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First let me congratulate you on an excellent website. It really inspires confidence. I get a buzz out reading the stories of people you have helped. If there is such a thing as Karma, then you’ll probably reincarnate with a full head of hair for the next thousand lifetimes! Ha ha.

Ok, serious now. I’m 36 and a class 4 or 5 balding. I am reasonably happy, however one day I got sun burnt on top. My girlfriend absolutely insisted on cutting up a tomato and placing it on my burnt balding head for relief, which I recall putting up with for about 15 mins. I swear that ever since that day, my hair has felt considerably thinner and has never felt the same since. My sun burn wasn’t THAT bad and I blame the tomato somehow. Can you offer some kind of perspective on this one? I’m curious to know if your surgery advocates using natural products like Olive or Peanut oil for scalp healing.

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I do not know about tomato treatments, nor do I have any experience with olive or peanut oils on the scalp. People with miniaturized hair will burn easier, because the hair, which normally protects against sunburn, becomes less effective as it becomes thinner. It is not unusual that one of the first signs of recognizing genetic balding is the ‘sunburn’. As the hair provides less coverage, the sun does more and more damage and people with considerable miniaturization will have a higher incidence of skin cancers. Many patients seek out a hair transplant to reduce the sun and ultraviolet effects which produce skin damage. As you seem to be a regular reader of this blog, you probably already know this, but you should have your scalp mapped out for miniaturization to determine if you have genetic type balding.


What is your opinion on ScalpMed a product being sold via infomercial that has been getting reviews? Also, assuming someone had no more donor area from having had a few procedures, but still wanted to grow more hair, what would be the most effective way to do it? I have a full head of thinning hair, barely covering the crown, and thin in the front, but with a hairline.

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You’ve indicated that you are located in Beverly Hills, so it would be best for you to be evaluated in person. The depleted donor area is often heavily scarred and this would have to be assessed, balancing donor supply (if available) against need (demand). If you have a full head of hair, just now thin, do you really want more transplants? Question that goal carefully. If you’d like to come in for a free consultation at our Los Angeles location, please call my office at 800-NEW-HAIR.

ScalpMed has been referenced before, here.


Dear Dr. Rassman,

I’m a 22 year old male. I’ve been thinning since the age of 17, to my knowledge (probably a little prior) and have maintained my hair, somewhat, it’s thinner as time goes by but i have used lexington’s lasercomb for 9 months and have not lost any more hair and my crown actually got thicker,
but the front has stayed the same (no complaints). I would classify myself as a NW2, but no bald spots, just much thinning in a NW5 pattern, you can clearly see the pattern if you look for it, but i am wanting to get an HT to give myself a natural look. I visited a clinic here and they say with 1500 to 2000 i would be okay, and i agree but only if i do not continue to thin.

I am just concerned that, although i am maintaining quite well right now, would under going a procedure induce loss? I would think without treatment, yes? But how many individuals are on a treatment and halted their loss, but still have shock loss? Ideally, I would like to get this done, and maintain the results, but my concern is that I’ll lose my natural standing hairs and the HT will look horrible and pluggy and i’ll need to play “catch up”. What do you think? I realize I’m young, but if it wasn’t for being able to control my loss, i’d not consider an HT, as that would be ridiculous if you can’t maintain your hair prior at this point.

Thanks for your time.

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Norwood Class 2If you are a Norwood Class 2, then I find it a poor practice for a doctor to recommend transplants in someone at your age. You are correct to be concerned about hair loss and the things that might go wrong. Starting too early is just asking for trouble.

Shock loss following a hair transplant occurs more often in patients under 30 years old, more so if they are not on Propecia (probably 80% risk). You may not have a noticeable improvement from doing a hair transplant at your age and may only see the down side without seeing any short term benefits. Better to wait until you can determine your true pattern of hair loss.

With what you are telling me, I might think that the doctor is thinking more about his/her car payment rather than your hair and what is best for you. Once you start this process, you are committed for life on a hair transplant timeline without a Master Plan. I am not saying that your doctor is unethical, but I’ve heard about these types of situations before. Please read more about doctor ethics in past blog entries:


I have used the 5% Minoxidil solution for nearly two years as directed, ie., twice a day. While it seems to have worked with my hair loss, it seems that my sex drive has waned. Also, when I do, it seems erections aren’t what they were before. I am 46 and in otherwise good health.

