I just wanted to see what your thoughts were about my “theories” in regards to Minoxidil 5%.

Firstly, I have read online about how it has caused erectile dysfunction, anxiety, heart palpitations, etc.

Are there any studies that show that these are legitimate side effects, or are they just symptoms listed by individuals? I think it is highly possible that these individuals could be effected by the listed side effects due to psychological issues due to their hair loss, and assuming the minoxidil is causing these physiological symptoms.. What do you think?

Secondly, do you think that the failure rates of minoxidil are due to people who stop using the solution too early on, rather than the minoxidil not “working”?

What you read on the web isn’t always true.

The official reported side effects are listed on the minoxidil insert and the drug profile (see here). Minoxidil taken orally in pill form is a blood pressure lowering mediation, so it is conceivable you can get lightheartedness and heart palpitations if your body absorbs too much of the topical. Chest pain and fainting are also possible if you’re sensitive to the medication. Erectile dysfunction is more likely to be due to a psychological issue or an underlying medical issue, rather than minoxidil.

With respect to the failure rates of minoxidil, I believe it is partly because of compliance issues. Many men and women have a hard time adhering to a twice a day schedule, and therefore do not get the full benefit of the treatment.

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

Hi doctor, I’ve been using finasteride 5 mg for MPB, but in the third month I had total impotence and shrinkage, i stopped, sexual organs returned to normal size hear some gain libido,but erectile Dysfunction persists even after 6 months ( no morning erections, or nocturnal) and and I also have pain in the prostate, what should I do? ( I used previously for 2 years finasteride of 1mg without side effects.

We never recommend taking the 5mg dose of finasteride for the treatment of hair loss. Did you increase the dosage on your own to 5 times the normal amount for treating hair loss, or did your doctor prescribe this to you? And if you took the recommended 1mg dose for years without side effects, why was your dosage even increased?

In any case, you should see a urologist. These are prescription medications, and I don’t know enough about you (medical history, age) to really have an idea of what is going on.

Tags: finasteride, propecia, proscar, hairloss, hair loss, impotence, side effects

Let the buyer beware” has been placed at the end of many of our posts. Researching your doctor is your responsibility. You must do the necessary research to protect yourself from doctors who claim expertise in the hair transplant surgery field and then can not deliver what they promote.

A gynecologist in Puerto Rico moved to California and set up shop doing hair transplants. Unfortunately, the reviews this woman found online for this doctor lead her to have surgery with him, resulting in horrible complications. I don’t know how much research was done beyond reviews (did she meet patients to see real results in person?), but I feel for this woman and her story should be a cautionary tale for everyone.

I found this video from NBC News in the Bay Area (Northern California), which I’ve embedded below. Warning – The photos shown in the video require a tough stomach.

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First of all, I’m a huge fan of your blog, it helped me a lot.

I visited a surgeon a year ago and he said he would do the surgery for me, but finally i did not have it done. I’m 24 and I haven’t noticed any hair loss for a year or so. I’m only balding in the front and it’s not too bad either.

I’m thinking of doing it now. But I read here that it’s usually not suggested to have it done at this age. Does usually mean that there are exceptions and occasionally you have patients at this age? How do I know my surgeon has my best interest? I actually do trust him. He is a member of ISHRS and seems very trustworthy. He said he usually doesn’t do it for young people, but that I have a lot of hair in the donor area and that since my hair is bright and curly, it’s easy to hide the balding.

We put together this post to help people like you to select a doctor: Selecting a Hair Transplant Doctor. You have to apply judgment in filtering out the variables discussed in this reference.

At 24 years old, you are at the marginal edge for doing hair transplants. Ask yourself — what is the rush? Is it bothering you enough to do something about it now or would waiting another year help you make the decision?

Tags: hair transplant, surgery, hairloss, hair loss

I recently suffered from an OCD scalp-picking condition (dermatillomania) from high levels of stress, for about a year. Now, there are no scales on my scalp and it is really sensitive. All the hair is still there, it just sits really strangely on my head (without direction). I wanted to take steps to returning it to its original condition, but I’m not sure where to start. Thank you!

I’m not sure how you would be able to correct the direction of the hairs. You might try topical conditioners and test many of them. You may have caused permanent damage to the skin and thus seeing the directional issues with the hair.

Tags: dermatillomania, hair direction

I noticed your recent post about protein powders and how they have no effect on DHT and hair loss. I’ve seen some posts on your site, but I feel that exercise and supplements (other than steroids which obviously impact hair loss) have not been adequately addressed.

