Our office is closed today and tomorrow to celebrate Thanksgiving with our families. We’ll be back on Monday!


First of all, I just wanted to say you are doing a great job with this website. I come here almost daily and it has helped me a lot dealing with my hair loss. I am in my mid 30’s and have been on proscar for a few years. This is the first time I am posting anything, and I have four questions if you could answer, it would be really helpful to me.

1. If a person does not have BHP and still takes proscar, would they still have the urge to urinate more frequently? Does the frequency of urination mean the medication is still working even after prolonged use?

2. I noticed when I first started taking the drug my morning erections were virtually non existent. But now, I am getting them more frequently, does this mean the medication is not working as well and my body is immune to the drug or am I just one of the lucky 2% not to have any noticeable problems?

3. I have read on here that you have asked some users to increase their dosage of proscar. At the same time, I have also read on here you have said that 1 mg does the same job as 5 mg. So why do you tell certain people to increase their dosage if the results won’t be any better? (don’t mean to be rude or anything)

4. When is the ideal time to switch to avodart? Should I try first increasing my proscar dosage and if that doesn’t work switch right away or slowly introduce avodart into my routine and then after a few weeks quit proscar?


First, I hope the Proscar you’re taking is cut into pieces, rather than taking the full 5mg pill daily to treat hair loss. Finasteride 1mg (Propecia) is a hair loss treatment, Finasteride 5mg (Proscar) is for treating the prostate.

1. Proscar / Propecia (finasteride) should not cause changes in urination frequency in those men without enlarged prostates. So how frequently you urinate has no link to whether the medication is working.

2. If you do have erection problems in general it may be a 1 (or 2) in 100 side effect. The fact you’re having more morning erections now than before probably has nothing to do with the drug, but rather other extraneous causes (such as a healthier lifestyle, diet, mental health, etc.).

3. I generally do NOT encourage patients to take more than the recommended dose of finasteride. If I have been inconsistent or not clear over the years on this site, then please point me to the specific post. I realize there are plenty of newsgroups and forums that may have a different opinion, but in my professional experience of treating thousands patients, they do not see a difference when they increase the dose. More importantly, changing the dose of drugs or changing to another drug is something you must discuss with your prescribing doctor. Trying to self treat by researching medications on the Internet may lead to confusion and misinformation.

4. I do not endorse anyone taking Avodart (dutasteride) for treating hair loss. I’ve prescribed it off-label on a limited basis and once in a rare while I do meet patients who have been on it, but I do not personally see a large enough difference to weigh it against the higher side effect risk.

Tags: avodart, dutasteride, propecia, finasteride, urination

Snippet from the article:

23andMe Inc., the Google Inc.-backed DNA analysis company co-founded by Anne Wojcicki, was told by U.S. regulators to halt sales of its main product because it’s being sold without “marketing clearance or approval.”

The Saliva Collection Kit and Personal Genome Service, or PGS, tells users whether they carry a disease, are at risk of a disease and would respond to a drug. Most of the uses fall into the category of a medical device and require Food and Drug Administration approval, the agency told the Mountain View, California-based company in a Nov. 22 letter made public today.

Read the rest — FDA Tells Google-Backed 23andMe to Halt DNA Test Service

I subscribe to this service and such an action by the FDA is very disappointing. This is an inexpensive service ($200) that allows you to look at your genome and compare it to others with various diseases and genetic traits. Most of my family uses it, and it gives us the security that only good data can provide.

Tags: 23andme, genome, dna, fda

Dear Dr. Rassman,

First I’d like to say I really appreciate your informative website.. It has helped out alot.. My question is; how does someone that doesn’t make a lot of money afford a hair transplant? I’ve read about a number of people that have had multiple hair transplant surgeries, some of these people who appear to be younger. I was just wondering how they afford to keep going back. Surely not all of these people have great paying jobs..

I’m not sure if my question can even really be answered but I thought it was worth a try. Thanks!

