i’d like to know the possibility of having a transplant if i’m Norwood 6. I’m 21, had a transplant when i was 19 for the hair line of 2000 grafts but my main problem was density all over. i think i have good density. i opted for a hair piece which i’m really satisfied with it, but i know it has a short timeline so i’m considering a transplant again

so my question is.. how many procedures one can have if he is TYPICAL norwood 6?

You may have serious problems if you had a 2000 graft transplant at the age of 19. I generally look at 19 years old (or even 21 in your case) as a person who is not a candidate for a hair transplant. You need a Master Plan by a competent and caring doctor. The doctor you had is suspicious if he is doing 2000 graft cases on 19 year olds. I would guess that the surgery did not work well, so the hair piece addressed that issue.

Your question on how many transplant procedures are needed for a Class 6 balding pattern does not reflect an understanding of supply and demand (please read this post).

Tags: hair transplant, hairloss, hair loss

I’m 20 years old and considering quitting finasteride after 15 months as I’ve seen no effect at all, but I’ve read finasteride can make you more sensitive to dht. Is this true? By quitting will I be more susceptible to dht than I was before taking it, or will it down regulate aftertime. Many thanks.

You will not be more sensitive to DHT, but you will lose all of the benefits of the drug if you stop it. Even though you say you’ve had no positive effects, it is possible that the medication at least slowed the rate of your loss. After you stop taking finasteride you may see hair loss which would have reflected the hair you would have lost 15 months ago had you not taken the drug in the first place (which I refer to as “catch-up” hair loss).

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

Hello. I am a 33 year old male and up until 2 years ago had a thick, full head of hair. I have been noticing significant thinning in the front and top portions of my head. There seems to be channels throughout the front and I can see deep past the hairline when I style my hair. Baldness and thinning are not on either side of my family. I don’t understand what is going on.

I have had trouble with my job due to the economy and my marriage of 10 years is about to end in divorce so I have never been so depressed or worried in my life. Could this be the cause? If so, if ever things smooth over will I experience any regrowth?

Also, I have used hair gel for about 18 years now. Could this possibly be the cause? Something weird though, it feels like my hair hurts their in the same area that it appears thinning. Any insight from you would be definitely appreciated. Thank you.

Hair gel isn’t the reason for your hair loss, but stress can cause hair loss… and you clearly have a lot of stress. See a good hair doctor to get some advice after a thorough examination of your hair and scalp.

Tags: hair loss, hairloss, stress, divorce

I respect the fact that you advise using the medications first and clearly state the benefits of using Propecia. If I would not have read your blog I would have just tried Rogaine per my dermatologist. The information is just not out there to use this kinda of treatment / prevention. I was shocked to see some of the great results people have using this as a treatment alone. All you see or hear are the terrible things. I had no idea the drug even regrew hair for most people. Especially for men like me who are 30 with minimal thinning.

Anyway, I was scared to death to take this medicine. I am sure some people have had problems. People also have problems with cars, smoking, and beef. I am close to 90 days on treatment thus far and couldnt tell I have even taken it. The only side I have is feeling alot less stressed knowing I am at least on the proper medicine.

I think your blog is important and I truly believe there is so much misinformation online. Growing older and having some degree of hair loss is normal. I just had my hair cut this morning. I was again told I have tons of hair and this is all in my mind. Granted I dont have the same hair I did when I was 16. Men freak out.., I of course am one of them.

The absolute worst thing I have ever done for myself was trolling the internet. I cant believe I read and re-read these internet forums ( I am sure you are aware of the sites), where people talk about their experiences on these drugs and experimental treatments. I should have known that people who have great results on these drugs certainly do not write about it on hair loss forums. Lets me honest, have you ever had a great steak then written an online review of the place that cooked it? Its few and far between. Propecia is not a silver bullet. However, it is FDA approved and has undergone a battery of clinical tests over several years.

My main point here is, yes people need to do their due diligence in taking medicine. You would not buy a car without test driving it. No one writes anything positive. But be certain, if you have a bad experience you will tell everyone.

Thanks for your frank opinions. We have published many comments and some photos of people who have received wonderful benefits from Propecia over the years; however, seemingly just like on the TV news, you mostly only hear the bad news. The good news isn’t reported very often, because bad news sells and grabs the attention of the audience.