Are there any indications that long term use of Minoxidil (like I have used it) has any effect on either a male’s sex drive or erectial function? Thanks in advance.

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There are no known sexual side effects from topical minoxidil (also known as Rogaine). This is a drug that has been around since the 1970s (it was originally a medication for high blood pressure) so its safety and side effect profile are pretty well known – even for patients who have been on it for decades. It does work to strengthen hair growth.

There are several other possible causes for loss of libido not least of which is the pervasive rumor that “hair loss medications” cause decreased sex drive. While decreased libido/erectile dysfuntion is a rare (+/- one percent) and temporary (1-3 days usually) side effect of Propecia, it does not occur with minoxidil use to our knowledge.

Finally, (for the rest of you readers out there) it bears repeating that human beings are highly suggestable – if you tell someone, man OR woman, that they might possibly have a side effect or if they even just THINK that they will have it, they will often manifest it for you. (It is often joked that this goes double for guys when it comes to their manly functions but both sexes will have this effect.)

Back to the original writer of this blog entry – this is not to say your symptoms are not real – I believe they are. If you persist in having significant symptoms of decreased sex drive or erectile dysfunction, I’d HIGHLY recommend you talk about it with your doctor. In the meantime, I can reassure you that you may continue to use the minoxidil without fear that it is causing your symptoms.


Hi Dr. Rassman,

I am a 49 year old man. I had a transplant of 1800 hairs about 4 years ago. One year after the transplant, I was very pleased with the result. In fact, it looked so good that I resisted the temptation to do a second “fill-in” procedure. Everyone commented on how great it looked.

But since then, I have been very slowly losing my transplanted hair. It watch it very closely and I see the individual hairs miniaturize and then finally disappear. I estimate that I have lost 25 to 30 percent of the transplant. I would like to get another transplant but feel like there is no point if the hair will eventually be lost.

I have an excellent diet and health and also take Propecia. I was led to believe that I would keep my transplanted hair forever…

Could you give me some advice?

Thank you!

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Most men who report this are actually seeing the original hair population drop out, not the transplanted hair. Losing transplants over time is rare, but if it is really transplanted hair being lost, the miniaturization will be evident in your existing donor area. By mapping over the donor area for miniaturization, that diagnosis will be evident. See our article referring to Diffuse Unpatterned Alopecia, which states:

The diffuse androgenetic alopecias, that we will refer to simply as DA and which consist of Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA), can be further divided into various stages of progression with DA 0 representing the pre-balding state. The earliest stage of loss, in these diffuse alopecias, DA 1 , would be characterized clinically by a “slightly thinning” look in the front, top, and vertex, best visualized under strong lights or when the hair is wet. At other times it might not be noticeable. Almost all patients have subjective complaints of less fullness in the affected areas. Preliminary densitometry studies in the thinning area of these patients have revealed miniaturization to be in the range of 20-50%. DA 2 represents the stage when there is obvious thinning evident under normal lighting, but if the hair is styled properly, the degree of hair loss may be acceptable. Miniaturization for DA 2 is on the order of 50-75%. Patients with DA 3 have significant hair loss in the transplanted area, and the coverage it provides is no longer adequate. The frontal hairline, though still recognizable in it’s position as the mature hairline, does not have enough density to frame the face. Miniaturization in DA 3 is usually around 75-95%. The DA 4 patient has lost most of his terminal hair in the balding area (miniaturization > 95%), generally has involvement of the crown, and is similar in appearance to the typical Norwood Class VII.

We feel that the early identification of the diffuse alopecia patient is important in order to screen out those who will not be surgical candidates. In addition, because the diffuse alopecias are often associated with a rather rapid progression through the four stages described, the young patient is often not emotionally prepared for this degree of hair loss, especially with DUPA. Long-term planning and careful patient counseling is, therefore, critical before any restoration should be considered. We have not yet determined the exact incidence of the diffuse androgenetic alopecias in the general male population, but they appear to be significantly more common than are the Norwood Class A’s.

