Dear Dr. Rassman,

I am a 27 year old male who experienced extensive hair loss following the use of Accutane about 6 years ago. The hair loss stopped after about 18 months, but the original volume never recovered. I’ve been using Rogaine and Propecia for about 5 years. While my hair loss seems to have slowed (it’s been very gradually thinning ever since), the crown remains very thin to the point where it appears as an obvious bald spot, and my hair color (dark brown) exacerbates the problem.

I’ve attached some photos. I had a hair transplant evaluation two years ago by a dermatologist who specializes in hair science- he told me that while I have a thin crown, it wasn’t thin/bald enough to justify a hair transplant because the transplant would likely damage/destroy too many of my remaining crown hairs for there to be marginal gains in density. At the time of the evaluation, I had mistakenly left some hair thickening product in which may have influenced that evaluation.

My question is as follows: at what point in the balding process would most reputable doctors determine that the marginal gains of a hair transplant to the crown justify any damage/loss to whats left of the original hair in that area? Is there a certain metric that’s used (ie hairs per centimeter in the area)? Furthermore, I was just curious about the typical number of grafts required to restore a natural crown, given that the crown is very thin but not completely bald? Thanks!


Generally, men your age will respond to finasteride (Propecia) with regrowth in the crown, but clearly from your email, this was not your case. A good doctor should work with you through the specific logic and goals in your case. Treatment options may include Scalp MicroPigmentation / SMP (as long as you have hair there, this is a good option) or a hair transplant with between 1500-2000 grafts. The higher number is for individuals with fine hair.

Without an examination, it’s difficult for me to tell just how thin your crown is or what appropriate action you could take. There’s no exact metric to determine when the right time to transplant is. Everyone is different. Since it has been 2 years since your last evaluation with a physician, you should consider seeing a doctor again to find out if your options have changed.

Tags: hair loss, hairloss, crown, hair transplant

Hi Dr. Rassman,

My question is simple, yet I need to have some advices on how to handle it. I am worried for my man. He’s turning 24 in a month and is having some, let’s say, noticeable hair loss on the side of his head. I’ve always thought it was just the way his hair was but his hairdresser told him lately that she felt his hair was not as thick as it was before and that he might be losing it. The problem with that is, even though he recognizes having a problem, I don’t feel like he’s ready to do anything about it. I’ve told him to talk to his doctor, but he haven’t done it yet and doesn’t seem to be willing to.

I know there’s not much I can do if he’s not willing to help himself but, what can I possibly say, on a medical side, to convince him to at least see a doctor? I know the younger you are, the better are the chances to have great results. In the end, all I want him to understand is that i love him and I don’t want him to suffer in the long run, like when he’ll be 30 and bald. What are the facts about losing hair at a young age that you could tell me, so that if he decided not to do anything about it, he at least knows where it would lead?

Thank you for your support.

Honestly, it is up to him to decide if he wants to treat his hair loss. If you can’t accept his thinning hair, I think the problem may be yours. Treating hair loss with medication when it is early will provide the most optimal results, but it isn’t your place or mine to convince someone to seek out treatment that they don’t want or aren’t ready for.

If your boyfriend wants to do something about it, he will. This is a cosmetic issue, not a medical issue.

Tags: hairloss, hair loss

Snippet from the press release —

Over 101,000 people in the United States underwent hair transplant surgeries in 2010. The International Society of Hair Restoration (ISHRS) also reports that just over 89 percent of those surgeries were performed on men, with the average age of these men ranging from 50 to 59. The scalp is the most common site for hair transplants, and 92.8 percent of hair transplant surgeries target that area.

Celebrities are no strangers to hair transplants. Many male celebrities undergo hair transplants to retain a fuller head of hair. Here are 14 celebrities who admit they underwent hair restoration surgery to help correct male pattern baldness.

Read the rest — 14 Male Celebrities Who Underwent Hair Transplants

See the list of celebrities at the link above.

