About     Contact     Archives     Videos     Events     Hair Transplant

Dear Doctor,
First I would love to thank you for your informative website which is really helpful.

Two month ago I started Finastride 1 mg as my doctor told me to do. I felt a testicular pain within two days of using the medicine. It got worse everyday till the 6th day that I got annoyed so, I stopped taking the pill and the pain disappeared within a week. now I started again with 0.25 mg of the medicine as my doctor said to lower the dosage. Again the second day I felt the pain. I was wondering if it is harmful to wait for a while? and how long is the time that I can wait without being harmed by the drug, assuming that the pain is bearable?

There are reports of testicular pain with finasteride, although rare. Your history suggests a one to one relationship between the two. If half the dose (0.5mg Propecia) does not work and your doctor examined your testicles and they are normal, then you may not be able to tolerate the drug. Speak with your doctor before making that decision.

How come people can’t get a grip?

There is so much hysteria out there about the sexual side effects of Finasteride on all the balding forums and blogs that I though I should link a couple studies that might calm some of this down.

1. Medscape (*Editor’s note: requires login)
2. Journal of Sexual Medicine

Both of those independent studies were done with the 5mg dosage and both are aimed at explaining the occurrence of sexual side effects from taking the drug. The second one is especially interesting because it involved splitting users into two categories, ones who were told about the sexual sides and one who were not…big surprise; the ones who were informed of the sides reported side effects at a MUCH greater frequency then the people who were oblivious.

Both studies conclude that side effects are very rare and in most cases are psychological. Archives of Dermatology (PDF file)

Then there is this study done recently at the University of Bologna by Dr. Antonella Tosti where:

“The IIEF, a brief, reliable questionnaire, was self-administered to 236 patients taking Propecia® and 236 age-matched males attending the Department of Dermatology of the University of Bologna”

She concluded that sexual dysfunction is actually less common then reported in the literature and there was no real statistical difference in sexual dysfunction between the men on Propecia and the men who weren’t on anything.

I am someone who was considering taking Propecia but I was on the fence after all the horror stories I read, finding these articles really helped put my mind at ease and I hope they can help others as well.

I thank you on behalf of all the visitors to this site who are in a panic or undecided about this subject, which you so nicely elucidated!

I am 20 years old as of January of this year and I am female. I always had very long very full very beautiful and healthy hair but in my later years of high school i began doing a lot of processing to change the color on numerous occasions, this resulted in, while still long, very damaged stringy hair. One day I made the decision to cut it and it was more healthy than it had been in a very long time and very very full, however I was not confidant with the length and made the incredibly stupid decision to get hair extensions, of course I only know how stupid it was now that the damage is done. The type I had were individual pieces adhered by small metal tubes that were then clamped to stay in place, and I would say I had approximately 200 of them in at one time. I have noticed an incredible loss in the fullness of my hair not just in the ends but in my scalp. I feel that I’ve lost approximately 50-70% of my hair which I hope is me overreacting but I have lost many nights of sleep and it’s taken a toll on my sanity and my life. I am exploring the option of hair transplants since they say that is the only solution for traction alopecia which i’ve diagnosed myself with. I will be seeing a dermatologist in a few days so I will have more details but I was hoping you could tell me a few things about the transplants. From what I’ve read they are said to have good to excellent results in patients with traction alopecia but I would like to know:

1. Will the transplanted hairs have the capacity to grow to the desired length?
2. Some transplant doctors practice a method where they are able to put grafts in between existing hairs which is what I will require since the thinning is all over. I am wondering, will it be necessary to cut the existing hairs short? I am hoping this is not the case.
3. The only hair that has not been touched by the extensions and is healthy enough to be used as donor hair is in the front and is not a very large section. I am wondering, can the same donor area be used more than once if more hair is required to fill the missing spaces than the donor area can create at one time?
4. This hair is 100% certain to grow back just as full as before, yes?
5. Is there any scarring that will arise as a result of this? Do the risks for scarring increase if the donor area is used more than once?

I hope that you will reply to this message because I am very distraught and extremely depressed which I’m beginning to fear may lead to further hair loss caused by stress, and am rigidly searching for answers to this problem. Thank you for taking the time to read about my story and I’m hoping to hear from you soon.

You’ve likely seen your dermatologist by now and have a better idea of the degree of your hair loss, but I hope these answers to your questions help a bit.

1. Yes. Transplanted hair will grow to the same length as the hair in the back of your head, since that is where the hair is being moved from.
2. No. We routinely leave the recipient area long and do not cut the areas where we are going to do the transplant.
3. Unlikely. Hair for transplantation is taken from the side and back of the head. I would have to evaluate your alopecia before giving you an opinion.
4. Almost. Nothing in this world is 100% certain, but I would expect that hair transplants will grow at a 98% confidence factor.
5. Yes. The donor area does scar and the degree of scarring depends upon many things, including:
   1. the number of surgeries
   2. the size of the donor strip
   3. tissue factors unique to each person
   4. the surgical technique used

I just saw this photo of the singer Fergie from Black Eyed Peas and don’t know what to make of it. is she just under bad light or do you think she could be losing her hair? it kinda looks like a female pattern huh.

Examiner.com - Fergie might be balding

It does appear in the photo that the singer known as Fergie has got some thinning in the female pattern… but to what degree, I couldn’t say. Does she have actual loss or is it just bad lighting or something else entirely? No clue. I’ve never met her and this one photo makes it difficult to form an opinion.

