Hello Dr. Rassman, I’m a 22 years old living in Brazil and I have been balding since I was 15 (right now norwood class 3). I’m thinking about going to a hair doctor to start taking propecia and maybe even do some kind of hair transplant, but I would like to go to a doctor as good as you. Do you usually do transplants in people around my age? I would love to see some photos.

I was also thinking about travelling to the US next year and have a consultation with you. How should foreigners proceed?

Thank you very much!

To start, you can send me photographs to the email address on the Contact page. Since there is the obvious distance between Brazil and my office in Los Angeles, the internet will be the easiest communication tool (specifically, email) so that it can be determined if you’re even a candidate. We can also setup a phone consultation, if you’d like to go that route.

I do not have any hard rule on what age I will consider a hair transplant, but generally I like my patients to be at least 25 years old. I have, however, transplanted men of your age when the hair loss pattern is fully defined and maturity is there.

I do not have a hair loss problem, but I do have a hair line that is not even close to being straight. I was courious to know if there is anything that can be done about this?

Hair transplants can be done on the frontal hairline to address this problem in non-balding men and women. If you come to one of our free open house events, you can meet patients and look closely at the hairlines we’ve created to determine if what you see meets your standards. Hair transplants in people who wish to balance their hairlines or fill in the natural hairlines they are born with, constitute a small percentage of my practice and by its nature is a cosmetic procedure, rather than a restorative one.

Hello!
I’ve been losing my hair since I was 14. I’m now 20. I was told I had MPB and the doctor said to take finasteride 1mg everyday. I’ve been taking finasteride for 3 years, and I don’t know if it’s really helping. No person have hair loss in my family. My dad started to develop temples at his 50’s. All my family have thin straight hair, but no sign of balding.

I have right now big temples and diffuse hair loss all over the top. I also can see small (1 cm) thick hairs all over my head that never grow. I have some problems like anxiety, stress, and I guess bad diet. Also I have very little appetite and I’m under my weight. But I’m working on solving it. I did a blood test and I got high bilirrubine levels. I’m trying to trigger my problem and see if it’s really MPB. So, I was thinking I could get another opinion from you. What do you think?

Thanks for your attention

The key is establishing a measurement (metric) on the degree of miniaturization you have. No miniaturization present would mean that you are not balding from genetic male hair loss; progressive miniaturization extending from just the corners of your hairline to the top and back would indicate progression of the balding process.

Men who take Propecia (finasteride) can see if they slowed, stopped, or reversed the hair loss process when the scalp miniaturization map is compared over time. You need to get an expert to help you manage this process.

Hello doctor, I’m a 31 year old male that is about to have have a CO laser treatment to remove a some acne scars I had gotten when I was younger. My plastic surgeon did a “test patch” too see if I’d have any pigmentation issues during the healing process. Duning that time, the CO₂laser left my skin quite exposed, as it was raw from the treatment.

My question is, I currently use 5% Minoxidil twice a day and I’m worried what might happen to my treated skin if maybe a drop of Minoxidil accidently came in contact with it? I currently style my hair, after the Minoxidil has dried, I see the minoxidil particles that flake off when I brush. Could these dried airborne minoxidil particles create irrevocable damage to laser treated skin?

Thank you for your time and knowledge.

Minoxidil can be irritating to the skin. Try to keep it away from fresh wounds. If you can not, then it may be best to stop the minoxidil for a week or two and then restart it. The flakes you are seeing may be dried skin being shed and not the minoxidil that has dried out. I would doubt that these flakes, whatever the cause, would give you problems.

Dear Sir/Madam,

The right side of my forehead grows hair straight back off my face. It’s quite nice. However, the left side of my forehead has hair that falls limp and forward. I hate it. It takes a lot of product to sweep it back off my forehead to match the right side, and even then it doesn’t look natural.

Does anyone have any thoughts about possibly changing the direction of my hair growth on the left side of my head? Are there any chemical products to change the direction? Thank you.

This is a styling problem and that is why we have styling products. Training your hair to fall the way you want may help. If you’re losing hair, the miniaturized hairs can have a different character to them than normal hairs so I would want to know if you are balding.

Hi Dr Rassman

I have read your blog for some time and find it an oasis of sensible, factual information in the desert of hair loss websites.

I am writing to you to ask about the BX 3.4 helmet. I know you have mentioned it before but I wanted to draw your attention to a paper written by Dr Tony Chu, a consultant dermatologist in the UK. I have seen Dr Chu for years for my acne and he has managed it amazingly well, and he pioneered a laser therapy for acne which he proved with rigorous studies and research.

When I mentioned my (minimal) hair loss to him, he alerted me to the BX 3.4 helmet, and I did some research. I found a paper he wrote somewhere on the internet, to the UK Advertising Standards Authority, pulling together all the various studies and research on the subject of electromagnetic treatment of hair loss. IT looked very persuasive to me as a layman, and suggested room for further studies. I can’t find the paper now, which is annoying, but know it exists.

What are your thoughts? Have you seen the paper he wrote? If not, do you have some way of getting it and looking at it? If not, are you aware of all the studies he cited concerning this subject, and what are your thoughts on them?

I did buy the helmet from ebay at greatly reduced cost (£750 is a lot of money) and it does *seem* an insane idea to me, but then so did laser therapy for my long standing acne problem, and that worked, so I never like to say never.