Tags: celebrity, hair transplant, hairloss, hair loss

Dear Dr. Rassman,
This matter has become quite stressful to me. I went for a hair transplant a month ago, when I had a bit less than a 1000 grafts transplanted on my crown area. It was an FUE procedure. Most say that grafts should fall in 2-3 weeks following the procedure yet most of the grafts are still there on my head. They are not growing and they are not falling, period. The shaved donor area has grown but the recipient area still shows these tiny hairs with no significant change. I am becoming very worried about this matter. Is this normal ? I contacted the doctor and he said to give it more time, as hairs are supposed to fall. Any opinions/advice from your side would be very helpful.

I am starting to feel that I wasted 1000 very good grafts (as the doc said the quality was great, I had many 3-4 hairs follicles). Many thanks and best regards.

I will say every surgery is different and the hairs will probably fall out eventually, especially when the new hairs grow in. It’s not “normal” to have them stay in your head. Even if it does (or doesn’t) fall out, the success of the surgery is still not related to the initial hairs falling out. You will only know how successful your surgery was in about 10 to 12 months.

You already spoke to the doctor who performed your surgery, so I’m not sure what kind of assurance I can provide. I don’t know you and I did not perform your surgery, so I have no way to know about your healing. It’s possible that there was a problem with the surgery, but it’s also possible that it will all turn out fine and you’ll be pleasantly surprised. I wish I was able to provide some real info, but I’m limited without knowing more about your surgery or even having an examination.

Think positively, be patient, and good luck.

Tags: hair transplant, hair growth, fue

Snippet from the press release:

Survey results released today by the ROGAINE® brand, in partnership with Men’s Health, reveal the extent to which hair loss psychologically impacts men. In a survey of over 900* Men’s Health readers, one-third of men experiencing hair loss admitted to feeling “helpless” and over 66% used negative language like “victim,” “defeated” or “unavoidable” when describing the condition.

Read the rest — The ROGAINE Brand Reveals New Insights About The Psychological Impact Of Hair Loss

This is basically just a press release for a new marketing campaign by Rogaine with some buzzwords that caught my eye (it worked!), but I found the negative language used by the surveyed men to be interesting. Hair loss is treatable with medication if caught early enough, and other treatments such as surgery or SMP are also available.

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

Hey, can stress trigger or quicken the progress of a mature hairline?

I really don’t know the answer to this question, but I would think that the answer is probably “no”. I believe a apoptosis (cell death) is a genetically triggered event.

Tags: mature hairline, stress, hairloss, hairline

I’ve studied a number of HT docs for hair loss info and I’d say you and Dr. Bernstein are at the top of my list as far as knowledge and being trustworthy. You say that shock loss or additional hair loss from a transplant is uncommon these day though Dr. Bernstein says that you will probably have some loss from the transplant itself. I think he said it would be unrealistic not to expect some loss. Obviously a confusing contradiction for me. Could you address this?

I also find your history with Dr. Bernstein interesting. How do you 2 originally connect? You were partners at one time?

Dr. Robert Bernstein and I do not disagree on much. Hair loss secondary to a transplant is what is commonly called shock loss (it is a matter of degree of loss) and I think that is where your problem is. Traditional shock loss has been satisfactorily treated with finasteride in young men, but hair transplants do damage some existing native hair. Hair that is miniaturized is what is lost first, so what you see may not be a radical change even if you lose some miniaturized hairs that did not contribute to the hair bulk you have.

As for the second part of your email — Dr. Bernstein worked at New Hair Institute with me for 10 years before he opened his own practice in New York. We are good friends and colleagues. We published many groundbreaking medical articles over the years.

Tags: bernstein, shock loss, hairloss, hair loss

Snippet from the article:

During the last decade, more than 1,500 Americans died after accidentally taking too much of a drug renowned for its safety: acetaminophen, one of the nation’s most popular pain relievers. Acetaminophen – the active ingredient in Tylenol – is considered safe when taken at recommended doses. Tens of millions of people use it weekly with no ill effect. But in larger amounts, especially in combination with alcohol, the drug can damage or even destroy the liver.

Davy Baumle, a slender 12-year-old who loved to ride his dirt bike through the woods of southern Illinois, died from acetaminophen poisoning. So did tiny five-month-old Brianna Hutto. So did Marcus Trunk, a strapping 23-year-old construction worker from Philadelphia.

