos

Both myself (49) and my wife (47) had very very thick hair. Our parents in the late 70’s still has most of their hair. And no baldness in both of our family. But we noticed in the last year both of our hair is getting very thin and showing sign of pattern balding.

The perplexing question is why is it happening to both of us at the same time?

I am not sure what you meant by pattern balding and the overall information you supplied is scant. To do a proper investigation of the coincidence, would would want to look carefully at what this hair loss pattern is, what are the possible environmental factors involved and give both of you a very thorough hair and scalp examination, as well as take a very careful, detailed medical history.

Tags: hairloss, hair loss, family

Snippet from the article:

Healthy young men with a Western-style diet may be able to boost their sperm quality by eating a small packet of walnuts a day.

These are the findings of a new study that shows healthy American men in their 20s and 30s who ate a 75g (2.5 ozs) packet of walnuts a day were able to increase the vitality, motility and structure of their sperm compared to counterparts who did not eat walnuts.

A report on the study appeared online on 15 August in the Biology of Reproduction journal’s papers-in-press section.

Infertility and subfertility is a common problem that affects about 70 million couples worldwide. Between a third and a half of cases are due to poor semen quality in the male partner, with scientists giving a number of reasons for this in industrialized societies: pollution, unhealthy lifestyles and the Western-style diet cited amongst them.

Read the rest — Walnuts May Improve Sperm Quality

The study included 117 men (between 21 to 35 years old) and was partially funded by the California Walnut Commission.

Tags: sperm, fertility, walnuts

This patient came back to see me some years after he had his last transplant with NHI. He had 3365 grafts transplanted over two procedures in 1995 and 1998 (grafts placed throughout the frontal hairline and top of the scalp).

This patient visited the office recently to ask about some thickening in the area behind the transplants where he believed he is thinning. He has been on Propecia since the transplants were done, and although most of the hair has been held, the genetics has been persistent at taking some of his hair away.

Click the photos to enlarge.

2012 (after):


1998 (before *):


* Note that the “before” photos above were actually from just before his 2nd procedure in 1998. The photos from before his 1st surgery in 1995 are not available (they weren’t digital), and although the quality of these 1998 photos isn’t the best, I really just wanted to show how the transplant looks after a lot of time has passed.

Tags: hair transplant, hairloss, hair loss, photos

Hello, I was wondering if you could help me out in explaining my blood results.

I am a 20 years old male and it seems and i am experiencing hair loss. I have Gilbert’s syndrome and i was told that it may somehow benefit to hair loss but i am unsure how. I used to have low iron in my blood and i thought that it could be an issue however i have normal levels of iron in my blood now but im still losing hair.

My blood results showed that my testosterone levels are normal however my dht levels are 3 times above normal. I recently experienced some weight loss. Could it be that my liver condition adds to the dht increase? can the dht increase be temporary due to my weight loss? what can i possibly do to slow it down?

Thank you!

I do not believe Gilbert’s syndrome (a liver condition) has any relation to genetic androgenic hair loss. The two are not related.

Gilbert’s syndrome is a hereditary condition that relates has to do with how your body metabolizes bilirubin. I am not sure how it may relate to your DHT levels or if that even has any factor in androgenic hair loss. I would recommend you consult with your doctor or an endocrinologist.

Tags: gilberts syndrome, gs, hairloss, hair loss

First off, great job on the blog Dr. Rassman. It’s probably the most valuable information regarding hair loss on the internet.

I noticed the first “signs” of MPB when i was 22 (26 now). I thought the corners of my hairline started to recede. That coupled with my brother and father being bald I freaked out and decided to see a doctor. I sought the help of a reputed NYC area specialist (I’m not going to mention his name) and upon a hair miniaturization test and the divulging of my family history he advised I go on Propecia. He assured me though that the minituarization was only slightly present just in the front of the hairline.

I got on Propecia right away and 4 years later my hair looks exactly the same short of a little more recession in the hairline but I would say that I am STILL not 100% at the mature hairline point that you describe so thoroughly on this blog.

Because my brother was pretty much bald (full NW5) by the time he was 22 and my father also a full NW5 by age 26 is it somewhat safe to assume that I may have dodged the bullet since I am 26 and not even a full NW2 yet? If it makes any difference I also physically take after my mother and in her family baldness is not common.

It is also very much possible that Propecia may be responsible for me keeping all my hair but I would want to know if there is any way to find out for sure. I would not want to take a drug I don’t really need for all my life especially with all the recent commotion about this product.

Thank you.

Thank you for sharing your story. I guess the way to find out for sure if Propecia was responsible, you’d have to stop taking the medication and see if your hair falls out. Not exactly ideal, and not something I’d recommend.

