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After seeing Steve Hartman of CBS/AM570 in person I am amazed at the process of his hair restoration. My situation is the typical male pattern baldness on the top and back of my head, not the front. How do you handle that?

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Steve Hartman’s hair transplant procedure is what I like to refer to as the fast-track approach. With his situation, one surgery did the job he needed and if he stays on Propecia, hopefully he has seen the end of any more than this one surgery. For transplanting the crown, I have general reservations in the very young men (under 30) unless there is very good donor hair density and good laxity (looseness) of the scalp in the back of the head. Other elements of the supply/demand formulae must also be accounted for and those men with good quality hair and skin color tend to do better than those without either when the hair must be distribued to cover a wide balding crown. I am always worried that the crown will take all of the donor hair and when the front balds, then the patient may run out of donor hair. There are many times, however, that crown transplants are appropriate. In those men over 35 (for example) with a 3 Vertex balding pattern (frontal corners and crown only balding) or those with pure crown (vertex) balding in people like me. I had 1600 grafts into the crown and my frontal hairline is normal without any balding. I use Propecia to maintain any further hair loss and I have been stable for years since my transplants were done in the late 1990s.

Propecia is the mainstay for hair restoration in the top and crown (particularly for the younger men whose final pattern is not predictable), so you should first get assessed for miniaturization and then go on that drug if appropriate. Transplants rarely will be needed if you catch the top and crown loss early enough.


Hi doctor, A doctor in france suggested to me to use Aminexil SP94(by Kerastase) capsules (commercial name:”Vichy Dercos”) applied on the crown area and the shaded are of the head directly. I noticed from many people’s feedback in France that dermatologists there recommands to apply Aminexil as a safe alternative to propercia since it doesnot have any sexual side effects,and that Aminexil actually stops the thining of the hair caused by dihydrotestesterone ( it does not stops DHT like propecia), rather it thickens the hair follicle which becomes resistive to DHT. What do you recommand doctor i need please your advice please(ie: I used propecia from several weeks and i have serious sexual problems). Thanks A lot

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I looked up Aminexil and found that it is basically a minoxidil compound with the type of results that minoxidil gives. The question of course becomes, “Is it better than minoxidil by itself?” I would think that no one really knows the answer to that question, because they may not want to know. The general thought about minoxidil is that it may impact the length of the hair cycle by increasing it, amongst other benefits. That would add more hair, as less hair would be in the catogen phase and more hair in the anogen phase at any one time.

With regard to sexual side effects from Propecia, they are very rare (less than 1%) and much of it may be the power of suggestion as we men are very sensitive to anything that MAY impact the performance of our penis. It is great to blame Propecia for erectile dysfunction (ED), when in actuality it may not be the Propecia, but rather psychological or relationship issues associated with social issues that occur. That is clearly not always the case, but I suspect that it is mostly what is being reported on the sexual erectile dysfunction (ED) issue.


Dr. Rassman,

My hairline continues to retreat. I have been using Propecia and Minoxidil 5% for more than 6 years with some success. What do think about using additional topicals such as Spironolactone 5% and higher strength Minoxidil? Have these topicals proven to be worthwhile? Should I just accept the continued loss of my hairline?


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There are mixed feelings about higher doses of minoxidil, mostly positive providing that the skin irritation and other side effects do not increase significantly. As you may know, minoxidil can drop your blood pressure and make you light headed and it is a skin irritant. Be sure that the side effects do not become a problem.

With regard to Spironolactones, see my previous blog answers here: Spironolactones


Several years I had hair loss patch the size of Half dollar and my two end finger nails were lines and pecked. I was diagonosed as having alopecia areata. Treatment w/ cortisone shots did not help. in last year or so I developed more of these loss of hair and sometimes it itches. I had biopsy done and the results “the findings are suggestive of (but not diagonostic for) collagen vascular disease such as lupus erythemaous. The blood test shows that I’m negative for Lupus. What is the outlook in terms of medication, regrowth and outlook? Is there any thing to grow hair? will a transplant work?

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Sometime blood tests for SLE (Systemic Lupus Erythematosus) are not completely accurate. I recommended that you visit a rheumatologist to further your evaluation process. SLE is one of the many causes for hair loss. Hair can regrow if your cause is due to SLE or any reversible disease that arrests and then subsides. Some people will have lost their hair permanently, even if the disease goes away. Hair transplantation will not work if you have an active disease causing the hair loss, but if the disease is known and is not active, then a hair transplant will work, that is, unless it gets reactivated. Again, it is best to see a rheumatologist and a perhaps even a good dermatologist who focuses upon such problems.


i am 19 years old / female. when i was younger, in my middle teen years i had thick, thick hair, now its so thin. whenever i take a shower i lose so much hair its ridiculous. i’ve been using mousse for my hair for a long time. i started really using it when i was about 14-15 years old, but now i use it frequently in my hair but i never put in on my scalp. i always put it in the middle to the ends of my hair. i colored my hair once and that was when i was 15-16 yrs. old, and i’ve been smoking marijuana for about 2-3 years, but not every day. i also started two new pills, one is a birth control pill levora. i’ve been taking that for a year and the other the one is zelnorm. ive been taking that for 4 months now. my question is what could be the cause of this? my mother has noticed my hair loss, and i’m scared i could go bald at a young age. i’ve lost so much hair in the past year or two. could what i’m doing or taking be the cause or what????