Hair loss in women is not uncommon, particularly if she’s in the entertainment business and relies on wigs and hair extensions to change her look from day to day. Extensions can create traction on the hair, resulting in something like what you’d see in that photo. Also, chemical processing of the hair can lead to this… and she’s certainly changed her hair color and character over the years. Here’s an example patient of mine that can give you an idea of what Fergie might look like if she is suffering from female genetic balding from the top looking down — here.

Dear Dr. William Rassman,

First I want to thank you for your updated and truthful blog. It has surely helped me and obviously many others understand the many things about balding. I am a 25 year old male with what I would perceive as a Norwood III. I have significant loss in the hairline but no baling spot in the back or top the head. I’m not going crazy about the loss of hair but surely want to do whatever it takes to try and stop it from becoming worse.

After reading your blog I know that I have pretty much three current options that I am comfortable with: finasteride, minoxidil, and of course surgery. I don’t feel as though its bad enough to go for surgery right now and find that topical solutions just don’t outweigh the effort (id rather shave my head instead of having to apply the stuff daily), so i started finasteride about three months ago. I have very little if any side effects from the finasteride and have no problem taking it daily. As you know, three months isnt a long time to be on finasteride and its hard to tell if it is actually working for me. however, I plan on taking it for at least a year before I come to a conclusion.

I know that finasteride’s focus is to prevent further hairloss and any regrowth should be looked at as only a positive benefit but my question is that if I were to see any regrowth, how long do you think it would take? Again, I am not taking finasteride with the assumption that it will result in regrowth, I am just wondering when it would be noticeable it regrowth were to occur.

To give you a little background of my family history, there are a few people on both sides of my family that have receding hairlines and thinning on the top of the head. However, there is no one (and i even asked some elders) in anyone’s recollection in my family to have a completely shiny “chrome dome” scalp.

I realize that thing email is particularly long for such a small question but I wanted to give you as much information without pictures as possible. Thanks for any reply you might give and thanks again for having such an informative blog!

Graciously,
Anonymous

I am sorry, but you will likely not see regrowth on your front hairline (or front corners) if you are Norwood Class 3. It’s very rare for those areas to improve from medication. If regrowth happens it is mostly on the top crown areas where there is miniaturization. The best outcome for you on Propecia is slowing or cessation of hair loss in the front. If this happens it would take about 6 to 12 months for you to appreciate.

I’m 60. My brother has been bald for years, but I had kept most of my hair until the last 18 months during the stress of a business failure. Now it is very thin on top with a bald spot on the back. I began using 5% minoxidil about 45 days ago. Is there anything else I can do to at least stabilize the situation? Thanks.

It is rare to see balding start at your age, but we are programmed to have a certain number of hair cycles in hairs in different parts of the head. Maybe you have reached the age limit and number of cycles of some of your hair. It is not unusual for it to appear in patterns. Taking Propecia (finasteride) would probably slow it down and could reverse the thinning areas, considering that the entire process is recent, which is when the drug works best.

Its been 6 months since my HT Follicular Extraction surgery, and I notice that i have been shedding hair for the last month. The hairs that have been falling out have been robust and as thick as my donor hair. Initially after my HT, I never remembered any of my transplanted hairs falling out. Is it possible i never had an initial shed?

As I usually map out the scalp hair for miniaturization in advance of a hair transplant, I know quite a bit about what is happening when someone like you has this type of problem. Shock loss can occur as long as 6 months after a surgery, but I agree with you that it should not impact normal, non-miniaturized terminal hairs.

I finally amounted the courage to go to the my GP(General Practitioner) and seek help for my hair loss, only for him to tell me I haven’t got hair loss when I quite clearly have, receding hairline and all. He wouldn’t listen, he said it was just me but I know I mean I really know I do. What should I do now, I’m only 17 but I want a Propecia prescription.

At 17 years old, you may not be a candidate for Propecia just yet (it’s not out of the question, though). I’d find another doctor that will listen to your concerns, as educating the one you have sounds hopeless.

This is a 60 year old woman who had 2700 grafts to fill in the area where she was very thin. She uses a combination of Toppik in the first inch of the hairline only, a good solid perm for the rest of her head and a reddish hair coloring that works to minimize her hair color contrast. Red coloring at times gives wonderful results and this lady was very careful to style her hair to maximize coverage. The curly nature of her hair changes the characteristics of her hair, which is normally straight.

She could have done it all with transplants alone, but it might have taken twice the amount of hair transplants than she got with the three step approach she used. Click the photos to enlarge.

After

Before

I’ve been taking Saw Palmetto Capsules for the hair loss control but discontinued because I started taking provillus dietary supplement(because containing Saw Palmetto), Can I continue with the Saw Palmetto capsules (The reason: I’m interested in the protate benefits)along with Provillus. Thank you in advance for your help.

Saw palmetto and Provillus are over the counter natural supplements, though Provillus now contains minoxidil along with saw palmetto. The use of saw palmetto may or may not work, but one of the problems is the dosage between different manufacturers and as it is an herbal remedy it is not covered by the FDA regulations for claims. I really don’t believe it works in treating hair loss, but I also see no harm in taking it. I would be careful not to take excessive dosages of any natural supplements, though. Unfortunately, I cannot tell you what an excessive dose of saw palmetto would be.

Provillus has 5% minoxidil in it now with their “improved formula” (it should say so on the bottle), which means that it is now as good as the cheaper generic minoxidil you can get at any pharmacy or most supermarkets.