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I’m very seriously considering starting a course of propecia/proscar. But before I began I wanted to ask two questions.

1. It has been said that if you start propecia early the better chance you have of slowing down/halting hair loss, but that doesn’t tally with the propecia chart from studies which show that it generally peters out after 3 years. so surely you’d only save your hair for 3 years and then it would quickly regress, not making much difference how early you start because you only have 3 years of good hair.

2. I was wondering if you could recommend a good dermatologist/hair doctor in London, who I could have a consulation with before I begin taking proscar, do you know any who do miniturisation tests or some kind of form of monitoring on hair loss? There are a lot of snake oil merchants in London that are willfully telling you that you must get on medication and I just want to talk to who is honest and experienced.

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I have many patients that have reversed their crown loss and held the reversal over 10 years. Everyone is different, but the official studies show that the expected maintenance should be about 5 years on average. That means that some men get better than 5 years and some worse results while on the drug. It depends upon how aggressive your genes are.

As to your second question about London-based doctors, Dr. Bessam Farjo is a contributor to this site. He and his wife are terrific doctors and worthy of a trip to their offices (in London and Manchester). They may be able to give you a referral if you call their office.

Tags: propecia, proscar, finasteride, hairloss, hair loss, london


Hi dear Dr Rassman

I am a 43 years old man which have taken Propecia (1 mg) for 7 months. I know taking the said pill for women is forbidden and they should not even touch it. So, if a man who is taking Propecia and want to bring a baby, he should stop using the pill before intercourse with his wife? I mean the finasteride dose not transfer through the sperm.

If the answer is yes, how long before intercourse the man should stop using the Propecia?

Your soonest reply will be appreciated. Thank you

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After extensive studies in this very issue, we know that the drug is not transmitted to the woman through sexual intercourse. We have not seen the problems of fetus sexual differentiation in women who were fertilized by men taking this drug at the 1mg dose for hair loss. It is generally considered safe to have a successful pregnancy while a man is taking finasteride (Propecia).

Tags: propecia, finasteride, hairloss, hair loss, pregnancy


Hello Drs.,

I am a 35 year old male (of Korean descent) and I currently have a Norwood 2 hairline (by checking the top of my hair with a mirror).

My question is in regards to hair transplantation for those who are at the early stages on the Norwood scale. I know that most responsible hair transplant doctors will not treat Norwood 2 patients. Thus, my question is what is the minimum stage a person must be at on the Norwood scale for a serious consideration of hair transplant surgery? Thank you.

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I’ve been asked this before, but I’d have to advise a one-on-one consultation. Each case is different. It is possible that a non-balding person does not like the shape or the height of the hairline and wants it altered. Such cosmetic surgery is not hair transplant surgery for balding.

Tags: hair transplant, norwood, hairloss, hair loss, hairline


My question is about coping with hair transplants. It seems like one of the biggest challenges/inconvenience of transplants is for patients to go out in public and resume their daily responsibilities after surgery because of the physical appearance of the scalp and how it initially is red, scabby, and punctured after surgery. I find this a very unappealing aspect about transplants and Im wondering how do patients cope considering the gruesome appearance of the scalp after surgery- do they take time off work and just lock themselves in their house until their scalp starts healing?

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The scabbing can be easily addressed with good techniques and small wounds by the surgeon. Add good daily washes and most patients will have no significant crusting after the surgery. Everyone is different, but in regards to redness, only a few patients develop this. You can usually find out if you are one of them by performing a scratch test on the skin of your forehead. If it turns red 2-5 minutes after the scratch is performed, then you run a high risk of redness after surgery. The scratch incites histamine release at the skin level.

Remember, no matter how you want to look at it, a hair transplant is a cosmetic surgery. Just like any nose job, face lift, etc, there will be healing time needed. Some patients might get permission to wear a hat to work, others might adopt a new styling method to cover any initial redness from the surgery. Many of our patients go back to work fairly quickly after surgery (usually 2-5 days).

Tags: hair transplant, healing, surgery


Dear Dr Rassman,

Have you had any patients who have taken very low doses of finasteride (i.e. less than 0.25mg)?

I am not keen to take propecia because I’m concerned of the effects to my internal body chemistry but would also love to keep my hair for longer. I have had issues with my sex drive previously and do not want to mess with my hormone balance too much as a man still in my 20’s. Another reason being that I’m an athlete and want to be at my peak physically. I’ve read a lot about how finasteride affects the hormones, particularly the obvious reduction in DHT but also the decrease in free (not total) testosterone and the rise in estrogen.

