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Hi I’m a 23 year old male who has lost the corners and the top is also beginning to thin. I had a consult at a local clinic and received a prescription for propecia and a rough estimate of 1800 to 2000 grafts. I still have a lot of hair but it looks miniaturized on the top giving a see through look, especially when spiked. My question is I have been on procepia for a month now and of course it is too early to be able to see anything but I can feel many very short thicker hairs in the area where i am thinning on top. I don’t want to read too much into this since it’s so early but i’m curious of any signs of propecia working? Will the finer hair be shed and replaced by hair that is thicker or will the hair thicken in mid growth cycle? I’ve pretty much ruled out a transplant for about a year just to see if I can get any hair back from this. Thanks, this website is one of the best on the internet lots of good information.

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You are very wise that you should wait at least 8-12 months for a visual effect from the Propecia. I also try to always tell my patients not to watch too closely. Watching the hair grow is like watching a child grow or the graft grow. If you watch too closely, you will not be doing yourself a service. As hard as it is, try not to look at it much for 6 months. To be more specific, I would think that in a 23 year old with good response to the drug Propecia, both reversal of hair loss and reversal of miniaturization is possible.


I have “holes” in my mustache area as a consequence of radiation treatment for cancer in that area. I would like to have my mustache restored. What donor area do you use for this procedure? I have heard that it can be done by taking beard hair from under the chin. Can you suggest someone who has been doing this?

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I have done quite a few moustache repairs at NHI using donor hair from the permanent zone on the back of the head. If the hair from the head is not of the same quality, then you could FUE hair from other parts of the beard or take if from below the chin. As you are in NY, I can recommend that you schedule a consult appointment with Dr. Robert Bernstein in his Manhattan office and spend some time with him going over your options. His phone number is 866-576-2400.


Two years ago i noticed that my hair was thinning on top. I found this strange because I was already 25 and my brothers all have full heads of hair. Two years later its noticeable and i cant stand the thought. What is the best treatment(NO TRANSPLANTS) available to me?

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Once you make sure that there are no underlying medical issues that could be causing hair loss, and that the balding is genetic, I would suggest that you make an appointment with a hair loss specialist and find out whether Propecia is indicated. The drug slows or stops hair loss in the majority of young men.


I have been taking Propecia for 7 years. I started in my early 30’s when I noticed some thinning. It worked well for me, stopping any further hair loss, and possibly re-growing what had thinned. Recently though, I’ve noticed some significant overall thinning that seems to have come on quite suddenly in the past 2-3 months. I am still taking Propecia daily, and have not missed a day in 7 years.

My question is this… Does Propecia lose it’s effectiveness after a period of time? Would it be of benefit to switch to Proscar, or Dutasteride? Please advise! Thanks!

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After the initial improvement in hair count you get from Propecia during the first two years, there is a slow decline in hair count. But this decline is much slower and less drastic than what you would have seen if you had not taken Propecia at all. Stopping Propecia at this time would cause you to lose all of the hair that Propecia has protected for the past seven years. Proscar is the same drug (finasteride) as Propecia, just a higher dose. It has not been proven that a higher daily dose of finasteride is more beneficial, and you do run the risk of having more side effects. Dutasteride is not yet an FDA approved drug for hair loss, so I do not prescribe it.


I had my first restoration procedure March 2nd 2005. the new hair is about 1/4″ to 1″ long now, (6/25/05) I am improved but need more density. How long do I need to Wait between Proedures? I am 56 yrs old, use both Propecia and Minoxidil topical. How long before the doner area will be adequately “streachable”? Thanks for the mailing. I appreciate this site,

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I usually recommend a minimum of eight months between surgeries. You will be getting more hair growing out and more length with most of the benefit obvious at the 8th month. You will certainly have more bulk over the next few months. I am glad that you enjoy the mailings. Patient education is one of my passions!


Can you tell something regarding the change in pH value when using shampoos? I am 20 yrs old and I am using a mild shampoo which I use 3 to 4 times a week. Will that change any pH value and affect me?

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The pH value measures how acidic or alkaline a substance is, from 0 (most acidic) to 14 (most alkaline). The range of healthy skin and hair is 4.5 to 5.5. You should choose your shampoo by what makes your hair look great. The type of shampoo and frequency of use will not cause hair loss.


How many hairs (grafts) does a person have to transplant?

