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I am a young teenager who is not balding (yet.) I am worried about hairloss, because every male in my family is totally bald, except on the sides and back. I probably will have it by the time I turn 25 or 30(never asked anyone in my family when they started to lose hair, but I know my uncle started to lose hair at about 27 or 28.) But I have a question about my hair now. My hair has always had these various areas where there is really thin hair. They are like lines, not spots and seem very thin. I really don’t want to take pills or other applications to keep the hair I have, but am considering hair transplants when I do start to experience male pattern balding. If I do get hair transplants will there be an option to make my hair thicker? If not, will taking propecia after a hair transplant session make it thicker, or at least make the thin areas seem thicker? Please respond. Thank you for your time.

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People use the word “thickness” to describe various contributors to ‘fullness’ that reflect very different aspects of hair; (a) the diameter of the hair shaft (i.e. the mass of the hair), (b) the density of the hair per square centimeter of scalp, (c) the character or wavy nature of the hair, (d) the color and contrast between hair and skin color (the lower the better). Propecia can improve the diameter of the hair shaft in a balding area, stop its eventual loss, or possibly make it regrow making the area thicker. Transplants can add donor hair (from the back) in between native hair (at the top or wherever the thinning area is) to increase the density of the hair in a particular area, also making it thicker. It is a little more complicated then this explanation, but not much. Doing both together (Propecia and Transplants), as you might imagine, will have an additive effect – that is, it will look even better. But doing both may not always be the right thing, if the anticipation of the results of Propecia alone may achieve the results without a hair transplsnt. Then you get the benefits without a surgery. That means that when you get evaluated by a doctor who can transplant your hair, you want a doctor with high integrity, one who will not recommend surgery if there is a reasonable possibility that Propecia alone will do the job.

As an aside, every male (and even some females) in my family also has some degree of hair loss, so I know where you are coming from. First and foremost, please get an assessment of miniaturization in order to detect when and if the genetic process started. A yearly check with a good doctor should show that to you. If and when you start balding, you may want to reconsider your decision not “to take pills or other applications to keep the hair I have.” Recent studies indicate that patients get the most improvement and are happiest when they keep the hair that they have, in addition to replacing what they have lost. As a surgeon I can tell you that nature does it a lot better than any doctor can – keeping what you’ve got is truly the best course of action overall.


Do REAL versions of generic Proscar/Propecia exist? I see them at online pharmacies but I’m not sure I should trust in them.

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Legal generic versions of Propecia and Proscar do not exist. In countries that do not recognize the US and International patent systems, generic versions are produced, but then you do not know if they work or if they are even real. A patient who recently came back from India brought back some Indian Viagra, which he said did not work for him, although the American version did clearly work. It is easy to see if Viagra works, but on the other hand, Propecia is harder to tell if it is working. The old rule, “Buyer Beware”, still prevails!


I cut my bangs too short in the front and now I have a bald spot. what do I do to cover it up besides a hat? HELP

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The good news is your hair will grow back, the bad news is that it will take time. Other than a hat, I often suggest color-matched Toppik to help cover areas with hair loss where the scalp shows. Honestly, though, if you have a good sense of humor, that is the best way to cope. You might also try a professional hair stylist to avoid the problem in the future.


I understand that miniaturization is the first step for most people to begin understanding hair problems. But this procedure seems very exclusive as I have not often seen this on the internet for searches in my area.

I live in montreal Canada and I don’t even know who to look for to consult: Hair Doctor? Hair Specialist? Hair Consultant? I do not know the name of the profession so finding someone to help me is difficult.

What am I looking for exactly? And do you know if this procedure is availible for my area?

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Visualizing instruments that magnify the detailed microscopic view of hair follicles, allow the viewer to estimate the miniaturization of all of the hair as compared to the healthy hairs in the field of view. The term ‘miniaturized hairs’ have been around for decades and they are the hallmark of genetic balding. I (Rassman) invented a practical instrument which I called the “Densitometer’ and patented it in the early 1990s so that every doctor could do the analysis. The tool was eventually sold by Radio Shack as a hand microscope for about $12/U.S. There are hair transplant surgeons in Canada, several good ones actually, and you should look for just that, a “hair transplant surgeon” who looks for the health of the hair and makes projection of the long term hair loss pattern with this hand held instrument. If the donor area has significant miniaturization, then the patient may have a poor outcome from a transplant. Now, my $12 hand held instrument is hooked up to video monitors and computerized for about $6,000. Still, although I use the video versions of it that are commercial (I paid about $5000 for mine), I still use the $12 hand version for measurement.