Then I read this forum post:

It seems that taking a dose as low as 0.05mg is enough to lower scalp DHT considerably while keeping 20% more DHT in the blood. Like the original poster in the forum thread who is considering crushing a pill and measuring smaller doses – this prospect is more appealing to me. If I could just lower my blood DHT by 40-50% instead of 70% then surely my hair would still get some benefit and I would be able to keep my hormones at a more normal level. I have ruled out taking 1mg but am really curious about taking 0.05mg if only I could just measure it accurately each time (I wouldn’t want to take fluctuating dosages each day).

It makes me wonder why propecia isn’t available at a much smaller dose (0.05mg or 0.1mg)

Could you comment please? I’d very much appreciate it. Thanks for such an informative blog.

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Propecia (finasteride) at 1mg was determined to be the ideal dose for treating hair loss. Lower doses do work, but how low? I’ve said that 0.5mg produces 80% of the benefit, and 0.25mg probably give 50% of the benefit. I don’t have a clue about lower dosages.

But by dosing the 1mg level, it is the most effective treatment level to use… so why dose lower unless there are significant side effects?

Tags: propecia, finasteride, hormones, hairloss, hair loss


Hypothetically can Finasteride for shock loss be discontinued after a period of time has elapsed after the Hair Transplant operation and the risk of shock loss has receded?

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Yes, you can take finasteride temporarily to just protect against shock hair loss. I generally tell patients to take it for 8 or so months to bridge the gap between the transplant procedure and growth from the new grafts.

Tags: finasteride, propecia, hairloss, hair loss, shock loss


Hi Dr. Rassman,

My understanding from reading your blog is that FUE is over-hyped because it does not produce a linear scar, but is still inferior to the strip method in producing the most number of grafts with the least amount of transection. If hair cloning technology was to ever become a mainstream option that hair transplant surgeons offered, would that then make FUE the gold standard/go-to choice since the number of grafts needed could be created from a smaller amount of donor follicles?


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The point of the post you’re referencing from a couple weeks ago (FUE Back into the Linear Scar vs Scar Revision) was that once a strip surgery has been done and a linear scar is already present, a FUE procedure should not be the harvesting method of choice.

To answer your question on cloning, if the clone somehow came from the scalp, then FUE would be used, but if the cloned hair came from a petri dish, then no harvesting mechanism will be needed and the cloned hair would be put directly into the recipient site.

Tags: hair cloning, fue, hairloss, hair loss


Since Acell has failed and seemed a year ago to be “A Cure for Baldness in Five Years” its seems to me that the only 2 research institutes that are really getting substancial funding are Aderans Research and Replicel. Aderans uses a small piece of tissue that is removed from the neckline…”Cells are cultivated in controlled conditions where they are encouraged to multiply by the addition of proprietary growth media. When enough new cells are formed, they are returned to the scalp, where they are injected and elicit new hair growth and thickness, ultimately producing more hair than the client had before.” Replicel has a way to isolate dermal sheath cup cells and cultivate them. They are hopeful that injecting them into the scalp will cause regrowth on the scalp.

Since both Aderans Research and Replicel are in phase 2 of their clinical trials one would think that unless the subjects of the trial were locked in a room for 6 months someone would obviously have come out and said that these injections are working. If so…investors and inside traders wouldn’t flinch to buy Replicel stock (Aderans Research is a private company.) But Replicels stock…regardless of its clinical studies that have been going on for all this time…has a low volume of trade and is at 2.35 a share. With all of this put together…it seems blatantly obvious that besides the procedure being safe…both Replicel and Aderans Research Institute’s attempts at regenerating hair follicles is failing. What is your take on this?

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I guess that is one way to look at it. I am unaware of any leaked information, and I’m not even familiar with the ins and outs of these particular trials. I’d have to assume there are non-disclosure or confidentiality agreements which prevent participants from discussing their results (if any). If they are successful, the results will be announced when they’re ready. Rushing things isn’t going to help.

As for looking to insider trading as a sure-fire way to know if a product is coming to market… good luck with that.

Tags: hair cloning, replicel, aderans, hairloss, hair loss


I am very confused by one of your answers. You said Testosterone levels peak in the morning, but everything else I read says they peak at night. Is this just a mistake on your part?

Take Propecia With or Without Food?

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It’s no mistake on my part. Testosterone levels peak in the morning, drop through the day, and then rise in the evening. Further reading here (PDF).

Tags: testosterone, hormones


We’re taking the day off and we’re going to be on a limited posting schedule this week. Be back tomorrow!


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