If and when Piloscopy becomes a thing, will you adopt it too?

I’m asking this because you are a very skillful surgeon and it would be a great thing if big surgeons such as you adopt it..

First, what is Piloscopy. A presentation of an endoscopic approach to follicular unit extraction was presented at the ISHRS conference last October by Wesley. The idea was to use an endoscope to enter the scalp from a 2 cm incision and extract follicular units from below the scalp near the skull side with a 1.2 mm punch under suction. At this point in time, it would compete against a well established FUE procedure which is well understood and used by surgeons world-wide. There is no evidence that his technique (which is mostly theoretical) can work efficiently used, if in fact, at all. There are clearly wounds that would be made at different parts of the scalp which would have to be sutured and these wounds would scar. Anyone who claims a ‘wound-less’ surgery is wrong. If the grafts were taken out from an approach below the scalp, there would be a small wound at every folliclar unit where the connection to the epidermis must be cut to get the follicular unit free of the epidermis. This write-up is based upon my memory of his talk before the hair society in October.

See the Consumer Alert in ISHRS website.

Hi Doctor, your blog is extremely useful. I am an 18 year old Indian who has a hairline like Taylor Lautner when he was 18 years old…

You said in that post that he lost immature hairline rounded corners but otherwise had a juvenile hairline. My question doc is that, is losing the corners a sign of a receded hairline that falls under the category of a maturing hairline or is it still a juvenile hairline. Also, I would also like to point out that few of my friends have also lost there rounded corners. Is this normal. By normal I mean, is it not MPB or is it MPB or is it a maturing hairline or is it a juvenile?

I really hope you answer this question and ward off my worries. Thank you so much! Hope you have a great day!


Actor Taylor Lautner does not have balding. His front corner hair line looks slightly higher now than it did when he was younger. Thus I call this maturing hairline or loss of his juvenile hair line. Not balding.

Finally there is no such thing as “abnormal” MPB. Some people have the genes for Male Pattern Balding and some do not. Everyone has a juvenile hair line when they are in their “juvenile” years. Almost everyone will lose their juvenile hair line as they mature (in age). Some will go on to lose more hair (in their 20s and 30s) if they have the gene for Male Pattern Balding.

what’s with all the horror stories being posted on this blog about side effects that are irreversible- or reversible over a long period of time?

I’d very much like to try minoxidil and would really appreciate a professional opinion on the matter.

These anecdotes about wrinkles, dark circles, etc.. are all over the internet. Yet no official info exists.

What gives?

It just shows that Internet can be a great source of information as well as mis-information. Thus I advocate seeing a doctor face to face to ask your medical questions. Please point me to the link on this BaldingBlog if you have found a conflicting information on side effects. You can easily do a search (upper right corner) for this topic on my Baldingblog.

What other readers write about their personal opinion and anecdotes are just that.

Propecia is reported to have sexual side effects in 1 to 2 percent of men. There are reports that it caused permanent side effects but how the study was verified is questionable.
There are reports of Rogain causing wrinkles and dark circles but they are also anecdotes. I have not personally seen this in my 23 years of practice.

I am 27 year old Male. I have diffuse thinning of hairs. There is no bald spot yet and i can hide my thinning with thickening shampoo. But thinning became quite visible when my hairs are wet or oily. I have been using 2% Rogain for past 2 years and it helped in hair loss. But thinning continues.I want to move on to Propecia but recently i read about articles of its effect on semen. I will be getting married in a year and want to have kids in near future. Will it be advisable to start Propecia? Is any of your patients became father even on Propecia ? Any advise will be helpful. Thanks

There have been questions raised on the relationship between low sperm counts or fertility issues and the use of Propecia (finasteride 1mg). While there is no clear evidence that there is a direct relationship, there are reports you may find on the Internet that may justify such concern. The best advice is to speak with your doctor about your concern before starting any medication and consider your risks and benefits.One thought is to have your sperm count and your fertility tested before you start the medication. This is what is often missing in all the case reports. I do not know of any of my patients with this issue and I’ve known many patients (on Propecia) who married and had children.

Hi Dr. Rassman, I’ve been a “lurker” on your blog for yrs, 46 yrs old and if I were to guess, a Norwood 3. I’ve been taking finaesteride for about 1 1/2 years, shampoo with nizoral a couple times / week. I started using Rogaine foam for a few months, but at $62 CAD / mth, it was starting to add up. I’m single, confidence is severely lacking as a result of my receding hairline, so dating isn’t really an option and needless to say I’m always looking for options. l almost considered going for a consultation with Hair Club, but decided against it for now at least. I did come across this article and wondered if you had heard anything about it.

Thanks for having this blog, allowing for people like me a chance to see your advice, keep up with any new developments etc.

