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I always ask my patients if they needed brain or heart surgery, would they try to find the least expensive doctor and hospital. Although hair transplants usually won’t kill you (although there have been deaths reported but they are rare in the US, Europe and Asia), what you get on your head from a hair transplant will (1) be there for everyone to see, (2) impact your donor supply so if the transplant is not part of a Master Plan, then a single hair transplant impact will be short term and there may be long term consequences of (a) depleting the donor supply, (b) continued balding which is 100% for men, and (3) growth, to be good, reflects the experience of the surgeon and his/her team. You may not get this with the least expensive option. The problem with many of the Turkey clinics, is that over 90% of them are illegal clinics and we never hear about deaths from anesthesia (because it would be bad for business) but we do see many complications in the US and Europe from many of these bad clinics.

600-1000 grafts cost? from tressless


Post Finasteride Syndrome is very uncommon. In my practice of 27 years, I have prescribed this drug on tens of thousands of men, although I did hear reports of sexual side effects in between 2-4% of these patients, I have never had a single case of PFS discussed with me. I have very good relationships with my patients and I am absolutely sure that if their sexual side effects would have persisted, I would have been part of the solution for these patients and been involved in their management of the problem.


Both Caffeine and Minoxidil when applied to the scalp, can induce hair growth. In a recent study in a peer reviewed journal, both 2% caffeine and the 5% minoxidil were both equal in value when applied to the scalp topically.?


I always talk about a “tug of war” between finasteride and genetic balding.  Sometimes the finasteride wins, other times it is overwhelmed by the genetic balding process.  This is why you need a doctor to help you develop a Master Plan to determine the next steps that you need to take when you are losing the Tug of War.


From the tens of thousands of patients I have prescribed this drug to, I have never heard such a complaint.


I have been on finasteride for over 2 years with good results, but I’ve been dealing with pretty bad sleep/energy/anxiety issues the last ~18 months. (No sexual sides, though.)

I’ve made a lot of lifestyle changes to try to address those issues, but nothing’s really worked. I’m beginning to wonder if the issues are finasteride-related.

I’m thinking about cutting down from 1mg/day to 0.5mg per day for a month or two. Depending on how that goes, I might stay there or continue tapering off.

Is there any general advice regarding lowering/tapering off finasteride dosage?

Reducing your finasteride to half the dose may not have an impact on your hair; however, the more you cut, the greater your risk of losing the hairs you retained. If that happens, you might not get it back. I have seen many patients stop the drug for a couple of months and then lose ground so bad that they never get back to where they were before stopping it. Reducing the dose to every other day or every third day still keeps the drug effective above 50% of the full dose, so this is a reasonable approach if you think that your symptoms are drug-related.


This is the classic nocebo effect. However, finasteride does reduce DHT which is the boner hormone, so don’t be too surprised if your dong isn’t 100%.  This effect is real as it can impact the physiology of the body, showing you how powerful the mind actually is.


If you are over 26, you might be a reasonable candidate for a hair transplant. Why 26? Because the patterns of balding become more evident at the age of 26, but the risk or more balding make it difficult, at times, to plan appropriately. If you use up your donor hair as many men do, then you are left deformed when the balding patterns finalize.

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Modern day hair restoration procedures usually provide very satisfying results when performed by reputable accredited hair transplant surgeons. Major skin related permanent side effects or severe health problems during and after a hair transplant procedure is becoming a rarity.

However, even the best surgeons out there will have some bad results due to unforeseen circumstances or, in rare cases, the surgeon or assisting technician having a bad day. Nevertheless, this risk is much smaller in countries such as the US where official accreditation is indicative of at least a minimum level of competency.

On the other hand, if you get a hair transplant abroad in order to save money, you will need be very careful in selecting your surgeon. You want to make sure the surgeon is accredited by the non-profit ISHRS, is locally board certified, has decent online reviews, and allows you to meet a few of his or her past patients.

Earlier today, this issue was brought forward front and center into my mind after Pakistan based actor Sajid Hasan posted a graphic video online about his botched hair transplant gone wrong. It seems like the person who did this procedure several weeks ago might have been a medical doctor or general surgeon, and not even an official hair transplant surgeon.

Besides having persistent health-related side effects, Mr. Hasan’s scalp currently looks like something that was worked upon by a butcher.

In the 27 years I have been doing hair transplants with as many a 7 doctors working for me, we have performed over 16,000 surgeries and never saw a case like Mr. Hasan’s. I have, however, seen many cases of necrosis which came to me after the hair transplants were done. I have, with associates, perform balloon expander surgeries on these patients to address the area of necrosis. If these areas of necrosis were not large, they often can be treated with wound care and then transplanted with proper techniques. Mr. Hasan does not have to live with this deformity.

central necrosis


Young men rarely get Telogen effluviums.  When it does happen, it goes away by itself.  If it does not go away, it is likely early genetic hair loss. If it is early genetic balding, it will not reverse.  You might want to see a doctor and get a HAIRCHECK test for a good baseline measurement to compare with future measurements so that you know what is happening with your balding pattern.

To learn more about HAIRCHECK tests, see here:


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