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Dear Dr. Rassman,
I’ve been taking propecia since I first noticed my hairloss, at age 20. Now I’m almost 24, and while I’ve retained some hair in the vertex, there’s been substantially more loss in the front/temple areas. Transplants are probably not a financially plausible option for me presently, so I’ve weighed other solutions (mostly vitamin/herbal supplements), bearing in mind the advice published in your blog. The website for “hairgenesis” touts an FDA-regulated published study supporting it’s claims: Is this information credible, or is it merely a marketing ploy? What other information should I look for when considering treatments other than propecia and surgery?

Thank you in advance for considering my question.

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I do not like the Hair Genesis site, because it is very heavy on claims that appear unsubstantiated. As I have no experience with it, I can not tell you what I do not know or have not learned, but when there are so many claims and reflections on FDA ‘endorsements’, I would doubt their credibility. The field of homeopathic and herbal medications is generally unregulated, but it is not proper or ethical to claim FDA ‘endorsements’ like this company seems to have done. To my knowlege, only minoxidil and Propecia have been FDA approved for safe and effective hair loss treatment and there is good scientific evidence that minoxidil and Propecia works. When it comes to natural and herbal medications, there are many harmful natural and herbal medications. Arsenic, of example, is a natural medication that has been used in historical medicine for the treatment of syphilis, but I would not use it for prevention of syphilis nor for any human use as it is a well known poison, so ‘natural’ does not imply safety. The message here is BUYER BEWARE, and remember that just because claims are posted on a website, it does not imply true safety or effectiveness.


Hello Dr. Rassman,

I am a 26 year old male, and have been losing my for about 4-5 years now. I’m currently a Norwood class 3.

I am using 2milligram of Propecia daily as it seems to work much better for me than 1 milligram. This might be because of my size (I’m 6’3″ and 205 pounds). I had tried one milligram daily, and still noticed substantial fallout. This fallout was hampered once I started on the two milligrams daily.

My question is weather or not the 2 milligrams of Propecia I am taking can come with any side effects, and weather or not it is completely safe to keep up with the 2 milligrams daily.

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If you are not having a side effect at the 2mg dose, then I suspect that you will not see any side effects over time. I do not see a down side to taking the larger dose. The official dose response studies that I am familiar with show that 1mg is as effective as all higher doses and I believe that the studies take it to 5, 10 and even 20 mgs in one doctor’s case. I am not recommending higher doses but it it works for you, I do not see a problem with the 2mg dose.


I took a shot of deproprovera 2 1/2 years ago, and 3 months after I decided not to get another shot (b/c of weight gain and shoulder/neck aches) may hair started falling out like crazy, now it is 2 1/2 years later and it is still falling out, about 30-50 in the shower/combing out every morning. I’m down to about 1/2 the hair I had 2 years ago. Any advice? It is so frustrating. My 3 sisters have not hair loss issues (in fact 2 of them complain about too thick of hair). My mother’s hair has thinned the last 5 years because she is on strong cancer/rheumatoid arthritis drugs, but no problems before that (all my male/female relatives have hair also–my dad’s is thick at 68 years old–no bald men in my family, and woman all have hair too. Help. 2 dermatologists say I have TE and to ride it out.

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Depo-Provera is a contraceptive and has hair loss as a known side effect (between 1-5% of women), as do many birth control pills. Female genetic hair loss does not follow the patterns of genetic inheritance that run on the male side of the family, but it is not unusual for women who have genetic hair loss to have other women (mothers, aunts, sisters, grandmothers) with similar histories and findings.


I just turned 20 years old and for a year now my hairline has receeded and started to thin dramaticly. Which I am very self-conscious of. I have been taking a natural suppliment called Procerin and using a daily treatment called Curetage for a little over a month and a half, but have noticed no difference. Do external treatments work, and pills work? Or are they just a waste of time? I also heard that hair transplants can’t be done on young men, is this true? Is there anything else i can do to make my hair grow back?

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I have written about Procerin before (see past blog entries: Procerin and Procerin Info). The only topical treatment that seems to work is Minoxidil. Many add compounds to Minoxidil to try to make it more effective (e.g. Retin-A, which adds irritation to the skin and some burn to it as well) or combine it with other ‘magical’ formulations to sell it at a high price to take advantage of the value of its marketing label. The best and only real treatment for you is Propecia. There are many things done for hair loss and many people making money from the panic of hair loss victims. ‘Curetage’ sounds like one of them.

Stick with what works and do not risk permanent hair loss to go outside the known effective treatments that are available. Get a good doctor to work with you.


I keep reading and seeing all these photos of people using Avodart and the results are amazing.Why is this drug not FDA approved.I really want to start a new game plan with my hairloss.I can not afford anymore hairloss.

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This drug is approved by the FDA for the treatment of prostate enlargement. So while Avodart has been deemed safe for treating the prostate, it is not approved for hair loss. The drug is currently targeted towards older men, but any drug for hair loss would probably be targeted at a younger market. I am not an expert on the toxicology of drugs, so I can not comment on the effects of Avodart use by the young man, however, I do believe that there may be indications for use in young men, such as those who are failing to get their hair loss under control with Propecia, for example. I am not the manufacturer or the FDA, and without clinical trials and proven scientific results about the use of Avodart in hair loss, I can’t have complete confidence of its efficacy. A doctor can elect to prescribe this drug ‘off label’ if the doctor is comfortable with the medication use.

