Norwood 7We just spoke with a patient who had a full Norwood class 7 balding pattern with an approximate 2 1/2 inch height to the posterior rim. His donor density was very low from the pictures he sent prior to our phone consultation.

He had been making rounds with various doctors showing his picture and wanting a full head of hair. One doctor he spoke with quoted a certain dollar figure and told him that he could get a full head of hair from transplantation. I think he wanted to believe what he was told by this other doctor, and he was basically price checking with us. We told him that what he wanted was impossible, though. His goal was unrealistic and another doctor was about to take advantage of him.

Again and again, I hear of promises about bringing back hair from a hair transplant with goals that are not possible to attain. The promises from doctors who need the income seem to never stop. So as we always say — “Let the Buyer Beware”.

Tags: hairloss, hair loss, hair transplant, results

I found out that I have Peyronie’s disease and have been taking Propecia for some time. Is there any connection (cause and effect)?

I looked it up. One site said that Peyronie’s was reported in 6 of 4,700 patients on finasteride, which would be an incidence of 0.13% of this population. In the general population (even in those that do not take Propecia), the incidence is between 0.5 – 13%, and varies with age. That would suggest that Propecia is not a cause of this disease and perhaps (long shot) with its lower incidence with people on finasteride it even has some protective properties.

We’ve written about this before, but the connection is still unknown.

Tags: peyronies disease, hairloss, hair loss, finasteride, propecia

Snippet from the article:

A third of men suffering hair loss claimed it affected their confidence, a survey revealed. And nearly four in 10 admitted feeling envious when they saw a stranger with a full head of hair. One in seven said hair loss affected a relationship – and just over three per cent claimed they temporarily lost their sanity.

When asked what they would swap for a full head of hair, one in 10 men said they would give up a year of their life and a quarter were willing to waive a pay rise.

Read the rest — We’d give up a year of life to have hair, say 1 in 10 baldies

This comes on the heels of a separate survey of women that showed 16% would trade a year of life for a perfect body.

Tags: hairloss, hair loss, survey

I am quite interested and for many years now have been following and consulting with numerous HT doctors around the world regarding their results of using injectable hair stimulation PRP (+/- ACell) for treatment of MPB as stand-alone non-surgical treatment. HT surgery is something I am not interested at this time due to myriad of factors (e.g., DNA genetic programming resulting in possible future progressive hair loss and miniaturization of existing hairs, accelerated loss of native hairs due to the trauma of surgery, depletion of donor hair, multiple transplant procedures / sessions over my lifetime, not every person knows if they will achieve 100% satisfied result, picking right doctor is not easy as HT doctors have varying egos/costs/skills/artistry/ethics, etc). So for now I am content with only non-surgical methods and not HT surgery.

Obviously, I am not a doctor, and just another 55 year old male suffering from MPB thinning and receding hairline….but from all these years this is the information I have been able to glean regarding PRP (+/- ACell) treatment for MPB without HT surgery:

• Currently there are no scientific studies to indicate PRP (+/- ACell) works to regrow hair. There are positive anecdotal results with some enthusiastic and cutting edge HT doctors (e.g., Dr. Jerry Cooley and Dr. Gary Hitzig) but nobody can tell me what success percentage I will achieve, and will it be significant or not. Unfortunately, there is no established, standardized, or proven protocol that has been shown to be superior to any other delivery method….and each doctor is trying something different on their own through a trial-error effort to get to the point where a proven protocol will provide consistent results.

• Some HT doctors are spinning their own PRP with cheaper equipment and injecting what they claim are optimal platelet concentrates at < 5x platelet concentrates....on the other hand there's Dr. Cooley who claims optimal results using 5x or > platelet concentrates via the ANGEL system….and some HT doctors are now copying Dr. Cooley’s protocol after networking and sharing his notes @ various ISHRS meetings and conferences. Bottom line, it appears HT doctors are injecting differing platelet concentrate amounts in their practices depending on results….which again shows there is no established, standardized, or proven protocol for PRP (+/- ACell) hair injections.

• With HT surgery, as it is with PRP (+/- ACell) treatment by itself without HT surgery, it appears individual DNA genetic programming plays key role in determining overall treatment outcomes/success for each individual….and the ideal platelet concentration amount of PRP injected appears to have profound impact regarding how patients respond and their results….and presence of different cell types and growth factors also impact final results.

• Appears there is limited evidence to suggest lasting benefit with injection of PRP (+/- ACell) or growth factors, although there may be thickening of native hair follicles. It is unclear how long the benefits of treatment last and if the benefit will continue through subsequent hair growth cycles. However, all HT doctors agree on several factors regarding duration of treatment benefits: 1) underlying genetic balding pattern (e.g., PRP will last for a shorter time period for those who are DNA genetically prone to bald faster); AND 2) other maintenance treatments the patient is using (e.g., Propecia, Rogaine, LLLT or LaserCap, other topicals).

