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Hello Dr. Rassman.
Thank you for taking the time to respond. I also wanted to ask you about going on Avodart (Dutasteride) or it’s Generic Dutagen. I have been on Propecia since 1999, and I think it is no longer working. I read Merck’s official report on Propecia’s 5 year efficacy, and it looks like after 5 years Propecia stops growing any hair at all, and it’s ability to keep hair is weakened. Dutasteride appears to block 93% of DHT production, where Propecia can only block 38-45% DHT. Can I get a prescription form you or Dr. McClellan? I am noticing that my “own” non-transplanted hair is thinning, and hopefully the Dutasteride or it’s generic version can stop any more loss.

Also, I am using Nizoral shampoo (Ketoconazole) 2 times a week, and Head and Shoulders shampoo (Pyrithione Zinc) on the other days. Is it safe to mix the Ketoconazole and P. Zinc? A friend told me that the P. Zinc can cause miniaturization of the hair follicle, and mixing the 2 shampoos can have disastrous results. Then on the the other hand, many people on online hair loss forums are saying it is fine to mix the two shampoos. Only using Nizoral 2x a week does not stop my newly acquired incessant itching. It would be great if I knew it was safe to use Ketoconazole and P.Zinc.

Thank you so much for you time, I’m sure you hear all these worries all of the time. Now that I see my new hair sprouting, I want to keep it growing, and keep or grow more of my own.

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Here is a link to some of my other posts with my comments on Avodart. I will make a decision with regards to prescribing Avodart in early September, after I return from the International Society of Hair Restoration Surgery meetings in Sydney, Australia.

With regard to the various questions you had concerning the shampoos you mentioned, I really do not know the answer, as many people respond differently to each. Experiment with each and when you find something working, then stick to it. Mixing shampoos should not be a problem.


I’m a former NHI patient with a bothersome donor scar. Say I came in and it was determined a certain repair treatment was indicated — would you charge full freight as if I were from another clinic?

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Scars come from either the patient’s healing traits or the techniques used. For this reason, we have not charged any of ‘our’ past patients for a donor scar repair, providing that we did not have to transplant the scar. I believe that the new surgical techniques we have developed where scars can be removed, can improve scars that come about for failings of the older techniques. I believe that we should take care of our patients and that is part of our responsibility.

If we have to resort to an FUE for the repair, we have a charge between $1000-2000 per surgery (much less than our going rate) and most of these can be done in one or two sessions. In the past year, most of our patients have successfully improved their donor scars with this new technique and as a result we have not needed to do any FUE repairs in the past half year or so.


I started my research on the fue procedure about six months ago and have come accross an organization known as DHI. My cousin had an fue transplant from them last year and recommended their work, their website is full of info and they have numerous locations. BUT, until I stumbled upon your website, I didnt know half the things I know now, for example the fact that a Doctor is best trained to perform such procedures and that one should look for endorcements from pioneers in the field. While browsing their section on what doctors say about their procedures, I found that your name was listed. PLEASE could you tell me if DHI is a good choice for my procedure, as after studying your credentials I graetly value your opinion. If I dont go with DHI, your organization will be next on my list. I thank you for your time in advance and will greatly appreciate your proffessional advice.
Thank you.

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With regard to FUE, the field is still new and most of what I read/hear is through the advertising of particular doctors who promote FUE. From an insider point of view, I suspect some doctors who promote their skills in this area are not able to do a competent job at FUE, but I am not willing to name them because of possible slander issues and my lack of good solid information. This site is not put together to police the profession, but to give good advice to people like you on questions covering the entire range of subjects with regard to hair care. In searching out a doctor, you should always meet patients that they have done to be assured of the skills of that doctor. You would want to get good vibes on that doctor.

A while ago, I got a list of 500 patient references (source was a doctor who I knew was terrible and unethical). I picked up the phone and called the first 20 references that the doctor listed. Every one of the references (all had surgery with that medical group) told me horror story after horror story. I then realized that by publishing such a list, that particular doctor knew that few patients would make the effort to actually call these people and that the list of 500 references was enough to produce the credentials he wanted. This shows that when you do your research, you MUST follow the threads until you have clarity on the inquisition. This is a buyer’s market and as a buyer, please beware.

