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This is an important article because it explains why I probably have never seen a case of post-finasteride syndrome in the thousands of patients who were prescribed the drug by me over the past almost 2 decades. When someone complains of ED, I either reduce the dose until the symptoms go away, or discontinue the drug.  According to this article, it takes years on the drug to get PFS, so since I am responsive to recommending withdrawing the drug, the incidence in my practice is non-existant.



I am 38 years old and in the early stages of male pattern baldness. Currently I am probably type 2 but it could evovle into type 4. I have been using coconut oil for the past 1-2 months and I do notice some growth (maybe 5pct). However, I was looking into getting a minor hair transplant (FUE). I just had a few questions. If you could shed some light, I would be grateful. Thanks!

  1. I have a short haircut in general with buzzed sides and long on top. Do I have to shave my head completely for the procedure?

  2. If I get a minor transplant, and somehow it gets worse in the future, would I be able to get another one? Why do some people say you can only get a few transplants throughout your lifetime? Assuming you have enough donor hair.

  3. Do I have to be on medication after getting a transplant? I am looking into this because I did not want to be on propecia or monoxidil from the side affects.

  4. How often do you have to come back for checkup and what does the entire procedure entail?

  5. Is there usually a minimum number of grafts that a doctor requires?

1- You only need to shave the back of your head short and within a week it will look normally short haired.
2- There are lifetime limits to FUE and hair transplants in general. If you exceed these limits, then you can become bald in the back of your head. Read here:
3- I would like to see pictures of you and if you were my patient I would do a HAIRCHECK test to find out what is hiding that the eye can’t see from planning purposes. Send me photos:
4- Once it is done, other than a final sign-off with the doctor when it is grown out, unless you lose more hair there is no real maintenance for it.
5- There is an activation cost for the surgery room, the staff and the set-up which we embed into our fees. Generally there is a $3500 minimum cost but that would include about 600 grafts if it is not FUE
I look forward to hearing more from you after reviewing photos.


It is very difficult to tell from this photos if you are receding or developing a maturing hairline. The best way to determine this is to lift your eyebrows so that your forehead wrinkles and the hairline should be no higher than one finger breath above the highest wrinkle. If this is the case, maybe you are just maturing your hairline.

am i losing hair


This is a 60 year old male who is a patient of mine who I had not seen for 5 years.  Over the past 5 years, his neck hair has significantly been reduced as shown in the attached photo. I have told most of my patients never to harvest the neck hair for two reasons: (1) it does not last their lifetime as regular scalp hair and (2) it leaves terrible scars. Too many doctors in a rush to get more grafts so that they can charge more money in performing a hair transplant, will harvest the neck hair and get these two problems as a person ages.

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I have about 90cm2 of baldness and about 200cm2 possible donor area. When I counted 1cm2 of donor 3 times I got 110,113 hairs and 123 Fu per 1cm2. I was wondering if the ones with red arrow are still the same Fu even though the hairs are spaced out? Different to one with green arrow.

You are pointing out the follicular units that have more than one hair. Sometimes they exit the same pore and sometime, it appears to exit next to the main pore? The count of 110,113 hairs is about the average hair count in a Caucasian male and the number of follicular units are about 50,000 or 2.2 hairs per follicular unit on average. Clearly some of the Follicular units have higher hair counts and other may just have a single hair. If you look at the leading edge of a normal hairline, you will see all one hair follicular units transitioning into more hairs per follicular unit as you go back from the leading edge. You were very astute in your analysis. The next step is to calculate the size of the balding area you are thinking about transplanting.  That is just the beginning of the next analysis where multivariate analysis comes into play. The other variables that must be considered is (a) hair thickness, (b) character of your hair (wavy or straight), (c) the thickness of the hair shafts (fine, medium or coarse) and last and most important is where you are heading with your existing balding (based upon HAIRCHECK analysis, family history, your age and if you are going to treat the progressive nature of balding and what is your long term medical plan with regard to going forward management).

follicular units


I have s been noticing my hair has been thinner around my crown for about 8 months. When I tell my parents they say they don’t notice until i point it out and no one else has pointed it out but when i take pics i can clearly see the area where the hair is thinner than the rest of my hair. My hairline is not receding so I don’t have that problem but I was wondering if there is anything I can do to reverse the thinning before it’s to late. I have been using nizoral for about a month

The crown is often the place that the genetic balding starts and it starts with thinning. You might want to see a doctor and get a diagnosis and build a Master Plan for what your future hair loss will be. A HAIRCHECK test is a good idea as well to get good baselines as to where you are now. Nizoral will not help you.


So I went to the dermatologist after my barber noticed a bald spot on my crown.

He didn’t seem to really care (he was bald) but He wrote me a prescription for fin and min.

However, my wife and I are about to have our first child and we want to have another one. She’s taking a strong stance on me not going on fin until we have our second kid. She’s worried about fertility.

Is it worth starting on min then getting on fin in a couple years?

I’m worried I won’t stick to min twice a day, I work shift work so it makes it really tough to apply. Plus I’m petrified of the 

You can use minoxidil once a day, at night after a hot shower and leave it on until morning. That works and it is less headache.


One never gets enough information. Estrogen protects the hair follicle from the genetic devastation in women that normally hits men with the same genetic code.


You have a classic movement to a maturing hairline. This movement is in process. You can see bits of your juvenile hairline still present which were originally a rounded hairline look. A mature hairline is V-shaped. The picture on the right shows what is a disappearing rounding to the hairline.

maturing hairline2


Leg hair is not a great idea as only 50% of it is in growth phase at any one time so it doubles the cost. Also leg hair does not grow long and falls out in 5-6 months, then goes to sleep and wakes up to grow for another 5-6 months before falling out and then goes back to sleep. It works well for eyebrows.


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