• Appears for many HT doctors/Dermatologists/Cosmetic Surgeons/Estheticians….especially in the United States….they charge excessive amount for PRP (+/- ACell) injections because they view as easy revenue steaming source due to desperation and gullibility of people with MPB issues buying into the HYPE for the next BIG THING or BALDNESS CURE….which it’s not.

With that in mind, I do have specific questions regarding personally using PRP (+/- ACell) for MPB without HT surgery. These questions may seem anal and more detailed than normal, but I have to ask because of the personal costs involved, and the fact there are still no established, standardized, or proven protocols to date for PRP (+/- ACell) hair injections for MPB without HT surgery .

• What specific protocols are you using that provide consistent results for PRP (+/- ACell) for MPB patients (without HT surgery)? Where did you receive and why did you determine to use these specific protocols?

• What centrifugal equipment are you using for PRP platelet concentrations? What PRP platelet concentration levels are you getting? What amount of PRP (+/- ACell) injections for individual patients? And how do you determine concentration level amounts of PRP (+/- ACell) injections for individual patients?

• How much do you charge for PRP (+/- ACell) injections?

• How many PRP (+/- ACell) injections per year do you recommend someone getting? Is PRP (+/- ACell) injections perfectly safe over the long haul many years from now due to stimulating cell growth? Obviously, cancers are concern for everyone and nobody wants to wake up or stimulate genetically predisposed cancer cells, etc.

• How many PRP (+/- ACell) injections for MPB (without HT surgery) have you performed to date? How long have you been performing these PRP (+/- ACell) injections in your practice?

• What is the success percentage of total PRP (+/- ACell) injection patients for MPB (without HT surgery) that actually grow more hair and increase diameter size of existing miniaturized native hairs? From these successful injections, can you measure or visually see the significant or appreciable percentage difference in overall hair growth and appearance for your patients? (e/g., 25% better stronger looking hair?/50% better stronger looking hair?/75% better stronger looking hair, etc)?

• Do you have portfolio of these patients before/after photos that I can see on-line? Even better if possible, can I contact these patients myself either via email or telephone to ask their overall impressions regarding their results?

The above text was written to my private email and is a good overview of the PRP topic, so I have included it in our blog.

I do not engage in using PRP and ACell for hair growth or in hair transplantation. We do use on occasion ACell with the patients permission for donor wound healing, but we do not charge the patient any money for this. We absorb the few hundred dollars for the ACell since we cannot positively claim its benefit. Once I see value, clinical proof, and scientific proof, I can change my mind about the offering.

I don’t believe that these treatments are anything more than human experimentation for profit, or just a profitable venture. Desperate people will spend lots of money chasing the pot of gold under a distant rainbow.

Dear Docs,

is there any way to determine one’s hair shaft thickness (whether coarse or medium etc) without microscopic measurements? Some websites suggest that coarse hair needs more time to dry than normal, others claim that fine hair reflects more light and can’t be felt between thumb and index finger. Are these statements true? Sometimes I realize that even in my donor some hairs vary in colour and thickness, cant remember if this has always been the case. On top of that, whats the difference between medium and medium coarse?


I suppose you can use a micrometer and caliper to measure the shaft diameter, but I wonder how this information will be helpful to you? If you have fine, medium, or coarse hair, that is just who you are. Hair can vary in thickness depending on what stage of the growth cycle they are in.

As for defining medium and medium coarse, it sounds pretty self-explanatory to me. Medium hair thickness is the middle of the spectrum, and medium coarse would be just between medium and coarse.

Tags: hair character, medium hair

Snippet from the article:

BALDING brothers Barry and Brian Cowan have gone back to their roots to save their careers. Barry — lead guitarist with Scots indie band Vigo Thieves — and male model Brian were horrified when they began losing their hair. So the boys, from Wishaw in Lanarkshire, decided to do something about it. They discovered a revolutionary new transplant treatment on offer for the first time in Scotland.

Yesterday, at The Glasgow Clinic in the city centre, the brothers had around 5,000 hair follicles transplanted from thicker hair at the back of their heads to the thinning top and crown.

Read the rest — Cowan brothers baldly go for hair transplant treatment

I guess this was news because it hadn’t happened in Scotland before, but we have had many dual procedures where brothers go at a transplant on the same day, even some sets of twins. We have had father and son transplants on the same day as well. This produces great spirit and brings our staff together in great joy.

Tags: hair transplant, brothers, hair surgery

Hi Doc,

So a little background. Have been on finasteride for approximately 8 months. I think its working, since I have not progressed at all and maybe perhaps (don’t know if its my mind playing tricks) have seen very slight thickening.