For example, many studies indicate that creatine increases testosterone and DHT. Also, generally speaking, exercising increases testosterone levels. Therefore, wouldn’t exercise and working out increase DHT and therefore hair loss? Also, maybe we can get a more straight forward answer on certain common supplements such as Creatine and Glucosamine. Thanks

I do not believe that working out will increase hair loss, but the straight forward answer is that we don’t know for sure. If you search the web, many talk about creatine and how it may relate to increased DHT, and ultimately hair loss. I do not know of any well constructed, reliable, or definitive studies about it, though.

In the world of genetic male pattern hair loss, the keyword is genetic. I suppose there are extraneous things you can do or take (anabolic steroids – a drug/hormone – not a supplement) to make the genetic trait worse or accelerate it. But in the end, even if you don’t do anything, but you have the genes for it, you will lose hair.

If taking creatine or glucosamine or other supplements worries you, then consider not taking them. Prioritize your goals. If you are taking these supplements to enhance your workout and gain muscle etc, nothing beats actually working out (an extra day per week or an extra 10 minutes in the gym is better than any supplements in my personal opinion).

Tags: creatine, glucosamine, hair loss, hairloss, exercise

I am 41 years old and a female. When i was 4yrs of age, i lost all my hair, including eyebrows, eyelashes, scalp and the nails on my fingers and toes. With homeopathy over a period of time, i regained my eyelashes, eyebrows, nails. With puberty, i grew hair in the correct places, normally. Just my scalp, arms and legs remain without hair till today.

I was diagnosed with Alopecia Totalis. I am happily married with a son also now. Do you have any hope for me,whatsoever? If not clinical, then
anything cosmetic that you can recommend for me which would be available in India?

Unfortunately, there is little anyone can offer for treating alopecia totalis. There are people with this disease where the gene runs in the family and the hair loss goes complete at the age of about 4. These conditions do not reverse.

You can visit the National Alopecia Areata Foundation site for support and the latest research.

Tags: alopecia totalis, hairloss, hair loss

When applying rogaine, does it matter where you apply it on the scalp for it to work? Doesnt it get absorbed in the blood vessels and spreads out throught out your scalp?

For example if you apply it on the top wouldnt it work for the front as well, or does it have to be applied on the exact area of hairloss? Thanks

I would follow the instructions including in the packaging. The basic idea is that you apply Rogaine (minoxidil) where you want hair to grow, twice daily. If you apply it on the top, it wouldn’t really do much for the front.

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

Hi there doctor rassman
here is a study on minoxidil injected to the scalp vs topical treatment – Egyptian Dermatology Online Journal

The injected minoxidil was done 2 times and then one time a week and yielded greater results than topical treatment.

This is clearly not an approved study; however, I would not doubt the results reported by the Egyptian doctor. Minoxidil was originally an oral medication for the treatment of high blood pressure, and it worked, though not well.

At an ISHRS meeting a couple of years ago, it was reported that minoxidil by mouth or intramuscularly could reverse hair loss and was a common practice in India. We know from the old studies on the oral minoxidl that systemic administration produced excess hair production in different parts of the body.

I will not be offering it in my practice until the FDA comes out in favor of it, but it is interesting research.

Tags: minoxidil, injection, hairloss, hair loss

Snippet from the article:

Going by the recent study on Alopecia by Chandigarh-based Plastic Surgeon Dr Tejinder Bhatti, it’s not just the “G” factor but the “A” factor that plays a major role in baldness. Dr. Bhatti has explained that the “G” factor – genes – do play an important role, but the “A” factor – A+ blood group, especially in males – makes one more prone to baldness. Dr Bhatti initiated the study in 2007 and completed it in December 2012.

Dr Bhatti opined that although patients blame water content or quality of their shampoo for baldness, but blood groups play an equally important role. A+ blood group people are unable to optimally absorb B vitamins, including Biotin, in their blood and therefore the thickness of the hair is quite low.

Read the rest — ‘A’ factor leading to baldness?

I’m not sure that I agree with this. It would be interesting to read it on a medical journal.

They kind of lost me once I read, “Dr Bhatti says that In male pattern baldness (MPB), in 80% cases the gene causing baldness comes from the mother’s side. So if your nana or mama are bald, there are 80% chances you too will be bald.” That actually just a myth and has never been proven.