For information on FUE, please see:


34y/o female, on birth control, no visible medical conditions that I am aware. Started losing hair about 7 years ago once graduated from college and ended a three year engagemenet under stressful lconditions. Hair loss has progressedandrecentlynoticed the amount of thinning as I had a head full of thick hair. Now thinner, and every night shwer, there is always some hair in drain. Ihave tired multivitamins, Kevis, Advecia, and Hairgenesis….the vitamins helped but still falling out. I dont knowwha tto do….I am 5’2″, weight about 115-120 pounds. I was addicted to laxatives at one time but have since recovered. Could I have a vit. deficiancy? hormone problem dueto birth control? My thyroid checked out fine. I dont want to be 40 and bald. I have no children, no otehr medications.

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It is hard to know exactly what the cause and solutions might be via email without first meeting you. My suggestion would be to please read my many answers to women with hair loss. I discuss the medical work-up required for women, plus the causes for it. A good doctor to check you out and a good hair doctor will go along way to help you focusing upon your hair loss problem. I am sorry to sound evasive, but hair loss in women is a difficult differential diagnosis.


Dr Rassman
I have heard anecdotal reports that the use of Minoxidil for diffuse thinning in men can cause the good terminal hair one currently has to become Minoxidil dependent and change the “good hair” into a fuzzier Minoxidil produced hair—any truth to that? Thank you

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Minoxidil dependence does occur for the thinning hair associated with balding in both men and women. When it works, it can be dramatic, but the dependence is a reality that you must face, for if you stop the drug, you will lose all of the benefits including the hair that is preserved. Those men and women with normal hair do not have to worry about minoxidil dependence.


I want to have a widow’s peak like I did when I was younger. Can you transplant a widow’s peak?

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Yes, you can transplant the widow’s peak. People have different types of widow’s peaks, with some having different directions. Any of them can be made. Here’s a widow’s peak that is 100% man made, along with the entire frontal hairline. The “before” photo is on the left, followed by the “after” on the right. The “after” photo was taken after two sessions totalling 3,702 grafts. Click the images below to enlarge.

This patient is also featured on the NHI website:


I am consuming propecia for the past 6 month and i can see good results. My question is, i and my wife would like to have a baby. Is it safe to have a baby while i am on this medication because i have been told by a pharmacist that i should stop consuming propecia for at least 1 month before planning to do so. He said that it will probably do damage to a newly born child.

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The half life of Propecia is 4 hours. That means that in 4 hours, there is 50% of the dose remaining, in 8 hours 25% remaining, in 12 hours 12.5% remaining, in 16 hours 6% remaining, in 20 hours, 3% remaining and in 24 hours 1.6% remains in your system.

Now the official answer from Merck is that you can continue to take Propecia while you are trying to get you wife pregnant. Different opinions from different doctors who are generally skeptical, tell their patients the following:

  1. Stop taking the drug while you are trying to get your wife pregnant.
  2. Stop taking the drug while your wife is pregnant.
  3. Stop taking the drug the month you are trying to get your wife pregnant and when successful, go back on it.
  4. Stop taking the drug for the one week a month when your wife is in her fertile period.

Clearly, this is your decision. I tend to recommend #4, not because I believe it, but because it is reasonably safe and will minimize the time off the drug. I am always concerned about losing the benefits of the drug, and running the risk of a dramatic hair loss.


Please read and comment: Propecia (Finasteride) has been available since 1997 and is the first oral medication to ever be approved by the F.D.A. specifically for the prevention of hair loss. A physician’s prescription is required. The overwhelming majority of men using this drug experience some benefit from its use, sometimes dramatically. It takes a full year before the full benefits can be fully seen and appreciated. The recent 5-year research studies show that, for most patients, there is a substantial increase in the number and quality of hairs growing on the patient’s scalp for around 4 years. After that, the patient’s overall hair mass on top very gradually starts dropping ever so slightly each year, so that at the end of around 10 years, the patient is back to where he started 10 years earlier. So, in effect, for most patients it holds off the hereditary expression of hair loss for around 10 years. There also are many clinicians and investigators who believe that finasteride works nearly as well when administered in dosage amounts substantially lower (and cheaper) than that recommended by Merck.