Choose a doctor who does hair transplantation exclusively (not on the side) and who has a good reputation among their patients. Often these people will call themselves a “hair doctor” but it is okay to question someone about their practice if you are unsure. “Hair Specialist” or “Hair Consultant” is likely to be a non-medical professional (in North America), usually knowledgeable about the procedure but not medically trained. I suggest you check their website, visit the doctor’s office and ask to meet many of his/her patients. At our offices in Los Angeles and San Jose, we hold open house events every month, which allow prospective patients to meet actual completed transplant patients, for we always say, what you see is what you are going to get. I personally like photographs, but photographs have the limitation of showing you what the photographer wants you to see. When you actually meet patients you can trust your eyes. Our upcoming Open House event schedule is available on our site. Also, go to the ISHRS site to find a listing of doctors who focus in this specialty and in your area.


Dr Rassman
Can you please tell me if its know whether mega doses of nutritional supplements (other than Vitamin A) can contribute to hair loss?
Thank you

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This is a very broad question and one that this blog gets asked often. Unfortunately, since nutritional supplements are not regulated by the FDA, there is often very little information in the medical literature regarding side effects and/or scientific studies about how/if they work. You are correct that Vitamin A toxicity is known to cause hair loss so you should avoid doses greater than 50,000 IU. It would also be a good idea to avoid anything which alters your metabolism (thyroid is often a buzzword there) or your hormone levels. Some high protein diets have noted hair loss as a side effect, too. In the final analysis, it is just not possible to know without a specific analysis of a particular nutritional supplement.


I have started Propecia with by the first night, I lost all of my sexual drive. Is this a usual effect and so quickly?

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I can not imagine that one dose of Propecia will make you impotent. Most people who lose their sex drive with Propecia, notice it over time. Those who increase their sex drive while on the drug, also see it over time. One day on Propecia tells me that there is a likelihood that you are like most men, whose sexuality is highly suggestive and highly influenced by the fear of impotence rather than the drug impact on your libido.

I have addressed this before when men say they lost their sex urge, what they mean is that they could not get an erection. I believe that if most men think that they won’t be able to perform sexually, their worst nightmare usually happens. The power of suggestion is a very influential anti-aphrodisiac and it happens more than just when taking a new drug. Just think back on how many times you worried about not getting an erection when the pressure was on! My suggestion is that you should focus on things other than your penis and maybe everything will be OK. I would not deprive myself of the benefits of Propecia from a single panic attack.


First I would like to thank you for providing this site, it has help me a great deal. Here is my question. I am a 31 year old female suffering from hair loss, and as of yet I do not know the definite cause. My question is concerning all that I have read about the possibility of vitamin deficiency causing hair loss in women. My doctor runs routine bloodwork every year, and for approximately the past 10 years I have had low iron, low B12, and my last set of tests, last year, did show that I also have an overactive thyroid. Throughout this time I have never taken the supplements that were advised by my doctor, I am now regretting that, and have since started. Now to the question, with being low in iron and b12 for so long cause miniaturization? I have miniaturization hairs throught my entire head, and very thin on the crown, and this is why I am questioning the effects of vitamins and hair loss. From what I have read miniaturization and thinning at the crown usually indicates AGA, however I did read once that low iron could mimic AGA with miniaturization. And I am hoping that this hair loss that I have is from low vitamins for a long period of time, and not AGA.
Thank you so much in advance.

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Yes, low iron and B12 can cause hair loss. Get a good doctor to take charge of you, as that is the best approach to the problem.


Dr. Rassman,

I am 46 years old. My father and brother have extensive hairloss on top. I am blonde and have very fine hair. No hair loss on maternal side. About a year ago I noticed some thinning at the hairline after many years of very slight creeping at the temples…still a NW 1-2 with very good density and caliber. I became alarmed given the extent of loss of my younger brother whose loss started as a 20 yr. old.

