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Hello,
I’m an 18 year old white male. I first started wondering if I was thinning a little over a year ago. Since then I have gone back and compared photos and noticed a huge difference. I can no longer grow my bangs out without them looking thin and scraggly, particular the hairs coming from the temples. I have gone to a shorter haircut, and am still very satisfied with the amount of hair I have left on my head. Most people would think I was crazy if I told them I was balding, but given my family history (Father and Grandfather started balding at 17, every adult male in my family is bald)and the thinning I’ve seen, I’m certain the process has begun. Since I’ve started studying my hair, I’ve noticed some changes in the color of the hairs on the top of my head (brown to a lighter almost blond) particularly on the crown. I appear to have a very preliminary bald spot.

So finally to my question. I have done a lot of research about hair loss and I understand the concept. It is my understanding that Minoxidil is used to stimulate new growth but won’t fix the route dht problem. Only Propecia can do that. I’m really worried about the side affects of Propecia, even though I believe that a lot of what is on the web is junk. Would Rogaine be an effective treatment to halt my hair loss? Or would you recommend propecia. Also, I’ve been using Nizoral over the counter for almost 4 months and appear to be seeing better growth and thickening. So final question. Will Rogaine halt the loss or should I just go see a Doctor about Propecia. If so, what kind of doctor?

Thanks for all your help. I love your website.

Propecia (finasteride 1mg) is the best approach for men with early hair loss, not minoxidil. Minoxidil can grow hair in the crown in some people, but it doesn’t halt the loss (because it doesn’t block DHT, as you mentioned). Propecia, on the other hand, halts the loss and regrows hair. The side effect risks of Propecia are about 1% and if you get them, you can deal with them if you have a doctor managing you. It is insane to worry about a side effect you probably will never get while your hair loss progresses.

Find out what is going on now! You need to have your hair mapped out for miniaturization, so that you can establish a baseline for where your hair loss is today. This mapping procedure will give you a metric that you can compare over the years.

Hi there,

To get a tan I started using the drug melanotan II for a few weeks(i know im stupid). When I stopped a month later hair loss started. It’s getting worse every day. Before I used it I never encountered hair loss.

I know you maybe not know anything about melanotan but was wondering if there could be a connection between my hair loss and using melanotan or is it just coincidence it happened?

I’m really looking forward to your reply.

I’ve posted before what I know about Melanotan — and I still know nothing. I’m not any more familiar than I was a few years ago when someone asked about it. I did try to find some kind of connection for you by searching with Google, but I came up empty.

It could just be coincidental or perhaps you had an allergic reaction of some sort. I don’t know enough about you (age, for starters) to really provide a path for you to go. At this point, you may just wish to wait it out or see your doctor for an exam.

In response to “Propecia Benefits Won’t Last Forever?”

I understand this is a difficult question to answer but say two identical twins under same environmental conditions etc were losing their hair, one took propecia the other didn’t and continued indefinitely, would some time down the track (say 40 years) would they reach the same point of hair loss as each other or would their be lasting effects of propecia maintaining a substantial difference between the two?

I would guess that the twin taking Propecia will not lose the same amount of hair as the untreated twin, but that would depend upon the final pattern of the non-treated twin. The lower the Norwood balding pattern (see patterns here), I’d expect there to be less of a difference after 40 years, but the treated twin would have the benefits of maintaining his hair longer than his brother if he treated it in the early stages of the balding process. Good question!

I am a 47 year old african american female. I have been losing massive amounts of hair for the last three weeks. I have consulted with my family doctor, dermatologist and even a gynecologist. My scalp is very itchy and I also have external genital itching. Where else can I go for help?

Female hair loss can be tricky in determining the source (see here). I don’t know that the scalp hair loss and itching in the pubic area are related, though.

If you are on the east coast, see Dr. Bernstein in New York and if you are on the west coast, you can see me. Alternatively, go to ISHRS.org and look up a doctor in your area.

I’m 26 and have been thinning for the past year on top/crown and my hairline is receding a little. I have finally started rogaine and just found out about “shedding”. This makes me very nervous, and I have some questions:

1. What percentage of men who use rogaine experience shedding?
2. What are the side effects if I discontinue rogaine during the shedding phase?
3. How many men who report shedding also report not regrowing the hair that was shed?
4. Are there other drugs that can be used besides propecia that contain finasteride?
5. If rogaine only regrows hair and doesn’t prevent hair loss how is it helpful in maintaining a full head of hair?
6. How many of your patients who use rogaine see results?
7. Do you recommend Propecia and, if so, why?

Thank you very much

Calm your nerves!

1. Shedding from Rogaine (minoxidil) is really not that common, but I don’t have actual percentage statistics to back that up. I’m just going by my experiences with patients. It might seem like there are a lot of incidents as reported on the Internet, but remember that those with a complaint will often want to alert others, and those with no problems just go about their day.
2. If you have taken Rogaine for some time (more than 3 months) you can shed hair when stopping it, as there is a dependence on Rogaine in some people.
3. I can not answer this question. I’ve got no statistical info.
4. There are two pills available that contain finasteride. They are Propecia (1mg finasteride for hair loss) and Proscar (5mg finasteride for prostate). Plus, generics depending on your country. You do not want to take Proscar for hair loss treatment though.
5. Rogaine does not work all that well for most patients. Sure, there are some results, but I’ve never seen Rogaine give anyone a full head of hair. Hair growth is a side effect of the drug.
6. My candid view is that minoxidil generally does not yield much regrowth in most patients. Again, I don’t have actual stats to tell me how many patients that just use a single medication have had positive results. This is the kind of information that is gathered by doing a focused study, of which I have no interest in doing. Plus, many patients that use Rogaine will also take Propecia, making it difficult to say which medication is providing benefits.
7. I do recommend Propecia. For known genetic balding, finasteride is the drug of choice to stop, slow, or reverse hair loss.