Tags: hairloss, hair loss, blood type

Just wondering, im 30 years old hair starting to thin, i’m on propecia and curious about taking HGH. I want to get a bit bigger, but will this cause my hair to fall out? and is the safe to take this many drugs at once?

Human growth hormone (HGH) can cause hair loss, though one could speculate that Propecia might reduce the possibility of loss. Talk to your prescribing doctor about your plan.

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

Hi, if you do scalp micropigmentation to correct a donor scar with non-permanent ink. Can you later do FUE into that scar afterwards if you don’t like the results of the micro pigmentation. How long do you have to wait before doing it ? Must all pigments be faded ? Are there any risks ?


Since we have been performing Scalp Micropigmentation (SMP), there have been various clinics that started offering something like SMP, but with non-permanent ink. Non-permanent ink is just like makeup or just drawing something on your head with a pen, in my opinion, so you don’t have to worry about other procedures (it will erase off like a pen eventually).

On the other hand, SMP is permanent… but like all tattoos or cosmetic/medical pigments, it fades to a lighter color over the years. You may need a touch up, but it will NOT just erase. SMP is great to disguise an old hair transplant scar if you are going to shave your head or buzz it short with a zero guard.

There is no issue if you choose to have another hair transplant (strip or FUE) after the SMP, or even transplant into the scar if that is what you want. It just means that there will be more scars (linear scar from strip or hundreds of FUE scars) and you will need to pay and go through the entire SMP process over again if you want to hide the new scars. Very few patients have actually had another transplant into the scar, because our satisfaction rate is extremely high.

Tags: smp, pigment, hair transplant

Dr. Rassman
I saw a story that showed a hair transplant using the ARTAS system. The only downside to ARTAS is the machine only extracts grafts and doesn’t place them. I know you mentioned you had a patent to placing the grafts once they are extracted. Any idea on when Restoration Robotics will use that patent of yours?

The folks at Restoration Robotics know about my patents for placement of grafts. I am not privileged to know what they have planned for future versions of their ARTAS system, but I am sure that they will eventually automate the placement of grafts.

I don’t know how far along, if at all, they are with going down that path, but it would be the next logical step in their automation process.

Tags: fue, robot, restoration robotics, artas®

Snippet from the article:

For some men with prostate cancer, hormonal therapy to beat the disease could be safely cut from three years to half that time, a new clinical trial suggests.

When men have cancer that is confined to the prostate gland but at high risk of worsening, one treatment option is radiation therapy plus drugs that cut testosterone levels, because this male hormone feeds the cancer.

Right now, doctors routinely give that hormonal therapy for two to three years, during which time men may suffer unpleasant side effects.

But that routine is based on a clinical trial from the 1990s that found that adding three years of hormonal therapy to radiation could cure certain prostate cancers. That doesn’t necessarily mean three years is ideal.

Read the rest — Could Duration of Prostate Cancer Hormone Therapy Be Halved?

Tags: prostate, cancer, health, treatment

When I was an intern with the cardiac service of CW Lillehei at the University of Minnesota. Dr Lillehei had just performed a surgery on a 16 year old girl with a Tetralogy of Fallot (a congenital heart defect). Being 16, Maria was unusually old for this type of surgery as most children with this condition who are left untreated typically would die from the disease before reaching adolescence.

Maria had severe heart failure when she came to us for treatment. It was a very risky surgery for her, which at 16 and extremely ill, had very low chances of survival. I was the intern on the case and followed her into the coronary care unit after the surgery. She suffered 260 cardiac arrests over the first week (I believe a record). For this reason, I stayed with her day and night, addressing each and every cardiac arrest episode as quickly and as efficiently as possible. She was fearful if I ever left her room, even for a bathroom break. I ate my meals beside her and slept in the adjacent bed next to her if it was not occupied, or on the floor, or in a chair.

After the multiple cardiac arrests, her chest wound incision (the mediastinum incision from the base of her neck to the bottom of her breast bone), could not tolerate the repeated cardiac compression episodes and electric shocks for defibrillation, and the chest wound eventually opened up, exposing her heart. When she would sit up, her heart came out of her chest. Eventually, the heart became infected and I was assigned the job of washing out the chest cavity, putting my gloved hand into the chest and breaking up pockets of pus that formed around the heart and great vessels. The process of clearing up the infection went on for many months and eventually another intern took over that responsibility.

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