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Much of my opinion is projection and conjecture. Propecia hair loss curves show that hair loss continues, albeit slower, with the drug than without the drug after an initial gain in hair volume, but Propecia is still not the magic bullet for hair loss. After 5 years, the hair may return to the level that it was at prior to starting the drug, but that varies with patients. I had a discussion some years ago with researcher David Whitting, who told me that the Merck studies showed that Propecia was just as effective at 1mg, 5mg, 10mg and higher. The effectiveness dropped by 20% at ½ mg. So all I know is what the 7 years data shows (hair loss continues at a slower rate) and that lower doses than the recommended 1mg level are less effective. You are using generalities on what may happen at the 10 year mark. It may or may not happen. Avodart may be more effective than Propecia, but as of this moment, the data is not in my hands and the FDA has not ruled on safety and effectiveness issues.


As i am concerened by hairloss, I have looked at your site and read some useful information. The one question I had was, while going through the Horror Stories link [note: on our sister site,], are there any horror stories which have occured after about the year 2000, and the development of FUE and FUT. I can understand that an operation which cuts a large chunk of skin out of a persons head is going to run the risk of causing a large scar and other related complications, but has the development of new techniques like those above which allow the removal of single hairs got away from these problem or has got other ones? Also why do so many people choose to keep the name of a bad doctor to themselves?

Thank you

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You are correct that fewer and fewer horror stories are appearing because today’s techniques are much better than those of the 80s and early 90s. Certainly, the quality of the work of the top notch surgeons has improved to produce virtually undetectable transplants. The focus of those surgeons is now on improving the growth of transplanted hair. There are still some failures with these modern techniques because today’s FUE and FUT techniques require exacting methods which, if not followed, will cause the transplant not to grow.

Well trained doctors using modern techniques should produce not only undetectable transplants, but a very high survival rate. Still, there are some doctors who do not know what they are doing, and I still see some terrible complications which reflect a doctor’s lack of training, skills or ethics. I am also seeing more and more patients who are being transplanted that should not have been transplanted and those who being sold more grafts which are put in beyond the balding area and into the permanent hair zone, just to increase the fees. Find yourself an ethical doctor who uses modern techniques and be sure to meet with some of his patients before you take him/her on.

I often ask the same question that you did in this email: “Why are the names of bad doctors kept secret?” The answer here is that men are generally not confrontational, and they do not like to be reminded that they made a mistake. They do not want to relive a bad experience over and over again. Just sharing their stories to prevent others from making their same mistakes is not a pleasant experience for these victims.


I am 20 years old and very nervous about losing my hair. Since about my senior year in highschool ive seen the front of my hair line recide. This is a very stressfull and private thing for me so I only talk to my family members about it. When I ask if it looks like im going bald the answer is always no. But my hair line from my senior pictures to now has deffinately changed. Its seems to be going back on the sides, right above the eyebrow.(im sure you know what im talking about. So I do have a couple of questions.

  1. Am I to young to get a hair transplant?
  2. How much hair do I have to lose to actually be able to get one. Im always reading different sites and all kids my ages ask almost hte same questions but everyone always says wait till you go more bald… Well I dont want to wait, I want to prevent it before it starts. I dont want any sign of thining hair or a reciding hairline. Its like my petpeve.
  3. Do hair transplants look like real hair, or can you tell the difference? Ive seen about 2 people in person that got them done..and one person It was pathetic he had like 3 strands of hair growing out of one section. Then about a 1/4 inch space and then more hair. If I get a transplant I want it to look so real that even I cant tell it was doen.

Also I was reading a question that someone posted on your site. And I read an answer by some John Doe. He said that there were scars from his transplant. This is the first time that ive ever heard anyhting about scars. Can you tell me more about that?

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You have many questions, all good ones, but not easy to answer without writing a book. I actually wrote a book, The Patient’s Guide to Hair Restoration, which you can get by clicking here. The entire book is available in PDF format, but you can also order a complimentary print copy complete with photos at the Request Additional Info page. Many of these questions will be answered by the book or even in the previous blog questions from other young men about your age. No matter what I tell you, you must have a visit with a competent, caring doctor. Although I have performed hair transplants on patients as young as 18 years old, it is not my usual case, but before I would do this, I would want to know what is happening to you. Make an appointment with a good doctor who specializes in hair loss treatments. Dr. Robert Bernstein in New York is such a doctor, if you can handle the 5 hour drive to visit him. He is at (201) 585-1115.


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