This is an excellent article discussing the safety and effectiveness of oral minoxidil. “Systemic adverse effects were infrequent and only 1.7% of patients stopped the treatment due to adverse effects.”

This second article reviewed 10 published papers addressing oral minoxidil use for alopecia in men and women:

Results: Ten articles were included for review comprising a total 19,218 patients (215 women and 19,003 men). Oral minoxidil dose ranged from 0.25 to 5 mg daily to twice daily. The strongest evidence existed for androgenetic alopecia and alopecia areata (AA), with 61-100% and 18-82.4% of patients demonstrating objective clinical improvement. Successful treatment of female pattern hair loss, chronic telogen effluvium, monilethrix, and permanent chemotherapy-induced alopecia was also reported. The most common adverse effects with oral minoxidil included hypertrichosis and postural hypotension.

Conclusion: Oral minoxidil is a safe and successful treatment of androgenic alopecia and AA. In addition to its therapeutic benefits, practical advantages over topical minoxidil stem from improved patient compliance.

Dr. Rassman:  In my opinion, oral minoxidil is a reasonable second line drug for those men who can not use finasteride

Can you explain what hair weight actually means? Is it the thickness of individual strands of hair or the hair bulk altogether?

The experts call it Hair Mass Index, which reflects the value of the thickness of the hair shafts of your hair. It runs in simple terms, fine, medium or coarse. Fine hair has the least coverage value on its own. The article shows that men with miniaturized hairs may reverse miniaturized hair with a thicker hair shaft with finasteride but the thickness will only go as far as your normal hair thickness. A new publication by Dr. James Harris, he uses a simpler term “Hair Diameter Index”.


These articles published in peer reviewed journals, suggest that there are long term effects on using finasteride and dutastertide.  It is important for anyone taking these drugs for long term use, to understand what these articles are implying.,and%20in%20men%20with%20AGA.&text=We%20suggest%20that%20long%2Dterm,disease%20and%20potential%20kidney%20disease

Dr Rassman, quick question for you…obviously this guy had hair follicles which he was able to ‘wake up’ with medication….some people might have gone straight for a transplant to fix the recession. If follicles are transplanted then aren’t they just being placed on top of follicles that maybe could have been reawakened if they’d have tried treatment? Is there a danger that by going for a transplant before trying medication that you kill off follicles that could have come ‘back to life’, so to speak?

I have seen a patient who had 3000 grafts and never had balding. I used the HAIRCHECK instrument ( to determine if there was more hair in the transplanted area than the donor area.  What I found was that the 3000 grafts grew and increased his hair bulk as expected so I can conclude that damaging hair with a hair transplant doesn’t stop new or existing hair from growing. Of course, you ask why would a man who is not balding get 3000 grafts, well the answer is he had a scummy doctor who made him believe he was balding because his father was bald and the doctor saw him as $$$ for his pocket. Deplorable behavior.

If this woman has another hair transplant it will also fail. The doctor should be able to make the diagnosis of Frontal Fibrosing Alopecia (FFA) which is an autoimmune disease which will kill off the transplants.  This is why you need to have a knowledgeable hair transplant surgeon evaluate your hair loss, to first and foremost make a proper diagnosis.  From these pictures alone, I can tell she has either Frontal Fibrosing Alopecia or LLP.

I am a 27 year old male who recently ascribed to getting finasteride, and I was wondering in your experience how often have you met patients who had serious side effects on it? I am well read on the subject(I think) of sides, as well as the ‘nocebo’ effect. And I could not care less about loss of libido/sex drive as I am unfortunately very riled up to put it pleasantly most of the time. Watery semen as well does not bother me, nor does ED.

However the effects I do ponder on are about the mental ones i.e. serious depression/anxiety/brain fog as well as gyno. Have you had many patients within your care that reported on these symptoms? If so, did they discontinue after a while? Thank you in advance for your time Doctor, I appreciate it as well your contribution to the help of the psyches and confidences of men and women across the globe.

