Month: January 2023

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Why Does Minoxidil Packaging Say to Only Apply on the Vertex?

I recently received topical generic minoxidil solution and it says that it is only to be used on the vertex and is not for frontal hair loss. Is this true, will applying it to the front hairline be useless, if so, why?

Also, i would like to use a non-finasteride supplement in addition to the minoxidil, can you recommend one, or which ones are most popular??

The FDA only approved claims for crown benefits for minoxidil so the manufacturer complies with the FDA ruling. I don’t think it’ll be completely useless in the front, but the success rates are likely higher in the vertex than in the hairline.

There is no good substitute for finasteride in my opinion, but a popular natural supplement is saw palmetto. Popularity and reliability are too different things, however.


2008-12-18 14:45:27Why Does Minoxidil Packaging Say to Only Apply on the Vertex?

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Why Does Low Estrogen Cause Hair Loss in Women?

If DHT causes hair loss, how come women whose estrogen levels drop lose hair? Seems contradictory.

I am not an expert in hormones, but things in medicine are not so binary. Dihydrotestosterone (DHT) is the cause of hair loss in men (not women) who are genetically predisposed to hair loss. You can have a high level of DHT and still have a full head of hair. Women lose hair in a different way than men. There are many causes of hair loss in women. Estrogen levels may play an important part in supporting hair and preventing hair loss in women and when women reach menopause and their estrogen levels drop, they may become victims of their genetics. It doesn’t correlate with DHT in most women.

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Why does Finasteride not throw the body’s hormones out of balance?

I don’t know that I can really answer that. The human body does very well to adjust to small changes like what Finasteride does. We know, for example, that testosterone levels often rise with Finasteride, which is a body response to the drug. My son got an increased sex drive from his higher level of testosterone when he went on Finasteride.

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Why Does Catch-Up Hair Loss Occur When Stopping Propecia?

Hey Doc.,

I have a question regarding the shedding after quitting propecia. Why is it that when one quits propecia the shedding occurs much more rapidly then the natural progression of hair loss? That is, why don’t we go through the same “minituarization” that normally occurs with hair loss?

You cannot escape genetic balding. Hair has a normal life expectancy (see this post) so when the Propecia is withdrawn, the apototic process kicks in. Medications such as Propecia slow this process down by preserving or strengthening the dying miniaturized hairs (the hairs that are genetically programmed to die and fall out). When you no longer take the medication, all the genetically predisposed hairs that should have fallen out naturally will no longer be supported by Propecia. As such, they will fall out. That is a simple way of thinking about catch-up hair loss. In other words, you didn’t stop the time line of genetic hair loss by taking Propecia.


2009-03-03 15:49:31Why Does Catch-Up Hair Loss Occur When Stopping Propecia?

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What causes bad hair transplant surgeries?

I agree he got a really good result so if he went to a different surgeon maybe he would get a bad result. So if he had a bad result, would it be because of the surgeon’s crappy artistic skills? or the patients hair quality? or is it because of the technicians that plant the follicles? What’s the most common reason why people sometimes get not very good looking transplant?

Surgical failures come in many flavors: (1) the patients not establishing realistic expectations with his surgeon’s communication skills, (2) poor surgical planning (just targeting # of grafts that don’t fit into a patient’s Master Plan, (3) surgeons who do it for the $$ and never learned the art and technique through proper training, (4) over-hyped marketing to set unrealistic expectations on all hair transplant buyers, (5) unskilled surgeon, (6) lack of experience and disciplined team with a focus on quality control, (7) surgeries that last too long leaving the grafts out of the body too long, (8) Grafts that are traumatized at any point from the time they are taken out of the body until they are put back into the recipient site and this includes poor placement of the grafts, (9) poor site making by the surgeon producing hair that points in the wrong direction, (10) Poor post operative protocols resulting in loss of grafts, infection from poor techniques, (11) poor patient selection as patients may have diseases that will kill some or all of the transplanted grafts, or the patient doesn’t have the quality or quantity of hair needed to address the bald area. Bad doctors (there are a few) just care about making money so they do hair transplants because they get paid up-front. For these rotten applies, there is motive to take responsibility for these unfortunate patients.