I asked you a similar question before regarding the generic finasteride from pharmascience. You stated that I should be good with this drug as the company is a reputable one here in Canada.

However today my question is about the 5MG. I take that and cut it into quarters and have been doing so since the beginning of my treatment (so that its cheaper for me)…I read somewhere on your site that this is not recommended….and some people/doctors claim that the ingredients of the pill are not equally divided??? could you elaborate on this…am I fine with what I do or should I switch to the generic 1MG (which is available in Canada)…do you roughly (again roughly) still get 1.25 if you quarter the pill with a pill cutter?? So just wondering if I may be loosing ground with what I do, or that I am infact fine with the above regimen?

Thanks in advance

I am not sure where you read on this site that cutting the 5mg finasteride wasn’t recommended, but I’ve been suggesting doing this for years. You just need a doctor to prescribe the higher dose with the instruction that the pill is to be cut.

Cutting a 5mg tablet of finasteride in quarters is just as good as taking a 1mg pill. In a perfectly ideal world the drug companies would make a 1mg version and sell it cheaper than the 5mg version, but for now the 5mg version is about $30 for 90 pills while the 1mg version is $100 for 90 pills.

So in the interest of cost savings, you can cut the 5mg version into four pieces to make 1.25mg. If you know how to cut a small pill into 5 equal pieces to make 1mg each, go for it! In general, when you cut the pill you will never be precise and you may get more or less 1.25mg. This is alright in my opinion as long as you consistently take the medication on a daily basis. My reasoning behind this is that studies show 0.5mg is almost as effective as 5mg dose, so the daily variation should not matter as long as the drug is taken on a consistent basis.

Tags: finasteride, propecia, hairloss, hair loss

Hi Doc Rassman,

my compliments for a fantastic webpage. I’m a 39-year old male, had FUE 4 weeks ago on the front of my head. So now after 4 weeks, my surgeon has prescribed 5% Minoxidil solution to be applied twice a day on the transplanted area and the crown. (Not on the sides and back he said)

From your blog here I understand that this needs to be applied lifelong? And if I stop,then whatever hair has grown/ strengthened will also fall off. In this event, is it advisable to start the minoxidil? I have already had a transplant, so is there really any need for this solution?

If I want thickness in certain areas, I can always use hair concealers like Dermatch and Toppik.

What are your thoughts about this assessment of mine?

Thanks for your help.

Once you start the medication it is generally recommended that you take it indefinitely. If you stop, the gains you see from the medication will go away. Using topical concealers is up to you.

I’m not sure how big your hair transplant procedure was, so I don’t know if the medication may be beneficial. Why don’t you ask your doctor what the Master Plan is?

Tags: hairloss, hair loss, minoxidil, rogaine

Hey Doctor R,
I was just wondering about growth cycles of hair. In terms of non-scalp hair, or body hair, which tends to have a shorter growth phase – what happens here? Like do the genes which navigate hair growth just shut off after the hair reaches a particular length? Like I began to get curious about this when I trimmed some body hair – but did not shave it completely off. After, it is trimmed the hair begins to grow again and stops at the same length.

How does the hair “know” its been cut? Do the genes controlling hair growth become active again when body hair is trimmed or shaved? I know this is kind of a weird question, but I thought you may be able to provide me with some kind of explanation. Thank you!’

Body hair grows to a certain length and also has a different growth / rest cycle than scalp hair. Scalp hair has a longer growth cycle, which is why you can have your scalp hair grow very long. When it is cut short, the impact of gravity is lessened, and its character is more evident. People with crew cuts have a bristly feel of the scalp, but when the hair is very long, its weight impacts they way it looks. The characteristics of the hair is genetic.

Hair is not sentimental, does not feel pain and holds no grudge when it is cut short.

Tags: body hair, hair, haircut

After my visit to your office today, I was more confused because your miniaturization analysis showed no miniaturization and your bulk analysis seemed to contradict the finding by identifying early balding. I thought that miniaturization was the most important test a doctor could do to determine balding. Please help me understand what appears to be a discrepancy.

I am sorry that I confused you. Before the Haircheck bulk measuring device was invented by a Florida hair transplant surgeon, the only way one could tell if hair loss was occurring was:

  1. Seeing excess hair falling out (very early and not conclusive)
  2. Seeing a balding pattern developing (maybe too late)
  3. Looking for miniaturization (does not always appear, especially when hair loss is slow)
  4. Taking photographs and comparing them (often too late)

By doing bulk measurements, it is a very sensitive way of understanding hair loss with a metric that is replicable once the measurements are repeated and compared over time. In your case, the metrics showed early hair loss, but there was no miniaturization present in the area of concern. Based upon this, the drug finasteride was recommended. By repeating this test in a year, you will know if the hair loss is stable or reversing, and if you are progressing in both anatomic areas as well as local measurements to see the state compared to what was done today.