Your comment about reviewing a great steak is spot on. If your food wasn’t prepared to your satisfaction, you’re probably more likely to let people know how dissatisfied you are. As I’ve written before, those that feel wronged by something are generally the most vocal. Everyone else will just continue to live their lives.

Tags: hairloss, hair loss, propecia, finasteride


My mother died in 10 months ago. The night before the service i washed my hair and noticed a patch of my hair was gone. It is now 10 months later and no hair has come back, but the patch has not gotten any bigger. what can i do?

See a good doctor to make an assessment of your problem. There are many causes for hair loss and an experienced doctor can give you a diagnosis after a good examination of your hair and scalp.

It’s possible the stress from the loss of your mother caused your loss, and if that is the case I would expect some hair to start growing within a year.

Tags: bald spot, stress, hairloss, hair loss

Hello doctor.

I have been using minoxidil 5% topical solution for a while now, and have always had this question on my mind. When I apply it, should I just get the substance spread out on my scalp and be done there, or should I actually rub the substance in thoroughly afterwards?

Thanks in advance, I am looking forward to hearing back from you.

A good application to the scalp is enough to get the benefits of minoxidil. Massage it gently into the scalp, but keep in mind that rubbing excessively could pull out the weak hairs on your head.

Tags: hairloss, hair loss, minoxidil, rogaine

Dr. Rassman,
You have mentioned before that you have the classic mature hairline. Would it be possible for you to post a good size photo of yourself to get a better example of how deep the mature hairline is?


There is no secret to a mature hairline. If your hairline seems too high for you, then it is too high for you (mature or not). The real issue is whether you are balding (getting a higher hairline over the months and years) and if you want to do anything about it. Keep in mind that a mature hairline is usually about one finger width above your highest forehead wrinkle. This isn’t necessarily a hard rule, but it generally works out that way.

Upon your request, here is a photo of myself (click to enlarge):


Tags: mature hairline, hairline, hair loss, hairloss, rassman

I am a 53 year old caucasion female (post menopausal) with fibromyalgia and some sub-clinical auto-immune syndromes, chronic pain syndrome, failed back syndrome, and on and on. I have also been experiencing hair loss from the entire head and have several plaques that my rheumatologist is concerned about, because the skin is tightening. I have also had numerous spots of alopecia areata. Mometosone furoate 0.05 cream has stopped the general shedding,but i am still dealing with the alopecia spots. I want to have injections (kenalog or similar) to get the hair growing fast in those spots, while they can still be treated. could you comment on some or all of the following treatments:

1) oral prednisone
2) aldacton
3) aldara
4) very brief and minimal use of mometasone furoate ointment 1/g on the worst spots.
5) if a woman begins treatment with rogaine, do she have to use it forever?

Thanks if you are able to answer any of these questions. i realize this is not the equivalent of seeing a physician.

I really can not go into the multiple medications you discussed, as I am not your treating physician and don’t have your medical history. Alopecia areata can come and go, and any doctor that is going to manage your medications and various conditions should be a doctor who you respect and like.

Rogaine (minoxidil), when used, takes at least 12 months. If it is effective, it must be considered a lifetime medication or any benefits will cease if the treatment is stopped.

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

Snippet from the article:

Hair loss is a common disorder that affects many men and women due to aging or medical conditions. Current FDA-approved drugs can minimize further hair loss but are unable to regrow new hair. The Institute of Bioengineering and Nanotechnology (IBN) has recently engineered a new hair follicle model that could help discover new drugs for hair regeneration1.

IBN Executive Director Professor Jackie Y. Ying said, “We have applied our cell and tissue engineering expertise to create a hair follicle-like structure that is very similar to the native hair follicle. This model allows us to better understand the mechanisms that control the development and growth of hair follicles. We hope that our invention would lead to novel ways to treat hair loss, which affects millions of people worldwide.”

Read the rest — New 3D hair follicle model to accelerate cure for baldness

The title of the article is quite hopeful, but essentially this is something they hope to sell to pharmaceutical companies to aid in their hair loss drug treatment development.