There was an article on SCIENTIFIC AMERICAN April 9, 2015 Hair Regrowth Discovery Suggests Skin Cells Communicate Like Bacteria
“When a researcher at the University of Southern California and his colleagues plucked 200 hairs from mice in a specific pattern in a confined area—ensuring that many neighboring hairs were pulled—more than 1,000 hairs grew back in their place, including some beyond the plucked region. “
This finding does not translate into finding a cure for male pattern balding or hair loss in humans. in fact, if you continued to pluck your hairs, they would eventually stop growing. The finding in the study does not mean that if you pluck your own hairs, more will grow. It does however give us a new perspective on cell signaling. More research would be needed to see how it can be applied for practical human applications.

To address your concern for hair loss that relates to a lack of confidence or dating: There are plenty of confident bald or receding men where hair loss is not a factor. Of course everyone is different and if hair loss or hair recession bothers you, see a doctor for possible treatment options. Norwood 3 hair loss pattern can be easily addressed with a good hair transplant surgery.

Creator of Cancer-Cure Diet Faked Her Cancer
Nick Mulcahy April 23, 2015

“The creator of a best-selling mobile phone app and cookbook,The Whole Pantry, has confessed that her story of healing terminal brain cancer through diet and other natural therapies is a fabrication.”…

Dr Saunders continued: “This story shows the difficulty scientists have in getting their stories heard over snake oil salespeople.”

“Hopefully this will make people think twice and do some basic checking of facts,” he added. “We need to be skeptical of the mythical lone genius selling magical cures that ignore basic science and hard evidence.”

I get hundreds of emails a week asking me about my opinion on new hair loss treatment or my thoughts on side effects of Propecia. While the Internet is a great source for information, it is not always accurate. My point has always been there is no substitute for seeing a doctor (in person) when it comes to your personal medical issues which include side effect from Propecia or your hair loss issues. Finally the old adage, if it sounds too good to be true, it probably is.

Your website is a great and informative, objective source of information. Well done.

I’m 48 and been on fin for nearly 15 years under the care of a doctor. I started on 1 mg per day, but reduced to 0.25 mg per day mid last year in response to what I perceived as libido issues. These are now resolved.

I have also noticed a return of morning wood at the lower dose. My question is: do you know of any science to support a negative correlation between finasteride dosage and morning erections, and if so what is the mechanism?

Thank you for your efforts.

I am not aware of any studies and I would be guessing at the mechanism of how morning erections are correlated with finasteride dose. It could just be a perceived effect not related to the dose or it may be the dose change after all. It is not hard to imagine that less drug should cause less side effect. The other issue to consider is that would less drug produce less benefit for what the drug was treating. There is a delicate balance between these two statements.

The observation you pose is real (for yourself) but it is difficult to prove on an absolute basis unless you have hundreds (if not thousands) of patients who are willing to take the a pill that is randomized to different dose or just a placebo (“sugar pill”) and report their erection in the morning. Even the doctor overseeing the patient would not know if the pill was a placebo until the entire study was complete (double blind randomized control test).

My personal thought is that if you and your doctor are in agreement with what works for you, then so be it.

If I have been using Propecia religiously but also been experiencing anxiety to the point of palpitations and twitching, would Propecia blunt any possible stress-related hair loss? If stress is what has lately been causing thick hairs to fall out when I gently comb my hair with a wide-tooth comb, are those hairs gone forever?


Propecia is only for the treatment of androgenic alopecia in almost exclusive men. It has no effect on other types of hair loss and no effect on most women. Hair loss from stress is not androgenic alopecia.

I’ve noticed recently in the shower that short hairs are falling out that are tapered at the end of my hair, not the root. I’ve noticed more of these recently. Some are thinner and some are thick. All my uncles are balding on my mothers side. Are these hairs a sign of future balding? Thanks.

Hair loss in men occurs in a pattern and that is why it is called “Male Pattern Balding”. How a hair looks don’t really mean much unless you are looking at miniaturized hairs will look thinner for people who are balding. We all can lose up to 100 hairs a day normally and if you do the math, 100 hairs per day is 36,500 hairs per year and as the average Caucasian male has 100,000 hairs on his head, that means that his hair cycle is 3 years as he replaces all of the hair on his head every three years.

Can that numbing agent that the dental assistant repeatedly injected into my gums before she cleaned my teeth cause hair loss?

There is no connection between your gum anesthesia and your hair, but if you are stressed, you might induce more hair loss as stress is a factor for hair loss.