The toll does not have to be so high.

The U.S. Food and Drug Administration has long been aware of studies showing the risks of acetaminophen – in particular, that the margin between the amount that helps and the amount that can cause serious harm is smaller than for other pain relievers. So, too, has McNeil Consumer Healthcare, the unit of Johnson & Johnson that has built Tylenol into a billion-dollar brand and the leader in acetaminophen sales.

Read the rest — Use Only as Directed

This is a really informative and lengthy article you should read if you have some spare time. In a nutshell, the article says — the FDA isn’t perfect, around 150 people die every year from Tylenol misuse, and restrictions exist in many countries that aim to prevent overdose.

Tags: tylenol, acetaminophen, health, danger, overdose


You recently answered a question that perhaps I didn’t ask right about using Minoxidil for many years and the benefit on adding Propecia. I’d like to try again, because I think the answer is important. If you have used minoxidil for many years most hair subject to miniaturization would be minox dependent. Would that be a correct assumption? If so what is the benefit of adding Propecia to minoxidil dependent hair.. which after many years would be most miniaturized hair. Wouldn’t it be too late at that point since the hair Propecia might have helped are already minox dependent?

And since minoxidil is for life I assume any future miniaturized hair would become minoxidil dependent too. So what is propecia going to do at this point? I hope I was more clear this time.

Thanks again..

There is no way to answer this question appropriately without a controlled clinical study on this specific situation (those that start finasteride years after minoxidil dependence). That study doesn’t exist as far as I am aware.

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

I have two crowns on the top of my head. If I can expect to start thinning at the crown later in life, will it be from one crown over the other, or both? One of my crowns in more centralized in respect to the other. If only one were to experience thinning, would that be the most likely culprit?

Also, any news on the alleged hair loss creme that reduces PGD2 levels in men? It was announced in 2012 that because there are already cremes that reduce PGD2 levels for other ailments, that we could expect it on shelves as early as 2014.

Two crowns…. do you have two heads? The crown is the top of your head. Are you referring to two cowlicks or swirls on your head? If you were born with the genes for male pattern baldness, then you will lose your hair in a certain pattern as described in the Norwood classification chart (see here).

I am not privy to any new hair loss treatment creams that work. Prostaglandin D2 (PGD2) was being touted as a potential baldness “cure”, but the last I remember reading about it was that it was going to start clinical trials in a couple years, not necessarily be on shelves by then. There’s a long way to go still before PGD2 is proven to work for humans beyond hypotheses and lab mice research.

Tags: crown, hairloss, hair loss, pgd2

Snippet from the article:

It’s no secret that paying attention to diet, exercise, stress levels and getting social support may extend your life. But a new study shows healthy living may even reverse aging deep in our cells.

A small study shows that positive lifestyle changes lead to longer telomeres, which are protective caps at the end of chromosomes that help protect a cell from aging.

Telomeres are made of DNA and protein, and they work as a shield for chromosomes and help keep them stable. Over time they become shorter and weaker, leading the cells to age quicker and eventually die. Scientists have compared telomeres on chromosomes to protective plastic caps at the end of shoelaces. Telomere length has been linked to risk for diseases including some cancers, stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis, diabetes and even the common cold.

Read the rest — Healthy lifestyle may slow aging in our cells

The study was very small, tracking 35 men with “localized, early-stage prostate cancer for five years”. If the findings can be validated in a large-scale study, it could reduce the risk of a wide variety of diseases.

Tags: telomere, health

Hello Doctor,
I came across this article regarding Follica – Hairloss Cure: Could Follica Be A New Breakthrough In Baldness Prevention Products?

What are your thoughts about this? Is it something you are looking forward to?

Would you peel your scalp skin back? As the article states: …“sounds mildly terrifying: they start with a process called ‘skin-peturbation’ where the top layers of the scalp are peeled back.

There’s a long way to go before Follica would be able to be taken to market, so I’m not going to get excited about it yet. I’ve seen a lot of promising “cures” go nowhere over the years. We shall see.