There are unique problems with FUE including poor harvesting distribution and too much graft damage when grafts are removed. Poor distribution can produce balding in the donor area or necrosis in the donor area (see here: https://baldingblog.com/collection-victim-photos-internet-harvested-depleted-donor-areas/). There are also unique problems with strip surgeries in the hands of inexperienced surgeons including wound problems, nerve damage, bleeding, AV malformations (both FUE and Strip surgeries) and poor planning or improper placement for the location of the strip or taking out too wide a strip to produce increased scarring and even infection and necrosis.

I can write a book about this question, but I will stop here.


2020-04-19 12:43:42What causes bad hair transplant surgeries?

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Why Do You Prefer to Prescribe Propecia Rather Than Transplanting?

You have not made it clear why you would prefer to prescribe drugs for hairloss rather than a surgery. It is safer in every way to administer a hair transplant. Perhaps you realize that patients will opt out of treatment altogether since many men would never consider the very significant and costly method of pursuing a transplant?

I would use a non-surgical recommendation for a wide range of problems (e.g. many forms of heart disease, Parkinson’s disease, epilepsy, herniated lumbar disc). In some situations, I would recommend hair transplants as I get to know the patient if I am convinced that it is in his best interest. That puts the burden on the patient to convince me about his agenda.

I am not a plumber who is fixing a leaky pipe. I am a caring, responsible doctor who always does the best thing for his patient. Think about how strongly I must feel about this. I would rather offer a free consultation and then prescribe Propecia for a total fee to me of $85. My average surgical fee exceeds $5000… so I must really believe in the welfare of my patients to turn that down.

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Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

Dr. Rassman,

I’m a 32-year-old with a Norwood 2-3 pattern in the front and some very mild but immistakable loss in the Crown. I very recently started taking propecia and am strongly considering trying that in conjunction with Rogaine Foam. Your esteemed colleague, Dr. Bernstein recommends the use of both of these products simultaneously, right off the bat. You suggest that one hold off on Rogaine until propecia has been shown to be ineffective, as it causes “dependencies”…

Not to create friction, but what is the source of your disagreement on this? What do you mean by “dependencies”? I don’t understand because doesn’t propecia create a dependency as well? (i.e. if you stop taking it, you lose all of the benefit)…

There is no disagreement. I would also recommend Propecia and Rogaine. But, think ahead for a second:

  1. Once you start both Propecia and Rogaine, you need to take both for life.
  2. You will never really know which medication is working more or less if you start both at the same time.
  3. Rogaine can be difficult for many men to follow the twice a day application (a pill like Propecia is easier to deal with and faster to take).

If you can accept the above, I agree you should take both Rogaine (minoxidil) and Propecia (finasteride 1mg). Both create the same dependencies and I’ve never tried to downplay that. If you stop either medication, the benefits received (maintaining or regrowing hair) will be lost, therefore you will depend on both to keep your hair loss in check. The medications work differently, so finasteride can’t retain hair grown by minoxidil and vice versa.


2008-01-25 10:57:42Why Do You Only Recommend Starting Propecia and Not Minoxidil Too?

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Why Do You Carry Revivogen In Your Office Now?

Dr. Rassman,

I noticed you sell Revivogen in your office. I thought you do not endorse or believe these products work! What gives?

For the record, I do not endorse many products out there. I still maintain my buyer beware mantra, and I will be the first to say this to all my patients. But I also recently acquired a Dermatology / Cosmetic practice (Wilshire Center for Dermatology) and expanded my medical services with new physicians who offer non-hair related services.

The office also sells a variety of skin and hair care products, and Revivogen is just one of the many products we offer. Revivogen is a natural supplement (non-medical) line of products.

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Why Do Some Men Lose Hair Much Later in Life?

doctor,
since we know DHT is a cause of hairloss, why do some people start showing sings of male pattern baldness later in life? I know a few family friends pople who have had extremely thick beautiful hair norwood 1, with no signs of balding in their 40’s and late 40’s. then in their 50’s they started get thin and crown balding. if dht is the cause then i’m sure these guys had dht in their body in there 20’s, 30’s, and 40’s. why all of a sudden in there 50’s the dht decided to choke the follicles?

Dihydrotestosterone (DHT) is the cause of hair loss when it is associated with the genetic disposition of male pattern baldness. The genes that cause hair loss are preprogrammed and often express themselves at different ages.

For example, some men and women get grey hair in their 20’s, whereas some never do. Most men with the balding gene will go bald in their 20’s and 30’s, but there are always exceptions to the rule as you pointed out.