Tags: hairloss, hair loss, model, research

I was interested in getting a strip surgery in a couple of years. I was wondering if it better for a person to get a large session done at one time such as 4500 grafts? Or is it better for a person to get a smaller session such as 2500 grafts, and then wait for a few months and get additional 2000 grafts? Also, I have noticed that doctors provide a discount after 2500 grafts. Are they encouraging people get larger sessions done?

On the hair loss forums I have seen a person picture where he got 4000 grafts implanted through the FUE method. This man paid for 4000 grafts, but his surgery resulted in a failure. In the end he lost money, and had to live in embarrassment for the rest of this life. I was wondering if the strip surgery has similar risks for large sessions?

It is not all about numbers. You need a doctor who understands the progression of your hair loss — how to address future hair loss along with present hair loss. You need a plan rather than just thinking of short term goals. Each and every patient is different, with different needs and different hair loss degrees. To some it may be reasonable to have a 4000 graft surgery and be done with the entire ordeal. But with 4000 grafts at one time may come a large donor scar. My point is that your surgeon should discuss all of these factors and give you a Master Plan tailored to your genetic hair loss pattern and your social needs.

We are all born with a finite amount of hair. Some people have more donor hair and some people have less. The availability of hair is a demand (how much you need) / supply (how much you have) issue that must be understood by everyone who is going to have a hair transplant.

The cost of the surgery, while it is a factor, should not be the main factor in your decision making process. Hair transplant surgery is permanent and I am always flabbergasted at the patients who seek out the lowest bidder. This is not like buying a car. The surgeon and the medical group, no matter what they advertise, are ALL different in their techniques and results. Not all strip surgery is the same and not all FUE surgery is the same. As you clearly point out with the failure of the 4000 graft FUE surgery you saw on a forum, the results will be forever and any hair loss from failed or poorly done hair transplants can not be priced just by doing another transplant. The hair supply reduces with every transplant, so losing money can be replaced by more money, but if the hair is gone, then there is no solution. Valuable donor hair reflects more value than losing money.
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Hey Dr Rassman,

If a patient were to come and request to have as many grafts that their donor supply would allow then have the SMP procedure done in between those grafts and also had the scar camouflaged in the back of the scalp, wouldn’t it be nearly impossible to tell the persons head of hair from a non balding person?

Like for those individuals with high donor densities if some had 10,000 grafts placed on their scalp then had the micro pigmentation procedure done i would think they would be able to get close to their juvenile hairline back and they would also be able to grow their hair out to probably a number 1 clipper without it looking too odd. What are your thoughts on this?

Yes, we have done this before. Here’s an example of a patient that wasn’t satisfied with his transplant and had SMP done to give it a fuller look. Another patient that comes to mind had SMP done first, then had 500 or so FUE grafts placed into his head to give him the feel of stubble.

Though, if you’re going to have 10,000 grafts placed, I would probably wonder why you’d want to shave your head down to a 1 guard.

Tags: smp, hair transplant, pigment, scalp micropigmentation

Snippet from the article:

Hair loss can be one of chemotherapy’s most despised side effects. Now US researchers are about to put an experimental hair-preserving treatment to a rigorous test. The goal is to see if strapping on a cap so cold it numbs the scalp during chemotherapy works well enough to be used widely in this country, as it is in Europe and Canada.

The first time Miriam Lipton had breast cancer, her thick locks fell out two weeks after starting chemotherapy. But when the disease struck again, she used a cold cap during treatment and kept much of her hair, making her fight for survival seem a bit easier. ‘‘I didn’t necessarily want to walk around the grocery store answering questions about my cancer,” recalled Lipton, 45, of San Francisco. ‘‘If you look OK on the outside, it can help you feel, ‘OK, this is manageable, I can get through this.’ ”

Near-freezing temperatures are supposed to reduce blood flow in the scalp, making it harder for cancer-fighting drugs to reach and harm hair follicles. But while several types of cold caps are sold around the world, the Food and Drug Administration hasn’t approved their use in the United States.

Read the rest — Cold caps tested to prevent hair loss in cancer patients

For years now, we’ve written about cold caps to help retain much of the hair for those undergoing chemotherapy, so I’m glad it is getting more attention. This latest study of early stage breast cancer patients is set to begin this summer.