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Birth control pill could potentially cause hair loss. However, Zelnorm does not directly cause hair loss. Zelnorm is for (Irritable Bowel Syndrome) IBS with constipation symptoms. Patients with IBS may have a nutrient deficiency leading to hair loss, so a focus upon your diet may be appropriate. There are many causes for female hair loss. I recommend that you visit your physician for blood work to rule out anemia and hypothyroidism, which could also potentially cause hair loss. The general causes for hair loss are hypothyroidism, alopecia areata, androgenic alopecia, repeatedly over plucking, eyebrows lifting, trichotillomania, stress, chemotherapy, radiation, eczema, seborrhea, scleroderma, lupus, hormonal imbalance, psoriasis, parasites, fungal, autoimmune disorders, poor diet, poor nutrients, burn, trauma, leprosy, and drugs. The common medications which may cause hair loss are beta-blocker, coumadin, oral contraceptive pill, antibiotics and chemo-medications.

Genetic hair loss starts in some women as early as 17-19 years of age. You need a complete examination for miniaturization to make the diagnosis, one way or the other. Get a good hair doctor, as that is critical for you to have a better understanding of what is happening to you.


Hello Dr. Rassman,

I am a 22 year old male with a widows’ peak that I would like removed. I also have bad acne if you take care of that at all. Please let me know costs, etc…


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Removing a widow’s peak is not easy and has side effects which include scarring, depigmentation, pitting, etc. That of course, depends upon the mechanism that you chose to remove the widow’s peak. FUE works, but may leave small depigmented areas, just like electrolysis might do. Laser hair removal may work but also runs the risk of depigmentation and the failure rates with laser hair removal and electrolysis is higher than 50% per hair treated.

With regard to acne, you need to see a good dermatologist. Costs are not appropriate to discuss at this time, because there is much to do to determine if you are a candidate for any of the treatments I discussed above. At 22, I am concerned about a focus to remove a widow’s peak.



The folks over at are having their annual Medical Weblog Awards, and I’m very excited to announce that Balding Blog is up for the Best New Medical Weblog award!

Thank you very much for your support!

UPDATE: Voting is now over.


I am down right angry about everyone targeting balding men as the butt of jokes. People do not understand that behind every bald man, is a feeling sensitive man and I wish that people will stop jabbing at us.

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In this week’s issue of The New Yorker magazine (January 9, 2006; pages 43-48), there is an excellent article about hair loss titled “The Power of Hair”, by Burkhard Bilger. There is a great quote in the article from an anonymous source that says, “The man who isn’t bald never thinks about baldness. The man who is losing hair never thinks about anything else.” It is full of wonderful stories about balding looking backward in time, and looking forward to genetic cures, cloning, and some of the recent work done on an experimental basis. The article is worth reading, concluding from a patient who had a hair transplant, “Having hair on your head, you feel like you’re still young. You feel like you’re alive. Nobody wants to look old, man. Nobody want to look old.”


Dear Dr. Rassman,
I am 22 years old and had a hair transplant last year when I was 21. Unfortunately, I am quickly thinning everywhere that I did not get the transplant and I am very dissapointed with the way I look. I wish I hadn’t jumped to this descision and had just accepted being bald. I read your articles on FUE’s to revise the scars on the back of the head. Is using laser hair removal as well as laser resurfacing practical for removing the hair and fixing the scars where the transplants were placed? Please respond as this issue is extremely troubling to me. Thanks.

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At 22 years old, it is easy to sell ourselves on a solution that seems easy. I always tell people that hair transplants are permanent and that is the good and bad news. For you in your present situation, it sounds like bad news. You may compound your situation, making it worse with things like laser hair removal, trying to undo the transplant with FUE and the like. Some of these things, depending our your specific situation, may work. FUE can take out the grafts, but it may not fix any skin dimpling you might have or wipe out the scar if you plan on shaving your head. Skin resurfacing sounds great, but it changes the texture of your skin, possibly making it worse than where you are now. You should see a real expert and with good guidance and good medication (like Propecia), you might want to consider another hair transplant (this time with a Master Plan) as an option to doing it right this time. Just how bald you will become is critical for the plan you need to make. I would personally love to work with you, as I have three sons in their 20s and early 30s and I seem to understand men of your age. Just be careful and do not make another bad decision without every piece of information you can put together in hand, and this time command what you learn. As I’ve said before, you are in the driver’s seat, so drive carefully.


Dear sir,
First of all i like to thank you you for helping the poor people who are feeling very sad over their hair loss. I am having continuous hair loss for the past 2 years. All of my hairs are becoming thinner and thinner day by day. i used all kinds of shampoo which don’t give me good results. i also have a dandruff problem. if i use oil it goes away, but comes back quickly after 2 or 3 days. please tell me what can i do for preventing more hair loss? please tell me not only which medication to use, but also tell me any useful shampoo which can give more help with medication. thank you.

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It is not good medical practice to diagnose and make treatment recommendations without the ability to see and evaluate your problem. Your symptoms are very general, like asking an auto mechanic: “What is wrong with my car? It does not sound right!” A good mechanic likes to see what the problems are, and to be able to evaluate everything about your car.

For me, I need to examine your scalp, looking for genetic balding and other diseases like psoriasis (which sometimes looks like plain dandruff). Make an appointment with a good doctor and do not treat yourself, for your problem may be more difficult than you think.


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