Realizing the cost can be high for a person who earns a low wage, we do offer financing options that are taken up by many of our patients. The key to cost is good communication with your doctor so you can see what he/she can do to help. We offer significantly discounted Standby rates to fill any open or cancelled slots on our surgery schedule, as well as offer a travel program that helps offset the costs of getting and staying here for out-of-town patients. Learn more about it on our Fees and Payment Options page.

In the end, a hair transplant is not a necessity as it is an elective cosmetic procedure. I realize some may not be able to afford it, but in my 20+ years of treating hair loss patients, the determined ones always seem to find a way to finance the procedure. One patient I recall (I believe he was a waiter) had a brown bag that he used to collect all of his tip money over years in until he had enough to pay for the surgery.

Tags: hair transplant, affordability, hairloss, hair loss, surgery, surgical cost

I’m 37, male and had 1700 graft hair transplant 10 days ago. I’m very careful of not touching the grafted area even if when it itch. there still a lot of scabs and now my head smells. Even with daily use of shampoo, it still stinks. Is it infected or is it normal? Do I need to start rubbing my graft area when showering to get rid of scabs? Can I now use medicated shampoo like selsun blue or nizoral? Is the graft now fully secured?

These are questions you should pose to your surgeon. It seems that you didn’t get proper aftercare instructions. I always recommend a washing routine starting on the day following surgery; however, it seems that you did not do this.

You might have an infection, so see your doctor to have that checked out.

Tags: hair transplant, aftercare, post-operative, hairloss, hair loss

Is there any evidence that shows that Minoxidil solutions greater than 5% are anymore effective than the 5% solution?

Many doctors think that the higher the percentage, the greater the benefit… but along with a potentially greater benefit comes more and more problems with side effects such as postural hypotension, dizziness, tinnitus, scalp irritation, etc. As well, anything over 5% topical minoxidil (from my understanding) requires a physician’s prescription, probably due to the aforementioned side effects that may require monitoring.

I am not aware of any double blind randomized study / scientific evidence that higher minoxidil concentration works better at growing hair. In my opinion, a higher dose minoxidil for treating hair loss is marketing inspired (“more is better” concept) and anecdotal accounts.

Tags: minoxidil, hairloss, hair loss, rogaine

My understanding is that the propecia patent ran out in January of this year, and that Dr Reddy’s no longer has the monoply on the generic form. However I live in the UK and have heard nothing about the release of generic finasteride in the UK. Propecia prices have not moved an inch and there has been no information on the release of generic finasteride over here.

I was wondering if you had any idea when we might start seeing the release of generic Finasteride here in the UK in 1mg tablet form?

I’m not sure about the release of a 1mg Propecia generic in the UK, but I’m pretty sure the 5mg Proscar generic is available there (they’re the same drug, just different dosages). I would make a call to your local pharmacy, as they would likely have availability info about generic Propecia.

In the interest of cost savings, many patients request a prescription for the 5mg finasteride generic pill and cut it into four pieces, making it almost equivalent to the Propecia (finasteride 1mg). In the US, the 5mg generic pill runs about $3-$6/month at discount pharmacies, but I do not know the cost breakdown in other countries.

Tags: propecia, finasteride, generic, hairloss, hair loss, united kingdom

Snippet from the article:

An article in yesterday’s financial press surveys recent high-profile cases of alleged coronary-stenting overuse, described by a sources as “just the tip of the iceberg,” and alternates them with stories from some of the patients involved. Although there are a few comments from leaders in the cardiology community that try to put the cases in perspective, the 3500-word story ultimately portrays a subspecialty too often abused by practitioners bending or ignoring the guidelines in pursuit of procedure-based profits.

“When stents are used to restore blood flow in heart-attack patients, few dispute they are beneficial,” notes the story from reporters Peter Waldman, David Armstrong, and Sydney P Freedberg published yesterday in Bloomberg BusinessWeek . But heart attacks account for only about half of stenting procedures, it notes.