There’s also the HairDX Finasteride Response test, but it won’t tell you if Propecia is the reason you still have hair on your head. It should tell you if you’re responding to finasteride, though.

Tags: propecia, finasteride, hairloss, hair loss

Dear Doctor,

I moved from Quebec to Vancouver (Canada) and I am waiting to get my health insurance here. In the mean time, no dermatologist accepted to see me.

Of all the Internet, which is a pretty big place, you have been the greatest thing. Not only for your knowledge, but also because of the way you speak, because it feels like you actually care. I’ve seen very few doctors like this in my life.

I don’t know if you are a real doctor or not, I don’t know what you have to gain from this, but thank you. The comfort I found in your blog combined with the quality of information was a great source of relief. I believe I am not the only one who feels this way.

Thank you

What a nice way to start the day!

Yes, BaldingBlog is written by real doctors. While we can’t give specific medical advice, I am glad you’ve found some useful information on the site. Your words are appreciated.

Tags: baldingblog, thanks


I must be at an early norwood 3, in my mid 20’s and have started propecia, (its been a little over a month), has two questions;

1) Have there ever been cases where a complete reversal of baldness has taken place with use of propecia ALONE.

2) Could you explain the post finasteride syndrome (extremely scared of reports on the internet) and was wondering how often it is seen in patients (not just the sexual side effects, but also all the others described by some patients such as brain fog, memory loss, stumbling on words etc etc)

I have done a lot of reading and decided to take the pill anyways, so far no known side effects, except for a slight pressure in my prostate which went away within a week.

I have seen some dramatic results with Propecia, but I would not say a complete reversal.

I do not know the exact issues that are referred to as this post-finasteride syndrome. I realize there are anecdotal stories from people on the Internet who claim Propecia ruined their lives forever, but in the 15 or so years that I’ve been prescribing this medication, I have not seen anyone with permanent and lasting effects after they stop taking it.

I have read about it online, I know a select few readers/commenters on this blog are very vocal about it, and we’ve written about the interviews with patients that have resulted in a study that the media went crazy over… yet I still don’t know what is considered “post-finasteride syndrome”, since there are so many random side effects that people apply to this medication.

I do not know how Propecia may cause pressure on the prostate. I do not think I would even how that may feel. Please speak with your doctor on these issues.

Tags: propecia, finasteride, post-finasteride syndrome, hairloss, hair loss

I am 16 years old and I think I am starting to show signs of male pattern baldness. I noticed a few weeks ago that the hair on the crown area and top of my head was thinning, but I haven’t noticed any major signs of a receding hairline. I started researching and found that hair loss can be genetic. So I asked my grandfather on my mother’s side when he began to lose hair and he informed me that he started noticing hair loss when he was 18.

Another thing I found while researching was that amount of exercise can be linked to hair loss. Which, if true, can be linked to my hair thinning because I was training in MMA fighting for about two months but recently stopped and suddenly didn’t do any exercise at all. As soon as I stopped training is when I began to notice that my hair was thinning.

Also, I am experiencing slight itching and tingling in the crown area of my head. Another thing is that I do shower and wash my hair, on average, two times a day. I was surprised when I noticed my hair was thinning because I grow hair on almost every other part of my body except for my back. I have already set an appointment with my dermatologist, but it won’t be for another few weeks.

I was wondering in the meantime if it would be a good decision to start using a thickening shampoo and take vitamins. So if there are any suggestions that you can provide I would greatly appreciate it.

Genetic hair loss in men can generally start with the onset of puberty. The hair loss seen after your MMA training could’ve been coincidental, and body hair growth is unrelated to scalp hair loss. I’ve read online chatter that exercise / weight training and hair loss are linked, but I’ve not seen that to be the case.

There is no stopping or reversing a genetic predisposition forever. Hair thickening shampoos and vitamins are not cures, but may make your hair feel thicker. If you are worried about hair loss, you may want an objective examination and diagnosis before starting on an expensive journey of investing in shampoos and supplements. At 16 years old, you should also get a parent involved.

Tags: hairloss, hair loss, mma, exercise, shampoo

Dr. Rassmann,

I am 21 year old male and I recently had surgery to correct an underbite. I started propecia shortly after my surgery. Will the propecia protect against possible shock loss after the surgery? I’m concerned because I saw in earlier posts that in balding men with shock hair loss, the hair does not usually return.

Propecia is taken for treating androgenic alopecia, not for shock loss following underbite correction surgery. Hair loss after general anesthesia or medical issues is not related to androgenic alopecia.

If you were prescribed Propecia to treat your genetic hair loss, it might protect you… but I wouldn’t recommend the medication solely for protecting from a temporary shock loss.