Hi Doc,
Firstly I would like to say great site!I have two questions:

This is speculative but could be me in a few years: I know that you are not reluctant in performing transplants to you people, but if a 23 year old male came into your office having taking propecia for 4 years with a norwood class 4A balding pattern would you carry out the transplant if this person insisted and that a master plan had been established?

What is the age of the youngest person that you have performed a hair transplant to?

If there is a balding pattern like a Norwood Class 4A, no matter what the age, he would probably be a candidate for a hair transplant provided that:

1. He had enough maturity and knowledge at hand with realistic expectations.
2. He understands the financial short and long-term nature of paying for the process.
3. His examination shows that he has the required donor hair to meet his needs.

As for the youngest… well, I have done hair transplants in a few children as a result of accidents, brain surgery, and birth defects. These are unique cases and not like re-establishing a hairline or crown swirl.

Dr uses Latisse on scalp. Here is the youtube link

I’d consider this as human experimentation and there is no evidence that Latisse (bimatoprost) grows hair on the scalp. It was FDA approved for growing longer eyelashes, but it is not approved for use on the scalp. Could it work? Possibly, but I don’t know why you’d want to be the guinea pig. Aside from potential safety risks in applying it all over the scalp, there is the financial part of it since the drug is normally sold in a very tiny tube meant to apply to eyelashes.

I’ve embedded the video here:

I read your posts everyday and I would like to thank you for educating me and keeping me up to date. I’ve noticed several different times that you say there is no official age limit for a hair transplant. I would agree. I’m 21 years old and I had a hair transplant 10 months ago. For the first six months things did move pretty slowly but I would like to say things are going great now. My hair is looking better than it has in years and should continue to get even better. At the time of the transplant my hair loss was an advanced Norwood 3. I had been on propecia for 12 months. My density is slightly above average and I have a lighter medium course hair. With all that being said I still don’t know if my doctor would have performed surgery on me had I not been as educated as I was.

My biggest piece of advice for all of the younger readers out there who are serious about getting a hair transplant is you have to be informed and know what you’re getting into. You have to understand the process; see if your hair loss is more than just a maturing hairline, find out how good of a candidate you are for the surgery and be able somehow finance it. Also, find a good caring doctor.

Obviously, if a teenager doesn’t like his maturing hairline, that doesn’t make him a candidate for surgery… but the “rules” about minimum age for hair transplantation are flexible to a point. As a physician, I won’t perform a procedure that wouldn’t be in the best interest of the patient down the line. Not all doctors follow these same guidelines, but educating yourself is key to not becoming a victim. Nobody should ever rush into a hair transplant, because this is a permanent procedure! I’m glad you found the site helpful and I hope your grafts grow in nicely.

I have noticed a loss of hair and a change in texture in the last two months. I have been taking propecia for years and never had any trouble. I have been stressed and also cut my head open in a perfect vertical line in the front of the scalp. Could these be the reasons or is something else possible? There really is a difference and it is beginning to worry me. I have BDD and this is actually affecting my life. Thank you for your time.

Situations like this are why you need to see a doctor who will create a Master Plan for you. I don’t know the definitive cause of your texture change, though stress and injury could be contributing. That being said, body dysmorphic disorder (BDD) patients really need a good doctor or the imagination runs amok.

Hey Dr. Rassman,

I must tell you that your blog has become an important part of my daily routine and can not thank you enough for your continual work on it. I know you probably have your reserves about this head tattoo procedure, but how about getting it done just on the scars from a HT procedure, it seems like a great way to cover up scars for people who want to shave their heads, especially on the sides and back, where you do not have to worry about losing hair. I am thinning on the top and receding and I am hesitant to get the procedure done on the top of my head in case i ever want to grow my hair out again and continue receding, but at least on my HT scar it makes sense? What are your thoughts? Thanks.

Tattoos can work if they are stippled so that they look like hair, but changes in color of the tattoo can be a real problem (imagine a green tattoo over time). As I understand it, most inks won’t change color, but from the few patients I’ve seen with a tattooed scalp that hasn’t been the case. Be sure to research the tattoo issue, as I’m not that informed about the various inks and methods.

I am not sure if you had a hair transplant and have a scar or if you’re considering a hair transplant and are worried about the scar. In either case, scars can be largely prevented most of the time, but if you have one, a revision of the scar (at least one attempt) should be made. Each case is different, so a good doctor is what you want to have. Ask your doctor about the frequency of scars and the sizes that he/she sees. Consider sending me a photo of your scar if you have one.

The photo below is a 4 year old scar after a single procedure of 2090 grafts done here with a trichophytic closure. There is a scar, but it is barely noticeable, typical of trichophytic closures in my hands. Click to enlarge.