Tags: follica, hair loss, cure, stem cells

Hey Doc,

I’m a little confused, and concerned about my hair. I went to a dermatologist last year as my scalp is inflamed and scabby, and was prescribed Ketopine shampoo. I also asked about my hair as I had been concerned about it, and was told I was not suffering from hair loss. However, I’ve recently had a hair cut, and it’s shorter than normal, and decided I’d take some pics, just to see what it was like. I’m a little uncomfortable by what I’ve seen, and I’m now I’m really quite worried as to whether I am suffering from hair loss, or whether the fact my hair was damp at the time of taking the (worse) pictures have contributed to my hair looking the way it does.

These pics were right after my hair cut, with damp hair. Different pics with flash, and others without: Photo. These are from before my hair cut, using the webcam on my computer to take the pics: Photo.

Finally, these two pics are from today, whilst my hair is dry. I have product in – I tend to always wear product to control my hair. This is just after getting up this morning, so I’ve not wash my hair or anything. Photo 1, Photo 2

As you can see, I’m a little confused as to whether it’s an illusion that my hair appears to be thinner, or if there genuinely is something going on. And I’m more confused by my dermatologist saying it was ‘fine’.

I appreciate that this is long and that there are many pics, but I don’t mind if you post anything. I’d just like to know if I’m worrying about nothing, or have a genuine reason to be concerned.


I’ve only posted a couple of the photos here, though I kept all the links to additional pictures in your above letter for those that are curious.


I don’t know that you have anything to be worried about, nor do I know anything about your hair loss history (or even your age)… but if you were confused by what your dermatologist told you, you probably should’ve asked him/her for clarification.

Wet hair and harsh lighting could make your hair appear thinner, but by what I can see in the photos you sent, I am not seeing any loss even with the lighting and damp hair. That said, I have written about the hair bulk analysis we provide by using an instrument called HairCheck. When tested with this instrument, your donor area is compared to other parts of your scalp so that you will know with reasonable certainty if you are suffering from the balding process, even before you can see it.

Tags: hairloss, hair loss, hair bulk


I am 29 years old and since 21 I’ve been on finasteride 1mg every single day. I started going bald at 14-15 years old with progressive receding of the corners. At 18, 19 years I was clearly a norwood 3. At 20 I noticed that my hair in general and mainly the frontal line was becoming more and more thinner, so at 21 I started my treatment with finasteride. I have to say that the results were better than I expected.

After 2 years I noticed my hair has become stronger and its quality improved significantly. The results were kept for more than 3 years. After that, I noticed a considerable reduction of the general volume of my hair that I could see (over strong light). I think today I am still a Norwood 3 and for people in general my balding can be hidden well, but the fact is that the genetic process is still running.

At the moment I am on finasteride every day, dutasteride once a week and ketoconazole shampoo twice a week. I would like an opinion about my situation. What more can I do to keep my hair and what is your prediction for a case like mine based on your experience over all these years? My father is bald and his process started very early too. Otherwise, my grandfather (mother’s side) has a head full of hair even in his 87 years.

You are fighting your genetics… and your genetics will eventually prevail. Sorry to tell you the bad news.

I hope you are under the care of a doctor, because dutasteride and ketoconazole do not add much benefit in hair loss treatment. You are likely doing enough by taking finasteride daily. I don’t know how I can form an opinion about your situation without seeing you, though.

Tags: finasteride, dutasteride, hairloss, hair loss

Snippet from the press release:

Histogen, Inc., a regenerative medicine company developing innovative therapies based on the products of cells grown under simulated embryonic conditions, today announced that the United States Patent & Trademark Office has issued patent 8,535,913, entitled “Soluble Composition for Promoting Hair Growth Produced by Hypoxic Culture of Fibroblast Cells”.

The patent, which is the fourth US patent issued to the Company, covers the liquid composition of proteins and cofactors that is secreted by multipotent stem cells through Histogen’s technology process, and the method of administering that composition to stimulate hair growth. Histogen’s Hair Stimulating Complex (HSC), covered by this new patent, is in clinical development as an injectable treatment for male pattern and female diffuse hair loss.

Read the rest — Histogen’s Composition for Hair Growth Receives US Patent

Tags: histogen, hair loss, hairloss, patent