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I assume that you are talking about the donor hair supply. The supply is calculated by using the most bald person you can find. Assuming normal density of his hair, a person with the Norwood Class 7 hair loss pattern (the worst case) will lose 70% of the total hair he was born with. This will leave him with a 3 inch by 14 inch wreath of hair around the back and sides of his head. Assuming 100,000 original hairs averaging 2 hairs per follicular unit, that would mean that such a person could theoretically move half of the permanent wreath of hair (15,000 hairs or 7,500 grafts). There are other factors involved such as the looseness of the scalp and healing factors. We have a number of patients with Class 6 and 7 hair loss patterns than have moved between 15,000-20,000 hairs. The ones with the very high numbers generally had higher densities of the hairs on the head. One patient comes to mind had a birth hair population of about 150,000 hairs. He had 50% more to work with and he took advantage of that supply with wonderful results.

Generally, that is a lot of hair to move and unless you are very, very bald and have a very ‘perfectionist’ view of your need for fullnesss, most people get away with moving less hair.


Hi, Dr. Rassman. I had a procedure done a few years ago in Texas with Dr. McClellan and I’m very happy with the results. My hair loss has been very slow, thankfully, in some part perhaps due to the fact that Dr. Bob put me on Propecia after my initial consultation. I took it up until about a year ago, and now my crown is thinning pretty badly (I know – it was stupid to stop). My question is this: I’ve read on other hairloss sites of guys buying Proscar and cutting them into fourths or fifths so that they are down to, or near, the 1 mg found in Propecia. Will this give you the same results? It is, after all, a cheaper route. Most of these guys get the Proscar from Canada or overseas, which makes me wonder about the authenticity of the drugs, but I guess that is another question altogether. Thanks, and this is a very helpful site.

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I am glad that you are pleased with the results. Dr. Bob does excellent work! As to your question, Finasteride is marketed in two strengths: Proscar (5 mg for prostate problems) and Propecia (1 mg for hair loss). While you can get the same result if you were to exactly cut the Proscar tablet into fifths, it is sometimes difficult to cut the pill in equivalent doses. As a NHI patient, this is something you may want to discuss with us when you need a new prescription. Give us a call at 800-NEW-HAIR (800-639-4247) to set up a phone re-check. I do recommend that you only order prescription drugs from reputable suppliers.


I have followed your work for years, and believe me when the time comes, you are the one I will be going to. How come the crown continues to be so challenging? Most photos seem to show sparse coverage. I have taken proscar for several years, and my crown has filled in nicely. The front filled in a bit with rogaine but not at the density I would like. I am intrigued by the FOX and Mega sessions, but is the donor area so large that you gain hair in one area and lose it in the other? What happens in the large donor area?

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Everyone is different. I try to imagine and plan for the worst case hair loss. Depending upon age and family history, I can often make a reasonable intellectual guess on what the worst case hair loss pattern will be. With Propecia, the worst case is usually ‘less’ worse. The crown is usually slower to bald for many people so Propecia works better because it is usually started before the crown goes bald enough to notice.

The size of the donor area is determined by the density of your donor hair, your scalp laxity and the size of the non-balding area. You are correct, that once you move most of the available donor hair, then there may not be enough hair available for future hair loss. If you have good scalp laxity and your density is high, then there could be enough hair to cover the entire head, even for the baldest of men. A good surgeon will make sure that the donor area is the appropriate size and take into consideration future balding and how the donor scar can be hidden by existing hair (if it should scar). I would have to see you to determine where you are in the balding process and where you might lose more hair. As you are in Los Angeles, a free visit to my office will help. We also hold monthly open houses, so you might want to come and see patients for yourself, watch a surgery and let us examine you all at the same time. In fact, our next open house even will be held next Thursday, July 7, at our LA office. Please see the NHI Events page for more details.


Does Cool Laser Therapy work?

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The low laser energy therapy is relatively new in the United States. It has been used in Europe for some time. The evidence is anecdotal, but there is no real good objective science to prove value. Everyone wants to believe that it works. Products like the laser comb are available for around $600 and people seem to be willing to invest in such products in the hope that it will work. I have reviewed all of the cursory science from Europe, and possibly there is a suggestion that the increase in hair fullness may be in the order of 10%. If that happens, then it would be good, but the issue is ‘at what cost?’ I am going to participate in a well controlled assessment of this therapy shortly. If the company follows through with the study, it will put numbers to the value of laser treatment so people like you can determine its worth in your approach to hair loss. At this time, I can not endorse it, but I feel that there is no down side to its use except the money you invest.


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