Hi Dr. Rassman. I’ve heard quite a few stories claiming that generic finasteride is not as effective as Propecia. Do you prescribe both, and if so have you noticed a difference in your patients responses?

Some patients have reported reduced effectiveness when they switch from propecia to the genetics but there are a few manufacturers of the generics and I have not kept a record of which is which.

I’ve been trying to get some sort of idea of about how much a hair transplant would cost to just fill in my temples. I’ve been on finasteride and minoxidil for over a year now with great results, but my temples are still thinner than i would like.

Anyone able to give a rough estimate of what the cost might be just to fill in thin temples? I think 500 grafts would be the absolute most I would need. And yes I am in the process of setting up a consultation but I would like to have an idea beforehand.

Hair transplant pricing is all over the place; however, think about what you are actually buying. If you needed a heart transplant or brain surgery, would you try to find the least expensive place to do it? I have seen many men find a cheap hair transplant and then, when either it failed or the doctor who performed it, didn’t bother to build a Master Plan for your future and then you find out that you lost a significant amount of your donor supply that is limited, the fee becomes ridiculously high regardless of how little that you think you paid for it. I have seen many hair transplant result where the doctor ruined the donor area or did it too soon just to get your money. Make sure that the doctor is reputable and if he employs a salesmen, don’t trust the consultation or possibly even the surgery. Try to find dirt on the doctor from Yelp, Realself, and Reddit. There are many potholes in selecting a doctor so don’t fall into one.

Here is a review sent into Realself for me this morning about the consultation I gave him yesterday and that I told him not to do a hair transplant, which is why he came in to see me:

As the years have gone by, I have started to notice some thinning up top. After doing some research, I decided to setup a hair loss consultation with Dr. Rassman.

I chose to setup my appointment via an online form, and was surprised when I received a phone call from Dr. Rassman himself within 15 minutes! Turns out, he happened to see my consultation request while relaxing on his deck, and decided to give me a call! He was very friendly and personable on the phone, which made me feel better about my upcoming in-person consultation.

I arrived on the day of my consultation and was seen very promptly. Dr. Rassman was as friendly and jovial in-person as he was on the phone. He did a quick visual examination, and then performed an inspection using a device called the Haircheck. This devices takes measurement of hair density per square inch at different sites on the scalp, using the back of the head as a baseline to compare with other locations on the scalp. I had never seen this type of device used before, and I was impressed by Dr. Rassman’s objective and data-based approach to evaluating hair loss.

After the Haircheck inspection, he informed me that there was some thinning, but not enough to recommend a hair transplant. He then gave me a thorough description of my options and talked through the potential side effects, while interjecting some lighthearted humor, which made me feel at ease. He was very knowledgeable, and was up to date on the latest research. In addition, he answered all of my questions and promised to email me additional info. I was surprised and delighted to find that Dr. Rassman followed-through on his promise quickly, emailing the additional info in about an hour.

I suspect that many other surgeons would have simply taken my money and performed a hair transplant, but I respect Dr. Rassman for his candor and honesty in recommending against a hair transplant. If you are thinking about seeing someone about your hair loss, I would definitely recommend seeing Dr. Rassman for a consultation!

I heard that hair falling is an autoimmune disease, with the body attacking its own hairs. Then, there is Wim Hof (google him), that has scientifically shown to control consciously so many processes in his body that were previously thought to be impossible.

Some forms of alopecia have an autoimmune cause. This is more common in women then men. 99% of men who are losing their hair find genetic causes inherited through various family lines.

Most of the stem cell treatment being offered are scams. A few doctors have built a reputation for delivering stem cell treatments and have made a fortune on men chasing the impossible. There are no stem cell treatment that are known to work.

Here are some considerations I’ve had before jumping into the HT route and wanted to share these with the community to get feedback and possibly provide some additional options for those in a similar position:

Background on me: 29M diffuse thinning throughout top of head. Finasteride/Minox for the last ~6 years that has slowed, but not stopped hair loss. When I first began noticing hair loss, I always considered a HT a possibility, but now my hair has progressed to where I think it may be appropriate to start considering it as an real option.

Everything you’ll read on the hairloss forums essentially boils down to the fact that getting a HT is a one way street. In almost all cases (especially if you are young) you will need a total of 2-4 surgeries. You will need to be financially and mentally ready for that. Even after that, you may not get the results you were really targeting.

The biggest hang-up for me, and undoubtedly for some of you, is that there’s not really any going back from the HT route. Regardless of if you go FUE or FUT, there will be scarring. If you get an unsatisfactory result, you will not be able to completely shave your head down without exposing those scars.

Here is the plan that I’m circling towards and may offer an avenue for some of you as well (I think this may be partiucularly suited for diffuse thinner like myself):

1. Go for an initial moderate-large size FUE procedure (2.5K-3.5 grafts). I’d really only go with this if you have the funds to go with a top surgeon

2. Enjoy your denser hair for 5-10 (hopefully!) years and then go for a second FUE procedure as age takes its toll and continues to take your native hair

3. At this point, in all honesty, you really won’t be able to shave your head with all the FUE scarring. If you still have areas that you’re not happy about, I think it’s wortwhile to look at SMP (maybe temporary at first) into both the FUE scars and in the transplanted recipient area. This helps boost the illusion of density even if you are out of available donor grafts.

I think having a plan for that 3rd step is crucial because there are so many results on here and the forums that end in regret and the person gets stuck because their result is sub-optimal AND they can no longer shave their head due to the scarring.

Hoping to discuss this plan with all you on here perhaps give me something else that I had not considered.

The Master Plan I always discuss with my patients is what happens now for the near and distant future. If hair transplants are in the future for you, you absolutely must know your donor density (a number) which will will deplete with each hair transplant. For FUE, the limit is half of the number as for a strip surgery and if you are not aware of this, then you could end up deformed as I often discuss on this site.

i’d really appreciate if you could have a glance at these pictures taken with a microscope to confirm whether i have dupa hair loss/miniaturization. pardon the oily hair and hair fragments (recent haircut) :)

There are 9 slightly miniaturized hairs (arrows point to them)  out of a total 50 hair count. This is not DUPA as it requires substantially more than 20% of the hairs.  Also it is important that these miniaturized hairs are usually part of a follicular unit with at least 2 normal terminal hairs, so your donor hair count may be just dropping slightly, something I see as boys become men, or as men get older.

I have these bumps since I have had my FUE. What is happening to me?

You have what appears to be burried grafts from a faulty FUE technique. These are probably infected buried grafts which will probably require surgical drainage by an expert.