Thanks

I’ve received a few emails over the past year and a half about this BX 3.4 helmet, and as I wrote before, there is no science that I can see behind claims that electromagnetic waves can have a positive impact on hair regrowth. I was just reading on their website that this helmet requires a monthly purchase of “essential oils” from the helmet maker, although the prices aren’t listed. What are these magic hair-regrowing oils, you wonder? The site lists Bay Saint-Thomas, Laurel leaf, Rosemary, Patchouli, Thyme Borneol, Cedar, Sage, Clary Sage, Myrtle, and Ylang-Ylang. So there’s extra costs on top of the nearly $1500 hair helmet.

A number of years ago, a professor from one of the local universities had developed electromagnetic treatments for diabetic ulcers of the legs and suggested that there was some data indicating an application for bringing back hair in a situation where hair loss occurred. The work to find out if it would work would’ve been an enormous task (and one which I just didn’t have time for), so I decided to pass on an opportunity to get involved to determine the value of this treatment modality.

As many regular readers of this site will probably know, I am a skeptic of most of the new treatments for hair loss, as most of them are not based on science, but motivated by commercial and monetary gain. I have not read Dr. Chu’s paper (I looked for it online and was unsuccessful), but since you’ve purchased one of these helmets, I’m guessing that you believe in it. Please keep us informed of your progress.

Consumers spend collectively millions, if not billions, of dollars on products for that allusive hair loss cure and as long as we are willing to spend the money simply to “give it a shot”, these products (including this electromagnetic helmet) will continue to entice people. I suppose the reasoning is that if the price is right, it may be worth the gamble, and to many people, the price of hair has no limit. On the other hand, the savvy entrepreneurs will keep selling these products for the “right” price and make their fortune.

Note: Image is for illustrative (and humor) purposes only. This is not the actual BX3.4 helmet.

Hi Dr,
I just posted a question to u before realizing to ask your advice on another topic. I’m 29 and have been taking propecia and minoxidil for the past year. I have noticed that some of the hair that i am losing is short but not necessarily finer than other hair. Also when i run my fingers over my scalp, i can feel a fair amount of stubble. Is this hair that is growing back or just a part of the hair loss process with hair falling out and growing back with a shorter life than before? If propecia and minoxidil is working for me then i shouldnt see the shorter hairs (about one inch long) falling out right?

Thanks for your advice on this difficult to understand topic!

Unfortunately, I can not comment on your observations just based on what you wrote — I’d need to examine your scalp. What I generally do is examine the hair with a video microscope right where it is growing and then I can tell a great deal about the hair you are talking about. I know that when I had hair transplants, I felt the new hair breaking through, so I have some personal feelings that what you are reporting may be new hair.

With regard to your questions/comments on hair cycling, we know that minoxidil does impact the hair by increasing length of the hair growth phase, but these two medications (Propecia/Minoxidil) may kick in the telogen cycle when it is first started up, making the hair cycle shorter. There are many things that occur (possibly at the same time in some people), but I don’t know if you can draw any conclusions from a year’s experience with these drugs.

I’ve been using MiN New York’s shampoo for more than a year now and I swear it has worked wonders for my hair. The ingredients are all high-quality (no sulfates, etc.) and it contains all sorts of DHT blocking compounds. It’s the best shampoo I’ve ever used, and I’ve used a lot.

I know you are skeptical of a shampoo’s ability to re-grow hair, and rightfully so. I don’t think MiN re-grows anything; what it does is create a healthier scalp environment. You can’t grow good crops in poor soil, and the same goes for hair. I use 1mg finasteride in the morning, minoxodil at night and MiN products throughout the day. My hair looks better now than it has at any time over the last few years.

Well, I like that you are using standard medications (finasteride and minoxidil) with your MiN products. Without good controlled studies though, nobody can tell which drug or product is giving you the benefits you’re seeing.

The claim that this shampoo is a DHT blocker flunks FDA regulations by making a medical claim that can not be backed up by the type of scientific research that the FDA supervises in their approval process. Don’t believe everything you read.

Doctor,
Your website has helped me discover a lot about balding, so much so that it has led me to believe that my previous diagnosis of having MPB may be inaccurate. I am a 16 year old male who was told by two dermatologists to begin taking Rogaine Foam to stop my hairline from receding, and my hair on top from thinning. I’ve been taking it twice a day, every day. But my hairline has now evened out (i.e., the corners which had receded now match the middle length) and the hair on the top of my head, which still feels thinner than my other hair, does not seem to be anything more than normal. Could this be because of two months of Rogaine, or because I only had a maturing hairline and was misdiagnosed?

And if that is the case, is it safe for me to stop using the Rogaine?

Thank you

If you are 16 years old and seeking the advice of dermatologist for hair loss, the doctor is likely to find that you have the development of a maturing hairline. After just 2 months of treatment with minoxidil, I would doubt that it had a major impact on you, but without the results of a microscopic examination of your hair to determine the degree or pattern of miniaturization, I cannot tell you if you are balding. I doubt stopping minoxidil will have a drastic impact on your hair loss at this time.

Doc,

You talk of “donor densities”, but how about of donor areas? When you saw me a month ago, you told me I have a below average donor density of 1.8 hairs/mm squared and a fine hair shaft and a loose scalp. However, I have a fairly large back of head that can easily fill my Norwood 3A pattern. Will my large head help out the fact that I have a low 1.8 density compared to my caucasian brethren? This is just a curious question since I am not yet a candidate for a hair transplant and have been on 1 mg finasteride since our visit.

Thank you in advance

This is always a demand and supply issue for donor hair. Large heads have more donor hair than smaller heads, but lower Norwood balding patterns (Class 3) means that if you control your hair loss with drugs like Propecia, then your lower than average density may never be an issue for your need for donor hair. Large heads have larger Class 3 patterned areas than smaller heads.