I am a 25 year old male with dark and curly hair. Some family background: My father has no hair loss, but has a high hairline. Possibly NW2/NW2A. My paternal and maternal grandfathers both experienced Male Pattern Hairloss around the age of 60. My maternal uncle is an NW2 but has no other hairloss. My younger brother (age 23) however while having a higher hairline than mine has definitely experienced noticeable frontal hairline recession in the last year. Around October of this year I became concerned with my hairline after getting a shorter than normal haircut. I usually wear my hair medium length and longer in the front which completely covers any visibility of my hairline. I expressed concern to my parents and a few close friends at the time and all of them said I had no noticeable hair loss, and if anything maybe had receded a tiny bit at the hairline. I did make an appointment with my PCP to check it out but ended up being scheduled to see another doctor at the last minute. I had never seen this physician before and she said that she could not give me an answer about hair loss because she had never met me before nor had she seen my hair. She ordered blood tests which all came bak normal. I went on with my life. During the months of December and January I experienced extreme emotional stress and more sleep deprivation than normal as a result of the new job I started around Christmas time. Around February I got another haircut, and shortly afterward felt extreme itching and burning at the back of my head right where the occipital bone meets the top of the neck. My rommate had a look and said that it looked very red and inflammed. I made an appointment with my PCP and met with him a few days later. I described my symptoms and my thoughts about possible hair loss. He had a look all over my head and asked if I had a history of thin hair or anything while also noting redness on below my occipital bone where I had experienced the itching. I said no because people have always told me I have had thick looking hair. His diagnosis was that I had “Age related hair loss” on my hairline and “possible” thinning on my vertex crown. He said he could not be sure. I asked if this meant I had a mature hairline or was undergoing male pattern baldness. According to him there was no way to tell either way until it gets worse/if it gets worse. He spoke to me about minoxidil and finasteride which I was already familiar with after extensive research online. However he said in my case it was much to early to start on either of these treatments. I left the office not feeling entirely convinced of his diagnosis. Later after going online and seeing examples on forums of men who were thinning at the crown and hairline I became very stressed and thought that if I possibly had thinning this may be a sign of mpb and should begin treatment immediately. I emailed my physician and asked him if it were possible to get a referral to a dermatologist for a second opinion. He said of course but that either way the treatment for hairloss would be finasteride/minoxidil and didn’t see the benefit of seeing a dermatologist. In fact he prescribed me Proscar and said I could begin using Minoxidil if I wanted to. This was a bit over a month ago and since that time I have been using both medications. However, since that time I have continued to have itching, bumps, and pain all over my scalp (even down my neck) and ears along with what seems to be a rash on my ears. Also, in speaking with my mother and others it came to my attention that I had apparently always had a cowlick near my crown and that it looked exactly the same as always which may have been what the doctor was talking about when he discussed my “possibly” thinning crown. That said I apparently do have a more noticeable line of thinning hair behind my head in between the vertex crown and my neck which the physician apparently didn’t notice. However after looking up pictures online I don’t really see any examples that look similar to the thinning pattern I have behind my head. I am going to continue using the medications advised my my pcp until my dermatologist appointment which is scheduled a little bit less than a month from now however I can’t help but feel a little wary in regards to the medical treatment/advice I’ve received up to this point.

My questions are:
Would Finasteride/Minoxidil have an effect on my hair if I didn’t in fact have MPB? I now find 1 or 2 hair strands when running my hands through my hair for a time. Sometimes more. However, I know that Minoxidil is said to cause an increase of shedding 1-3 months after initial usage.

2. How often do you find cases where patients where misdiagnosed in regards to their hairloss?

3. Is a line of thinning below the rim of the crown along with itching/pain in the scalp, ears, and eyebrows something you see in patients with genetic hairloss?

4. Do dermatologists often do miniaturization studies or hair bulk measurements? I know from reading many of your answers to questions that this is the most crucial part of measuring possible hairloss, and am worried my dermatologist will either not have the equipment to do those measurements or not know how to do them period. I live in Seattle and there are not a great deal of hair loss specialists nearby, and none of the HT surgeons I’ve looked up seem to be highly recommended.

The simple fact is I cannot diagnose your condition. If you think you were wrongly diagnosed, see another doctor. Genetic Male Pattern Balding is not a difficult diagnosis to make. Having a small microscope to look at your scalp helps for a miniaturization study but this is not always necessary. Propecia does not work for non balding patients and Norwood 2 is generally not considered balding as it more reflects the impact of a maturing hairline than genetic balding in most men.


I’m 32 and have been taking Propecia for 1.5 years. I’ve also been having problems with erections and possibly libido. They’ve gotten worse and are causing real problems in my life.

I’m not 100% sure it’s because of the Propecia because for a few yearsbefore I started taking Propecia, I was having some issues with maintaining an erection, though much less severe.