I would never discount the impact of permanent side effects, although very rare, I believe. The other side effects that you are worried about are also rare and they have mostly gone away within a month or two of stopping the medication if you are one of the unfortunate people who gets them

I would want to perform a trichoscopic examination of these hairs on the sides to make sure that you don’t have DUPA.  An examination is critical to making intelligent decisions however, I would want to evaluate all of your hair donor area as well.  Here is an example of DUPA:

Would it be better to order fin powder so I can control directly how much fin gets into my body vs cutting up a tablet and dealing with filler material? Or does fin powder not have certain delivery ingrediants that a pill like propicia has?

I would advise you to stick to the standard FDA approved medications so you know what you are going to get. Why would you take chances.  What is important is not the blood levels that you achieve from finasteride but the tissue fixation that occurs and lasts at least a week.

I remember a 33 year old marathon runner that dropped dead at the peak of his health.  Nobody knows why it happened. One can suspect that his heart had an ectopic beat that came in a particular part of the cardiac cycle and induced Ventricular Fibrillation (no heart beat).  I knew a 40 year old close friend of the family, who died in a field 100 feet from his house.  Nobody knew why.

There are reports of death after having your dentist give you Xylocaine for a local anesthetic.  It happens.  One of my patients had a heart attack the evening before his hair transplant. It could have happened during the transplant I feared.  The key for good doctors is to know how to respond to the unpredictable.  For those of you who go to Turkey and have a clinic without a doctor, beware as who would address any catastrophe?

In the above magazine example, I saw them mention that this man had significant facial swelling and was hospitalized suggesting something strange happened after the surgery. Could it have been an allergic reaction to a medication he was given?  I don’t know why it happened but lack of blood tests for healthy men is the standard of care in the US today for all ambulatory surgery done under local anesthesia in young healthy surgical candidates so I would be critical of that complaint by the writer of the article.   I always get a medical history on my patients before the surgery and make sure that they are healthy without complaints or on-going medical conditions.

The statement makes no sense. The looseness of tightness of your scalp has nothing to do with hair loss.

For those of you not actively seeing dermatologists or have prescriptions, how do you get yours? I see sites like ‘all day chemist’ but they ask for an upload of files… yet you can skip this part i think. I’m not sure if they’ll call or email you afterward asking. Also found a thailand pharmacy site that doesn’t require paperwork. Anyway as the title says, what’s the easiest way to get a hold of some? Thanks

This is a prescription drug when given orally. See an expert doctor. An old saying says: “If you treat yourself, you have a fool for a doctor”.

Here is a good picture of a man with a persistent frontal hairline which shows hair in the leading edge of his hairline despite a bald head behind it.  It have seen these Persistent Frontal Hairlines exist when they are so strong, that the man can grow the hair long enough to make it look like a full head of long hair (a Comb-back is like a Comb-over just front to back rather than side to side)

Medications don’t always work, but it is important as you explore these medical options, to be realistic, knowing that they may not work.  Your genetic balding could be too strong and not responsive. With regard to finasteride, over 90% of men on this drug get at the least, some slowing of the hair loss. This has been well documented, but slowing from what?  That is a hard question to answer.

The hair transplant option is a good option for those of you who are not responders to medications or microneedling. The best part of a hair transplant is that once it is done on a person who has stabilized their hair loss (usually someone over 25), they can get their hair back and stop worrying. This is what my patients tell me over and over again. It is worth considering and saving up enough money to do it with the right doctor, the right plan and as said in the title of this post, setting realistic expectations.

More and more patients are getting FUE by doctors or non-physicians that just don’t understand how to manage the donor area (photos). These photos keep coming to my inbox from all over the world.  Who is to blame? Well the patient must take part of the blame for not doing their proper research and the doctors or technicians who victimize these patients are criminals. Criminals should pay!










I’m so saddened and distraught to see that my hair is very much what it looked like before . I think I may have scarring alopecia or something else that causes the follicles not to grow. I see where the hair has been transplanted but it hasn’t grown at all and has just scarred over. What do you think my next steps should?

Certainly the presence of a scarring alopecia which is active would kill off a hair transplant. To find out, your doctor can biopsy the area and that will let you know if scarring alopecia or some other autoimmune alopecia is responsible for the failure. ?