Tags: hairloss, hair loss, hair bulk, miniaturization, examination

Hello Dr. Rassman

I have a question about a condition I’ve had since the age of 17. During school i first noticed that the hair on the sides of my head started to thin, i then noticed general thinning of my entire scalp hair, i noticed the thinnest hair coming from the crown. as a few years pasted i noticed slight recession on both sides of my hairline.

What i find bizarre is that I’m now approaching 26 and still have pretty good coverage, the only thing I’ve noticed in the last 3 years is 2-3 tiny bald spots in random locations across the scalp (no conventional pattern) my crown thinning has not to my knowledge progressed

What i can tell you is that i am a male, my mother also has entire scalp thinning, but even thinner than mine but no slight recession. i always remember my mother having hair like this.

My father who’s 69 has still got quite a lot of hair, in fact he only started losing a bit of hair around his early 60’s.

If i do in fact have DUPA what does the future hold for me in terms of further hairloss?

I do not know what you have, but if you have diffuse unpatterned alopecia (DUPA), then in the future you will have diffuse thinning in no particular pattern. I have no way to know how much more you will lose hair though, as everyone is different.

There is a cosmetic treatment for DUPA patients, called Scalp MicroPigmentation (SMP). It is not a cure by any means, but it can make you look fuller. In any event, you should see a doctor and get a diagnosis.

Tags: hairloss, hair loss, dupa

Hi Doctors,

Just wanted to say thank you to your commitment to this website — as a medical student (University of Virginia) I’m impressed daily by your not only your expertise but your willingness to provide honest advice, even when this is not advantageous to you, financially or otherwise. I see too many doctors doing otherwise on a daily basis, unfortunately.


We appreciate your kind words. :)

We’re off today to pay respect to the men and women who gave their lives for their country… also known as the unofficial start of summer, Memorial Day. We’ll be back tomorrow!


Snippet from the article:

In the world of TV soap operas, it’s a familiar storyline. A brilliant but troublesome character who was written out of the script years ago makes an unexpected comeback, sending ripples of excitement through the community but also reopening old wounds. That, in essence, is what happened in stem cell research this week, with the return of a technique called therapeutic cloning. What comes next should make for compelling viewing.

A few years ago, therapeutic cloning looked like the future of medicine. It promised to realise the dream of repairing damaged tissues and organs using a patient’s own cells. But it also had a dark side: producing its supply of stem cells required the creation of human embryos which were later destroyed.

Read the rest in New Scientist — Stem cells: Back to the future

So maybe this means that within our horizon, we will be able to create hair cells from our donor area with cloning instead of transplanting the hair itself. Of course, this is theory right now and there is much to be worked out… but perhaps this points the map for the work we have to do.

From the same issue of New Scientist, I read another article about stem cells, more specifically about human stem cells created using the Dolly cloning technique:

    The idea is to take a cell from a patient – from skin, for example – and fuse it with a human egg cell emptied of its own chromosomes. The fused cell behaves like an embryo and generates hESCs [human embryonic stem cells]. In theory, these cells can be turned into whatever tissue the patient needs.

Hair could be a target for this just as the heart, kidney, or liver can be. I am aware of an effort that was made in the 1990s where hair cells were reproduced and injected into hairless mice. These hair cells grew in the Petri dish, but when injected into mice, they grew wild and in all directions, causing infection that killed all of the mice. Not so easy, huh!

Tags: hairloss, hair loss, hair growth, stem cells


I’m a male that recently turned 22. I’ve been suffering from hair loss for about 4-5 years and started with minoxidil at the age of 19½. The last 9-10 months have been like hell (my hair loss accelerated quickly and the depression started). I had decent coverage all over the scalp last summer but that’s not the case anymore. The hair is thin all over the scalp and I’m soon going to have a baldspot on the back of my head.

I’m somewhere between NW4 and NW5 on the norwood scale. I’ve got alot of tiny almost transparent hair on my scalp.

I want to keep the hair I still got on my head but also reverse it if possible. What do you recommend? Shall I try propecia or even dutasteride?

Nprwood 5You probably should have started Propecia (finasteride 1mg) when the hair loss process began, instead of minoxidil. Young men can reverse hair loss on finasteride, but without trying it, you will not know. At the least, the process can be slowed or stopped with finasteride.

You need a good doctor to manage your situation, because after all, it is your hair and your future hair loss we are talking about.

Tags: finasteride, propecia, hairloss, hair loss