I’ve answered quite a lot of Avodart questions on this blog. Here’s a quick roundup of some of the past Avodart posts:


I would like to know if it is possible to repair the donor area. I had transplants done over 20 years ago, but they never formed well. I was able to survive on a comb over, but about ten years ago got a good hairpiece. I am satisfied with the piece and have no desire whatsoever to do a HT again (it is still painful in the back today).

The problem I have is that they took way too much hair on the back/left of my donor area. It has always been a problem and I had even resorted to using “Top Coverage” to fill it in so it wouldn’t be noticeable. If my hair gets wet or if I am laying on a pillow watching TV, when I get up, it is noticeable – VERY noticeable.

Ideally, I would love to remove the transplants form the top of my head and put them back on the side. Or, at least, reduces the thinning area in back.

Any ideas? Thank you

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Today, we can relocate transplanted hair by removing them from within the old plugs thereby thinning them. When they are taken out, we can then move these follicles into areas of need. The areas of need could be the scars from the old transplants or to fix some abnormalities that make your ‘look’ less than what you may wnat to look like. Look at the links below and see some of the wonderful ‘fixes’ we have done. Send photos of yourself (confidential of course) and then give me a call and I would be happy to evaluate you and your problem.

For more information on repairs, please check out:


I read your blog from beginning to end and found it very resourceful- thank you. There are a few questions on which I would like clarification.

  1. I have read briefly about itchy scalp which requires use of Nizoral. Is this a very common side effect which I should expect if I decide to take Propecia, or does this only happen to a small number of patients you have seen? I had to stop using generic Minoxidil after three days because it gave my hair a greasey feel. Will Nizoral cause a similar problem or other side effects?
  2. I have read somewhere that you might expect to see accelerated loss for the first four months as the follicle’s “cycle” adjusts. What percentage, if any, of your patients would you estimate see this accelerated loss?
  3. I take various supplements for body building purposes, such as creatine, glucosamine, and whey protein. Since hair loss is related to testosterone/DHT, are there certain substances which I should be avoiding in order to prevent extra testosterone generation in the body?
  4. What is your real world experience with the Laser Comb? With all the various internet sites which sell this type of gadgetry, is there a reputable company or site which you would trust?

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  1. Itchy scalp does not require any particular treatment, but some people feel strongly about their medications and post their opinions on the internet. This is particularly true for those who sell the medications. In my experience, not one patient complained about itchy scalp after being placed on Propecia, but they do complain of this from the use of minoxidil. Many people find that styling hair is made difficult with minoxidil. If you want the non-greasy minoxidil, try the minoxidil for women, as it is alcohol based and is not greasy.
  2. I have personally not seen any patients complain about a period of hair loss when they start Propecia, but I have heard reports by some of my colleagues. I must therefore assume that it is a rare occurance.
  3. Anything that builds up testosterone production will raise DHT levels and accelerate the course of male pattern balding. Check with the claims on the bottles and check out each component of the nutritional substance you are taking.
  4. I have no personal experience with the Laser Comb. The story is still out on all laser hair treatments, but I remain very hopeful. See Low Laser Light Therapy for Hair Loss for more details.


So since there are already tests that determine the pubic hair a possibility for transplantation to the scalp, are there any doctors currently performing this procedure now? If so, how much would it roughly cost?

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I remember a picture and article in the parody tabloid Weekly World News from many years ago, of a person with a pubic hair to head transplant. The pictures looked exactly as described — like curly pubic hair transplanted onto a head. Obviously, being parody, we can’t take this at face value, but it serves as an example. If your head hair is like your pubic hair, then this may work fine for you, but I would want to know why you want to use your pubic hair for the donor supply rather than using your other head hair? Personally, I would not want my transplants to look like pubic hair if the other hair was different in character. It would be like transplanting hair from a french poodle to a bulldog. To answer your question, I can’t recommend anyone that may be doing this procedure.


Hello Doctor. I’m a 16 year old boy with a family history of MPB. My father (who is almost completely bald now) told me how he started balding in High School and was almost completely bald when he got out of college. I recently noticed my hair line receding. My hair is somewhat long so it’s easy to cover up, but I was wondering if any treatments can help stop, or delay my fate. I’ve been to my doctor to ask about Propecia, but she recommended against it, saying I’m too young, and opted for Rogaine or it’s generic counter-parts instead. Is there anything I can do?

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In young men your age, it is unclear if an aggressive hair loss pattern will respond to Propecia as well as if the hair loss started later in your life. The data is not in. With that said, I do not believe that you are too young for Propecia. I feel strongly that Propecia is the only drug that can help you slow or stop the hair loss. If your doctor does not have a better solution, get another opinion. Minoxidil just will not stop the hair loss that you will have, assuming of course that you follow your father’s pattern (a likely scenario based on what you’ve told me here).


How long does it take for the transplants to grow?

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I generally tell my patients to wait a full 8 months to have 80-90% of the impact of growth on stylable hair. Hair grows about 1/2 inch per month and as transplants often do not start until 3-5 months after the surgery, growth can be calculated from that point. For those hairs that start to grow at 5 months, they will be 1 1/2 inches at 8 months, while those that started at 3 months will be 2 1/2 inches long. Usually a person has a combination of the two. On less frequent occasions, about one in twenty people have instant growth of all of their transplants.

In good hands, however, growth will always occur. I hope that answers your questions.


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