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

some time ago i’ve noticed my hair becoming thin, i also have a bad habit of smoking cigs which ive been smoking for 2 years. so i figured if i stop smoking my hair might grow back thicker and fuller.well i just recently stopped smoking cigs for about a week.

not enough time has gone by to see if my hair would grow back, but i wanted to see if i could save my hair and whether or not cigs have anything to do with it

I don’t know anything about you other than you’re losing hair and smoked for 2 years. Smoking might contribute indirectly in some way, but I doubt that it is the reason your hair is thinning. In the great majority of cases, it is your genetics that causes hair loss. Of course I recommend that you stop smoking for your overall health, but I wouldn’t expect that quitting smoking would make your hair regrow.

Tags: cigarettes, smoking, hairloss, hair loss

Listen guys, I am sure you get this question a lot, but I’m 18 years old. Within the last year, my hairline has receded noticeable and on the crown of my head there is definitely thinning.

The side-effects of propecia (loss of libido, impotence, etc) turned me off to the product, so I first considered minoxodil (aka rogaine), well upon further research it seems that rogaine has a very rare and similar side-effects such as loss of libido and impotence which is long-lasting affecting the youthful and the more elderly.

Can anyone clear the air on this matter, please if you use/used rogaine explain if those horror stories hold any water. The company does not list it as a possible side-effect, but the amount of scenarios ive read on the internet (i know not very reliable) has implanted an idea that this may somehow be correlated with sexual side-effects.

I appreciate all of the help, I would really like to retain what I have, family does not have a good history with balding, yet speaking with them all, I am very young to have already begun experiencing this, most of them began in their late 20’s early 30’s, so I’m crossing my fingers because i like wearing my hair long.

All medications have side effect potential. Growing old also has a side effect of loss of libido, as well. Thinking about a side effect and growing scared to take a medication due to possible side effect after reading (as you state) “unreliable” information on the Internet, can cause that side effect to manifest itself.

I am sure you will find people who used Rogaine (minoxidil) claiming loss of libido, but it’s not a known side effect in the literature as far as I’m aware. Many of the people on forums that talk about various side effects they get from any medication diagnose themselves and look for the easiest answer to come up with as a source of their problems.

Get a clear diagnosis of your medication condition. Then find a doctor who can go over your treatment goals and come up with a Master Plan. After weighing out your risk and benefits, you can make the ultimate decision if you want to take the medication.

Tags: minoxidil, rogaine, libido, side effects, propecia, hairloss, hair loss

I have lost more then 40% of my hair. My dermatologist said I am still actively shedding. I had hormone replacement. I was told in October of 2011 that my level was a 4. I have had a hysterectomy and am menopausal.

A pellet of testosterone was inserted sub-subcutaneously I February. I developed severe cystic acne, shortly after. My testosterone levels were three times the norm from my age (in the high 200s almost 300) and sex. My dermatologist advised me to not get implanted again- then three months later my hair began to fall out. My dermatologist said this also was a result of the drastic swing in my testosterone levels- they are still quite high.

The men in my family start to experience hair loss around age 20. I’ve never seen a female in my family lose hair,- they have it in their 90s. Shouldn’t women be warned that Hormone replacement therapy can cause hair loss? I have no other health issues, had no disease or took other medications that cause hair loss.

I realize you are experiencing hair loss, but I cannot say if hormone replacement itself is the cause or if there should be a mandatory warning label associated with the therapy. Menopause itself could be the cause or there may be other medical issues, as well. I believe you are under the care of a physician and communications between patient and doctor is the most important element. My point is, before you start any medical treatment, side effects and treatment issues should always be explored.

Tags: hormone replacement, female hair loss, hairloss, hair loss

Hey Dr. Rassman,

Have been taking propecia for approximately 4 years and for the past two switched to finasteride due to it being cheaper. Have had fantastic results with my hair (have more hair now at 30 than I did at 24!)

However, I have slowly been developing sexual side effects over the past 2 years which has come to a breaking point recently. It is now difficult for me to get and maintain an erection and my semen is watery/decreased volume. I am currently taking 1.25 mg of fin a day. I am seeing a doctor today to get my hormone levels checked. I have two questions for you:

1. Do you think these side effects may go away if I lower my dosage to 0.5 mg/day and do you even think that is worth doing? I would love to keep my hair but I am worried I am poisoning my body.

2. If I want a hair transplant in the future, will me being off finasteride significantly limit my options?


Lowering the dose of finasteride may lower the side effects, as I have seen this in my practice. Always discuss your medication changes with your prescribing doctor.

While it is advantageous to be on finasteride when considering a hair transplant surgery, it is not an absolute factor. Many patients undergo hair transplantation without taking finasteride.

Tags: finasteride, propecia, hairloss, hair loss