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First of all, I just wanted to let you know that I have found your blog very useful.

I am a 24 male and for the last couple of years I have noticed my hairline receding and then my hair getting much thinner. I look back at pictures from 3 or 4 years ago and I am in awe at how much my hair looks different. Anyway, I have tried rogaine for about 4 months and have not seen much of a difference, plus it is kind of a pain to use. In fact my hair seems to just continue getting thinner.

I would like to try Propecia, however, I am in medical school and I really cannot justify using that much loan money for propecia, if you know what I mean. I have noticed that you and others suggest using 5mg generic Finasteride normally used for BPH as an economic alternative. I would like to ask my doctor about this option. My question is whether this is considered ethical/legal and how physicians usually respond to this.

Thank you for your time

There are no ethical or legal issues associated with prescribing finasteride for androgenic alopecia. There is however a financial issue, as finasteride 5mg is about $30-$60 for 90 pills and finasteride 1mg is about $150 to $200 for 90 pills. If you cut the 5mg finasteride in four parts, the 90 pills should last you 360 days! This drastic difference is based on U.S. Patent laws that give protection to Merck, as they have the rights to manufacture the 1mg dose of finasteride up until mid-2013. The 5mg finasteride is available as a generic because the 5mg patent expired already, so the prices are way, way lower.

As far as doctors are concerned in prescribing medications, as a medical student, I hope you will soon find that there are hundreds of medications with generic versions that are exactly the same and just as effective as their branded counterpart. Consider this when you prescribe branded medications to patients after the drug companies wine and dine you.

On a final note, there is an ethical issue to the patient if they decide to cheat the system by getting the generic finasteride 5mg using their insurance card. The insurance companies may approve finasteride 5mg thinking you are treating a prostate problem. Finasteride used for androgenic alopecia is not covered by insurance.

Hi,
I have a question. I am willing to do hair transplantation both back area and front area as well. I was deciding first to go front area and then back area. How many months or days gap should be given between two surgeries. Kindly help with information. Regards

First, you need to have your supply and demand understood. If your donor density is enough to address the balding problem, then starting in the front is the best way to go about the process. Will you be doing an FUE or a strip method for harvesting the grafts? That may be important in the timing.

Strip wounds will heal easily in 3-4 months and likewise, FUE wounds may heal in less time. As the areas of your focus are different (front and crown) you can have the second procedure as early as 3-4 months following the frontal surgery, provided everything is well healed.

Dear doctor,

I am a male of 22 years old. I am experiencing very slight recession of my hairline at this moment almost invisible for the human eye. I also have some shedding which freaks me out a lot(not an understatement) because I always have got extremely thick hair and never noticed any shedding. My dermatologist prescribed me minoxidil and the second appointment because I was still worried gave me a prescription for Finasteride 2.5 mg. She said I could take it ‘preventive.’ Is this true? My pharmacist forgot to write the dose on the box so I have been taking 5 mg for one month. Is this dangerous; should I start taking the right dose now(i.e. 2.5 mg or just keep on with the 5 mg.

Thanks a lot in advance

What you are doing (taking 5mg finasteride daily) is not dangerous, but it is not the right dose. For the treatment of androgenic alopecia, the correct dose of finasteride is 1mg a day.

In your case, there is nothing you are telling me that you were even diagnosed with androgenic alopecia! You should not be taking any drug for preventive measures. Perhaps you need to find another doctor and a pharmacist.

In December 14 2005, someone wrote that he started losing hair soon after beginning to use Head & Shoulders shampoo. At the time, you advised that, to your knowledge, the shampoo did not contribute to hair loss. However, in 2008, you posted a fair amount of reader commentary, much of which linked the readers’ hair loss to that shampoo by their own account. Does your opinion remain unchanged from that of 2005?

Yes, my opinion on Head and Shoulders causing hair loss is unchanged. Maybe there’s an allergic reaction or something else entirely… but generally speaking, shampoos won’t cause hair loss.

I don’t shy away from posting reader comments on products, but it is their opinions and/or experiences.

Hello Dr. Rassman,

How did the holidays treat you and your staff?

I had a question about keeping up with hair loss. Have you ever had a young or middle aged patient run out of donor hair? I saw this picture of Nicholas Cage and shuddered. I don’t mean to pile on the Cage/Hair issue but I think it helps illustrate what poor planning can lead to. He had some work done and now, despite his fame and fortune, he is a prisoner in his own body.

Will the equipment that NHI uses to calculate future hair loss (miniaturization mapping, hair bulk analyzer) pick up on advanced patterns like this one?

Thanks and enjoy your day!

There’s been rumors circulating for years in the gossip rags that Nicolas Cage had a hair transplant, but until he comes out and says one way or the other, it’s just speculation. I honestly don’t know when his loss started, how it progressed, or what his goals are/were. Actors will commonly have high end hairpieces/wigs used in their movies (depending on what the role calls for), so creating a timeline to note his hair loss progression is sketchy.

It may seem to you or others that his hair restoration process was due to poor planning, but to others and (himself) it may be what he wanted. Without good pictures, it is impossible to tell just where is hair loss is and what he had done. You also don’t realize maybe he may continue on with another hair transplant to seek more fullness. I do not know! It is all speculation.

Looking at the photo at right (full size here), his hairline is high… too high for a normal look. It should be located in the mature position, and if it were so located, it would not look transplanted.

As for the miniaturization mapping or bulk analyzer tool, neither will predict the future, but both do help us keep track of hair loss and the treatment progress. They’re just tools we use to come up with our Master Plan for each individual.

And to answer your first question… the holiday season was nice. Thanks for writing!

I was wondering if you have considered using ACell combined with plasma and injecting it back into the scalp using a tattooing gun. This would create the necessary scaring effect allowing ACell to, in a since, rejuvenate the scar. What do you think?

Pushing ACell into a scar with a tattoo machine will not work to do what you’re probably looking to do. There’s still no hair present in the scarred area, as ACell won’t make hair suddenly sprout in scar tissue where hair does not exist.

While it’s an interesting idea, I’d be skeptical of any doctor claiming to do scar rejuvenation in the way you described. I’m not sure if you’re just curious about an idea you came up with or if someone out there is offering it already (believe me, I’ve read about some far fetched ideas that some doctors are selling to patients). Unfortunately, I’d have to see some really solid evidence to change my thinking on this.

I understand that a 1mg dose of Propecia is recommended. What I want to know, however, is how much more hair grew at a 2mg dose vis-a-vis the 1mg dose — 10% more? 15% more? I know these data exist. So, what incremental improvement might there be with a 2mg dose?

While it’s quite possible that the data for 2mg finasteride hair loss treatment benefits exists, I don’t have it, I don’t recall seeing it, and I’m not sure if it was ever made available to the public.

I do know that there were studies that looked at high dose and low dose finasteride (prior to Propecia becoming available) for treating hair loss. More is not better and I am not aware of a 2mg study showing any additional benefit. The stories that I do hear are anecdotal.

Hello Dr,
Is it true that the position you sleep (i.e on your face or side) can cause hair loss in your brow? I have heard this before and was wondering if its an old wives tale or if its true? I know a few people who have sworn this is the case with them, and want your expert opinion as a hair loss specialist. Thanks!

I’ve never seen eyebrow hair loss from sleeping on your face before, nor have I even heard of this occurring. It probably is an old wives’ tale, but I’m open to ideas others might have about this.