After doing what I thought was sufficient research and an recommendation from my Dermatologist who had used Propecia very successfully for 7 years, I started on the drug in early March of this year. I noticed little difference in my hair other than very slow thinning in front and on top. At 6 months (Labor Day) loss of libido had become an issue and E.D. became a problem. Watery and loss of ejaculate also surfaced. I wasted no time and quit the drug cold turkey. The sexual sides resolved in a couple of weeks, but that was just the beginning. After a few weeks my hair began shedding like crazy from all parts of my scalp..front, top, back, sides, nape of neck, sideburns, eyebrows, arms and hands too! This has continued steadily and I have lost an enormous amount of hair in 4 months…probably 30-40% of total! I am very depressed, nearly paralyzed and suffering severe anxiety..can’t sleep and having trouble functioning in my professional career. My life is cascading downward rapidly.

I am afraid there has been some sort of androgen/dht backlash. My hair seems to have miniaturized all over my head in a few months. Remaining hair is very fine and wispy ..hard to manage. The falling hairs seem to be very fine and less pigmented as well. This was not nearly as evident until a couple of months ago. I feel like I have the hair of an 80 year old man all of the sudden.

I have experienced “burning scalp” symptoms where MPB would normally be evident. I am terrified by the speed in which things have occured. I have not done anything in terms of treatment for fear of more shedding. Can you please suggest a course of action. I have no one to turn to. There are no reputable hair restoration physicians up here in Oregon.

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Propecia is often effective at slowing hair loss, however, once it is stopped your hair loss can appear to accelerate. Your hair loss plays ‘catch-up’ to get to the point where your balding would have been without having taken the drug in the first place. This therefore, may look like accelerated hair loss. If this happens, you may continue to lose whatever hair that had been saved by Propecia and then continue the loss at whatever rate would have been ‘programmed’ for you by your genetic code (assuming your have genetic hair loss). An important question to consider: ‘Could you have been at the beginning of a rapid hair loss period from genetic or medical causes?’ Your situation does sound more complicated than simple genetic hair loss and this means to me that you might need a full medical work-up looking for other causes of hair loss (including appropriate blood tests). Stress can add substantially to the rate of hair loss and you are clearly being heavily stressed now.

Men in their 40s often (40%) will have ED (Erection Dysfunction) and Viagra might be worth trying (you need a doctor’s prescription) for any sexual ED problems you might have. If you feel that you are the 1% of patients who get a decrease in your libido from Propecia, then you should probably not take the drug, but you need a good, caring doctor to evaluate you along the lines as I have discussed in this blog over and over again. Your strong words above say a lot to me. You are VERY concerned and you want to take charge of the process that is impacting your hair, so be smart about it and whatever you do, do it the right way, ‘partnering’ with a good doctor. We have an office in San Jose and Los Angeles and a trip to one of these offices may be in your best interest. If you see me in Los Angeles, there will be no charge for the visit.


I have studied the norwood scale and have established that i am btween stages 2 and three – intial stages of rhair loss.

Reading through your articles , I have noted that propecia has limited results in treating hair loss towards the front of the head. are there any treatments which you have known to be effective in treating the front of the head?

many thanks

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Men who think that they are balding may actually just be undergoing a change from a childhood hairline into an adult hairline. Many people who think that they are balding don’t realize that the Norwood Class 2 pattern is normal. For some people, the early part of the Norwood 4 may not even be balding at all. Get a good doctor and get yourself checked out for miniaturization before you obsess into believing that you are going bald.


I am a 47 year old woman who had slight graying hair. My hairdresser talked me into highlighting my hair. She used a volume 20 bleach and a toner. 24 hours later I had itching, burning and swelling and saw my allergist. He put me on prednisone for a week and cortisone lotions. A month later my hair feels like cotton as the strands of hair are thinner, breaking off at the crown and generally coming out at the root after washing/combing.

What if anything can I now do? Obviously, I will never again use chemicals on my hair.

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You have likely had a chemical Alopecia (hair loss) with a skin reaction. I know exactly what you are going through (having had a spiral perm in the eighties with the same thing happen) and although it is likely all your hair will grow back just as it was, it will take time, especially if you wear your hair long. Avoiding harsh shampoos and conditioning your hair regularly may help the hair that is there, but little will help it grow faster which is what really needs to happen. Concealing options like hats, scarves, and Toppik are all options as well. If this condition persists past 6 months, I would recommend a follow-up visit to your doctor to determine if anything else is going on.


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