My prescribing doctor, who specializes in hair loss, says it’s very unlikely it’s the Propecia, citing the trials that show ~1% difference from placebo. To try and help the erection issues, he prescribed that I take a half a Viagra before bed every other night for three nights (without following it with sex) to see if that extra physical help might help me overcome a psychological issue. Though the Viagra helped when I took it, it didn’t change anything longer-term.

A little frustrated with this doctor and his dismissiveness towards my concerns, I went to get a second opinion. The second doctor immediately said that I should stop Propecia. He seemed convinced that Propecia was causing it, especially since I’m relatively young. He said the most prudent course of action right now is to immediately discontinue use and he suggested using Rogaine to try and retain

I’m not sure what to do with the two extreme opinions. I know that sometimes these symptoms can by rooted in psychological causes, especially since I was very nervous about this particular side-effect for years before finally starting Propecia. And I guess I should mention that Propecia seems to be working well with my hair loss.

I’m stuck between two seemingly extreme opinions and was hoping you guys might have some additional information that these two doctors haven’t given me. For example, I’ve read anecdotes about people reducing to 0.5mg and the symptoms improving. Any ideas on what I should look in to?

Thank you guys so much.

I am not the one to break the tie between the two doctors who have different opinions on Propecia and its side effects and how it relates to your issues.

I do know that Propecia can cause sexual side effects in 1 to 2% of the men. I also know men in their 30’s can also have libido and erection problems. It may even be a combination of both. I do not know!

You should see a doctor and have some basic testing such as your testosterone level and consider all your options, make an informed decision on a plan of action, and follow up with that doctor to see how the plan is working.

“Alcohol-dependent patients in general hospitals live significantly shorter than patients without alcohol dependency. According to a German-British study published in “European Psychiatry”, they die 7.6 years earlier on average. In addition, they suffer from several concomitant diseases.


We often get question on if alcohol can cause hair loss. While alcoholism do not cause balding, it seems it causes an earlier death.
This was the result of analyzing 23,371 patients over 1.5 years with know alcohol dependency along with 233,710 patients without alcohol dependency. This, they said, can be reversed with appropriate treatment and cessation of the problem.

“I’m seeing a few hundred hairs in the shower drain every day. I really don’t think I am balding, but I came to ses you because I wanted to be sure that if I was balding, you could transplant my hair and keep it looking good.”

This comment reflected the comments, one way or the other, of many men who visit me, but this particular day, this 26 year old actor who just finished his first role in a major movie came to me with the above comment. He looked like a typical hairy 26 year old male and I thought that after I measured his hair bulk, that I would reassure him that he was not balding. Much to my surprise, the numbers from the tests surprised me but shock him. The tests indicated that he already lost 50% of his hair bulk in the front of his head just behind his hairline, and 40% in the top (between his ears) and crown (back) of his head. He came apart emotionally. “This can’t happen to me”, he said. “I am going to hit it big time in Hollywood, I have an interview coming up for my second film, now a leading man, and I just can’t go bald”.

I tried to calm him down. At 26, he could go on the drug finasteride and probably stop most of his hair loss, so that was the ‘good news’ I told him. But despite my reassurance, he had difficulty letting go of the idea that his career was going to be ruined. “They won’t take me on if they knew”, he said. Again, I tried to reassure him that the drug might very well buy him years on keeping his hair, but he would not, could not focus on what I said. Over and over again he said “It over, my life is over”.

Hair loss is devastating for many young men and they don’t have to be heading to the top of the Hollywood scene to feel the way this man did. Although the drug often turns out to be effective in 26 year old men, the reality is that some day he will have to face balding. Although preventive hair transplants are a terrible and improper decision for him now, if and when he starts losing his hair, this may become an option. He left very unhappy and even unwilling to consider taking the drug finasteride. I asked him to return to see me, but he was from out-of-town and not easily accessible, but I called him a week later anyway and he promised to see me in 4 months on his return to Los Angeles. I wonder if he will deny what I told him or if he will think this matter through and make the logical decision to try to slow down the balding process and fill the prescription I gave him.

Thank you for taking time to read this and I love how this site is very informative. I have always been wondering if there is anyway to let baby hairs grow into normal hair. Lots of my hair stops growing at a very short length and it gives the impression of the lack of hair. Hope to hear from you! Thank you!

Baby hairs you are referring you vellus hair or peach fuzz on your skin. It is actually all over your body except on your palms, soles of feet, and lips. It does not grow to normal terminal hairs. If someone can find a way to turn these hairs into longer terminal hairs, the results may not be what you expect or desire. or example, there is a condition called Hypertrichosis where there is abnormal amount of hair growth all over the body. I am not aware of any mediation or treatment that can change the morphology of the vellus hairs or target its growth specially.