Tags: dignicap, cold cap, study, chemo, cancer, chemotherapy, hairloss, hair loss

Dear Dr Rassman,

first of all, many compliments for the work that you are doing, writing blogs, responding to questions using your in-depth knowledge, as well as having unique sensitivity for patients in your responses. Sincerely, such professionals are hard to find anywhere in the world.

This brings me to my issue. I am a 26 year-old male from Eastern Europe. The look/appearance of my hair has always been really important to me. I also appear on stage a lot (I am a musician), so not having to worry about hair appearance too much is of vital importance for my self-confidence. Unfortunately, I was not blessed with very good hair quality. I have some balding pattern on my mother’s side, although my father is not bald. I first noticed that my hairline was receding in high school. It was on the sides on the frontal part, with the right side advancing far more quickly. The hair at the top of the scalp was maybe slighty receding, but not noticably to the general public. So the biggest problem is the frontal part.

At 20 years old, I decided to start using Propecia. I think generally the situation with my hairline has not gotten worse since then, I do not appear bald or anything. The problem is that the hairline of the frontal part is beginning to bother me more and more – a little wind blows and it messes the hair up, or I have to stand in front of the mirror for ages to get the desired look at the frontal part, which is really a tedious drill that I don’t wanna do any longer.

Since this is really an issue that’s been bothering me for 8 or 9 years now, I believe that a procedure to restore the frontal hairline would be the right solution. Preferably, I would very much like to do it at the NHI, since you guys really appear to be professionals and great advisors – the money would be well spent. In my country, we do have some practitioners that do hair transplants, but they all do other forms of cosmetic surgery as well (like nose-jobs etc.). I really don’t want some semi-competent doctor messing with my hair and finally messing it up.

So, my question is the following: since I just started working and my budget is pretty low, I really don’t have to money to travel to LA and to pay for the procedure, unfortunately. It also appears you do not have offices in Europe, which is a pity. But maybe you could give me some advice (names of doctors) near my country ( e.g. Italy, Germany, Hungary) for whom you know that their work is of best quality – I suppose you often meet in different fora, etc. – so that I could undergo the procedure as soon as possible.

I would be extremely grateful for your response.

The Moser Clinic in Austria does work of the quality I do. I have met many doctors from Europe, but have not directly seen their work. That may change in the future. If you want to stay local, just be sure to do a lot of research. Try ISHRS.org as a starting point for finding a doctor in your area.

If you want NHI to do your procedure, we do offer a Standby Fee of $5.00/graft with one of my associates, and I will allow up to 5% of the fee to apply for travel expenses. We also supply one night stay in a local hotel at our cost.

The photos you sent me show corner recession, and I would expect that it would take about 1000 grafts to fill it in with a density equal to 25% of your original density. A second session may be required to get to the ideal 50% of the original hair density, but many people can get away with one session (at 25% of the original density) and look perfectly natural and normal. The key is to not have it look like a hair transplant.

Tags: europe, hair transplant, hair loss, hairloss

I am 41 years old and have been on finasteride 1.25 mg daily for 10 years. My father had prostate cancer in his late 60s and I wish to get the PSA antigen test but hear the finasteride drug obscures the results. How is it evaluated the PSA score when on this drug?


For those unaware, a prostate-specific antigen (PSA) test measures the enzyme levels of the prostate. Elevated PSA levels can point to prostate cancer. The results of a PSA test for men taking Propecia can result in a decreased level of PSA. At 41 years old, prostate cancer is very rare, but getting a good baseline while you are on Propecia is a good idea as any increase in the years to come might well be an indicator for prostate cancer.

If you’re thinking about having a prostate cancer screening done, you should tell your doctor that you’re on finasteride so that they can double your PSA score.

Tags: propecia, finasteride, psa, prostate cancer

Snippet from the article:

Last week, former President George H. W. Bush had a full head of hair when he gave President Barack Obama a pair of socks. Today, it’s gone, shaved to the scalp in solidarity with a young cancer patient.

According to a statement from a spokesman for the 41st president, Bush shaved his head after members of his Secret Service detail shaved theirs, meant to show solidarity with Patrick, the two year-old son of one of the detail who is battling leukemia.

Read the rest — Bush 41, security detail, shave heads to show solidarity with young cancer patient

Tags: politics, bush, cancer