It is possible that in many instances diffuse, unpatterned alopecia is not a true “androgenetic” alopecia at all but actually represents a similar pathophysiology to what has been termed “senile alopecia,” 2 only occurring at a younger age. These authors evaluate the donor area for a miniaturization in every person consulted in our office for hair loss. We believe that some degree of clinically significant diffuse androgenetic alopecia occurs in a substantial number of men as they age. We have observed this in men as young as 17. Regardless of what the actual pathophysiology might prove to be, these authors believe that it is important to make a quantitative assessment of miniaturization , using densitometry, when evaluating each patient so that the physician can more accurately determine the total available supply of stable donor hair.


I am a 33 year old woman who just underwent 2 surgeries under general anesthesia in the last 5 months. The first was liposuction that resulted in sepsis, pulmonary hypertension, fat emboli etc. Various meds included lasix, decadron, antibiotics, cardizem, xanax, lexapro. The second surgery was to repair internal damage, lyse adhesions, and explore possible pancreatic duct damage, and cholecystectomy. Other meds included Dilaudid and valium. Luckily prior to this I had extremely thick hair and very healthy hair. I am now losing tremendous amount of hair and it is becoming thinner every day. I am worried. Will it return? Are any of these meds directly related? Is it the Anesthesia?
Thank you

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Wow! You have been through quite a bit and you have my best wishes for a full recovery! You are experiencing a “telogen effluvium” which in simplest terms is a reaction of your body to the stress it has gone through. Many condiditons and situations can cause you to lose hair like this, emotional stress, rapid weight loss, a car accident, giving birth (for the women out there), and even a colonoscopy! It has little or nothing to do with the anesthesia or the meds, and the good news is that you will regrow your hair.


Hi Dr.
Many Thanks for your efforts here. I’ve this one little enquiry. Have had a strip surgey for some 1000 grafts, Will the deep massaging of my 5 months old linear scar have any beneficial effects? like enhancing/improving it’s future appearence, Also, can now i resume my sport activites like swimming, jogging & some weight lifting without worrying that my scar could stretch, overheard that scars take up to 18 months to reach their maturity stage.

Thanks again & Best Regards

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Deep massage can help loosen your scalp for future graft harvesting, however it will not improve the appearance of the scar. Sport activities such as swimming and jogging a few weeks after surgery should not widen the scar, provided that the incision was not made in the high neck area. When neck excisions are done, there is a higher incidence of widening donor scars. In the short term period after a hair transplant (first 4-6 weeks after a strip harvesting technique is use) weight lifting can potentially cause widening of the scar because straining the neck muscle may want to traction on the scar. After 5 months, I believe that everything is somewhat fixed in position. Massaging the scalp will have value if the scalp is tight.

For your information, there are three phases of wound healing:

  1. Inflammatory response — day 0 to 4 days
  2. Fibroblastic repair — day 4 to 6 weeks
  3. Maturation/remodeling — 6 weeks to 2-3 years, although most of the strength (the width of the wound) is established by the end of the 4th month


When i was younger about 10 i had a cyst develop on my eyebrow. They hospital removed this cyst but there was a fairly wide gap on my right eyebrow which will not grow back, is there any possible way i can get hair on my eyebrow like a transplant?

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Hair transplants are a good fix for this as they can fill in the gap of your eyebrow. I do not believe any medicine will help in your case. Some examples of eyebrow transplants can be found here, here, and here. For past blog entries about eyebrow transplantation, please click here.


Does MSM make hair grow faster, and if so, by about how much?

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I read and agree with this article: MSM and Hair Loss for a Treatment. Many claims, not much data.


I am a 33yr old male. I first experienced hair loss at age 23. At age 25, Propecia was available on the market so I tried it. I got good results but decided after going back and forth a few times that I did not want to have to get a prescription and take a pill every day. Is there any other proven remedy? I notice celebrities such as Tiger Woods, Matthew McConaughey, Eric Lindros, and Bruce Springsteen to name a few, reverse their balding trend. Help me make the most informed decision please.

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Propecia will help reverse some of your hair loss at a young age. Stopping it is not a wise decision. Although Propecia is a wonderful drug, I believe that this drug has its limits and will not reverse balding that is stable like a hair transplant will. There are many celebrities that I know of personally who have had multiple hair transplants and continue to take Propecia to prevent further hair loss. I only wish they would let me use their names, however I respect their wishes and take patient confidentiality very seriously.


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