“Among the other half —elective-surgery patients in stable condition—overuse, death, injury, and fraud have accompanied the devices’ use as a go-to treatment,” the article says, citing “thousands of pages of court documents and regulatory filings, interviews with 37 cardiologists and 33 heart patients or their survivors, and more than a dozen medical studies.”

Read the rest — Coronary-Stenting Abuse Cases Highlighted in Bloomberg Story

The harsh reality of the Bloomberg story shows that doctors can be immoral when it comes to making money and patient decisions, even with life threatening diseases such as coronary artery disease.

If a cardiologist abuses his power and influence on a patient with heart disease (fear of dying) to have a procedure that is highly remunerative to the cardiologist, then what do you think happens when a person with hair loss goes to a doctor who makes money doing a hair transplant surgery that may never help him, but pays the surgeon well? With hair, the situation is in many ways worse, as the doctors may not have mastered the surgery, yet can’t turn down a dollar in his/her pocket even if they really do not know what they are doing.

There are many hair transplant failures driven by a doctor’s greed for the almighty dollar. The main difference between the cardiologist doing an unnecessary procedure and a hair transplant surgeon doing a procedure that may not help the patient, is that the risk of death is far smaller with the hair transplant than the cardiac stinting.

Tags: cardiology, cardiologist, hair transplant, surgery

Snippet from the article:

Clinging to hope, the Linden, N.J., couple took Josia to see Stanislaw Burzynski, a Houston doctor claiming to be able to do what no one else can: cure inoperable pediatric brainstem tumors.

Virtually any other doctor might have recited the same sad statistics: Although doctors can now cure 83% of pediatric cancers in the U.S., there is usually no hope for kids with Josia’s tumor. Perhaps 5% survive five years.

Burzynski — an internist with no board certification or formal training in oncology — has said publicly that he can cure half of the estimated 200 children a year diagnosed with brainstem tumors. The Cottos were told that treatment could cost over $100,000, mostly out of pocket, because insurance plans often refuse to cover Burzynski Clinic treatments.

Read the full story (or watch the video at this link) — Doctor accused of selling false hope to families

USA Today has an interesting exposé about an alternative medicine practitioner that is peddling his snake oils to cancer patients, even with the National Cancer Institute saying that he hasn’t cured any patients and he has nothing about his claims published in a respected, peer-reviewed medical journal.

Tags: cancer, snake oil, quack, usa today, burzynski

Why are the hair follicles with one and two hairs used in the front instead of the ones with three and four hairs? Also how far back are the ones and twos placed?

I’ve had one transplant before but i would like to add a 1/4 of inch on my frontal hair line. If that’s all that i were to have done would i have to have the FUE procedure instead of the strip because the area only desires follicles with one or two hairs?

We place one hair grafts in the front to achieve a natural, soft hairline. If you were to look at people who have never had a hair transplant you will see they have single hairs in the front. Having three or four-hair grafts in the front will look unnatural and be detectable as a man-made process.

Tags: hair transplant, hairloss, hair loss

Some men go bald some men don’t. Is the reason for this the fact that the non balding man’s hair is resistant to DHT or is it some other reason like the none balding man has less DHT in his system? Thanks for your response.

The reason why some men go bald is because of the genetic trait they inherited from their parents. This genetic trait causes them to be susceptible to the hormone DHT, which triggers apoptosis (cell death) in male pattern (genetic) balding. If you do not have the genetic trait for balding then DHT does not matter.

Everyone makes their own DHT which comes from the metabolism of testosterone. When we treat a balding person with a DHT blocker like finasteride (Propecia) we block the interaction of DHT at the hair follicle level for those who are genetically susceptible to DHT-related male pattern baldness.

Tags: dht, dihydrotestosterone, hairloss, hair loss

I have noticed dramatic hair loss in the last 6 months bang area. I went from having long thick bangs to short hairs and visible scalp. I went to a hair loss doctor and he said I have female pattern baldness. I believe this is the core problem–but could it also be that I am continuing to brush vigorously with a brush dryer and using tight rollers when hair is wet. Will the hair re-grow now that I have stopped doing this?

Tight rollers or pulling or brushing your hair vigorously can cause hair loss that may be permanent. The only way to tell if your hair will grow back is to wait it out. It may take about one year for you to see regrowth. If you do not see regrowth after a year then it is likely permanent.

If you were diagnosed with female pattern hair loss, it is possible that you have a combination of genetics and traction alopecia from the pulling… but I have no way to know that for certain.

Tags: female hair loss, hair loss, hairloss, hair curler

Hello Dr. Rassman,

Through the search feature on the site, I have read about previous questions that asked about creatine and hair loss. It seems like you addressed the topic of increasing DHT being a potential issue, however, you seemed to believe that it didn’t have a direct correlation as shown in this question here (link).

My question is, do you have any new knowledge, updates or opinions on creatine and hair loss? Any information would help, as the last time this topic was discussed seemed to be at least 3 years ago.


I have no new knowledge or opinions on creatine. I personally do no think it affects hair, but I am sure you can find plenty of sites that say different. If it worries you enough, then maybe you should take a conservative approach.

Tags: creatine, hairloss, hair loss

I had hair transplant surgery 15 months ago, and the back of my head is still numb and tingly. It starts from the incision line and goes up to the top of the back of my head. The numbness and tingly has not changed at all. I told my doctor about this numerous times, and he just stated each time that it will go away. Years ago, I had two hair transplant surgeries of 800 grafts and 250 grafts. After those two surgeries, I had no numbness at all. However, with this surgery, which was over 2000 grafts, I had numbness and tingly right after surgery, and it hasn’t changed yet. Is there anything that I can do?

During the surgery, I heard one of the helpers say to the person who was cutting the strip of hair that he cut too deep. Could this be a possible cause of the numbness? Is there anything that I can do? It’s a constant annoyance, day in and day out. I’m also getting head aches. Could this be the cause of that?

Thank you for your time

Generally speaking, any scalp numbness from a hair transplant surgery should go away after about one year. If the doctor cuts too deep or cuts a large nerve (called the greater occipital nerve) the numbness may be permanent. It is one of the rare unfortunate risks associated with hair transplant surgery.

The concept and theory of hair transplant surgery is easy. The execution and practice is highly variable. There is no formal training in hair transplant surgery and just because a doctor is a Plastic Surgeon does not mean he/she is a capable hair transplant surgeon. There is no American Board of Medical Specialties (ABMS) for hair transplant surgery (like there is for Plastic Surgery). Just because a doctor belongs to hair transplant societies such as ISHRS and ABHRS, it does not mean they are “board certified” or trained in hair transplant surgery. It just means they paid a membership fee. Thus, choosing a well qualified, well trained hair transplant surgeon is difficult and highly variable.

Having said all this, your doctor may be a well trained and reputable surgeon and this may just be one of those rare unfortunate instance of the risks associated with surgery.

Tags: hair transplant, surgery, nerve

I’m currently taking one 0.5 mg capsule of Avodart for hair loss daily. Visiting a hair transplant doctor the other day he said I could take it once a week and have the same results, as avodart stays in ones system for several weeks. What is your advice? I’m a 58 year old male. Thanks

My advice is speak to your doctor. If you were prescribed the medication, discuss any questions you may have with the doctor that prescribed it to you.

I do not advocate the use or usually recommend Avodart (dutasteride) for treating hair loss. I have prescribed it in select cases, but Avodart does have a long half life and many doctors have many different opinions on how to take the medication. There isn’t any defined dosage for it as a hair loss treatment.

Tags: avodart, dutasteride, hairloss, hair loss